Bakgrund: Hos sjuksköterskor på akutmottagning råder delade meningar om närståendes närvaro vid hjärt-lungräddning. Detta kan bero på om sjuksköterskan har positiva eller negativa upplevelser av situationen. Sedan flera år finns internationella riktlinjer skrivna som förespråkar närståendes närvaro, dessa används generellt inte i någon större utsträckning. Syfte: Att belysa sjuksköterskans upplevelse av närståendes närvaro vid hjärt-lungräddning på akutmottagning. Metod: En litteraturstudie har genomförts med 12 kvalitativa och kvantitativa vetenskapliga artiklar. Resultat: Under senare år har majoriteten av sjuksköterskorna gått från negativ inställning till positiv för närståendes närvaro vid HLR. Att närstående varit närvarande i de fall där HLR inte varit lyckad trodde sjuksköterskorna kunde underlätta det kommande sorgarbetet. Sjuksköterskorna trodde att närstående lättare kunde acceptera det plötsliga dödsfallet om de fick beröra, ta farväl och vara ett stöd den sista stunden i livet för sin familjemedlem. Slutsats: För att sjuksköterskan ska kunna behålla sin positiva upplevelse till närståendes närvaro vid HLR på akutmottagning krävs utvecklings–och förbättringsarbete. I detta arbete krävs både teoretisk och praktisk utbildning inom området. Samt etablering av de internationella riktlinjerna till lokala riktlinjer. / Background: Among nurses in emergency department is a difference of opinion regarding the issue of relatives being present during cardiopulmonary resuscitation. This can depend on the nurse have positive or negative experience of the situation. Since several years international guidelines are written to recommend relatives being present but in general they are not used. The aim: Of this study was to explain nurse’s experiences of relative’s presence during cardiopulmonary resuscitation in emergency department. Method: A literature review in which 12 qualitative and quantitative scientific papers have been reviewed. Results: During the last years most parts of the nurses changed their opinion from negative to positive regarding to relatives being present at CPR. If relatives been present when CPR wasn´t successful the nurses believed could help the coming grieving process. Nurses believed that relatives easier could accept the sudden death if they were able to touch, to say goodbye and share the last moments in life with their family member. Conclusion: To maintain the nurse positive experience of relative presence during CPR in emergency department needs development- and improvement work. This work needs both theoretical and practical education. And also there are needs to establish the international guidelines to local guidelines.

Bakgrund: Etiska riktlinjer vid hjärtstopp rekommenderar att närstående ska få möjlighet att närvara vid hjärt- och lungräddning om de önskar och inte utgör ett hinder. Befintlig forskning visar att många närstående vill närvara och att närvaron gynnar både patient och närvarande närstående. Trots detta är sjuksköterskors upplevelser och åsikter kring ämnet fortfarande delade. Genom att sammanställa sjuksköterskors upplevelser i en övergripande litteraturöversikt kan sjuksköterskor utveckla sin professionella omsorg och därmed bidra till att stärka människors hälsoprocesser. Syfte: Att belysa sjuksköterskors upplevelser av att närstående närvarar vid hjärt- och lungräddning på sjukhus. Metod: En litteraturöversikt, baserad på 14 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. Resultatet har sammanställts genom en beskrivande syntes. Resultat: Resultatet presenteras i två huvudteman med tre underteman vardera. En källa till nya möjligheter belyser sjuksköterskors upplevelser av mellanmänsklig relation där nya perspektiv och erfarenheter för att göra skillnad råder. En källa till oro belyser sjuksköterskors upplevelser av oönskade minnen, försvårande omständigheter och en rädsla för påföljder. Konklusion: Sjuksköterskor upplever i linje med växande erfarenhet att oron dämpas och istället blev närståendes närvaro en källa till möjligheter. / Background: Ethical guidelines for cardiac arrest recommend that relatives should be given opportunity to be present during cardiopulmonary resuscitation, if they wish and aren’t a hindrance. Existing research shows that most relatives would attend and that their presence benefits both patient and relative. Despite this, nurse’s attitudes and opinions about present relatives during resuscitation remain fragmented. This places emphasis to merge this fragmented picture into an overall literature review containing nurse’s experiences of this practice. Based on this picture nurses could develop their professional care and help to strengthen people's health processes. Aim: To highlight nurse’s experiences of relatives being present during CPR in hospital. Method: A literature review, based on 14 scientific articles with both qualitative and quantitative approach. The result was compiled through a descriptive synthesis. Results: Is presented in two main themes with three subthemes each. A source of new opportunities illuminates nurse’s experiences of interpersonal relationship in which new perspectives and experiences of making a difference prevail. A source of concern illuminates nurse’s experiences of unwanted memories, aggravating factors and fear of sanctions. Conclusion: Nurses experience that when their experience grew, their concern dampened and it became a source of opportunities having relatives present.

Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain.

Diese Arbeit beschäftigt sich mit den Auswirkungen der Herz-Lungen-Maschine auf das Gewebe des Hippocampus in einem Ferkelmodell. Die Tiere untereilte man in 5 Gruppen: „Kontrolle“, „Kontrolle mit Minozyklin“, „HLM pulsatil“, „HLM nicht-pulsatil“, sowie „HLM nicht-pulsatil mit Minozyklin“. Es wurde untersucht, ob eine pulsatile Perfusion Schäden in den Zellen des Hippocampus gegenüber eines nicht-pulsatilen Blutflusses während der extrakorporalen Zirkulation abmildern kann. Des Weiteren überprüfte man neuroprotektive Effekte des Tetrazyklin-Derivates Minozyklin während eines kardiochirurgischen Eingriffes mit Herz-Lungen-Maschine. Während der Operation wurde bei allen Ferkeln eine Hypothermie von 28 °C durchgeführt und die HLM-Zeit betrug 90 Minuten. Die Rekonvaleszenzzeit umfasste 120 Minuten. Minozyklin verabreichte man in den entsprechenden Gruppen sowohl zu Beginn des Versuches (4 mg/kg KM) und nach Abkopplung von der Herz-Lungen-Maschine (2 mg/kg KM) intravenös. Hauptbestandteil der Arbeit waren histologische und immunhistochemische Färbemethoden zur Untersuchung des Hippocampus. Mithilfe eines Mikroskops wurden Veränderungen auf zellulärer Ebene im CA1- und CA3-Areal des Cornu ammonis im Hippocampus ausgewertet. Für die Ergebnisse betrachtet man die Pyramidenzellen des Stratum pyramidale. In der Hämatoxylin-Eosin-Färbung wurden Zellen mit den Eigenschaften „Ödem“, „Eosinophilie“ und „Pyknose“ für jedes Versuchstier gezählt. Mit den immunhistochemischen Färbungen sollten Faktoren für den programmierten Zelltod, für Hypoxie (HIF 1-alpha) und für oxidativen Stress (3-Nitrotyrosin) detektiert werden. Als Marker für Apoptose wählte man den Apoptose-induzierenden Faktor (AIF), cleaved Caspase 3 und Poly(ADP)Ribose (PAR).

The objective of the present article is the approach of 2010 ECC & CPR Guidelines and their principal modifications. Guidelines are the result of scientific evidence and clinical research that support statements and new recommendations. Some important changes in 2010 present in the Chain of Survival which includes aspects of Postresuscitation Care1,2. CPR Guidelines were published and uploaded on-line (Resuscitation and Circulation publication) in October 18th, 20109,10. One of the most important training and learning strategies is the dissemination of concepts from ILCOR CPR and ECC Guidelines which had extended into ERC and AHA. This has allowed the medical personnel to treat patients victims of cardiac arrest or cardiac emergency efficiently. We are convinced that interactive methodology and clinical simulation are essential for training and learning. We cannot know cardiopulmonary resuscitation without discussion of science and performance of lively clinical scenery cases for each of the main topics in CPR and ECC / El presente artículo busca como objetivo primordial, una aproximación a las Guías 2010 y principales cambios; estamos convencidos que el entrenamiento y aprendizaje de ella se basa en los conceptos de metodología activa y simulación clínica, no podemos tener un conocimiento de la ciencia y protocolos de reanimación cardiopulmonar sin antes no haber experimentado la discusión de temas y desarrollo de casos escenarios vivenciales, para cada uno de los tópicos descritos a continuación. Una de las estrategias más importantes es la diseminación de los conceptos contenidos en las Guías ILCOR de Reanimación Cardiopulmonar que se han consensuado en la ERC y AHA. Ello ha permitido que el personal de salud trate a los pacientes victimas de paro cardiaco o emergencias cardiacas con mayor eficiencia. Las guías actuales fundamentan todos sus aspectos en investigación y recomendaciones, los cambios se iniciaron con una variación sustantiva de la cadena de supervivencia incorporando conceptos de integración de cuidados postparo1,2. Las Guías de Reanimación Cardiopulmonar fueron publicadas y puestas on-line (Resuscitation y American Heart Association) en Octubre 18, 20109,10.

This microcirculatory study compared the effects on oxygen transport of two hemodilution fluids: HBOC-201 (Biopure Corp., Cambridge, MA) a Hemoglobin-Based Oxygen Carrier (HBOC), and 5.9% Human Serum Albumin (HSA) an iso-oncotic non-oxygen carrying colloid solution. Measurements using intravital microscopy were made on the spinotrapezius muscle of male, Sprague-Dawley rats. Interstitial PO2 was measured using phosphorescence quenching microscopy, and recorded before and after isovolemic hemodilutions (HD) at hematocrits of 40% (baseline), 30% (moderate HD) and 15% (severe HD). Oxygen consumption (VO2) of the spinotrapezius muscle was derived from PO2 recordings following the rapid inflation of a plastic bag placed around the objective. When the bag was inflated, blood flow in the muscle was arrested and PO2 rapidly fell over several seconds; the rate of decline of PO2 was proportional to VO2. For moderate HD (Hct ~ 30%) with HBOC-201, interstitial PO2 did not change from baseline conditions (Hct ~ 40%), while HD with HSA showed a decrease. For severe HD (Hct ~ 15%) both PO2 and VO2 were significantly lower for the HSA group than for the HBOC-201 group. These findings indicate that HBOC-201 maintains both a higher PO2 and VO2 during hemodiluted states compared with a non-oxygen carrying colloid solution (HSA). Furthermore, 5.9% HSA does not affect the mean arterial pressure (MAP) and vessel diameters, whereas HBOC-201 causes vasoconstriction, and consequently an increase in MAP. However, the vasoconstriction is not uniform among different branches of the arteriolar network, and most of the changes occur in the larger vessels, i.e., feed and arcade arterioles, while minimal in smaller vessels, i.e., transverse arterioles. In addition, findings show that MAP and vessel diameters return to baseline within 1-3 hours, implying that vasoconstriction and hypertension caused by HBOC-201 are acute responses.

This diploma thesis presents a new form of outdoor activity called Priessnitz Walking, which means a connection of nordic walking, cooling limbs in a cold water and a yoga breathing exercises. A physiological grounds of each of its parts has been explained in the theoretical part of the thesis as well as its benefits for older people. Next to this, the thesis concerns about a physiology of aging and the importance of regular physical activity in later life. Our clinical experiment investigated an effect of PW during six-week training programe in older women attending Cardio Club Motol. A significant change in cardiorespiratory function and a positive subjective evaluation of the participates has been shown. Besides, we have found Priessnitz walking to be a save kind of endurance training for older people. A long-term adherance, which we also focused on, was not confirmed. Powered by TCPDF (www.tcpdf.org)

Abstrakt Titel: Vårdpersonalens upplevelser av anhörigas närvaro vid hjärt- och lungräddning – en kvalitativ litteraturstudie. Bakgrund: Varje år drabbas över 10 000 personer av ett plötsligt hjärtstopp. Vid hjärtstopp drabbas hjärnan av syrebrist med risk för obotliga hjärnskador som följd. Startas hjärt- och lungräddning (HLR) tidigt kan överlevandsfrekvensen öka. Det kan vara en sjuksköterska som bekräftar hjärtstoppet samt påbörjar HLR. En uppgift sjuksköterskan kan ställas inför är kontakten med de anhöriga, det kan innebära att förmedla information, inhämta kunskap och stötta dem. Syfte: Belysa vårdpersonalens upplevelser av anhörigas närvaro vid hjärt- och lungräddningssituation av patienter med akut hjärtstopp. Metod: En litteraturstudie baserad på nio vetenskapliga artiklar med kvalitativ ansats. Resultat: Möjligheter vid anhörigbevittnad hjärt- och lungräddning är att ta farväl och få ett avslut, skapa en relation, förståelse genom delaktighet och anhöriga som resurs. Hinder för god omvårdnad yttrade sig genom: emotionella uttryck och rädslor hos vårdpersonalen, ansvar för anhörigas upplevelse och försvårande omständigheter i arbetssituationen Konklusion: Det finns både för- och nackdelar med anhörigbevittnad hjärt- och lungräddning. Sjuksköterskorna upplevde det positivt för anhöriga men ansåg att det kunde påverka deras förutsättningar att ge omvårdnad negativt. Nyckelord: Hjärt- och lungräddning, återupplivning, anhöriga, sjuksköterskor, erfarenhet / Abstract Title: Health professionals’ experience with relatives presence during cardiopulmonary resuscitation – a qualitative literature study. Background: Every year, over 10 000 persons suffer from sudden cardiac arrest. During cardiac arrest, the brain suffers from lack of oxygen with the risk of irreversible brain damage as a result. Early cardiopulmonary resuscitation (CPR) can increase the rate of survival. Sometimes a nurse confirms the cardiac arrest and start CPR. A task nurses may face is contact with related persons, it may include to convey information, obtain knowledge and support them. Aim: To illuminate health professionals’ experience of relatives presence during cardiopulmonary resuscitation of patients with acute cardiac arrest. Methods: A literature study based from nine scientific articles with qualitative design. Results: Opportunities with relative witnessed resuscitation is to say goodbye and get closure, build a relation, understanding through participation and relatives as a resource. Barriers to good care was expressed by emotional expression and fears of health professionals, responsibility for relatives experiences and aggravating circumstances in the work situation Conclusion: There are both advantages and disadvantages with presence of relatives during cardiopulmonary resuscitation. Nurses experienced it as positive for relatives, but felt that it could affect their ability to provide care as negative. Keywords: Cardiopulmonary resuscitation, resuscitation, relatives, nurses, experience

La chirurgie cardiaque sous circulation extra-corporelle conduit à une altération de la perfusion de la microcirculation, qui peut contribuer de façon importante à la dysfonction d’organe postopératoire. Cette thèse rassemble des études cliniques et animales, dont le but était d’investiguer les mécanismes expliquant la dysfonction microcirculatoire en chirurgie cardiaque sous circulation extra-corporelle. En outre nous avons eu pour but d’évaluer deux stratégies thérapeutiques pour la préservation de la perfusion microcirculatoire au cours de la circulation extracorporelle : l’utilisation d’un flux pulsé comparativement à un flux non pulsé conventionnel durant la circulation extra-corporelle, et le traitement par imatinib dans le but de réduire la fuite vasculaire en inhibant la dysfonction de la barrière endothéliale. La thèse actuelle a démontré que la perfusion microcirculatoire est altérée durant et après la chirurgie cardiaque, et que ceci peut être attribué principalement à la dysfonction inflammatoire de la barrière endothéliale et à la fuite vasculaire conséquente. L’hémodilution concomitante en chirurgie cardiaque sous circulation extra-corporelle peut s’ajouter et contribuer également à la réduction de la perfusion microcirculatoire et de l’oxygénation. Nous avons montré que l’utilisation d’un flux pulsé durant la circulation extracorporelle améliore la perfusion microcirculatoire en postopératoire comparativement à un flux non-pulsé. Le traitement par imatinib a réduit la dysfonction de la barrière endothéliale et la fuite vasculaire dans notre modèle de circulation extracorporelle sur le rat et a permis de préserver la perfusion microcirculatoire et l’oxygénation durant et après la circulation extra-corporelle. En outre, le traitement par imatinib a permis de diminuer les marqueurs de souffrance rénale, pulmonaire et digestive après circulation extra-corporelle. A partir de nos résultats, la réduction de la fuite vasculaire et l’utilisation d’un flux pulsé durant la circulation extra-corporelle sont des interventions prometteuses pour la prévention des complications postopératoires chez les patients à risque de défaillance d’organe au décours de la chirurgie cardiaque sous circulation extra-corporelle. / Cardiac surgery with cardiopulmonary bypass leads to impaired perfusion of the microcirculation, which may be an important contributor to postoperative organ dysfunction. This thesis combines clinical and animal studies that aimed to investigate the mechanisms underlying microcirculatory dysfunction in cardiac surgery with cardiopulmonary bypass. Moreover, we aimed to evaluate two treatments strategies for preservation of microcirculatory perfusion during cardiopulmonary bypass : the use of pulsatile flow as compared to the conventional non pulsatile flow during cardiopulmonary bypass and treatment with imatinib in order to reduce vascular leakage by inhibiting endothelial barrier dysfunction.The current thesis has demonstrated that microcirculatory perfusion is impaired during and after cardiac surgery, and this can be attributed mainly to inflammatory endothelial barrier dysfunction and consequent vascular leakage. Concomitant hemodilution may additionally contribute to reduced microvascular perfusion and oxygenation in on-pumpcardiac surgery. We showed that the use of pulsatile flow during cardiopulmonary bypass improves postoperative microvascular perfusion as compared to non pulsatile flow. Imatinib treatment reduced endothelial barrier dysfunction and vascular leakage in our rat model for cardiopulmonary bypass and resulted in preservation of microcirculatory perfusion andoxygenation during and after extracorporeal circulation.Moreover, imatinib treatment resulted in reduced markers ofrenal, pulmonary and intestinal injury after cardiopulmonary bypass. Based on our findings, reduction of vascular leakage and use of pulsatile flow during cardiopulmonary bypass are promising interventions for the prevention of postoperative complications in patients at risk for organ failure following cardiac surgery with cardiopulmonary bypass.

ABSTRACT Nurses’ Cardiopulmonary resuscitation (CPR) competence has been a subject of many research studies. The need for nurses to be competent in CPR is not debatable, because nurses are expected to preserve and promote life. This study assessed and compared CPR competence between two groups of Advanced Student Nurses in a Kenyan Medical Training College. The study used a descriptive comparative design. The participants were assigned to two groups based on the CPR training they had received. Group I had Advanced Life Support (ALS) training n=23 (comprised ICU advanced nursing students) and group II had Basic Life Support (BLS) training n=48 (comprised Midwifery, Ophthalmic, Community and Psychiatric advanced nursing students). The study sample constituted 71 participants of whom 28.2% were males and 71.8 % were females. Out of the 71 students who took part in the study only five attained the competence score, the remaining 66 failed the competence test. The five who passed the competence score were from the ALS group. The null hypothesis tested in the study was subjected to paired t-test and a p-value of p= 0.0001 was obtained. The null hypothesis was thus rejected based on this finding. The study confirmed previous findings that nurses CPR competence is below the expectation and the difference in training for the two groups of Advanced Student Nurses.