Bakgrund: Hjärtstopp är en av de vanligaste dödsorsakerna i Sverige. Tack vare att vårdenständigt utvecklats har överlevnaden efter ett hjärtstopp tredubblats de senaste 30 åren. Att ha överlevt ett hjärtstopp innebär ökad kontakt med vården. För att kunna tillämpa en godvård till de här patienterna läggs ett stort ansvar på vårdpersonalen och det är av stor viktatt förstå och fånga patienternas upplevelse kring händelsen och dess följder. Syfte: att undersöka personers upplevelser av livet efter ett hjärtstopp. Metod: En litteraturöversikt med systematisk sökstrategi ligger till grund för det här arbetet. Datainsamling genomfördes via databaserna CINAHL och PubMed. Totaltinkluderades 17 artiklar med kvalitativ ansats som kvalitetsgranskats. Däreftergenomfördes en tematisk dataanalys. Resultat: Litteraturöversikten resulterade i tre huvudteman: ”patienters erfarenhet av vården”, ”ny tillvaro” och ”existentiella tankar”, som i sin tur genererade totalt nio underteman. Det framgick i resultatet att patienterna var tacksamma för att ha överlevt ett hjärtstopp och att det erhållit en andra chans. De uttryckte även en tacksamhet för vården och deras resurser. Trots det upplevde patienterna en saknad av information och stöd i att hantera symtomen, känslorna och tankarna som hjärtstoppet genererat, vilket orsakade en ny otrygg vardag. Det framkom även att hjärtstoppet hade orsakat en påverkan på både livet och relationer. Slutsats: Hjärtstoppet genererade en ny vardag och för vissa en ny identitet vilket kunde innebära förändrade relationer samt en oförmåga att lita på sin kropp. Den nya vardagen kom oväntat och personerna var oförberedda på vad den skulle innebära. För att stödja de här personerna behöver sjukvården fånga upp dem och uppmärksamma alla deras behov. / Background: One of the most common causes of death in Sweden is cardiac arrest. Thanks to the constant development of care, survival after a cardiac arrest has tripled in the last 30 years. Surviving a cardiac arrest leads to an increased contact with healthcare. To be able toprovide good care for these patients, healthcare professionals have a responsibility tounderstand the experience of the arrest and its consequences. Aim: To explore persons experiences of life after surviving cardiac arrest. Method: The method of unsystematic literature review with a systematic search strategy was chosen and data was collected from the databases CINAHL and PubMed. A total of 17 articles with a qualitative approach were included once they had been reviewed. To analyzethe data, a thematic analysis was carried out. Results: The review resulted in three main themes: “Patients experience of healthcare”, “A new existence” and “Existential thoughts” which generated nine subthemes. The result showed that the patient was grateful of the healthcare and its resourses. However, patient experienced a lack of information and support to handle their symptoms, the emotions and thoughts caused by the cardiac arrest which generated a new insecure everyday life. The result also showed that the arrest had an impact on both relationships and life in general. Conclusion: The cardiac arrest generated a new everyday life for the patients and for some of them even new identities which could lead to changes in their relations and inabilities to trust their bodies. The new everyday life came unexpected and the persons were unprepared. To support these persons the healthcare system needs to understand and pay attention for their needs

Bakgrund: Hjärtstopp är ett livshotande tillstånd som kräver livsuppehållande åtgärder. Varje år drabbas 1,3 miljoner människor av hjärtstopp världen över. Tack vare medicinska framsteg ökar antalet överlevande. Aktuell forskning visar att patienter som överlevt drabbas av besvärande fysiska och psykiska komplikationer. Den efterföljande vården och omvårdnaden har beskrivits som bristfällig, då patienternas omvårdnadsbehov går obemärkt förbi. Syfte: Syftet var att belysa patienters erfarenheter av att överleva hjärtstopp. Metod: En allmän litteraturstudie som inkluderade åtta kvalitativa, en kvantitativ och en mixad studie. Resultat: Resultatet belyser fem huvudkategorier: Hälsopåverkan, utmaningar i mötet med vården, en förändrad tillvaro, tacksamhet till livet och existentiella frågor. Flera överlevare drabbades av nedsatt kognitiv förmåga, fysisk nedsättning och försämrat psykiskt mående. Erfarenheter från patienter som överlevt var att livet förändrades helt efter hjärtstoppet.  Patienterna beskrev att de fick otillräcklig uppmärksamhet av vårdpersonal, att de kände sig övergivna och att den efterföljande vården hade brister. Patienternas erfarenheter var också att de fått en ny syn på livet och tacksamhet för att vara vid liv. Konklusion: Ett förbättringsarbete av omvårdnaden efter hjärtstopp är av behov. Ytterligare forskning krävs av kvinnors erfarenheter av att överleva hjärtstopp. / Background: Cardiac arrest is a life-threatening condition that requires life sustaining measures. Each year 1.3 million people suffer cardiac arrest worldwide. Thanks to medical progress the number of survivors is increasing. Current research shows that survivors were troubled from physical and psychological complications. The post-cardiac arrest care has been described as inadequate, as patients’ care needs go unnoticed. Aim: The aim was to highlight the patients’ experiences surviving cardiac arrest. Method: A general literature study that included eight qualitative studies, one quantitative study and one mixed method study. Results: The result highlights five main categories: Health impact, challenges in the encounter with healthcare, a changed existence, gratitude for life and existential questions. Several survivors suffered a decreased cognitive ability, physical impairment, and a negative impact on their psychological well-being. Experience from patients that survived was that life changed completely after the cardiac arrest. Patients expressed that they received insufficient attention from the healthcare staff, they felt abandoned, and the aftercare was inadequate. Patients experienced a new perspective on life and gratefulness to be alive. Conclusion: There is a need for quality improvement of the nursing care post-cardiac arrest. Further research is needed on women’s experiences of surviving cardiac arrest.

Varje år drabbas cirka 13 000 personer av hjärtstopp i Sverige, på och utanför sjukhus. Närmare 1600 personer överlevde ett hjärtstopp år 2022 i Sverige. Det blir kognitiva, fysiska, psykiska och sociala konsekvenser av hjärtstopp. Syfte: Syftet med litteraturstudien är att beskriva personers upplevelser av att ha överlevt hjärtstopp. Metod: En beskrivande litteraturstudie. Resultatet grundar sig på 10 vetenskapliga artiklar som söktes fram i databasen PubMed. Artiklarna har kvalitativa ansatser och har granskats och analyserats. Huvudresultat: Syftet med litteraturstudien var att beskriva personers upplevelser av att ha överlevt hjärtstopp. Resultatet framställdes i tre teman: ”En andra chans i livet: reflektioner av att möta döden och fortsätta leva” med subteman som berör upplevelser av att möta döden och överlevnad som en gåva och tacksamhet, ”förändringar efter hjärtstopp” med subteman som berör fysiska och kognitiva förändringar samt känslor, och ”stöd och relationer efter hjärtstopp” med subteman som berör stöd och vårdplanering samt relationers betydelse. Resultatet visade att personerna fick fysiska begräsningar till exempel nedsatt kondition och mindre ork i vardagen. Även känslomässiga förändringar som nedstämdhet, ångest, oro och försämrad självkänsla samt identitet. Personer fick kognitiva nedsättningar såsom minnesluckor och koncentrationssvårigheter. Vissa personer upplever att de fått tillräckligt stöd och en del har inte fått hjälp utifrån deras behov. Slutsats: Personerna upplevde fysiska, psykiska, kognitiva och sociala förändringar. Oro, ångest och skuld var vanligt förekommande känslor. Det var en brist på stöd, hjälp och information från vårdpersonal under återhämtningsprocessen. Personerna upplevde det betydelsefullt att prata med andra som varit med om liknande upplevelser. De hade en känsla av tacksamhet för att de fick en andra chans i livet. / Introduction: Each year, around 13000 people suffer from cardiac arrest in Sweden, both in and out of hospitals. Around 1600 people survived a cardiac arrest in 2022 in Sweden. The consequences of a cardiac arrest are both cognitive, physical, psychological and social. Purpose: The purpose of this literature study is to describe people’s experiences of having survived cardiac arrest. Method: A descriptive literature study. The result is founded upon 10 scientific articles that were published in the database “PubMed”. The articles have a qualitative approach and have been thoroughly examined and analyzed. Result: The purpose of this literature study was to describe the experience of people who have survived cardiac arrest. The result was presented in three themes: “a second chance in life: reflections over meeting death and continuing to live” with subthemes that concern near-death experiences and survival as a gift and gratuity, “changes after cardiac arrest” with the subthemes that concern the physical and cognitive changes as well as emotions and “support and relations after cardiac arrest” with the subthemes that concern support and care-planning as well as the significance of relations. The result showed that people received physical limitations, for example reduced cardiovascular fitness as well as less energy throughout the day. Emotional changes such as depression, anxiety, worsened self-esteem and identity were also shown in the result. Issues related to cognitive functions such as blackouts, memory loss and difficulty concentrating were all present in all people in the study. Some people experienced that they received enough support whilst others did not receive the support they needed based on their needs. Conclusion: The people in the study experienced physical, psychological, cognitive and social changes. Anxiety and guilt were very common and reoccurring emotions. There was a lack of support and information from the nurses during the recovery process. The people found it meaningful to talk with others that have been through similar experiences. They felt a feeling of gratuity that they got a second chance in life.

Successful cardiopulmonary resuscitation is the first step to rescue life during cardiac arrest. High mortality even after successful restoration of spontaneous circulation is substantially caused by patophysiological process associated with ischemia-reperfusion injury and it is widely called post-cardiac arrest syndrome (PCAS). There are many patophysiological mechanisms involved in the development and progress of this syndrom; the key role seems to play oxidative stress, triggering the activation cascade of systemic inflammatory reaction. In our study we have tested different possibilities of influencing the post-cardiac arrest syndrom. In the first experimental study we have compared the effect of mild therapeutic hypothermia with controlled normothermia on PCAS in a porcine model of cardiac arrest. In the second study we have compared in the same model the protective effects of mild therapeutic hypothermia, administration of nitric oxide and ischemic postconditioning. Results of the first experiment have revealed that mild therapeutic hypotermia is superior in the resuscitability, maintenance of blood pressure, oxidative stress suppression and organ damage protection than controlled normothermia. In the second experiment we have shown that neither nitric oxide administration, nor ischemic...

Hjärtstopp uppstår när hjärtaktiviteten plötsligt upphör och kroppens olika organsystem  inte längre försörjs med blod. Om inte hjärt- och lungräddning samt andra åtgärder vidtas omedelbart kan detta tillstånd leda till plötslig död. I Sverige drabbas cirka 10 000 individer av hjärtstopp utanför sjukhus varje år, ungefär en av tio överlever. Tack vare “överlevnads kedjan” har antalet överlevande ökat. Sjuksköterskan kommer möta dessa patienter i olika vårdenheter, därför är det av betydelse att hen etablerar ett personcentrerat förhållningssätt i bemötandet eftersom hjärtstoppöverlevande uppvisar både fysiska och psykiska besvär till följd av hjärtstoppet som behöver uppmärksammas. Syftet med studien är att sammanställa och beskriva evidens om patienters upplevelser av att överleva ett hjärtstopp utanför sjukhus. Val av metod är en litteraturöversikt som grundar sig i elva studier av empirisk forskning med både kvalitativ och kvantitativ studiedesign. Resultatet genererade tre huvudteman och nio subteman. Slutsatsen är att hjärtstoppet upplevs som en traumatiserande och omvälvande händelse för den drabbade individen, eftersom den orsakar långvariga fysiska och psykiska funktionsnedsättningar. Den drabbade står inför existentiella utmaningar som ger upphov till psykiska besvär såsom ångest, depression och posttraumatisk stressyndrom. Hjärtstoppspatienter uttryckte att omställningen till vardagslivet var påfrestande på grund av informationsbrist som skulle ha hjälpt de att bättre förstå och hantera sina symtom. De efterfrågade en bättre individanpassad vård och uppföljning som tar större hänsyn till deras psykiska lidande eftersom detta kan bidra till snabbare återhämtning. Sjuksköterskan kan genom en personcentrerad vård uppenbara patientens behov och i samverkan med denne och sin närstående finna strategier som underlättar återhämtningen och ökar välbefinnandet. / Cardiac arrest occurs when the heart's activity suddenly stops, and the body's various organ systems are no longer supplied with blood. If cardiopulmonary resuscitation and other measures are not taken immediately, this condition can lead to sudden death. In Sweden, approximately 10,000 individuals suffer cardiac arrest outside of a hospital each year, approximately one in ten survives. Thanks to the "chain of survival", the number of survivors has increased. The nurse will meet these patients in different care units, therefore it is imperative that they establish a person-centered approach in the treatment because cardiac arrest survivors exhibit both physical and psychological problems as a result of the cardiac arrest that needs attention. The aim of the study is to compile and describe evidence about patient’s experiences of surviving a cardiac arrest outside a hospital. Choice of method is a literature review based on eleven studies of empirical research with both qualitative and quantitative study design. The results generated three main themes and nine subthemes. The conclusion is that cardiac arrest is experienced as a traumatizing and upheaval event by the affected individual, as it causes long-term physical and mental impairments. The sufferer faces existential challenges that give rise to psychological problems such as anxiety, depression, and post-traumatic stress disorder. Cardiac arrest patients expressed that the transition to everyday life was stressful due to a lack of information that would have helped them better understand and manage their symptoms. They requested better individualized care and follow-up that takes greater account of their mental suffering because this can contribute to faster recovery. Through person-centred care, the nurse can identify the patient's needs and, in collaboration with the patient and their loved ones, find strategies that facilitate recovery and increase their well-being.

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.

Providing emergency basic life support in life threatening situations is a duty of everyone. Adequate knowledge of all recommended procedures is a prerequisite for succesful management of a critical situation including identification of an emergency, activation of rescue system and provision of first help. Cardiac arrest is a significant socioeconomic burden. Survival of cardiac arrest victims depends on the underlying disease and lenght of cardiac arrest. Early CPR (cardiopulmonary resuscitation) is a most important factor of potential survival. However, effectivity of CPR for longterm survival reaches only around 10%. Therefore, ongoing education of general population in all techniques of CPR is justified and necessary. Just the initiation of CPRitself increases the chances for survival 2-3 fold. But, unfortunately, this emergency help is not provided always. This work is focused on evaluation of the quality of informations on recommended procedures and activities during acute setting and provision of lay person basic life support. In a theoretical introduction I describe the history of CPR and education of general population. Empirical part provides quantitative research based on a questionnaire with 100 respondents. Respondents are divided into two groups, persons who survived cardiac arrest...

Introduction : L’arrêt cardiaque réfractaire est défini par l’absence du retour à l’activité circulatoire spontané (RACS) après 30 minutes de réanimation cardiopulmonaire médicalisé. ExtraCorporeal Membrane Oxygenation (ECMO) représente une thérapie alternative urgente dans cette population. L’hémodynamique post la réanimation cardiopulmonaire extracorporel (E-CRP) est un entité complexe et le pris en charge dans les premières heures suivant l’implantation d’ECMO n’est pas bien décrit. L’objectif de cette étude est d’évaluer l’effet de deux stratégie de débit d’ECMO dans un modèle porcin d’arrêt cardiaque réfractaire sur les conséquences métaboliques, microcirculatoires et inflammatoires.Matériels et Méthodes : l’arrêt cardiaque a été induit par la ligature l’artère intraventriculaire antérieure (IVA) chez 18 cochons. E-RCP a été initié après 40 minutes de low-flow avec un débit d’ECMO bas de 30-35 ml.kg-1.min-1 ou un débit d’ECMO standard de 65-70 ml.kg-1.min-1, avec la même pression artérielle moyenne (PAM) au niveau de 65 mmHg. Les paramètres hémodynamiques et métaboliques ont été évalués avec la clairance de lactate et le débit sanguin carotidien. Les paramètres microcirculatoires ont été évalués par la microcirculation sublinguale avec l’imagerie de SDF et NIRS. Cytokines inflammatoires ont été mesurés avec un plateforme de ELISA multiplexe. Résultats : Pas de différence entre les deux groups à H basale et à l’initiation d’ECMO (H0). La clairance de lactate était plus faible dans le groupe débit bas comparé au groupe débit standard (6.67[-10.43-18.78] vs. 47.41[19.54, 70.69] %, p=0.04). Le débit carotidien était plus bas significativement (p<0.005) dans le groupe débit bas pendant les dernières quatre heures malgré le même niveau de la pression artérielle moyenne. Pour les paramètres microcirculatoires, le flux microcirculatoire sublingual évalué par SDF et le StO2 par NIRS ont été altéré transitoirement à H3 dans le groupe débit bas. Le niveau de cytokine IL-6 était plus élevé significativement dans le groupe débit bas à la fin d’expérimentation. Conclusions : Une réanimation à objectif de débit d’ECMO bas 35 ml.kg-1.min-1 versus standard 70ml.kg-1.min-1dans les six premières heures d’un ACR réfractaire n’est pas associé à une meilleure réversion des conséquences métaboliques, microcirculatoire et inflammatoire avec un objectif de PAM à 65 mmHg dans un modèle porcin / Introduction : Refractory cardiac arrest is defined by the absence of the return of spontaneous circulation (ROCS) within 30 minutes of cardiopulmonary resuscitation (CRP) under medical supervision. ExtraCorporeal membrane oxygenation (ECMO) is an emerging alternative therapy in this population. The post extracorporeal cardiopulmonary resuscitation (ECPR) hemodynamic state is a complex entity and the critical care management in the first hours following ECMO implantation is not well defined. This study was designed to assess the effect of two veno-arterial Extracorporeal Membrane Oxygenation (ECMO) blood-flow strategies in an experimental model of ECPR (extracorporeal cardio-pulmonary resuscitation) on macrocirculatory, metabolic and microcirculatory parameters in the first six hours of ECMO initiation. Material and methods : Cardiac arrest was induced in 18 pigs by surgical ligature of the left descending coronary artery. ECPR was initiated after 40 minutes of low-flow with an ECMO blood-flow of 30-35 ml.kg-1.min-1 (low-blood-flow group, LBF) or 65-70 ml.kg-1.min-1 (standard-blood-flow group, SBF), with the same mean arterial pressure target (65 mmHg). Macrocirculatory and metabolic parameters were assessed by lactate clearance and carotid blood-flow. Microcirculatory parameters were assessed by sublingual microcirculation with Sidestream Dark Field (SDF) imaging and peripheral Near-InfraRed Spectrometry (NIRS). Inflammatory cytokine levels were measured with a multiplexed ELISA-based array platform. Results : There was no between-group difference at baseline and at ECMO initiation (H0). Lactate clearance at H6 was lower in LBF compared to SBF (6.67[-10.43-18.78] vs. 47.41[19.54, 70.69] %, p=0.04). carotid blood flow was significantly lower (p<0.005) during the last four hours despite similar mean arterial pressure levels. For microcirculatory parameters, SDF and NIRS parameters were transitorily impaired at H3 in LBF. IL-6 cytokine level was significantly higher in LBF at the end of the experiment. Conclusion: In an experimental porcine model of refractory cardiac arrest treated by ECMO, a low-blood-flow strategy during the first six hours of resuscitation was associated with lower lactate clearance and lower cerebral blood-flow with no benefits on ischemia-reperfusion parameters

Bakgrund Ambulanssjuksköterskans hantering av luftvägen och ventilering vid hjärtstopp är av stor vikt för att en patient ska kunna återupplivas. Många hjälpmedel finns för att underlätta detta arbete, men prehospitalt finns det åtskilliga faktorer att ta hänsyn till som inte existerar på sjukhus och som kan inverka på ambulanssjuksköterskans val av metod för ventilering. Syfte Att undersöka vilka faktorer som påverkar ambulanssjuksköterskans val av metod för ventilering vid hjärtstopp. Metod En kvalitativ design användes med semistrukturerade intervjuer. Åtta intervjuer med specialistsjuksköterskor inom intensivvård och ambulanssjukvård genomfördes. Kvalitativ innehållsanalys användes för att analysera materialet.  Resultat Dataanalysen resulterade i fyra kategorier med tillhörande underkategorier. I kategorin Tiden prioriterades snabb ventilering för patienten samtidigt som avståndet till sjukhus också påverkade val av metod. Patienten och dennes förutsättningar är en kategori där bakomliggande orsaker till hjärtstoppet, patientens anatomiska förutsättningar samt om hjärtstoppet avslutades på plats eller inte påverkade ambulanssjuksköterskans metodval. Tredje kategorin var resurser som påverkade metodvalet genom att antalet enheter på plats och deras kompetens och erfarenhet hade en inverkan på metodval. Den fjärde kategorin användarvänlighet handlar om miljöfaktorer som påverkade metodvalet samt transport av patienten där avancerade metoder föredrogs för att underlätta förflyttningen. Slutsats Många av dessa faktorer är sådant som inte är något problem på sjukhus men som ambulanssjuksköterskan behöver vara medveten om. Vissa av faktorerna kan avhjälpas av verksamheten med ökad utbildning och modern utrustning men andra faktorer är sådant som ambulanssjuksköterskan behöver vara redo för att hantera. / Background Airway management is of great importance to the resuscitation in patients with cardiac arrest. There are a lot of tools to alleviate this task, but there are several factors to consider in out-of-hospital cardiac arrest, that doesn't exists within the hospital walls, that may influence the ambulance nurse method for managing the ventilation. Aim To study witch factors that influence the ambulance nurse choice of method to ventilate an out-of-hospital cardiac arrest. Methods A qualitative design was used with semi-structured interviews. Eight interviews were conducted with nursing specialists within intensive- and prehospital care. Qualitative content analysis was used to analyze the collected data. Results Data analysis resulted in four categories with associated under-categories. In the category Time distance to hospital had an effect on the choice of ventilation and fast ventilation was prioritized. The Patient was a category where the cause of the cardiac arrest, the patient anatomy and if the resuscitation was terminated on the spot or not was identified to have an impact on the method of airway management. The third category was Resources that influenced the airway approach was the amount of units on the scene and their competence and experience. The fourth category was ease-of-use where environment had an influence on airway management as well as the transportation of the patient. Conclusion Even though these factors often are a none-issue in the hospital it's vital to the ambulance nurse to be aware of these. Some factors can be alleviated by the agency with increased education and modern equipment but other factors are just something the ambulance nurse needs to be aware of and able to handle.

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.