Syfte: var att undersöka vilken pedagogisk metod, instruktörsledd eller filmbaserad med facilitator som ger bäst kunskap såväl kortsiktigt som långsiktigt vid hjärt-lungräddningsutbildning (HLR) i årskurs sju. Syftet var även att undersöka elevers motivation till att ingripa i en akut hjärtstoppssituation. Teori Då lärande enligt läroplanen ska ske i social miljö, genom samspel har jag i studien valt att utgå från det sociokulturella perspektivet där kontexten är viktig i ett sammanhang, i kombination med praktikorienterad teori för att beskriva lärandet. Metod Datainsamling har skett genom en kombination av kvantitativ och kvalitativ metod. Åttio elever utförde treminuters praktiskt test direkt efter utbildningstillfället i HLR samt efter tre månader. Bedömning av medvetandekontroll och andningskontroll utfördes genom direktobservation. Kvalitet på utförd HLR registrerades via en övningsdocka kopplad till ett datorbaserat program, Leaerdal PC skill reporter. Insamlad data registrerades i en modifierad version av mätinstrumentet Cardiff Test. I testet bedömdes 13 variabler med total poängsumma 12-48 poäng. Primärt effektmått var den totala poängen med enskilda variabler som sekundär endpoints. En hypotes är att det inte är någon skillnad mellan utbildningsmetoderna gällande elevernas totalpoäng, vilket medför att den filmbaserade metoden är effektivare då den utförts i helklass. Semistrukturerade intervjuer genomfördes direkt efter utbildningstillfället för att undersöka elevers motivation till att göra en livräddande insats. Resultat: Ingen signifikant skillnad ses mellan utbildningsgrupperna beträffande kvalitetstestets totalpoäng, vare sig vid mätning direkt efter utbildningstillfället; instruktörsledd 33 poäng, DVD-baserad 34 poäng, eller vid tre månaders uppföljning; instruktörsledd 31 poäng, DVD-baserad 30 poäng. Vid tremånaders test utförde majoriteten av eleverna bröstkompressioner med handplacering för långt ned mot bröstbensspetsen, DVD-baserad 20 %, instruktörsledd 48 %. I den instruktörsledda gruppen sågs vid tre månaders uppföljning en signifikant ökning av andelen elever som utförde kompressioner med korrekt kompressionsdjup (5-6 cm), 7,5 % vs 32,5 %, DVD-baserad 10 % vs 25 %. Flertalet elever ansåg spontant att de hade tillräckliga kunskaper för att göra en livräddande insats. Vid följdfrågor framkom dock att flertalet av de intervjuade kände oro och rädsla för bristande kunskaper, dels för att skada den drabbade, dels för att göra fel vid en livräddande insats i verkligheten. Några elever beskrev att bekräftelse och återkoppling bidrog till att stärka elevens självkänsla till att våga ingripa i en verklig situation, vilket kan vara svårt att hinna med vid utbildning i stora grupper. En möjlig slutsats är att den filmbaserade metoden är effektivare sätt till antal utbildade deltagare, men med stöd av sociokulturell teori bör det i framtida utbildningar avsättas mer tid för gemensamt lärande, tillvaratagande av frågeställningar samt avsättning av tid för individuell och gemensam reflektion. / Aim: To compare students’ practical CPR skills and attitude to perform bystander CPR after instructor-led versus DVD-based training. Method:  Data was collected through a combination of quantitative and qualitative methods. CPR skills were assessed of 80 seventh grade students during a three minutes practical test, directly after training and at three months follow up by using a PC Skill Reporting System. For CPR skills a total score, 12-48 points, was calculated.  A hypothesis is that there is no difference between training methods regarding students' total score, which means that the DVD-based method is more efficient when performed with the whole class. Nine semi-structured interviews were conducted immediately after the training to investigate students' motivation to make a life-saving effort. Result: There were no significant differences between the instructor-led or the DVD-based group regarding CPR skills, a total score of 33 points versus 34 points directly after training and 31 points versus 30 points at three months, respectively.Most students felt spontaneously that they had enough knowledge to make a life-saving effort, but the follow-up questions showed that the majority of the responders, felt worry and fear of lack of sufficient knowledge, to harm the victim or to make mistakes in a life-saving situation. Some students described that feedback after the practical test, helped to strengthen the student's self-esteem, which can be difficult to find time for when training in large groups.One possible conclusion is that the DVD-based method is more efficient in number of participants trained, but with support of the socio-cultural theory, it should in future trainings aside more time for joint learning, valorization of issues and deposition of time for individual and collective reflection.

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.

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.

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

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.

A parada cardiorrespiratória (PCR) é a ocorrência de maior emergência atendida nos serviços pré e intra-hospitalares. Para os profissionais de saúde a PCR e a realização da Ressuscitação Cardiopulmonar (RCP) são eventos de extrema importância dentro da assistência, na qual exigem-se conhecimento, execução de técnicas adequadas e agilidade para prestar um atendimento de qualidade. A única chance de sobrevivência do paciente está vinculada à identificação precoce desse evento e à intervenção rápida e eficaz através das manobras de RCP dentro da sistematização do atendimento à PCR/RCP determinadas pelas Corrente de Sobrevivência do Adulto, seguida do Suporte Básico (SBV) e Suporte Avançado de Vida (SAVC). Trata-se de um estudo exploratório, descritivo, com abordagem quali- quantitativa que visa estabelecer as exigências críticas no atendimento à PCR/RCP em unidade de emergência no Hospital Escola do interior do estado de São Paulo, através da vivência de 27 profissionais da equipe de enfermagem na realização das manobras de RCP, identificando os incidentes críticos positivos e/ou negativos durante esse atendimento, além das facilidades e dificuldades vivenciadas pela equipe de enfermagem na execução dessas manobras através da Técnica do Incidente Crítico (TIC). Os dados coletados foram categorizados segundo as situações críticas semelhantes (situações secundárias), uma vez que a situação principal era a PCR e a situação secundária era a realização da RCP, seguida dos comportamentos e das consequências positivas e negativas decorrentes das diversas situações. Desta análise emergiram cinco categorias de incidentes críticos: Competências do atendimento à PCR/RCP, sentimentos e emoções da equipe frente à PCR/RCP, estrutura e ambiente na RCP, Eventos adversos à PCR/RCP e Capacitação da equipe de enfermagem. Relacionado aos comportamentos positivos, destacou-se três categorias: Aplicando a sistematização no atendimento à PCR/RCP, estabelecendo gestão durante á RCP e utilizando tecnologias na RCP. Dentre os comportamentos negativos, observaram-se seis categorias: convivendo com a falta de habilidades técnicas; vivenciando a falta da sistematização no atendimento à PCR/RCP; convivendo com recursos materiais e humanos insuficientes; o ambiente; percebendo os sentimentos e emoções da equipe frente a RCP e observando a falta de capacitação permanente da equipe na RCP. Uma vez selecionadas as situações críticas, os comportamentos positivos e os comportamentos negativos, pudemos categorizar o óbito como uma conseqüência imediata negativa e o restabelecimento das funções vitais como uma conseqüência imediata positiva ao paciente/cliente. Na avaliação das categorias resultantes, verificou-se como conseqüência negativa, os saber lidar com o sofrimento da perda e como conseqüência positiva, a RCP bem sucedida além dos sentimentos dos profissionais de enfermagem. A partir dos incidentes críticos identificados, foram estabelecidas as exigências críticas no atendimento à RCP no local de estudo e ressaltou-se que para um bom desempenho na realização da RCP é necessário rapidez, eficiência, conhecimento técnico-científico e habilidade técnica por parte de toda a equipe que realiza esse atendimento, seguindo sistematização referida pelos protocolos do AHA. Além disso, identificou-se a necessidade de capacitação continuada dos profissionais de enfermagem e médica, trabalho harmônico e sincronizado multiprofissional e infra-estrutura adequada, visando o restabelecimento da vida, a limitação do sofrimento, a recuperação do paciente/cliente e a ocorrência mínima de sequelas. Portanto, a RCP imediata, sistematizada e de qualidade é requisito básico de segurança para esses pacientes, reduzindo as dificuldades identificadas pela equipe e favorecendo as chances de reanimação destes pacientes / The cardiopulmonary arrest (CPA) is the major emergency occurrence attended pre and intra hospital services. For the health professionals, the CPA and the performance of cardiopulmonary resuscitation (CPR) are events of utmost importance during the care, demanding knowledge, implementation of appropriate techniques and agility to provide a quality service. The unique opportunity of patient\'s survival is linked to the early identification of this event and to the fast and effective intervention through CPR manoeuvres within the treatment systematization CPA/CPR determined by Adult Survival Current followed by Basic Life Support (BLS) and Advanced Life Support (ACLS). It\'s an exploratory and descriptive study with a qualitative-quantitative approach that aims to establish critical requirements in the CPA/CPR treatment within an emergency room at a teaching hospital in São Paulo State, through the experience of twenty seven professionals of nursing staff during manoeuvres of CPR, identifying the positive/negative critical incidents during this treatment as well as facility and difficulties experienced by nursing staff during this procedures though the Critical Incident Technique (CIT). The collected data was categorized accordingly to similar critical situations (secondary situation), since the main situation was CPA and secondary one was CPR realization in addition to behaviors and positive/negative consequences resulting from various situations. From this analysis, it was arisen five categories of critical incidents: treatment competences to CPA/CPR, feelings and emotions of the nursing staff towards CPA/CPR, structure and environment during CPR, adverse events to CPA/CPR and nursing staff training. Related to positive behaviors, it was highlighted three categories: applying systematization in CPA/CPR treatment, establishing conduct during CPR and using technologies in CPR. It was observed six categories among negative behaviors: dealing with no technical skills, living through the lack of systematization to CPA/CPR treatment, cohabiting with insufficient human and material resources, the environment, realizing nursing staff\'s feelings and emotions towards CPR treatment and observing the lack of nursing staff\'s ongoing training. Once selected critical situations, positive and negative behaviors, we can classify Death as an immediate negative consequence and Restoring Vital Functions as a positive consequence to the patient/client. Assessing the emerging categories, it was verified, as a negative consequence, how to deal with the loss suffering and, as a positive consequence, the successful CPR in addition to the nursing professionals\' feelings. From the identified critical incidents, it was established critical requirements to CPR treatment at the study site and it was pointed out that, to a good performance in the CPR, is necessary quickness, efficacy, scientific and technical knowledge and technical ability of the whole staff that perform this treatment, following systematization referred by the AHA protocols. Furthermore it was also identified the necessity for an ongoing training of medical and nursing professionals, harmonious and synchronized multiprofessional work and appropriate infrastructure aiming at life restoring, suffering limitation, the patient and client\'s recovery and the least occurrence of sequelae. Therefore, an immediate systematized and quality CPR is basic requirement for these patients\' safety, reducing the difficulties identified by the staff and providing opportunities for resuscitation of these patients

Introdução: Apesar dos avanços e uniformização preconizada pelas diretrizes mundiais de ressuscitação cardiopulmonar (RCP), ainda é insuficiente o conhecimento da efetividade da RCP intra-hospitalar no Brasil. Neste estudo avaliamos variáveis clínicas e demográficas de pacientes submetidos à RCP e preditores independentes associados à sobrevivência imediata (recuperação da circulação espontânea acima de 24h), sobrevivência até a alta hospitalar, em seis e doze meses. Métodos: este estudo transversal incluiu, de forma prospectiva, 763 pacientes em parada cardiorrespiratória (PCR) entre 1º de novembro de 2007 a 1º de novembro de 2010, ocorrida no ambiente intra-hospitalar de 17 hospitais gerais e institutos de especialidades. As manobras de RCP foram executadas em 575 pacientes. Resultados: A modalidade de PCR mais frequente foi a assistolia (40,7%), seguida de atividade elétrica sem pulso (39,3%). A sobrevivência imediata foi de 48,8%, sobrevivência até a alta hospitalar foi de 13%, de 4,3% em seis e de 3,8% em doze meses. Os preditores independentes associados à sobrevivência imediata foram o ritmo inicial em fibrilação ventricular ou taquicardia ventricular sem pulso (Razão de Taxas RT 1,31; IC 95% 1,10 a 1,55; p=0,002); presença de sinais de consciência da vítima, ao chegar a equipe atendimento (RT 1,37; IC95% 1,16 a 1,61; p<0,001); uso de epinefrina durante a RCP (RT 1,61; IC 95% 1,32 a 1,98; p < 0,001); hipoglicemia como causa da PCR (RT 1,68; IC 95% 1,11 a 2,55; p=0,014). Foram preditores independentes associados à menor sobrevivência imediata: hipotensão como causa da PCR (RT 0,74; IC 95% 0,61 a 0,90; p=0,003); sedentarismo como antecedente à PCR (RT 0,76; IC 95% 0,66 a 0,88; p< 0,001) e tempos da duração da RCP: maiores tempos com menor sobrevivência. Como preditores independentes associados à sobrevivência até a alta hospitalar, foram identificados: presença de médicos e enfermeiros treinados em ACLS e/ou BLS na equipe de atendimento (HR 3,07; IC 95% 1,39 a 6,78; p=0,006) e ritmo sinusal após a recuperação da circulação espontânea (HR 1,44; IC 95% 1,26 a 1,75; p=0,002). Como preditores independentes para maior sobrevivência em seis meses identificou-se: uso de epinefrina (HR 4,09; IC 95% 1,14 a 14,69; p=0,030), ritmo sinusal após a recuperação da circulação espontânea (HR 4,09; IC 95% 1,14 a 14,69; p=0,030) e antecedente de infarto do miocárdio (HR 4,08; IC 95% 1,51 a 11,06; p=0,006). Não foram identificados preditores independentes para sobrevivência em doze meses. Conclusões: Foram identificados como preditores independentes para sobrevivência imediata o ritmo inicial em fibrilação ventricular ou taquicardia ventricular sem pulso, presença de sinais de consciência da vítima, uso de epinefrina durante a RCP, hipoglicemia como causa da PCR. Como preditores independentes associados à sobrevivência até a alta hospitalar a presença de médicos e enfermeiros treinados em ACLS e/ou BLS e o ritmo sinusal após a recuperação da circulação espontânea. Os achados sugerem perfil multicêntrico nacional da ressuscitação, fornecendo dados potencialmente representativos da ressuscitação cardiopulmonar intra-hospitalar no Brasil. / Introduction: in spite of the advances and worldwide standardization for cardiopulmonary resuscitation recommended by international guidelines, knowledge on the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) is not yet sufficient in Brazil. In this study, we evaluated both demographic and clinical variables in patients underwent cardiopulmonary resuscitation and independent predictors associated to immediate (recovery of spontaneous circulation up to 24 h), until hospital discharge, six and twelve months survival rates. Methods: This cross-sectional study included, prospectively, 763 patients who presented in-hospital cardiac arrest between November 1st 2007 and 01 November 1st 2010, from 17 general hospitals and specialty institutes. CPR procedures were performed in 575 patients. RESULTS: The cardiac arrest modality most frequently found was asystole (40.7%), followed by pulseless electrical activity (39,3%). Immediate survival was 48,8%, survival until hospital discharge was 13%, 4.3% in six months and 3.8% in twelve months. Independent predictors associated with higher immediate survival were: ventricular fibrillation or ventricular tachycardia without pulse as the initial rhythm of cardiac arrest (Rate Ratio- RR 1.31; IC 95% 1.10 to 1.55; p = 0.002); presence of victim consciousness signs when arrival of the emergency staff (RR 1.37; IC95% 1.16 to 1.61; p < 0.001); use of epinephrine during CPR (RR 1.61; IC 95% 1.32 to 1.98; p < 0.001); hypoglycemia as cause of cardiac arrest (RR 1.68; IC 95% 1.11 to 2.55; p = 0.014). Independent predictors associated with lower immediate survival were: hypotension as cause of cardiac arrest (RR 0.74; IC 95% 0.61 to 0.90; p = 0.003); sedentary lifestyle prior to cardiac arrest (RR 0.76; IC 95% 0.66 to 0.88; p < 0.001) and duration of the cardiopulmonary resuscitation: the longer the duration, the lower the survival. Independent predictors associated with hospital discharge survival were: presence of doctors and nurses with ACLS and/or BLS previous training, in the emergency team (HR 3.07; IC 95% 1.39 to 6.78; p = 0.006) and sinus rhythm after recovery of spontaneous circulation (HR 1.44; IC 95% 1.26 to 1.75; p = 0.002). Independent predictors of higher six-month survival rate were use of epinephrine (HR 4.09; IC 95% 1.14 to 14.69; p = 0.030), sinus rhythm after return of spontaneous circulation (HR 4.09; IC 95% 1.14 to 14.69; p = 0.030) and previous myocardial infarction (HR 4.08; IC 95% 1.51 to 11.06; p = 0.006). Independent predictors of 12-month survival were not identified. Conclusion: As independent predictors for immediate survival we identified: ventricular fibrillation or ventricular tachycardia without pulse as the initial rhythm, presence of signs of awareness of the victim, use of epinephrine during RCP, hypoglycemia as cause of PCR. As independent predictors associated survival until discharged the presence of doctors and nurses trained in ACLS and BLS and the sinus rhythm after recovery of spontaneous circulation (ROSC). These findings suggest a multicentre and national resuscitation profile, providing relevant information, potentially representative of the in-hospital cardiopulmonary resuscitation in Brazil.

Um dado de relevante importância nos países desenvolvidos e em desenvolvimento, como o Brasil, é a crescente incidência de mortes por doenças cardíacas, sendo a Parada Cardiorrespiratória (PCR) a situação mais temida pelos profissionais nos departamentos de emergência e em ambiente pré-hospitalar. O diagnóstico deve ser rápido e preciso, e as manobras de Ressuscitação Cardiopulmonar (RCP) devem ser iniciadas precocemente a fim de aumentar as chances de sobrevivência dos pacientes. Para um atendimento de qualidade são necessários conhecimentos técnicos e científicos, e programas de educação em RCP devem ser implantados. Considerando que a sobrecarga dos serviços de atendimento dificulta o acesso dos profissionais a capacitações, surge a necessidade da utilização de estratégias de ensino atrativas, sendo o computador uma alternativa eficaz, por facilitar a difusão de conhecimentos. Este estudo tem como objetivos desenvolver um Ambiente Virtual de Aprendizagem (AVA) para educação em Suporte Básico de Vida na PCR e avaliar a qualidade do seu conteúdo junto a especialistas na área de Urgência e Emergência. Trata-se de uma pesquisa aplicada, de produção tecnológica. Para tanto, a metodologia utilizada foi baseada no Modelo de Design Instrucional - ADDIE (em inglês: analysis, design, development, implementation and evaluation), que estrutura o planejamento de ensino- aprendizagem em estágios distintos: análise, desenho, desenvolvimento, implementação e avaliação. O AVA para Capacitação em RCP foi composto por textos elaborados a partir de pesquisa bibliográfica, links de domínio público, um vídeo construído a partir de um cenário de simulação em laboratório e questões para avaliar a fixação do conteúdo. O desenvolvimento dos conteúdos foi realizado em módulos, constituídos das seguintes estruturas: identificação do módulo, objetivos, conteúdo, links e referências. Para o desenvolvimento do AVA foi utilizada a linguagem HTML (Hyper Text Markup Language), que permite a interação com o conteúdo e pode ser acessada por meio de plataformas como celulares ou tablets. O AVA foi submetido à avaliação junto a oito juízes, com objetivo de avaliar se este corresponde à proposta educacional a que se destina, assim como se o acesso é eficaz e eficiente. Os especialistas avaliaram que os objetivos foram alcançados, sugerindo algumas modificações. As melhorias foram feitas e o AVA foi disponibilizado para acesso no endereço eletrônico: www2.eerp.usp.br/nepien/pcr. Com o desenvolvimento deste estudo, espera-se apresentar e disponibilizar para uso uma estratégia de ensino inovadora, que poderá aprimorar o aprendizado, colaborando com a qualidade da assistência prestada / Relevant information in developed and developing countries such as Brazil is the growing incidence of deaths caused by heart disease; cardiorespiratory arrest is the situation most feared by professionals in emergency rooms and in care administered prior to hospital admission. The diagnosis must be fast and precise and Cardiopulmonary Resuscitation (CPR) must promptly be initiated to increase a patient\'s chances of survival. Technical and scientific knowledge is necessary to provide quality care and CPR training programs should be implemented. Considering that the overload of services hinders the access of workers to training programs, there is a need to use attractive teaching strategies; computers are an efficacious alternative to facilitate the dissemination of knowledge. This study\'s objectives include developing a Virtual Learning Environment (VLE) to provide Basic Life Support in CPR training and assess the quality of its content with experts in the field of Emergency and Urgent Care. This is an applied study with technological matters. The methodology used was based on the instructional systems design ADDIE, which stands for analysis, design, development, implementation and evaluation, different stages to structure the teaching and learning planning. The VLE to provide CPR qualification was composed of texts based on bibliographic research, public domain websites, video with a laboratory simulation scenario and questions to assess the apprehension of context. Content was developed in modules composed of the following structures: module identification, objectives, content, links and references. Hyper Text Markup Language (HTML) was used, which enables interaction with content and can be accessed from platforms such as mobile phones or tablets. Eight judges assessed the VLE. Their objective was to verify whether the VLE corresponded to its educational proposal and whether access was efficacious and efficient. The experts assessed which objectives were achieved and suggested some improvements. Changes were implemented and the VLE was released for access on the website: www2.eerp.usp.br/nepien/pcr. The development of this study is expected to present and make available an innovative teaching strategy that can improve learning and facilitate the quality of care delivery

Um dado de relevante importância nos países desenvolvidos e em desenvolvimento, como o Brasil, é a crescente incidência de mortes por doenças cardíacas, sendo a Parada Cardiorrespiratória (PCR) a situação mais temida pelos profissionais nos departamentos de emergência e em ambiente pré-hospitalar. O diagnóstico deve ser rápido e preciso, e as manobras de Ressuscitação Cardiopulmonar (RCP) devem ser iniciadas precocemente a fim de aumentar as chances de sobrevivência dos pacientes. Para um atendimento de qualidade são necessários conhecimentos técnicos e científicos, e programas de educação em RCP devem ser implantados. Considerando que a sobrecarga dos serviços de atendimento dificulta o acesso dos profissionais a capacitações, surge a necessidade da utilização de estratégias de ensino atrativas, sendo o computador uma alternativa eficaz, por facilitar a difusão de conhecimentos. Este estudo tem como objetivos desenvolver um Ambiente Virtual de Aprendizagem (AVA) para educação em Suporte Básico de Vida na PCR e avaliar a qualidade do seu conteúdo junto a especialistas na área de Urgência e Emergência. Trata-se de uma pesquisa aplicada, de produção tecnológica. Para tanto, a metodologia utilizada foi baseada no Modelo de Design Instrucional - ADDIE (em inglês: analysis, design, development, implementation and evaluation), que estrutura o planejamento de ensino- aprendizagem em estágios distintos: análise, desenho, desenvolvimento, implementação e avaliação. O AVA para Capacitação em RCP foi composto por textos elaborados a partir de pesquisa bibliográfica, links de domínio público, um vídeo construído a partir de um cenário de simulação em laboratório e questões para avaliar a fixação do conteúdo. O desenvolvimento dos conteúdos foi realizado em módulos, constituídos das seguintes estruturas: identificação do módulo, objetivos, conteúdo, links e referências. Para o desenvolvimento do AVA foi utilizada a linguagem HTML (Hyper Text Markup Language), que permite a interação com o conteúdo e pode ser acessada por meio de plataformas como celulares ou tablets. O AVA foi submetido à avaliação junto a oito juízes, com objetivo de avaliar se este corresponde à proposta educacional a que se destina, assim como se o acesso é eficaz e eficiente. Os especialistas avaliaram que os objetivos foram alcançados, sugerindo algumas modificações. As melhorias foram feitas e o AVA foi disponibilizado para acesso no endereço eletrônico: www2.eerp.usp.br/nepien/pcr. Com o desenvolvimento deste estudo, espera-se apresentar e disponibilizar para uso uma estratégia de ensino inovadora, que poderá aprimorar o aprendizado, colaborando com a qualidade da assistência prestada / Relevant information in developed and developing countries such as Brazil is the growing incidence of deaths caused by heart disease; cardiorespiratory arrest is the situation most feared by professionals in emergency rooms and in care administered prior to hospital admission. The diagnosis must be fast and precise and Cardiopulmonary Resuscitation (CPR) must promptly be initiated to increase a patient\'s chances of survival. Technical and scientific knowledge is necessary to provide quality care and CPR training programs should be implemented. Considering that the overload of services hinders the access of workers to training programs, there is a need to use attractive teaching strategies; computers are an efficacious alternative to facilitate the dissemination of knowledge. This study\'s objectives include developing a Virtual Learning Environment (VLE) to provide Basic Life Support in CPR training and assess the quality of its content with experts in the field of Emergency and Urgent Care. This is an applied study with technological matters. The methodology used was based on the instructional systems design ADDIE, which stands for analysis, design, development, implementation and evaluation, different stages to structure the teaching and learning planning. The VLE to provide CPR qualification was composed of texts based on bibliographic research, public domain websites, video with a laboratory simulation scenario and questions to assess the apprehension of context. Content was developed in modules composed of the following structures: module identification, objectives, content, links and references. Hyper Text Markup Language (HTML) was used, which enables interaction with content and can be accessed from platforms such as mobile phones or tablets. Eight judges assessed the VLE. Their objective was to verify whether the VLE corresponded to its educational proposal and whether access was efficacious and efficient. The experts assessed which objectives were achieved and suggested some improvements. Changes were implemented and the VLE was released for access on the website: www2.eerp.usp.br/nepien/pcr. The development of this study is expected to present and make available an innovative teaching strategy that can improve learning and facilitate the quality of care delivery