No description available.

<p>Death from heart diseases is the most common type of mortality in western countries and the survival rate of cardiac arrest is dismally low. In the treatment of cardiac arrest, two therapeutic methods are most important: cardiopulmonary resuscitation (CPR; chest compressions and ventilations) and defibrillation (electrical shocks to restart a fibrillating heart).</p><p>An automated external defibrillator is commonly used for such shocks, and records and performs signal analysis on the electrocardiogram(ECG) in order to advice when to shock the patient. However, the mechanical activity during CPR introduces artifact components in the ECG. To perform reliable ECG signal analysis, CPR is therefore discontinued for a substantial time before the potential delivery of a shock. This wastes valuable therapy time, and if this hands-off time could be reduced or eliminated by removing these artifacts, it should improve the chance of return of spontaneous circulation.</p><p>We propose a method for removing CPR artifacts using a novel multichannel adaptive filter, the computationally efficient and numerically robust MultiChannel Recursive Adaptive Matching Pursuit(MC-RAMP) filter. Using the most realistic data set to date, human out-of-hospital cardiac arrest data of both shockable and non-shockable rhythms, we test MC-RAMP and evaluate the feasibility of ECG analysis during CPR. In our experiments we use a shock advice algorithm and individual ECG signal features to reach the conclusion that after CPR artifact filtering, ECG rhythm analysis during ongoing CPR is feasible. </p><p>Finally, we analyze and quantify the time intervals without blood flow (no flow time(NFT)) during external automatic defibrillation in cardiac arrest patients and show that these patients were not perfused around half of the time. We propose methods using CPR artifact filtering to reduce the NFT, and show their significant and promising potential. By introducing the proposed methods into defibrillators, the NFT would be significantly reduced, hopefully increasing the survival.</p>

Death from heart diseases is the most common type of mortality in western countries and the survival rate of cardiac arrest is dismally low. In the treatment of cardiac arrest, two therapeutic methods are most important: cardiopulmonary resuscitation (CPR; chest compressions and ventilations) and defibrillation (electrical shocks to restart a fibrillating heart). An automated external defibrillator is commonly used for such shocks, and records and performs signal analysis on the electrocardiogram(ECG) in order to advice when to shock the patient. However, the mechanical activity during CPR introduces artifact components in the ECG. To perform reliable ECG signal analysis, CPR is therefore discontinued for a substantial time before the potential delivery of a shock. This wastes valuable therapy time, and if this hands-off time could be reduced or eliminated by removing these artifacts, it should improve the chance of return of spontaneous circulation. We propose a method for removing CPR artifacts using a novel multichannel adaptive filter, the computationally efficient and numerically robust MultiChannel Recursive Adaptive Matching Pursuit(MC-RAMP) filter. Using the most realistic data set to date, human out-of-hospital cardiac arrest data of both shockable and non-shockable rhythms, we test MC-RAMP and evaluate the feasibility of ECG analysis during CPR. In our experiments we use a shock advice algorithm and individual ECG signal features to reach the conclusion that after CPR artifact filtering, ECG rhythm analysis during ongoing CPR is feasible. Finally, we analyze and quantify the time intervals without blood flow (no flow time(NFT)) during external automatic defibrillation in cardiac arrest patients and show that these patients were not perfused around half of the time. We propose methods using CPR artifact filtering to reduce the NFT, and show their significant and promising potential. By introducing the proposed methods into defibrillators, the NFT would be significantly reduced, hopefully increasing the survival.

Bakgrund: I Sverige drabbas varje år cirka tiotusen personer av ett hjärtstopp varav cirka trehundra personer överlever. Ett hjärtstopp påverkar den drabbades liv på olika sätt och det är därför viktigt att sjuksköterskan har kunskap om dessa personers upplevelser. Syfte: Syftet var att beskriva hur patienter upplever sin livskvalitet efter ett hjärtstopp. Metod: En allmän litteraturstudie genomfördes med induktiv innehållsanalys. Resultat: Patienterna drabbades av fysiska förändringar som de på olika sätt försökte hantera. Stöd och information var viktigt för att kunna hantera det som hänt. Många patienter bar på en rädsla efter hjärtstoppet som påverkade deras livskvalitet negativt. Diskussion: Upplevelsen av att överleva ett hjärtstopp är olika eftersom varje individ utgår från sin egen livsvärld. Patienter som drabbades av minnessvårigheter efter hjärtstoppet upplevde en försämrad livskvalitet. Det kan bero på att problemen inte uppmärksammas och att patienterna inte får den hjälp de är i behov av. Slutsats: För att sjuksköterskan ska kunna ge en god omvårdnad måste patientens livsvärld vara i centrum. På så sätt kan sjuksköterskan förstå patientens upplevelse av att ha drabbats av ett hjärtstopp och hur livskvaliteten påverkats. / Background: About ten thousand persons suffer a cardiac arrest in Sweden each year and about three hundred survive. A cardiac arrest affects the victim's life in different ways and it’s therefore important for the nurse to have knowledge about the experiences of these patients. Purpose: The purpose was to describe how patients experience their quality of life after a cardiac arrest. Method: A literature review was conducted using an inductive content analysis. Results: Patients experienced physical changes which they handled differently. They needed information and support to be able to move on. Some patients carried a fear after the cardiac arrest which affected their quality of life negatively. Discussion: The experience of surviving a cardiac arrest is different because each individual has its own life-world. Patients that were suffering from memory problems after the cardiac arrest experienced a decreased quality of life. The reason could be that the problems are not noticed and the patients do not get the help they need. Conclusion: To be able to provide good care, the patient's life-world has to be in the centre. This allows the nurse to understand the experience of having suffered a cardiac arrest and how the quality of life is affected.

Mötet mellan sjuksköterskan och närstående har en betydande roll i omvårdnaden, inte minst i ett prehospitalt skede. Sjuksköterskan inom ambulanssjukvården får i komplicerade situationer möta chockade närstående till patienter med hjärtstopp. Syftet med denna studie är att beskriva sjuksköterskans erfarenheter av mötet med närstående till patienter med hjärtstopp inom den prehospitala sjukvården. Datainsamlingen har skett genom intervjuer med åtta sjuksköterskor inom ambulanssjukvården. Informanterna har berättat om möten de haft med närstående till patienter med hjärtstopp. Intervjuerna spelades in och transkriberades. Därefter genomfördes en kvalitativ innehållsanalys av texterna där tre huvudteman samt ett antal underteman framkom. Dessa tre huvudteman var ”Kommunicera med närstående”, ”Hantera närståendes reaktioner”, och ” Agera etiskt försvarbart gentemot närstående”. Resultatet visar att sjuksköterskans sätt att kommunicera har betydelse för mötet. Genom ett förtroendegivande och tydligt uppträdande försöker sjuksköterskan skapa kontakt med närstående. Detta skapar förutsättning att förmedla lugn och förståelse hos närstående för situationen. Dock kan ibland närstående projicera sin sorg och förtvivlan på sjuksköterskan som kan anklagas för att inte ha gjort tillräckligt. Det framkom att närstående kan komma i andra hand vid de hjärtstopp då endast en ambulansbesättning finns på plats. Genom erfarenhet ökar möjligheten att uppnå ett bra möte mellan sjuksköterskan och närstående. / The encounter between the nurse and relatives is of great significance within healthcare treatment, not the least in prehospital emergency care. Nurses within the ambulance services will in complicated situations meet chocked relatives of patients with cardiac arrest. The aim of the study is to describe nurses’ experiences of the encounter with relatives of patients with cardiac arrest within the prehospital emergency care. The collection of data was conducted through interviews with eight nurses within the ambulance services. The informants have rendered encounters they’ve had with relatives of patients with cardiac arrest. The interviews were recorded and transcribed. Thereafter a qualitative content analysis was made on the texts, from where three major themes, and a number of sub themes, emerged. The three major themes were “Communicating with relatives”, “Managing relatives’ reactions” and “Acting ethically correct towards relatives”. The result shows that the nurse’s way of communicating affects the encounter. Through a convincing and distinct manner the nurse seeks contact with relatives. This makes it possible to convey calmness to the relatives, and help them comprehend the situation. Sometimes though, relatives can project their grief and despair onto the nurse, who may be accused of not having done enough. It was detected, that relatives may be a second priority in a cardiac arrest-situation where there has only arrived one set of ambulance crew. Through experience the chances to reach a good encounter increases.

No description available.

The Analysis of Ilan¡¦s Out-of-Hospital Cardiac Arrest (OHCA) Patients Abstract The study uses Ilan¡¦s out-of-hospital cardiac arrest (OHCA) patients as the research object to understand the variable backgrounds of OHCA patients how they are affected by first aid factors between the period of pre-hospital and post-hospital admission. The study also discusses whether there is a correlation between first aid factors and first aid prognosis among those OHCA patients during pre-hospital and post-hospital admission periods. The study is retrospective and based on the Utstein style format. It collects 284 out-of-hospital cardiac arrest (OHCA) patient cases with trauma and non-trauma (282 effective samples) in an example of a regional teaching hospital in Ilan from 2007 to 2009. It uses descriptive statistics, independent sample t test, and Chi-Square test as the statistical analysis to obtain the following conclusions: 1. There are 282 effective sample patients in the study. There are 57 patients ( 20.2 %) who were return of spontaneous circulation (ROSC) after cardiac arrest approximately 14.77 minutes on average. There are 33 patients (11.7 % ) who survived to be hospitalized for 15.36 days on average, and there are 6 patients ( 2.1 % ) who were discharged from the hospital. 2. Internal medicine disease is the major causative factor of out-of-hospital cardiac arrest. Among those internal medicine disease cases, the history showed hypertension, diabetes mellitus, and heart diseases are the main causes of out-of-hospital cardiac arrest. Patients who are older than 65 years old are the main age groups, accounting for 67.7% of these cases. 3. The pre-hospital admission factors which affect the prognosis after the Emergency Department (ED) are the place of the accident, whether there are witnesses, scene process time , total reaction time , whether automatic external defibrillation was used, and whether people at the scene used CPR. 4. The post-hospital admission factors which affect the prognosis after the ED are initial cardiac rhythm, body temperature, pupil size , dose of epinephrine, whether defibrillation was used, the time of applying emergency first-aid, and medical expense. 5. The percentages of return of spontaneous circulation and survival rates in the study are lower than those of past studies of Taipei City and National Taiwan University Hospital. The possible factors are probably related to differences between rural and urban areas in the quality of emergency medical service systems (EMSS), and healthcare training. 6. From now on, in addition to improving the first-aid continuous monitoring system, we should also enhance EMT related training, and actively educate people to understand and learn CPR, so that comprehensive first-aid systems are available everywhere to effectively increase the success rate of first-aid. Keywords¡GOut-of-hospital cardiac arrest (OHCA), Cardiopulmonary resuscitation

<p>Mötet mellan sjuksköterskan och närstående har en betydande roll i omvårdnaden, inte minst i ett prehospitalt skede. Sjuksköterskan inom ambulanssjukvården får i komplicerade situationer möta chockade närstående till patienter med hjärtstopp. Syftet med denna studie är att beskriva sjuksköterskans erfarenheter av mötet med närstående till patienter med hjärtstopp inom den prehospitala sjukvården.</p><p>Datainsamlingen har skett genom intervjuer med åtta sjuksköterskor inom ambulanssjukvården. Informanterna har berättat om möten de haft med närstående till patienter med hjärtstopp. Intervjuerna spelades in och transkriberades. Därefter genomfördes en kvalitativ innehållsanalys av texterna där tre huvudteman samt ett antal underteman framkom. Dessa tre huvudteman var ”Kommunicera med närstående”, ”Hantera närståendes reaktioner”, och ” Agera etiskt försvarbart gentemot närstående”.</p><p>Resultatet visar att sjuksköterskans sätt att kommunicera har betydelse för mötet. Genom ett förtroendegivande och tydligt uppträdande försöker sjuksköterskan skapa kontakt med närstående. Detta skapar förutsättning att förmedla lugn och förståelse hos närstående för situationen. Dock kan ibland närstående projicera sin sorg och förtvivlan på sjuksköterskan som kan anklagas för att inte ha gjort tillräckligt. Det framkom att närstående kan komma i andra hand vid de hjärtstopp då endast en ambulansbesättning finns på plats. Genom erfarenhet ökar möjligheten att uppnå ett bra möte mellan sjuksköterskan och närstående.</p> / <p>The encounter between the nurse and relatives is of great significance within healthcare treatment, not the least in prehospital emergency care. Nurses within the ambulance services will in complicated situations meet chocked relatives of patients with cardiac arrest. The aim of the study is to describe nurses’ experiences of the encounter with relatives of patients with cardiac arrest within the prehospital emergency care.</p><p>The collection of data was conducted through interviews with eight nurses within the ambulance services. The informants have rendered encounters they’ve had with relatives of patients with cardiac arrest. The interviews were recorded and transcribed. Thereafter a qualitative content analysis was made on the texts, from where three major themes, and a number of sub themes, emerged. The three major themes were “Communicating with relatives”, “Managing relatives’ reactions” and “Acting ethically correct towards relatives”.</p><p>The result shows that the nurse’s way of communicating affects the encounter. Through a convincing and distinct manner the nurse seeks contact with relatives. This makes it possible to convey calmness to the relatives, and help them comprehend the situation. Sometimes though, relatives can project their grief and despair onto the nurse, who may be accused of not having done enough. It was detected, that relatives may be a second priority in a cardiac arrest-situation where there has only arrived one set of ambulance crew. Through experience the chances to reach a good encounter increases.</p>

Chest compressions in cardiopulmonary resuscitation are of utmost importance although not without a risk. Many injuries are described but the incidence of these is hard to define due to methodological differences. It is strenuous to perform chest compressions and therefore mechanical chest compressions have been looked upon with interest. This thesis presents new insights on the panorama and incidence of injuries in modern CPR and a comparison of safety and efficacy between manual chest compressions and mechanical chest compressions with the LUCAS™ device. We also evaluated if computed tomography could be an aid in the detection of these injuries. Two pilot trials were conducted and one presented no difference in early survival with 26% and 31% having return of spontaneous circulation when comparing manual chest compressions with the LUCAS device in out-of-hospital cardiac arrest. The other revealed no difference in autopsy-detected injuries. A third multicentre autopsy trial revealed that in patients treated with manual chest compressions 78.3% had at least one injury and 63.9% had at least one rib fracture. The corresponding numbers for patients treated with the LUCAS device was 92.8% (p = 0.002) and 77.7% (p=0.022). Sternal fractures occurred in 54.2% and in 58.3% of the cases treated with manual chest compressions and the LUCAS device respectively (p = 0.556). The median number of rib fractures was 7 in the group receiving manual chest compressions and 6 in the group receiving chest compressions with the LUCAS device. In 31 cases a computed tomography was conducted prior to autopsy and we found a very strong correlation in the discrimination of patients with or without rib fractures (kappa=0.83). Mean difference between the two methods in detecting rib fractures was 0.16. The detection of other injuries did not have a strong correlation. In conclusion there is no difference in early survival between the two methods and mechanical chest compressions adds 14-15% more patients with rib fractures but the amount of rib fractures, sternal fractures and other injuries is equal. CT can aid but not replace autopsies in the detection of these injuries.

Pulmonary dysfunction following cardiopulmonary bypass surgery is a widely explored complication and a multitude of factors have been implicated, including but not limited to: operative trauma; the cardiopulmonary bypass circuit; cardioplegia; the type of donor grafts utilised; anaesthesia and fluid administered. There is a paucity of information regarding the effect of cardioplegia on the lungs. No studies have previously investigated whether allowing cold-blood cardioplegic solution to enter the lung parenchyma, during the period of cardioplegia delivery, has an effect on the clinical outcome of lung function following cardiopulmonary bypass surgery. For this reason an original study was done to determine the effect of preventing cardioplegia from entering the lungs, by evacuating overflow of cardioplegia not drained via the atriocaval cannula, by using a pulmonary artery vent. A total of 403 patients admitted to undergo full cardiopulmonary bypass were screened and 142 patients who fitted the criteria for inclusion and provided informed consent took part in this prospective double blind randomised clinical trial. The control group underwent routine cardiopulmonary bypass grafting. The study group had the intervention of a pulmonary artery vent sutured in position at the time the heart was cannulated for bypass. During cardioplegia delivery the cardioplegia was removed via the atriocaval cannula in the control group (A) and via the atriocaval cannula and the pulmonary artery vent in the study group (B). Aside from this difference, the two groups were managed identically intra- and post-operatively. Outcomes which were compared included eight time measures of arterial blood gases; electrolytes and shunt fraction; bedside lung spirometry measures over five time periods; radiographic measures of atelectasis and effusion over three time points; as well as physiotherapy and hospitalisation requirements. Numerous other potentially extraneous variables were measured and compared in order to monitor homogeneity of the study samples. The consistency of the results within each group throughout the study provides strong evidence that the measurements taken were accurate. The use of standardised equipment and vigilant adherence to the protocol ensured no extraneous deviation. The internal validity of this study was therefore good and accurate. The findings of the study however brought into question a previously accepted belief that the pulmonary artery vent prevents the overflow of cardioplegia, not drained from the right atrium, from entering the lungs. There was no literature or previous studies to confirm or dispute this accepted ‘observation’ by cardiac surgeons that the cardioplegia does enter the lung parenchyma. To therefore validate the findings of the study a further four original studies were designed and initiated. The objective of these studies was to establish the efficacy of the pulmonary artery vent and to determine whether cardioplegia indeed circulates through the lung parenchyma or merely accumulates and ‘pools’. Technetium (Tc-99m), a radio labelled isotope was added to the cold blood cardioplegia solution prior to delivery in order to determine this. In the four sub-studies it was confirmed that the pulmonary artery vent is 90-100% effective in retrieving any cardioplegic solution not drained by the atriocaval cannulae, thus confirming the effectiveness of the pulmonary artery vent in preventing cold blood cardioplegic solution from entering the lungs. The findings of the main study confirmed that respiratory impairment after uncomplicated cardiopulmonary bypass, even in low risk patients, is relatively common, as within each group there was a significant change in outcome measures over time. Inter-group comparisons however showed these changes were not significant, with both groups deteriorating by the same degree post-operatively, therefore establishing that these changes were independent of the intervention of the pulmonary artery vent. In the control group, the cold blood cardioplegia solution that did not drain from the atriocaval cannula entered the lungs and circulated the lung parenchyma during cardiopulmonary bypass. The study group made certain that none, or very little, of the cold blood cardioplegia solution entered the lungs. The main findings of this study are therefore that pulmonary function and gas exchange, although markedly reduced following cardiac surgery, are not affected by placement and suctioning via a pulmonary artery vent during the time of cardioplegia delivery intraoperatively. Furthermore, these studies strongly suggest that cold blood cardioplegia solution is innocuous to the lungs / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2006.