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1
Couper, Keith. "Debriefing for cardiac arrest." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/67921/.
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Early data from North America supports the use of educational cardiac arrest debriefing as a strategy to improve the quality of cardiopulmonary resuscitation (CPR) in the hospital setting. As some debriefing approaches are challenging to deliver in the NHS setting, there was a need to develop debriefing approaches that are both effective and suited to NHS working practices. This thesis is modelled on the Medical Research Council framework for the development and evaluation of complex interventions. Undertaken between October 2011 and January 2015, it describes the development and feasibility assessment of three cardiac arrest debriefing approaches, which were specifically designed to be deliverable in NHS hospitals. Development work comprised three work packages (systematic review, process evaluation, qualitative study). These studies provided evidence to support the use of cardiac arrest debriefing, but showed that weekly group debriefing is undeliverable in many NHS hospitals. Through qualitative work, I identified six distinct mechanisms by which debriefing may affect clinical practice. Synthesis of these data led to the development of three cardiac arrest debriefing approaches (monthly group debriefing, individual oral debriefing, written feedback). We tested the feasibility of delivering these interventions by implementing them in three NHS hospitals (one intervention per hospital). In a before/after study, it was demonstrated that, despite practical challenges, interventions were deliverable in NHS hospitals. However, they were found to have no effect on either CPR quality or patient outcome. This finding was attributed to high performance in study hospitals at baseline. This thesis demonstrates that the developed cardiac arrest debriefing interventions are deliverable in NHS hospitals. It has also generated important new theory about the mechanisms by which debriefing may affect clinical practice. This thesis lays the foundation for future work to evaluate the clinical and cost-effectiveness of these cardiac arrest debriefing interventions.
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Taghavi, Fouad John. "Post-cardiac arrest myocardial dysfunction." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/18885/.
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One of the major medical advances of the twentieth century is the development of cardiac transplantation. Cardiac transplantation is the definitive treatment for end-stage heart disease. Cardiac transplantation relies on organs procured from Brain Dead Donors (DBD). Donation after Circulatory Death (DCD) organs are being increasingly used for renal, liver and lung transplantation. Hearts from DCD donors have not been utilized as there is a fear that they will have sustained irreversible myocardial injury post cardiac arrest. We have a limited understanding of Post cardiac arrest myocardial depression due to the lack of a good physiological model of the disease. Objective: To develop a model of in-vivo cardiac arrest and resuscitation in order to characterize the biology of the associated myocardial dysfunction and test potential therapeutic strategies. Methods and Results: We developed a rodent model of post arrest myocardial depression (DCD model) using extracorporeal membrane oxygenation for resuscitation, followed by invasive haemodynamic measurements. In isolated cardiomyocytes, we assessed mechanical load and Ca2+-induced Ca2+ release (CICR) simultaneously using the microcarbon fiber technique and observed reduced function and myofilament calcium sensitivity in the post arrest group. Additionally, in contrast with findings from Langendorff models of ischemia-reperfusion, there is a marked augmentation of CICR in isolated cells. This increase in calcium serves to maintain contraction in the face of myofilament dysfunction and, it seems to be mediated by autophosphorylation of calcium-calmodulin protein kinase II (CAMKII). It is further dependent on ryanodine receptor calcium but not PKA leading us to speculate that it is triggered by adrenergic activation but maintained by CAMKII. Finally, activation of aldehyde-dehydrogenase II by the small molecule Alda-1 dramatically improved whole animal and cellular contractile performance after arrest, and restored CICR to close to normal levels. Conclusions: Cardiac arrest and reperfusion lead to calcium cardiac memory, which support cardiomyocyte contractility in the face of post arrest myofilament calcium sensitivity. Alda-1 mitigates these effects and improves outcome.
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De, Maio Valerie Jill. "EMS-witnessed cardiac arrest, descriptive epidemiology, predictors of survival, and survival comparison with bystander-witnessed cardiac arrest." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/MQ45213.pdf.
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Soo, Lin Hoe. "Out-of-hospital cardiac arrest in Nottinghamshire." Thesis, University of Nottingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341974.
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Semenas, Egidijus. "Sex Differences in Cardiac and Cerebral Damage after Hypovolemic Cardiac Arrest." Doctoral thesis, Uppsala universitet, Anestesiologi och intensivvård, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-146314.
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Resuscitation from haemorrhagic shock and the subsequent circulatory arrest remains a major clinical challenge in the care of trauma patients. Numerous experimental studies in sexually mature animals have shown a gender dimorphism in response to trauma and haemorrhagic shock. The first study was designed to evaluate sex differences in outcome after resuscitation from hypovolemic circulatory arrest. We intended to examine innate sex differences, and chose to study sexually immature animals. The study showed that cerebral cortical blood flow was greater, blood-brain-barrier was better preserved and neuronal injury was smaller in female as compared to male piglets. The second study demonstrated that female sex was associated with enhanced haemodynamic response, cardioprotection, and better survival. This cardioprotective effect was observed despite comparable estradiol and testosterone levels in male and female animals, indicating an innate gender-related cardioprotection. In both studies (I and II) female sex was associated with a smaller increase in the cerebral expression of inducible and neuronal nitric oxide synthase (iNOS and nNOS). Thus in the study III we tested the hypothesis that exogenously administered 17β-estradiol (E2) could improve neurological outcome by NOS modulation. The results showed that compared with the control group, animals in the E2 group exhibited a significantly smaller increase in nNOS and iNOS expression, a smaller blood-brain-barrier disruption and a mitigated neuronal injury. There was also a significant correlation between nNOS and iNOS levels and neuronal injury. A hypothesis if female-specific cardioprotection may be attributed to a smaller NOS activity was tested in study IV. The animals received methylene blue (MB) during CPR, but were otherwise treated according to the same protocol as studies I-II. The female-specific cardioprotection could be attributed to a smaller NOS activity, but NOS inhibition with MB did not improve survival or myocardial injury, although it abated the difference between the sexes.
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Ede, Mauricio. "An alternative agent to induce cardiac arrest for normothermic cardiac surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0022/NQ32879.pdf.
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Yamada, Tetsu. "Impact of the cardiac arrest mode on cardiac death donor lungs." Kyoto University, 2015. http://hdl.handle.net/2433/200492.
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Karlsson, Viktor, Josef Dankiewicz, Niklas Nielsen, Karl B. Kern, Michael R. Mooney, Richard R. Riker, Sten Rubertsson, et al. "Association of gender to outcome after out-of-hospital cardiac arrest - a report from the International Cardiac Arrest Registry." BioMed Central Ltd, 2015. http://hdl.handle.net/10150/610310.
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INTRODUCTION: Previous studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest (OHCA), but the results are conflicting. We aimed to investigate the association of gender to outcome, coronary angiography (CAG) and adverse events in OHCA survivors treated with mild induced hypothermia (MIH). METHODS: We performed a retrospective analysis of prospectively collected data from the International Cardiac Arrest Registry. Adult patients with a non-traumatic OHCA and treated with MIH were included. Good neurological outcome was defined as a cerebral performance category (CPC) of 1 or 2. RESULTS: A total of 1,667 patients, 472 women (28%) and 1,195 men (72%), met the inclusion criteria. Men were more likely to receive bystander cardiopulmonary resuscitation, have an initial shockable rhythm and to have a presumed cardiac cause of arrest. At hospital discharge, men had a higher survival rate (52% vs. 38%, P <0.001) and more often a good neurological outcome (43% vs. 32%, P <0.001) in the univariate analysis. When adjusting for baseline characteristics, male gender was associated with improved survival (OR 1.34, 95% CI 1.01 to 1.78) but no longer with neurological outcome (OR 1.24, 95% CI 0.92 to 1.67). Adverse events were common; women more often had hypokalemia, hypomagnesemia and bleeding requiring transfusion, while men had more pneumonia. In a subgroup analysis of patients with a presumed cardiac cause of arrest (n = 1,361), men more often had CAG performed on admission (58% vs. 50%, P = 0.02) but this discrepancy disappeared in an adjusted analysis. CONCLUSIONS: Gender differences exist regarding cause of arrest, adverse events and outcome. Male gender was independently associated with survival but not with neurological outcome.
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Waien, Sohail Akbar. "Outcomes of cardiac arrest patients in Metropolitan Toronto." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq28755.pdf.
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Youssef, Asser M., Jahromi Alireza Hamidian, and Cuthbert O. Simpkins. "Arterial versus Venous Fluid Resuscitation; Restoring Cardiac Contractions in Cardiac Arrest Following Exsanguinations." BAQIYATALLAH UNIV MEDICAL SCIENCES, 2016. http://hdl.handle.net/10150/626110.
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Background: Arterial cannulation and intra-arterial (IA) fluid and blood resuscitation in the patients with severe shock is an easier approach compared with the intravenous (IV) access if concerns regarding the efficiency and safety of this approach are addressed. Objectives: We hypothesized that IA fluid resuscitation is more effective than IV resuscitation in restoring cardiac contractions (CC) of cardiac-arrested mice following severe hemorrhagic shock. Methods: Mice (N = 22) were anesthetized using ketamine/xylazine. Arterial and venous systems accessed through cannulation of the carotid artery and the Jugular vein, respectively. As much blood as possible was aspirated from the carotid artery access. Mice were observed until the complete cessation of chest wall motions. Following 30 seconds delay, IV (N = 5) and IA access (N = 6) were used for fluid resuscitation using Ringer Lactate (RL) in a similar volume to the aspirated blood. Mice were observed for restoration of chest wall motions. In phase-II of the study, after cessation of chest motions, mice (N = 11) underwent a thoracotomy and CCs were observed. In three mice, IV RL Infusion after cardiac arrest failed to restore CCs and was followed by IA RL infusion. In eight mice, following cardiac arrest intermittent IA RL infusion was performed. Results: While IV RL Infusion failed to restore chest motion in mice (N = 5), IA RL infusion restored chest motion in all mice examined (N = 6) (P = 0.0067). In three mice, IV RL infusion after cardiac arrest showed no effect on CC. After failure of venous infusion, IA RL infusion was performed which resulted in restoration of CC for 13.33 +/- 1.76 minutes. In eight mice, intermittent IA infusion of RL after cardiac arrest, sustained CC for 31.43 +/- 10.9 minutes (P = 0.017). Conclusions: IA fluid resuscitation is superior to IV resuscitation in hemorrhagic shock induced cardiac arrest.
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Plewa, Luke Joseph. "Sudden Cardiac Arrest Prediction through Heart Rate Variability Analysis." DigitalCommons@CalPoly, 2015. https://digitalcommons.calpoly.edu/theses/1449.
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The increase in popularity for wearable technologies (see: Apple Watch and Microsoft Band) has opened the door for an Internet of Things solution to healthcare. One of the most prevalent healthcare problems today is the poor survival rate of out-of hospital sudden cardiac arrests (9.5% on 360,000 cases in the USA in 2013). It has been proven that heart rate derived features can give an early indicator of sudden cardiac arrest, and that providing an early warning has the potential to save many lives. Many of these new wearable devices are capable of providing this warning through their heart rate sensors. This thesis paper introduces a prospective dataset of physical activity heart rates collected via Microsoft Band. This dataset is indicative of the heart rates that would be observed in the proposed Internet of Things solution. This dataset is combined with public heart rate datasets to provide a dataset larger than many of the ones used in related works and more indicative of out-of-hospital heart rates. This paper introduces the use of LogitBoost as a classifier for sudden cardiac arrest prediction. Using this technique, a five minute warning of sudden cardiac arrest is provided with 96.36% accuracy and F-score of 0.9375. These results are better than existing solutions that only include in-hospital data.
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Gililland, Kimberly Sue. "Staff Education and Training for the Maternal Cardiac Arrest." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5709.
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Maternal cardiac arrest is among the most frightening events that can happen on the labor and delivery unit. A maternal arrest can have catastrophic results. Staff must be vigilant, competent, and ready to handle the maternal arrest emergency at all times. A maternal cardiac arrest requires coordination among multiple disciplines and precise performance is paramount in saving not one life, but two. The purpose of the project was to establish a clinical training course for maternal arrest intended for education to improve staff knowledge during a maternal cardiac arrest. Evaluation of the knowledge and skills were through an exam, participation in a mock maternal cardiac arrest, and annual competencies for all appropriate staff. Results of the advanced cardiac life support first time exam pass rate was 92% with 100% second time pass rate. The neonatal resuscitation protocol exam pass rate was 100% on the first attempt. Total pre confidence score for RNs M 30.32, SD = 4.34, range = 15.0. Total post confidence score for RNs M = 40.14, SD = 3.24, range = 12.0. Total pre confidence scores for MDs M = 37.91, SD = 2.51, range = 9.0. Total post confidence score for MDs M = 44.37, SD = 3.20, range = 12.0. Total pre confidence score for RTs M = 33.5, SD = 3.83, range = 9.0. Post confidence score for RTs M = 41.17, SD = 2.71, range = 8.0. All scores increased in a statistically significant way p=.000. The major themes that emerged from the debriefing were angst, rush, relief. Recommendations include an annual competency and frequent, monthly checks for skills. The impact on social change is a highly trained, competent, and confident hospital staff, which is a positive change for the critical access hospital.
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Lee, Ming-tong Tony, and 李銘棠. "Detection of occult influenza infection in patients with sudden cardiac death." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40738218.
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Wong, Ka-man, and 黃嘉文. "The effectiveness of automatic external defibrillator (AED) for improving cardiac arrest survival in out-of-hospital setting: a literature review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42997938.
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Byron-Alhassan, Aziza. "State of the Heart: Neurophysiological and Neuropsychological Sequelae of Out-of-Hospital Cardiac Arrest In Good Outcome Survivors." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/41030.
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Survivors of out-of-hospital cardiac arrest (OHCA) are at risk for hypoxic-ischemic brain injury, which can cause a broad range of effects from death to subtle cognitive impairment. This dissertation includes two studies of OHCA patients who had made good neurological recovery after OHCA. In both studies, patients were evaluated near the time of hospital discharge, when crucial decisions such as rehabilitation plans are made. In addition, OHCA survivors were compared with a myocardial infarction (MI) control group in both studies. Study 1 explored the frequency, severity, and predictors of cognitive dysfunction in OHCA survivors, and characterized the cognitive profile of these patients using a comprehensive neuropsychological battery. Study 2 explored grey matter volume (GMV) in OHCA survivors, MI patients, and healthy controls, and correlated these with cognitive dysfunction and important clinical characteristics (e.g., downtime). While OHCA patients performed poorer on cognitive testing than MI patients, both groups showed decreased GMVs compared to healthy controls. OHCA survivors who have had good neurological recovery may still face significant challenges when they re-engage in difficult cognitive tasks post-arrest. To date, these cognitive issues after OHCA have been somewhat overlooked in Canada's healthcare system. A better understanding of hypoxic-ischemic brain injury among survivors will aid in the promotion of targeted interventions and rehabilitation efforts, and may help clinicians predict those who are most at risk.
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Lee, Ming-tong Tony. "Detection of occult influenza infection in patients with sudden cardiac death." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40738218.
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Wong, Ka-man. "The effectiveness of automatic external defibrillator (AED) for improving cardiac arrest survival in out-of-hospital setting a literature review /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42997938.
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Ashcraft, Alyce Louise Smithson. "The clinical reasoning of expert acute care registered nurses in pre-cardiopulmonary arrest events." Thesis, Full text (PDF) from UMI/Dissertation Abstracts International, 2001. http://wwwlib.umi.com/cr/utexas/fullcit?p3008269.
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Mörtberg, Erik. "Assessment of the Cerebral Ischemic/Reperfusion Injury after Cardiac Arrest." Doctoral thesis, Uppsala universitet, Anestesiologi och intensivvård, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-132681.
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The cerebral damage after cardiac arrest is thought to arise both from the ischemia during the cardiac arrest but also during reperfusion. It is the degree of cerebral damage which determines the outcome in patients. This thesis focuses on the cerebral damage after cardiac arrest. In two animal studies, positron emission tomography (PET) was used to measure cerebral blood flow, oxygen metabolism and oxygen extraction in the brain. After restoration of spontaneous circulation (ROSC) from five or ten minutes of cardiac arrest there was an immediate hyperperfusion, followed by a hypoperfusion which was most evident in the cortex. The oxygen metabolism decreased after ROSC with the lowest values in the cortex. The oxygen extraction was high at 60 minutes after ROSC, indicating an ischemic situation. After ten minutes of cardiac arrest, there was a hyperperfusion in the cerebellum. In 31 patients resuscitated after cardiac arrest and treated with hypothermia for 24 hours, blood samples were collected from admission until 108 hours after ROSC. The samples were analyzed for different biomarkers in order to test the predictive value of the biomarkers. The patients were assessed regarding their neurological outcome at discharge from the intensive care unit and after six months. Brain derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) was not associated with outcome. Neuron specific enolase (NSE) concentrations were higher among those with a poor outcome with a sensitivity of 57% and a specificity of 93% when sampled 96 hours after ROSC. S-100B was very accurate in predicting outcome; after 24 hours after ROSC it predicted a poor outcome with a sensitivity of 87% and a specificity of 100%. Tau protein predicted a poor outcome after 96 hours after ROSC with a sensitivity of 71% and a specificity of 93%.
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Wong, Po-luk, and 王寶綠. "An evidence-based guideline of defibrillation for cardiac arrest patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193065.
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Survival to discharge following a cardiac arrest is dependent on rapid and effective basic and advanced life support. As stated in the latest guideline of the American Heart Association (AHA, 2010), healthcare providers who treat cardiac arrest in hospital should use the defibrillator or other facilities with automated external defibrillators to provide immediate cardiopulmonary resuscitation.
Defibrillation plays an important role in restoring normal electrical rhythm and natural pacemaker control to the heart from chaotic heart rhythm such as ventricular fibrillation or pulseless ventricular tachycardia. This dissertation aims to identify the best evidence and develop an evidence-based guideline of defibrillation for cardiac arrest patients. The objectives of this thesis are to conduct a search of available literatures on defibrillation, mainly focusing on the defibrillation waveform and energy level, perform a critical appraisal on the literature, establish tables of evidence, and develop recommendations and defibrillation protocol for cardiac arrest patients.
A systematic search was performed using four electronic databases, including PubMed, Ovid Medicine, CINAHL and the journal Resuscitation. Six randomized controlled studies were selected from thousands of related studies which fulfilled the inclusion criteria of this dissertation. Data were extracted by tables of evidence and critical appraisal was performed. Also, the level of evidence for each study was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) framework. By synthesizing the data from the six selected studies, the biphasic waveform with 200J as the first shock energy and 200J-300J-360J as subsequent shocks was shown to help to achieve more desirable clinical outcomes to cardiac patients. The implementation potential, including transferability, feasibility and cost/ benefit ratio of the innovation, was assessed, and the evidence-based practice protocol are beneficial for cardiac arrest patients. Also, a comprehensive implementation plan was demonstrated by discussing communication between different stakeholders and transitions the practice from initiation to guiding and sustaining stage. Pilot testing would be carried out to explore any unexpected technical and logistic issues that could be avoided in the full-scale implementation of the innovation. A full evaluation plan concerning patient outcomes, healthcare provider outcomes and system outcomes would then formulated and demonstrated in the end of this dissertation.published_or_final_version
Nursing Studies
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Master of Nursing
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Walters, Geraldine. "Strategies for dealing with pre-hospital cardiac arrest in London." Thesis, University of Surrey, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305057.
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Whitehead, Laura. "Identifying a core outcome set for cardiac arrest effectiveness trials." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/93947/.
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Cardiac arrest research seeks to improve survival rates and the quality of patient survival, but the comparability of research is limited by heterogeneous outcome reporting. The Core Outcome Set for Cardiac Arrest effectiveness trials (COSCA) study sought to identify the most important outcome domains that should be reported as minimum across all cardiac arrest effectiveness trials as part of a core outcome set (COS). Multiple perspectives were sought across COS development to ensure relevance. Potential outcome domains for COS inclusion were identified in: a systematic review of outcomes reported in published randomised controlled trials (RCTs) and interviews with survivors of cardiac arrest and their partners to understand the health outcomes that really matter. Consensus on the most important outcome domains was achieved in: an international modified Delphi survey and an international consensus meeting. Great heterogeneity (164 outcomes) was reported across current RCTs, failing to capture a number of outcomes important to cardiac arrest survivors identified in interviews. Across 2 rounds of ranking and rating exercise 48 outcome domains (18 health domains across 5 time points) were scored on their importance in the modified Delphi survey. Subsequently, 30 outcome domains were further discussed at a face to face consensus meeting. Three core outcome domains were defined: survival to hospital discharge/30 days, neurological outcome at hospital discharge/30 days and health related quality of life (HRQoL) within 1 year. Preliminary guidance on appropriate assessment tools were made but further evidence and understanding of the most appropriate measurement tools is required. Implementation of the defined COS has the potential to improve outcome reporting across cardiac arrest effectiveness trials, aiding the comparison of findings through homogeneous outcome reporting and ensuring the most important outcome domains to key stakeholders are reported.
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Wilson, Michelle. "The psychosocial outcome of anoxic brain injury following cardiac arrest." Thesis, University of Lincoln, 2012. http://eprints.lincoln.ac.uk/18966/.
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Aim of the study The psychosocial outcome of anoxic brain injury following cardiac arrest is a relatively under researched, but clinically important area. The aim of the current study was to add to the limited existing literature exploring the psychosocial outcome for cardiac arrest survivors, but specifically explore if there is a greater impact on psychosocial outcome in individuals experiencing anoxic brain injury as a result. Methods A range of self report measures were used to compare the quality of life, social functioning and symptoms of anxiety, depression and post traumatic stress of individuals with and without anoxic brain injury following cardiac arrest. Measures of subjective memory and executive difficulties were also used to investigate whether psychosocial difficulties were associated with subjective cognitive difficulties. Participants took part in the study between six months and four years post cardiac arrest. A MANOVA was used as a primary method of analysis. Results There was a significant multivariate difference between the two groups; with individuals with anoxia reporting more psychosocial difficulties than the nonanoxia group. Participants in the anoxia group had more social functioning difficulties and more anxiety, depression and post traumatic stress symptoms. There was no significant difference in self-reported quality of life between the two groups, although better quality of life was associated with better social functioning and fewer anxiety, depression and post traumatic stress symptoms. Although there was no significant difference between the two groups in regard to self-reported cognitive difficulties, fewer reported difficulties were also significantly associated with better quality of life, better social functioning and fewer anxiety, depression and post traumatic stress symptoms. There was no significant association with psychosocial outcome and time since cardiac arrest and no significant gender differences. Conclusion As the first known study to compare outcome for cardiac arrest survivors with anoxia with those without, the results suggest psychosocial outcome is worse for individuals with anoxia. Individuals with anoxia experience significantly more social functioning difficulties and symptoms of anxiety, depression and post traumatic stress. It is suggested that the difference is due to a combination of neuropsychological, social and psychological factors resulting from anoxic brain injury following cardiac arrest, however further research is required to explore the contributing factors in more depth.
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Claesson, Andreas. "Lifesaving after cardiac arrest due to drowning. Characteristics and outcome." Doctoral thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-3660.
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Aims The aim of this thesis was to describe out-of-hospital cardiac arrest (OHCA) due to drowning from the following angles. In Paper I: To describe the characteristics of OHCA due to drowning and evaluate factors of importance for survival. In Paper II: To describe lifesaving skills and CPR competence among surf lifeguards. In Paper III: To describe the characteristics of interventions performed by the Swedish fire and rescue services (SFARS) and evaluate survival with or without rescue diving units. In Paper IV: To describe the prevalence of possible confounders for death due to drowning. In Paper V: To describe changes in characteristics and survival over time and again to evaluate factors of importance for survival Methods Papers I and III-V are based on retrospective register data from the Swedish OHCA Register reported by Emergency Medical Service (EMS) clinicians between 1990-2011. In addition, in Paper III, the data have been analysed and compared with the SFARS database for rescue characteristics. In Paper IV, the data have been compared with those of the National Board of Forensic Medicine (NBFM). Paper II is a descriptive study of 40 surf lifeguards evaluating delay and CPR quality as peformed on a manikin. Results Survival in OHCA due to drowning is about 10% and does not differ significantly from OHCA with a cardiac aetiology. The proportion of witnessed cases was low. Survival appears to increase with a short EMS response time, i.e. early advanced life support. Surf lifeguards perform CPR with sustained high quality, independent of prior physical strain. In half of about 7,000 drowning calls, there was need for a water rescue by the fire and rescue services. Among the OHCA in which CPR was initiated, a majority were found floating on the surface. Rescue diving took place in a small percentage of all cases. Survival when using rescue divers did not differ significantly from drownings where rescue diving units were not used. No survivors were found after >15 minutes of submersion in warm water. After submersion in cold water, survival with a good neurological outcome was extended. Among 2,166 autopsied cases of drowning, more than half were judged as accidents and about one third as intentional suicide cases. Among accidents, 14% were found to have a cardiac aetiology, while the corresponding figure among suicides was 0%. In a 20-year follow-up of OHCA due to drowning in Sweden, both bystander CPR and early survival to hospital admission are increasing. The proportion of cases alive after one month has not changed significantly during the period. Conclusions Survival from OHCA due to drowning is low. A reduction in the EMS response time appears to have high priority, i.e. early ALS is important. The quality of CPR among surf lifeguards appear to be high and not affected by prior physical strain. In all treated OHCA cases, the majority were found at the surface and survival when rescue diving took place did not appear to be poorer than in non-rescue diving cases. In a minor proportion of cases, cardiac disease could be a confounder for death due to drowning. Bystander CPR in OHCA due to drowning has increased over a 20-year period and the proportion of early survivors to hospital admission is increasing. We speculate that our studies were underpowered with regard to the opportunity adequately to assess the effects of bystander CPR on survival to hospital discharge. A uniform Swedish definition of drowning based on the recommended international terms should be implemented throughout Swedish authorities and health care, in order to enhance the quality of data and improve the potential for future research.Disputationen sker Fredagen den 20 September 2013, kl. 13.00 Sahlgrens aula, Blå stråket 5, Sahlgrenska universitetssjukhuset, Göteborg.
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Lyon, Richard Mark. "Temperature post out-of-hospital cardiac arrest : the TOPCAT study." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/29233.
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Introduction: Out-of-hospital cardiac arrest (OHCA) is a significant cause of death and severe neurological disability in Scotland. Optimal pre-hospital resuscitation is required for the patient to achieve return of spontaneous circulation (ROSC). The only post-ROSC therapy shown to increase survival is mild therapeutic hypothermia (MTH), but its mechanism of action and optimal application are still unknown. The quality of pre-hospital resuscitation in Scotland is unmeasured. The relationship between body temperature post-OHCA, systemic inflammation, markers of brain injury and outcome are still poorly defined. This study examines two aspects of OHCA; firstly, the clinical practice of resuscitation in the prehospital and Emergency Department (ED) setting and, secondly, the post-ROSC physiological changes of body temperature, systemic inflammation and serum markers of brain injury. Methods: Prospective observational study of all OHCA patients admitted to a single centre for a 14- month period (1/08/2008 to 1/02/2010). Oesophageal temperature was measured, blood samples assayed for markers of systemic inflammation (TNF-a, IL-ip, 1L-6, IL-8, IL-10, 1L- 12, elastase, cell surface markers of neutrophil activation) and markers of brain injury (neuron-specific enolase [NSE], SI00b, glial fibrillary acidic protein [GFAP]) in the ED and Intensive Care Unit (ICU). Selected patients had pre-hospital temperature monitoring and blood sampling. Routine physiological variables were recorded. Patients who survived to ICU had repeat blood samples taken at 24-,48-,72- and 120-hours post-ROSC. Patients were followed up for 6-months. We conducted qualitative analysis of the effect of having a doctor on-scene at an OHCA and performed a Scottish national survey on the ED management of post-OHCA patients. Results: 236 OHCA patients were included in the study. 161 (68%) were pronounced dead at the scene or in the ED. 75 (32%) were admitted to ICU for cooling; 49 (21%) died in ICU and 27 (11%) survived to hospital discharge. We have characterised the natural progression of core body temperature post-OHCA. Patients who achieved ROSC and had oesophageal temperature measured pre-hospital all had temperatures below normal. Quality of prehospital resuscitation performed by ambulance crews was observed to be highly variable. Standard ED care of post-OHCA patients varied across Scotland. All patients arriving in the ED post-OHCA had a relatively low temperature (34.3°C, 95% CI 34.1-34.5). Patients surviving to hospital discharge were warmer on admission to ICU than patients who died in hospital (35.6°C vs. 34.4°C, p < 0.01). Patients surviving to hospital discharge also took longer to reach target therapeutic hypothermia level than non-survivors (222 vs. 313 min, p < 0.05). Cell surface markers of neutrophil activation, IL-6, IL-8, IL-10 and elastase were all significantly raised in the early post-ROSC period. The degree of cytokinaemia at 24- hours was related to survival outcome. In the context of MTH, SI00b at 24-hours was superior to NSE and GFAP at predicting in-hospital death following OHCA, with an AUCROC of 0.90 (95% CI 0.82-0.98). Conclusions: The quality of pre-hospital and in-hospital resuscitation in Scotland is variable. Both prehospital and ED management of OHCA patients varied on a local and national scale. Following OHCA all patients have oesophageal temperatures below normal in the prehospital phase and on arrival in the ED. Patients who achieve ROSC following OHCA and survive to hospital discharge are warmer on arrival in ICU and take longer to reach target MTH temperatures compared to patients who die in hospital. A systemic inflammatory response occurs earlier in the post-ROSC phase than previously anticipated. SI00b is a more reliable predictor of outcome following OHCA than NSE or GFAP. The mechanisms of action underlying changes in oesophageal temperature and survival from OHCA remain unclear. This study adds to the information around oesophageal temperature post-OHCA and MTH further studies are warranted to clarify the mechanism of action of MTH post-OHCA and the role of inflammatory response in determining survival.
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ElSaadany, Yosuf. "A Wireless early prediction system of cardiac arrest through IoT." Miami University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=miami1500990636074389.
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Carlucci, Marcelo Tabary de Oliveira [UNESP]. "Parada cardíaca e mortalidade perioperatória por trauma: estudo no período de 14 anos em hospital universitario de atendimento terciário." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/97716.
Full textAbstract:
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Não há estudos publicados sobre parada cardíaca (PC) e mortalidade no perioperatório nos pacientes com trauma. O objetivo dessa pesquisa foi avaliar a incidência, causas e desfechos das PCs que ocorreram no perioperatório nos pacientes com trauma em hospital terciário de ensino de janeiro de 1996 a dezembro de 2009. Após aprovação do Comitê de Ética e Pesquisa da Faculdade de Medicina de Botucatu, UNESP, iniciou-se a pesquisa sobre a incidência de PC durante a anestesia em pacientes com ou sem trauma, prospectivamente identificada a partir de um banco de dados. Houve 90.909 anestesias durante o período estudado. Os dados coletados incluíram características demográficas dos pacientes, procedimento cirúrgico (eletivo, urgência ou emergência), classificação do estado físico segundo a ASA (American Society of Anesthesiologists), informações sobre o procedimento anestésico, o tipo de cirurgia, a clínica cirúrgica e o desfecho. Todas as PCs no trauma foram revisadas e agrupadas segundo o fator causal em quatro categorias: totalmente relacionadas à anestesia, parcialmente relacionadas à anestesia, totalmente relacionadas à cirurgia e totalmente relacionadas à doença e/ou condição do paciente. Ocorreram nos pacientes com trauma 58 PCs (6,4 por 10.000 anestesias) e 47 óbitos (5,2 por 10.000 anestesias). O maior risco de PC nos pacientes com trauma ocorreu na faixa etária de 18 a 35 anos (p=0,04), no sexo masculino (p<0,0001), no estado físico ASA III ou pior (p=0,04), nas cirurgias de emergência (p=0,04), nas clínicas cirúrgicas multiclínicas e torácica e nos pacientes gravemente enfermos que receberam cuidados de monitorização e suporte hemodinâmico. O choque hemorrágico e o trauma cranioencefálico foram as causas mais importantes de PC e mortalidade. A maioria das PCs e óbitos no perioperatório...
No studies of perioperative cardiac arrest and mortality in trauma patients have been published. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in trauma patients in a Brazilian tertiary general teaching hospital between 1996 and 2009. After institutional review board approval (UNESP, School of Medicine, Botucatu, Brazil), the incidence of cardiac arrest during anesthesia in patients with and without trauma was prospectively identified from an anesthesia database. There were 90,909 anesthetics during the study period. The data collected included patient demographics, surgical procedures (elective, urgent or emergency), ASA (American Society of Anesthesiologists) physical status classification, anesthesia provider information, type of surgery, surgical areas, and outcome. All of the cardiac arrests in trauma patients were reviewed and grouped by cause of cardiac arrest into one of four groups: totally anesthesia-related, partially anesthesia-related, totally surgery-related and totally trauma patient condition-related. Fifty–eight cardiac arrests (6.4 per 10,000 anesthetics) and 47 deaths (5.2 per 10,000) had occurred in the trauma patients. The major risk factors for cardiac arrest in the trauma patients were age (18 to 35 yr, p=0.04), male sex (p<0.0001) with ASA physical status III or poorer (p=0.04), emergency surgery (p=0.04) in multiclinical or thoracic surgery and monitored anesthesia care in very injured patients (p=0.04). Uncontrolled hemorrhage and head injury were the most significant causes of cardiac arrest and mortality. The majority of the intraoperative cardiac arrests and deaths in the trauma were patients condition-related. One cardiac arrest was totally anesthesia-related, and one cardiac arrest and death was surgery-related. Motor vehicle... (Complete abstract click electronic access below)
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Boaventura, Ana Paula 1975. "Registro do atendimento da parada cardiorrespiratoria no ambiente intra-hospitalar : validade e aplicabilidade de um instrumento." [s.n.], 2004. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312399.
Full textAbstract:
Orientador: Izilda Esmenia Muglia AraujoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A situação encontrada na prática dos atendimentos da parada cardiorrespiratória é a de que os registros não são feitos adequadamente, ou são incompletos, relatando apenas o horário da PCR e o óbito, quando deveriam conter maior número de informações, como fármacos utilizados durante o atendimento, os ritmos cardíacos, o número de choques realizados, entre outros. Se forem analisados os prontuários médicos de pacientes hospitalizados que apresentaram parada cardiorrespiratória, possivelmente haverá dificuldades na realização de estudos retrospectivos de ressuscitação cardiorrespiratória, pela impossibilidade de coletar dados que poderiam colaborar no aprimoramento e na avaliação da atuação da equipe, como também, de estudos de sobrevida e prognóstico em ressuscitação cardiorrespiratória diante da escassez de dados que são registrados.O presente estudo teve por objetivo validar e aplicar um instrumento para o registro do atendimento da PCR/RCR no ambiente intra-hospitalar de uma instituição de ensino. A validação de um instrumento é etapa de fundamental importância antes da sua utilização pois verifica a qualidade dos dados. Sua aplicação em uma determinada população também permite perceber como se comporta o instrumento no ambiente em que se pretende implementá-lo, para isso, o instrumento adapatado foi submetido a validação de conteúdo e verificada também sua aplicabilidade. O instrumento foi validado por juízes, quanto ao seu conteúdo. Após, os instrumentos foram utilizados pelos enfermeiros das unidades: PS, UTI, EC/CT, Cardiologia e Moléstias Infecciosas para avaliação da aplicabilidade do instrumento. Na análise dos dados da avaliação dos juízes não houve discordância significativa quanto à clareza (p= 0,353), objetividade (p=0,333) e organização (p=0,107) (Teste de Cochran). Foram coletados 54 registros de atendimento da RCR e após o preenchimento os enfermeiros avaliaram o instrumento quanto a sua utilidade, praticidade e objetividade, obtendo-se mais que 90% de respostas positivas. Na análise dos preenchimentos constatou-se que a média de preenchimento dos dados de identificação do paciente foi de 92,7%; da PCR 72,18%; RCR 81,75%; pós-RCR 89,58%; equipe de atendimento 27,41% e anotações apenas 7,41%. Conclui-se que o instrumento adaptado para o registro dos atendimentos da PCR/RCR, no ambiente intra-hospitalar, foi validado e atende às necessidades da realidade desses atendimentos no hospital estudado. Dessa forma a utilização deste instrumento que apresenta menor complexidade poderia estimular a prática de registros do atendimento da PCR / RCR, orientar novos treinamentos, bem como, direcionar investimentos em recursos físicos e materiais adequados para as unidades destinadas ao cuidado de pacientes críticos e contribuir para a melhoria dos atendimentos
Abstract: Usually, during in-hospital cardiopulmonary resuscitation (CPR), there is a lack of comprehensive records about the whole procedure, or, more often, they are incomplete, reporting only the times of cardiac arrest (CA) and of death. OBJECTIVES: The objectives of the present study were to validate and to apply an instrument that was elaborated to record in-hospital CPR maneuvers in a teaching institution. The validation is the fundamental importance before utilization of an instrument, verifies your quality and the application of an instrument in a determined population also is going to perceive as behaves the instrument in environment that him implemented, for that, the instrument was submitted the validation of content and verified also its aplicability. METHODS: The instrument was previously validated by experts judges regarding its subject matter, and thereafter it was applied by registered nurses at the emergency room, adult intensive care unit, clinical and surgical emergency wards, during cardiac arrest events in order to evaluate its pratical applicability. RESULTS: Data analysis has shown that there was no disagreement among judges regarding the instrument¿s intelligibility (p=0,353), objectivity (p=0,333) and organization (p=0,107). (Cochran¿s test). Fifty- four records of in-hospital CPR have been done, and the nurses were argued to evaluate the instrument¿s utility, praticity and objectivity, within more than 90% of positive answers. Informations concerning patient¿s identification (92,7%), CA characterization (72,18%), CPR maneuvers (81,75%), post-CPR procedures (89,58%), team of attendance (27,41%) and general annotations (7,41%), were possible to be retrieved form the applied instrument. CONCLUSIONS: It was concluded that an adapted instrument for recording in-hospital CPR procedures could be validated and easily applied by nurses in a teaching hospital. The utilization of this instrument would be able to stimulate to practical of records, news training, direct investments and adequate in-hospital CPR maneuvers in the units destined to take care of critical patients and contribute for the improvement during in-hospital cardiopulmonary resuscitation
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem
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Bordas, Rafel. "Multiscale modelling of the cardiac specialized conduction system." Thesis, University of Oxford, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.573804.
Full textAbstract:
Death due to lethal cardiac arrhythmias is the leading cause of mortality in Western society. Many of the fundamental mechanisms underlying the onset of arrthythmias, their maintenance and termination, still remain poorly understood. The specialized conduction (or His-Purkinje) system is fundamental to ventricular electrophysiological function and is a key player in various cardiac diseases. In recent years, computational simulation has become an important tool in im- proving our understanding ofthese mechanisms. Current state-of-the-art computational ventric- ular electrophysiology models often do not feature a detailed representation of the specialized conduction system. Ventricular models that do incorporate the specialized conduction system often use a simplified anatomical description and are commonly based on the monodomain equations, rather than the more general bidomain equations. Thus, using computational simula- tion to investigate both normal physiological function of the specialized conduction system and pathologies in which it is involved presents difficulties. This thesis develops the techniques and tools required to model the specialized conduction sys- tem at the ventricular scale. We derive one-dimensional bidomain equations that model elec- trical propagation in the system by reducing the equations associated with a three-dimensional fibre. To complement the derived equations, we develop a numerical solution scheme for the model that is efficient enough to allow ventricular simulations. The one-dimensional bido- main model allows defibrillation studies to be performed with the specialized conduction sys- tem. Secondly, we investigate the imaging and mesh generation tools required to integrate an anatomically detailed mesh of the specialized conduction system into a current state-of-the-art ventricular mesh. Using these tools, a highly detailed rabbit-specific specialized conduction system anatomical model is developed. Simulations are performed that dem~strate the re- sponse of the specialized conduction system to defibrillation strength shocks and we compare activation sequences generated using the model to experimental recordings. Finally, we investi- gate variability in the anatomy of the system. The tools and ventricular model presented in this thesis fulfil an important role in allowing the study of the e1ectrophysiological function of the specialized conduction system at the ventricular scale.
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Ewy, Gordon. "The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest." BioMed Central, 2012. http://hdl.handle.net/10150/610245.
Full textAbstract:
Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.
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Jonsson, Martin. "Socioeconomic status and out-of-hospital cardiac arrest : A quantitative analysis of the relationship between socioeconomic status, incidence, and survival from out of hospital cardiac arrest." Thesis, Stockholms universitet, Sociologiska institutionen, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-102746.
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BACKGROUND This thesis studies the relationship between area-level socioeconomic status and the incidence and 30-day survival of out of hospital cardiac arrest. The effect of socioeconomic status on health has been studied for over 150 years. Although cardiac arrest is a major public health problem there has been very little focus on socioeconomic status and out of hospital cardiac arrest. DATA AND METHODS The cardiac arrest data are obtained from the Swedish cardiac arrest registry. Data on age structure and percentage of immigrants is from SCBs total population registry and socioeconomic data come from SCBs LISA database. The incidence analysis is made in two steps. The first step calculates the age standardized incidence and the second step is an OLS analysis. For the survival analysis a logistic regression analysis is made to measure the probability of survival in different income areas. RESULTS For the socioeconomic status – incidence analysis the results from the OLS analysis suggest that the incidence is almost twice as high in the lowest income area. Intercept (Highest group) = 26.8 and <140 000 (lowest group) = 24.5. In the survival analysis (using a binary logistic regression analysis) there was a significantly lower OR for the lowest income group for all patients (OR= 0.521, p= 0.049) and for the sub group (patients 18-75 years old) there was a significant negative relationship for the two lowest groups. <140 000 (OR= 0.444, p= 0.032) and 140 000-159 000 (OR= 0.620, p= 0.046). CONCLUSION There is a significant relationship between living in a poor neighborhood and out of hospital cardiac arrest. Those living in poorer areas have both an increased incidence and lower chance of survival of out of hospital cardiac arrest.
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Böttiger, B. W., A. Lockey, R. Aickin, M. Castren, Caen A. de, R. Escalante, K. B. Kern, et al. "“All citizens of the world can save a life” — The World Restart a Heart (WRAH) initiative starts in 2018." Elsevier Ireland Ltd, 2018. http://hdl.handle.net/10757/624722.
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“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by “first responders”. Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR (“KIDS SAVE LIVES”), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.Revisión por pares
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Carlucci, Marcelo Tabary de Oliveira. "Parada cardíaca e mortalidade perioperatória por trauma : estudo no período de 14 anos em hospital universitario de atendimento terciário /." Botucatu, 2012. http://hdl.handle.net/11449/97716.
Full textAbstract:
Orientador: Leandro Gobbo BrazBanca: Paulo do Nascimento Junior
Banca: Luiz Marcelo Sá Malbouisson
Resumo: Não há estudos publicados sobre parada cardíaca (PC) e mortalidade no perioperatório nos pacientes com trauma. O objetivo dessa pesquisa foi avaliar a incidência, causas e desfechos das PCs que ocorreram no perioperatório nos pacientes com trauma em hospital terciário de ensino de janeiro de 1996 a dezembro de 2009. Após aprovação do Comitê de Ética e Pesquisa da Faculdade de Medicina de Botucatu, UNESP, iniciou-se a pesquisa sobre a incidência de PC durante a anestesia em pacientes com ou sem trauma, prospectivamente identificada a partir de um banco de dados. Houve 90.909 anestesias durante o período estudado. Os dados coletados incluíram características demográficas dos pacientes, procedimento cirúrgico (eletivo, urgência ou emergência), classificação do estado físico segundo a ASA (American Society of Anesthesiologists), informações sobre o procedimento anestésico, o tipo de cirurgia, a clínica cirúrgica e o desfecho. Todas as PCs no trauma foram revisadas e agrupadas segundo o fator causal em quatro categorias: totalmente relacionadas à anestesia, parcialmente relacionadas à anestesia, totalmente relacionadas à cirurgia e totalmente relacionadas à doença e/ou condição do paciente. Ocorreram nos pacientes com trauma 58 PCs (6,4 por 10.000 anestesias) e 47 óbitos (5,2 por 10.000 anestesias). O maior risco de PC nos pacientes com trauma ocorreu na faixa etária de 18 a 35 anos (p=0,04), no sexo masculino (p<0,0001), no estado físico ASA III ou pior (p=0,04), nas cirurgias de emergência (p=0,04), nas clínicas cirúrgicas multiclínicas e torácica e nos pacientes gravemente enfermos que receberam cuidados de monitorização e suporte hemodinâmico. O choque hemorrágico e o trauma cranioencefálico foram as causas mais importantes de PC e mortalidade. A maioria das PCs e óbitos no perioperatório... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: No studies of perioperative cardiac arrest and mortality in trauma patients have been published. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in trauma patients in a Brazilian tertiary general teaching hospital between 1996 and 2009. After institutional review board approval (UNESP, School of Medicine, Botucatu, Brazil), the incidence of cardiac arrest during anesthesia in patients with and without trauma was prospectively identified from an anesthesia database. There were 90,909 anesthetics during the study period. The data collected included patient demographics, surgical procedures (elective, urgent or emergency), ASA (American Society of Anesthesiologists) physical status classification, anesthesia provider information, type of surgery, surgical areas, and outcome. All of the cardiac arrests in trauma patients were reviewed and grouped by cause of cardiac arrest into one of four groups: totally anesthesia-related, partially anesthesia-related, totally surgery-related and totally trauma patient condition-related. Fifty-eight cardiac arrests (6.4 per 10,000 anesthetics) and 47 deaths (5.2 per 10,000) had occurred in the trauma patients. The major risk factors for cardiac arrest in the trauma patients were age (18 to 35 yr, p=0.04), male sex (p<0.0001) with ASA physical status III or poorer (p=0.04), emergency surgery (p=0.04) in multiclinical or thoracic surgery and monitored anesthesia care in very injured patients (p=0.04). Uncontrolled hemorrhage and head injury were the most significant causes of cardiac arrest and mortality. The majority of the intraoperative cardiac arrests and deaths in the trauma were patients condition-related. One cardiac arrest was totally anesthesia-related, and one cardiac arrest and death was surgery-related. Motor vehicle... (Complete abstract click electronic access below)
Mestre
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Hutin, Alice. "Etude expérimentale de l’arrêt cardiaque réfractaire chez le porc : nouvelles approches thérapeutiques." Thesis, Paris Est, 2017. http://www.theses.fr/2017PESC0030/document.
Full textAbstract:
L’arrêt cardiaque (AC) extrahospitalier est un problème majeur de santé publique, malgré la mise en place d’une véritable « chaine de survie ». Les durées de réanimation sont souvent prolongées et aboutissent à des séquelles irréversibles avec un assombrissement dramatique du pronostic. Dans de nombreuses situations, l’AC ne parvient pas à être réanimé avec les soins courants, laissant apparaître un AC « réfractaire » qui nécessite une prise en charge thérapeutique avancée. L’objectif général de ce travail de thèse était d’évaluer de nouvelles approches expérimentales pour la prise en charge de l’AC réfractaire. Nous avons étudié deux stratégies expérimentales chez le porc, consistant à induire une hypothermie ultra-rapide par ventilation liquide ou à mettre en place une assistance circulatoire au cours d’un AC d’origine ischémique.Dans un premier travail, nous avons ainsi évalué la faisabilité d’une hypothermie thérapeutique ultra-rapide par ventilation liquidienne totale (VLT) chez le porc. Cette approche consiste à instiller des perfluorocarbones dans le poumon de façon à induire un refroidissement ultra-rapide. Le poumon est ainsi utilisé comme bio-échangeur thermique, tout en maintenant des échanges gazeux normaux. Dans des travaux préliminaires, le laboratoire a montré que la VLT permettait de réduire la température sanguine jusqu’à 32°C en moins de 10 minutes chez le lapin. Le but de notre étude était de déterminer si la VLT pouvait aussi permettre un refroidissement ultra-rapide chez le porc. L'effet de la VLT a ainsi été évalué dans un premier temps à cœur battant, puis à cœur arrêté sur un modèle d’arrêt cardiaque réfractaire bénéficiant d’une réanimation cardio-pulmonaire prolongée. Dans les conditions physiologiques « à cœur battant », la température de 34°C était atteinte en moins de 10 minutes dans tout l'organisme. Lors de la réanimation prolongée d’un AC réfractaire, le refroidissement corporel était également obtenu rapidement, en moins de 25 minutes, quel que soit le site de mesure de la température. La VLT n’altérait aucunement la qualité du massage cardiaque externe, suggérant un intérêt pour cette approche dans l’induction d‘une hypothermie intra-AC, dans une perspective d’augmentation de l’efficacité des défibrillations ou de préservation d’organe.Dans un deuxième travail, nous nous sommes intéressés à l’AC réfractaire compliquant un syndrome coronaire aigu, traité par assistance circulatoire extracorporelle. Notre but était d’évaluer l'importance de la revascularisation coronaire précoce dans cette situation chez le porc, c’est-à-dire son impact sur le statut hémodynamique et les chances de réanimation. Après anesthésie et instrumentation, les animaux ont ainsi été soumis à une occlusion coronaire, suivie d’un AC par fibrillation ventriculaire non traitée pendant 5 minutes. Ils ont ensuite bénéficié d’une réanimation cardio-pulmonaire de base puis d’une assistance circulatoire extracorporelle. Nous avons comparé les effets d’une revascularisation précoce à ceux d’une revascularisation tardive, c’est-à-dire d’une reperfusion 20 ou 120 min après le début de l'assistance circulatoire. La revascularisation coronaire précoce augmentait significativement les chances de reprise d’activité cardiaque spontanée, limitait l’état de choc, améliorait la perfusion cérébrale et limitait la taille d’infarctus. Cela montre bien l’importance d’une prise en charge rapide du syndrome coronarien en cas d’AC de cause cardiaque présumée, y compris dans une situation d’assistance circulatoire extracorporelle.En conclusion, nous avons montré que la VLT permettait d’induire un refroidissement ultra-rapide dans l’ensemble de l’organisme, tant à cœur battant que pendant une réanimation prolongée. Par ailleurs, la revascularisation précoce d’un AC réfractaire ischémique traité par assistance circulatoire extracorporelle permettait d’améliorer globalement les chances de réanimation et le statut hémodynamiqueOut of hospital cardiac arrest (CA) is a major public health issue, despite the implementation of a “chain of survival”. Resuscitation durations are often extended with irreversible organ damage and poor outcome. Frequently, conventional care does not allow the return of spontaneous circulation, leading to a refractory CA, with the need for advanced therapeutic care. The general objective of this work was to evaluate new therapeutic strategies in the management of refractory cardiac arrest. We studied two experimental strategies in swine, involving ultrafast cooling with total liquid ventilation or extracorporeal cardiopulmonary resuscitation in a CA of ischemic origin.As a first step, we evaluated the feasibility of ultra-fast therapeutic hypothermia using total liquid ventilation (TLV) in swine. This approach involves perfluorocarbon instillation in the lungs to induce ultra-fast cooling. The lungs are thus used as a heat exchanger, while maintaining normal gas exchanges. In previous studies, the laboratory has shown that TLV could reduce blood temperature to 32°C in less than 10 minutes in rabbits. The objective of this study was to determine if TLV could lead to ultra-fast cooling in swine. We first studied the cooling capacity of hypothermic TLV in beating heart pigs, and then during ventricular fibrillation with prolonged chest compressions. In physiological conditions, in “beating heart” animals, the target temperature of 34°C was obtained in less than 10 min in the whole body. In prolonged resuscitation of refractory CA, whole body cooling was also rapidly obtained, within less than 25 min. TLV did not alter the hemodynamic effect of cardiac compressions, suggesting further use of this “intra-resuscitation” cooling in order to increase chances of defibrillation or for organ preservation for the purpose of organ donation.As a second step, we addressed the subject of ischemic refractory CA treated by extracorporeal cardiopulmonary resuscitation (ECPR). Our objective was to evaluate the importance of early coronary reperfusion in this situation, i.e., it’s impact on hemodynamic status and chances of defibrillation. After anesthesia and surgical preparation, animals were submitted to a coronaryocclusion followed by 5 min of CA by ventricular fibrillation. Conventional cardiopulmonary resuscitation was then initiated and followed by extracorporeal cardiopulmonary resuscitation.We compared the effect of early versus late reperfusion, i.e., reperfusion after 20 or 120 min of ECPR. Early reperfusion significantly increased chances of return to spontaneous circulation with limited shock status, increased cerebral perfusion and decreased infarct size. This confirms the need for early treatment of acute coronary syndrome if cardiac cause of CA is suspected, even in the situation of ECPR.In conclusion, we have shown that TLV could provide ultra-fast whole body cooling, both in beating heart swine and during prolonged resuscitation. Secondly, early reperfusion in refractory ischemic CA treated by ECPR globally increases chances of return to spontaneous circulation and improves hemodynamic status
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Thorén, Ann-Britt. "How can we optimize bystander basic life support in cardiac arrest /." Göteborg : Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy at Göteborgs University, Sahlgrenska University Hospital, Göteborg, 2007. http://hdl.handle.net/2077/7566.
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Larsson, Ing-Marie. "Post-Cardiac Arrest Care : Therapeutic Hypothermia, Patient Outcomes and Relatives’ Experiences." Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-229758.
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The overall aim of the thesis was to study post-resuscitation care of cardiac arrest (CA) patients with a focus on therapeutic hypothermia treatment, outcomes up to six months post-CA and relatives’ experiences during the hospital stay. In Paper I, the aim was to asses effectiveness of hypothermia treatment with cold, 4°C, intravenous crystalloid infusion combined with ice packs. In conclusion, the described cooling method was found to be useful for inducing and maintaining hypothermia, allowed good temperature control during rewarming and to be feasible in clinical practice. The aim in Paper II was to investigate biomarkers and the association of serum glial fibrillary acidic protein (GFAP) levels with outcome, and to compare GFAP with neuron-specific enolas (NSE) and S100B. The result showed increased GFAP levels in the poor outcome group, but did not show sufficient sensitivity to predict neurological outcome. Both NSE and S100B were shown to be better predictors. A combination of the investigated biomarkers did not increase the ability to predict neurological outcome. In Paper III, the aim was to investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months post-CA. There was improvement over time in HRQoL, but changes over time in anxiety and depression were not found. Physical problems seemed to affect HRQoL more than psychological problems. The results also indicate that the less anxiety and depression patients perceive, the better their HRQoL. In the fourth paper, the aim was to describe relatives’ experiences during the next of kin’s hospital stay after surviving a CA. The analysis resulted in three themes: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. In conclusion, the results of the thesis have helped to improve knowledge within the areas studied and reveal aspects that should be taken into account in the overall treatment of this group of patients. The thesis have also shown the importance of developing an overall view and establishing a chain of care from an individual’s CA until follow-up for both the patient and his/her relatives.
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Di, Maio Rebecca Concordia. "Investigation of new methodologies to improve survival rates post cardiac arrest." Thesis, University of Ulster, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446461.
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Tully, Jeffrey. "Pediatric Out‐of‐Hospital Cardiac Arrest in the State of Arizona." Thesis, The University of Arizona, 2014. http://hdl.handle.net/10150/315931.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Comprehensive databases which collect data on out of hospital cardiac arrests have been useful in identifying markers of outcome in adults, but this data is limited in children. The Arizona Department of Health Services’ Save Hearts in Arizona Registry and Education (SHARE) database contains data on pediatric cardiac arrests in the field and offers a unique opportunity to examine outcome measures and pre-hospital care. We retrospectively analyzed 312 children (1-215 months) from the SHARE database between 2004-2010. Variables assessed included: bystander cardiopulmonary resuscitation (CPR) administration, transport times and impact of Pediatric Intensive Care Unit (PICU) availability on outcome to hospital discharge. Data were analyzed by t-test and Fisher’s exact test. Of 312 children with out of hospital cardiac arrest, 11 (3.6%) survived to hospital discharge. The low survival rates in this review make statistical comparisons difficult, though potential trends were noted that, with additional numbers to increase power, may provide insight into factors affecting survival from pediatric OHCA that have not been assessed on a wide scale in this vulnerable population.
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Roberts, Brian. "SPONTANEOUS HYPOCAPNIA AFTER CARDIAC ARREST IS ASSOCIATED WITH 60-DAY MORTALITY." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/501825.
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Public HealthM.S.
Background: Hypocapnia exposure after successful resuscitation from cardiac arrest has been previously demonstrated to be associated with poor clinical outcomes. During mechanical ventilation after return of spontaneous circulation (ROSC) it is unclear if spontaneous hyperventilation, as opposed high prescribed minute ventilation, is a common cause of hypocapnia. The objectives of this study were to determine the incidence of hypocapnia induced by spontaneous hyperventilation (spontaneous hypocapnia) among patients successfully resuscitated from cardiac arrest and to test if spontaneous hypocapnia is independently associated with 60-day mortality. Methods: Pre-planned analysis of a prospective multi-center cohort. We included adult, cardiac arrest patients who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation (ROSC). We excluded patients with cardiac arrest due to trauma or sepsis. Per protocol, partial pressure of arterial carbon dioxide (PaCO2) was measured at one and six hours after ROSC. Hypocapnia was defined as a PaCO2 < 35 mmHg. We defined spontaneous hypocapnia as hypocapnia plus a measured actual respiratory rate greater than the prescribed respiratory rate and induced hypocapnia as hypocapnia plus an actual respiratory rate not higher than the prescribed respiratory rate during the initial six hours after ROSC. The primary outcome was 60-day mortality. A multivariable Cox proportional hazards model was used to test the associations between spontaneous hypocapnia and 60-day mortality compared to induced hypocapnia and no hypocapnia exposure. Results: Of the 280 patients included, 112 (40%) had exposure to hypocapnia; 89 vs. 23 spontaneous and induced hypocapnia, respectively. Sixty-day mortality occurred among 55% of patients in the entire cohort, and 47%, 57%, and 70% among patients with no, induced, and spontaneous hypocapnia respectively. Spontaneous hypocapnia was independently associated with 60-day mortality, hazards ratios 1.64 (95% CI 1.43-1.87) compared to no hypocapnia exposure and 1.44 (95% CI 1.10-1.88) compared to induced hypocapnia. Conclusion: Spontaneous hypocapnia is common during the initial six hours after return of spontaneous circulation and is independently associated with 60-day mortality.
Temple University--Theses
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Dumas, Florence. "Analyse de l’influence des interventions thérapeutiques précoces au sein d’une cohorte de patients survivants d’arrêt cardio-respiratoire." Thesis, Paris 5, 2012. http://www.theses.fr/2012PA05S006/document.
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Position du problème. L’arrêt cardiaque extra-hospitalier (ACEH), dont la forme clinique la plus caricaturale correspond à la « mort subite », représenterait la première cause de mortalité à travers le monde. Malgré les améliorations apportées à leur prise en charge, le pronostic de ces patients demeure très péjoratif, y compris chez ceux qui ont bénéficié d’une réanimation initiale avec succès. En effet, la longue période d’ischémie suivie du phénomène de reperfusion secondaire au retour d’une activité circulatoire (RACS) est à l’origine d’une cascade de phénomènes physiopathologiques qui caractérisent le syndrome post-arrêt cardiaque. Plusieurs éléments thérapeutiques, telles que la reperfusion coronaire précoce et l’hypothermie thérapeutique, se sont développés ces dernières années afin de diminuer la morbi-mortalité importante observée dans cette situation. L’intérêt de ces interventions précoces sur le pronostic ultérieur demeure cependant débattu, car il a souvent été établi sur des sous-groupes de patients très sélectionnés. Objectif. L’objectif de ce travail était d’évaluer l’influence de ces interventions thérapeutiques précoces sur le devenir des patients victimes d’ACEH et admis vivants en service de réanimation. Méthode. Depuis 2000, une cohorte de patients survivants d’ACR et admis vivants en réanimation a été constituée dans un centre spécialisé. L’ensemble des caractéristiques démographiques, pré-hospitalières et hospitalières ont été analysées. L’analyse multivariée des facteurs pronostiques dans cette cohorte a utilisé principalement les méthodes de régression logistique. Résultats principaux. Entre 2003 et 2008, 435 patients ont été admis, ne présentaient pas d’étiologie extra-cardiaque évidente et ont bénéficié d’une coronarographie immédiate et systématique. Une lésion coronaire récente a été observée chez près de la moitié d’entre eux. Les moyens de détection d’une étiologie cardiaque sont extrêmement limités que ce soit par des modèles prédictifs simples utilisant des paramètres démographiques ou circonstancielles ou par des paramètres para-cliniques tels que l’électrocardiogramme ou les enzymes cardiaques. En effet, ces derniers possèdent des valeurs prédictives médiocres et ne peuvent être considérés comme outil de triage de ces patients. En revanche, la coronarographie immédiate et systématique (suivie d’une reperfusion coronaire si nécessaire) était associée de manière significative et indépendante à la survie hospitalière (OR ajusté= 2.06 (1.16-3.66)) et ceci quelque soit l’aspect électrocardiographique. Entre 2000 et 2009, 1145 patients ont été admis et 2/3 d’entre eux ont été traités par hypothermie thérapeutique. Parmi eux, 708/1145 (62%) avait initialement un rythme cardiaque choquable et 437/1145 (38%) présentait un rythme non choquable. Après ajustement sur les autres facteurs pronostiques, l’hypothermie thérapeutique avait un rôle protecteur sur le pronostic neurologique des patients à la sortie de réanimation dans le groupe présentant initialement un rythme choquable (OR ajusté= 1.90 (1.18-3.06)). En revanche, l’association entre le pronostic et l’intervention dans le groupe « non-choquable » n’était pas significative (OR ajusté=0.71 (0.37-1.36)). Parmi les facteurs susceptibles d’altérer le bénéfice lié à ce traitement, les complications infectieuses chez les patients traités par hypothermie thérapeutique s’avèrent courantes La plus fréquente est la pneumopathie précoce, dont l’apparition est associée de manière significative au traitement par hypothermie (OR ajusté= 1.90 (1.28-2.80)), mais son rôle sur le pronostic n’est pas démontréBackground: Out-of-Hospital Cardiac Arrest (OHCA), usually clinically described as “sudden death”, is the leading worldwide cause of death. Despite recent improvements in management of OHCA, the prognosis of these patients remains very poor, even in those who benefitted from a successful initial resuscitation. During the period of ischemia following the Return of Spontaneous Circulation (ROSC), several pathophysiological phenomenons occur, characterizing the post cardiac arrest syndrome. Furthermore, different treatments, such as immediate coronary reperfusion or therapeutic hypothermia, are now implemented for the management of this syndrome in order to decrease the morbidities and the mortality involved during this period. However, the influence of these hospital interventions on prognosis is still debatable, since they have been assessed in very selected subgroups of patients.Objectives: The aim of our work was to assess the influence of these early interventions on the outcome of OHCA patients admitted alive in intensive care unit (ICU).Method: We set up an investigation cohort (starting in 2000) of OHCA patients, in whom a successful ROSC had been obtained and who were admitted alive in ICU. We gathered all demographic data, cardiac arrest circumstances, pre-hospital and hospital characteristics. We analyzed the different predictive factors of outcome using multivariate analysis, especially logistical regression.Results: Between 2003 and 2008, 435 patients without obvious extra-cardiac cause were included and benefited from an immediate and systematical coronary angiogram. We observed a recent lesion in nearly half of them. Detecting a cardiac etiology is very challenging even using simple predictive models including patient’s baseline characteristics and circumstances of the cardiac arrest. Moreover, other parameters, such as EKG patterns or cardiac biomarkers, did not seem helpful either. Indeed, these parameters had poor predictive values and consequently could not be considered as triage tools for these patients. Nevertheless, the immediate and systematical coronary angiogram, with percutaneous intervention if appropriate, was independently associated with an improvement of hospital survival (adjusted OR= 2.06 (1.16-3.66)), regardless of the EKG pattern.Between 2000 and 2009, 1145 patients were admitted and two third of them were treated with therapeutic hypothermia. Among them, 708/1145 (62%) had an initial shockable rhythm and 437/1145 (38%) presented a non shockable rhythm. On the one hand, after adjustment with other predictive factors, the therapeutic hypothermia significantly improved the good neurological outcome at ICU discharge (adjusted OR= 1.90 (1.18-3.06)). On the other hand, the influence of this intervention was not associated with prognosis on the “non-shockable” sub-group (adjusted OR=0.71 (0.37-1.36)). Among the undercurrent factors, which could minimize the benefit of this intervention, infectious complications in treated patients were common. The most frequent complication was early onset pneumonia, whose occurrence was significantly associated with hypothermia (adjusted OR= 1.90 (1.28-2.80)), even if its role on prognosis was not determined.Conclusions: Our findings support the international guidelines regarding the management of post-cardiac arrest, identifying the subgroups of patients who may benefit the most. These results encourage further prospective studies and randomized trials and bring helpful information in that way. Finally, ancillary analysis on an investigation cohort of hospital survivors suggests that protective
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Alqarawi, Wael Abdulrahman A. "The Role of Mitral Valve Prolapse in Patients with Unexplained Cardiac Arrest." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42491.
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Mitral valve prolapse (MVP) is thought to be one of the causes of unexplained cardiac arrest (UCA). However, previous studies are limited by the lack of a standardized evaluation of UCA and the absence of a control group to identify predictors of cardiac arrest. We performed a systematic review of studies that examined the yield UCA evaluation. We then reported the prevalence and characteristics of MVP patients from a multi-centre registry of patients with UCA. Lastly, we completed a protocol of a matched case-control study aiming at comparing echocardiographic features of MVP patients with and without cardiac arrest. As a result of these studies, we proposed a standardized algorithm for UCA evaluation and a definition for idiopathic ventricular fibrillation. Also, we reported the prevalence of MVP in patients with UCA and described few features that could potentially help distinguish patients with MVP at risk for cardiac arrest.
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Fukushima, Hidetada, Micah Panczyk, Chengcheng Hu, Christian Dameff, Vatsal Chikani, Tyler Vadeboncoeur, Daniel W. Spaite, and Bentley J. Bobrow. "Description of Abnormal Breathing Is Associated With Improved Outcomes and Delayed Telephone Cardiopulmonary Resuscitation Instructions." WILEY, 2017. http://hdl.handle.net/10150/626000.
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Background-Emergency 9-1-1 callers use a wide range of terms to describe abnormal breathing in persons with out-of-hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process. Methods and Results-We conducted an observational study of emergency call audio recordings linked to confirmed OHCAs in a statewide Utstein-style database. Breathing descriptors fell into 1 of 8 groups (eg, gasping, snoring). We divided the study population into groups with and without descriptors for abnormal breathing to investigate the impact of these descriptors on patient outcomes and telephone CPR process. Callers used descriptors in 459 of 2411 cases (19.0%) between October 1, 2010, and December 31, 2014. Survival outcome was better when the caller used a breathing descriptor (19.6% versus 8.8%, P<0.0001), with an odds ratio of 1.63 (95% confidence interval, 1.17-2.25). After exclusions, 379 of 459 cases were eligible for process analysis. When callers described abnormal breathing, the rates of telecommunicator OHCA recognition, CPR instruction, and telephone CPR were lower than when callers did not use a breathing descriptor (79.7% versus 93.0%, P<0.0001; 65.4% versus 72.5%, P=0.0078; and 60.2% versus 66.9%, P=0.0123, respectively). The time interval between call receipt and OHCA recognition was longer when the caller used a breathing descriptor (118.5 versus 73.5 seconds, P<0.0001). Conclusions-Descriptors of abnormal breathing are associated with improved outcomes but also with delays in the identification of OHCA. Familiarizing telecommunicators with these descriptors may improve the telephone CPR process including OHCA recognition for patients with increased probability of survival.
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Street, Jennifer R. "Have National Collegiate Athletic Association institutions increased the number of American Heart Association recommendations for cardiac screening?" Morgantown, W. Va. : [West Virginia University Libraries], 2008. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=5549.
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Wu, Chun Andy, and 胡俊. "The effectiveness of dispatcher-assisted cardio-pulmonary resuscitation on survival of out-of-hospital cardiac arrest: a literature review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48426507.
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Background
According to data from Department of Health, in 2011 heart diseases was the second commonest leading cause of death in Hong Kong [13]. Shortening the time from cardiac arrest to Cardio-pulmonary Resuscitation (CPR) could increase the chance of survival. If the brain of the patient who suffers from cardiac arrest does not receive oxygen within 4 minutes, severe brain damage might occur [14]. In some countries like US and Finland, dispatcher will give CPR instruction to caller when cardiac arrest is recognized. Therefore, the patient could receive early CPR before the arrival of paramedics. If dispatcher-assisted CPR is implemented in Hong Kong, the chance of survival of out-of-hospital cardiac arrest (OHCA) patient could be increased.
Objective
1. To evaluate whether it is evident that dispatcher-assisted CPR and dispatcher instruction [22] would improve survival of OHCA.
2. To evaluate whether these measures could be implemented in Hong Kong.
Data Source
PubMed was searched for articles in English language with no limit set for time of the study. The keywords were dispatcher-assisted CPR and out of hospital. No inclusion criteria were set on the publication type and other details.
Results
Initial PubMed search resulted in 24 articles. After reviewing the abstracts, 10 articles were selected for full-text assessment. Finally, four relevant articles were selected for the literature review. Of the four papers, two were retrospective cohort studies; one was before-after comparison study while the remaining one was randomized control trial.
Three papers (Rea et al, Eisenberg et al, and Kuisma et al.) used the survival to hospital discharge as the effect measure for the primary outcome to evaluate the effectiveness of dispatcher-assisted CPR. The remaining paper (Hallstrom et al.) mainly studied the potential benefit and harm from dispatcher-assisted CPR.
Using no bystander CPR as the reference group, the multivariate adjusted odds ratio of survival was 1.45 (95% CI, 1.21, 1.73) for dispatcher-assisted bystander CPR and 1.69 (95% CI, 1.42, 2.01) for bystander CPR without dispatcher assistance [2]. The percentage of total bystander-initiated CPR increased from 45% to 56% after the programme (difference: 11.1%, 95% CI, ±9.3%). Besides, the percentage discharged for dispatcher-assisted CPR group after the programme was 15% higher than that before the programme [6]. The most important findings are related to the number of cardiac arrest calls in that when the dispatcher handled on less than 4 Ventricular Fibrillation (VF) calls during the study period, the survival to hospital discharge was 22.1% compared to 38.2% and 39.4% when the dispatcher handled 4 to 9 calls or more than 9 calls (p = 0.0227 for the three groups) [8]. With telephone guided CPR, the survival to hospital discharge was 43.1% compared with 31.7% when CPR instructions were not provided (p = 0.0453) [8]. In patients (n = 3,320) receiving advanced cardiac life support (ACLS) a total of 993 (29.9%) was found to be benefited from dispatcher-assisted CPR [7].
Conclusion
Instructions by dispatcher can improve bystander CPR rates, which in turn increases the chance of survival [26]. Dispatcher-assisted CPR is worth considering to be recommended to all callers reporting a patient in cardiac arrest in Hong Kong.published_or_final_version
Public Health
Master
Master of Public Health
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Hassan, Tajek Basheer. "Strategies to improve the outcome of pre-hospital cardiac arrest in Leicestershire." Thesis, University of Leicester, 2000. http://hdl.handle.net/2381/29613.
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Despite the increasing complexity of pre-hospital care systems, the outcome from cardiac arrest (CA) remains extremely poor. The major objective of this thesis was to explore the ways in which outcome could be improved within a defined Emergency Medical Service (EMS) system in the UK. The four studies were designed to investigate certain structures and processes of care involved in achieving a successful outcome. The first study provides a detailed descriptive account of the incidence, processes of care and outcomes for adults suffering a pre-hospital CA in a defined EMS system with a predominant single tiered ALS response. Results are compared with other relevant work. In the second study, I evaluated the resource implications of additional single paramedic units with a priority dispatch system and their impact on the short term outcome of pre-hospital CA. Prioritised response and introduction of single paramedic units had no significant impact on the number of lives saved from pre-hospital CA. Significantly increased NHS costs were incurred per life year gained. The third study was a double blind placebo controlled trial using empirical intravenous magnesium sulphate as a therapeutic intervention. My hypothesis was that given early in the resuscitation phase for patients in refractory or recurring VF, outcome could be significantly improved. However, the results showed no significant improvement in outcome. Finally, I designed and carried out a study to develop consensus opinion on future design characteristics of EMS systems in the UK using senior expert staff from Ambulance Trusts in the UK. Consensus confirmed the need for multi-tiered systems, fully implemented priority dispatch and increasing use of 'first responders'. Opinion was significantly different from the present EMS model recommended by the Department of Health. This work has shown that despite a number of strategies to improve the outcome of pre-hospital CA in the Leicestershire EMS, no significant improvement could be produced. A more radical re-configuration of system design is suggested by experts in the field of EMS which could have a more significant impact on outcome. The thesis has also provided robust data which can be used locally in Leicestershire as well as providing avenues for future research.
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Deye, Nicolas. "Cardiac Arrest-Induced Brain Injury : Diagnostic And Prognostic Values of Circulating Biomarkers." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCC150.
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Le pronostic de l’arrêt cardiaque (AC) reste dramatique. Diagnostiquer sa cause rapidement et prédire précocement son pronostic ("pronostication") de manière fiable permettrait de mieux guider les traitements initiaux, en évitant de traiter futilement les patients avec faible probabilité d’évolution favorable ou à l’inverse de permettre d’intensifier le traitement de patients avec forte probabilité d’évolution favorable. Les biomarqueurs, dont l’utilité diagnostique et pronostique reste débattue, semblent actuellement insuffisamment sensibles et précis, surtout dans les 1ères heures après la reprise de l’activité circulatoire spontanée (RACS). Dans l’algorithme pronostique, seule la Neuron Specific Enolase (NSE) est validée après le 3ème jour post-AC et en 2ème intention. Notre première étude a montré que la valeur diagnostique des biomarqueurs "spécifiques" des lésions cérébrales en post-AC (protéine S100B : S100 et surtout NSE) était insuffisante, à l’admission en réanimation, pour étayer précisément le diagnostic de cause neurologique d’AC. Si la coronarographie précoce est l’outil diagnostique de référence de l’AC de probable cause cardiaque, les biomarqueurs ne peuvent remplacer le scanner cérébral pour diagnostiquer une cause neurologique d’AC. La deuxième étude a évalué, au 1er jour post-AC, S100 et NSE avec 2 témoins d’œdème cérébral proposés comme outils pronostiques : le diamètre de l’enveloppe du nerf optique (DENO) par échographie et le rapport de dédifférenciation substance grise / substance blanche (DSG/B) par scanner cérébral. Même si une relation directe ne peut être affirmée formellement entre ces paramètres, l’élargissement du DENO à J1 post-AC était corrélé aux lésions cérébrales, surtout l’œdème cérébral et les lésions neuronales suspectés sur l’élévation de la NSE (à l’admission et à J1) et la baisse de DSG/B. Si NSE, DSG/B et DENO à J1 étaient liés, S100, plus spécifique de la glie, n’était pas corrélée au DENO ni au DSG/B. NSE et S100 à l’admission, à J1 et J2 post-RACS et DENO à J1 étaient associées à la mortalité hospitalière. La troisième étude évaluait la valeur pronostique des biomarqueurs à la phase précoce de l’AC (NSE et S100 étant prélevées en médiane 220 min après la RASC). S100, réalisée en aveugle des cliniciens, était le biomarqueur le plus précis à l’admission en réanimation pour prédire correctement le pronostic défavorable à la sortie de l’hôpital et à 3 mois après AC, par rapport au lactate, pH et créatininémie, et surtout à la NSE. Les variations de S100 dans le temps permettaient d’affiner cette prédiction. S100 à l’admission était un facteur indépendant du pronostic défavorable à la sortie de l’hôpital, avec la durée sans massage cardiaque, le rythme initial non-choquable, le lactate initial et la présence de convulsion clinique. Selon les recommandations, la pronostication nécessite théoriquement d’être différée et multimodale, les biomarqueurs seuls n’étant pas recommandés, surtout précocement. Les biomarqueurs ne peuvent constituer une alternative, en comparaison à l’imagerie, pour l’aide diagnostique de la cause d’AC. A l’inverse, certains biomarqueurs comme la S100 après admission pourraient facilement et spécifiquement discriminer les AC ayant une certitude de pronostic défavorable. Associée à d’autres outils prédictifs clinico-radiologiques, la S100 pourrait être incorporée dans des algorithmes permettant de guider les thérapeutiques initiales. Une pronostication correcte précoce pourrait éviter des traitements invasifs inutiles, ou au contraire optimiser certaines thérapeutiques agressives. Le choix de méthodes recommandées et automatisées de contrôle ciblé de la température, très efficaces mais invasives et onéreuses, ou l’indication d’utiliser -ou pas- une assistance cardio-circulatoire extra-corporelle pourrait bénéficier d’une telle stratégie précoce de sélection des patientsOutcome of cardiac arrest (CA) remains dramatic. To quickly diagnose the cause of CA and establish a reliable outcome prediction (prognostication) as early as possible could help to guide initial treatments. It could avoid futile treatments in patients with low chance of survival or of good neurological recovery, or conversely allow treatment optimization in patients expected to have a high likelihood of good neurological outcome. Usefulness of biomarkers to guide clinicians in finding the CA diagnosis and helping prognostication is debated. Biomarkers are considered as not sensitive and accurate enough, especially within the first hours after return of spontaneous circulation (ROSC). Their use is only recommended in prognostication for Neuron Specific Enolase (NSE) as a second line tool and after the third day from CA. Our first study confirmed that biomarkers “specific” of brain injury (S100B protein: S100 and moreover NSE) cannot sufficiently discriminate the neurological cause of CA on ICU admission. If early coronary angiogram is the standard for diagnosing a probable cardiac cause of CA, biomarkers cannot replace brain computed-tomography (CT) in CA from a neurological cause. The second study evaluated, during the 1st day after ROSC, the link between biomarkers (S100 and NSE) and 2 surrogates of brain oedema recently proposed as outcome predictors: echography of the optic nerve sheath diameter (ONSD), and grey to white matter attenuation ratio (GWR) on brain CT-scan. Even though we cannot conclude on a definitive relationship between these parameters, ONSD enlargement at day 1 was associated with specific brain damage after CA, such as brain oedema and mostly axonal injuries, as reflected by increases in NSE (on admission and at day 1) and low GWR measurements. Whereas NSE, GWR and ONSD at day 1 were correlated, S100, which is more specific of glial injuries, did not reach significance. NSE and S100 on admission, at days 1 and 2 after ROSC, as well as ONSD at day 1, were associated with survival at hospital discharge. The third study evaluated the prognostic value of several biomarkers in the early phase after CA (NSE and S100 being sampled at median 220 min after ROSC). S100, blinded to physicians, was the biomarker with the best accuracy after ICU admission to correctly predict unfavourable outcome at hospital discharge and at 3 months after CA, compared with all other biomarkers such as lactate, pH, creatinine, and especially NSE. S100 variations during the first day after admission refined prognostication. Initial S100 was an early independent predictive factor associated with unfavourable outcome at hospital discharge, with the no-flow duration, initial lactate value, initial non-shockable rhythm, and the presence of clinical seizure. According to guidelines, prognostication theoretically needs to be delayed and multimodal, biomarkers alone not being recommended especially in the early phase after CA. Biomarkers cannot seem to be an alternative option compared to imaging to precisely diagnose the CA cause. By contrast, some biomarkers, such as S100 after admission, could easily and specifically discriminate CA patients with certainty of unfavourable outcome. Associated with other predictive tools (clinical or using imaging), biomarkers could interestingly be incorporated in early decisional algorithms to optimally guide initial therapies. This correct patient classification could help to avoid unuseful treatments versus to maximize aggressive therapies. The choice of recommended servo-controlled targeted temperature management devices, very efficient but invasive and expensive, or the indication -or not- of a cardio-circulatory assist device implementation should be guided in the early stage after ROSC using this simple strategy of patient selection
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Bellan, Margarete Consorti 1967. "Capacitação do enfermeiro para o atendimento da parada cardiorrespiratoria." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309773.
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Orientador: Izilda Esmenia Muglia AraujoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A equipe de enfermagem freqüentemente é quem testemunha a parada cardiorrespiratória (PCR). Portanto, deve possuir conhecimentos suficientes para realizar os primeiros atendimentos. O sucesso da reanimação cardiorrespiratória (RCR) depende do tempo entre a ocorrência e o início do tratamento, da harmonia e sincronismo da equipe e da capacitação dos profissionais. Foram objetivos do estudo: elaborar um programa de capacitação para enfermeiros na RCR, capacitar o enfermeiro para o atendimento da PCR, avaliar o conhecimento dos enfermeiros antes e após sua participação no programa e comparar a atuação dos enfermeiros submetidos ao programa com os do grupo controle. O estudo foi desenvolvido em um hospital universitário e contemplou três etapas: etapa-I, capacitação teóricoprática; etapa-II, avaliação recente do conhecimento teórico-prático; e etapa-III, avaliação tardia. A amostra foi composta por 21 enfermeiros no grupo-A (controle ¿ não participou do programa de capacitação) e 38 no grupo-B (experimental ¿ participou do programa). Os instrumentos teórico e prático foram submetidos à validação de conteúdo e pré-teste. Na avaliação dos juízes não houve discordância significativa quanto à organização (p=0,368), objetividade (p=1,000), exceto quanto à clareza (p=0,042) para o instrumento-I (teórico). Em relação ao instrumento-II (prático), não houve discordância em nenhum dos itens (p=0,05). Na análise de desempenho dos enfermeiros verificou-se que a média das notas da avaliação teórica no grupo-A variou de forma progressiva nas três etapas: 6,45, 6,66 e 7,10; e no grupo-B de forma oscilante: 6,48, 8,36 e 8,0, respectivamente, com diferença estatisticamente significativa entre os grupos nas etapas II e III (p<0,001). Em relação às atividades práticas do suporte básico de vida (SBV) e suporte avançado (SAV), no grupo-A as médias de notas foram 3,90 e 3,49 na etapa-II e 4,32 e 3,72 na etapa-III, respectivamente, enquanto no grupo-B obtiveram as médias de notas 6,92 e 5,66 na etapa-II e 7,08 e 4,99 na etapa-III, espectivamente. As diferenças entre os grupos nas duas etapas das duas atividades foram significativas (p<0,001). Conclui-se que os conteúdos abordados e os instrumentos utilizados subsidiaram de forma favorável a execução e avaliação do programa de capacitação elaborado e implementado para os enfermeiros no atendimento da PCR. Observou-se melhora no desempenho tanto nas atividades teóricas quanto nas práticas. O grupo-B foi superior em ambos os desempenhos em relação ao grupo-A. No entanto, o desempenho na atividade teórica do grupo-B após uma semana foi superior ao de três meses; já na atividade prática do SBV, o desempenho na etapa-III foi superior à etapa-II, enquanto no SAV o desempenho da etapa-III foi inferior ao da etapa-II. O comportamento do desempenho dos sujeitos do grupo-A diferiu tanto nas atividades teórica como na prática em relação ao grupo-B. Na avaliação teórica observou-se uma melhora progressiva nas três etapas, assim como nas duas etapas das atividades práticas de SBV e SAV. Diante destes resultados, acreditase que o programa de capacitação elaborado poderá ser amplamente utilizado na instituição estudada e também adaptado para utilização em outras
Abstract: Nursing team members are frequently cardiac arrest witness, and therefore must acquire knowledge to perform basic (BLS) and advanced cardiac life support (ACLS). Successful cardiopulmonary resuscitation (CPR) depends on the treatment starting time, team¿s harmony/synchrony and involved professionals¿ capability. The study¿s main objectives were: to elaborate a nursing capacitation program in CPR; to train nurses in performing CPR; to evaluate nurses¿ CPR-knowledge before and after their participation in the program; and to analyse, comparatively, the CPR-performance of nurses that took part or not in the program. The study was developed in an university-hospital and faced three stages: stage-I, theorical-practical capacitation; stage-II, recent evaluation of theorical-practical knowledge; and stage-III, delayed evaluation of theorical-practical knowledge. The time interval between stages I and II was one week and between II and III, three months. Nurses were divided into two groups [A ¿ control (n=21), did not participate; and B ¿ experimental (n=38), did participate on the capacitation program]. Theorical and practical instruments were submitted to content validation and to a pre-test. There were no disagreements amongst judges concerning organization (p=0,368) and objectivity (p=1,000), except for clearness (p=0,042) of the instrument-I (theorical). In relation to instrument-II (practical), there were no disagreement in any items (p=0,05). On the analysis of nurses¿ performance, it was verified that group-A average punctuation in theorical evaluation varied in a progressive way on the three stages (6.45, 6.66 and 7.10, respectively), and in group-B in a non-steady way (6.48, 8.36 and 8.0, respectively) [group-B better than group-A on stages II and III (p<0,001; Tukey-test)]. In relation to practical activities on BLS and ACLS in group-A, the average punctuations were 3.90 and 3.49 on stage-II, and 4.32 and 3.72 on stage-III, respectively, while group-B has got average punctuations of 6.92 and 5.66 on stage-II, and 7.08 and 4.99 on stage-III, respectively [group-B better than group-A on the two stages of two activities (p<0,001; Tukey-test)]. Based on these results, it can be concluded that the approached contents and the used instruments helped in a most favorable way the execution and evaluation of the capacitation program elaborated and implemented to improve nurses¿ CPR-performance. It was observed an improvement not only on theorical activities but also in practical ones. Group-B has shown superior performances than group-A. However, it could be verified that theorical activity performance of group-B, within a week (stage-II), was superior in relation to stage-III (after three months); on the BLS practical activity, subjects¿ performance on stage-III was superior to stage-II, while on the SAV, performance of stage-III was inferior to stage-II. Group-A performance behavior differed not only on theorical activity but also on practical one in relation to group-B. On the theorical evaluation, it was observed a progressive improvement in all three stages, and also on both stages of BLS and ACLS practical activities. Facing these results, it is believed that this elaborated capacitation program can be largely utilized in our own institution and possibly could be adapted and extended to other ones
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem
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Mundin, Tainy Benassi. "Ressuscitação cardiopulmonar: análise do atendimento pré-hospitalar na cidade de Ribeirão Preto de 2011 a 2013." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-07032016-213114/.
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A parada cardiorrespiratória (PCR) no pré-hospitalar é tida como a terceira causa de morte nos Estados Unidos da América (EUA) e as doenças isquêmicas cardíacas são consideradas as principais causas de morte súbita na Europa. No mundo ocidental, inclusive no Brasil, o infarto agudo do miocárdio é responsável por grande número desses óbitos. Avaliar a qualidade da assistência prestada as pessoas que sofreram PCR em ambiente pré-hospitalar, podem influenciar nas sobrevivências destes pacientes. O objetivo deste estudo foi analisar os registros das Fichas de Sistematização da Assistência de Enfermagem (FSAE) do Serviço de Atendimento Móvel de Urgência (SAMU) Regional Ribeirão Preto das pessoas que sofreram PCR em ambiente pré-hospitalar. Trata-se de um estudo analítico retrospectivo de análise documental das FSAE no período de a janeiro de 2011 à dezembro de 2013. Foram incluídos, atendimentos as pessoas maiores de 18 anos e PCR de origem cardíaca. Foi realizado analise estatística no Programa SPSS versão 17.0 e aplicaram-se os testes Qui-Quadrado ou exato de Fisher. Valores com p<0,005 foram considerados significantes. Foram analisados 439 (100%) registros de pessoas que sofreram PCR. O sexo masculino representou 54,2%, a mediana de idade foi de 64 anos. Pessoas sofreram mais PCR com idade acima de 61 anos 54,9%. As cardiopatias foram as comorbidades mais prevalentes. O ritmo inicial foi a assistolia em 28% dos casos e a adrenalina 31% foi o medicamento mais administrado. Os atendimentos realizados pelo SAMU foram categorizados em: local de maior ocorrência foi nas residências 47,8% seguido das unidades de saúde 43,5%; o período matutino 33,5% foi maior empenho da ambulância; as pessoas sofreram mais PCR as segundas, quartas e sextas feiras igualmente, sendo que, o sexo feminino teve maior frequência de PCR aos domingos e o sexo masculino, as sextas-feiras; o inverno 26%,foi a estação do ano que mais ocorreu o evento. Para verificar a associação entre as variáveis categóricas, sexo, faixa etária, empenho da ambulância, dias da semana, com o local de ocorrência da PCR aplicou-se os testes Qui-Quadrado ou exato de Fisher, na qual não houve diferença estatisticamente significante (p>0.005). Independente do sexo, ter idade acima de 61 anos teve associação com o evento de PCR, (p = 0,002) em comparação com as outras faixas etárias. Entre as variáveis categóricas sexo, faixa etária, empenho da ambulância, dias da semana, final de semana e semana associado com desfecho (óbito e sobrevivência) do evento da PCR não apresentou diferença estatisticamente significante(p>0,005). Local de ocorrência comparado ao desfecho teve diferença estatisticamente significante (p=0,001) as pessoas que sofreram PCR nas unidades de saúde, 160(76,9%) sobreviveram, comparado a sobrevivência nas residências 34(16,3%). Recomenda um investimento nos sistemas educacionais, colocando em execução a ciência da ressuscitação, por meio de treinamentos práticos de habilidades em RCP à prestadores de saúde e leigosA cardiorespiratory arrest (CRA) in pre-hospital care is the third cause of death in the United States of America (USA) and the ischemic cardiac diseases are considered the main sudden death causes in Europe. In the western world, including Brazil, the acute myocardial infarction is responsible for a big part of these deaths. Evaluating the quality of the assistance provided to people who suffered CRA in pre-hospital care, can have an influence in these patients\' survivals. The purpose of this study was to analyze the data in the nursing assistance systematization records (NASR) of the emergency medical services (SAMU) in Ribeirão Preto regarding those people who suffered CRA in pre-hospital care. This is a retrospective analytical study of documentary analysis of the NASR from January 2011 to December 2013 in which caring for people over 18 years old and CRA of clinical origin were included. A statistical analysis was performed on the SPSS 17.0 summer version show where the chi-square and Fisher\'s exact test were applied. Values with p<0,005 were considered significant. Among the records of people who suffered CRA, 439 (100%) were analyzed, being 54,2% males with an average of 64 years old. Most people who suffered CRA were over 61 years old. Heart diseases were the most prevalent comorbidities. The initial rhythm was the asystole in 28% of the cases and the adrenalin in 31% being the most administered medicine. The medical cares performed by SAMU were categorized in: residence 47,8%, health units 43,5% being 33,5% morning period, the greater commitment of ambulances. People suffered more CRA on Mondays, Wednesdays and Fridays whereas females suffered most CRA on Sundays and males on Fridays and winter 26%, was the season of the year that most of those cases happened. To check the variation between the categorical variables such as gender, age range, commitment of ambulance, days of the week with the place where the CRA happened the chi-square and Fisher\'s exact test were applied in which there was not a significant statistic difference (p>0.005). Regardless the gender, being over 61 years old was related to the CRA event, (p = 0,002) comparing to other age ranges. Among categorical variables gender, age range, commitment of ambulance, days of the week, weekends and week related to denouement (death and survival) of the CRA event, there was not a significant statistic difference (p>0,005). Place where it happened comparing to the denouement there was a statistic difference (p=0,001) people who suffered CRA in the health units, 160(76,9%) survived comparing to residences\' survivals 34(16,3%). In conclusion, an investment in the education system by putting into execution resuscitation science and practical abilities trainings regarding CRA -not only to health professionals but also to people who are untrained - is recommended
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Sivaswamy, Senthil Roppel Thaddeus A. "Microfabricated electrode arrays suitable for stimulation and recording in cardiac electrophysiological studies." Auburn, Ala, 2008. http://repo.lib.auburn.edu/EtdRoot/2008/SPRING/Electrical_and_Computer_Engineering/Thesis/Sivaswamy_Senthil_58.pdf.
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Södersved, Källestedt Marie-Louise. "In-Hospital Cardiac Arrest : A Study of Education in Cardiopulmonary Resuscitation and its Effects on Knowledge, Skills and Attitudes among Healthcare Professionals and Survival of In-Hospital Cardiac Arrest Patients." Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-150386.
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This thesis investigated whether outcome after in-hospital cardiac arrest patients could be improved by a cardiopulmonary resuscitation (CPR) educational intervention focusing on all hospital healthcare professionals. Annually in Sweden, approximately 3000 in-hospital patients suffer a cardiac arrest in which CPR is attempted, and which 900 will survive. The thesis is based on five papers: Paper I was a methodological study concluding in a reliable multiple choice questionnaire (MCQ) aimed at measuring CPR knowledge. Paper II was an intervention study. The intervention consisted of educating 3144 healthcare professionals in CPR. The MCQ from Paper I was answered by the healthcare professionals both before (82% response rate) and after (98% response rate) education. Theoretical knowledge improved in all the different groups of healthcare professionals after the intervention. Paper III was an observational laboratory study investigating the practical CPR skills of 74 healthcare professionals’. Willingness to use an automated external defibrillator (AED) improved generally after education, and there were no major differences in CPR skills between the different healthcare professions. Paper IV investigated, by use of a questionnaire, the attitudes to CPR of 2152 healthcare professionals (82% response rate). A majority of healthcare professionals reported a positive attitude to resuscitation. Paper V was a register study of patients suffering from cardiac arrest. The intervention tended not to reduce the delay to start of treatment or to increase overall survival. However, our results suggested indirect signs of an improved cerebral function among survivors. In conclusion, CPR education and the introduction of AEDs in-hospital – improved healthcare professionals knowledge, skills, and attitudes – did not improve patients’ survival to hospital discharge, but the functional status among survivors improved.