Bakgrund: Antalet patienter som drabbas av ett hjärtstopp och överlever ökar varje år. I och med detta är även närstående en ökande grupp. Det finns ett behov av att undersöka hur patienter och deras närstående upplever ett hjärtstopp. Syfte: Syftet var att undersöka hur patient och närstående upplever ett hjärtstopp samt om det fanns något i eftervården som patienterna saknade. Metod: En litteraturstudie har gjorts med 12 kvalitativa originalartiklar varav sju var från patientperspektiv, fyra från ett närståendeperspektiv och en från bådas perspektiv. De kvalitetsgranskades och en resultatanalys gjordes med en kvalitativ metod. Resultat: Resultatet presenterades utifrån fyra kategorier och åtta subkategorier. Resultatet visade att patienter och närstående upplevde ångest och oro, men även tacksamhet och glädje efter hjärtstoppet. Vikten av information och stöd från sjukvård samt att få stöd och samtal av närstående och vänner var viktigt för både patienter och närstående. Patienter och närstående upplevde båda att livet förändrats men att de hade en längtan att återgå till livet innan hjärtstoppet. Patienterna upplevde skuld över vad de utsatt sina närstående för och närstående kände att de åsidosatte sig själva. Patienterna upplevde kroppsliga förändringar, fysiska såväl som psykiska. Slutsats: Patient och närstående upplevde oro och ångest samt glädje och hopp efter hjärtstoppet. Både patient och närstående upplevde liknande känslor, därav är det viktigt att följa upp båda parter i eftervården. Det behövs mer forskning inom området hur patient och närstående upplever ett hjärtstopp. / Background: The number of patients suffering from a cardiac arrest and survives increases every year. With this, relatives are also an increasing group. There is a need to investigate how patients and their relatives experience a cardiac arrest. Aim: The purpose was to investigate how patients and relatives experienced a cardiac arrest and whether there was something in the aftercare that the patients lacked. Method: A literature study has been made with 12 qualitative original articles, seven of which were from a patient perspective, four from a relative’s perspective and one from a perspective of both. Quality assurance and a performance analysis were made using a qualitative method. Result: The result was presented in four categories and eight subcategories. The results showed that patients and relatives experienced worry and anxiety, but also gratefulness and joy after the cardiac arrest. Patients and relatives experienced the importance of information and support from healthcare as well as receiving support from relatives and friends. Both experienced that life changed but that they had a desire to return to the life before the cardiac arrest. Patients felt guilty of what they put their relatives through and relatives felt they set aside themselves. The patients experienced bodily changes, both physical and mental. Conclusion: Patients and close relatives experienced worry and anxiety as well as joy and hope after the cardiac arrest. Both patient and related experienced similar emotions, so it is important to follow up on both parties in aftercare. More research in the area of ​​how patients and relatives are experiencing a cardiac arrest is needed.

Objective: The survival rates for cardiac arrest patients to hospital discharge are very low. Post-arrest patients have an immune response and usually a period of immunosuppression. When CD3+ T cells activate, they switch from primarily relying on aerobic metabolism to primarily relying on anaerobic metabolism. The goal of this study is to characterize the immune system of post-cardiac arrest patients. The specific objectives are (1) to determine the time period after the occurrence of a cardiac arrest that a patient acquires an infection, (2) to identify the most common types of infections in post-arrest patients, (3) to compare in vitro the cellular oxygen consumption of immune cells post-cardiac arrest with healthy controls, and (4) to compare cell proliferation and ATP production of immune cells post-cardiac arrest with healthy controls. Methods: We conducted a retrospective chart review of 170 cardiac arrest patients (Beth Israel Deaconess Medical Center) who had return of spontaneous circulation. We measured oxygen consumption rates of peripheral blood mononuclear cells (PBMCs) in cardiac arrest patients and healthy controls. We also measured cell proliferation and ATP production of CD3+ T cells in cardiac arrest patients and healthy controls. Results: Of the 170 cardiac arrest patients we reviewed, 42% had at least one incidence of infection. The length of time from cardiac arrest to first positive culture was 4 days, with pneumonia and urinary tract infections the most common diagnoses. The PBMCs of cardiac arrest patients showed a significant decrease in oxygen consumption post arrest compared with healthy controls. When thiamine was added to the PBMC samples of cardiac arrest patients, there was a significant increase in oxygen consumption from baseline. There was no significant difference in cell proliferation or ATP production of CD3+ T cells between the two groups of post-cardiac arrest patients and healthy controls. Conclusion: Many patients suffer from infections post-cardiac arrest, and future research is needed on this subject. Our data support the hypothesis that post-arrest patients have a period of hyperimmune response followed by a period of immunosuppression.

Introduction: This dissertation thesis aims to describe microcirculatory changes in cardiac arrest setting and to assess the impact of circulatory supports (i.e. mechanical chest compressions and extracorporeal membrane oxygenation (ECMO)) on tissue microcirculation. Methods and results: Two separate studies were designed. Microcirculation was monitored sublingually by a recent Sidestream Dark Field (SDF) technique and its parameters were evaluated offline, separately for small (of diameter ≤ 20µm) and other vessels. In order to monitor microcirculation during cardiac arrest (CA) and resuscitation (CPR) an experimental pig model was used; eighteen pigs were commenced to 3 minutes of untreated CA and subsequent 5 minutes of mechanical CPR. During CA the microcirculatory parameters deteriorated, in CPR they improved and reached 59 - 85 % of the prearrest values. The microcirculatory variables correlated neither to parameters of systemic circulation (mean arterial blood pressure and carotid blood flow) nor to lactate. In the second, clinical, study the sublingual microcirculation was monitored 29 (± 17) hours after the CA onset in 15 patients, who were after unsuccessful conventional CPR rescued by ECMO. In comparison to healthy (sex and age matched) volunteers, the patients showed mild but...

Background: Through medical research and practice it's possible to save many of the lives of those who suffered from a cardiac arrest. After this trauma the work begin to regain the person’s quality of life, a complex and central process for nurses and other healthcare professionals as well as for the person affected. Aim: To describe factors that's important for how people experience their quality of life after surviving a cardiac arrest, also to investigating selected data collection methods in included articles. Method: A descriptive literature study. The searches resulted in 12 articles that underlie the results. Main Results: The quality of life is strongly threatened in this patient group. Factors that have been shown to be important for the quality of life is cognitive recovering, mental, emotional and spiritual well-being and independence in ADL/IADL. Also minor factors that were not as frequent recurring were described. The person's previous life quality and history of illness/health, ability to return to work, autonomy, partnership, initial heart rhythm and the treatment of hypothermia. The data collection methods was interviews, surveys, journal data and other data. Conclusion: It reveals that a cardiac arrest often affect the person’s quality of life negative. The literature presents a variety of factors that are described as important for the quality of life, how they are interrelated to each other and how the factors together create new experiences of quality of life. It’s clear that nurses has good potential for influence. / Bakgrund: Genom medicinsk forskning och praktik är det idag möjligt att rädda livet på många av de som drabbas av ett plötsligt hjärtstopp. Mot bakgrund av den traumatiska upplevelse ett hjärtstopp visat sig vara påbörjas därefter arbetet med den drabbades livskvalité, ett både komplext och viktigt arbete för såväl sjuksköterska och annan vårdpersonal som för patienten själv. Syfte: Att beskriva vilka faktorer som har betydelse för hur personer upplever sin livskvalitet efter att ha överlevt ett plötsligt hjärtstopp, samt kartlägga valda datainsamlingsmetoder i inkluderade artiklar. Metod: En deskriptiv litteraturstudie. Sökningarna resulterade i 12 vetenskapliga artiklar vilka ligger till grund för resultatet. Huvudresultat: Enligt litteraturen är livskvalitén kraftigt hotad hos denna grupp. Faktorer som visat sig vara av betydelse för hur livskvalitén ska upplevas är om personen återhämtar sig kognitivt, personens psykiska, emotionella och spirituella välbefinnande och självständighet i ADL/IADL. Även mindre, om än betydelsefulla, faktorer som inte var lika frekvent återkommande beskrevs i litteraturen: Personens tidigare livskvalité och sjukdoms-/hälsohistoria, möjlighet att kunna återvända till sitt arbete, personens autonomi, partnerskap, initial hjärtrytm samt behandlingsformen hypotermi. Förekommande datainsamlingsmetoder var intervjuer, enkäter, journaldata och annan data. Slutsats: I föreliggande studier synliggörs det att ett hjärtstopp ofta påverkar personens livskvalité negativt. Litteraturen presenterar en rad olika faktorer som beskrivs som betydelsefulla för hur livskvalitén ska upplevas, slutligen hur dessa är interrelaterade till varandra och tillsammans skapar nya upplevelser av livskvalité. I litteraturen framgår det också att sjuksköterskan har goda möjligheter till påverkan.

Bakgrund: Hjärtstopp är ett livshotande tillstånd och chansen för överlevnad ökar om hjärtrytmen återställs inom några minuter. Tidigt larm, hjärt- och lungräddning samt defibrillering är kedjan som räddar liv. Uppföljning och eftervård efter hjärtstopp ser olika ut beroende på var i världen patienten befinner sig och skiljer sig även mellan sjukhus i Sverige. Sjuksköterskor behöver känna till patienters erfarenheter av hjärtstopp för att kunna individanpassa bemötande och omvårdnad. Syfte: Syftet var att beskriva patienters erfarenheter av att överleva hjärtstopp. Metod: En litteraturöversikt genomfördes och baserades på 16 vetenskapliga artiklar, varav sju stycken var kvalitativa åtta kvantitativa och en mixed method. Sökningarna gjordes i databaserna CINAHL Complete och Pubmed och analys utfördes enligt Friberg (2017). Resultat: I resultatet formades fyra teman: fysiska och psykiska förändringar, erfarenheter av vården, ett nytt sätt att leva och mening och gemenskap. Hjärtstopp medför både fysiska och psykiska förändringar som erfars både positivt och negativt av patienterna. Erfarenhet av sjukvården, behovet av stöd från familj och närstående, hälsa och livskvalitet är områden som berörts av hjärtstoppet. Diskussion: I metoddiskussionen diskuteras litteraturöversiktens styrkor och svagheter. Resultatdiskussionen har diskuterats utifrån Watsons teori om mänsklig omsorg, vetenskapliga artiklar, litteratur och de centrala delarna av patienters erfarenheter som framkom i resultatet. Författarna diskuterar hur vården kan individanpassas och förbättras utefter litteraturöversiktens resultat. / Background: Cardiac arrest is a life-threatening condition and the chance of survival increases if the heart rate is restored within a few minutes. Early alarm, cardiac and lung rescue and defibrillation is the chain that saves lives. Follow-up and post-treatment after cardiac arrest vary depending on where the patient is and is also different between hospitals in Sweden. Nurses need to know patient´s experiences of cardiac arrest in order to be able to personalize treatment and nursing. Aim: The purpose was to describe patients' experiences of surviving cardiac arrest. Method: A literature review was conducted and based on 16 scientific articles, seven of which were qualitative eight quantitative and one mixed method. The searches were made in the databases CINAHL Complete and Pubmed and analysis was conducted according to Friberg (2017). Results: In the result, four themes were formed: physical and mental changes, experiences of care, a new way of living and meaning and community. Cardiac arrest causes both physical and mental changes that are experienced both positively and negatively by the patients. The experience of healthcare, the need for support from family and close relatives, health and quality of life are areas affected by the cardiac arrest.  Discussion: The method discussion discusses the strengths and weaknesses of the literature review. The outcome discussion has been discussed on the basis of Watson's theory of human concern, scientific articles, literature and the central parts of patients' experiences as expressed in the results. The authors discuss how care can be personalized and improved according to the results of the literature review.

Aims There is a growing body of evidence that some individuals are at risk of developing post-traumatic stress disorder (PTSD) after life-threatening cardiac events, such as myocardial infarction (MI) or cardiac arrest, which can result in distress, dysfunction and increased risk of mortality. In relation to this population, this thesis had two aims: to review the evidence regarding whether pain during MI predicts post-traumatic stress symptoms; and to explore the characteristics and impact of traumatic imagery experienced by individuals who develop symptoms of post-traumatic stress subsequent to MI or cardiac arrest. Methods A review of the evidence relating to pain as a potential risk factor for PTSD subsequent to MI is presented in the systematic review. The findings from a qualitative study investigating the characteristics of traumatic imagery and associated behaviours experienced by individuals who have symptoms of post-traumatic stress subsequent to MI or cardiac arrest, are presented in the journal article. Interpretative Phenomenological Analysis (IPA) was used to identify themes in the data. Results The systematic review indicated that there are mixed findings for pain as a risk factor for PTSD subsequent to MI. The limited number of studies in this area and significant methodological limitations within the existing evidence make it difficult to draw any firm conclusions with regard to the relationship between pain and PTSD post-MI. With regard to the qualitative study, the majority of imagery related to flashbacks of the event and were focused mainly on external experiences. Themes arising from the distressing flashback imagery included: loss of control; realisation of threat; negative impact on others; physical sensations; and actions of others. Imaginary elements and distortions were a feature of some traumatic imagery experienced, and non-flashback imagery connected with mortality was also experienced. Imagery was associated with avoidance behaviour and affected behaviour within relationships. Conclusions Findings from the systematic review indicate that further studies are warranted in this area to establish the link between pain and PTSD post-MI. These studies should seek to address methodological limitations of the current evidence by using a standardised pain measurement tool; adopting a prospective design; using a diagnostic tool to measure PTSD; ensuring PTSD is measured at least one month after the MI; assessing prior PTSD of non-cardiac origin; including a sufficient sample size and using an appropriate method of recruitment to improve generalisability. External experiences during a cardiac event are the main focus of traumatic visual imagery experienced by people with intrusive post-traumatic stress symptoms post cardiac event. Specific aspects of the cardiac event may be particularly distressing and these may be represented in post-traumatic visual imagery. Both gradual exposure and imagery rescripting techniques may be useful for reducing distress associated with the imagery, depending on the type of imagery experienced.

A parada cardiorrespiratória (PCR) é a ocorrência de maior emergência atendida nos serviços pré e intra-hospitalares. Para os profissionais de saúde a PCR e a realização da Ressuscitação Cardiopulmonar (RCP) são eventos de extrema importância dentro da assistência, na qual exigem-se conhecimento, execução de técnicas adequadas e agilidade para prestar um atendimento de qualidade. A única chance de sobrevivência do paciente está vinculada à identificação precoce desse evento e à intervenção rápida e eficaz através das manobras de RCP dentro da sistematização do atendimento à PCR/RCP determinadas pelas Corrente de Sobrevivência do Adulto, seguida do Suporte Básico (SBV) e Suporte Avançado de Vida (SAVC). Trata-se de um estudo exploratório, descritivo, com abordagem quali- quantitativa que visa estabelecer as exigências críticas no atendimento à PCR/RCP em unidade de emergência no Hospital Escola do interior do estado de São Paulo, através da vivência de 27 profissionais da equipe de enfermagem na realização das manobras de RCP, identificando os incidentes críticos positivos e/ou negativos durante esse atendimento, além das facilidades e dificuldades vivenciadas pela equipe de enfermagem na execução dessas manobras através da Técnica do Incidente Crítico (TIC). Os dados coletados foram categorizados segundo as situações críticas semelhantes (situações secundárias), uma vez que a situação principal era a PCR e a situação secundária era a realização da RCP, seguida dos comportamentos e das consequências positivas e negativas decorrentes das diversas situações. Desta análise emergiram cinco categorias de incidentes críticos: Competências do atendimento à PCR/RCP, sentimentos e emoções da equipe frente à PCR/RCP, estrutura e ambiente na RCP, Eventos adversos à PCR/RCP e Capacitação da equipe de enfermagem. Relacionado aos comportamentos positivos, destacou-se três categorias: Aplicando a sistematização no atendimento à PCR/RCP, estabelecendo gestão durante á RCP e utilizando tecnologias na RCP. Dentre os comportamentos negativos, observaram-se seis categorias: convivendo com a falta de habilidades técnicas; vivenciando a falta da sistematização no atendimento à PCR/RCP; convivendo com recursos materiais e humanos insuficientes; o ambiente; percebendo os sentimentos e emoções da equipe frente a RCP e observando a falta de capacitação permanente da equipe na RCP. Uma vez selecionadas as situações críticas, os comportamentos positivos e os comportamentos negativos, pudemos categorizar o óbito como uma conseqüência imediata negativa e o restabelecimento das funções vitais como uma conseqüência imediata positiva ao paciente/cliente. Na avaliação das categorias resultantes, verificou-se como conseqüência negativa, os saber lidar com o sofrimento da perda e como conseqüência positiva, a RCP bem sucedida além dos sentimentos dos profissionais de enfermagem. A partir dos incidentes críticos identificados, foram estabelecidas as exigências críticas no atendimento à RCP no local de estudo e ressaltou-se que para um bom desempenho na realização da RCP é necessário rapidez, eficiência, conhecimento técnico-científico e habilidade técnica por parte de toda a equipe que realiza esse atendimento, seguindo sistematização referida pelos protocolos do AHA. Além disso, identificou-se a necessidade de capacitação continuada dos profissionais de enfermagem e médica, trabalho harmônico e sincronizado multiprofissional e infra-estrutura adequada, visando o restabelecimento da vida, a limitação do sofrimento, a recuperação do paciente/cliente e a ocorrência mínima de sequelas. Portanto, a RCP imediata, sistematizada e de qualidade é requisito básico de segurança para esses pacientes, reduzindo as dificuldades identificadas pela equipe e favorecendo as chances de reanimação destes pacientes / The cardiopulmonary arrest (CPA) is the major emergency occurrence attended pre and intra hospital services. For the health professionals, the CPA and the performance of cardiopulmonary resuscitation (CPR) are events of utmost importance during the care, demanding knowledge, implementation of appropriate techniques and agility to provide a quality service. The unique opportunity of patient\'s survival is linked to the early identification of this event and to the fast and effective intervention through CPR manoeuvres within the treatment systematization CPA/CPR determined by Adult Survival Current followed by Basic Life Support (BLS) and Advanced Life Support (ACLS). It\'s an exploratory and descriptive study with a qualitative-quantitative approach that aims to establish critical requirements in the CPA/CPR treatment within an emergency room at a teaching hospital in São Paulo State, through the experience of twenty seven professionals of nursing staff during manoeuvres of CPR, identifying the positive/negative critical incidents during this treatment as well as facility and difficulties experienced by nursing staff during this procedures though the Critical Incident Technique (CIT). The collected data was categorized accordingly to similar critical situations (secondary situation), since the main situation was CPA and secondary one was CPR realization in addition to behaviors and positive/negative consequences resulting from various situations. From this analysis, it was arisen five categories of critical incidents: treatment competences to CPA/CPR, feelings and emotions of the nursing staff towards CPA/CPR, structure and environment during CPR, adverse events to CPA/CPR and nursing staff training. Related to positive behaviors, it was highlighted three categories: applying systematization in CPA/CPR treatment, establishing conduct during CPR and using technologies in CPR. It was observed six categories among negative behaviors: dealing with no technical skills, living through the lack of systematization to CPA/CPR treatment, cohabiting with insufficient human and material resources, the environment, realizing nursing staff\'s feelings and emotions towards CPR treatment and observing the lack of nursing staff\'s ongoing training. Once selected critical situations, positive and negative behaviors, we can classify Death as an immediate negative consequence and Restoring Vital Functions as a positive consequence to the patient/client. Assessing the emerging categories, it was verified, as a negative consequence, how to deal with the loss suffering and, as a positive consequence, the successful CPR in addition to the nursing professionals\' feelings. From the identified critical incidents, it was established critical requirements to CPR treatment at the study site and it was pointed out that, to a good performance in the CPR, is necessary quickness, efficacy, scientific and technical knowledge and technical ability of the whole staff that perform this treatment, following systematization referred by the AHA protocols. Furthermore it was also identified the necessity for an ongoing training of medical and nursing professionals, harmonious and synchronized multiprofessional work and appropriate infrastructure aiming at life restoring, suffering limitation, the patient and client\'s recovery and the least occurrence of sequelae. Therefore, an immediate systematized and quality CPR is basic requirement for these patients\' safety, reducing the difficulties identified by the staff and providing opportunities for resuscitation of these patients

A parada cardiorrespiratória (PCR) é a principal causa de morte em países desenvolvidos e em desenvolvimentos, ocorrendo principalmente em ambientes extra hospitalares. Frente a esse panorama mundial considerado um problema de saúde pública atual, a capacitação de leigos no Suporte Básico de Vida (SBV) com uso da simulação clínica tem papel relevante para a melhoria das taxas de sobrevivência das vítimas de PCR. Estudo com objetivo de avaliar o conhecimento (teórico) e das habilidades (práticas) de leigos antes e após a sua participação no curso de SBV para leigos submetidos a estratégias de ensino-aprendizagem, aula expositivo-dialogada e atividade prática em laboratório de habilidades ou aula simulada no atendimento a PCR/RCP com SBV para leigos. Estudo com delineamento quase experimental, abordagem quantitativa com delineamento tempo-série. A população consistiu dos estudantes do primeiro ao quarto semestre de graduação da Faculdade de Enfermagem da Universidade Federal do Mato Grosso e a amostra de 104 estudantes que participaram do curso em SBV para leigos em duas etapas. Na etapa I todos os estudantes foram submetidos ao pré teste teórico, à aula expositivo-dialogada seguida de atividade prática em laboratório de habilidades com manequim de média fidelidade e uso do Desfibrilador Externo Automático (DEA), simulação clínica em laboratório utilizando o mesmo manequim e DEA e pós teste teórico imediato. A Etapa II ocorreu de 15 a 20 dias após a primeira e todos os estudantes foram submetidos à simulação clínica em laboratório utilizando o mesmo manequim de média fidelidade e DEA seguido de pós teste teórico mediato. Elaboraram-se os instrumentos de avaliação teórica, cenário de simulação e OSCE - avaliação clínica objetiva e estruturada no cenário de simulação com (checklist), validados em aparência e conteúdo por comitê de juízes. A estratégia de coleta de dados foi o curso de SBV para leigos. Foram avaliados as avaliações teóricas e OSCE (Exame Clínico Objetivo Estruturado) - avaliação clínica estruturada em Laboratório de Simulação, este último empregando como ferramenta o manequim de média-fidelidade e DEA. A atividade foi filmada e analisada por três avaliadores. Analisaram-se os desfechos nas etapas I e II do curso de SBV para leigos: desempenho teórico nos testes teóricos e práticos no OSCE, tempo de execução total e de cada domínio do OSCE e a qualidade das compressões torácicas externas (CTE) quanto a frequencia e profundidade em 120 segundos de reanimação cardiopulmonar (RCP). Resultados: 86 estudantes eram do sexo feminino e 18 do sexo masculino, a idade média 23,32±6,66 anos. No pré-teste a nota média foi de 3,52±2,03, e a mediana 3,0. No pós-teste imediato (pós 1) a nota média foi 8,01±1,19 (mediana 8,0) e no pós teste mediato (pós 2) foi de 7,41±2,68 (mediana 8,5). Comparando-se as médias obtidas no pré-teste, pós 1 e pós 2 há diferença estatisticamente significante (p<0,001) com retenção do conhecimento. Comparando as notas do pós 1 e pós 2 teóricos evidenciou diferença estatisticamente significante (p=0,019) com perda do conhecimento no pós 2. A média no OSCE na etapa I (pós 1) foi 3,63±0,30 e na etapa II (pós 2) de 3,63±0,31; comparou-se tais notas verificando-se que não há diferença estatisticamente significante (p=0,966). O tempo médio de execução do OSCE no pós 1 foi de 156,96±8,16s e no pós 2 foi de 138,68±43,58s, havendo diferença estatisticamente significante (p<0,001). O domínio de intervenção do OSCE \"Chegada em Cena\" apresentou média 20,78±6,20s no pós 1 e 16,46±4,56s no pós 2, o domínio \"Checar a responsividade\" média de 6,38±3,48s no pós 1 e 5,13±2,36s no pós 2, o domínio \"Usar o DEA\" média de 77,30±14,45s no pós 1 e 66,80±11,44s no pós 2, todos com diferença estatisticamente significante (p<0,001). Avaliando a qualidade das CTE a profundidade média atingida em milímetros (mm) apresentou média de 36,26±9,62 (mediana 35,00) no pós 1 e 39,36±10,96 (mediana 40,00) no pós 2. O nº de CTE média por minuto apresentou média de 116,01±21,72 (mediana 116,00) no pós 1 e 98,94±19,52 (mediana 100,00) no pós 2, o nº total de compressões (CTE) em 120 segundos apresentou média de 227,88±41,81 (mediana 226,00) no pós 1 e 197,31±30,42 (mediana 195,50) no pós 2, o nº de CTE muito superficiais média de 132,20±89,94 (mediana 146,50) no pós 1 e 74,96±75,76 (mediana 53,00) no pós 2, todos com diferenças estatisticamente significante (p<0,001). Já o nº de CTE incompletas apresentou média de 25,09±56,95 (mediana 0,00) no pós 1 e 14,51±35,45 (mediana 0,00) no pós 2 com diferença estatisticamente significante (p=0,012). No presente estudo, apesar de diferentes estratégias de ensino abordarem o SBV para leigos, os resultados demonstram que as mesmas foram eficazes e os objetivos de aprendizagem foram alcançados, pois houve incremento nas notas obtidas nos pós-testes e no OSCE tanto na etapa I quanto na etapa II em relação ao conhecimento prévio e habilidades, porém houve perda da retenção de conhecimento e habilidade de 15 a 20 dias após o curso de SBV para leigos o que reforça a necessidade da capacitação permanente / Cardiac arrest is the leading cause of death in developed and developing countries, and mainly occurs in non-hospital environments. With this global scenario, which is considered a present public health problem, training laypeople in Basic Life Support (BLS) with clinical simulation has an important role in improving survival rate of the cardiac arrest victims. This present study aims to evaluate the knowledge (theoretical) and skills (practical) of laypeople before and after the BLS training underwent to teaching and learning strategies, expository and dialogue class and practical activities in skills lab or simulation class in CPR/CPA. This study has an almost experimental, quantitative and time-series approach. The population study is composed of students from the first to fourth semester of Nursing at Federal University of Mato Grosso (UFMT) and the sample of 104 participants in BLS for laypeople in two steps. In Step 1, all the students had to undergo to the theoretical pretest, expository and dialogue class followed by practical activity in the skills lab with a mid-fidelity manikin and using automated external defibrillator (AED), clinical simulation in the lab using the same manikin and AED and immediate theoretical posttest. Step 2 occurred from the 15th to 20th days after the first one and all the students had to undergo to clinical simulation in the lab using the same mid-fidelity manikin and AED followed by immediate theoretical posttest. It was elaborated theoretical evaluation tools, simulation scenario and OSCE - objective structured clinical examination in the clinical scenario with checklist, validated in aspect and content by a judges committee. The data collection strategy was the BLS for laypeople. It was evaluated the theoretical tests and OSCE (objective structured clinical examination) - clinical examination structured in Simulation Lab, using as tool the mid-fidelity manikin and AED. The activity was filmed and analysed by three evaluators. The outcomes of Step 1 and 2 of BLS for laypeople were analysed: theoretical performance on theoretical and practical tests in OSCE, total execution time, each OSCE realm and the quality of external chest compression (ECC) such as frequency and deepness in 120 seconds of cardiopulmonary resuscitation (CPR). Outcomes: 86 female and 18 male students, median age 23.32±6.66. Median score in pretest was 3.52±2.03 and the average 3.0. At immediate posttest (post 1) the median was 8.01±1.19 (average = 8.0) and at immediate posttest (post 2) 7.41±2.68 (average = 8.5). Comparing the pretest averages and posttests 1 and 2, there is a statistically significant difference (p<0.001) of knowledge retention. Comparing theoretical posttests 1 and 2 revealed the statistically significant difference (p=0.019) with knowledge loss at posttest 2. Step 1 OSCE average (posttest 1) was 3.63±0.30 and Step 2 (posttest 2) 3.63±0.31; when compared, these scores demonstrated that there is not a statistically significant difference (p=0.966). The OSCE execution time average at posttest 1 was 156,96±8,16 seconds and at posttest 2 138.68±43.58 seconds, which demonstrated statistically significant difference (p<0.001). OSCE intervention realm \"Arrival on the scene\" showed posttest 1 20,78±6,20s and posttest 2 16,46±4,56s averages, the realm \"Check Responsiveness\" had averages of 6,38±3,48s in posttest 1 and 5,13±2,36s in posttest 2, the realm \"Using DEA\" averages of 77,30±14,45s in posttest 1 and posttest 2 of 66,80±11,44s, all of them with statistically significant difference (p<0,001). Evaluating the quality of ECT the reached deepness average in millimeters (mm) resulted 36.26±9.62 (average 35.00) in posttest 1 and 39.36±10.96 (average 40.00) in posttest 2. The number of ECC per minute showed 116.01±21.72 (average 116.00) in posttest 1 and 98.94±19.52 (average 100.00) in posttest 2, the total of compressions (ECC) in 120 seconds showed 227.88±41.81 (average 226.00) and 197.31±30.42 (average 195,50) in posttest 2, the number of surface ECC 132.20±89.94 (average 146.50) and 74.96±75.76 (average 53,00) in posttest 2, all of them with statistically significant difference (p<0,001). In the incomplete ECC showed 25.09±56.95 (average 0,00) in posttest 1 and 14.51±35.45 (average 0,00) in posttest 2 with statistically significant difference (p=0,012). In this present study, besides the different teaching strategies approaches for laypeople, the outcomes demonstrate that they were effective and the learning goals reached, since the posttests had higher scores in previous knowledge and skills of steps 1 and 2 of OSCE. However it showed a loss of knowledge and skills retention in 15 to 20 days after the BLS training for laypeople, what demonstrates the need of permanent training

A parada cardiorrespiratória (PCR) é uma intercorrência inesperada em diversos momentos, constituindo grave ameaça à vida das pessoas, principalmente das que sofrem um colapso não-presenciado e dos pacientes/clientes hospitalizados em estado crítico. Neste estudo, sob a luz da pesquisa qualitativa, fazendo uso da técnica do incidente crítico (TIC), foram entrevistados 30 enfermeiros de unidades de internação clínicas de um hospital universitário do interior do Estado de São Paulo, a fim de se estabelecer as exigências críticas no atendimento à PCR em unidades de internação neste hospital, através da vivência de enfermeiros durante as manobras de ressuscitação cardiopulmonar (RCP), identificando os incidentes críticos positivos e/ou negativos durante esse atendimento, além das ocorrências iatrogênicas durante as manobras de RCP. Os dados coletados foram categorizados segundo as situações secundárias, uma vez que determinamos que a situação principal era a ocorrência da PCR, os comportamentos e as conseqüências decorrentes das diversas situações. Nas situações secundárias encontramos as seguintes categorias: estado e/ou condições clínicas do paciente/cliente; habilidades técnicas inerentes à profissão; conhecimento ou não acerca da PCR; identificação e reconhecimento (ou desconhecimento) do local de trabalho; condições dos materiais e equipamentos; capacitação e treinamento; e circunstâncias adversas. Relacionado aos comportamentos positivos, destacamos as seguintes categorias: vivendo a sistematização no atendimento à PCR; a questão dos materiais; e estabelecendo funções durante o atendimento à PCR. Já, quanto aos comportamentos negativos, podemos destacar as seguintes categorias: vivenciando a falta (ou ausência) da sistematização no atendimento à PCR; convivendo com as dificuldades técnicas; o ambiente situacional; materiais: é difícil conhecer a sua importância?; vivendo as ocorrências adversas; e estabelecer funções: lidando com prioridades. Uma vez selecionadas as situações secundárias, os comportamentos positivos e os comportamentos negativos, pudemos categorizar as conseqüências imediatas ao paciente/cliente; na categoria que traz as conseqüências positivas temos: restabelecimento das funções vitais; como categorias com conseqüências negativas ao paciente/cliente temos: até que ponto a RCP ajuda o paciente/cliente e sua família? e óbito. Avaliando as conseqüências positivas para a equipe de enfermagem temos a categoria: salvar vidas: o que isso proporciona ao profissional de enfermagem? E como categoria abrangendo as conseqüências negativas para esses profissionais temos: fazer parte da equipe de enfermagem é saber lidar com o sofrimento. A partir dos incidentes críticos identificados, pode-se estabelecer as exigências críticas no atendimento à PCR no local de estudo e, ressaltar que para um bom desempenho no atendimento à PCR é necessário rapidez, eficiência, conhecimento técnico-científico e habilidade técnica por parte de toda a equipe que realiza esse atendimento. Além disso, identifica-se a necessidade de infra-estrutura adequada, trabalho harmônico e sincronizado entre todos os profissionais, visando o restabelecimento da vida, a limitação do sofrimento, a recuperação do paciente/cliente e a ocorrência mínima de seqüelas. A partir do momento em que esses requisitos não são atendidos, os riscos tornam-se evidentes, as ocorrências iatrogênicas freqüentes e a segurança do paciente/cliente, seriamente comprometida. / The cardiac arrest is an unexpected alternative in several moments, comprising a serious threaten to people’s lives, mostly of those who suffer an unwitnessed collapse and those hospitalized patients in critical state. In this study, under the light of quality research, making use of critical incident technique, 30 nurses of medical admission units of a university hospital in the state of São Paulo were interviewed, in order to establish the critical requirements in taking care of cardiac arrest in admission units in this hospital, through the nurse experience during the maneuvers of cardiac pulmonary resuscitation, identifying the positive and/or negative critical incidents during such care, and also the iatrogenic occurrences during the maneuvers of cardiac pulmonary resuscitation. The recorded data were classified according to secondary situations, once we determinated that the main situation was the occurrence of cardiac arrest, the behaviors, and the alternative consequences of the several situations. On secondary situations, we found the following categories: the patient/client clinical state and conditions; ability of techniques of profession; knowledge or ignorance around the CRA; identification and recognition (or ignorance) of workplace; conditions of material and appliances; capability and training; and adverse circumstances. In relation to the positive behaviors, we highlight the following categories: experiencing the systemization in taking care of cardiac arrest; in relation to the materials; and determining the functions during the medical care to cardiac arrest. As for the negative behaviors, we can highlight the following categories: experiencing the lack (or absence) of systemization in medical care to cardiac arrest; living with adverse occurrences; and to establish functions: dealing with priorities. Once the secondary situation, the positive and negative behaviors were selected, we could classify the immediate consequences to the patient/client, and as category the gruping of positive consequences we have: recovery of vital functions; as categories of negative consequences to the patient/client we have: to what extent the does the cardiac pulmonary resuscitation help the patient/client and his/her family? and death. Evaluating the positive consequences for the nursing team we have the category: saving lives: what does it promote to the professional? And as category comprising the negative consequences for these professional we have: to be part of the team is to know how to deal with pain. From the identified critical incidents we can accentuate that for a good performance in taking care of CRA it is necessary rapidity, efficiency, scientific-technical knowledge and the ability of all the team who perform the medical care. Besides that we identify the need of the adequate infra-structure, harmonious work between all of the professionals, aiming the recovery of life, the limitations of pain, the recovery of the patient/client and the minimal ocurrence of sequelae. From the moment those requirements are fulfilled risks become evident, the iatrogenic occurrences frequent and the patient/client safety seriously committed.

Introdução: A parada cardiorrespiratória intra-hospitalar (PCR-IH) é um problema de saúde pública com alta morbimortalidade em todo o mundo. Os casos de ritmos não chocáveis de PCR, como Assistolia e Atividade Elétrica sem Pulso (AESP), persistem inalterados nos últimos 30 anos. A despeito das atualizações das diretrizes de ressuscitação a cada 5 anos, não obtivemos sucesso no aumento da sobrevida desses pacientes. Há necessidade de fatores prognósticos e diagnósticos durante a PCR para auxiliar no aumento da chance de sobrevida desses pacientes e otimizar recursos disponíveis. O ecocardiograma transtorácico (ETT) fornece informações valiosas sobre diagnóstico e, possivelmente, sobre o prognóstico por meio de imagens em tempo real. Este estudo descreve a utilização do ETT em pacientes com PCR com ritmos não chocáveis (Assistolia ou AESP) em uma unidade de terapia intensiva de um hospital universitário. Tem como objetivos caracterizar os dois grupos, avaliar possíveis fatores prognósticos no retorno à circulação espontânea (RCE), bem como avaliar a sua sobrevida. Métodos: O ecocardiograma transtorácico realizado por médicos intensivistas treinados para o método foi inserido no protocolo de suporte avançado de vida. Trata-se de uma coorte prospectiva que incluiu 49 pacientes, sendo 32 (65%) em AESP e 17 (35%) em Assistolia. Resultados: Pacientes com AESP têm mais chances de reverterem RCE do que os pacientes em assistolia (RR=2,66; IC95% [1,22;6,52]; p=0,033). Os pacientes Pseudo-DEM (contratilidade presente e sem pulso central) respondem melhor à reversão (RR=2,99; IC95%[1,22;7,29]; p=0,016). A sobrevida desses pacientes também é maior (HR=0,47; IC95% [0,24; 0,91]; p=0,025). Conclusão: A presença de contratilidade miocárdica pode ser um fator prognóstico a curto e longo prazo durante a PCR. / Background: In-hospital cardiac arrest (IHCA) is a public health problem with high morbidity and mortality worldwide. Cardiac arrest of non-shockable rhythms such as asystole and pulseless electrical activity (PEA) remain unchanged in the last 30 years. Despite periodically updates of resuscitation guidelines no success in increasing survival of these has been provided, so far. There is a need for prognostic factors and diagnoses during cardiac arrest in order to increase survival chance in these patients and optimize available resources. Transthoracic echocardiography (TTE) provides valuable information about diagnosis and possibly prognosis through real-time images. This study describes the use of TTE in patients with cardiac arrest with non-shockable rhythms (Asystole or PEA) in intensive care unit of a academic hospital. Aims at characterizing the two groups, assess possible prognostic factors in the return of spontaneous circulation (ROSC) and assess their survival. Methods: transthoracic echocardiography was inserted into the advanced life support protocol , performed by critical care physicians trained in the method. This is a prospective cohort study that included 49 patients: 32 (65%) in PEA and 17 (35%) in Asystole. Results: Patients with PEA were more likely to ROSC than those in asystole (RR = 2.66; 95% CI [1.22; 6.52]; p = 0.033). Pseudo-DEM patients (myocardial contractility without central pulse) had a better response to reversal (RR = 2.99; 95% CI [1.22, 7.29]; p = 0.016). Survival of these patients was also higher (HR = 0.47; 95% CI [0.24, 0.91]; p = 0.025). Conclusion: Tthe presence of myocardial contractility may be a prognostic factor for short and long-term survival during resuscitation.