ABSTRACT Background Sudden cardiac arrest in young athletes is a tragic event that can potentially be reduced through the implementation of a pre-participation screening program. While the absolute contents of this program are debated, consensus does exist, that should such a program be implemented, a reduction in mortality will be found. The emphasis of any pre-participation screening is found in a history and basic physical examination, with or without routine electrocardiogram testing. This is based on the understanding that 90% of sudden cardiac arrests are attributable to an underlying cardiac pathology with the majority being hypertrophic cardiomyopathy. Debate continues around the cost effectiveness of such a program but there is no doubt that in a society that is promoting an active lifestyle and with the pressure of competitive sport at most schools, there is likely to be zero tolerance for not being able to screen for potentially lethal cardiac pathology.

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).

Information was collected in an eight and a half month prospective study about 358 recent cardiac disease-related cardiac arrest cases which were attended by personnel from the Provincial Ambulance Service in the Lower Mainland of British Columbia. When possible, advanced life support personnel (EMA Ills), regular ambulance attendants (EMA Ms) and Fire Department staff are dispatched to cardiac arrest calls. At the time of this study some areas in the region did not have advanced life support coverage, and some cardiac arrest calls occurred while the EMA Ills were already engaged with another case. Such calls, attended by EMA lis, but not by EMA Ills, served as the comparison group for paramedic performance in this study. Patient outcomes were compared at admission to hospital and at discharge from hospital for the group of patients treated by EMA Ms and the group of patients treated by EMA Ills, or by a combination of EMA Ills and EMA Ms. Strongly significant differences in initial outcome (hospital admission) were found between the two patient groups, with EMA IM patients faring better (p.=0.002). Marginally significant differences in final outcome (discharge alive) between the two patient groups were found, with the EMA III group again doing better (p.=0.10). Whether or not the receiving hospital had a coronary care unit was not associated with a difference in initial (p.=0.45) or final outcome (p.=1.0) for the entire group of patients in the study. Short time in arrest without CPR was associated with better initial outcome (p.=0.00), and with better final outcome (p.=0.01) for all patients. in the study, as was short time to definitive care (initial outcome p.=0.001; final outcome p.=0.03). EMA II patients had a better chance of survival when they arrested during attendance by EMA lis than they did when they were found in arrest. This study suggests that significantly more cardiac arrest victims reach hospital alive, and more survive to be discharged alive from hospital, when their prehospital treatment is provided by advanced life support personnel than when it is provided by regular ambulance personnel. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Background: The incidence of ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) treated by first responders has declined over the past decade. Since VF OHCA occurs primarily in the setting of severe coronary artery disease, primary and secondary prevention strategies may in part account for the decline. However, such strategies may not have a similar impact on non-ischemic arrest. Methods: All Rochester Minnesota residents who presented with a VF OHCA from 1991 to 2004, treated by emergency medical services (EMS), were included in the study. Incidence rates were calculated based on the population for Rochester during the time period. Changes over time were tested using Poisson regression models. The significance of the trends was estimated according to the Mantel-Haenszel test for association, and two-tailed p-values reported. Results: The overall incidence of EMS-treated VF OHCA in Rochester during the study period was 10.6 per 100,000 (95% CI 9.1-11.8). The incidence decreased significantly (p < 0.001) over the study period [1991-1994: 18.2/100,000 (95% CI 13.4-21.9); 1995-1999: 11.8/100,000 (95% CI 10.4-17.9); 2000-2004: 8.7/100,000 (95% CI 6.0-13.0)]. The incidence of VF OHCA with ischemic heart disease also declined [1991-1994: 13.4/100,000 (95% CI 8.9-16.9); 1995-1999: 11.1/100,000 (95% CI 8.2-15.9); 2000-2004: 5.5/100,000 (95% CI 3.8-8.2), p < 0.001]. In contrast, the incidence VF OHCA with non-ischemic heart disease increased [1991-1994: 2.1/100,000 (95% CI 1.13-3.1); 1995-1999: 2.3/100,000 (95% CI 1.9-3.7); 2000-2004: 2.9/100,000 (95% CI 2.0-3.4), p < 0.001]. Conclusion: The incidence of VF OHCA is declining. The decline is attributable to the reduction of VF cardiac arrest with ischemic heart disease; suggesting an impact of treatment strategies targeted at coronary artery disease. The relative increasing incidence of non-ischemic VF OHCA suggests that more efforts are required to minimize mortality in this cohort population.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 123-130).

No description available.

Thesis (Ph. D.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 209-255).

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 5 uppsatser.