Pesquisa de abordagem qualitativa que consistiu em avaliar o potencial de leigos para atuar como circunstantes nos procedimentos de reanimação cardiorrespiratória e no manejo do desfibrilador externo automático (DEA). Teve como objetivos: descrever o perfil dos participantes; realizar um processo de capacitação dos participantes sobre os primeiros atendimentos à PCR, utilizando o protocolo de atendimento à PCR da AHA para leigos; destacar as habilidades apontadas por eles e analisar suas percepções sobre o processo de atendimento inicial à PCR e o manejo do DEA. Pela especificidade do objeto de estudo, a metodologia utilizada foi pesquisa-ação. A investigação foi realizada na cidade de Marília/SP. O local foram selecionados por meio de mapeamentos específicos e de acordo com a legislação estadual e municipal sobre quais deveriam atender as exigências ao disponibilizar pessoas com capacitação específica, além da manutenção do dispositivo DEA. Selecionou-se um local público, o Terminal de Transporte Urbano de Marília/SP, segundo o número de circulação de pessoas por dia. Os sujeitos deste estudo foram pessoas voluntárias, leigas, trabalhadores de diversas categorias profissionais e ocupacionais do Terminal. Os sujeitos participaram de reuniões informativas sobre a pesquisa e a importância dos procedimentos iniciais à PCR. Realizou-se-se o curso de capacitação e, em seguida, um grupo focal para coleta de dados. Focou-se nas percepções dos participantes sobre o atendimento inicial à PCR, os sentimentos e habilidades relatadas em relação ao processo preconizado como um todo, incluindo o manejo dos materiais envolvidos nessa situação simulada. Posterior à coleta, os dados foram categorizados, tendo sido usada a técnica de análise de conteúdo descrita por Bardin. Os dados foram analisados e discutidos à luz dos referenciais teóricos e pedagógicos propostos por Paulo Freire, a teoria do modelo de crenças em saúde do campo da promoção da saúde e o papel do Estado democrático. Como resultados obteve-se os Grupos 1 e 2, compostos por 11 participantes, em sua maioria constituído de homens. Observaram-se diferenças relacionadas a escolaridade, capacidade comunicativa e intensidade na participação. As principais categorias empíricas foram: as percepções sobre cidadania; as vivências antes do curso; a percepção sobre o processo de capacitação e a não operacionalização do preceito legal. Em síntese, verificou-se o desconhecimento sobre a existência do arcabouço legal, assim como direito de acesso aos serviços e bens públicos decorrentes dos princípios normativos no resgate à cidadania. Emergiram expressões inusitadas de medo de agir por desconhecimento e por temer consequências do insucessos enfrentamento de processos judiciais, em contraste à solidariedade. Sobre habilidade antes do curso de simulação, os participantes relataram alguma vivência na preparação para o advento mal súbito, sobressaindo a insuficiência no aprendizado das habilidades manuais. Após a simulação, houve relatos de possibilidade e de enfrentamento da situação como circunstante, valorizando a oportunidade de aprendizado e apontando a necessidade de maior tempo para a assimilação de conteúdo, com foco nas habilidades em massagem cardíaca e segurança na condução da situação. Quanto à tecnologia DEA, foram unânimes quanto à facilidade interativa com o circunstante. Enfatizaram a necessidade de implementar processos de capacitação para leigos com o uso do DEA, condicionados à mobilização da sociedade civil n a operacionalização dos dispositivos legais por meio de reordenamento das políticas públicas locais. / Qualitative research, which was to assess the potential for laymen to act as bystanders in CPR procedures and management of the automated external defibrillator (AED). Aimed to describe the profile of the participants, conduct a training process with the participants on the first calls to PCR using the PCR protocol compliance with AHA for laymen; highlight the skills mentioned by participants and analyze the perceptions of participants about the process of initial care and management of the PCR DEA. The specificity of the object of study, the methodology was action research and the test was performed in the city of Marilia / SP. The sites were selected through specific mappings and in accordance with state law and city where they should meet the requirements to provide people with specific training in addition to maintaining the device DEA. We selected the public place, Terminal Urban Transport Marilia/SP according to the number of movements of people per day. The subjects of this study were secular groups, made up of volunteers / workers of various professional and occupational this Terminal. Proceeded methodological following routes: the subjects participated in briefings on the research procedures and the importance of the initial PCR. Proceeded to the training course and programming focus group data collection. Focused on participants\' perceptions about the initial care to PCR, feelings and skills reported in relation to the process advocated as a whole, including the handling of the materials involved in this situation simulated. After collection, the data were categorized, relying on the technique of content analysis described by Bardin. Data were analyzed and discussed in the light of theoretical / pedagogical proposed by Paulo Freire\'s, theory of health belief model in the field of health promotion and the role of the democratic state. The results obtained Groups 1 and 2, comprising 11 participants, mostly consisting of men. Observed among members, differences related to education: communication ability and intensity of participation. The main categories were: perceptions of citizenship; experiences before the course, the perception about the training process and not operationalize the legal precept. In summary there was ignorance about the existence of the legal framework for the majority, as well as right of access to public goods and services resulting in the rescue of normative principles to citizenship. Emerged unusual expressions of fear to act by ignorance and/or fear the consequences of failure to act and facing lawsuits contrast with the predominance of either solidarity. About skills before the course simulation, emerged on experience in preparation for the event sudden illness, highlighting the inadequacy of learning with regard to craftsmanship. After the simulation showed reports of chance and face the situation as bystander, valuing the learning opportunity and pointing the need for more time in the assimilation of content focusing on skills in CPR and driving safety of the situation. As for technology DEA was unanimous to its ease interactive with the bystander. It was emphatically the need to implement the processes of training lay people using the DEA, conditioned the mobilization of civil society in the operationalization of legal devices through reorganization of local public policies.

Introduction : De nombreuses différences liées au sexe ont été décrites en pathologie cardiovasculaire. Cependant, les données concernant les spécificités liées au sexe, dans le domaine de la mort subite, sont rares. Objectifs : Dans ce travail, nous avons souhaité décrire les caractéristiques des morts subites survenant pendant une activité sportive, en fonction du sexe. Ensuite, nous avons décidé d’étudier le pronostic de la mort subite en fonction du sexe en population générale. L’étape suivante a pour objectif de décrire et analyser les interventions coronaires réalisées en fonction du sexe. Enfin, le dernier travail a eu pour objectif d’étudier les caractéristiques selon le sexe des patients ayant présenté une mort subite en population générale. Matériels et méthodes : Pour la première partie du travail, nous avons inclus les patients de l’observatoire des morts subites du sportif (cas de morts subites pendant le sport dans 60 départements français de 2005 à 2010). Nous avons comparé les caractéristiques et l’incidence de ces morts subites, par tranche d’âge et par sexe. Dans la deuxième partie, nous avons réalisé une revue systématique de la littérature avec une méta-analyse des études rapportant le pronostic après une mort subite en fonction du sexe. La méta-analyse a suivi un modèle à effets aléatoires, et nous avons rapporté l’hétérogénéité statistique entre les études suivant la statistique I2. La troisième partie a inclus les patients de la base de données PROCAT (patients admis en réanimation à l’hôpital Cochin après une mort subite réanimée). Parmi ces patients, nous avons étudié la fréquence de réalisation d’une coronarographie et d’une angioplastie en fonction du sexe, et l’association entre intervention coronaire précoce et pronostic en fonction du sexe. Les analyses ont été réalisées suivant une régression logistique uni- puis multivariée ; le critère de jugement était la survie avec un bon résultat neurologique en sortie d’hôpital. Enfin, dans la dernière partie, la population d’étude était composée des patients inclus dans le registre régional du Centre d’Expertise Mort Subite CEMS (morts subites survenues dans Paris et les 4 départements de la petite couronne), de 2011 à 2016. Nous avons étudié les caractéristiques, le pronostic et les étiologies des morts subites en fonction du sexe. Résultats : Pour la première partie du travail, 820 morts subites du sportif ont été colligées (dont 5% de femmes). L’incidence était de 0.51 cas par million de pratiquants chez les femmes contre 10.1 chez les hommes (P<0.001), avec une répartition différente en fonction de l’âge. Les caractéristiques Utstein des patients étaient homogènes entre hommes et femmes dans la mort subite du sportif, et les femmes avaient une survie significativement meilleure à l’arrivée à l’hôpital (47% vs 30%, P=0.02). Dans la 2e partie, concernant la mort subite en population générale, la revue systématique a inclus 13 études sur le sujet, et la méta-analyse a retrouvé une survie meilleure chez les femmes (OR ajusté=1.1, IC95% 1.03-1.20, P=0.006). Dans la troisième partie, nous avons mis en évidence que les femmes ont moins souvent une coronarographie que les hommes à l’admission (OR ajusté de coronarographie=0.57, IC95% 0.41-0.79, P=0.001) mais que les taux d’angioplastie après une coronarographie étaient similaires, et l’association au pronostic ne différait pas en fonction du sexe. Enfin, dans la 4e partie, nous avons démontré que le meilleur pronostic retrouvé chez les femmes était essentiellement lié à un meilleur taux de survie préhospitalier (OR=1.3, IC95% 1.2-1.5, P<0.001). De plus, les hommes avaient plus souvent une cause ischémique que les femmes (51% vs 28%), et les femmes davantage de causes hypoxiques ou d’embolies pulmonaires. (...) / Introduction: Several gender-specificities have been described in cardiovascular diseases. By contrast, data regarding gender-specificities in the field of sudden cardiac death remain sparse. Objectives: Our first aim was to describe the characteristics of sports-related sudden death, according to gender. Secondly, we assessed the prognosis after sudden death according to gender. The third step aimed at describing and analyzing gender differences in early invasive strategy after cardiac arrest. In the last part, we wanted to assess the respective characteristics of sudden death in men and women in general population. Material and Methods: In the first part, we included cases of sports-related sudden death observatory (sudden deaths that occurred during sport activity in 60 french districts between 2005 and 2010). We compared characteristics and incidence of sudden death, according to age and sex. In the second part, we performed a systematic review and meta-analysis to assess the association between gender and survival after sudden cardiac death. We used a random-effects model, and reported statistical heterogeneity across the studies using I2 statistic. The third part included patients from PROCAT database (cohort of patients admitted alive in intensive care unit in Cochin hospital after a resuscitated sudden death). Among these patients, we studied gender differences regarding early coronary angiogram and percutaneous intervention after sudden death. We also reported the association between coronary intervention and prognosis, according to gender. Analyses were performed with uni and multivariate logistic regression; primary outcome was favorable neurologic outcome at hospital discharge). In the last part, population was drawn from Sudden Death Expertise Center registry (including sudden death in Paris and 4 districts around), from 2011 to 2016. We described characteristics, prognosis and etiologies of sudden death according to gender. Results: In the first part, 820 sport-related sudden deaths were included (including 5% women). Incidence was 0.51 cases per million among women, compared with 10.1 in men (P<0.001), with different distribution among age categories. Utstein characteristics of patients were homogeneous between men and women in sport-related sudden deaths, and women had significantly higher survival at hospital admission (47% vs 30%, P=0.02). In the second part, systematic review included 13 studies, and meta-analysis found a significant association between female gender and survival after sudden death (adjusted OR=1.1, 95% CI 1.03-1.20, P=0.006). In the third part, we found that women had less coronary angiography than men (adjusted OR for coronary angiography=0.57, 95% CI 0.41-0.79, P=0.001) but the rates of percutaneous interventions after coronary angiography were similar. Association between coronary intervention and prognosis did not differ according to sex. Finally, in the fourth part, we reported that the better prognosis reported among women was mainly related to a better survival rate before hospital admission (OR=1.3, 95% CI 1.2-1.5, P <0.001). In addition, men had more often ischemic cause than women (51% vs 28%), who presented more hypoxic causes or pulmonary embolism. Conclusion: In this work, we used several sources (a national observatory, a systematic review of the literature, an hospital database and a regional registry) to clarify the specificities of sudden death in women. We highlighted several specificities associated with female gender in sudden death, regarding characteristics, management and prognosis. Assessing the medical history prior to the event, and examining the long-term prognosis according to gender are the next steps to explore.

Bakgrund: Hjärtstopp är något som kan drabba vem som helst, när som helst. Varje år drabbas cirka 10.000 personer av hjärtstopp, av dessa inträffar cirka 4.500 på sjukhus. Två övergripande orsaker till hjärtstopp är hjärtfel samt respiratoriska problem. Vid överlevnad av hjärtstopp påverkas överlevaren både psykiskt samt fysiskt. Syfte: Litteraturstudiens syfte är att beskriva personers upplevelser av hur det dagliga livet påverkas efter ett hjärtstopp. Metod: Studien är en litteraturstudie där resultatet grundar sig i relevant information som tagits ur tio stycken kvalitativa studier. Resultat: Resultatet har delats upp i tre kategorier vilka är fysisk påverkan i det dagliga livet, psykisk påverkan i det dagliga livet samt existentiella tankar. Under dessa tre kategorier finns det fem underkategorier vilka är fysisk funktion av det dagliga livet samt att återgå till ett aktivt dagligt liv som tillhör kategorin fysisk påverkan. Oro/rädsla/ ångest, behov av samtal för psykisk återhämtning samt kognitiva begränsningar i det dagliga livet tillhör kategorin psykisk påverkan. Konklusion: Den mest förekommande samt återkommande upplevelsen hos de flesta deltagarna var oro, rädsla samt ångest vilket skulle kunna innebära att fler behöver omvårdnad genom stöttning samt samtal av sjuksköterskan. De flesta kände en stor tacksamhet över att ha fått livet tillbaka men samtidigt drogs med en del negativa konsekvenser vilket hade kunnat förbättras genom erbjudan av gruppsamtal för att få möjlighet att dela sina erfarenheter med andra människor. Många kände sig begränsade i sitt dagliga liv, den fysiska förmågan som fanns där innan hjärtstoppet var inte densamma samt att deltagarna hela tiden drogs med tanken om ett nytt hjärtstopp. Genom att arbeta efter kärnkompetensen, samverkan i team hade sjuksköterskan kunnat erbjuda fysioterapi eller kuratorkontakt för att se till att personens behov uppfylls. / Background: Cardiac arrest is something that can affect anyone at any time. Each year, about 10.000 suffer from cardiac arrest and about 4.500 of these occur in hospitals. The two major overall causes of cardiac arrest are heart failure and respiratory problems. Of those who survive a cardiac arrest, the survivor is affected both mentally and physically. Purpose: The purpose of this literature study is to describe people’s experiences of how daily life is affected after a cardiac arrest. Method: The study is a literature study were the result is based on relevant information taken from ten qualitative studies. Result: The result has been divided into three categories which are physical influences in daily life, mental impact in daily life and existential thoughts. Under these three categories there are five subcategories which are physical function in daily life and returning to an active daily life which belongs to the category physical influences. Worry/ fear/ anxiety, the need for conversation for a mental recovery and cognitive limitations in the everyday life belongs to the category mental impact in daily life. Conclusion: The most common and recurring experience in most participants was worry, fear and anxiety which could mean that more people need nursing through support and conversations by the nurse. Most of them felt a great gratitude for having returned to life, but at the same time they were drawn with some negative consequences which could have been improved through the offer of group conversations in order to be able to share their experiences with other people. They felt limited in their daily life, the physical ability they used to have before the cardiac arrest was not the same. The participants were also constantly drawn with the idea of a new cardiac arrest. By working after the core competency, collaboration in teams, the nurse had been able to offer physiotherapy or curatorial contact to ensure that the person's needs were answered.

Bakgrund: I Sverige, drabbas 5000 personer av hjärtstopp varje år och av dessa räddas 500 personer. Att drabbas av ett hjärtstopp är traumatiskt för den drabbade och kräver tid för återhämtning. Anhöriga har en central roll i omvårdnaden av den drabbade, både vid hjärtstoppet samt tiden efter. Syfte: Denna litteraturstudie syftar på att öka förståelsen av de anhörigas upplevelse då deras närstående drabbas av ett hjärtstopp. Metod: Studien genomfördes med en kvalitativ ansats. Tio relevanta artiklar fanns vid sökning i databaserna Cinahl och Pubmed. Artiklarna kvalitets granskades och analyserades via Fribergs (2017) modell. Resultat: studien resulterade i fyra huvudkategorier: De första känslorna, information och kommunikation, känsla av kontroll samt förändring. Vidare framkom 15 subkategorier. Konklusion: Vid ett hjärtstopp upplever anhöriga olika känslor; det är en överväldigande och chockerande incident. De ställs inför livsförändringar och deras egna hälsa påverkas. Att ta hand om de anhöriga är av stor betydelse för den närståendes tillfrisknande. Kunskap om de anhörigas upplevelse då deras närstående drabbas av ett hjärtstopp är essentiell för sjuksköterskan för att hon ska kunna bidra med omhändertagande av de. / Background: In Sweden, every year approximately 5000 people suffer from cardiac arrest, from these 500 get saved. A cardiac arrest is traumatizing for the ones affected and requires time for recovery. The relative has a central part in the care of the one affected, both during and after the event. Aim: This literature study aims to get a better understanding of relatives lived experiences when a relative suffers from a cardiac arrest and survives. Method: The study was conducted as a literature review with a qualitative approach. Ten articles were found through CINAHL and Pubmed database which were examined in quality and furthermore analyzed through the model of Friberg (2017). Results: The study resulted in four main categories: The initial feelings, information and communication, feeling of control, and change. From these 15 subcategories were formed. Conclusion: At a cardiac arrest, relatives experience a lot of different emotions. It is an overwhelming and shocking event. They face significant changes in life, and their health is affected. Taking care of a relative is of solid matter for a patients recovery. The knowledge of relatives' experience is essential for a nurse to make sure relatives receive proper care in devastating events.

L’arrêt cardiaque (AC) est un problème de santé publique dont la mortalité reste très élevée malgré les progrès de la réanimation. La majorité des décès à distance de la réanimation cardio-pulmonaire (RCP) initiale est la conséquence du syndrome post‑AC provoqué par les lésions cellulaires d'ischémie-reperfusion (I/R) qui touchent principalement le cœur et le cerveau. L’ouverture du pore de transition de perméabilité mitochondrial (PTP), en lien avec la cyclophiline D (CypD), est un déterminant majeur des lésions d'I/R. L’hypothermie thérapeutique est le seul traitement adjuvant de la RCP qui a démontré un bénéfice sur la survie des patients en limitant le syndrome post-AC. Ses mécanismes d’action complexes ne sont que partiellement compris. Dans ce travail de thèse, nous avons, dans un premier temps, utilisé notre modèle d'AC chez le lapin pour étudier les mécanismes mitochondriaux de l’hypothermie thérapeutique. Notre modèle a d'abord permis de mettre en évidence le rôle important joué par la température dans la gravité du syndrome post‑AC et les effets protecteurs de l’hypothermie sur le cœur et le cerveau. Notre travail montre également que l'hypothermie inhibe l’ouverture du PTP par un mécanisme dépendant de la CypD et agit sur une voie de signalisation cellulaire. Nous avons, dans un second temps, mis au point un nouveau modèle d'AC chez la souris déficiente en CypD montrant que l'inhibition complète du mécanisme dépendant de la CypD d'ouverture du PTP améliore le succès de la RCP ainsi que le pronostic à long terme des animaux traités par hypothermie thérapeutique. Ainsi, nos travaux contribuent à identifier les mécanismes d'action mitochondriaux de l’hypothermie thérapeutique ainsi que des pistes pour améliorer le pronostic des patients après un AC réanimé / Despite advances in resuscitation science, mortality after cardiac arrest (CA) remains very high. A substantial proportion of cardiac arrest deaths occur in patients following successful resuscitation and can be attributed to the development of post-CA syndrome caused by cellular ischemia-reperfusion (I/R) injury that primarily affect heart and brain cells. The opening of the mitochondrial permeability transition pore (PTP), promoted by cyclophilin D (CypD), is a major determinant of I/R injuries. Therapeutic hypothermia is the only adjuvant therapy to cardiopulmonary resuscitation (CPR) known to improve survival by limiting the post-AC syndrome. The mechanisms of action of therapeutic hypothermia are still poorly understood. In this present work, we used our model of CA in rabbit to study the role of the PTP in the mechanisms of action of therapeutic hypothermia. Our model first highlighted the important role played by temperature in the severity of post-AC syndrome and the protective effects of hypothermia on heart and brain injuries. Our work also determined that hypothermia inhibited PTP opening by a CypD-dependent mechanism and acted on a pro-survival signaling pathway. We then developed a new CA model using CypD-deficient mice showing that complete inhibition of the CypD-dependent mechanism of PTP opening improved success of CPR and long-term survival of hypothermia-treated animals. Thus, our work contributes to identifying the mitochondrial mechanisms of action of therapeutic hypothermia and ways to improve the prognosis of patients after CA

Bakgrund: År 2018 drabbades cirka 8700 personer av ett hjärtstopp i Sverige. Hjärtstopp kan upplevas som en traumatisk händelse och kan påverka personens upplevelse av det fortsatta livet. Teoretisk referensram som tillämpats är ”Känsla av sammanhang ”(KASAM) av Aaron Antonovsky. Syfte: Att beskriva patienters upplevelse av att överleva ett hjärtstopp. Metod: En litteraturöversikt av kvalitativ design med induktiv ansats har tillämpats. Resultat: Två teman identifierades. En förändrad kropp med subteman; kognitiva förändringar, fysiska förändringar, emotionella förändringar, existentiella förändringar. En andra chans med subteman; En ny syn på livet, behov av information och stöd och närståendes betydelse. Resultatet visade att kognitiva, fysiska och emotionella förändringar var vanligt. Patienter som överlevt ett hjärtstopp kände ett behov av stöd från anhöriga och sjukvård. Slutsats: Att drabbas av hjärtstopp innebär en livsomvälvande upplevelse. Händelsen visar sig ha såväl fysiska som psykiska konsekvenser. Patienterna känner ett ökat behov av stöd och information från sjukvården. Sjuksköterskan har en viktig roll att tillgodose patientens behov och stärka patientens känsla av sammanhang. Eftersom antalet överlevare ökar finns ett större behov av evidensbaserad kunskap om hur sjuksköterskan på bästa sätt kan stödja denna patientgrupp. Nyckelord: Erfarenheter, hjärtstopp, känsla av sammanhang, omvårdnad, patient, överlevare. / Background: In the year 2018, approximately 8700 people were affected by a cardiac arrest in Sweden. Cardiac arrest can be experienced as a traumatic event and affect the person's experience of the future life. The theoretical reference is “Sense of coherence” (SOC) by Aaron Antonovsky.  Aim: To describe peoples experiences of surviving a cardiac arrest  Method: A literature review of qualitative design with inductive approach. Results: Two themes were identified. A changed body with subthemes cognitive changes, physical changes, emotional changes and existential thoughts. A second chance with subthemes, a new vision on life, need for information and support and the meaning of close relatives. The result showed that cognitive, physical and emotional changes were common. Patients who suffered from cardiac arrest needed support from relatives and healthcare. Conclusion:  Suffering from av cardiac arrest involves a life-changing experience.  The event turns out to have both physical and mental consequences. The patients feel an increased need for support and information from the healthcare system. The nurse has an important role in meeting the patient's needs and strengthening the patient's sense of coherence. As the number of survivors increases, there is a greater need for evidence-based knowledge of how the nurse can support this patient group in the best way. Keyword: experiences, cardiac arrest, survivors, nursing, patient, sense of coherence

Bakgrund: I Sverige och runtom i världen drabbas många av ett plötsligt hjärtstopp. Då statistik visar på att överlevnaden förbättras blir det fler som får uppleva den svåra vardagen efter hjärtstoppet. I efterförloppet finns risken för att vardagen kantas av många tankar och känslor som påverkar den överlevandes liv. Syfte:Syftet med litteraturöversikten var att studera patienters upplevelser av att överleva ett hjärtstopp. Metod: Litteraturöversikten bestod av kvalitativt analyserade studier och baserades på en induktiv ansats. Fjorton artiklar godkändes utifrån ett kvalitetsprotokoll och valdes till resultatet. Under analysen tog tre huvudkategorier samt sex underkategorier form. Resultat: Litteraturöversikten resulterade i olika beskrivningar av patienters upplevelser av att ha överlevt ett hjärtstopp. Känslor av tacksamhet, förändring och existentiella tankar var dominerande och det framkom att människorna ville se en mening och få en förståelse för det som inträffat. Slutsats: I takt med att fler överlever ett hjärtstopp ökar behovet av stöttning med att hantera sina tankar och känslor i efterförloppet då detta visade sig vara en stor del av personernas vardag. Med god kunskap i hur dessa mår efteråt kan sjuksköterskor stödja dessa i att söka mening och sammanhang i deras förändrade vardag. / Background: In Sweden and around the world, many people suffer from a sudden cardiac arrest. As statistics shows that the survival is improving, more people will experience the difficult everyday life after a cardiac arrest.  In the aftermath, there is a risk that the everyday life is fraught with many thoughts and feelings that affect the survivor’s life. Aim: The aim of the literature review was to study patients' experiences of surviving a cardiac arrest.Method: The literature review consisted of qualitative analysed studies and was based on an inductive approach. Fourteen articles were approved based on a quality protocol and selected for the result. During the analysis, three main categories and six subcategories emerged. Results: The literature review resulted in different descriptions of patients' experiences of surviving a cardiac arrest. Feelings of gratitude, change and existential thoughts were dominant, and it turned out that people wanted to see a meaning and gain an understanding of what had happened. Conclusions: As more people survive a cardiac arrest, the need for support increases in dealing with their thoughts and feelings in the aftermath, as this turned out to be a big part of people’s everyday lives. With good knowledge of how these feel afterwards, nurses can support them in seeking meaning and coherence in their changed everyday lives.

Bakgrund: Hjärtstopp skördar årligen många liv. Goda kunskaper krävs för att identifiera hjärtstopp för att tidigt kunna inleda behandling. Sjuksköterskan behöver kärnkompetenser för att kunna identifiera problem och etiska dilemman genom ett personcentrarat förhållningssätt. Syfte: Syftet var att beskriva sjuksköterskans uppfattning av vad som påverkar beslutsfattandet vid hjärtstopp prehospitalt.Metod: Studien utfördes som en allmän litteraturstudie där åtta vetenskapliga artiklar granskades och analyserades. Resultat: Tre kategorier framkom: Sjuksköterskans kompetens och erfarenhet, tillgänglig information samt emotionellt ansvar. Tidigare erfarenheter av att ha behandlat patienter med hjärtstopp innebär en bearbetning av känslor och åsikter, vilket framöver kan påverka beslutsfattandet och kliniska åtgärder. Fullständig information måste vara insamlat innan ett avgörande beslut fattas om återupplivningsförsöket ska fortgå eller avslutas. Sjuksköterskor upplevde att erfarenheter av sorg kunde vara fördelaktigt både i samtalet med närstående men också i beslutsfattandet. Konklusion: Kompetens och erfarenhet påverkar sjuksköterskornas beslutsfattande. Information kring patientens sjukdomsbild och den förväntade livskvalitén kan influera sjuksköterskans uppfattning om insjuknandet vilket kan vara avgörande för beslutet. / Background: Cardiac arrests kills many patients every year. Significant knowledge is required to identify cardiac arrests before being able to start early treatment. The nurse needs skills to be able to identify problems and ethical dilemmas trough a person-centered approach. Aim: The purpose was to describe the nurse's experiences of what influences decision-making in prehospital cardiac arrest. Method: The study was conducted as a general literature study where eight scientific articles were reviewed and analyzed. Results: Tree categories emerged: The nurse competence and experience, available information and emotional responsibility. Experience in treating cardiac arrest patients leads to the management of emotions and opinions that affects decision making and the quality of care. Complete information must be gathered before a decisive decision is made as to whether the resuscitation attempt should continue or be terminated. Nurses felt that experiences of grief could be beneficial both in the conversation with relatives but also in decision-making Conclusion: Competence and experience influence the nurses’ decision-making. Information about the patient's overall illness and the expected quality of life can influence the nurses’ perception of the illness, which can be vital for the decision.

The objective of the current study is to present the case of an intercollegiate basketball player diagnosed with an ifliopathic cardiomyopathy. The athlete illustrated in the case study experienced ongoing chest discomfort with exercise. Episodic chest pain and syncope in athletes is often alarming and may signal an underlying cardiac condition. Early recognition and maJagement of these athletes is vital to the prevention of sudden cardiac death (SCD). Fortunately, the athlete was referred to a cardiologist by her team physician during her pre-participation physical examination to rule out heart conditions that may lead to SCD. The athlete was presented a mildly reduced ejection fraction during her screening with the cardiologist. In cardiovascular physiology, ejection fraction is the fraction of end-diastolic volume that is ejected from the ventricle with each heart beat. Damage to the myocardium, as seen in cardiomyopathies, decreases the heart's ability to eject blood and therefore reduces the ejection fraction. The athlete underwent VO2max testing as well where it was discovered that her VO2max was exceptionally low for a physically active division-I athlete. This low VO2max suggested that the athlete had an insufficient oxygen uptake during intense exercise. The athlete experienced a treatment protocol consisting of a progressive conditioning regimen of additional cardiovascular exercise that proved to be effective in raising her VO2max by 10%. The athlete returned to full participation and remained asymptomatic throughout the remainder of the season. The pre-participation physical examination is crucial in early detection of events that may lead to sudden cardiac death. A thorough history and physical examination are the most efficient screening methods for detecting cardiovascular abnormalities. Any athlete with episodes of syncope, hypertension, or changes in heart rhythm should be referred to a physician.

Bakgrund: Incidensen av hjärtstillestånd i Sverige uppskattas till 5000 fall varje år. Barn drabbas också av hjärtstopp hos tandläkare, därför är det viktigt att tandläkare har kunskap inom HLR till barn för att öka chansen för överlevnad. Syfte: Att ta reda på hur mycket kunskap tandläkarstudenter på tandläkarutbildningar i Stockholm, Göteborg och Malmö har om HLR till barn och att undersöka om tandläkarstudenterna behöver ytterligare utbildning i HLR till barn för att säkerställa kunskaper inom området. Material &amp; Metod: Webbaserad enkätstudie där tandläkarstudenter på sista terminen på utbildningsorterna; Stockholm, Göteborg och Malmö tillfrågades om deltagande och att besvara 20 frågor om hantering och kunskaper gällande barn-HLR. Resultat: Totalt tillfrågades 263 tandläkarstudenter från Stockholm, Göteborg och Malmö, och 90 personer av dessa svarade 34,2 %. Av alla tandläkarstudenter uppvisade 31,1 % korrekt kunskap i alla steg att kunna utföra HLR i rätt ordning, som bröstkompressioner samt skapandet av fria luftvägar. Av Göteborgs tandläkarstudenter uppvisade 54,5 % rätt kunskap medan motsvarande siffror för Malmö och Stockholm var 23,8 % respektive 23,1 %. Av de svarande önskade 85,6 % mer information om att hantera en situation vid hjärtstopp av barn.  Slutsats: Fler studier med ett större antal deltagare behövs för att kunna kartlägga kunskapen hos tandläkarstudenter om akut hantering och omhändertagande av situationen vid hjärtstopp och andningsstopp hos barn. Genom framtida samarbete mellan tandläkarutbildningar så kan flera möjligheter erbjudas till studenter för att uppnå högre kunskapsnivå. Det kan även finnas ett behov att erbjuda HLR-utbildning för att öka kunskapen i samhället. / Background: The incidence of cardiac arrest in Sweden is estimated to be 5,000 cases per year.  Cardiac arrest also happens at the dentist, therefore it is important that dentists have knowledge in CPR for children. The aim: To investigate how much knowledge dental students in Stockholm, Gothenburg and Malmö have about CPR for children and investigate whether students need additional training. Material &amp; Method: Web-based survey where dental students in their last semester in Stockholm, Gothenburg and Malmö, were asked to participate in answering 20 questions about  children-CPR. Results: A total of 263 dental students from Stockholm, Gothenburg and Malmö, and 90 of them responded 34.2%. Of all dental students, 31.1% demonstrated correct knowledge in all stages to be able to perform CPR in the correct sequence, such as chest compressions and the creation of free airways. Of Gothenburg's dental students, 54.5% demonstrated the correct knowledge, while the corresponding figures for Malmö and Stockholm were 23.8% and 23.1% respectively. Of the respondents, 85.6% wanted more information about handling a situation in the event of cardiac arrest in children. Conclusion: More studies with a larger number of participants are needed to be able to assess the level of knowledge of dental students about emergency management of situations of cardiac arrest and respiratory arrest. Through future collaboration, several opportunities can be offered to students to achieve a higher level of knowledge. There may also be a need to offer CPR training at both adult and child level.