Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

Sammanfattning Syfte: Syftet är att beskriva hur individer som överlevt ett hjärtstopp samt individer som överlevt ett hjärtstopp och erhållit en ICD upplever sin livskvalitet utifrån ett fysiskt, psykiskt och socialt perspektiv. Vidare var syftet också att beskriva kvaliteten på de ingående artiklarna avseende undersökningsgrupp. Metod: Beskrivande litteraturstudie med 12 ingående resultatartiklar. Sökningar gjordes i databaserna Cinahl, PubMed och PsychINFO. Huvudresultat: Upplevelsen av livskvalitet påverkas ur flera aspekter hos individer som drabbats av hjärtstopp. Den fysiska förmågan var försämrad och med en för många uttalad trötthet försvårades det dagliga livet för dessa individer. Många upplevde oro och ångest och detta tillsammans med depression var en betydlig bidragande del till en minskad upplevelse av livskvalitet. Slutsats: Upplevelsen av livskvalitet är individuell och många upplever en sämre livskvalitet efter hjärtstoppet medan andra upplever att livet är lika bra som innan eller bättre efter hjärtstoppet. Sjuksköterskan har i sitt arbete ett stort ansvar att se till den enskilda individen och förmedla information, kunskap och hopp. / Abstract Aim: To describe how individuals who have survived a cardiac arrest, and individuals who have survived a cardiac arrest and received an ICD perceive their quality of life from a physical, psychological and social perspective. Furthermore, the aim was also to describe the quality of the included articles relating to the investigation group.Methods: Descriptive literature review study of 12 articles detailed results. Searches were made in the databases Cinahl, PubMed and PsychInfo. Main results: The perception of quality of life is affected by several aspects in individuals suffering from cardiac arrest. The physical ability was impaired and many experienced an extreme fatigue hampered the daily lives of these individuals. Many felt anxiety and this along with depression was a significant contributing factor to a reduced perceived quality of life. Conclusion: The experience of life is individual and many experience a poorer quality of life after cardiac arrest, while others feel that life is as good as before or even better after the arrest. The nurse has a large responsibility to the individual and to convey information, knowledge and hope.

The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.

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.

Thesis (M.S.)--University of Michigan, 2002. / Date from spine. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 41-44).

Thesis (M.S.)--University of Michigan, 2002. / Date from spine. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 41-44).

Orientador: Leandro Gobbo Braz / Banca: 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

“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

Made available in DSpace on 2014-06-11T19:29:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-11-05Bitstream added on 2014-06-13T19:37:58Z : No. of bitstreams: 1 carlucci_mto_me_botfm.pdf: 471461 bytes, checksum: 2342e00f902cacf2ae4e5157bb962c6d (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / 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)