Orientador: Izilda Esmenia Muglia Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T20:04:18Z (GMT). No. of bitstreams: 1 Bellan_MargareteConsorti_M.pdf: 1469477 bytes, checksum: 6b246d40e4df19b1a0571c088ab4f183 (MD5) Previous issue date: 2006 / 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

Orientador: Izilda Esmenia Muglia Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T18:13:55Z (GMT). No. of bitstreams: 1 Almeida_AngelicaOlivettode_M.pdf: 622575 bytes, checksum: 951208f5ece75c14658a513160fe4a78 (MD5) Previous issue date: 2008 / Resumo: A partir de 2002, o Ministério da Saúde estabeleceu a Política Nacional de Atendimento às Urgências e Emergências devido ao aumento da demanda, da violência e do número de acidentes, além da insuficiência de serviços, superlotação dos pronto-socorros e queda da qualidade na assistência. A rede assistencial foi então modificada, surgindo as Unidades não-hospitalares de Atendimento a Urgência e Emergência (UNHAU/E), com a finalidade de atender pacientes com quadros agudos ou crônicos agudizados e ordenar os fluxos de urgência. Os objetivos deste estudo foram analisar a organização das UNHAU/E em relação à estrutura física, recursos materiais e humanos e o conhecimento teórico dos enfermeiros sobre parada cardiorrespiratória (PCR) e ressuscitação cardiopulmonar (RCP), dessas unidades. Estudo descritivo e exploratório utilizando um questionário pré-elaborado e validado por juízes que foi aplicado a 73 enfermeiros das UNHAU/E da Região Metropolitana de Campinas (RMC), compreendendo sete municípios e 16 UNHAU/E. Três enfermeiros de cada UNHAU/E, de diferentes turnos, foram aleatoriamente selecionados e entrevistados sobre o dimensionamento de recursos humanos e materiais e a organização assistencial da Unidade. O questionário sobre conhecimento teórico de PCR/RCP foi aplicado a todos os enfermeiros. Em relação à área física constatou-se que além da falta das divisões em blocos, muitas foram improvisadas com adaptações para se tornarem UNHAU/E. Quanto aos recursos materiais observou-se a ausência daqueles preconizados para uso em urgência e emergência (respirador adulto e infantil, bomba de infusão, material para cricotiroidostomia, caixa de pequena cirurgia, gerador de energia elétrica). Constatouse a ausência do profissional enfermeiro no período noturno. Os municípios que possuem maiores déficits em estrutura organizacional das UNHAU/E foram os municípios D, E e F. Resumidamente, destacam-se: mais de 60% dos respondentes não sabem detectar corretamente a PCR; cerca de 70% não sabem as condutas imediatas após a sua detecção; mais de 80% não sabem quais são os padrões de ritmos presente na PCR; acima de 60% não sabem a seqüência do suporte básico de vida (SBV); apenas 20% sabem a postura corporal correta para a realização da compressão torácica externa (CTE); mais de 60% não sabem a relação ventilação/compressão; acima de 70% sabem posicionar as pás dodesfibrilador, porém quase 70% desconhecem o valor da carga elétrica a ser utilizada; menos de 10% sabem em que consiste o SAV; menos de 7% sabem quais as vias possíveis para administração de fármacos; 100% sabem parcialmente quais os fármacos utilizados na RCP e 50% conhecem parcialmente para que servem e, apenas 20% sabem o que deve conter o registro do atendimento da PCR. Os enfermeiros do município C foram os que apresentaram pior desempenho na nota final. Conclui-se que as UNHAU/E apresentam grandes déficits em relação à área física, recursos materiais e humanos. Em relação aos conceitos teóricos em PCR/RCP os enfermeiros das UNHAU/E da RMC obtiveram uma nota média de 5,18 (±1,42), indicando uma deficência de conhecimentos em relação ao exigido para profissionais que atendem um quadro tão complexo, apesar das inúmeras diretrizes sobre o assunto disponíveis na literatura / Abstract: Since 2002 the Ministry of Health established the National Policy on care for Urgencies and Emergencies due to increased demand and high rates of urban violence and accidents. The services were insufficient, with subsequent overcrowding of emergency rooms and a low quality of care. The system was then modified and stemmed the Non-Hospital Emergency Care Units (N-HECU) aiming to dealing with patients in chronic or acute situations and to coordinate the flow of medical urgencies. The study's main objectives were: to analyze the organization of N-HECU in relation to the physical structure, material and human resources and to examine the theoretical knowledge of their nurses on cardiac arrest and cardiopulmonary resuscitation (CPR). A descriptive and exploratory survey was done by applying a questionnaire pre-endorsed by judges to 73 nurses from N-HECU of the Metropolitan Region of Campinas (MRC) comprising seven cities and 16 N-HECU. Three nurses from each N-HECU and from different shifts, randomly selected, were inquired about the material and human resources, and organization of the Unit. The questionnaire with theoretical knowlegde about cardiac arrest and CPR was applied to all nurses. The results regarding the physical area have shown that besides the lack of rooms in blocks, many were improvised with adjustments to become N-HECU. In relation to material resources it was found a lack of those routinely needed for use in emergency situations (adult and child respirator, infusion pump, material for traqueal intubation, small surgery box, electrical generators). There is a lack of registered nurses in the night shift. It was found that cities with the greatest deficits in organizational structure of N-HECU were cities D, E and F. Briefly stands out: over 60% of respondents don't know how to properly detect a cardiac arrest; almost 70% don't know the procedues after its immediate detection; above 80% don't know what are the rhythms' patterns of cardiac arrest; above 60% don't know the BLS sequence; only 20% know the correct body position to carry out the chest compressions; above 60% don't know the compression-ventilation ratio; above 70% know the position of the defibrillator paddles, but almost 70% don't know the value of electric charge to be used; less than 10% know what is the ACLS; less than 7% know what are the possible ways for drug administration; 100% know partly which drugs are used in CPR and 50% know partly what are their finality; and only 20% know what there must contain the record of CPR attendance. The nurses of the city C were those who had the worst performance in the final grade. It was concluded that N-HECU have large deficits in relation to physical area material and human resources. Regarding theoretical concepts on cardiac arrest and CPR it was found that N-HECU nurses obtained an average grade of 5,18 (± 1,42), indicating a knowledge level lesser than that required for an adequate management of this complex situation, despite the great number of guidelines available in the literature / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Orientador: Izilda Esmenia Muglia Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T11:53:58Z (GMT). No. of bitstreams: 1 Boaventura_AnaPaula_M.pdf: 414108 bytes, checksum: faae3158a2586452ce01d7978f40b00b (MD5) Previous issue date: 2004 / 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

Aim: Spanish-only speaking residents in the United States face barriers to receiving potentially life-saving 911 interventions such as Telephone-cardiopulmonary resuscitation (TCPR) instructions. Since 2015, 911 dispatchers have placed an increased emphasis on rapid identification of potential cardiac arrest. The purpose of this study was to describe the utilization and timing of the 911 system during suspected out-of-hospital cardiac arrest (OHCA) by Spanish-speaking callers in Metropolitan Phoenix, Arizona. Methods: The dataset consisted of suspected OHCA from 911 centers from October 10, 2010 through December 31, 2013. Review of audio TCPR process data included whether the need for CPR was recognized by telecommunicators, whether CPR instructions were provided, and the time elements from call receipt to initiation of compressions. Results: A total of 3398 calls were made to 911 for suspected OHCA where CPR was indicated. A total of 39 (1.2%) were determined to have a Spanish language barrier. This averages to 18 calls per year with a Spanish language barrier during the study period, compared with 286 OHCAs expected per year among this population. The average time until telecommunicators recognized CPR need was 87.4 s for the no language barrier group compared to 160.6 s for the Spanish-language barrier group (p < 0.001). Time to CPR instructions started was significantly different between these groups (144.4 s vs 231.3 s, respectively) (p < 0.001), as was time to first compression, (174.4 s vs. 290.9 s, respectively) (p < 0.001). Conclusions: Our study suggests that Hispanic callers under-utilize the 911 system, and when they do call 911, there are significant delays in initiating CPR. (C) 2017 Elsevier B.V. All rights reserved.

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.

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 hémodynamique. / Out 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.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21700号 / 社医博第91号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 今中 雄一, 教授 佐藤 俊哉, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Bakgrund: Svenska Hjärt-Lungräddningsregistret rapporterade år 2019 att 1532 personer överlevt hjärtstopp. Vid en sådan händelse är larmning, hjärt- och lungräddning samt tidig strömstöt från hjärtstartare viktig för ökad chans till överlevnad. De sjuksköterskor som ställs inför dessa situationer har en betydande roll i mötet med dessa patienter och deras anhöriga. Syfte: Att beskriva personers erfarenheter av att överleva hjärtstopp under de första 6 åren efter händelsen.Metod: En beskrivande litteraturstudie med en tematisk analysmetod baserad på 12 vetenskapliga artiklar. Huvudresultat: Resultatet av denna litteraturstudie visade förändringar och utmaningar både fysiskt, psykiskt samt emotionellt. Överlevarna uttryckte en stor tacksamhet till en andra chans i livet, men även ångest och oro för att våga lita på sin kropp igen. De beskrev minnesförluster efter händelsen där många av dem hade behov av att fylla dessa minnesluckor. Det var en stor omställning att gå från tryggheten på sjukhuset med all personal, till att behöva klara sig själv när det var dags att åka hem. Väl hemma var det en utmaning att vänja sig vid ett nytt liv och finna sin nya identitet. Slutsats: Att uppleva ett hjärtstopp väckte många känslor kring liv och död. Hjärtstoppet gav överlevarna en påminnelse om att livet är skört samt en känsla av tacksamhet för en andra chans i livet. Händelsen efterlämnar mycket ångest och rädslor inför framtiden samt en känsla av att inte vara densamma varken fysiskt eller psykiskt. Med bättre stöd för de komplikationer som hjärtstoppsöverlevarna drabbats av, kan den individuella livskvalitén samt upplevda hälsan öka. / Background: The Swedish Heart- and Lung register reported in 2019 that 1532 people survived cardiac arrest. In such an occurrence, early warning, cardiopulmonary resuscitation (CPR) and early electric chock from defibrillation are important for increasing the chance of survival. The nurses who face these situations have a significant role in meeting these patients and their relatives. Aim: To describe people's experiences after surviving a cardiac arrest during the first 6 years after the occurrence.Method: A descriptive literature review with a thematic analysis method based on 12 scientific articles. Main Result: The result of this review showed changes and challenges both physically, mentally, and emotionally. Cardiac arrest survivors expressed gratitude for a second chance in life, but also anxiety and worry about trusting their body again. They describe memory loss after the occurrence where many of them felt the need to fill these memory gaps. It was a big change to go from the safety of the hospital with all the staff, to having to take care of themselves when it was time to go home. Once they were home, it was a challenge to get used to a new life and find their new identity. Conclusion: Experiencing a cardiac arrest evokes many feelings about life and death. The cardiac arrest reminded the survivors that life is fragile, and gave a feeling of gratitude for a second chance at life. The event leaves a lot of anxiety and fears for the future as well as a feeling of not being the same, either physically or mentally. With better support for the complications suffered by cardiac arrest survivors, the individual quality of life and perceived health can increase.

Background: Cardiac arrest is a public health problem worldwide. A cardiac arrest often occurssuddenly and without warning. If no cardiopulmonary rescue starts immediately, the outcome will be death. Surviving a cardiac arrest has an impact on the quality of life. Aim: The aim of this study was to describe the patient´s experiences after a cardiac arrest. Method: Qualitative articles are used as a foundation in this literature review. Results: Two major themes emerged from analysing eight qualitative articles. The results showed complicated effects of cardiac arrest on patients´ lives. After a cardiac arrest patients needed support and safety. Support from nurses must be organized in a more structured way. This should be handled with continuity and vigilance in health care by nurses. Conclusion: Patients who survive a cardiac arrest experience that their lives are affected from several aspects. For example, mentally, physically, emotionally and existentially. This can result in emotional challenges and uncertainty about the future. In this new life situation, the nurse could help by guiding, following up and supporting the patients. / Syftet med denna litteraturstudie var att beskriva patienters upplevelser efter ett hjärtstopp. Studien resulterade i två teman (att anpassa sig till en ny vardag och andra livsperspektiv) med sex underteman (ständig oro, återgång till tidigare livssituation, att hantera känslor efter hjärtstopp, stöd från familjen, en ny syn på livet och strävan efter att leva i nuet). Efter ett hjärtstopp upplevde patienterna att deras liv påverkades på flera plan. Både fysiskt och psykiskt.Att ha ett forum att diskutera utmaningar samt bekräftelse på att återhämtningen gick åt rätt hållvar viktigt för patienterna. Att drabbas av ett hjärtstopp är vanligtvis något som kommer plötsligt och behandlas det inte är prognosen dödlig. Det är vanligast att patienterna har en bakomliggande kranskärlssjukdom men andra orsaker kan vara överdoser av droger eller läkemedel, drunkningstillbud, andningsstopp, astmaanfall eller kraftiga elektriska strömstötar. Kvalitativ ansats användes för att genomföra studien och 8 artiklar ligger till grund för detta examensarbete. Behovet av strukturerat stöd visade sig vara stort, patienterna efterfrågade bekräftelse på hur återhämtningen fortskred. Ångest, brist på säkerhet och kroppsliga begränsningar var deras främsta bekymmer. Känslan av ångest och osäkerhet ökade när patienterna skrevs ut från sjukhuset och kom hem till sin gamla vardag. Av den anledningenvar det viktigt att återgå till hur livssituationen såg ut före händelsen. Målet att återgå till en tidigare livssituation visades dock vara svårt på grund av nya kroppsliga och kognitivabegränsningar

Cardiac arrest has been reported in patients with mitral valve prolapse; however, clinical characteristics and survival information are limited since most of the cases reported include autopsy data. Nine patients (2 male, 7 female) with mitral valve prolapse were identified who had cardiac arrest; ventricular fibrillation was documented in 8 patients; resuscitation was unsuccessful in 2. Eight had a history of palpitations (months to 15 years duration) and ventricular arrhythmias, 3 had a history (5-15 years) of recurrent syncope, and 1 was totally asymptomatic. Cardiac catheterization-angiographic studies in 8 patients demonstrated normal coronary artery anatomy and mitral valve prolapse. All 9 patients had auscultatory and echocardiographic evidence of mitral valve prolapse. Seven survivors (6 still alive) were followed from 3 to 14 years after cardiac arrest. A subset of patients with mitral valve prolapse and cardiac arrest is described in whom past medical history is compatible with cardiac arrhythmias or syncope, and whose long-term prognosis appears better than patients with other causes of cardiac arrest.