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In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial, but are not supported by firm scientific evidence.

Introduction: In 2005, new international evidence-based guidelines for cardiopulmonary resuscitation (CPR) were published by the International Liaison Committee on Resuscitation (ILCOR). The aim of these new guidelines is to improve the quality of care and, thereby, the outcome from cardiac arrest. This necessitates that the guidelines are known and implemented in clinical practice. The purpose of this investigation is to elucidate the extent of implementation of Guidelines 2005 (G2005) among doctors on Cardiac Arrest Teams (CAT) one year after the publication. In addition, the date of implementation is examined among medical emergency services and major providers of basic life support (BLS) courses., Material and Methods: A telephone enquiry about CPR among CAT doctors on-duty. Ambulance services and BLS-course providers are contacted by e-mail., Results: Approximately 70% of the doctors were able to answer simple and essential topics on CPR, e.g. compression/ventilation ratio and the number of shocks in a sequence in accordance with G2005. The ambulance service, Falck A/S, implemented G2005 during 2007, while the other ambulance services implemented G2005 within six months after publication. The majority of BLS-course providers implemented the guidelines one year after their publication., Conclusion: One year after the publication of G2005, there is limited knowledge of the guidelines among doctors on duty. The study does not give any explanation for the lack of implementation. The barriers to implementation should be clarified, and future guidelines should be accompanied by an active strategy for implementation.

Intraosseous infusion is widely used in children, but its use in adults is much less common. This is probably because another vascular access can usually be achieved, and also because of lack of knowledge of the technique. Placement in adults is a quick procedure with a high rate of success. Drugs and fluids do not change the pharmacodynamics or pharmacokinetics of intraosseous administration, and anything can be given. Infusion rates have been achieved that in part make fluid resuscitation possible. Its uses are many and the contraindications few; complications are rare when simple guidelines are followed.