O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

Vinte e seis pacientes com cardiomiopatia hipertrófica e fatores de risco de morte súbita, foram submetidos a implante de cardioversor-desfibrilador implantável de dupla-câmara, com seguimento médio de 19 meses. Observou-se quatro choques em arritmias letais, 4 pacientes apresentaram TVNS e 5 taquiarritmias supraventriculares. Ocorreu um óbito.Conclusões: Observamos: TPSV em 19,2%; TVNS em 15,4% e TVS/FV em 15,4%. Nenhuma variável clínica ou demográfica, discriminou o comportamento clínico ou funcional pós-implante de CDI; a recorrência de síncope pós implante de CDI, não se associou à presença de eventos arrítmicos e a hipertrofia maior que 30 mm se associou à choque precoce do CDI (p=0,003). / During 19 months of average follow-up period, we followed 26 patients with hypertrophic cardiomyopathy and high risk for sudden death, all treated by dual chamber implantable cardioverter-defibrillator. 4 patients had received appropriate ICD discharge, 4 patients with NSVT and 5 supraventricular arrhythmias. One death had occurred. Conclusions: we observed: supraventricular arrhythmias in 19,2%; NSVT in 15,4% and VT/VF in 15,4%. The clinical or demographic outcomes did not suggest any clinical or functional results after ICD implantation; syncope may occur after ICD implantation and no arrhythmias recordered by intracardiac electrograms and left-ventricular-wall thickness greater than 30 mm is associated with early ICD shocks (p=0,003).

Abstrakt Bakgrund: Användning av i implanterbar kardioverter-defibrillator (ICD) och pacemaker ökar i samhället då fler överlever hjärtkomplikationer. Många av dessa patienter överlever genom att patienten har fått en pacemaker eller ICD implanterad. Samtidigt som implanterbar kardioverter-defibrillator ökar så ökar även MR-undersökningarna i samhället. MR - modaliteten är en undersökning som inte ger patienter joniserande strålning samt ger denna modalitet bättre bildkvalité på människans mjukvävnader till jämförelse med en DTundersökning. MR - undersökningarna har blivit en populär metod att diagnostisera patienter och även patienter med pacemaker eller ICD. Trots detta har externa magnetfältet påverkat pacemakern och ICD till den grad att patienter har avlidit. Syftet: Syfte med studien är att belysa befintlig kunskap om säkerhetsrutiner och risker vid MR-undersökningar av patienter som har pacemaker eller implanterbar kardioverter-defibrillator. Metod: Studien genomfördes som en allmän litteraturöversikt. Artikelsökningar gjordes i databaserna Pubmed och Cinahl. Tolv kvantitativa artiklar valdes som sedan granskades och analyserades för att svara mot syftet. Resultat: Säkerhetsrutiner och risker kring pacemaker och ICD sammanställdes i två huvudkategorier vilka är säkerhetsrutiner och risker. Slutsats: I röntgensjuksköterskans yrkesroll är det viktigt att följa det lokala säkerhetsrutiner såsom att följa sjukhusets protokoll och att ha bra kommunikation med patienter med pacemaker eller ICD för att följa upp så patienten inte får några symtom under eller efter undersökningen. Genom att följa dessa säkerhetsrutiner förebygger vårdpersonalen symtom hos patienter och riskerna minimeras. / Abstract Introduction: The use of implanted cardiovascular devices such as pacemaker and ICD is increasing in society as more people survive cardiac complications. Many of these patients survive by having a pacemaker or ICD implant. While implanted cardiovascular devices are increasing, so are MRI scans in society. MRI is an examination that does not give patients ionizing radiation and provides better image quality of human soft tissues compared to CT scan. MRI scans have become a popular method of diagnosing patients and also patients with pacemaker or ICD. Despite this the external magnetic field affects the pacemaker and ICD to the point where patients have died. Aim:The purpose of the study is to shed light on existing knowledge about safety routines and risks in MRI examinations of patients who have a pacemaker or implantable cardioverter-defibrillator. Method: The study was conducted as a general literature overview. Article searches were made in the Pubmed and Cinahl databases. Twelve quantitative articles were selected which were then reviewed and analysed to meet the purpose. Results: Safety routines and risks around pacemaker and ICD were compiled into two main categories, which are safety routines and risks. Conclusion: In the professional role of the radiographer, it is important to follow local safety procedures such as following hospital protocols, monitoring and also having good communication with patients who have pacemaker or ICD during and after examinations so the patient does not experience any symptoms. By following these safety procedures the healthcare professionals will minimize the risks and symptoms in patients with cardiovascular implantable during and after MRI scan.

Bakgrund: Årligen drabbas cirka 5000 personer i Sverige av ett hjärtstopp utanför sjukhus. Tidig start av hjärt- och lungräddning är en förutsättning för ökad överlevnad vid ett hjärtstopp, samtidigt visar forskning på att ambulansens framkörningstid har ökat. I väntan på ambulans har sms-livräddare implementerats för att påbörja livräddande åtgärder. I dagsläget finns få studier gjorda på sms-livräddares erfarenheter och insatser vid accepterat hjärtstoppslarm, för att synliggöra hinder och eventuella fysiska och psykiska påfrestningar som de kan möta. Vid ett hjärtstopp arbetar ambulanssjuksköterskan och sms-livräddare tillsammans i team, detta gör det viktigt för ambulanssjuksköterskan att ha en ökad förståelse för sms-livräddares erfarenheter.  Syfte: Studiens syfte var att beskriva sms-livräddares erfarenheter och insatser i samband med ett accepterat hjärtstoppslarm. Metod: En blandad metod enkätstudie med en explorativ sekventiell design användes. Materialet utgick från 1231 enkäter som samlats in av Heartrunner Sweden. Materialet analyserades i tre faser. Resultat: Resultatet visade på att sms-livräddare möttes av flera hinder som medförde att deras insatser försvårades eller uteblev. Resultatet resulterade i fyra kategorier: Erfarenheter av utlarmning, Hjärtstartare, Samverkan i team och emotionella reaktioner. Sms-livräddare upplevde många känslor i samband med larmet som visade på ett eventuellt behov av debriefing. Slutsats: Trots negativa erfarenheter var 99,9% av sms-livräddarna motiverade att fortsätta sina insatser i framtiden. Resultatet tyder på att sms-livräddare hade en viktig roll i samverkan med ambulans och räddningstjänst. Sms-livräddare kunde behöva mer bekräftelse för deras insatser och stöttning för eventuella känslor som kunde uppkomma vid larm om misstänkt hjärtstopp utanför sjukhus. / Background: Every year, approximately 5000 people in Sweden suffer an out-of-hospital cardiac arrest. Early start of cardiopulmonary resuscitation is a prerequisite for increased survival in a cardiac arrest, while research shows that ambulance arrival time has increased. While waiting for an ambulance, mobile-phone dispatch of laypersons has been implemented to initiate life-saving measures. At present, few studies have been conducted on the experiences and interventions of mobile-phone dispatch of laypersons in the event of an accepted cardiac arrest alarm, in order to highlight obstacles and any physical and psychological stresses that they may face. In a cardiac arrest, the ambulance nurse and mobile-phone dispatch of laypersons work together in teams, this makes it important for the ambulance nurse to have an increased understanding of mobile-phone dispatch of laypersons ' experiences. Aim: The aim of the study was to describe mobile-phone dispatch of laypersons experiences and interventions in connection with an accepted cardiac arrest alarm. Method: A mixed method survey study with an explorative sequential design was used. The material was based on 1231 questionnaires collected by Heartrunner Sweden. The material was analysed in three phases. Results: The results showed that mobile-phone dispatch of laypersons were faced with several obstacles that made their interventions difficult or absent. The study resulted in four categories: Experience in emergency response, defibrillators, teamwork and emotional reactions. Mobile-phone dispatch of laypersons experienced many emotions in connection with the alarm, indicating a possible need for debriefing. Conclusion: Despite negative experiences, 99.9% of mobile-phone dispatch of laypersons were motivated to continue their interventions in the future. The result suggests that mobile-phone dispatch of laypersons had an important role in collaboration with ambulance and rescue services. Mobile-phone dispatch of laypersons could benefit from more acknowledgement of their interventions and support for any emotions that may arise when a suspected cardiac arrest is reported outside a hospital.

L'arrêt cardiaque est principalement d'étiologie cardio-vasculaire. Dans le contexte actuel des arrêts cardiaques extrahospitaliers, 20 à 25% des victimes présentent une fibrillation ventriculaire. Environ 3 à 5% des personnes sont sauvées sans séquelle neurologique. La survie à un arrêt cardiaque extrahospitalier dépend d'une prise en charge précoce et rapide de la victime. Les premiers témoins actifs réalisant la réanimation cardio-pulmonaire combinée à l'utilisation d'un défibrillateur sont ainsi un maillon important pour sauver la victime.Notre objectif principal est d'améliorer le taux de survie à un arrêt cardiaque extrahospitalier. Une première voie d'investigation est de proposer un fonctionnement de défibrillateur optimal combinant judicieusement les différents modules de détection embarqués (détection de fibrillation ventriculaire, détection de massage cardiaque, détection d'interférences électromagnétiques) afin de réduire les temps de pause péri-choc durant la procédure de réanimation. En effet, pendant ces temps, dits « hands-off » en anglais, aucun geste de secours n'est administré au patient qui, lui, voit d'une part sa pression de perfusion coronarienne chuter, d'autre part la probabilité de succès des tentatives de défibrillation décroître. C'est pourquoi une deuxième voie d'investigation porte sur la prédiction de l'efficacité de choc. Dans ce contexte, nous proposons de combiner des paramètres de l'électrocardiogramme dans les domaines temporel, fréquentiel et de la dynamique non-linéaire. Un classifieur bayésien utilisant le modèle de mélange de gaussiennes a été appliqué aux vecteurs de paramètres les plus prédicteurs de l'issue de la défibrillation et l'algorithme Espérance-Maximisation a permis de mener à bien la procédure d'apprentissage des paramètres du modèle probabiliste représentant les distributions conditionnelles de classe.L'ensemble des méthodes proposées a permis d'atteindre des résultats prometteurs pour à la fois réduire les temps de pause péri-choc et prédire l'efficacité de défibrillation et ainsi espérer améliorer le taux de survie à un arrêt cardiaque / The cardiac arrest is mainly of cardiovascular etiology. In the actual context of out-of-hospital cardiac arrests, 20 to 25% of the victims present a ventricular fibrillation. About 3 to 5% of the victims are saved without neurological damage. The chance of surviving a cardiac arrest outside an hospital depends on the early and fast support of the victim. The first active witnesses performing cardiopulmonary resuscitation combined with the use of a defibrillator are an important link to save the victim.Our main objective is to improve survival rate in out-of-hospital cardiac arrest cases. A first way of investigation is to propose an optimal functioning of defibrillator combining wisely the different processes of detection embedded (ventricular fibrillation detection, chest compressions detection, electromagnetic interferences detection), in order to reduce the peri-shock pauses during the resuscitation procedure. In fact, during these pauses, known as "hands-off" pauses, no emergency action is provided to the patient, what is correlated to a drop of the coronary pression, but also to a decrease of the chance of successful defibrillation. That is the reason why, a second way of investigation is based on the prediction of the efficiency of defibrillation. In this context, we propose to use a combination of parameters extracted from electrocardiogram in time, frequency and non-linear dynamics domains. A bayesian classifier using a gaussian mixture model was applied to the vectors of parameters, which are the most predictor of the defibrillation outcome and the algorithm Expectation-Maximization allowed to learn the parameters of the probabilistic model representing the class conditional distributions.All of the proposed methods allowed to reach promising results for both reducing the peri-shock pauses and predicting the efficiency of defibrillation in hope to improve the survival rate in cardiac arrest cases