Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references. Available also from UMI Company.

Class of 2015 Abstract / Objectives: There is limited information regarding medication use during in-hospital cardiac arrest (IHCA). The purpose of this study was to characterize medication use during IHCA, and determine the association between medications used and survival to hospital discharge. Methods: This was a retrospective cohort study conducted in an academic medical center looking at IHCA between October 2009 and December 2013. Data regarding medication use during IHCA and other pertinent predictors of survival were collected. The primary objective was to characterize medications used during IHCA and to assess the relationship between medications used and survival to hospital discharge. Results: There were 171 patients who were included in the study and 44 (26%) survived to hospital discharge. The medications most commonly used were epinephrine, sodium bicarbonate, calcium chloride or gluconate, atropine, amiodarone, vasopressin, magnesium sulfate, and lidocaine. Patients who died were more likely to receive total epinephrine ≥3 mg (53% versus 27%, p=0.005), sodium bicarbonate (73% versus 55%, p=0.025), and calcium (59% versus 27%, p<0.001), compared to survivors, respectively. After adjusting for duration of resuscitation, total epinephrine ≥3 mg (OR 0.38, 95% CI 0.18 to 0.83, p=0.015) and calcium (OR 0.30, 95% CI 0.14 to 0.64, p=0.002) was associated with decreased survival. Conclusions: This study found that 3 mg or more of epinephrine, calcium salts and sodium bicarbonate are linked to decreased survival to hospital discharge. Further research should be done to define the cause of this link.

Cardiac arrest is a common cause of coma with frequent poor outcomes. Palliative medicine teams are often called upon to discuss the scope of treatment and future care in cases of anoxic brain injury. Understanding prognostic tools in this setting would help medical teams communicate more effectively with patients’ families and caregivers and may promote improved quality of life overall. This article reviews multiple tools that are useful in determining outcomes in the setting of postarrest anoxic brain injury.

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.

Hypoxia as a stressor has physiological implications that have been a focal point for many physiological studies in recent years. In some studies, hypoxia had large effects on the organ tissue degeneration, which ultimately effects multiple ecological processes. These organ tissue studies played a part in the development of new fields like neurocardiology, a specialty that studied the relationship between the brain and the heart. This thesis focuses on how hypoxia-induced cardiac arrest alters the amounts of GLYT2, a glycine reuptake transporter, in the central nervous system of zebrafish, Danio rerio. At 7 days post-fertilization (dpf), zebrafish were exposed to acute, severe hypoxia until they lost equilibrium, and minutes later, subsequent cardiac arrest occurred. Zebrafish were then placed into recovery groups to measure the GLYT2 levels at multiple points in zebrafish recovery. Fish were then sacrificed, and their brains dissected. Using immunofluorescence, the outer left optic tectum of the zebrafish was imaged, and mean image pixel fluorescent intensity was taken. There were significant changes (one-way ANOVA) in the levels of GLYT2 compared to that of the control groups during the course of recovery. GLYT2 levels continued to rise through the 24-hour recovery mark but did not show significant difference after 3 hours of recovery. This suggest that GLYT2 levels increased rapidly in the first 3 hours of recovery and continued to increase through 24 hours at a slower rate. Changes in GLYT2 levels may affect motor and sensory information, movement, visualization, and audition in these zebrafish. Further research should be conducted to determine how long it takes for GLYT2 levels to return to baseline, as well as behavioral measurements through each recovery period as it relates to glycine function.

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 &lt;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. &lt;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.

No description available.

This exploratory study used Diagnostic Content Validity (DCV) and the Clinical Diagnostic Validation (CDV) models proposed by Fehring (1986) to clinically identify and validate the defining characteristics for Alteration in Tissue Perfusion: Cardiac. The literature based Kelly Cardiac Assessment Tool (KCAT) was designed as the data collection tool. The diagnostic content validity of the KCAT was 0.70. Twenty subjects, 18 years old and older were selected from a population who were admitted as inpatients in a southwestern university affiliated hospital. Data were collected through patient interviews, independent nurse assessment, and review of laboratory data. Using the steps described in Fehring's CDV model (1986) one major defining characteristic and 13 minor defining characteristics were clinically validated. The tool CDV score was 0.62. The nursing diagnosis Alteration in Tissue Perfusion: Cardiac was clinically validated and one major and 13 minor defining characteristics were identified.

OBJECTIVES The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. BACKGROUND Cohort studies have shown that 1 in 4 post-cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. METHODS Thirty-two swine (mean weight 35 +/- 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34 degrees C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. RESULTS At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 +/- 19.6% (p < 0.05). Group C had an intermediate infarct size at 29.5 +/- 20.2%, whereas groups B and D had the largest infarct sizes at 41.5 +/- 15.5% and 41.1 +/- 15.0%, respectively. CONCLUSIONS Acute coronary occlusion is often associated with cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal. (J Am Coll Cardiol Intv 2016; 9: 2403-12)

Bakgrund: På svenska sjukhus dör cirka sjuttio procent av de som drabbas av hjärtstopp. Eftersom hjärtstopp kan inträffa överallt på ett sjukhus och det inte alltid finns tillgång till defibrillator eller sjukvårdspersonal kan ett hjärtstoppsteams ankomst till platsen för hjärtstopp vara avgörande. Detta då tiden till första defibrillering har ett starkt samband med överlevnad. Syfte: Belysa intensivvårdssjuksköterskors erfarenheter av hjärtstoppsteamets transport inom sjukhuset vid larm om hjärtstopp. Metod: En kvalitativ studie där tolv stycken semistrukturerade intervjuer utfördes på Intensivvårdsavdelningen på ett sjukhus i norra Sverige. Innehållsanalys användes för skapandet av subkategorier och kategorier. Resultat: Ur analysen uppstod tre kategorier och tolv subkategorier. De tre kategorierna var ”Interna och externa resurser”, ”Variabler för olika transportsträckor” och ”Samförstånd mellan olika aktörer”. Slutsats: Många barriärer som kunde påverka hjärtstoppsteamets transport till platsen för hjärtstopp identifierades och utgjordes av bland annat långa avstånd, svårpasserade dörrar, folk och saker i vägen samt ombyggnationer. De hjälpmedel som hjärtstoppsteamet hade till förfogande kunde likaså utgöra hinder, då exempelvis transportmedlet i form av en hjärtstoppscykel identifierades stor och tung. Att identifiera och åtgärda barriärer som fördröjer hjärtstoppsteams ankomst till platsen för hjärtstopp är av vikt då detta påverkar patientsäkerhet och överlevnad för den drabbade. / Background: Among those who suffer from cardiac arrest in Swedish hospitals, there is a 70% mortality rate. Since cardiac arrests can occur in any area of the hospital that might lack defibrillators or hospital personell the arrival of the cardiac arrest team is crucial. Time to initial defibrillation is strongly correlated to survival after cardiac arrest. Aim: To illustrate intensive care nurses’ experiences of the cardiac arrest team’s transportation within the hospital to the location of a cardiac arrest when being dispatched. Method: A qualitative study where twelve semi-structured interviews were conducted at the Intensive care unit in a hospital in the northern part of Sweden. Content analysis was used to create sub-categories and categories. Results: From the analysis three categories and twelve sub-catagories emerged. The three categories were ”Internal and external resources”, ”Variables for different transport distances” and ”Shared understanding between different actors”. Conclusion: Many barriers that could affect the cardiac arrest team’s transportation to the location of a cardiac arrest were identified, includig long distances, doors that were difficult to pass, restricted passage by people and objects, and reconstructions. The assisting devices used by the cardiac arrest team could also compose obstacles. The cardiac arrest bike used during transportation was for example identified as big and heavy. It is of importance to identify and eliminate barriers that delay the arrival of the cardiac arrest team at the location of a cardiac arrest, since patient safety and survival can be affected.