Pulmonary dysfunction following cardiopulmonary bypass surgery is a widely explored complication and a multitude of factors have been implicated, including but not limited to: operative trauma; the cardiopulmonary bypass circuit; cardioplegia; the type of donor grafts utilised; anaesthesia and fluid administered. There is a paucity of information regarding the effect of cardioplegia on the lungs. No studies have previously investigated whether allowing cold-blood cardioplegic solution to enter the lung parenchyma, during the period of cardioplegia delivery, has an effect on the clinical outcome of lung function following cardiopulmonary bypass surgery. For this reason an original study was done to determine the effect of preventing cardioplegia from entering the lungs, by evacuating overflow of cardioplegia not drained via the atriocaval cannula, by using a pulmonary artery vent. A total of 403 patients admitted to undergo full cardiopulmonary bypass were screened and 142 patients who fitted the criteria for inclusion and provided informed consent took part in this prospective double blind randomised clinical trial. The control group underwent routine cardiopulmonary bypass grafting. The study group had the intervention of a pulmonary artery vent sutured in position at the time the heart was cannulated for bypass. During cardioplegia delivery the cardioplegia was removed via the atriocaval cannula in the control group (A) and via the atriocaval cannula and the pulmonary artery vent in the study group (B). Aside from this difference, the two groups were managed identically intra- and post-operatively. Outcomes which were compared included eight time measures of arterial blood gases; electrolytes and shunt fraction; bedside lung spirometry measures over five time periods; radiographic measures of atelectasis and effusion over three time points; as well as physiotherapy and hospitalisation requirements. Numerous other potentially extraneous variables were measured and compared in order to monitor homogeneity of the study samples. The consistency of the results within each group throughout the study provides strong evidence that the measurements taken were accurate. The use of standardised equipment and vigilant adherence to the protocol ensured no extraneous deviation. The internal validity of this study was therefore good and accurate. The findings of the study however brought into question a previously accepted belief that the pulmonary artery vent prevents the overflow of cardioplegia, not drained from the right atrium, from entering the lungs. There was no literature or previous studies to confirm or dispute this accepted ‘observation’ by cardiac surgeons that the cardioplegia does enter the lung parenchyma. To therefore validate the findings of the study a further four original studies were designed and initiated. The objective of these studies was to establish the efficacy of the pulmonary artery vent and to determine whether cardioplegia indeed circulates through the lung parenchyma or merely accumulates and ‘pools’. Technetium (Tc-99m), a radio labelled isotope was added to the cold blood cardioplegia solution prior to delivery in order to determine this. In the four sub-studies it was confirmed that the pulmonary artery vent is 90-100% effective in retrieving any cardioplegic solution not drained by the atriocaval cannulae, thus confirming the effectiveness of the pulmonary artery vent in preventing cold blood cardioplegic solution from entering the lungs. The findings of the main study confirmed that respiratory impairment after uncomplicated cardiopulmonary bypass, even in low risk patients, is relatively common, as within each group there was a significant change in outcome measures over time. Inter-group comparisons however showed these changes were not significant, with both groups deteriorating by the same degree post-operatively, therefore establishing that these changes were independent of the intervention of the pulmonary artery vent. In the control group, the cold blood cardioplegia solution that did not drain from the atriocaval cannula entered the lungs and circulated the lung parenchyma during cardiopulmonary bypass. The study group made certain that none, or very little, of the cold blood cardioplegia solution entered the lungs. The main findings of this study are therefore that pulmonary function and gas exchange, although markedly reduced following cardiac surgery, are not affected by placement and suctioning via a pulmonary artery vent during the time of cardioplegia delivery intraoperatively. Furthermore, these studies strongly suggest that cold blood cardioplegia solution is innocuous to the lungs / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2006.

Alla människor kan drabbas av hjärtstopp och varje år inträffar ungefär 15 000 hjärtstopp i Sverige. Att drabbas av hjärtstopp är en traumatisk upplevelse som påverkar individen på olika sätt. En ökad kunskap om patienters upplevelser utgör grunden för att ge professionell omvårdnad och kunna bemöta patienten i sin livsvärld. Syftet var att belysa patientens upplevelser efter att ha överlevt hjärtstopp. Studien genomfördes som en litteraturstudie där tio vetenskapliga artiklar utgjorde underlaget för resultatet. Två huvudteman framkom: Livet ruskas om och Omvärdering av tillvaron. Sju underteman gestaltades: återväcks till livet; osäkerhet, rädsla och ångest; minnesförlust; trötthet och svaghet; sårbarhet; bemästrande och ny syn på livet. Den här patientgruppen är i behov av ett omfattande stöd för att bli delaktig i sina hälso- och vårdprocesser för att få möjlighet att återgå till ett välfungerande liv. Ytterligare kvalitativ forskning inom detta område är önskvärt, framför allt på hjärtstoppspatienter utan ICD-behandling. Att vidga kunskapen kring patientens upplevelser och livsvärld kan möjliggöra för sjuksköterskan att bemöta den här patientkategorin med individuella evidensbaserade omvårdnadsåtgärder i den kliniska verksamheten. / Everyone can be the victim of a cardiac arrest and each year in Sweden alone about 15000 people suffer from cardiac arrest. Being the victim of a cardiac arrest is a traumatic experience that affects the individual in different ways. An increased knowledge about the patient´s experiences is the best way to be able to give professional nursing care and to meet the patient in their life-world. The aim of the study was to highlight the patient´s experiences of surviving a cardiac arrest. A literature study was done comprised of ten scientific articles. Two main themes were identified: Life is turned upside down and Re-evaluation of one’s existence. Seven sub-categories were mentioned: resuscitation; insecurity, fear and anxiety; amnesia; tiredness and weakness; vulnerability; to overcome and get a new outlook on life. These patients are in need of extensive support to be able to participate in the health care and nursing process needed in order to return to a well-functioning life. Further qualitative research in this area would be needed primarily for patients without ICD treatment. Expansion of knowledge about patients experiences and life-world can enable nurses to meet and help this patient group with individual evidence based nursing care in a clinical setting.

Syfte: Att kartlägga vårdpersonalens kunskapsläge samt utbildningsfrekvens i hjärtlungräddning på ett länssjukhus i Mellansverige, samt beskriva följsamheten till att registrera behandlade hjärtstopp till det svenska hjärt-lungräddningsregistret. Metod: Enkätstudie med kvantitativ ansats bestående av 177 respondenter samt även som en retrospektiv observationsstudie. Huvudresultat: Enskilda personer svarade rätt på alla kunskapsfrågorna men som grupp fanns det brister i kunskapen i hjärtlungräddning. Då man jämförde vårdpersonalens kunskap påvisades att i fyra av sju kunskapsfrågor fanns en signifikant skillnad i kunskap mellan den vårdpersonal som har mer regelbunden utbildning, än den som har mindre. De som hade mer regelbunden utbildning hade flera rätt. En signifikant skillnad påvisades även beroende på när man hade haft sin senaste HLR-utbildning, där de som haft sin utbildning nyligen hade flera rätt. Följsamheten hos vårdpersonalen till att registrera patienter som behandlats för hjärtstopp på sjukhus till det svenska hjärt-lungräddningsregistret, kan sammanfattas med att det brister i rapporteringen. Konklusion: Det är viktigt att skapa förutsättningar för frekventa utbildningar till vårdpersonal för att öka kunskap och beredskap i hjärt- och lungräddning, vilket även kan ses som ett kvalitetssäkringsarbete. Ett förbättringsarbete är nödvändigt för att förbättra följsamheten till registreringen. / Objective: To identify the healthcare professional´s knowledge and training frequency of cardiopulmony resuscitation in a county hospital in central Sweden, and compliance of the Swedish Register of cardiopulmony resuscitation. Method: Survey with quantitative approach consisting of 177 respondents, as well as a retrospective observational study. Main results: Individuals answered correctly to all knowledge questions, but as a group, there were deficiencies in the knowledge of cardiopulmonary resuscitation. When comparing healthcare professional´s knowledge it was demonstrated that in four of the seven knowledge questions it was a significant difference in knowledge between the health professionals who have more regular training than those with fewer. Those who had more regular education had more right answers. A significant difference was also detected depending on when they had their latest CPR training, where those who have had their education more recently also had more right answers. Compliance of healthcare professional´s to register patients treated for cardiac arrest in hospital at the Swedish CPR registry, can be summarized by the deficiencies in reporting. Conclusion: It is important to create conditions for frequent training to health professionals to increase the knowledge and preparedness in CPR, which can also be seen as a quality assurance work. An improvement is necessary in order to improve compliance to registration.

No description available.

Bakgrund: I Sverige drabbas ungefär 5000 patienter årligen av plötsligt hjärtstopp på våra sjukhus: Hjärtstopp behandlas med hjärt-lungräddning (HLR). Sjuksköterskan är ofta den som upptäcker patienter med hjärtstopp, och den som utbildar i HLR. Syfte: Syftet var att beskriva nya alternativ till den traditionella metoden för HLR-utbildning. Metod: Examensarbetet är gjord som en litteraturöversikt och inkluderar elva vetenskapliga artiklar. Litteratursökningar gjordes i databaserna Pubmed, Cinahl och SveMed. Resultat: Tre olika nya typer av HLR utbildning identifierades; användandet av en simulatordocka som ger datorbaserad återkoppling eller ljudbaserad återkoppling, videoinspelning med självreflektion samt interaktiva datorspel. Metodiken som använde simulatordockor med datoråterkoppling och ljudbaserad återkoppling gav bäst utvecklingsresultat på värden som bröstkompressioner och inblåsningar. Diskussion: Ett optimalt HLR utbildning scenario består av fyra komponenter. Dessa komponenter består av; simuleringsdockor som ger feedback via ljudspår och datorprogram, videoinspelning på den individuella sjuksköterskans insats, interaktiva datorspel samt att sjuksköterskor undervisar sjuksköterskor för bästa möjliga HLR insats. Slutsats: För att vårdpersonal, framförallt sjuksköterskor, ska kunna optimera sina insatser vid HLR-situationer, bör de nyare metoderna för utbildning göras tillgänglig i både grundutbildningen till sjuksköterska och även för verksamma sjuksköterskor. / Background: In Sweden approximately 5000 patients suffer from sudden cardiac arrest in our hospitals every year. Cardiac arrest is treated with cardiopulmonary resuscitation (CPR). Nurses are often those who come across patients with cardiac arrest, and also those who teach CPR. Purpose: The purpose of this paper was to describe new alternatives to the traditional methods for teaching CPR. Method: This examination paper is designed as a literature review, and includes eleven scientific articles. The literature search was made in the databases Pubmed, Cinahl and SveMed. Result: Three different types of new CPR educations were identified; the use of simulation equipment which gives computer based feedback or audio feedback, video recordings with self-reflection, and interactive computer games. Discussion: An optimal CPR education scenario consists of four components; Simulation equipment which gives feedback by audio and computer programs, video recording of the individual nurses contribution, interactive computer games and also nurses who educates nurse for the best CPR effort. Conclusion: In order to optimize healthcare professionals, especially nurse contribution to CPR scenarios, should the new educational types be made available in both the basic education for nurses and also for active working nurses.

Abstract Aim of the study: Aim of the study was to investigate whether there were any connections in time between different parts of care in patients with cardiac arrest and hypothermia treatment and cognitive and physical function six months after cardiac arrest and to investigate neurological outcome related to primary registered cardiac arrest rhythm after six months and if there were any changes in cognitive and physical functions as well as self-related health between discharge from hospital and six months after cardiac arrest. Method: The study included 39 patients admitted to three Swedish hospitals between 2008-2011. Cognitive and physical function was evaluated with Cerebral Performance Cathegory, CPC completed with Mini Mental State Examination, MMSE for cognitive function and Bartels Index, BI for physical function and Euroqol-VAS for evaluating the self-related health. Result:  A significant connection was shown between time to start hypothermia treatment and BI, patients with longer time showed improved physical function after six months. Majority of the participants (66,7 %) had Ventricular fibrillation/Ventricular tachycardia, VF /VT, as primary registered cardiac arrest rhythm and in this group CPC and BI was significant better compared with the asystole /Pulsless Electrical Aktivity, PEA group. CPC, MMSE, BI and Euroqol-VAS were all improved over time. Conclusion: Participants with VF /VT as primary registered cardias arrest rhythm had significant better cognitive and physical function 6 months after hypothermia-treated cardiac arrest compared with participants with asystole/PEA as primary registered rhythm. This shows the importance of access to defibrillators in public places in the society and in hospitals and optimal education of lay people and medical staff. Cognitive and physical function and self-rated health improves over time, which might be a very important reason to convey patients, relatives and medical staff to continue cognitive and physical rehabilitation.   Keywords: Cardiac arrest, hypothermia, cognitive and physical function, wellbeeing

Thesis (Ph. D.)--Ohio State University, 2007. / Full text release at OhioLINK's ETD Center delayed at author's request

Thesis (M.Sc.)--Edith Cowan University, 2007. / Submitted to the Faculty of Computing, Health and Science. Includes bibliographical references.

Bakgrund: År 2016 drabbades 7 934 personer i Sverige av plötsligt hjärtstopp där någon slags behandling påbörjats. På grund av ökade kunskaper kring plötsligt hjärtstopp ökar antalet överlevare. Plötsligt hjärtstopp kan upplevas som en traumatisk kris och kan påverka personens liv. Detta medför ett behov av att förbättra kunskapen och förståelsen för hur personer upplever livet efter plötsligt hjärtstopp. Syfte: Att beskriva personers upplevelser av livet efter plötsligt hjärtstopp. Metod: Litteraturöversikt där nio artiklar med kvalitativ ansats analyserats induktivt. Resultat: Tre teman identifierades. Existentiellt kaos med subteman; Varför jag? och Närheten till döden. Tillbaka till tryggheten med subteman; Behov av närhet och Behov av information. Ett nytt liv med subteman; Livet förändras och Livet omprioriteras. Personerna som drabbats av hjärtstopp hade behov av att fylla i minnesluckor, försöka förstå vad som hade hänt samt finna en mening med händelsen. Slutsats: Resultatet visade att personer som genomgått plötsligt hjärtstopp upplevde att det nya livet innebar fysiska, kognitiva och emotionella svårigheter. Att lära sig leva igen innebar omprioriteringar i livet.

Background: Every year 10,000 people in Sweden suffer from a cardiac arrest. The chance to survive increases and also the lifespan. Having suffered a cardiac arrest means a change in everyday life, both emotionally and physically. Aim: The aim of this study was to describe adult people’s experiences after surviving a cardiac arrest. Method: A qualitative literature-based study. An analysis of nine qualitative articles was carried out. Results: Three main themes emerged; near death-experience, a changed body and to get a functioning everyday. The results showed that life after the cardiac arrest meant a major transformation. To suffer a near-death experience affected the people and there was a reprioritisations of everyday life. It was found that bodily changes created an insecurity and it was perceived as difficulty when the energy was not enough. Conclusion: People who survived a cardiac arrest are in need of support from the health care.