Program
Radisson Blu Scandinavia Hotel Amager Boulevard 70, København Tlf. 3396 5000
www.radissonblu.dk/scandinaviahotel-koebenhavn
DASAIMs Årsmøde 2011
10.-12. november
2
Velkommen til DASAIMs Årsmøde 2011
Acta Anaesthesiologica Scandinavica sponsorerer præmierne til foredragskonkurrencen med en 1., .2. og 3.
præmie. Derudover har vi en publikumspris samt en pris for bedste poster. Novo Nordisk giver igen i år Innova- tionsprisen til en yngre forsker, hvis abstract udmærker sig ved innovativ tankegang. De heldige modtagere af ovennævnte præmier og priser vil være at finde blandt det rekordstore antal indsendte abstracts, nemlig i alt 66.
Vi glæder os til at se jer!
Steen Møiniche, Lars S. Rasmussen og Tina Calundann Vi vil gerne byde jer velkommen til DASAIMs Årsmøde
2011, der er det tiende i rækken i aktuelle udformning. En stor tak til alle, der gennem årene har bidraget til at gøre mødet til en succes!
Som tidligere består årsmødet af 3 dage med forelæs- ninger, parallelsessioner, posterpræsentationer og foredragskonkurrence. DASAIMs bestyrelse og udvalg har sammen med organisationskomiteen sammensat programmet, der udover faglig opdatering også giver mulighed for diskussion i pauserne.
Vi vil gerne takke de mange, der stiller op som foredrags- holdere og moderatorer, men også sponsorer og ud- stillere, hvis støtte giver et solidt økonomisk fundament for dette arrangement.
Kongresområdet Hovedsponsorer
Registrering
Kongresområde
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Torsdag d. 10. november
08.00 - Registrering
09.00 - 10.00 Norway-Finland Room Den 11. Ibsen-forelæsning
Intensiv terapi - hvad har vi lært siden polioepidemien?
Moderator: Ole Nørregaard v/ Else Tønnesen
10.00 - 10.30 Udstilling - kaffe 10.30 - 11.00 Norway Room
Hjertestop udløst af hypotermi - hvordan opnås optimalt outcome?
Moderator: Anne Møller Nielsen v/ Steen Barnung
Sweden Room
Akut lungesvigt ved influenza-pneumonitis; ECMO og HFO Moderator: Dorte Keld
v/ Reinhold Jensen Finland Room
What good is talk? Evidence based psychological management of chronic pain Moderator: Luana L. Jensen
v/ Christopher Eccleston Iceland Room
Ny målbeskrivelse for speciallægeuddannelsen Moderator: Karen Skjelsager
v/ Kirsten Bested
11.00 - 12.00 Udstilling - sandwich/vand i udstillingsområdet
11.00 - 12.00 Bag posteren. Se den nye danske forskning og mød forskeren bag posteren 11.00 - 11.45 Denmark Room
Frokostsymposium - Astellas 12.00 - 13.30 Finland Room
Lindring af fødselssmerter - er der en afløser for fødeepiduralkateteret?
Moderator: Eva Weitling v/ Petri Volmanen Iceland Room
Hvordan sikres de rigtige kompetencer i præhospital behandling?
Moderator: Karen Skjelsager
v/ Kim Garde, Gustav Gerstrøm og Leif K. Rognås Sweden Room
Moderne teknologi i pædiatrisk anæstesi Moderator: Torsten Lauritsen
- Din nye bedste ven - optisk intubationsudstyr v/ Rolf Holm-Knudsen - Ultralyd og det akutte barn v/ Thomas Lohse
Norway Room
Iltbehandling og atelektaser ved anæstesi Moderator: Poul Lunau Christensen v/ Göran Hedenstierna m.fl.
13.30 - 14.00 Udstilling - kaffe
Torsdag d. 10. november, fortsat
14.00 - 15.30 Norway Room Posterdiskussion 1
Moderatorer: Jacob Steinmetz og Jørgen B. Dahl
abstract nr.
29 Patienter, opereret elektivt for abdominalt aortaaneurisme har større behov for postoperativ intensivbehandling end patienter, opereret for okklusiv sygdom i abdominale aorta v/ Jannie Bisgaard et al
5 Intubation of morbidly obese patients. A randomized clinical trial, comparing GlideScope® videolaryngoscope with FastrachTM Intubation Laryngeal Mask v/ Mogens Viberg Ydemann Nielsen et al
14 Flexibelt fiberoptisk versus videolaryngoskopisk intubation hos sederede patienter med forventet vanskelig luftvej v/ Charlotte Rosenstock et al
37 Prædiktion af vanskelig luftvejshåndtering - et kohortestudie af 188.000 patienter registreret i Dansk Anæstesi Database v/ Anders Kehlet Nørskov et al
40 Identification of the cricothyroid membrane using ultrasound - a novel stepwise approach v/ Michael Seltz Kristensen et al
41 Comparison of tracheal intubation with a flexible fibreoptic endoscope and the McGrath series five video laryngoscope in simulated difficult airway scenarios v/ Cecilie E.H. Jepsen et al
A Patients’ experience of awake versus anaesthetised orotracheal intubation: a controlled study v/ Didde Trærup Schnack et al
30 Perioperativ optimering af slagvolumen og oxygen delivery kan reducere antallet af postoperative komplikationer efter elektiv åben perifer karkirurgi v/ Jannie Bisgaard et al
Sweden Room Posterdiskussion 2
Moderatorer: Ann Møller og Karsten Skovgaard Olsen
abstract nr.
L Beneficial effect of Transversus Abdominis Plane (TAP) block after laparoscopic cholecystectomy in day-case surgery: A randomized clinical trial v/ Pernille Lykke Pedersen et al
M Pain and opioid consumption following ultrasound-guided ilioinguinal/ iliohypogastric nerve block for open inquinal hernia repair in adults v/ Finn Østergaard Bærentzen
Astellas Pharma A/S inviterer til frokostsymposium torsdag d. 10. november 2011, kl. 11.00 - 11.45
New local treatment for localized neuropathic pain
v/ Dr Till Wagner
Head of Pain Therapy and Palliative Care Medizinisches Zentrum Städteregion Aachen
Aachen, Germany
Frokostsymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2011. Der vil være frokost i tilknytning til symposiet.
Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig (se tilmeldingsblanket).
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Torsdag d. 10. november, fortsat
14.00 - 15.30 6 Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative (fortsat) intercostal catheter v/ Kim Wildgaard et al
9 Transversus Abdominal Plane (TAP) kateter anlæggelse til colonresektion: et metodestudie v/ Nils Bjerregaard et al
22 Ultrasound-guided bilateral dual transversus abdominis plane (TAP) block: Magnetic resonance (MR) imaging of the distribution of local anaesthetic v/ Tejs Jansen et al
27 Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for persistent inguinal postherniorrhaphy pain:
A randomized, double-blind, placebo-controlled, cross-over trial v/ Joakim M. Bischoff et al
45 Why in the post anaesthesia care unit after total hip and knee arthroplasty? v/ Troels Haxholdt Lunn et al D Hvilken nål anvender neurologer ved lumbalpunktur? v/ Line Stendell et al
Denmark Room Posterdiskussion 3
Moderatorer: Søren Mikkelsen og Jonna Storm Fomsgaard
abstract nr.
46 Preoperative prediction of acute postoperative pain in total knee arthroplasty v/ Troels Haxholdt Lunn et al B Pain treatment after craniotomy - where is the (procedure-specific) evidence? A systematic review
v/ Morten Sejer Hansen et al
44 Recovery after total hip arthroplasty with preoperative high-dose methylprednisolone: A randomized, double-blind, placebo-controlled trial v/ Troels Haxholdt Lunn et al
19 Partners’ experiences of the post-discharge period after day surgery - a qualitative study v/ Birgitte Majholm et al
11 Perioperative transfusion threshold and ambulation after hip revision surgery - a randomized trial v/ Kamilla Nielsen et al
32 Transfusion ratios during massive postpartum haemorrhage - does it protect the patient from hysterectomy?
v/ Anne Juul Wikkelsø et al
C Intranasal fentanyl in the treatment of acute pain - a systematic review v/ Morten Sejer Hansen et al 21 Triage of high-risk surgical patients with peptic ulcer perforation. An observational study
v/ David Levarett Buck et al Finland Room
Posterdiskussion 4
Moderatorer: Jan Bonde og Kirsten Møller
abstract nr.
28 Predictors of mortality in ARDS patients due to viral pneumonia with influenza A or B v/ Mathias P. Goldinger et al
24 Ex-vivo response to blood products and haemostatic agents in whole blood coagulation after cardiac surgery in children v/ Jo Bønding Andreasen et al
42 Genotyping of the butyrylcholinesterase gene is beneficial for selected patients v/ Karsten Kindberg et al P Respiratory rate monitored by sternal photoplethysmography v/ Mette H. Toft et al
Q Development of technical skills in focus assessed transthoracic echocardiography v/ Christian Alcaraz Frederiksen et al
20 Brain death changes renal COX-1 and COX-2 mRNA expression in pigs v/ Christine Lodberg Hvas et al 33 1 års follow-up undersøgelse af intensiv patienter efter svær H1N1 influenza pneumoni
v/ Mathias P. Goldinger et al
2 Skades- og mortalitetsmønster hos svært tilskadekomne børn på Rigshospitalet v/ Hien Quoc Do et al
Iceland Room Posterdiskussion 5
Moderatorer: Susanne Ilkjær og Jørn Wetterslev
abstract nr.
3 Long term psychological effects of a no sedation protocol in critically ill patients v/ Thomas Strøm et al J CRRT for critically ill infants and children v/ Ole Pedersen et al
K One-year mortality after acute kidney injury among Danish intensive care patients: a cohort study v/ Henrik Gammelager et al
O Do soluble levels of endothelial adhesion molecules reflect endothelial expression?
v/ Anders Gade Kjærgaard et al
R The use of fresh frozen plasma in ICU patients with septic shock v/ Nanna Reiter et al
T Systolic heart function remains depressed for at least one month after on-pump cardiac surgery v/ Peter Juhl-Olsen et al
Torsdag d. 10. november, fortsat
14.00 - 15.30 I Evaluation of the effect of three different inotropic support strategies in the normal newborn piglet heart on (fortsat) hemodynamics and myocardial metabolism v/ Janus Adler Hyldebrandt
4 The outcome of critically illness in decompensated liver cirrhosis v/ Thomas Strøm Chairmans Room
Posterdiskussion 6
Moderatorer: Anders Perner og Erika F. Christensen
abstract nr.
7 A novel non-invasive method for measuring fatigability of the quadriceps muscle in non-cooperating subjects:
Assessment of reliability v/ Jesper B. Poulsen et al
34 The Scandinavian starch for severe sepsis/septic shock (6S) trial: characteristics and outcome of the first 400 patients v/ Nicolai Haase et al
17 Lower mortality with higher fluid volume in patients with persisting septic shock v/ Søren H. Smith et al 25 Mortality in elderly patients admitted to the intensive care unit: a Danish one year cohort study
v/ Malene Schou Nielsson et al
43 Pleural effusion is a potential confounder for correct interpretation of conventional hemodynamic parameters.
An experimental porcine study v/ Kristian B. Wemmelund et al
38 Targeted delivery of dexamethasone to macrophages attenuates the cytokine response without decreasing cortisole levels - a porcine study v/ Asger Granfeldt et al
8 Reduced rate of force development and maximal volunary torque in ICU survivors 12-month after discharge v/ Jesper B. Poulsen et al
35 Clinical characteristics and outcome associated with blood transfusion in septic shock v/ Ragnhild G. Rosland et al
15.30 - 16.00 Udstilling - kaffe + frugt eller lign.
16.00 - 17.30 Sweden Room
Utøya/Oslo 22/7: Hvad kan vi lære af en katastrofe i en skandinavisk hovedstad?
Moderator: Jakob Stensballe v/ Tina Gaarder
Denmark Room
FYA goes higher - HEMS og CATS fra London Moderator: Øivind Jans
v/ Haris Begovic og Mona Tarpgaard Iceland Room
DAO Generalforsamling Finland Room
Forskningsinitiativet Moderator: Palle Toft
- Anne Juul Wikkelsø. Multitransfusion i relation til postpartum blødning - Christine L. Hvas. Intrakraniel blødning i en organdonor-model
- Henrik Torup. Effekten af Transversus Abdominis Plane (TAP) blok som postoperativ smertebehandling efter åben hysterektomi
- Mathias Paul Goldinger. 12 måneders follow-up undersøgelse af intensivpatienter efter H1N1 influenza-pneumoni - Morten Rune Eckhardt. Fra akutte til kroniske smerter. Betydningen af postoperative meddelte smerter
- Nicolai R.S. Haase. Blødning og hæmostase hos patienter med svær sepsis
- Sian I. Robinson. Evaluering af den optimale dosis af profylaktisk antikoagulation med lavmolekylær heparin subkutant til kritisk syge patienter - delstudie 2
- Sisse A. Thommassen. Individuel tilpasning af blood flow ved brug af kardiopulmonal bypass 17.30 - 19.00 Middag i Casino Ballroom
19.00 - 22.30 Norway Room
DASAIM generalforsamling
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Fredag d. 11. november
07.30 - Registrering 08.00 - 08.30 Norway Room
Kan enhver bedøve en hovedtraumepatient, der skal have et søm i benet?
Moderator: Karen-Lise Welling v/ Pernille Haure
Finland Room
Indsatsleder sundhed/KOOL - den nye pige i klassen Moderator: Kim Garde
v/ Charlotte Barfod Sweden Room
Perioperativ transfusionsstrategi: Hvad kan vi optimere?
Moderator: Mette Hyllested v/ Astrid Nørgaard
Iceland Room
Unge og voksne med medfødt hjertefejl (GUCH) Moderator: Lisbeth Bredahl
v/ Morten Helvind og Vibeke Hornbak 08.30 - 09.00 Udstilling - kaffe
09.00 - 09.30 Sweden Room
Thermografi - en mulig, objektiv metode til vurdering af udbredelsen af nerveblok på overekstremiteten Moderator: Jonna Storm Fomsgaard
v/ Semera Asgher Iceland Room
Behandling af mitralinsufficiens, kirurgisk vs. endovaskulært Moderator: Marianne Kjær Jensen
v/ Jens Thiis og Olaf Franzen Finland Room
Hvordan indretter man en intensiv afdeling?
Moderator: Jens Schierbeck v/ Erik Jylling
Norway Room
Hvad var nytten af den lægebemandede helikopter?
Moderator: Kim Garde v/ Rasmus Hesselfeldt 09.30 - 10.00 Udstilling - kaffe
10.00 - 12.00 Finland-Sweden-Iceland Room ACTA Foredragskonkurrence
Bedømmere: Else Tønnesen, Palle Toft, Niels Henry Secher og Jørn Wetterslev Moderator: Jørgen B. Dahl
abstract nr.
12 Impaired hypoxic cerebral vasodilation after lipopolysaccharide infusion in healthy humans: implications for sepsis-associated encephalopathy? v/ Ronan M.G. Berg et al
18 Local anaesthesia and remifentanil sedation versus total intravenous anaesthesia for operative hysteroscopic procedures in day surgery. A randomised clinical trial v/ Birgitte Majholm et al
36 Response to succinylcholine in patients carrying the K-variant in the butyrylcholinesterase gene v/ Claus Bretlau et al 23 Remote ischemic preconditioning in children operated for complex congenital heart disease does not reduce the risk of postoperative acute kidney injury: A randomized single center study v/ Kirsten Rønholt Pedersen et al 15 Effect of continuous adductor-canal-blockade on pain and mobilization after total knee arthroplasty v/ Pia Jæger et al 26 Engaging a whole community in resuscitation v/ Anne Møller Nielsen et al
Fredag d. 11. november, fortsat
12.00 - 12.45 Udstilling - sandwich/vand i udstillingsområdet 12.00 - 12.45 Denmark Room
Frokostsymposium - Norpharma 12.45 - 14.15 Finland Room
Efteruddannelse i præhospital behandling Moderator: Kim Garde
v/ Leif Rognås, Henrik Jørgensen, Peter Martin Hansen, Freddy Lippert Iceland Room
Trombektomi - en ny neurointerventionel behandling af cerebrale tromber Moderator: Karsten Bülow
v/ Claus Ziegler Simonsen og Niels Juul Norway Room
Nyere blokader
Moderator: Egon Godthåb Hansen og Jonna Storm Fomsgaard - TAP - en update v/ Pernille Lykke Pedersen og Henrik Torup
- Adductor kanal blok til knækirurgi v/ Pia Jæger, Malene Espelund og Jørgen Lund - Selektiv n. axillaris blok v/ Christian Rothe
Sweden Room
Etiske dilemmaer omkring organdonation Moderator: J. Asger Petersen
v/ Mickey Gjerris og Helle Haubro Andersen
Norpharma A/S inviterer til frokostsymposium fredag d. 11. november 2011, kl. 12.00 - 12.45
Derfor er der forskel på opioider
v/ Asbjørn Mohr Drewes, professor, overlæge, dr.med., ph.d.¸
Gastroenterologisk afdeling, Aalborg Sygehus
Frokostsymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2011. Der vil være frokost i tilknytning til symposiet.
Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig (se tilmeldingsblanket).
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Fredag d. 11. november, fortsat
14.15 - 14.40 Udstilling - kaffe Sweden Room
14.40 - 15.10 Smertensbarnet (i) FAM Moderator: Peter Berlac
v/ Iben Sorgenfrei og Marie-Laure B. Jacobsson Finland Room
Etiske udfordringer i en travl klinisk hverdag Moderator:
v/ J. Asger Petersen Iceland Room
Kvalitetssikring og certificering i FATE og TEE Moderator: Helle Laugesen
v/ Angela Mahdi Norway Room
Immunomodulation in acute lung injury Moderator: Kirsten Møller
v/ Ellen Burnham 15.10 - 15.15 Kort pause 15.15 - 15.45 Denmark Room
Strategi ved akut kirurgi til patienter i antitrombotisk behandling Moderator: Lars Folkersen
v/ Sisse Rye Ostrowski og Pär Johansson Iceland Room
Overlægers bijob - fritid eller arbejde Moderator: Kim Garde
v/ Berit Handberg og Michael Braüner Schmidt Norway Room
Alcohol and the lung Moderator: Kirsten Møller v/ Ellen Burnham Sweden Room
Ultralyd til luftvejshåndtering Moderator: Rasmus Hesselfeldt v/ Michael Seltz Kristensen 15.45 - 18.00 PAUSE
18.00 - 19.00 Den 42. Husfeldt-forelæsning
Anæstesi af ekstremer - fra 30 g til 5 tons Moderator: Karen Skjelsager
v/ Carsten Grøndahl
19.00 - 02.00 Middag og prisoverrækkelser
Lørdag d. 12. november
08.45 - Registrering 09.00 - 09.45 Norway Room
Professorerne har ordet Moderator: Lars S. Rasmussen Finland Room
Invasiv og non-invasiv behandling af neuropatiske smerter Moderator: Luana L. Jensen
- Nyt om neuropatiske smerter v/ Troels S. Jensen - Bagstrengsstimulation v/ Thomas P. Enggaard 09.45 - 10.00 Kaffepause
10.00 - 11.30 Norway Room
Kronisk pulmonal hypertension - medicinsk og kirurgisk intervention Moderator: Lars Folkersen
v/ Jens Erik Nielsen-Kudsk, Hanne Ravn og Lars Ilkjær Finland Room
Ledelse i sundhedsvæsenet Moderator: Jørgen B. Dahl
- Skal læger lede - eller skal vi overlade det til djøf’erne? v/ Peter Emmerich Hansen - Hvad er en god lægelig leder? v/ Jan Bonde og Kristian Antonsen
- Hvad er udfordringerne som lægelig mellemleder? v/ Mette Hyllested og Birgitte Ruhnau 11.30 - 12.45 Frokost
12.45 - 13.15 Norway Room
Autonomiens grænser, koder og behandlingsophør Moderator: Asger Bendtsen
v/ Asger Petersen Finland Room Kæderedning
Moderator: Søren Loumann Nielsen v/ Jesper Dirks
13.15 - 14.00 Norway Room Evt. politisk emne Moderator:
v/
• Andersen, Helle Haubro, centerleder Dansk Center for Organdonation, Århus
• Asgher, Semera, læge, ph.d.-studerende, anæstesiafd., Hillerød Hospital
• Antonsen, Kristian, lægechef ved Anæstesiologisk enhed for sygehusene i Hillerød, Helsingør og Frederikssund
• Barfod, Charlotte, afd.læge, ph.d., anæstesiafd., Hillerød Hospital
• Barnung, Steen, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Bested, Kirsten, overlæge, anæstesiafd., Sygehus Lillebælt Vejle
• Begovic, Haris, læge, London’s Air Ambulance
• Bendtsen, Asger, overlæge, operations- og anæstesiafd., Glostrup Hospital
• Berlac, Peter, ledende overlæge, akutafd., Hillerød Hospital
• Bonde, Jan, klinikchef, overlæge, dr.med., Intensiv Terapi Afsnit (ITA), ABD, Rigshospitalet
• Bredahl, Lisbeth, overlæge, thoraxanæstesiologisk afd., Rigshospitalet
• Burnham, Ellen, MD, MS, Associate Professor, Medical ICU Director, University of Colorado Hospital
• Bülow, Karsten, overlæge, anæstesi- og intensiv afd., Odense Universitetshospital
• Christensen, Erika F., lægelig chef, Præhospitalet, Region Midt
• Christensen, Poul Lunau, uddannelsesansvarlig overlæge, anæstesiafd., Bispebjerg Hospital
• Dahl, Jørgen B., professor, overlæge, dr.med., anæstesi, Rigshospitalet
• Dirks, Jesper, overlæge, ph.d., anæstesiafd., Hvidovre Hospital
Foredragsholdere og mødeledere
12
Foredragsholdere og mødeledere, fortsat
• Eccleston, Christopher, Professor, Coordinating Editor, PaPaS Cochrane Review Group & Director, Centre for Pain Research, The Univer- sity of Bath
• Enggaard, Thomas P., overlæge, ph.d., anæstesi- og intensiv afd., Odense Universitetshospital
• Espelund, Malene, læge, ph.d.-studerende, operations- og anæstesiafd., Glostrup Hospital
• Fomsgaard, Jonna Storm, overlæge, operations- og anæstesiafd., Glostrup Hospital
• Folkersen, Lars, overlæge, anæstesiafd., Århus Universitetshospital, Skejby
• Franzen, Olaf, overlæge, kardiologisk afd., Rigshospitalet
• Gaarder, Tina, MD, ph.d., Trauma Surgeon, Head of Dept. of Traumatology, Oslo University Hospital, Ullevål
• Garde, Kim, ledende overlæge, anæstesiafd., Næstved Sygehus
• Gerstrøm, Gustav, afdelingslæge, anæstesiafd., Århus Universitetshospital
• Gjerris, Mickey, teolog, lektor i biotik, Det Biovidenskabelige Fakultet, Københavns Universitet
• Grøndahl, Carsten, leder, dyrlæge, Zoologisk Have, København
• Handberg, Berit, afd.læge, anæstesiafd., Århus Universitetshospital, Skejby
• Hansen, Egon Godthåb, overlæge, SDL, anæstesiafd., Herlev Hospital
• Hansen, Peter Emmerich, cand.phil. et. cand.scient.pol., partner Implement Consulting Group
• Hansen, Peter Martin, afd.læge, anæstesi- og intensiv afd., Odense Universitetshospital
• Haure, Pernille, overlæge, anæstesiafd., Århus Universitetshospital/Aalborg afsnit Syd
• Hedenstierna, Göran, professor, Department of Clinical Physiology, Uppsala University Hospital
• Helvind, Morten, overlæge, thoraxkirurgisk afd., Rigshospitalet
• Hesselfeldt, Rasmus, læge, ph.d.-studerende, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Holm-Knudsen, Rolf, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Hornbak, Vibeke, overlæge, thoraxanæstesiologisk afd., Rigshospitalet
• Hyllested, Mette, overlæge, anæstesiafd., Bispebjerg Hospital
• Ilkjær, Lars, ledende overlæge, Hjerte-Lunge-Kar Kir. afd. T, Århus Universitetshospital, Skejby
• Ilkjær, Susanne, overlæge, ph.d., Århus Universitetshospital, Skejby
• Jacobsson, Marie-Laure B., overlæge, FAM, Hillerød Hospital
• Jans, Øivind, læge, ph.d.-studerende, enhed for kirurgisk patofysiologi, JMC, Rigshospitalet
• Jensen, Luana L., overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Jensen, Marianne Kjær, overlæge, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitetshospital
• Jensen, Reinhold, overlæge, Århus Universitetshospital, Skejby
• Jensen, Troels Staehelin, professor, overlæge, dr.med., neurologisk afd., Århus Universitetshospital
• Johansson, Pär, overlæge, dr.med., Blodbanken, Rigshospitalet
• Juul, Niels, overlæge, anæstesi- og intensivafd., Århus Universitetshospital
• Jylling, Erik, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitetshospital
• Jæger, Pia, læge, ph.d.-studerende, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Jørgensen, Henrik, overlæge, ph.d., anæstesiafd., Herlev Hospital
• Keld, Dorte, overlæge, overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Kristensen, Michael Seltz, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Laugesen, Helle, overlæge, anæstesiafd., Ålborg Sygehus
• Lauritsen, Torsten, overlæge, anæstesi- og operationsklinikken, JMC, Rigshospitalet
• Lippert, Freddy, overlæge, chef, Akut Medicin og Sundhedsberedskab, Region Hovedstaden
• Lohse, Thomas, overlæge, dr.med., anæstesisektor Nordjylland, 1. afd.
• Lund, Jørgen, overlæge, Privathospitalet Hamlet
• Mahdi, Angela, overlæge, thoraxanæstesiologisk afd., Ålborg Sygehus
• Mikkelsen, Søren, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitetshospital
• Møller, Ann, forskningslektor, overlæge, dr.med., anæstesiafd., Herlev Hospital
• Møller, Kirsten, overlæge, seniorforsker, dr.med., anæstesiafd., Bispebjerg Hospital
• Nielsen, Anne Møller, læge, ph.d.-studerende, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Nielsen, Søren Loumann, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Nielsen-Kudsk, Jens Erik, overlæge, dr.med., Århus Universitetshospital Skejby, Hjertemedicinsk afd. B
• Nørgaard, Astrid, overlæge, ph.d., klinisk immunologisk afd., H:S Blodbank, Rigshospitalet
• Nørregaard, Ole, overlæge, Århus Universitetshospital, Skejby, Respirationscenter Vest
• Olsen, Karsten Skovgaard, overlæge, dr.med., operations- og anæstesiafd., Glostrup Hospital
• Ostrowski, Sisse Rye, afd.læge, dr.med., Blodbanken, Rigshospitalet
• Pedersen, Pernille Lykke, afd.læge, operations- og anæstesiafd., Glostrup Hospital
• Perner, Anders, overlæge, klinisk lektor, ph.d., Intensiv Terapi Afsnit (ITA), ABD, Rigshospitalet
• Petersen, J. Asger, overlæge, anæstesiafd., Bispebjerg Hospital
• Rasmussen, Lars S., professor, overlæge, dr.med., anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Ravn, Hanne, overlæge, dr.med., anæstesiafd., Århus Universitetshospital, Skejby
• Rognås, Leif K., overlæge, anæstesi- og operationsafd., Regionshospitalet Viborg
• Rothe, Christian, læge, ph.d.-studerende, anæstesiafd., Hillerød Hospital
• Ruhnau, Birgitte, uddannelsesansvarlig overlæge, AN-OP, ABD, Rigshospitalet
• Schierbeck, Jens, overlæge, anæstesi- og intensiv afd., Odense Universitetshospital
• Schmidt, Michael Braüner, ledende overlæge, anæstesiafd., Århus Universitetshospital, Skejby
• Simonsen, Claus Ziegler, læge, ph.d., neurologisk afd., Århus Universitetshospital
• Skjelsager, Karen, uddannelsesansvarlig overlæge, anæstesiafd., Næstved Sygehus
• Sorgenfrei, Iben, overlæge, anæstesiologisk afd., Hillerød Hospital
• Stensballe, Jakob, afd.læge, ph.d., anæstesi- og operationsklinikken, HOC og transfusionsmedicinsk enhed, Blodbanken, Rigshospitalet
• Steinmetz, Jacob, traumemanager, overlæge, ph.d., anæstesi- og operationsklinikken, HOC
• Tarpgaard, Mona, anæstesiolog, fellow på Great Ormond Street Hospital for Sick Children
• Thiis, Jens, overlæge, thoraxkirurgisk afd., Rigshospitalet
• Toft, Palle, professor, overlæge, dr.med., anæstesi- og intensivafd., Odense Universitetshospital
• Torup, Henrik, læge, ph.d.-studerende, anæstesiafd., Herlev Hospital
• Tønnesen, Else, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital
• Volmanen, Petri, MD, ph.d., Lapland Central Hospital, Rovaniemi, Finland
• Weitling, Eva, overlæge, anæstesiafd., Sygehus Lillebælt Kolding
• Welling, Karen-Lise, overlæge, ph.d., neurointensivafd., Rigshospitalet
• Wetterslev, Jørn, overlæge, ph.d., Copenhagen Trial Unit, Rigshospitalet
Abstracts - ACTA Foredragskonkurence
12.
Førsteforfatter: Ronan M. G. Berg E-mail: ronan@dadlnet.dkAfdeling: Center for Inflammation og Metabolisme Hospital/Sygehus: Rigshospitalet
Medforfattere: Kevin A. Evans, Ronni R. Plovsing, Claus B.
Christiansen, Niels-Henrik Holstein-Rathlou, Damian M. Bailey, Kirsten Møller
Impaired hypoxic cerebral vasodilation after
lipopolysaccharide infusion in healthy humans: implications for sepsis-associated encephalopathy?
Background: Sepsis, the systemic inflammatory response to infection, is frequently complicated by brain dysfunction, which may involve disturbances in cerebral oxygen transport (Berg et al. 2011). We have previously established lipopolysaccharide (LPS) infusion as a human-experimental model of systemic in- flammation that mimics the early stages of sepsis (Taudorf et al.
2007). In the present study, we hypothesised that LPS infusion impairs cerebral oxygen vasoreactivity (COVR).
Methods: Ten healthy male volunteers aged 23 (mean, SD 2) years were enrolled in the study. A catheter was inserted in the radial artery, and volunteers underwent a four-hour intra- venous infusion of Escherichia coli LPS (total dose of 2 ng/kg).
Prior to the infusion and immediately after, cortical oxygenation and middle cerebral artery blood flow velocity (MCAv) were measured by dual-wavelength near-infrared light spectroscopy (NIRS) and transcranial Doppler ultrasonography, respectively.
During measurements, three interventions were conducted in a randomised fashion using a closed system (Ambu ’E’ valve) with a tight-fitting mask:
- 20 minutes of normoxia (21% O2), - 20 minutes of hyperoxia (40% O2), and - 20 minutes of hypoxia (12% O2).
To avoid the interference of hypocapnia-mediated vasoconstric- tion, all interventions were conducted in eucapnia by conti- nuously monitoring and adjusting end-tidal CO2. The cerebrova- scular resistance (CVR) was calculated as mean arterial pressure/
MCAv, and the arterial blood content of oxygen (CaO2) was calculated as Hgb x SaO2 + PaO2 x 0.01,
where Hgb is the haemoglobin concentration, and SaO2 and PaO2 is the arterial oxygen saturation and partial pressure of oxygen, respectively. COVR was subsequently calculated as the
% change in CVR per kPa change in CaO2 during hyperoxia and
hypoxia, respectively. The pro-inflammatory cytokine tumour necrosis factor a (TNF-a) was measured in arterial plasma by use of a Multiplex assay (Luminex).
Results: LPS induced an immense systemic inflammatory response with fever, flu-like symptoms, neutrocytosis, and a 34-fold increase in the circulating levels of TNF-a (all P< 0.001).
Although LPS infusion per se neither influenced CaO2 or cortical oxygenation (Table 1), hypoxic cerebral vasodilation was specifi- cally blunted after LPS (Figure 1).
Conclusion: LPS-induced systemic inflammation may affect COVR by impairing hypoxic vasodilation. This may contribute to brain dysfunction in critically ill, septic patients, by rendering the brain more vulnerable to fluctuations in CaO2.
Figure 1. Cerebrovascular responses to eucapnic hyperoxia (red) and hypoxia (blue) before and after lipopolysaccharide (LPS) in- fusion, calculated as the % change in cerebovascular resistance per kPa change in CaO2. ** Different from baseline, P < 0.0001.
Figure 1. Ce lipopolysacc in CaO2. **
Table 1. Art cerebral oxy presented a sequential B
erebrovascu charide (LPS
Different fro
terial blood g ygen vasorea as mean ± SD Bonferroni co
lar response S) infusion, c om baseline,
gases, cortica activity (COV D. * Different orrection.
es to eucapni alculated as P < 0.0001.
al oxygenatio VR) after lipo t from normo
ic hyperoxia the % chang
on (NIRS) du opolysacchar oxia, P < 0.0
(red) and hy ge in cerebo
uring inspirat ride (LPS) in 1. All P-value
ypoxia (blue) vascular res
tory hyperoxi fusion in hea es are adjust
) before and sistance per k
ia and hypox althy humans ted accordin
after kPa change
xia, and s. Data are
g to Holm's Figure 1. Ce
lipopolysacc in CaO2. **
Table 1. Art cerebral oxy presented a sequential B
erebrovascu charide (LPS Different fro
terial blood g ygen vasorea as mean ± SD Bonferroni co
lar response S) infusion, c om baseline,
gases, cortica activity (COV D. * Different orrection.
es to eucapni alculated as P < 0.0001.
al oxygenatio VR) after lipo t from normo
ic hyperoxia the % chang
on (NIRS) du opolysacchar oxia, P < 0.0
(red) and hy ge in cerebo
uring inspirat ride (LPS) in 1. All P-value
ypoxia (blue) vascular res
tory hyperoxi fusion in hea es are adjust
) before and sistance per k
ia and hypox althy humans ted accordin
after kPa change
xia, and s. Data are
g to Holm's
Table 1. Arterial blood gases, cortical oxygenation (NIRS) du- ring inspiratory hyperoxia and hypoxia, and cerebral oxygen vasoreactivity (COVR) after lipopolysaccharide (LPS) infusion in healthy humans. Data are presented as mean ± SD. * Different from normoxia, P < 0.01. All P-values are adjusted according to Holm’s sequential Bonferroni correction.
Table 1 Time intervals related to patient flow for the MAC group and TIVA group respectively.
MAC-group* TIVA-group* P-værdi** PC***
Time at the operating room 43 (22-92) 41 (25-75) 0.6 0.6 Recovery room – time to
mobilisation 53 (18-192) 69 (24-215) 0.017 0.034
Time from arrival at the OR§
to discharge readiness 118 (68-241) 138 (91-301) 0.0009 0.0027 Time from discharge readiness
to departure from DSU§§ 21 (0-165) 25 (0-128) 0.8 -
§) OR: Operating room, §§) DSU: Day surgery unit
*) median and range, (all in minutes)
**) Mann-Whitney test
***) Correction for multiple testing by the Bonferroni-Holm method.
(”Time from discharge readiness to departure from the DSU” is a security parameter and has therefore not been corrected.)
18.
Førsteforfatter: Birgitte Majholm E-mail: Birmaj01@heh.regionh.dk Afdeling: Anæstesiologisk Afdeling I Hospital/Sygehus: Herlev HospitalMedforfattere: Jens Bartholdy, Helle V Clausen, Rie A Virkus, Jens Engbæk, Ann M Møller
Local anaesthesia and remifentanil sedation versus total intravenous anaesthesia for operative hysteroscopic procedures in day surgery. A randomised clinical trial
Introduction: Operative hysteroscopic procedures are often per- formed during general anaesthesia in the day surgery setting.
However, by intravenous sedation-analgesia with supplement of local anaesthesia (monitored anaesthesia care (MAC)); it may be possible to minimize the time each patient occupies the operating room and postoperatively to achieve faster mobilisa- tion and discharge readiness. Thereby increasing effectiveness in the day surgery unit while maintaining safety and quality for the patients.
Aim: To compare total intravenous anaesthesia (TIVA) with MAC during operative hysteroscopy in a day surgical setting focusing
on the time spent in the operation room, the time until mobilisa- tion and discharge readiness as well as patient satisfaction.
Methods: Randomised clinical trial with parallel groups and no blinding. Randomisation to either MAC group: Remifentanil, (Ultiva®), sedation-analgesia combined with paracervical local anaesthesia or to TIVA group: Propofol and remifentanil. We
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14
Abstracts - ACTA Foredragskonkurence
36.
Førsteforfatter: Claus Bretlau E-mail: clausbretlau@gmail.com Afdeling: Dansk Kolinesterase Kartotek Hospital/Sygehus: Herlev HospitalMedforfattere: Martin Kryspin, Lars S. Rasmussen, Mona Ring Gätke
Response to Succinylcholine in Patients carrying the K-Variant in the Butyrylcholinesterase Gene
Background: Succinylcholine remains the drug of choice for rapid sequence induction (RSI), electroconvulsive therapy or reduction of joint dislocation. The butyrylcholinesterase enzyme (BChE) usually metabolizes succinylcholine quickly but genetic variants of BChE may prolong the duration of action of succi- nylcholine. A prolonged neuromuscular blockade may result in residual curarization or in a potentially catastrophic situation if
“cannot ventilate, cannot intubate” scenario emerges. The most common mutation in the butyrylcholinesterase gene (BCHE) is the Kalow (K) variant but the clinical significance has not been well studied. We hypothesised that the duration of action of suc- cinylcholine would be prolonged in patients with the K-variant genotype as compared to the normal genotype (wild type).
Methods: Ethics Committee approved this study. We included 70 elective adult surgical patients scheduled for general anesthe- sia with RSI consisting of alfentanil (10 µg/kg), propofol (2 mg/
kg) and succinylcholine (1 mg/kg). Duration of action of succi- nylcholine was assessed by acceleromyography. BChE activity and genotype were determined. Genotyping of BCHE K- and A- variants was done on isolated leucocyte DNA using the Taqman assay. The primary endpoint was the time to 90% recovery of first twitch in train-of-four (T1 90%) stimulation of the adductor pollicis longus muscle.
Results: Heterozygous presence of the K-variant prolonged the time T1 90% from 9.5 ±2.67 min to 11.6 ±3.5 min (p=0.0476), when compared to the wild type. Patients heterozygous for the K-variant had a BChE activity of 5.978 U/l compared with 7.703 U/l in the wild type group (p=0.0045). The wild type BCHE was present in 38 patients and 21 were heterozygous for the K- variant. Five patients had other genotypes and six patients were excluded due to technical errors.
Conclusion: The duration of action of succinylcholine was sig- nificantly prolonged in patients who carried the heterozygous K-variant of the butyrylcholinesterase gene.
Table 1 Time intervals related to patient flow for the MAC group and TIVA group respectively.
MAC-group* TIVA-group* P-værdi** PC***
Time at the operating room 43 (22-92) 41 (25-75) 0.6 0.6
Recovery room – time to
mobilisation 53 (18-192) 69 (24-215) 0.017 0.034
Figure 1, flow diagram
Assessed for eligibility (n = 310) )
Excluded (n = 219)
Not meeting inclusion criteria (n = 65) Risk of aspiration (4), antidepressants/
pain medication (16), not general anaesthesia (2), allergies (6), language (7), ASA III (5), BMI (9), surgical reasons (15).
Declined to participate (n = 114)
Other reasons (n = 40)
Fear of needles (1), no project surgeon at work (5), logistic reasons (34).
Analysed (n = 49)
Excluded from analysis (n = 0) Lost to follow-up (n = 0)
Discontinued intervention due to surgical difficulties and pain related to dilatation of the cervix (n = 1)
Allocated to MAC (n = 49)
Received allocated intervention (n = 49)
Lost to follow-up (n = 0) Discontinued intervention (n = 0) Allocated to TIVA (n = 42)
Received allocated intervention (n = 42)
Analysed (n =42)
Excluded from analysis (n = 0) Allocation
Analysis Follow‐Up Randomized (n =91)
23.
Førsteforfatter: Kirsten Rønholt Pedersen E-mail: kirstenronholt@hotmail.com Afdeling: Anæstesiologisk-Intensiv afd I Hospital/Sygehus: AUH, SkejbyMedforfattere: Johan Vestergaard Povlsen, Michael Rahbek Sch- midt, Erland Jørn Erlandsen,Vibeke Elisabeth Hjortdal, Hanne Berg Ravn
Remote ischemic preconditioning in children operated for complex congenital heart disease does not reduce the risk of postoperative acute kidney injury: A randomized single center study
Introduction: Acute kidney injury (AKI) requiring dialysis occurs in 10-15% of children operated for congenital heart disease and AKI is independently associated with increased risk of death.
Remote ischemic preconditioning (RIPC) has primarily been de- monstrated to protect the heart in adults and children undergo- ing cardiac surgery. Studies on the effect of RIPC on kidney func- tion in adults undergoing cardiovascular surgery have shown conflicting results. The effect of RIPC on kidney function in children operated for congenital heart disease has not yet been investigated. The objective of the present study was to evaluate if remote ischemic preconditioning can protect kidney function in children operated for complex congenital heart disease.
Methods: Children (n= 113) aged 0-15 years admitted for com- plex congenital heart disease were randomized according to age group to remote ischemic preconditioning or control group.
After exclusion of eight patients we conducted the analysis on 105 patients (remote ischemic preconditioning group n= 54 and control group n= 51). Before surgery, remote ischemic precon- ditioning was performed as 4 cycles of 5 minutes ischemia by inflating a cuff around one leg to 40 mmHg above the systolic pressure. End points were development of AKI, initiation of dia- lysis, plasma creatinine and the estimated glomerular filtration rate, plasma cystatin C, plasma and urine Neutrophil Gelatinase- Associated Lipocalin, and urine output. Secondary end points included postoperative blood pressure, inotropic score, and mortality, as well as morbidity reflected by reoperation, length of stay in the intensive care unit and in hospital.
included 91 healthy (ASA I or II) women aged 18 years or older and speaking the Danish language (figure 1). All women were scheduled for an operative hysteroscopic procedure at the day surgery units of the Copenhagen University Hosptails in Herlev and Hillerød, Denmark, between August 2008 and July 2010. The study was approved by the local Ethic Committee.
Primary outcome: Time from arrival to leaving the operating room.
Results: We found no significant differences between groups in the time from arrival to leaving the operating room (P = 0.6).
However, both the time until the patients were mobilised (P = 0.017) as well as their total time spent in the day surgery unit (P = 0.0009) were significantly reduced for patients in the MAC group. (Table 1). More patients in the MAC group (45 (91.8%)) than (24 (64.9%)) in the TIVA group have answered positive to the question: Would you like to receive the same kind of anaes- thesia for a similar procedure in the future? (P = 0.003).
Conclusion: Sedation-analgesia combined with paracervical local anaesthesia is suitable for hysteroscopy in the day surgery setting. Patients are mobilised and discharged faster compared to traditional total intravenous anaesthesia.
Acknowledgement: Study support by The Tryg Foundation.
Abstracts - ACTA Foredragskonkurence
15.
Førsteforfatter: Pia Jæger E-mail: pia.jaeger@rh.regionh.dkAfdeling: Anæstesi- og Operationsklinikken, HOC Hospital/Sygehus: Rigshospitalet
Medforfattere: Jenstrup MT, Lund J, Fomsgaard JS, Bache S, Mathiesen O, Larsen TK, Dahl JB.
Effect of Continuous Adductor-Canal-Blockade on pain and mobilization after total knee arthroplasty
Introduction: Total knee arthroplasty (TKA) is associated with intense postoperative pain. Besides providing optimal analgesia, reduction of side effects and enhanced mobilization is impor- tant in this elderly population. The Adductor-Canal-Blockade is theoretically an almost pure sensory blockade. Except from the nerve to the vastus medialis, there are only sensory fibers - from the saphenous nerve and the distal part of the posterior branch of the obturator nerve - traversing the adductor canal. We hypothesized that the Adductor-Canal-Blockade would reduce morphine consumption (primary endpoint), improve pain relief, enhance early mobilization ability, and reduce side effects after TKA compared with placebo (secondary endpoints).
Methods: We included 71 patients scheduled for TKA into this double-blind placebo-controlled randomized trial. The trial was approved by the Danish Medicines Agency, the local Regional Ethics Committee (H-1-2009-143) and the Danish Data Protection Agency, and registered at www.clinicaltrials.gov (NCT01104883).
Patients were allocated to a continuous Adductor-Canal-Block- ade via a catheter with either ropivacaine 0.75% (n=34) or pla-
cebo (n=37), administered in boluses, 30 ml initially followed by 15 ml every six hours. At 24 h all patients received ropivacaine 0.75%, 15 ml. Surgery was performed under spinal anesthesia.
Postoperative pain treatment consisted of paracetamol 1 g and ibuprofen 400 mg four times daily, and patient controlled anal- gesia with intravenous morphine. Morphine consumption, pain, nausea, vomiting, and sedation were assessed at 2, 4, 8, 24 and 26 h. Mobilization ability was assessed with the Timed-Up-and- Go (TUG) test, at 24 and 26 h.
Results: Total morphine consumption (0-24 h) was significantly reduced in the ropivacaine group compared with the placebo group (40 (21) mg vs.. 56 (26) mg (mean (SD), p=0.006). Pain (AUC 2-24 h) was significantly reduced during 45 degrees flexion of the knee (p = 0.01), but not at rest (p=0.058). Patients in the ropivacaine group performed the TUG test at 24 h significantly faster than patients in the placebo group (36 (17) seconds versus 50 (29) seconds, (mean (SD), p=0.03). At 26 h, two hours after administration of ropivacaine in both study groups, pain scores decreased significantly in the saline group compared with the ropivacaine group, both during flexion of the knee (p<0.001) and at rest (p=0.01). Furthermore, the statistically significant diffe- rence in mobilization ability disappeared at 26 h (p=0.21). There were no statistically significant differences between groups with regard to nausea, vomiting or sedation, but significantly fewer patients in the ropivacaine group required ondansetron (p=0.01).
Conclusion: The Adductor-Canal-Blockade significantly reduced morphine consumption and pain during 45 degrees flexion of the knee compared with placebo after TKA. Furthermore, it significantly enhanced mobilization ability at 24 h assessed with the TUG test.
26.
Anne Møller Nielsena*, Dan Isbye, Freddy Lippertb, Lars S.Rasmussena
a Department of Anaesthesia, Centre of Head and Orthopaedics, Copen- hagen University Hospital, Rigshospitalet, Denmark
b Head Office, The Capital Region of Denmark, Denmark
* Corresponding author: anne.mn@dadlnet.dk
Engaging a Whole Community in Resuscitation
Introduction: Survival after out-of-hospital cardiac arrest (OHCA) is influenced by each link in the chain of survival. On the Danish island of Bornholm (population 42.000, area 588 km2) 22% of witnessed OHCA patients (2004) received bystander basic life support (BLS) and none survived an OHCA in 2001-2003.
Therefore, a project was conducted aiming to improve BLS rates and survival after OHCA by strengthening each link in the chain of survival combined with a mass media focus on resuscitation.
Methods: Lay people completed a 24-min DVD-based-self-in- struction BLS course (MiniAnne, Laerdal), mainly at their work- places, or a 4-h BLS/AED course. The local television station had broadcasts about resuscitation and the purchase of automated external defibrillators (AED) was encouraged. The dispatch centre implemented an IT solution for referring bystanders to
the nearest AED. At the Emergency Medical Services (EMS) the ambulance attendants were assessed in a mock cardiac arrest scenario and individual feedback was given. Staff at the island hospital completed a BLS course or more advanced courses.
Therapeutic hypothermia was implemented.
Resuscitation data according to the Utstein recommendations were collected prospectively by the EMS.
Results: During the 2-year project period there were 103 OHCAs and 96 had presumed cardiac aetiology. Fiftyfour percent of these OHCAs occurred in public places and 35 were bystander witnessed. Among them 17 (49%) had ventricular fibrillation (VF), 7 (20%) had pulseless electrical activity (PEA), and 11 (31%) had asystole as the initial rhythm. The bystander BLS rate for witnessed OHCAs with presumed cardiac origin (N=35) incre- ased significantly from 22% (2004) to 74% [95% CI 58-86].
These patients had a median age of 66 years [25-75% range 55- 75] and 63% were male. Of the thirty-five, 7 (20%) had Return of Spontaneous Circulation (ROSC) at hospital admission. Survival to hospital discharge among those with bystander witnessed VF, PEA and asystole of cardiac aetiology was 19% (3/16) [95% CI 6-44], 14% (1/7) [95% CI 5-54] and 0%, respectively.
Conclusion: Strengthening all links in the chain of survival was associated with significant increases in bystander BLS rate and survival after out-of-hospital cardiac arrest.
Results: Overall, 57 (54%) of the children developed acute kidney injury with 27 (50%) in the remote ischemic precondi- tioning group and 30 (59%) in the control group (p >0.2) (Table 1). Remote ischemic preconditioning was not associated with improvement in any of the renal biomarkers or in any of the secondary end points (Table 1).
Discussion: We found a tendency towards a lower incidence of AKI based on changes in plasma creatinine and urine output (the
RIFLE criteria), but this was not supported by changes in more recently developed renal biomarkers. AKI was lower in RIPC- children above the age of 6 months, indicating that a certain maturation of the kidneys may be needed to respond to RIPC.
Conclusions: We found no evidence that remote ischemic pre- conditioning provided protection of kidney function in children operated for complex congenital heart disease.
16
