When an out of hospital cardiac arrest (OHCA) occurs, time is of the utmost importance. For every minute that the arrest goes untreated, the chance of survival decreases rapidly. The most common treatment, that is also the most known, is Cardiopulmonary Resuscitation (CPR). Thanks to new technology, the defibrillator is no longer a tool only available to hospital personnel but to anyone who knows where they are located. The objective of this thesis is partly to visualize OHCA occurrences as well as visualize the differences in OHCA occurrences between locations and years. The thesis will analyze where the optimal locations of AEDs are based on a number of variables such as location and year, which is referred to as risk analysis. The analysis was performed by using daytime and nighttime population data from Statistics Sweden (SCB) in combination with heart disease statistics from the national patient register of Socialstyrelsen as well as socio-economic data from SCB. Along with that data, AED locations at the end of 2013 and OHCA data from 2006 up until 2013 was used in visualizations and risk analysis. In order to determine the final optimal placement through the risk analysis, a Geographical Information System (GIS) tool named Multi-Criteria Evaluation (MCE) was used. This tool enabled the weighting of the different parameters against each other, which was integral for the final result. In order to visualize differences, e.g. between two years, a raster was created which consisted of a density difference between the two years. This analysis method shows the spots where there is a majority of either case, e.g. if one area had a larger number of OHCA cases one year compared to previous year. Simple plots were included to show an overview of the problem e.g. where OHCA occurred between the years 2006 and 2013. The results implied that the recommended locations of AEDs while using daytime population data were located in commercial areas. Recommended AEDs from using the nighttime population data was located differently but was located as well as clusters in residential areas. A large source of error in the analysis was the prior heart disease data. The chosen method, an assignment of a percentage chance of heart disease per age group, is a rough and inexact approximation of the actual heart disease statistics. Had there been data about exactly where patients with prior heart disease live and work, the results would most likely be even better. / När ett hjärtstopp utanför sjukhus (OHCA) inträffar, är tiden av yttersta vikt. För varje minut som hjärtstoppet går obehandlat minskar snabbt chansen för överlevnad. Den vanligaste behandlingen, som även är den mest kända, är hjärt- och lungräddning. Tack vare ny teknik är defibrillatorn inte längre ett verktyg som endast är tillgänglig för sjukvårdspersonal utan för alla som vet var de finns. Syftet med denna uppsats är att delvis visualisera förekomsten av OHCA men även att åskådliggöra skillnaderna mellan platser och år. I studien analyseras även, baserat på ett antal variabler, var de optimala platserna för Automatiska Externa Defibrillatorer (AED) är. Denna del av analysen är benämnd som riskanalys. Analysen genomfördes med hjälp av att använda dag- och nattidsbefolkningsdata från Statistiska Centralbyrån (SCB) i kombination med hjärtsjuksdomsstatistik från Socialstyrelsens nationella patientsregister och även socioekonomiska data från SCB. Dessa data, samt AED data från slutet av 2013 och OHCA data daterat från 2006 till 2013 användes både till visualiseringen och till riskanalysen. För att bestämma de slutgiltiga optimala platserna genom riskanalysen användes ett Geografiskt Information System (GIS) verktyg som heter multikriterieanalys (MCE). Detta verktyg gör det möjligt att vikta de olika parametrarna mot varandra, vilket var väsentligt för det slutgiltiga resultatet. För att kunna visualisera skillnader, till exempel mellan två år, skapades ett raster som bestod av en densitetskillnad mellan de två åren. Denna analysmetod kunde sedan visualisera var det finns en majoritet av det ena fallet, till exempel om ett område hade fler hjärtstopp ett år jämfört med tidigare år. Enklare kartor användes för att ge en översikt, till exempel var OHCA har skett mellan åren 2006 och 2013. Resultatet tyder på att de rekommenderade platserna för AED då dagtidsbefolkningsdata användes hamnade i områden med många arbetsplatser. De optimala platserna för AED med nattidsbefolkningsdata var annorlunda utplacerade men hamnade även dem i kluster i befolkningstäta områden med mycket bostäder. En av de större felkällorna i analysen tros vara hjärtsjuksdomsstatistiken. Den metod som användes var att extrahera ålder- och könsgrupper från ett patientregister vilket är en grov och inexakt approximation av den faktiska hjärtsjuksdomsstatistiken. Hade tillgång till data om var befolkning med hjärtsjukdomar faktiskt bor och arbetar funnits, kunde resultatet blivit mer pålitligt.

Bakgrund: Hjärtstopp är något som allt fler individer överlever och varje år ökar chansen att överleva procentuellt sett. En stor anledning till det ökade antalet överlevare är följsamheten till HLR riktlinjer. En person som överlever ett hjärtstoppkan ofta förvänta sig flera konsekvenser så som fatigue och problem med exekutiva funktioner. Då personer som överlever hjärtstopp står inför en stor livsförändring är det av vikt att undersöka deras upplevelser, och med det bidra till en ökad kunskap inom området. Syfte: Att beskriva patienters upplevelser av att överleva hjärtstopp. Metod: En litteraturöversikt gjordes med stöd av Fribergs analysmetod. Artiklarna hittades genom en sökning i databaserna Cinahl och PubMed. Sökningen resulterade i 14 kvalitativa peer-reviewed originalartiklar, skrivna på engelska och publicerade efter2014.  Resultat: Hjärtstoppet var svårt att förstå och skapade många funderingar. Fysiska symptom var förekommande vilket tvingade till förändringar i vardagen. Vissapatienter såg hjärtstoppet som ett uppvaknade genererade positiva livsstilsförändringar. Slutsatser. Deltagarna upplevde oro och ångest inför framtiden efter att ha överlevt ett hjärtstopp. Oron kan minskas genom att besvara individuella frågor och funderingar. Med ett gott omhändertagande med varje enskild individ i fokus kan sjuksköterskan skapa förutsättningen för att möta de individuella behoven. / Background: More people survive cardiac arrest, and the percentage of survival increases each year. One of the reasons is the compliance with HLR guidelines. A person that survives cardiac arrest usually suffers from multiple complications with the most common one being fatigue and problems with executive functions. Since people who survive cardiac arrest have gone through a life-changing event, it is important to study the experiences of patients to generate a deeper understanding of the subject. Aim: Describe patients' experiences of surviving cardiac arrest.  Method: A literature review was chosen as the method with inspiration taken from Friberg’s analysis method. The searches were conducted in the databases Cinahl and PubMed. The searches resulted in 14 peer-reviewed articles, written in English, and published after 2014.  Result: The cardiac arrest was hard for the patients to understand. Bodily symptoms were frequent in patients which led to changes in daily life. Some participants saw the cardiac arrest as a wake-up call which prompted positive lifestyle changes. Summary: The participants experienced anxiety about the future after surviving cardiac arrest. The anxiety can be reduced if individual thoughts and questions are properly addressed. With good care the nurse can answer to the individuals needs

Hjärtstopp sker oftast utanför sjukhus, långt ifrån avancerad sjukvård. För varje minut som går utan behandling minskar chansen att överleva avsevärt. Sju av tio personer som drabbats av hjärtstopp får hjärt-lungräddning innan ambulans är på plats. På grund av att fler ingripanden från åskådare sker innan ambulansen är på plats har tiden från hjärtstopp till start av hjärt-lungräddning minskat från 11 minuter till en minut. Syftet med studien är att belysa hur olika faktorer påverkar överlevnaden hos personer med hjärtstopp vid prehospital hjärt- och lungräddning. En litteraturöversikt valdes som metod. Sökningarna genomfördes i databaserna Cinahl ochPubMed och resulterade i 14 artiklar. Ytterligare fyra artiklar inkluderades manuellt. Artiklarna kvalitetsgranskades och klassificerades enligt Sophiahemmets högskolas bedömningsunderlag. Dataanalysen genomfördes med en integrerad analys. Resultatet påvisade att överlevnad efter hjärtstopp är starkt beroende av tiden. Tiden från kollaps till början av hjärt- lungräddning och tiden från kollaps till defibrillering är avgörande för överlevnadschansen. Kedjan som räddar liv (överlevnadsskedjan) representerar olika steg som skall följas vid ett hjärtstopp för att maximera chansen för optimal behandlingsstrategi vid ett hjärtstopp. Slutsatsen är att nya behandlingsstrategier behövs för att nå ut och behandla personer snabbare. AED gör det möjligt för lekmän att leverera livräddande chocker inom några minuter. Vidare gör utvecklingen av mobiltelefonteknik det möjligt att identifiera och rekrytera lekmän till närliggande hjärtstopp för livräddande åtgärder. / Cardiac arrest usually occurs outside hospitals, far from advanced healthcare. For every minute that goes without treatment, the chance of survival decreases significantly. seven out of 10 people who suffer from cardiac arrest receive cardiopulmonary resuscitation before an ambulance is on site. Due to the fact that more interventions from bystanders take place before the ambulance is in place, the time from cardiac arrest to start of cardiopulmonary resuscitation has been reduced from 11 minutes to one minute. The aim of the study is to shed light on how different factors affect the survival of people with cardiac arrest in prehospital cardiopulmonary resuscitation. A literature review was chosen as the method. The searches were performed in the Cinahl and PubMed databases and resulted in 14 articles. Another four articles were included manually. The quality of the articles were reviewed and classified according to Sophiahemmet University's assessment for quality. The data analysis was performed with an integrated analysis. The results showed that survival after cardiac arrest is strongly dependent on time. The time from collapse to the beginning of cardiopulmonary resuscitation and the time from collapse to defibrillation are crucial for the chance of survival. The chain that saves lives (the survivalchain) represents different steps that must be followed in a cardiac arrest in order to maximizethe chance of optimal treatment strategy in the event of a cardiac arrest. The conclusion is that new treatment strategies are needed to reach out and treat people faster. AED enables laymen to deliver life-saving shocks within minutes. Furthermore, the development of mobile phone technology makes it possible to identify and recruit lay peopleto nearby cardiac arrests for life-saving measures.

Use of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy, complications exist with this treatment modality. The purpose of this literature review is to examine potential complications secondary to induced hypothermia and highlight the nurse's role in managing patient care. At the present, patient protocols for induced hypothermia are lacking. The success of treatment is largely dependent on the skill of the healthcare team to prevent further harm and enhance therapeutic outcomes by providing astute assessment and management of complications in patients undergoing induced hypothermia. The desired outcome of this review is to promote integration of research in the development of evidence-based protocols for induced hypothermia.

Introduktion: Att skapa fri luftväg i samband med prehospitalt hjärtstopp är en komplicerad åtgärd i en stressande situation. Det finns flera metoder för denna åtgärd och de har olika svårighetsgrad beroende på vilken metod som ambulanssjuksköterskan behöver använda för att nå framgång. Denna åtgärd förväntas ambulanssjuksköterskan klara av trots att miljön är utmanande och tidspressen stor.   Syfte: Att beskriva ambulanssjuksköterskors upplevelser av etablering av fri luftväg i samband med hjärtstopp.   Metod: Kvalitativ intervjustudie som analyseras med latent innehållsanalys. Tolv semistrukturerade intervjuer genomfördes på tre verksamhetsställen i södra Sverige.   Resultat: Ambulanssjuksköterskorna berättade om hur luftvägshantering är en liten men viktig del av allt de ska klara av i sin yrkesroll. Det finns en otrygghet i momentet intubation som beror på bristande utbildning i kombination med hur sällan ambulanssjuksköterskan gör detta i det dagliga arbetet. Studien resulterade i tre huvudkategorier: Otrygghet i yrkesrollen, Prehospitala framgångsfaktorer och Personcentrerad vård genom samarbete med tillhörande tolv subkategorier. Det som bekymrade ambulanssjuksköterskorna mest var luftvägshantering på barn. Det som upplevs vara den största framgångsfaktorn betonades vara de enkla åtgärderna när det gäller luftvägshantering.   Slutsats: För att öka ambulanssjuksköterskans trygghet i luftvägshantering krävs ökade utbildningsinsatser. Arbetsgivaren bör ta ett ökat ansvar för utbildning genom att skapa förutsättningar och uppföljning. Vidare bör de riktlinjer som finns för luftvägshantering ses över. De enklaste metoderna är oftast de bästa prehospitalt. / Introduction: To manage an airway in a prehospital environment is a complex measure in a stressful situation. There are several methods for this measure and they have various level of severity depending on the method the ambulance nurse chooses to apply. This measure is expected to be managed by the ambulance nurse despite rough environment and lack of time.   Purpose: To describe the ambulance nurse’s experiences of airway management in a cardiac arrest situation.   Method:  Twelve semi-structured qualitative interviews was made and analyzed by content analysis. The interviews were made at three different ambulance organizations in the south of Sweden     Result: The ambulance nurses told about how small but essential task airway management is. But it’s still a task they must be able to perform in their work.  There is an insecurity in the moment of intubation which is related to lack of training and how rarely they perform the moment in their daily duties. The study resulted in three main categories: Insecurity in the profession, Prehospital success factors and Person-centered care through teamwork with twelve subcategories. What concerned the ambulance nurses the most was airway management on children. They describe the greatest success factor to be the simplest possible measures when it comes to airway management.   Conclusion: To increase the ambulance nurse’s security in airway management more education efforts is needed. Employers should take a greater responsibility for education by creating conditions and monitoring. Therefore, should the guidelines for airway management be reviewed. The simplest methods in airway management are often the most successful.

L’arrêt cardiaque extra-hospitalier (ACEH) est un problème de santé publique majeur. La réanimation cardio-pulmonaire (RCP) précoce ainsi que la défibrillation par les témoins sont associées à une augmentation du taux de survie. Cependant, malgré d’importants efforts ces dernières années, les taux de survie restent faibles dans la plupart des pays. Ce travail avait pour objectif d’identifier des facteurs ayant un impact sur la défibrillation publique, la RCP précoce et les connaissances du public sur la défibrillation. Nous avons testé différentes stratégies de déploiement des défibrillateurs automatisés externes (DAE). Nous avons également analysé l’effet du niveau socio-économique des quartiers sur la RCP par les témoins. Enfin, nous avons cherché à évaluer les connaissances du public concernant la localisation et les conditions d’utilisation du DAE le plus proche dans des lieux publics très fréquentés. Tous les ACEH survenus à Paris entre 2000 et 2010 ont été enregistrés dans un registre et géocodés. Nous avons comparé une stratégie basée sur les recommandations de placement d’un DAE dans les lieux où plus d’un ACEH survenait tous les cinq ans à deux nouvelles stratégies : une stratégie de maillage régulier du territoire avec des DAE placés à distances régulières et une stratégie de placement dans différents types de lieux publics. Le nombre de DAE nécessaires ainsi que la distance médiane entre les ACEH et le DAE le plus proche étaient calculés pour chaque stratégie. Nous avons également recherché l’association entre le niveau socio-économique des quartiers sur le fait de bénéficier d’une RCP. Enfin, nous avons réalisé une enquête dans des lieux publics très fréquentés (gare, centres commerciaux, jardin public) auprès de toutes les personnes situées dans un rayon de 100 mètres autour d’un DAE pour analyser leur connaissance de la localisation du DAE et leur capacité à l’utiliser. Parmi 4176 ACEH, 1372 (33%) sont survenus dans des lieux publics. La stratégie basée sur les recommandations aurait conduit au placement de 170 DAE avec une distance aux ACEH de 416 (180-614) mètres et une augmentation continue du nombre de DAE. Avec la stratégie de maillage régulier du territoire, le nombre de DAE et la distance aux ACEH auraient changé selon la taille du maillage avec un nombre optimal de DAE évalué entre 200 et 400. Avec la stratégie de placement dans différents types de lieux publics, la distance médiane entre les ACEH et les DAE aurait été de 324 mètres pour les bureaux de poste (195), 239 mètres pour les stations de métro (302), 137 mètres pour les stations Velib’ (957) et 142 mètres pour les pharmacies (1466). Parmi les 4009 ACEH géocodables enregistrés, 777 (19,4%) ont bénéficié d’une RCP par un témoin. Ceux qui en ont bénéficié étaient plus fréquemment dans un lieu public, en présence d’un témoin et dans un quartier de statut socio-économique (SSE) non défavorisé. Dans une analyse multiniveaux la RCP par les témoins était significativement moins fréquente dans les quartiers de SSE défavorisé que dans les quartiers d’autres SSE (OR 0,85 ; 95% IC 0,72-0,99). Notre enquête a été menée auprès de 301 participants. Environ la moitié des participants (49%) avaient bénéficié d’une formation aux premiers secours, dont 70% après 2007 et 37% qui avaient suivi une initiation d’une heure. Le logo universel des DAE était reconnu par 37% des participants et 64% pouvaient reconnaître un DAE en photo. La localisation du DAE le plus proche était connue par 16% des participants avec un impact positif des formations après 2007 et de la reconnaissance du logo ou des photos (p<0,0001). Une majorité de participants (66%) savaient qu’ils avaient le droit d’utiliser un DAE et 59% savaient dans quelles circonstances l’utiliser. Seulement 25% des participants déclaraient savoir comment utiliser un DAE. Notre travail présente une approche originale pour optimiser les stratégies de déploiement des DAE. (...) / Out-of-hospital cardiac arrest (OHCA) is a major public health concern. Early bystander cardiopulmonary resuscitation (CPR) and defibrillation are associated with higher survival rates for OHCA victims. Unfortunately, despite major efforts over the past decade, survival rates remain low in many communities. This work sought to highlight factors affecting public defibrillation, early CPR and public knowledge on defibrillation. We assessed different strategies for Automated External Defibrillators (AEDs) deployment. We also aimed to focus effect of neighborhood socio-economic status on bystander CPR. Finally, we sought to analyze public awareness of the AED nearest location and knowledge of AED use. All OHCAs attended by EMS in Paris between 2000 and 2010 were prospectively recorded and geocoded. We compared a guidelines-based strategy of placing an AED in locations where more than one OHCA had occurred within the past five years to two novel strategies: a grid-based strategy with a regular distance between AEDs and a landmark-based strategy. The expected number of AEDs necessary and their median (IQR) distance to the nearest OHCA were assessed for each strategy. We also evaluated the relationship between neighbourhood SES characteristics and the fact of receiving bystander CPR. Then, we performed a survey in three kinds of places (train station, city mall and public park) of all individuals within 100 meters from an AED to analyze their knowledge of the closest AED location and their confidence to use it. Of 4,176 OHCAs, 1,372 (33%) occurred in public settings. The guidelines-based strategy would result in the placement of 170 AEDs, with a distance to OHCA of 416 (180-614) meters and a continuous increase in the number of AEDS. In grid-based strategy, the number of AEDs and their distance to the closest OHCA would change with the grid size, with a number of AEDs between 200 and 400 seeming optimal. In landmark-based strategy, median distances between OHCAs and AEDs would be 324 meters if placed at post offices (n=195), 239 at subway stations (n=302), 137 at bike-sharing stations (n=957), and 142 at pharmacies (n=1466). Of the 4,009 OHCA with mappable addresses recorded, 777 (19.4%) received bystander CPR. Those receiving it were more likely to be in public locations, have had a witness to their OHCA, and to have collapsed in a non-low SES neighbourhood. In a multilevel analyses, bystander CPR provision was significantly less frequent in low than in higher SES neighbourhoods (OR 0.85; 95% confidence interval [CI] 0.72-0.99). A total of 301 people responded to the survey. About half respondents (49%) had a Basic Life Support training experience with 70 % of them trained after 2007 and 37% who attempted a one hour training initiation. The universal AED sign was recognized by 37% of all respondents and 64% could recognize an AED on a picture. The closest AED location was known by 16% of the respondents with a positive impact of training after 2007 and knowledge of AED sign and picture (p<0.0001). A majority of respondents (66%), considered they had the right to use an AED and 59% knew in which circumstances it is necessary to use it. Only 25% of the respondents declared to know how to use an AED. Our work presents an original evidence-based approach to strategies of AED deployment to optimize their number and location. This rational approach can estimate the optimal number of AEDs for any city. In Paris, OHCA victims were less likely to receive bystander CPR in low SES neighbourhoods. These first European data are consistent with observations in North America and Asia. Our survey conducted in places known to be at risk of OHCA highlights the need for a better AED visibility in public places and the need to improve public knowledge and confidence in the use of AED. (...)

Introduction : L'arrêt cardiaque (AC) est considéré comme un problème majeur de santé publique. Prévenir les arrêts cardiaques, les décès consécutifs et optimiser leur prise en charge sont les objectifs partagés à la fois par les professionnels de l’urgence et les décideurs des politiques de santé publique. A l’heure de la territorialisation prenant en compte les besoins des populations, très peu d’études ont été consacrées aux variations d’incidence induites par la localisation géographique des arrêts cardiaques et les caractéristiques socio-économiques des patients. L’objectif de cette thèse est d'identifier, à partir des données du registre national des arrêts cardiaques RéAC, dans les trois départements de la petite couronne d’Ile-de-France, des clusters de communes présentant une incidence élevée ou faible en matière d’arrêt cardiaque, puis de les caractériser à partir des facteurs socio-économiques qui peuvent leur être associés. Matériel et Méthodes : Nous avons étudié les données d’arrêt cardiaque des trois départements d’Ile-de-France composant la petite couronne francilienne. Nous avons ainsi travaillé sur un ensemble de 123 communes. Les données relatives aux arrêts cardiaques ont été extraites du registre français des arrêts cardiaques RéAC. Des données socioéconomiques ont été collectées pour chacune de ces communes auprès de l’Institut National de la Statistique et des Etudes Economiques (INSEE). En termes de méthodes, nous avons eu recours à une double approche sur le plan statistique, combinant des méthodes bayésiennes afin d’étudier les variations géographiques d'incidence des arrêts cardiaques et des statistiques de scan en vue d’identifier des clusters de communes selon le niveau d’incidence des arrêts cardiaques. Enfin, nous avons caractérisé et comparé ces clusters de communes selon des facteurs socioéconomiques. Résultats : Nous avons inclus 3.414 arrêts cardiaques sur une période de deux ans, entre août 2013 et août 2015. De fortes variations géographiques - significatives - ont été observées parmi 123 municipalités : 34 présentaient un risque d'incidence élevé et 37 présentaient un risque faible. Les statistiques de scan ont permis d’identifier 7 clusters significatifs sur le plan de l’incidence des arrêts cardiaques, dont 3 clusters à faible incidence (le risque relatif variait de 0,23 à 0,54) et 4 clusters à forte incidence (avec un risque relatif de 1,43 à 2). Les clusters de municipalités ayant une incidence élevée d'AC se caractérisent par un statut socioéconomique inférieur à celui des autres (clusters d'incidence d’arrêt cardiaque faible ou normale). L'analyse a montré des relations statistiquement significatives entre les facteurs de défaveur sociale et une incidence élevée. Discussion : L’analyse des taux d’incidence standardisés et lissés dans la zone de la petite couronne parisienne révèle l’existence d’une forte hétérogénéité en termes d’incidence des arrêts cardiaques. L’utilisation des statistiques de scan nous a permis d’identifier 7 clusters significatifs, dont 4 de sur-incidence et 3 de sous-incidence. Ces résultats, les premiers en France sur cette thématique, confirment ceux déjà existants dans la littérature internationale montrant une hétérogénéité spatiale de l'incidence de l'arrêt cardiaque et l’importance de certains facteurs socio-économiques. Enfin, le recours aux statistiques de scan, différente des méthodes généralement utilisées, permet de mettre en évidence l'existence de zones à haut risque d’arrêt cardiaque [...] / Cardiac arrest (CA) is considered a major public health problem. Preventing cardiac arrest and subsequent deaths and optimizing their management are objectives shared by both emergency professionals and public health policy makers. At a time when territorialization is taking into account the needs of populations, very few studies have been devoted to the variations in incidence induced by the geographical location of cardiac arrests and the socio-economic characteristics of patients. The objective of this thesis is to identify, based on data from the national register of cardiac arrests RéAC, in the three departments of the inner suburbs of Ile-de-France, clusters of municipalities with a high or low incidence of cardiac arrest, and then to characterize them based on the socio-economic factors that can be associated with them. Equipment and Methods: We studied cardiac arrest data from the three departments of Ile-de-France that make up the inner suburbs of the Paris region. We have worked on a total of 123 municipalities. Data on cardiac arrests were extracted from the French register of cardiac arrests RéAC. Socio-economic data were collected for each of these municipalities from the Institut National de la Statistique et des Etudes Economiques (INSEE). In terms of methods, we used a statistically twofold approach, combining Bayesian methods to study geographical variations in the incidence of cardiac arrest and CT statistics to identify clusters of communes according to the incidence level of cardiac arrest. Finally, we characterized and compared these clusters of municipalities according to socio-economic factors.

Contexte ─ L’incidence, les caractéristiques, et le pronostic (vital et fonctionnel) de la mort subite du sportif n’ont pas été étudiés en population générale. Méthodes ─ Etude observationnelle prospective menée par l’Institut National de la Santé et de la Recherche Médicale en collaboration avec le Service d’Aide Médicale Urgente (SAMU) dans 60 départements français (2005–2010) incluant les sujets de 10 à 75 ans présentant une mort subite (récupérée ou non) au cours d’une activité sportive de loisir ou de compétition. La détection des cas a été assurée par deux sources indépendantes. L’information a été recueillie selon le modèle d’Utstein. Les incidences ont été calculées par million d’habitants et million de participants sportifs, en considérant les 20ème et 80ème percentiles des départements les plus participants. Des analyses complémentaires ont été menées chez les femmes et pour les sports les plus en cause. Compte tenu de disparités régionales importantes en termes de survie, la distribution des facteurs (individuels et communautaires) classiquement associés à la survie (à la sortie de l’hôpital) a été examinée dans 4 groupes de survie (<10%, 10–20, 20–40, et >40%). L’analyse des facteurs associés à la survie a été effectuée par régression logistique.Résultats ─ Au total, 820 cas ont été collectés, et l’incidence totale a été évaluée entre 5 et 17 cas par million d’habitants par an en France. Seulement 6% des cas sont survenus chez le jeune athlète de compétition. Après considération des taux de participation sportive, l’incidence chez l’homme a été estimée entre 11,2 (95% IC 10,4–12,1) et 33,8 (95% IC 30,9–36,8) cas par million de participants et par an, l’incidence chez la femme étant, en comparaison avec l’homme, extrêmement faible, en particulier chez les 40–54 ans avec un risque relatif de 0,03 (95% IC 0,01–0,07). L’incidence augmentait significativement avec l’âge chez l’homme (risque relatif 2,51, 95 % IC 2,10–3,01, quand âge >35 ans), et était plus importante dans certains sports (cyclisme vs. natation, p<0,0001). L’âge moyen des sujets était de 46±15 ans. Des antécédents cardiovasculaires étaient rapportés dans 12% des cas. Le taux de survie moyen à la sortie de l’hôpital était de 15,7% (95% IC 13,2–18,2), avec cependant des disparités départementales majeures (de 0 à 47%), alors que le pronostic neurologique restait favorable chez 80% des survivants. La description en 4 groupes de survie a démontré l’absence de différence significative en termes de caractéristiques des sujets, de circonstances de survenue, de délai de prise en charge, et de mortalité intra-hospitalière. A l’inverse, des différences majeures ont été observées concernant l’initiation du massage cardiaque par le témoin (15% à 81%, p<0,001), le rythme initialement choquable (29% à 79%, p<0,001), le niveau de formation de la population aux premiers secours (p<0,001) et la densité de défibrillateurs extra-hospitaliers dans le département (p<0,001). Le défibrillateur n’a que rarement été utilisé par les témoins avant l’arrivée des premiers secours (<1%). Au final, les facteurs individuels suivants étaient indépendamment associés à la survie à la sortie de l’hôpital : massage cardiaque par témoin (OR 3,73, 95% IC 2,19–6,39, p<0,0001), délai d’intervention (OR 1,32, 95% IC 1,08–1,61, p=0,006), présence d’un rythme choquable initial (OR 3,71, 95% IC 2,07–6,64, p<0,0001). Après ajustement sur les facteurs pronostiques individuels, seul le niveau de formation de la population aux premiers secours restait associé de façon significative à la survie (OR 1,64, 95% IC 1,17–2,31, p=0,004).Conclusions et perspectives ─ La mort subite est un problème de santé publique faisant intervenir les pompiers, le SAMU, les réanimateurs, les cardiologues, les épidémiologistes. Sa prise en charge est nécessairement multidisciplinaire et les progrès viendront d’une action concertée de santé publique. Concernant la mort subite du sportif, nos conclusions sont que (...) / Background – Although such data are available for young competitive athletes, the prevalence, characteristics and outcome of sports-related sudden cardiac death have not previously been assessed in the general population.Methods – A prospective and comprehensive national survey was carried out throughout France by the French Institute of Health and Medical Research from 2005 to 2010, involving subjects aged 10–75 years. Case detection for sports-related sudden cardiac death, during competitive or leisure activities, including resuscitated cardiac arrest, was undertaken via emergency medical services (Service d’Aide Médicale Urgente, SAMU) reporting and web-based screening of media releases. Data were collected according to Utstein’s style. Incidence calculations were reported by million of inhabitants as well as million of sports participants. Specific analyses were also carried out among women and specific sports. After having documented major regional survival disparities, we identified to which extent conventional evidence-based individual factors, known to be associated to survival, were distributed among different groups of survival. Moreover, we assessed if functional outcome was variable among groups of survival. Factors associated with survival were analyzed using regression logistic model.Results – The overall burden of sports-related sudden cardiac death was estimated between 5 and 17 cases per million inhabitants per year. Only 6% of cases occurred among young competitive athletes, with a specific incidence calculated to 9.8 (95% CI 3.7–16.0) per million per year. After considering participation rates, incidence in men sport participants was estimated from 11.2 (95% CI 10.4–12.1) to 33.8 (95% CI 30.9–36.8) per million of participants per year, dramatically higher than women-related incidence, particularly in the 45–54 year range (relative risk 0.03, 95% CI 0.01 to 0.07). By contrast with women, the incidence of sports-related sudden cardiac death in men significantly increased over age categories (p<0.0001), and incidence rates were substantially higher in men aged >35 years than men aged 35 years or less (RR 2.51, 95% CI 2.10–3.01). The mean survival rate at hospital discharge was 15.7% (95% CI 13.2–18.2), with major regional disparities among districts (from 0 to 47%), with however a highly similar favorable neurological outcome (80%). No difference was observed regarding subjects’ characteristics and circumstances of occurrence (including presence of witnesses, delays of intervention and public use of automatic external defibrillators) across survival groups. By contrast, major differences were noted regarding bystander initiation of cardiopulmonary resuscitation (15% to 81%, p<0.001) and presence of initial shockable rhythm (29% to 79%, p<0.001). Public use of automatic external defibrillator was dramatically low (<1%). Independent factors for survival included bystander cardiopulmonary resuscitation (OR 3.73, 95% CI 2.19–6.39, p<0.0001), initial shockable rhythm (OR 3.71, 95% CI 2.07–6.64, p<0.0001) and short delay between cardiac arrest and resuscitation (OR 1.32, 95% CI 1.08–1.61, p=0.006). After adjustment on individual factors, only population education to Basic Life Support was significantly associated with survival (OR 1.64, 95% CI 1.17–2.31, p=0.004).Conclusions and perspectives – Sudden cardiac death is a public health issue, with the need for a multidisciplinary approach involving Emergency Cares, Cardiology, and Epidemiology. Regarding sports-related sudden death, our conclusions are the following (...)

INTRODUÇAO: O uso da epinefrina na ressuscitação cardiopulmonar (RCP) tem sido questionado devido aos efeitos adversos como dano miocárdico e cerebral. Fármacos como azul de metileno têm sido estudados como adjuvantes, objetivando reduzir essas lesões. OBJETIVOS: Neste estudo objetivou-se avaliar o efeito da administração do azul de metileno em bôlus durante a RCP, na lesão miocárdica e cerebral. MÉTODO: Quarenta e nove ratos Wistar machos submetidos a parada cardíaca por fibrilação ventricular foram distribuídos aleatoriamente em quatro grupos com 11 animais: azul de metileno (GA, 2mg/kg), solução salina (GC, salina 0,9% 0,1ml), epinefrina (GE, 20mcg/kg), epinefrina + azul de metileno (GM), além do grupo sham com 5 animais. A fibrilação ventricular foi induzida por estimulação elétrica direto no ventrículo direito por 3 minutos, sendo mantidos por mais 2 minutos em anóxia. As manobras de RCP foram iniciadas com o fármaco correspondente de cada grupo, massagem torácica, ventilação e desfibrilação. Após retorno a circulação espontânea (RCE), os animais foram observados durante quatro horas. Foram coletados sangue para gasometria e troponina, tecido cardíaco e cerebral para análise histológica, marcação de TUNEL, marcadores inflamatórios e de estresse oxidativo. Os grupos foram comparados por meio do teste não paramétrico de Kruskal-Wallis, com o teste de comparação múltipla com correção de Bonferroni quando adequado. RESULTADOS: Animais do grupo GE apresentaram 63% de RCE, enquanto o GC e GM obtiveram 40% e 45%, respectivamente, sem diferença estatística entre os grupos (p= 0,672). O grupo GA apresentou apenas 18% de RCE e foi excluído da análise. O tempo de RCP do GC foi maior comparado aos grupos GE e GM, mas sem diferença estatisticamente significativa. Os animais do grupo GM apresentaram PAM maior comparado ao grupo GC, no momento imediatamente após a RCE (P=0,007). Em todos os grupos os animais apresentaram acidose, queda da PaO2 e aumento do lactato após PCR e RCP. A mediana da troponina sérica foi maior no GC (130ng/ml) comparada ao grupo GE (3,8ng/ml), e GM (43,7ng/ml), porém sem diferença estatística. O grupo GC apresentou aumento significativo na expressão proteica dos marcadores BAX e TLR4. Não houve diferença estatística em relação a histologia e marcação de TUNEL entre os grupos submetidos a PCR. CONCLUSÃO: A utilização de azul de metileno em bolus na RCP de forma isolada apresentou resultados negativos em relação ao retorno da circulação espontânea. A utilização de azul de metileno associada a epinefrina não diminuiu a presença de lesões no cérebro e no coração decorrentes da parada cardíaca / INTRODUCTION: The use of epinephrine in cardiopulmonary resuscitation (CPR) has been questioned due to adverse effects such as myocardial and cerebral damage. Drugs such as methylene blue have been studied as adjuvants in order to reduce lesions. OBJECTIVES: The aim of this study was to evaluate the effect of methylene blue administration during CPR on myocardial and cerebral lesion. METHOD: Forty nine Wistar male rats submitted to ventricular fibrillation cardiac arrest (CA) were randomly assigned to four principal groups with 11 cases each one: methylene blue (MB, 2mg/kg), control (CTRL, 0.1ml saline 0.9%), epinephrine (EPI, 20?g/kg), epinephrine plus methylene blue (EPI+MB), and a sham group, wich have 5 cases. Ventricular fibrillation was induced by direct electrical stimulation in the right ventricle for 3 minutes and anoxia was maintained until a total of 5 minutes. CPR was initiated using the group drug, ventilation, chest compressions and defibrillation. The animals were observed for four hours after return of spontaneous circulation (ROSC). Blood samples were collected for blood gas and troponin measurements. Heart and brain tissues were harvested for the evaluation of oxidative stress, inflamation, histological and TUNEL staining. Groups were compared using the non-parametric Kruskal-Wallis test and Bonferroni post test. RESULTS: ROSC was achieved in 63% of the cases in EPI, 40% in CTRL, and 45% in EPI+MB (P=0.672). MB was excluded from analysis because of its low ROSC rate (18%). CPR duration was longer in CTRL compared to EPI and EPI+MB, without statistical significance. EPI+MB animals presented higher arterial pressure compared to the CTRL group, immediately after ROSC (P=0.007). All animals presented acidosis, decreased PaO2 and increased lactate after CA and CPR. Serum troponin was higher in CTRL (130ng/ml) compared with EPI (3.8ng/ml) and EPI+MB (43.7ng/ml), without statistical significance. CTRL presented higher BAX and TLR4 expression. There was no difference in TUNEL staining and histology among CA groups. CONCLUSION: Methylene blue in bolus during CPR did not improve outcome. Methylene blue combined with epinephrine did not decrease CA-related myocardial and cerebral lesions

Work name: The analysis of the Health Rescue Service City of Prag trips for the period 2007 - 2009 Aim of work: The aim of this work is to describe and assess by graphs the analysis of the Health Rescue Service City of Prag trips in Prag for the period 2007 - 2009. Further to classify its historical progress, describe its current state including the modern equipment and also describe access of resuscitations for the same period. Method: In this work a method of data collection from avaiable literature of the Health Rescue Service City of Prag is used as well as the consultation with experienced rescue workers and people who work on the operation centre and who are processing the data and statistics of the Health Rescue Service City of Prag trips. Results: The result of this work is the graphical representation of the single trips for the urgent life - threatening events and their subsequent comparison for the period 2007 - 2009. There is also the evaluation of the success of interventions. Key words: the Health Rescue Service, the medical emergency, a rescue worker, an emergency event, a sudden cardiac arrest, the resuscitation