Zugl.: Leipzig, Univ., Diss., 2005

Thesis (M. Med. Sc.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 34-49)

Thesis (doctoral)--Georg-August-Universität zu Göttingen.

Thesis (Ph. D. in Interdisciplinary Studies: Management of Technology)--Vanderbilt University, May 2005. / Title from title screen. Includes bibliographical references.

Diss. iur. Bern, 1957.

Survivors of out-of-hospital cardiac arrest (OHCA) are at risk for hypoxic-ischemic brain injury, which can cause a broad range of effects from death to subtle cognitive impairment. This dissertation includes two studies of OHCA patients who had made good neurological recovery after OHCA. In both studies, patients were evaluated near the time of hospital discharge, when crucial decisions such as rehabilitation plans are made. In addition, OHCA survivors were compared with a myocardial infarction (MI) control group in both studies. Study 1 explored the frequency, severity, and predictors of cognitive dysfunction in OHCA survivors, and characterized the cognitive profile of these patients using a comprehensive neuropsychological battery. Study 2 explored grey matter volume (GMV) in OHCA survivors, MI patients, and healthy controls, and correlated these with cognitive dysfunction and important clinical characteristics (e.g., downtime). While OHCA patients performed poorer on cognitive testing than MI patients, both groups showed decreased GMVs compared to healthy controls. OHCA survivors who have had good neurological recovery may still face significant challenges when they re-engage in difficult cognitive tasks post-arrest. To date, these cognitive issues after OHCA have been somewhat overlooked in Canada's healthcare system. A better understanding of hypoxic-ischemic brain injury among survivors will aid in the promotion of targeted interventions and rehabilitation efforts, and may help clinicians predict those who are most at risk.

The paper on maritime arrest describes the work of the international community for the arrest conventions from 1952 and 1999 as well as the practical impacts of the codes of civil procedure in Germany and Sweden.

“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by “first responders”. Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR (“KIDS SAVE LIVES”), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world. / Revisión por pares

Death due to lethal cardiac arrhythmias is the leading cause of mortality in Western society. Many of the fundamental mechanisms underlying the onset of arrthythmias, their maintenance and termination, still remain poorly understood. The specialized conduction (or His-Purkinje) system is fundamental to ventricular electrophysiological function and is a key player in various cardiac diseases. In recent years, computational simulation has become an important tool in im- proving our understanding ofthese mechanisms. Current state-of-the-art computational ventric- ular electrophysiology models often do not feature a detailed representation of the specialized conduction system. Ventricular models that do incorporate the specialized conduction system often use a simplified anatomical description and are commonly based on the monodomain equations, rather than the more general bidomain equations. Thus, using computational simula- tion to investigate both normal physiological function of the specialized conduction system and pathologies in which it is involved presents difficulties. This thesis develops the techniques and tools required to model the specialized conduction sys- tem at the ventricular scale. We derive one-dimensional bidomain equations that model elec- trical propagation in the system by reducing the equations associated with a three-dimensional fibre. To complement the derived equations, we develop a numerical solution scheme for the model that is efficient enough to allow ventricular simulations. The one-dimensional bido- main model allows defibrillation studies to be performed with the specialized conduction sys- tem. Secondly, we investigate the imaging and mesh generation tools required to integrate an anatomically detailed mesh of the specialized conduction system into a current state-of-the-art ventricular mesh. Using these tools, a highly detailed rabbit-specific specialized conduction system anatomical model is developed. Simulations are performed that dem~strate the re- sponse of the specialized conduction system to defibrillation strength shocks and we compare activation sequences generated using the model to experimental recordings. Finally, we investi- gate variability in the anatomy of the system. The tools and ventricular model presented in this thesis fulfil an important role in allowing the study of the e1ectrophysiological function of the specialized conduction system at the ventricular scale.

Background According to data from Department of Health, in 2011 heart diseases was the second commonest leading cause of death in Hong Kong [13]. Shortening the time from cardiac arrest to Cardio-pulmonary Resuscitation (CPR) could increase the chance of survival. If the brain of the patient who suffers from cardiac arrest does not receive oxygen within 4 minutes, severe brain damage might occur [14]. In some countries like US and Finland, dispatcher will give CPR instruction to caller when cardiac arrest is recognized. Therefore, the patient could receive early CPR before the arrival of paramedics. If dispatcher-assisted CPR is implemented in Hong Kong, the chance of survival of out-of-hospital cardiac arrest (OHCA) patient could be increased. Objective 1. To evaluate whether it is evident that dispatcher-assisted CPR and dispatcher instruction [22] would improve survival of OHCA. 2. To evaluate whether these measures could be implemented in Hong Kong. Data Source PubMed was searched for articles in English language with no limit set for time of the study. The keywords were dispatcher-assisted CPR and out of hospital. No inclusion criteria were set on the publication type and other details. Results Initial PubMed search resulted in 24 articles. After reviewing the abstracts, 10 articles were selected for full-text assessment. Finally, four relevant articles were selected for the literature review. Of the four papers, two were retrospective cohort studies; one was before-after comparison study while the remaining one was randomized control trial. Three papers (Rea et al, Eisenberg et al, and Kuisma et al.) used the survival to hospital discharge as the effect measure for the primary outcome to evaluate the effectiveness of dispatcher-assisted CPR. The remaining paper (Hallstrom et al.) mainly studied the potential benefit and harm from dispatcher-assisted CPR. Using no bystander CPR as the reference group, the multivariate adjusted odds ratio of survival was 1.45 (95% CI, 1.21, 1.73) for dispatcher-assisted bystander CPR and 1.69 (95% CI, 1.42, 2.01) for bystander CPR without dispatcher assistance [2]. The percentage of total bystander-initiated CPR increased from 45% to 56% after the programme (difference: 11.1%, 95% CI, ±9.3%). Besides, the percentage discharged for dispatcher-assisted CPR group after the programme was 15% higher than that before the programme [6]. The most important findings are related to the number of cardiac arrest calls in that when the dispatcher handled on less than 4 Ventricular Fibrillation (VF) calls during the study period, the survival to hospital discharge was 22.1% compared to 38.2% and 39.4% when the dispatcher handled 4 to 9 calls or more than 9 calls (p = 0.0227 for the three groups) [8]. With telephone guided CPR, the survival to hospital discharge was 43.1% compared with 31.7% when CPR instructions were not provided (p = 0.0453) [8]. In patients (n = 3,320) receiving advanced cardiac life support (ACLS) a total of 993 (29.9%) was found to be benefited from dispatcher-assisted CPR [7]. Conclusion Instructions by dispatcher can improve bystander CPR rates, which in turn increases the chance of survival [26]. Dispatcher-assisted CPR is worth considering to be recommended to all callers reporting a patient in cardiac arrest in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health