京都大学 / 新制・課程博士 / 博士(医学) / 甲第23068号 / 医博第4695号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 大鶴 繁, 教授 福田 和彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems. Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis. Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families. Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-07-13T12:02:18Z No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-07-18T12:59:17Z (GMT) No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Made available in DSpace on 2018-07-18T13:04:40Z (GMT). No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) Previous issue date: 2018-04-12 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Aim of the Study: The purpose of this study was to develop and validate a serious game for mobile platforms comparing with a video-assisted self-learning method to assist in the teaching and learning process of cardiopulmonary resuscitation (CPR) maneuvers. In a traditional training, CPR is based on learning by doing using a simulated model with the assistance of an instructor. However, this model presents an overall higher cost and less accessibility, provoking the need for cheaper and more accessible alternative methods. Methods: Forty-five volunteer first-year medical students completed a written multiple choice and practical pretest about CPR maneuvers skills and were randomly allocated into two groups. During a period of 20 minutes, the video self-learning group with 22 students was exposed to a video-based training about CPR, while the video game group with 23 students used a serious game simulating a cardiac arrest scenario where the student should perform virtual CPR to keep playing the game. Each group then performed, a written multiple choice score and practical post-test on a CPR training model while being evaluated by three blinded emergency doctors based on 2015 AHA-BLS (American Heart Association - Basic Life Support) protocol. Both groups were also evaluated about how long they kept interested on each self-learning system. Results: The video group had superior performance as confirmed by a written multiple choice score 7.56+-0.21 against 6.51+-0,21 for a video game (p=0. 001) and practical scores 9.67+-0.21 against 8.40+-0,21 for a video game (p<0. 001). The video game group stayed longer using the method as confirmed by 18.57+- 0,66 minutes for video game group and 7.41+-0,43 for the video group (p<0. 001), demonstrating greater interest in the video game method. Conclusions: The group that used a video game as a self-training method in a short period of exposure had a lower performance than the video group in both the theoretical and practical tests regarding cardiorespiratory resuscitation. However, there was a clear preference for students to use games rather than videos as a form of self-training. / Objetivo do estudo: O objetivo deste estudo foi desenvolver e validar um jogo s?rio para plataformas m?veis em compara??o com um m?todo de autoaprendizagem assistido por v?deo para auxiliar no processo de ensino e aprendizagem das manobras de ressuscita??o cardiopulmonar (RCP). Em um treinamento tradicional, a RCP ? baseada no aprendizado pela pr?tica, utilizando um modelo simulado com a ajuda de um instrutor. No entanto, este modelo apresenta um custo global mais elevado e de menor acessibilidade, despertando a necessidade de m?todos alternativos mais baratos e pratic?veis. M?todos: Quarenta e cinco volunt?rios, estudantes de medicina do primeiro ano, completaram um pr?-teste de m?ltipla escolha escrito e um pr?-teste pr?tico sobre RCP e foram alocados aleatoriamente em dois grupos. Durante um per?odo de 20 minutos, o grupo de autoaprendizagem v?deo, composto por 22 alunos, foi exposto a um v?deo de treinamento sobre a RCP, enquanto o grupo videogame, composto por 23 estudantes, utilizou um jogo s?rio, simulando um cen?rio de parada card?aca, onde o aluno deveria executar uma RCP virtual para continuar jogando. Ao t?rmino do treinamento, cada grupo foi submetido a um p?s-teste escrito de m?ltipla escolha e um p?s-teste pr?tico em um modelo de treinamento de RCP, sendo avaliados de forma cegada, por tr?s m?dicos com experi?ncia em atendimento de emerg?ncia, com base no protocolo 2015 AHA-BLS (American Heart Association - Basic Life Support). Ambos os grupos tamb?m foram avaliados quanto a quantidade de tempo que eles permaneciam interessados em cada sistema de autoaprendizagem. Resultados: O grupo v?deo apresentou desempenho superior confirmado por uma maior pontua??o no teste escrito de m?ltipla escolha, 7.56 + -0.21 contra 6.51 + -0,21 para videogame (p = 0. 001) e pontua??o no teste de avalia??o pr?tica 9,67 + -0,21 contra 8,40 + -0,21 para videogame (p <0. 001). O grupo videogame permaneceu mais tempo utilizando o m?todo, 18,57 + - 0,66 minutos para o grupo videogame e 7,41 + -0,43 para o grupo v?deo (p <0. 001), demonstrando maior interesse no m?todo do videogame. Conclus?es: O grupo que usou o jogo s?rio (grupo videogame) como um m?todo de autotreinamento em um curto per?odo de exposi??o teve um desempenho pior do que o grupo v?deo nos testes te?ricos e pr?ticos em rela??o ? ressuscita??o cardiopulmonar. No entanto, houve uma clara prefer?ncia por parte dos alunos em utilizar jogos em rela??o aos v?deos como forma de autotreinamento.

Bakgrund: Dödligheten vid hjärtstopp utanför sjukhus är hög och endast några få procent av de som drabbas räddas till livet. Tidig behandling är en avgörande faktor för överlevnad. Överlevnaden kan ökas markant av att människor på platsen, bystanders, ingriper med hjärt-lungräddning (HLR). Att vårda och utföra vårdhandlingar är inte exklusivt för sjuksköterskor. Vid hjärtstopp utanför sjukhus är det istället bystandern som förväntas utföra vårdhandlingen. I många fall sker dock inget ingripande trots att hjärtstoppet bevittnas och den vårdande handlingen uteblir därför. Syfte: Syftet med arbetet var att identifiera faktorer som påverkar människors vilja att ingripa vid hjärtstopp utanför sjukhus. Metod: Arbetet designades som en litteraturstudie där artiklar med både kvantitativ och kvalitativ ansats ingick. Resultat: Resultatet baserades på potentiella bystanders antaganden av hur de skulle agera och faktiska bystanders erfarenheter av att ha agerat. Skillnader i faktorer som påverkade viljan observerades mellan dessa. Viljan påverkades till stor del av rädslor, bristande HLR-kunskaper samt scenariot kring hjärtstoppet där bland annat en familjerelation mellan den drabbade och bystandern utgjorde en påverkande faktor. Slutsats: Resultatet visar att hindrande faktorer för viljan skulle kunna påverkas positivt genom förbättrad HLR-utbildning. Klinisk betydelse: Med hjälp av identifierade faktorer kan befintlig HLR-utbildning ses över och eventuellt förbättras. Detta skulle kunna öka antalet ingripanden och därigenom överlevnaden vid hjärtstopp utanför sjukhus. / Background: The lethality is high in out-of-hospital cardiac arrests and only a few percent of the victim’s lives are saved. Early treatment is crucial for survival. People at the scene can increase the survival significantly through CPR interventions. To care and the act of caring is not exclusively for nurses. In cases of out-of-hospital cardiac arrest, the bystander could be the one that performs the act of caring. In many cases, however, no interventions are made although the arrest is witnessed and therefore no act of caring is being performed. Objective: The aim of this essay was to identify factors that influence people's willingness to intervene in out-of-hospital cardiac arrest. Method: This study was designed as a literature study and both quantitative and qualitative research articles were included in the analysis. Results: The result was based on potential bystander's assumptions of how they would act and actual bystanders experience having acted. Differences in factors affecting the willingness were observed between them. The will seemed influenced by fears, lack of CPR skills and the scenario surrounding the arrest. A family tie between the victim and the bystander appeared also as an influencing factor. Conclusion: The findings show that the non-willingness to act could be affected positively by improved CPR training. Clinical significance: In light to the identified factors, improvement of the existing CPR training and increased education could improve the probability of intervention by bystanders and out-of-hospital cardiac arrest survival.

Bakgrund: Trots omfattande forskning avlider 9 av 10 patienter till följd av ett prehospitalt hjärtstopp i Sverige. När en person drabbas av plötsligt hjärtstopp krävs snabba åtgärder och tiden till hjärt- och lungräddning påbörjas är livsavgörande. Vårdmiljön är stressfull och komplext, vilket kan få konsekvenser för vårdandet. För den drabbade innebär ett hjärtstopp att personen blir sårbar och utlämnad till sin omgivning samtidigt som det är en traumatiskt och svår händelse för närstående att få bevittna. Det krävs därför att ambulanspersonalen, förutom att ta omedelbara beslut som kan vara livsavgörande, även måste ha ett etiskt förhållningssätt och goda kunskaper i omvårdnad. Syfte: Studiens syfte var att beskriva vårdprocessen vid prehospitalt hjärtstopp hos vuxna patienter.  Metod: Studiens genomförande var en litteraturöversikt med en integrerad analys. Datainsamlingen resulterade till att 15 kvalitativa och kvantitativa vetenskapliga artiklar inkluderades. Artikelsökningar genomfördes utifrån sökord i Cinahl Complete och PubMed.  Resultat: Bearbetningen av artiklarna resulterade i fyra kategorier och 11 underkategorier. När larmet kommer och vårdmötet inleds, Att ta rätt beslut för patienten, Ett värdigt avslut, Ett krävande ansvar för att kunna ge bra vård. Det var viktigtmed mental förberedelse för att kunna ge god vård, förutfattade intryck kunde riskerade att få konsekvenser för patienten. Att skapa ett skyddat vårdutrymme samt skapa tillit och låta närstående vara delaktig belystes, dock kunde den kaotiska och krävande situationen vara ett hinder för detta. Ett patientperspektiv var avgörande för att ta rätt beslut för patienten, gråzoner, etiska dilemman och närståendes förhoppningar kunde dock skapa ett onödigt lidande för patienten. Det var viktigt att skapa ett värdigt avslut för patienten och hantera den avlidnes kropp med respekt. Närståendes behov av omsorg sågs som en del i vårdandet, men krävde att ambulanspersonalen kunde låta sig själv påverkas. Rädsla eller osäkerhet att möta närstående deras sorg kunde få konsekvenser för deras behov av stöd. Vårdmötet innebar påfrestningar för ambulanspersonalen, för att kunna ge en god och professionell vård krävdes organisatoriskt och kollegialt stöd samt regelbunden utbildning. Vikten av erfarenhet belystes. Slutsats: Vårdprocessen vid hjärtstopp hos vuxna patienter prehospitalt kan vara varierande beroende på situation och patientens vård påverkas av flera olika faktorer. Det fanns en stark vilja att värna om patientens värdighet och integritet samt närståendes behov av stöd och omsorg. Att ta livsavgörande beslut var en tung börda vilket kräver erfarenhet och självsäkerhet i sin yrkesroll. Faktorer som gråzoner, tvivel, osäkerhet och påfrestningar på ambulanspersonalen kunde dock medföra onödigt lidande för patienten och att närståendes behov av omsorg åsidosattes under hjärt- och lungräddning. Studien betonar vikten och belyser brister i patientens och närståendes omvårdnadsbehov vid hjärtstopp prehospitalt. / Background: Despite extensive research, 9 out of 10 patients die as a result of an out-of- hospital cardiac arrest in Sweden. When a person suffers a sudden cardiac arrest, rapid action is required and the time for cardiopulmonary resuscitation to begin is vital. The care environment is stressful and complex, which can have consequences for caring. For the victim, a cardiac arrest means that the person becomes vulnerable and extradited to their surroundings at the same time as it is a traumatic and difficult event for close relatives to witness. It is therefore required that the ambulance staff, in addition to making immediate decisions that can be life-changing, also must have an ethical approach and good knowledge of nursing. Aim: The aim of the study was to describe the caring process in out-of-hospital cardiac arrest in adult patients. Method: The study was conducted as a literature review with an integrated analysis. The data collection resulted in the inclusion of 15 qualitative and quantitative scientific articles. Article searches were performed based on keywords in Cinahl Complete and PubMed. Result: The processing of the articles resulted in four categories and 11 subcategories. The main categories were; When the alarm goes off and the care meeting begins, To make the right decision for the patient, A dignified end, A demanding responsibility to be able to provide good care. Mental preparation was important in order to provide good care, predetermined impressions could risk having consequences for the patient. Creating a protected care space as well as creating trust and letting relatives be involved was highlighted, however, the chaotic and demanding situation could be an obstacle to this. A patient- perspective was crucial for making the right decision for the patient, gray areas, ethical dilemmas and relatives' hopes could, however, create unnecessary suffering for the patient. It was important to create a dignified ending for the patient and treat the deceased's body with respect. Relatives' need for care was seen as part of the care process, but required that the ambulance staff could allow themselves to be influenced. Fear or insecurity in facing relatives' grief could have consequences for their need for support. The care meeting meant stress for the ambulance staff, in order to be able to provide good and professional care, organizational and collegial support was required, as well as regular training. The importance of experience was highlighted as very important. Conclusion: The caring process in out-of-hospital cardiac arrests in adult patients vary depending on the situation and the patient's care is affected by several different factors. There was a strong will to protect the patient's dignity and integrity as well as the relatives' needs for support and care. Making life-changing decisions was a heavy burden, which requires experience and self-confidence in one's professional role. However, factors such as gray areas, doubts, insecurity and stress among the ambulance staff could lead to unnecessary suffering for the patient and that relatives' need for care was ignored during cardiopulmonary resuscitation. The study emphasizes the importance and highlights shortcomings in the patient's and relatives' care needs in the event of an out-of-hospital cardiac arrest.

Bakgrund: Dagligen drabbas mer än 25 personer av hjärtstopp utanför sjukhus där ungefär 500 av dessa räddas årligen. Luftvägshanteringen är en av de viktigaste faktorerna under hjärt-och lungräddning och en obehandlad hypoxi i samband med hjärtstopp ökar risken för att patienten kan erhålla neurologiska skador. Enligt Erikssons omvårdnadsteori kan olika former av lidande upplevas, men när kroppen, själen och anden är i balans uppnås hälsa. För att hantera luftvägen kan ambulanspersonal använda sig utav mask-och blåsa eller larynxmask. Endotrakeal intubation är även ett alternativ, men kräver särskild kompetens i Sverige vilken främst specialistsjuksköterska inom anestesisjukvård innehar. Studier visar på en låg procentuell framgång för antal lyckade försök gällande utövandet av endotrakeal intubation prehospitalt och att larynxmask numera används i stället av ambulanspersonalenför att den kan appliceras snabbt och enkelt. Syfte: Syftet var att belysa om förekommande luftvägshjälpmedel vid hjärtstopp utanför sjukhus kan påverka patientens utfall vid återkomst av spontan cirkulation. Metod: Litteraturöversikt med systematisk ansats. Cinahl plus och PubMed har använts som databassökning. Totalt 15 artiklar av kvantitativ metod inkluderades. Artiklarna har därefter analyserats genom integrerad analys. Resultat: De signifikanta huvudfynden som framkom med var att luftvägshantering med mask-och blåsa påvisade en hög prevalens för gynnsamt neurologiskt utfall och överlevnad medan endotrakeal intubation påvisade en högre prevalens för återgång av spontan cirkulation. Slutsats: Utifrån resultatet visade sig användning av mask-och blåsa ge mest utdelning för att uppnå ett gynnsamt neurologiskt utfall och ökad chans till överlevnad för patienten. Däremot framkom det att användning av endotrakealtub vid prehospitalt hjärtstopp medförde störst chans till återkomst av spontan cirkulation. Av de tre förekommande luftvägshjälpmedlen att använda sig av vid prehospitalt hjärtstopp kan det förekomma skillnader i utfallet för patienten. Det förekommer däremot inte tillräckligt med stora skillnader och resultatet bördärmed tolkas med försiktighet då det anses behövas fler studier inom området. / Background: Every day more than 25 people suffer from out-of hospital cardiac arrest, of which approximately 500 rescued annually. Airway management is one of the most important factors in cardiopulmonary resuscitation and an untreated hypoxia in conjunction with cardiac arrest increases the patient’s risk of receiving neurological damage. According to Eriksson's nursing theory, various forms of suffering can be experienced, and a state of health can only be achieved when the body, soul and spirit are in balance. To manage the airway, the ambulance clinician can use a bag-valve mask or laryngeal mask. Endotracheal intubation is also an alternative, but in Sweden, it requires specific competence that mainly specialist nurses in anesthesia care possess. Studies shows a low success rate regarding the practice of performing a prehospital endotracheal intubation and that laryngeal mask nowadays more used instead by ambulance staff because it’s applied quickly and easily. Aim: The purpose was to shed light on whether the available respiratory aids in out-of-hospital cardiac arrest can affect the patient outcomes on the return of spontaneous circulation. Method: Literature overview with systematic approach. Cinahl plus and PubMed has been used as database search. A total of 15 articles of quantitative method were included. The articles were analyzed through integrated analysis. Results: The significant main findings that emerged were that airway management with bag-valve mask correlated with a high prevalence for favorable neurological outcome and survival while endotracheal intubation showed a higher prevalence for return of spontaneous circulation. Conclusion: Based on the results, the use of bag-valve mask found to be the best option to achieve a favorable neurological outcome and increased chance of survival for the patient. However, the use of endotracheal tube in out-ofhospital cardiac arrest for increasing the chance of the patient regaining return of spontaneous circulation. Out of the three available airway aids to use in out-of-hospital cardiac arrest, there may be differences in the outcome for the patient. However, there are not enough significant differences, and the result therefore should be interpreted with caution as it is considered that more studies in the subject required.

En person som drabbas av hjärtstopp utanför sjukhus är beroende av att skyndsamt erhålla högkvalitativ hjärt-lungräddning för bästa möjliga förutsättningar till överlevnad. Bröstkompressioner behöver utföras med få avbrott för att anses högkvalitativa. Tidigare forskning indikerar att manuella bröstkompressioner kan hålla otillräcklig kvalitet. Hjälpmedel som utför mekaniska bröstkompressioner har tagits fram och utvecklats som alternativ till manuella bröstkompressioner. I Sverige har ambulanssjuksköterskor en möjlighet att använda sig av hjälpmedlet LUCAS för att utföra mekaniska bröstkompressioner. Forskning inom området har främst haft en medicinsk inriktning. Det saknas tillräcklig forskning om ambulanssjuksköterskors upplevelser i samband med hjärt- lungräddning och användande av mekaniska bröstkompressioner. Syftet med studien var att beskriva ambulanssjuksköterskors upplevelser av att utföra hjärt- lungräddning med det mekaniska bröstkompressionshjälpmedlet LUCAS. Studiens metod var beskrivande och utgick från en kvalitativ induktiv ansats. Urvalet var ändamålsenligt och bestod av tio sjuksköterskor med specialistutbildning med inriktning ambulanssjukvård yrkesverksamma i ett län i Mellansverige. Intervjuerna genomfördes utifrån en semistrukturerad intervjuguide och analyserades med kvalitativ innehållsanalys. Resultatet presenteras genom en huvudkategori, tre generiska kategorier och åtta subkategorier. Ambulanssjuksköterskor upplevde att LUCAS är en omvårdnadsresurs med betydelse för personal och patient. Ambulanssjuksköterskor beskrev att övning och utbildning krävs för korrekt handhavande, att LUCAS påverkar arbetsmiljö och patientsäkerhet och att LUCAS skapar andra förutsättningar för personalen. Slutsatsen var att denna studie visade att LUCAS är ett betydelsefullt och uppskattat mekaniskt hjälpmedel bland ambulanssjuksköterskor när de utför hjärt-lungräddning utanför sjukhus. Ambulanssjuksköterskor föredrog mekaniska bröstkompressioner framför manuella bröstkompressioner trots en medvetenhet om att behandling med mekaniskt hjälpmedel enligt tidigare forskning inte kunnat påvisa någon ökad patientöverlevnad. Istället beskrev ambulanssjuksköterskor att de vid bruk av LUCAS upplevde fördelar som hade betydelse för dem och deras arbetsmiljö, fördelar som inverkade på arbetssätt och säkerhet. Bland annat kunde ambulanssjuksköterskor använda bilbälte och således färdas säkert samtidigt som patienten erhöll högkvalitativa bröstkompressioner utförda av LUCAS. Utifrån studiens resultat kan det vara av vikt att verksamheter som bedriver ambulanssjukvård tar större hänsyn till ambulanssjuksköterskors perspektiv vid implementering, utveckling och utvärdering av ett mekaniskt hjälpmedel. / A person suffering from out-of-hospital cardiac arrest is dependent on promptly receiving high qualitative cardiopulmonary resuscitation for best possible survival outcome. Chest compressions need to be performed with few interruptions to be considered of high quality. Previous research indicates that manually performed chest compressions can be of inadequate quality. Aids that perform mechanical chest compressions have been developed as an alternative to manual chest compressions. In Sweden, ambulance nurses have the possibility to use the aid LUCAS to perform mechanical chest compressions. Research in the field has mainly been having a medical focus. There is insufficient research on ambulance nurse's experiences associated with cardiopulmonary resuscitation and the use of mechanical chest compression aids. The aim of the study was to describe the ambulance nurse's experience of performing cardiac pulmonary resuscitation with the mechanical chest compression aid LUCAS. The method of the study was descriptive and based on a qualitative inductive approach. The sample was convenient and consisted of ten nurses with a specialist nursing degree focusing on ambulance care working in central Sweden. The interviews were conducted based on a semi-structured interview guide and analyzed with qualitative content analysis. The result is presented by a main category, three generic categories and eight subcategories. Ambulance nurses find that LUCAS is a nursing resource of importance for staff and patients. Ambulance nurses described that exercise and training is required for proper handling, that LUCAS affects the work environment and patient safety and that LUCAS creates other conditions for the staff. The conclusion was that this study showed that LUCAS is an important and appreciated mechanical device among ambulance nurses when performing cardiopulmonary resuscitation outside hospitals. Ambulance nurses preferred mechanical chest compressions in front of manual chest compressions despite the awareness that treatment with mechanical devices in previous research has not been able to demonstrate increased patient survival. Instead, ambulance nurses described that, when using LUCAS, they perceived benefits that were important to them and their working environment, benefits that affect working methods and safety. Among other things, ambulance nurses could use seat belts and thus travel safely while the patient received high quality chest compressions performed by LUCAS. Based on the results of the study it may be important that ambulance services pay more attention to the perspective of the ambulance nurse in the implementation, development and evaluation of a mechanical device.

Introduction: Approximately 10 000 people suffer each year from out-of-hospital cardiac arrest in Sweden. At the turn of the millennia the survival rate for out-of-hospital cardiac arrest was circa three precent and in 2022 the survival rate had increased to around eleven percent. Survivors face cognitive, psychological, and motor problems post arrest which impacts their health-related quality of life (HRQoL) – ie. their perception of their own social and physical environment and health. The research regarding HRQoL following cardiac arrest is limited. With increasing survival rates comes an increasing need for extensive research mapping the HRQoL of cardiac arrest survivors. Aim: The aim of this study was to investigate patients’ perceived health-related quality of life after surviving cardiac arrest.   Method: This study was conducted as a quantitative general literature review with an inductive content analysis. This study used articles that included the SF-36 instrument to measure the HRQoL in cardiac arrest survivors. Main- and subcategories were created based on the data extracted from the included articles. Result: Cardiac arrest patients generally experience their health-related quality of life as worse compared to the general population. Physical, psychological and social factors were identified as the main components whose effect on HRQoL was found to be the greatest. Conclusion: Cardiac arrest survivors experience a reduced HRQoL compared to the general population. The HRQoL is affected in both the psychological and physical dimensions with long term consequences. These results create a foundation for the nurse in the work to improve the HRQoL for the patient.

L’arrêt cardiaque extra-hospitalier (ACREH) touche environ 30 à 40,000 personnes en France chaque année. Dans près de la moitié des cas, la cause de l’ACREH est une occlusion coronaire aiguë provoquant un trouble du rythme ventriculaire létal. Malgré les progrès réalisés ces dernières années en terme de prise en charge pré et intra-hospitalière, le pronostic de ces patients reste sombre, de par les lésions neurologiques se produisant très rapidement après l’arrêt circulatoire. Alors que le pronostic à court terme est relativement bien décrit, les données sur le devenir à long terme, en termes de survie, mais aussi de devenir fonctionnel, neurologique, et de qualité de vie, restent rares. Objectifs : L’objectif de ce travail est de décrire le devenir à long terme des patients victimes d’un ACREH et admis vivants à l’hôpital (qualité de vie liée à l’état de santé, devenir neurologique et fonctionnel) et d’évaluer les facteurs associés à ce devenir (biomarqueurs, revascularisation coronaire précoce). Patients et méthodes : Ce travail a consisté en l’analyse des données de la cohorte des patients victimes d’un ACREH et admis vivants en réanimation mé- dicale à l’hôpital Cochin. Cette cohorte a été constituée rétrospectivement entre 2000 et 2006 sur dossiers archivés puis prospectivement selon les recommandations internationales d’Utstein depuis 2007. Les données de survie ont été collectées. Le devenir neurologique et fonctionnel et les données de qualité de vie ont été collectées lors d’entretiens téléphoniques réalisés auprès des survivants sortis vivants de l’hôpital. Résultats principaux : La mortalité globale à J30 était de 68,2%. La revascu- larisation coronaire (ATL) immédiate était associée à une mortalité à J30 plus faible (ORcoro sans ATL vs. pas coro 0,79 [0,57;1,08], p=0,14 et ORcoro avec ATL vs. pas coro 0,61 [0,43;0,85], p<0,01). Les 466 patients vivants à J30 ont été suivis pendant une durée médiane de 3,2 ans [IQR : 0,7 ;6,7], avec une durée maximale de suivi de 13,5 ans. En analyse multivariée, la revascularisation coronaire immédiate restait inversement associée à la mortalité à long terme (HRcoro sans ATL vs. pas coro 0,78 [0,45 ;1,33], p=0,35 et HRcoro avec ATL vs. pas coro 0,40 [0,23 ;0,70], p<0,01).
La copeptine a été dosée chez 298/510 patients à l’admission et chez 224 patients à J3. Le taux médian à l’admission était de 261,3 [125,2 ;478,6] pmol/L. Le taux de survie à 1 an était inversement proportionnel au quintile de copeptine à l’admission (38,2, 32,6, 27,7, 31 et 13,6%, respectivement; p<0,01). En analyse multivariée, seul le cinquième quintile de copeptine à l’admission était associé à la mortalité à 1 an (HR5ème vs. 1er 1,64 [1,06;2,58], p=0,03). Après ajustement mutuel des taux de copeptine à l’admission et à J3, le taux de copeptine à l’admission n’était plus associé à la mortalité à 1 an mais le taux de copeptine à J3 restait asso- cié à la mortalité à 1 an par une relation concentration-dépendante (HR2ème vs. 1er 1,60 [0,90-3,17], p=0,10 ; HR3ème vs. 1er 1,94 [1,01 ;3,71], p=0,05 ; HR 4ème vs. 1er 2,01 [1,04 ;3,89], p=0,04 et HR5ème vs. er 2,38 [1,19 ;4,74], p=0,01 ; p de tendance =0,02). Au cours du suivi, 255 patients ont pu être recontactés. Le délai médian de recon- tact après la survenue de l’ACREH était de 50 [22-93] mois. 66% des patients sortis de réanimation avec un score CPC coté à 1 gardaient une performance neurolo- gique préservée au moment de l’interview (n=150/231). Les dimensions physiques et mentales agrégées du SF-36 étaient similaires chez les survivants d’ACREH en comparaison avec les individus de la population générale (47,0 vs. 47,1, p=0,88 et 46,4 vs. 46,9, p=0,45, respectivement). Les patients présentaient une altération plus marquée des dimensions physiques que des dimensions mentales du score SF- 36 en comparaison avec la population générale. L’activité physique (74,1 vs. 78,4, p=0,02) et la vitalité (50,7 vs. 56,2, p<0,01) étaient les dimensions les plus altérées. (...) / Out-of-hospital cardiac arrest (OHCA) occurs in about 30-40,000 people in France each year and is related to a culprit coronary occlusion in half cases. Although pre and in-hospital management of such patients dramatically improved last years, outcome remains poor because of the neurological damage related to brain anoxia. Short-term outcome is well-described but data are lacking on long-term outcome, functionnal and neurological outcome and health-related quality of life (HRQOL). Objectives : The main purpose of this work was to describe the long-term outcome of successfully resuscitated OHCA patients admitted alive at ICU. We aimed at picking up factors associated with HRQOL as well. Patients and methods : Data from the Paris registry were used. Consecutive sucessfully resuscitated OHCA patients admitted alive at Medical ICU of Cochin hospital, Paris, France are included in the database since 2000, January 1st, accor-ding to Utstein style. We also collected survival data. Neurological and functionnal outcome, as well as HRQOL (SF-36 questionnaire) were recorded during phone in- terviews in OHCA patients discharged alive from hospital. Main results : Overall mortality at day-30 was 68.2%. Immediate percutaneous coronary intervention (PCI) was associated with day-30 mortality (ORcoro w/o PCI vs. no coro 0.79 [0.57,1.08], p=0.14 et ORcoro w/ PCI vs. no coro 0.61 [0.43,0.85], p<0.01). The 466 patients alive at day-30 were followed-up for 3.2 years [IQR : 0.7-6.7]. After adjus- tement for cofounders, immediate PCI remained associated with long-term mor-
tality (HRcoro w/o PCI vs. no coro 0.78 [0.45,1.33], p=0.35 et HRcoro w/ PCI vs. no coro 0.40 [0.23,0.70], p<0.01). Copeptin was assessed in 298/510 patients at ICU admission and in 224 patients at day-3. Median admission copeptin level was 261.3 [125.2,478.6] pmol/L. Survival rates were 38.2, 32.6, 27.7, 31 and 13.6% through admission copeptin quintiles (p<0,01). In multivariate analysis, only the fifth quin-
tile was associated with one-year mortality (HR5ème vs. 1st 1.64 [1.06-2.58], p=0.03). After mutual adjustement of admission and day-3 copeptin levels, admission co- peptin level was not associated anymore with one-year mortality whereas day-3 copeptin level remained associated with one-year mortality in a concentration- dependent manner (HR2nd vs. 1st 1.60 [0.90-3.17], p=0.10; HR3th vs. 1st 1.94 [1.01- 3.71], p=0.05; HR 4th vs. 1st 2.01 [1.04-3.89], p=0.04 et HR5th vs. st 2.38 [1.19-4.74], p=0.01 ; p for trend =0.02). During follow-up, 255 OHCA patients dicharged alive from hospital were phone in- terviewed, after a median duration from cardiac arrest of 50 [22-93] months. 66% of patients kept a good cerebral performance after hospital discharge (n=150/231). Overall physical and mental SF-36 dimensions were similar between OHCA pa- tients and age- and gender-matched individuals from French general population (47.0 vs. 47.1,p=0.88 and 46.4 vs. 46.9, p=0.45, respectively). Physical dimensions were more significantly altered in OHCA patients, especially physical functionning (74.1 vs. 78.4, p=0.02) and vitality (50.7 vs. 56.2, p<0.01). In multivariate analysis, age, male gender, initial shockable rhythm were associated with an improvement in most of the SF-36 dimensions. Immediate PCI was associated with a gain in physical functionning (+7.0, p=0.06), general health (+7.3, p=0.02) and vitality (+4.4, p=0.08). Conclusion : Overall survival in this large cohort of successfully resuscitated OHCA patients was about 20%. Immediate PCI was associated with a decrea- sed short and long-term mortality. HRQOL was similar between OHCA patients and age and gender matched individuals from general population but physical di- mensions appeared significantly altered. Age, male gender and initial shockable rhythm were associated with a better HRQOL. (...)