Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21700号 / 社医博第91号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 今中 雄一, 教授 佐藤 俊哉, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

The Analysis of Ilan¡¦s Out-of-Hospital Cardiac Arrest (OHCA) Patients Abstract The study uses Ilan¡¦s out-of-hospital cardiac arrest (OHCA) patients as the research object to understand the variable backgrounds of OHCA patients how they are affected by first aid factors between the period of pre-hospital and post-hospital admission. The study also discusses whether there is a correlation between first aid factors and first aid prognosis among those OHCA patients during pre-hospital and post-hospital admission periods. The study is retrospective and based on the Utstein style format. It collects 284 out-of-hospital cardiac arrest (OHCA) patient cases with trauma and non-trauma (282 effective samples) in an example of a regional teaching hospital in Ilan from 2007 to 2009. It uses descriptive statistics, independent sample t test, and Chi-Square test as the statistical analysis to obtain the following conclusions: 1. There are 282 effective sample patients in the study. There are 57 patients ( 20.2 %) who were return of spontaneous circulation (ROSC) after cardiac arrest approximately 14.77 minutes on average. There are 33 patients (11.7 % ) who survived to be hospitalized for 15.36 days on average, and there are 6 patients ( 2.1 % ) who were discharged from the hospital. 2. Internal medicine disease is the major causative factor of out-of-hospital cardiac arrest. Among those internal medicine disease cases, the history showed hypertension, diabetes mellitus, and heart diseases are the main causes of out-of-hospital cardiac arrest. Patients who are older than 65 years old are the main age groups, accounting for 67.7% of these cases. 3. The pre-hospital admission factors which affect the prognosis after the Emergency Department (ED) are the place of the accident, whether there are witnesses, scene process time , total reaction time , whether automatic external defibrillation was used, and whether people at the scene used CPR. 4. The post-hospital admission factors which affect the prognosis after the ED are initial cardiac rhythm, body temperature, pupil size , dose of epinephrine, whether defibrillation was used, the time of applying emergency first-aid, and medical expense. 5. The percentages of return of spontaneous circulation and survival rates in the study are lower than those of past studies of Taipei City and National Taiwan University Hospital. The possible factors are probably related to differences between rural and urban areas in the quality of emergency medical service systems (EMSS), and healthcare training. 6. From now on, in addition to improving the first-aid continuous monitoring system, we should also enhance EMT related training, and actively educate people to understand and learn CPR, so that comprehensive first-aid systems are available everywhere to effectively increase the success rate of first-aid. Keywords¡GOut-of-hospital cardiac arrest (OHCA), Cardiopulmonary resuscitation

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BACKGROUND This thesis studies the relationship between area-level socioeconomic status and the incidence and 30-day survival of out of hospital cardiac arrest. The effect of socioeconomic status on health has been studied for over 150 years.  Although cardiac arrest is a major public health problem there has been very little focus on socioeconomic status and out of hospital cardiac arrest. DATA AND METHODS The cardiac arrest data are obtained from the Swedish cardiac arrest registry. Data on age structure and percentage of immigrants is from SCBs total population registry and socioeconomic data come from SCBs LISA database. The incidence analysis is made in two steps. The first step calculates the age standardized incidence and the second step is an OLS analysis. For the survival analysis a logistic regression analysis is made to measure the probability of survival in different income areas. RESULTS For the socioeconomic status – incidence analysis the results from the OLS analysis suggest that the incidence is almost twice as high in the lowest income area. Intercept (Highest group) = 26.8 and <140 000 (lowest group) = 24.5. In the survival analysis (using a binary logistic regression analysis) there was a significantly lower OR for the lowest income group for all patients (OR= 0.521, p= 0.049) and for the sub group (patients 18-75 years old) there was a significant negative relationship for the two lowest groups. <140 000 (OR= 0.444, p= 0.032) and 140 000-159 000 (OR= 0.620, p= 0.046). CONCLUSION There is a significant relationship between living in a poor neighborhood and out of hospital cardiac arrest. Those living in poorer areas have both an increased incidence and lower chance of survival of out of hospital cardiac arrest.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22380号 / 社医博第102号 / 新制||社||医11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 小池 薫, 教授 今中 雄一 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21301号 / 医博第4390号 / 新制||医||1030(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 小池 薫, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Nationellt drabbas varje år flera tusentals människor av hjärtstopp utanför sjukhus. För att öka chansen till överlevnad hos dessa individer är snabbt påbörjad hjärt-lungräddning av god kvalité av största vikt. Då det är fysiskt ansträngande att utföra hjärt-lungräddning, samt under vissa omständigheter svårt att utföra med bibehållen effektivitet och kvalité, har apparater som kan ge mekaniska bröstkompressioner utvecklats. Syfte: Syftet med studien var att undersöka vilka resultat mekaniska bröstkompressioner har vid hjärtstopp utanför sjukhus. Metod: Studien genomfördes som en allmän litteraturöversikt med en induktiv ansats. Efter kvalitetsgranskning inkluderades totalt 16 vetenskapliga artiklar där majoriteten var kvantitativa studier. Artiklarna inhämtades från databaserna PubMed och CINAHL. Databearbetning genomfördes utifrån en integrerad analys där teman identifierades. Resultat: Den integrerade analysen resulterade i fyra teman; överlevnad, återkomst av spontan cirkulation [ROSC], neurologisk funktion och övriga resultat. Ingen skillnad kunde ses i överlevnad och neurologisk funktion mellan mekaniska bröstkompressioner och manuella bröstkompressioner. Snarare ses en tendens till sämre överlevnad och sämre neurologisk funktion vid användning av mekaniska bröstkompressioner. I övrigt noteras förlängd tid till första defibrillering vid användning av mekaniska bröstkompressioner. Slutsats: De granskade studierna visade att användandet av mekaniska bröstkompressioner vid hjärtstopp utanför sjukhus inte har någon uppenbar fördel gällande överlevnad och neurologisk funktion jämfört med manuella bröstkompressioner. / Nationally, several thousands of people suffer from out-of-hospital cardiac arrest each year. In order to increase the chance of survival in these individuals, cardiac resuscitation of good quality is of the utmost importance. Since it is physically strenuous to perform cardiac resuscitation, and in some circumstances difficult to perform with maintained efficiency and quality, devices that can provide mechanical chest compressions have been developed. Aim: The aim of the study was to investigate the results of mechanical chest compressions on out-of-hospital cardiac arrest. Method: The study was conducted as a general literature review with an inductive approach. After quality review, a total of 16 scientific articles were included, the majority of which were quantitative studies. The articles were obtained from the PubMed and CINAHL databases. Data processing was performed on the basis of an integrated analysis where themes were identified. Results: The integrated analysis resulted in four themes; survival, return of spontaneous circulation [ROSC], neurological function and other results. No difference was seen in survival and neurological function between mechanical chest compressions and manual chest compressions. Rather, there is a tendency towards poorer survival and poorer neurological function when using mechanical chest compressions. Otherwise, extended time to first defibrillation is noted when using mechanical chest compressions. Conclusion: The studies reviewed showed that the use of mechanical chest compressions in out-of-hospital cardiac arrest has no apparent benefit on survival and neurological function compared to manual chest compressions.

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