Bakgrund: Dödligheten vid hjärtstopp utanför sjukhus är hög och endast några få procent av de som drabbas räddas till livet. Tidig behandling är en avgörande faktor för överlevnad. Överlevnaden kan ökas markant av att människor på platsen, bystanders, ingriper med hjärt-lungräddning (HLR). Att vårda och utföra vårdhandlingar är inte exklusivt för sjuksköterskor. Vid hjärtstopp utanför sjukhus är det istället bystandern som förväntas utföra vårdhandlingen. I många fall sker dock inget ingripande trots att hjärtstoppet bevittnas och den vårdande handlingen uteblir därför. Syfte: Syftet med arbetet var att identifiera faktorer som påverkar människors vilja att ingripa vid hjärtstopp utanför sjukhus. Metod: Arbetet designades som en litteraturstudie där artiklar med både kvantitativ och kvalitativ ansats ingick. Resultat: Resultatet baserades på potentiella bystanders antaganden av hur de skulle agera och faktiska bystanders erfarenheter av att ha agerat. Skillnader i faktorer som påverkade viljan observerades mellan dessa. Viljan påverkades till stor del av rädslor, bristande HLR-kunskaper samt scenariot kring hjärtstoppet där bland annat en familjerelation mellan den drabbade och bystandern utgjorde en påverkande faktor. Slutsats: Resultatet visar att hindrande faktorer för viljan skulle kunna påverkas positivt genom förbättrad HLR-utbildning. Klinisk betydelse: Med hjälp av identifierade faktorer kan befintlig HLR-utbildning ses över och eventuellt förbättras. Detta skulle kunna öka antalet ingripanden och därigenom överlevnaden vid hjärtstopp utanför sjukhus. / Background: The lethality is high in out-of-hospital cardiac arrests and only a few percent of the victim’s lives are saved. Early treatment is crucial for survival. People at the scene can increase the survival significantly through CPR interventions. To care and the act of caring is not exclusively for nurses. In cases of out-of-hospital cardiac arrest, the bystander could be the one that performs the act of caring. In many cases, however, no interventions are made although the arrest is witnessed and therefore no act of caring is being performed. Objective: The aim of this essay was to identify factors that influence people's willingness to intervene in out-of-hospital cardiac arrest. Method: This study was designed as a literature study and both quantitative and qualitative research articles were included in the analysis. Results: The result was based on potential bystander's assumptions of how they would act and actual bystanders experience having acted. Differences in factors affecting the willingness were observed between them. The will seemed influenced by fears, lack of CPR skills and the scenario surrounding the arrest. A family tie between the victim and the bystander appeared also as an influencing factor. Conclusion: The findings show that the non-willingness to act could be affected positively by improved CPR training. Clinical significance: In light to the identified factors, improvement of the existing CPR training and increased education could improve the probability of intervention by bystanders and out-of-hospital cardiac arrest survival.

Globally, out-of-hospital cardiac arrest (OHCA) occurs ranging between 20 to 140 per 100 000 people, with only 2-11% surviving. Immediate bystanders, i.e. a person close to the victim, performing Cardiopulmonary Resuscitation (CPR) have a vital role to play in the chain of survival from OHCA. Today CPR training takes place in many different contexts as workplaces and schools, but there is still a lack of knowledge concerning CPR in society at large. The overarching aim for this thesis is to find new ways of delivering CPR in order to train more laypeople and save more lives. By initially exploring CPR training in both workplaces and compulsory schools in Sweden, my final design question for this thesis has been: How might we empower the teachers to enable them to carry out CPR training at school? Ethnographic fieldwork both exploring CPR training in workplaces and schools including interviews with mainly instructors, teachers, and laypeople as well as participatory observations in CPR training, have been carried out. In addition, the fieldwork included being a participant in a CPR training course myself. The results from my research process were clustered into insights and potential opportunity areas. Departing from these insights a decision was made to continue the thesis with CPR training in schools as reaching out to children and young people already at school can open the path for more long-term sustainable knowledge. Despite CPR training being core content from year 7 in compulsory schools in Sweden, it is not carried out in a majority of them. My research shows that lack of CPR material as well as an unclear syllabus in Physical Education and Health in how to involve CPR in your teaching, are some of the main obstacles for teachers and reasons for why CPR training is not being carried out in every school today. Potential future scenarios were explored through creative workshops and idea sessions with the users and main stakeholders. The explorations led to focusing on the teachers, as they have a vital role in being the bridge between the CPR knowledge and the pupils. My final proposal is CiPRA: a collaborative CPR education platform for teachers and schools, with the aim to increase the knowledge and the conditions for teachers to carry out CPR training, starting already from six years of age. The structure of the platform follows the years of the Swedish school system and the recommended steps fromThe Swedish Resuscitation Council for CPR training and first aid. The platform enables teachers to plan and prepare CPR training, both long a short term irrespective of previous experience. The platform is based on three main parts; knowledge contributions from teachers, teaching content both through pre-made lessons and an idea bank as well as a shared booking system for practical CPR material. Together these parts unify in an individual lesson planning for every teacher. In my final design proposal, it has been important to emphasise the main insights as well as making sure that every involved stakeholder is represented.

Bakgrund: Trots omfattande forskning avlider 9 av 10 patienter till följd av ett prehospitalt hjärtstopp i Sverige. När en person drabbas av plötsligt hjärtstopp krävs snabba åtgärder och tiden till hjärt- och lungräddning påbörjas är livsavgörande. Vårdmiljön är stressfull och komplext, vilket kan få konsekvenser för vårdandet. För den drabbade innebär ett hjärtstopp att personen blir sårbar och utlämnad till sin omgivning samtidigt som det är en traumatiskt och svår händelse för närstående att få bevittna. Det krävs därför att ambulanspersonalen, förutom att ta omedelbara beslut som kan vara livsavgörande, även måste ha ett etiskt förhållningssätt och goda kunskaper i omvårdnad. Syfte: Studiens syfte var att beskriva vårdprocessen vid prehospitalt hjärtstopp hos vuxna patienter.  Metod: Studiens genomförande var en litteraturöversikt med en integrerad analys. Datainsamlingen resulterade till att 15 kvalitativa och kvantitativa vetenskapliga artiklar inkluderades. Artikelsökningar genomfördes utifrån sökord i Cinahl Complete och PubMed.  Resultat: Bearbetningen av artiklarna resulterade i fyra kategorier och 11 underkategorier. När larmet kommer och vårdmötet inleds, Att ta rätt beslut för patienten, Ett värdigt avslut, Ett krävande ansvar för att kunna ge bra vård. Det var viktigtmed mental förberedelse för att kunna ge god vård, förutfattade intryck kunde riskerade att få konsekvenser för patienten. Att skapa ett skyddat vårdutrymme samt skapa tillit och låta närstående vara delaktig belystes, dock kunde den kaotiska och krävande situationen vara ett hinder för detta. Ett patientperspektiv var avgörande för att ta rätt beslut för patienten, gråzoner, etiska dilemman och närståendes förhoppningar kunde dock skapa ett onödigt lidande för patienten. Det var viktigt att skapa ett värdigt avslut för patienten och hantera den avlidnes kropp med respekt. Närståendes behov av omsorg sågs som en del i vårdandet, men krävde att ambulanspersonalen kunde låta sig själv påverkas. Rädsla eller osäkerhet att möta närstående deras sorg kunde få konsekvenser för deras behov av stöd. Vårdmötet innebar påfrestningar för ambulanspersonalen, för att kunna ge en god och professionell vård krävdes organisatoriskt och kollegialt stöd samt regelbunden utbildning. Vikten av erfarenhet belystes. Slutsats: Vårdprocessen vid hjärtstopp hos vuxna patienter prehospitalt kan vara varierande beroende på situation och patientens vård påverkas av flera olika faktorer. Det fanns en stark vilja att värna om patientens värdighet och integritet samt närståendes behov av stöd och omsorg. Att ta livsavgörande beslut var en tung börda vilket kräver erfarenhet och självsäkerhet i sin yrkesroll. Faktorer som gråzoner, tvivel, osäkerhet och påfrestningar på ambulanspersonalen kunde dock medföra onödigt lidande för patienten och att närståendes behov av omsorg åsidosattes under hjärt- och lungräddning. Studien betonar vikten och belyser brister i patientens och närståendes omvårdnadsbehov vid hjärtstopp prehospitalt. / Background: Despite extensive research, 9 out of 10 patients die as a result of an out-of- hospital cardiac arrest in Sweden. When a person suffers a sudden cardiac arrest, rapid action is required and the time for cardiopulmonary resuscitation to begin is vital. The care environment is stressful and complex, which can have consequences for caring. For the victim, a cardiac arrest means that the person becomes vulnerable and extradited to their surroundings at the same time as it is a traumatic and difficult event for close relatives to witness. It is therefore required that the ambulance staff, in addition to making immediate decisions that can be life-changing, also must have an ethical approach and good knowledge of nursing. Aim: The aim of the study was to describe the caring process in out-of-hospital cardiac arrest in adult patients. Method: The study was conducted as a literature review with an integrated analysis. The data collection resulted in the inclusion of 15 qualitative and quantitative scientific articles. Article searches were performed based on keywords in Cinahl Complete and PubMed. Result: The processing of the articles resulted in four categories and 11 subcategories. The main categories were; When the alarm goes off and the care meeting begins, To make the right decision for the patient, A dignified end, A demanding responsibility to be able to provide good care. Mental preparation was important in order to provide good care, predetermined impressions could risk having consequences for the patient. Creating a protected care space as well as creating trust and letting relatives be involved was highlighted, however, the chaotic and demanding situation could be an obstacle to this. A patient- perspective was crucial for making the right decision for the patient, gray areas, ethical dilemmas and relatives' hopes could, however, create unnecessary suffering for the patient. It was important to create a dignified ending for the patient and treat the deceased's body with respect. Relatives' need for care was seen as part of the care process, but required that the ambulance staff could allow themselves to be influenced. Fear or insecurity in facing relatives' grief could have consequences for their need for support. The care meeting meant stress for the ambulance staff, in order to be able to provide good and professional care, organizational and collegial support was required, as well as regular training. The importance of experience was highlighted as very important. Conclusion: The caring process in out-of-hospital cardiac arrests in adult patients vary depending on the situation and the patient's care is affected by several different factors. There was a strong will to protect the patient's dignity and integrity as well as the relatives' needs for support and care. Making life-changing decisions was a heavy burden, which requires experience and self-confidence in one's professional role. However, factors such as gray areas, doubts, insecurity and stress among the ambulance staff could lead to unnecessary suffering for the patient and that relatives' need for care was ignored during cardiopulmonary resuscitation. The study emphasizes the importance and highlights shortcomings in the patient's and relatives' care needs in the event of an out-of-hospital cardiac arrest.

Bakgrund: Dagligen drabbas mer än 25 personer av hjärtstopp utanför sjukhus där ungefär 500 av dessa räddas årligen. Luftvägshanteringen är en av de viktigaste faktorerna under hjärt-och lungräddning och en obehandlad hypoxi i samband med hjärtstopp ökar risken för att patienten kan erhålla neurologiska skador. Enligt Erikssons omvårdnadsteori kan olika former av lidande upplevas, men när kroppen, själen och anden är i balans uppnås hälsa. För att hantera luftvägen kan ambulanspersonal använda sig utav mask-och blåsa eller larynxmask. Endotrakeal intubation är även ett alternativ, men kräver särskild kompetens i Sverige vilken främst specialistsjuksköterska inom anestesisjukvård innehar. Studier visar på en låg procentuell framgång för antal lyckade försök gällande utövandet av endotrakeal intubation prehospitalt och att larynxmask numera används i stället av ambulanspersonalenför att den kan appliceras snabbt och enkelt. Syfte: Syftet var att belysa om förekommande luftvägshjälpmedel vid hjärtstopp utanför sjukhus kan påverka patientens utfall vid återkomst av spontan cirkulation. Metod: Litteraturöversikt med systematisk ansats. Cinahl plus och PubMed har använts som databassökning. Totalt 15 artiklar av kvantitativ metod inkluderades. Artiklarna har därefter analyserats genom integrerad analys. Resultat: De signifikanta huvudfynden som framkom med var att luftvägshantering med mask-och blåsa påvisade en hög prevalens för gynnsamt neurologiskt utfall och överlevnad medan endotrakeal intubation påvisade en högre prevalens för återgång av spontan cirkulation. Slutsats: Utifrån resultatet visade sig användning av mask-och blåsa ge mest utdelning för att uppnå ett gynnsamt neurologiskt utfall och ökad chans till överlevnad för patienten. Däremot framkom det att användning av endotrakealtub vid prehospitalt hjärtstopp medförde störst chans till återkomst av spontan cirkulation. Av de tre förekommande luftvägshjälpmedlen att använda sig av vid prehospitalt hjärtstopp kan det förekomma skillnader i utfallet för patienten. Det förekommer däremot inte tillräckligt med stora skillnader och resultatet bördärmed tolkas med försiktighet då det anses behövas fler studier inom området. / Background: Every day more than 25 people suffer from out-of hospital cardiac arrest, of which approximately 500 rescued annually. Airway management is one of the most important factors in cardiopulmonary resuscitation and an untreated hypoxia in conjunction with cardiac arrest increases the patient’s risk of receiving neurological damage. According to Eriksson's nursing theory, various forms of suffering can be experienced, and a state of health can only be achieved when the body, soul and spirit are in balance. To manage the airway, the ambulance clinician can use a bag-valve mask or laryngeal mask. Endotracheal intubation is also an alternative, but in Sweden, it requires specific competence that mainly specialist nurses in anesthesia care possess. Studies shows a low success rate regarding the practice of performing a prehospital endotracheal intubation and that laryngeal mask nowadays more used instead by ambulance staff because it’s applied quickly and easily. Aim: The purpose was to shed light on whether the available respiratory aids in out-of-hospital cardiac arrest can affect the patient outcomes on the return of spontaneous circulation. Method: Literature overview with systematic approach. Cinahl plus and PubMed has been used as database search. A total of 15 articles of quantitative method were included. The articles were analyzed through integrated analysis. Results: The significant main findings that emerged were that airway management with bag-valve mask correlated with a high prevalence for favorable neurological outcome and survival while endotracheal intubation showed a higher prevalence for return of spontaneous circulation. Conclusion: Based on the results, the use of bag-valve mask found to be the best option to achieve a favorable neurological outcome and increased chance of survival for the patient. However, the use of endotracheal tube in out-ofhospital cardiac arrest for increasing the chance of the patient regaining return of spontaneous circulation. Out of the three available airway aids to use in out-of-hospital cardiac arrest, there may be differences in the outcome for the patient. However, there are not enough significant differences, and the result therefore should be interpreted with caution as it is considered that more studies in the subject required.

L'arrêt cardiaque est un problème majeur de santé publique. Il se caractérise par une perte subite des fonctions cardiaques, de la respiration et de l’état de conscience et est habituellement causé par une perturbation électrique au niveau du coeur. Les arrêts cardiaques hors hôpital (ACHH) concernent plus de 85% des arrêts cardiaques. Les taux de survie, tout en restant bas, varient largement à travers le monde, de 2 à 20%. Dans la population générale, l'incidence de la mort subite par arrêt cardiaque serait estimée à 4-5 millions de cas par an. La pollution de l'air est un problème environnemental majeur pour la santé. En 2013, elle était le quatrième facteur de risque de mortalité globale et était estimée être à l'origine de 5,5 millions de décès par an à travers le monde. Dans la littérature, l'exposition à court terme à la pollution de l'air, notamment en ce qui concerne les particules en suspension, est retrouvée en association avec la morbidité et la mortalité cardiovasculaire. Plusieurs études trouvent une association positive entre les particules fines notées PM2,5 (de diamètre aérodynamique inférieur à 2,5 μm) et les arrêts cardiaques hors hôpital (ACHH) bien que l'association soit non significative dans d'autres études. En ce qui concerne les particules en suspension notées PM10 (de diamètre aérodynamique inférieur à 10 μm), le dioxyde d'azote (NO2), l'ozone (O3) et le dioxyde de soufre (SO2), l'évaluation du risque d'ACHH conduit à des résultats discordants. Les mécanismes impliqués dans la relation entre la pollution de l'air et les ACHH ne sont pas clairement connus. Ils pourraient mettre en jeu des perturbations électriques et des réactions inflammatoires. Le but de notre travail est d'étudier l'effet de l'exposition à ces différents polluants à des échelles de temps horaire et journalière sur la survenue d'ACHH dans la région Nord-Pas de Calais, France. De plus, nous nous sommes intéressés plus spécifiquement aux ACHH survenant en période scolaire avec des analyses en sous-groupes notamment par sexe, âge, cause de l'arrêt, statut diabétique, afin de pouvoir révéler des sous-groupes potentiellement plus vulnérables. L'étude a collecté les ACHH qui sont survenus dans la région Nord-Pas-de-Calais, France, en 2015. Une étude de cas-croisé stratifiée sur le temps couplée à une régression logistique conditionnelle a été principalement utilisée pour évaluer l'association entre les ACHH et les polluants de l'air (PM2,5, PM10, NO2, O3, SO2) mesurés dans l'heure de l'arrêt jusqu'à 5 jours avant l'arrêt. 1039 cas ont été inclus dans l'étude. La plupart des associations positives significatives ont été observées pour les expositions aux PM2,5 et PM10 et pour les ACHH en période scolaire. Pour la plus petite p-value, le plus grand OR était : pour l'ensemble des ACHH et dans le sous-groupe des hommes, pour la moyenne cumulée sur 12 heures avant l'arrêt des PM10 (OR=1,33, p<0,001 et OR=1,34, p=0,001 respectivement) ; dans le sous-groupe des âges de 50 à 75 ans, pour la moyenne le jour de l'arrêt des PM2,5 (OR=1,27, p<0,001) ; dans le sous-groupe des arrêts de cause cardiaque, pour la moyenne quatre jours avant l'arrêt des PM2,5 (OR=1,26, p<0,001) ; dans le sous-groupe des cas avec diabète, pour la moyenne cumulée sur quatre heures avant l'arrêt des PM2,5 (OR=1,55, p=0,002). Les résultats montrent des associations significatives entre les particules en suspension et les ACHH en période scolaire, avec des sous-groupes de susceptibilité (hommes, âge de 50 à 75 ans, ACHH de cause cardiaque, et les diabétiques). L'exploration de sous-groupes de vulnérabilité est d'autant plus importante dans les études épidémiologiques des polluants de l'air du fait des risques peu élevés à l'échelle de la population habituellement observés. L'ensemble de ces informations pourraient encourager les autorités publiques à émettre des politiques de recommandations spécifiques ciblées pour les sous-groupes de susceptibilité. / Cardiac arrest is an important public issue. It refers to the sudden, unexpected loss of heart function, breathing and consciousness and usually results from an electrical disturbance in the heart. More than 85% of cardiac arrests are out-of-hospital cardiac arrests (OHCA). Overall survival rates remain low in most countries but vary widely across the world (range: 2–20%). In the general population, sudden cardiac death rates range from 4 to 5 million cases per year. Outdoor air pollution is a major environmental health problem. In 2013, it ranked as the fourth risk factor for global mortality and was estimated to cause 5,5 million deaths worldwide per year. Short-term exposure to air pollution especially with regard to fine particulate matter is increasingly associated in the literature with cardiovascular morbidity and mortality. A positive association can be found between fine particulate matter with an aerodynamic diameter under 2.5 μm (PM2.5) and OHCA in several studies, though the association remains insignificant in others. With respect to PM smaller than 10 microns (PM10), nitrogen dioxide (NO2), ozone (O3) and sulfur dioxide (SO2), the evaluation of risk of OHCA brings out inconsistent results. The way ambient air pollution and OHCA are related is still unclear. It might involve electrical disturbances and inflammatory reactions. The aim of our study is to investigate the effect of exposure to air pollution, on an hourly and daily scale, on the incidence of OHCA in Nord-Pas-de-Calais, France. Additional objectives were to investigate, among OHCA occurring during non-holiday periods, susceptible subgroups by sex, age, cause of the OHCA, diabetes status. The study included OHCA that occurred in the Nord-Pas-de-Calais region, France, in 2015. A time-stratified casecrossover study design coupled with a conditional logistic regression was primarily used to evaluate the association between OHCA and air pollutants (PM2,5, PM10, NO2, O3, SO2) measured within the hour of the arrest up to 5 days before. In all, 1039 cases were included. Most of the significant positive associations were found for PM2,5 and PM10 exposures and for OHCA during non-holiday periods. For the smallest p-value, the largest OR was : for all OHCA and within the subgroup of men, for the cumulative average twelve hours before the arrest of PM10 (OR=1,33, p<0,001 and OR=1,34, p=0,001 respectively) ; within the subgroup of age 50 to 75 years old, for the average on the day of the arrest of PM2,5 (OR=1,27, p<0,001) ; within the subgroup of arrests of cardiac cause, for the average four days before the arrest of PM2,5 (OR=1,26, p<0,001) ; within the subgroup of cases with diabetes, for the cumulative average four hours before the arrest of PM2,5 (OR=1,55, p=0,002).The findings show significant links between short-term exposure to particulate matter and OHCA during non-holiday periods, with susceptible subgroups (men, age 50 to 75 years old, OHCA of cardiac cause, and diabetics). Investigation of susceptible subgroups becomes especially important in epidemiological studies of air pollutants because of the small population-wide relative risks that are usually observed. The results of this study could encourage public authorities to implement specific policy recommendations aimed at vulnerable subgroups.

En person som drabbas av hjärtstopp utanför sjukhus är beroende av att skyndsamt erhålla högkvalitativ hjärt-lungräddning för bästa möjliga förutsättningar till överlevnad. Bröstkompressioner behöver utföras med få avbrott för att anses högkvalitativa. Tidigare forskning indikerar att manuella bröstkompressioner kan hålla otillräcklig kvalitet. Hjälpmedel som utför mekaniska bröstkompressioner har tagits fram och utvecklats som alternativ till manuella bröstkompressioner. I Sverige har ambulanssjuksköterskor en möjlighet att använda sig av hjälpmedlet LUCAS för att utföra mekaniska bröstkompressioner. Forskning inom området har främst haft en medicinsk inriktning. Det saknas tillräcklig forskning om ambulanssjuksköterskors upplevelser i samband med hjärt- lungräddning och användande av mekaniska bröstkompressioner. Syftet med studien var att beskriva ambulanssjuksköterskors upplevelser av att utföra hjärt- lungräddning med det mekaniska bröstkompressionshjälpmedlet LUCAS. Studiens metod var beskrivande och utgick från en kvalitativ induktiv ansats. Urvalet var ändamålsenligt och bestod av tio sjuksköterskor med specialistutbildning med inriktning ambulanssjukvård yrkesverksamma i ett län i Mellansverige. Intervjuerna genomfördes utifrån en semistrukturerad intervjuguide och analyserades med kvalitativ innehållsanalys. Resultatet presenteras genom en huvudkategori, tre generiska kategorier och åtta subkategorier. Ambulanssjuksköterskor upplevde att LUCAS är en omvårdnadsresurs med betydelse för personal och patient. Ambulanssjuksköterskor beskrev att övning och utbildning krävs för korrekt handhavande, att LUCAS påverkar arbetsmiljö och patientsäkerhet och att LUCAS skapar andra förutsättningar för personalen. Slutsatsen var att denna studie visade att LUCAS är ett betydelsefullt och uppskattat mekaniskt hjälpmedel bland ambulanssjuksköterskor när de utför hjärt-lungräddning utanför sjukhus. Ambulanssjuksköterskor föredrog mekaniska bröstkompressioner framför manuella bröstkompressioner trots en medvetenhet om att behandling med mekaniskt hjälpmedel enligt tidigare forskning inte kunnat påvisa någon ökad patientöverlevnad. Istället beskrev ambulanssjuksköterskor att de vid bruk av LUCAS upplevde fördelar som hade betydelse för dem och deras arbetsmiljö, fördelar som inverkade på arbetssätt och säkerhet. Bland annat kunde ambulanssjuksköterskor använda bilbälte och således färdas säkert samtidigt som patienten erhöll högkvalitativa bröstkompressioner utförda av LUCAS. Utifrån studiens resultat kan det vara av vikt att verksamheter som bedriver ambulanssjukvård tar större hänsyn till ambulanssjuksköterskors perspektiv vid implementering, utveckling och utvärdering av ett mekaniskt hjälpmedel. / A person suffering from out-of-hospital cardiac arrest is dependent on promptly receiving high qualitative cardiopulmonary resuscitation for best possible survival outcome. Chest compressions need to be performed with few interruptions to be considered of high quality. Previous research indicates that manually performed chest compressions can be of inadequate quality. Aids that perform mechanical chest compressions have been developed as an alternative to manual chest compressions. In Sweden, ambulance nurses have the possibility to use the aid LUCAS to perform mechanical chest compressions. Research in the field has mainly been having a medical focus. There is insufficient research on ambulance nurse's experiences associated with cardiopulmonary resuscitation and the use of mechanical chest compression aids. The aim of the study was to describe the ambulance nurse's experience of performing cardiac pulmonary resuscitation with the mechanical chest compression aid LUCAS. The method of the study was descriptive and based on a qualitative inductive approach. The sample was convenient and consisted of ten nurses with a specialist nursing degree focusing on ambulance care working in central Sweden. The interviews were conducted based on a semi-structured interview guide and analyzed with qualitative content analysis. The result is presented by a main category, three generic categories and eight subcategories. Ambulance nurses find that LUCAS is a nursing resource of importance for staff and patients. Ambulance nurses described that exercise and training is required for proper handling, that LUCAS affects the work environment and patient safety and that LUCAS creates other conditions for the staff. The conclusion was that this study showed that LUCAS is an important and appreciated mechanical device among ambulance nurses when performing cardiopulmonary resuscitation outside hospitals. Ambulance nurses preferred mechanical chest compressions in front of manual chest compressions despite the awareness that treatment with mechanical devices in previous research has not been able to demonstrate increased patient survival. Instead, ambulance nurses described that, when using LUCAS, they perceived benefits that were important to them and their working environment, benefits that affect working methods and safety. Among other things, ambulance nurses could use seat belts and thus travel safely while the patient received high quality chest compressions performed by LUCAS. Based on the results of the study it may be important that ambulance services pay more attention to the perspective of the ambulance nurse in the implementation, development and evaluation of a mechanical device.

Introduction: Approximately 10 000 people suffer each year from out-of-hospital cardiac arrest in Sweden. At the turn of the millennia the survival rate for out-of-hospital cardiac arrest was circa three precent and in 2022 the survival rate had increased to around eleven percent. Survivors face cognitive, psychological, and motor problems post arrest which impacts their health-related quality of life (HRQoL) – ie. their perception of their own social and physical environment and health. The research regarding HRQoL following cardiac arrest is limited. With increasing survival rates comes an increasing need for extensive research mapping the HRQoL of cardiac arrest survivors. Aim: The aim of this study was to investigate patients’ perceived health-related quality of life after surviving cardiac arrest.   Method: This study was conducted as a quantitative general literature review with an inductive content analysis. This study used articles that included the SF-36 instrument to measure the HRQoL in cardiac arrest survivors. Main- and subcategories were created based on the data extracted from the included articles. Result: Cardiac arrest patients generally experience their health-related quality of life as worse compared to the general population. Physical, psychological and social factors were identified as the main components whose effect on HRQoL was found to be the greatest. Conclusion: Cardiac arrest survivors experience a reduced HRQoL compared to the general population. The HRQoL is affected in both the psychological and physical dimensions with long term consequences. These results create a foundation for the nurse in the work to improve the HRQoL for the patient.

Introduktion: Antalet prehospitala förlossningar är få och därför kan det vara svårt för ambulanspersonal att upprätthålla tillräcklig kompetens inom området. Eftersom det händer sällan kan det väcka oro hos sjuksköterskor. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av att vårda vid prehospital förlossning. Metod: En kvalitativ metod användes med semistrukturerade intervjuer som analyserades med hjälp av kvalitativ innehållsanalys med induktiv manifest ansats. Nio sjuksköterskor verksamma i norra Sverige inkluderades. Resultat: Resultatet presenteras i fem kategorier; Vikten av information och förberedelse, Stress och oro för komplikationer, En känsla av skräckblandad förtjusning, Stöd och samarbete minskar oron och Kunskap och erfarenhet ökar upplevelsen av trygghet. Resultatet visade att sjuksköterskor inom ambulanssjukvården känner en skräckblandad förtjusning när det kommer till att ta sig an uppgiften att bistå vid en förlossning prehospitalt. Det är en arbetsuppgift som skänker glädje i slutändan men vägen dit kan vara fylld av stress, oro och en upplevelse av brist på kunskap inom området. Slutsats: Förlossningar är ett uppdrag som sjuksköterskor inom ambulansen känner sig mindre förberedda på, det är en sällanhändelse och det gör att de inte kan tillägna sig den erfarenheten de önskar. Det finns ett behov av ökad kunskap och övning inom området.

L’arrêt cardiaque extra-hospitalier (ACREH) touche environ 30 à 40,000 personnes en France chaque année. Dans près de la moitié des cas, la cause de l’ACREH est une occlusion coronaire aiguë provoquant un trouble du rythme ventriculaire létal. Malgré les progrès réalisés ces dernières années en terme de prise en charge pré et intra-hospitalière, le pronostic de ces patients reste sombre, de par les lésions neurologiques se produisant très rapidement après l’arrêt circulatoire. Alors que le pronostic à court terme est relativement bien décrit, les données sur le devenir à long terme, en termes de survie, mais aussi de devenir fonctionnel, neurologique, et de qualité de vie, restent rares. Objectifs : L’objectif de ce travail est de décrire le devenir à long terme des patients victimes d’un ACREH et admis vivants à l’hôpital (qualité de vie liée à l’état de santé, devenir neurologique et fonctionnel) et d’évaluer les facteurs associés à ce devenir (biomarqueurs, revascularisation coronaire précoce). Patients et méthodes : Ce travail a consisté en l’analyse des données de la cohorte des patients victimes d’un ACREH et admis vivants en réanimation mé- dicale à l’hôpital Cochin. Cette cohorte a été constituée rétrospectivement entre 2000 et 2006 sur dossiers archivés puis prospectivement selon les recommandations internationales d’Utstein depuis 2007. Les données de survie ont été collectées. Le devenir neurologique et fonctionnel et les données de qualité de vie ont été collectées lors d’entretiens téléphoniques réalisés auprès des survivants sortis vivants de l’hôpital. Résultats principaux : La mortalité globale à J30 était de 68,2%. La revascu- larisation coronaire (ATL) immédiate était associée à une mortalité à J30 plus faible (ORcoro sans ATL vs. pas coro 0,79 [0,57;1,08], p=0,14 et ORcoro avec ATL vs. pas coro 0,61 [0,43;0,85], p<0,01). Les 466 patients vivants à J30 ont été suivis pendant une durée médiane de 3,2 ans [IQR : 0,7 ;6,7], avec une durée maximale de suivi de 13,5 ans. En analyse multivariée, la revascularisation coronaire immédiate restait inversement associée à la mortalité à long terme (HRcoro sans ATL vs. pas coro 0,78 [0,45 ;1,33], p=0,35 et HRcoro avec ATL vs. pas coro 0,40 [0,23 ;0,70], p<0,01).
La copeptine a été dosée chez 298/510 patients à l’admission et chez 224 patients à J3. Le taux médian à l’admission était de 261,3 [125,2 ;478,6] pmol/L. Le taux de survie à 1 an était inversement proportionnel au quintile de copeptine à l’admission (38,2, 32,6, 27,7, 31 et 13,6%, respectivement; p<0,01). En analyse multivariée, seul le cinquième quintile de copeptine à l’admission était associé à la mortalité à 1 an (HR5ème vs. 1er 1,64 [1,06;2,58], p=0,03). Après ajustement mutuel des taux de copeptine à l’admission et à J3, le taux de copeptine à l’admission n’était plus associé à la mortalité à 1 an mais le taux de copeptine à J3 restait asso- cié à la mortalité à 1 an par une relation concentration-dépendante (HR2ème vs. 1er 1,60 [0,90-3,17], p=0,10 ; HR3ème vs. 1er 1,94 [1,01 ;3,71], p=0,05 ; HR 4ème vs. 1er 2,01 [1,04 ;3,89], p=0,04 et HR5ème vs. er 2,38 [1,19 ;4,74], p=0,01 ; p de tendance =0,02). Au cours du suivi, 255 patients ont pu être recontactés. Le délai médian de recon- tact après la survenue de l’ACREH était de 50 [22-93] mois. 66% des patients sortis de réanimation avec un score CPC coté à 1 gardaient une performance neurolo- gique préservée au moment de l’interview (n=150/231). Les dimensions physiques et mentales agrégées du SF-36 étaient similaires chez les survivants d’ACREH en comparaison avec les individus de la population générale (47,0 vs. 47,1, p=0,88 et 46,4 vs. 46,9, p=0,45, respectivement). Les patients présentaient une altération plus marquée des dimensions physiques que des dimensions mentales du score SF- 36 en comparaison avec la population générale. L’activité physique (74,1 vs. 78,4, p=0,02) et la vitalité (50,7 vs. 56,2, p<0,01) étaient les dimensions les plus altérées. (...) / Out-of-hospital cardiac arrest (OHCA) occurs in about 30-40,000 people in France each year and is related to a culprit coronary occlusion in half cases. Although pre and in-hospital management of such patients dramatically improved last years, outcome remains poor because of the neurological damage related to brain anoxia. Short-term outcome is well-described but data are lacking on long-term outcome, functionnal and neurological outcome and health-related quality of life (HRQOL). Objectives : The main purpose of this work was to describe the long-term outcome of successfully resuscitated OHCA patients admitted alive at ICU. We aimed at picking up factors associated with HRQOL as well. Patients and methods : Data from the Paris registry were used. Consecutive sucessfully resuscitated OHCA patients admitted alive at Medical ICU of Cochin hospital, Paris, France are included in the database since 2000, January 1st, accor-ding to Utstein style. We also collected survival data. Neurological and functionnal outcome, as well as HRQOL (SF-36 questionnaire) were recorded during phone in- terviews in OHCA patients discharged alive from hospital. Main results : Overall mortality at day-30 was 68.2%. Immediate percutaneous coronary intervention (PCI) was associated with day-30 mortality (ORcoro w/o PCI vs. no coro 0.79 [0.57,1.08], p=0.14 et ORcoro w/ PCI vs. no coro 0.61 [0.43,0.85], p<0.01). The 466 patients alive at day-30 were followed-up for 3.2 years [IQR : 0.7-6.7]. After adjus- tement for cofounders, immediate PCI remained associated with long-term mor-
tality (HRcoro w/o PCI vs. no coro 0.78 [0.45,1.33], p=0.35 et HRcoro w/ PCI vs. no coro 0.40 [0.23,0.70], p<0.01). Copeptin was assessed in 298/510 patients at ICU admission and in 224 patients at day-3. Median admission copeptin level was 261.3 [125.2,478.6] pmol/L. Survival rates were 38.2, 32.6, 27.7, 31 and 13.6% through admission copeptin quintiles (p<0,01). In multivariate analysis, only the fifth quin-
tile was associated with one-year mortality (HR5ème vs. 1st 1.64 [1.06-2.58], p=0.03). After mutual adjustement of admission and day-3 copeptin levels, admission co- peptin level was not associated anymore with one-year mortality whereas day-3 copeptin level remained associated with one-year mortality in a concentration- dependent manner (HR2nd vs. 1st 1.60 [0.90-3.17], p=0.10; HR3th vs. 1st 1.94 [1.01- 3.71], p=0.05; HR 4th vs. 1st 2.01 [1.04-3.89], p=0.04 et HR5th vs. st 2.38 [1.19-4.74], p=0.01 ; p for trend =0.02). During follow-up, 255 OHCA patients dicharged alive from hospital were phone in- terviewed, after a median duration from cardiac arrest of 50 [22-93] months. 66% of patients kept a good cerebral performance after hospital discharge (n=150/231). Overall physical and mental SF-36 dimensions were similar between OHCA pa- tients and age- and gender-matched individuals from French general population (47.0 vs. 47.1,p=0.88 and 46.4 vs. 46.9, p=0.45, respectively). Physical dimensions were more significantly altered in OHCA patients, especially physical functionning (74.1 vs. 78.4, p=0.02) and vitality (50.7 vs. 56.2, p<0.01). In multivariate analysis, age, male gender, initial shockable rhythm were associated with an improvement in most of the SF-36 dimensions. Immediate PCI was associated with a gain in physical functionning (+7.0, p=0.06), general health (+7.3, p=0.02) and vitality (+4.4, p=0.08). Conclusion : Overall survival in this large cohort of successfully resuscitated OHCA patients was about 20%. Immediate PCI was associated with a decrea- sed short and long-term mortality. HRQOL was similar between OHCA patients and age and gender matched individuals from general population but physical di- mensions appeared significantly altered. Age, male gender and initial shockable rhythm were associated with a better HRQOL. (...)

L’arrêt cardiaque extra-hospitalier (ACREH) touche environ 30 à 40,000 personnes en France chaque année. Dans près de la moitié des cas, la cause de l’ACREH est une occlusion coronaire aiguë provoquant un trouble du rythme ventriculaire létal. Malgré les progrès réalisés ces dernières années en terme de prise en charge pré et intra-hospitalière, le pronostic de ces patients reste sombre, de par les lésions neurologiques se produisant très rapidement après l’arrêt circulatoire. Alors que le pronostic à court terme est relativement bien décrit, les données sur le devenir à long terme, en termes de survie, mais aussi de devenir fonctionnel, neurologique, et de qualité de vie, restent rares. Objectifs : L’objectif de ce travail est de décrire le devenir à long terme des patients victimes d’un ACREH et admis vivants à l’hôpital (qualité de vie liée à l’état de santé, devenir neurologique et fonctionnel) et d’évaluer les facteurs associés à ce devenir (biomarqueurs, revascularisation coronaire précoce). Patients et méthodes : Ce travail a consisté en l’analyse des données de la cohorte des patients victimes d’un ACREH et admis vivants en réanimation mé- dicale à l’hôpital Cochin. Cette cohorte a été constituée rétrospectivement entre 2000 et 2006 sur dossiers archivés puis prospectivement selon les recommandations internationales d’Utstein depuis 2007. Les données de survie ont été collectées. Le devenir neurologique et fonctionnel et les données de qualité de vie ont été collectées lors d’entretiens téléphoniques réalisés auprès des survivants sortis vivants de l’hôpital. Résultats principaux : La mortalité globale à J30 était de 68,2%. La revascu- larisation coronaire (ATL) immédiate était associée à une mortalité à J30 plus faible (ORcoro sans ATL vs. pas coro 0,79 [0,57;1,08], p=0,14 et ORcoro avec ATL vs. pas coro 0,61 [0,43;0,85], p<0,01). Les 466 patients vivants à J30 ont été suivis pendant une durée médiane de 3,2 ans [IQR : 0,7 ;6,7], avec une durée maximale de suivi de 13,5 ans. En analyse multivariée, la revascularisation coronaire immédiate restait inversement associée à la mortalité à long terme (HRcoro sans ATL vs. pas coro 0,78 [0,45 ;1,33], p=0,35 et HRcoro avec ATL vs. pas coro 0,40 [0,23 ;0,70], p<0,01).
La copeptine a été dosée chez 298/510 patients à l’admission et chez 224 patients à J3. Le taux médian à l’admission était de 261,3 [125,2 ;478,6] pmol/L. Le taux de survie à 1 an était inversement proportionnel au quintile de copeptine à l’admission (38,2, 32,6, 27,7, 31 et 13,6%, respectivement; p<0,01). En analyse multivariée, seul le cinquième quintile de copeptine à l’admission était associé à la mortalité à 1 an (HR5ème vs. 1er 1,64 [1,06;2,58], p=0,03). Après ajustement mutuel des taux de copeptine à l’admission et à J3, le taux de copeptine à l’admission n’était plus associé à la mortalité à 1 an mais le taux de copeptine à J3 restait asso- cié à la mortalité à 1 an par une relation concentration-dépendante (HR2ème vs. 1er 1,60 [0,90-3,17], p=0,10 ; HR3ème vs. 1er 1,94 [1,01 ;3,71], p=0,05 ; HR 4ème vs. 1er 2,01 [1,04 ;3,89], p=0,04 et HR5ème vs. er 2,38 [1,19 ;4,74], p=0,01 ; p de tendance =0,02). Au cours du suivi, 255 patients ont pu être recontactés. Le délai médian de recon- tact après la survenue de l’ACREH était de 50 [22-93] mois. 66% des patients sortis de réanimation avec un score CPC coté à 1 gardaient une performance neurolo- gique préservée au moment de l’interview (n=150/231). Les dimensions physiques et mentales agrégées du SF-36 étaient similaires chez les survivants d’ACREH en comparaison avec les individus de la population générale (47,0 vs. 47,1, p=0,88 et 46,4 vs. 46,9, p=0,45, respectivement). Les patients présentaient une altération plus marquée des dimensions physiques que des dimensions mentales du score SF- 36 en comparaison avec la population générale. L’activité physique (74,1 vs. 78,4, p=0,02) et la vitalité (50,7 vs. 56,2, p<0,01) étaient les dimensions les plus altérées. (...) / Out-of-hospital cardiac arrest (OHCA) occurs in about 30-40,000 people in France each year and is related to a culprit coronary occlusion in half cases. Although pre and in-hospital management of such patients dramatically improved last years, outcome remains poor because of the neurological damage related to brain anoxia. Short-term outcome is well-described but data are lacking on long-term outcome, functionnal and neurological outcome and health-related quality of life (HRQOL). Objectives : The main purpose of this work was to describe the long-term outcome of successfully resuscitated OHCA patients admitted alive at ICU. We aimed at picking up factors associated with HRQOL as well. Patients and methods : Data from the Paris registry were used. Consecutive sucessfully resuscitated OHCA patients admitted alive at Medical ICU of Cochin hospital, Paris, France are included in the database since 2000, January 1st, accor-ding to Utstein style. We also collected survival data. Neurological and functionnal outcome, as well as HRQOL (SF-36 questionnaire) were recorded during phone in- terviews in OHCA patients discharged alive from hospital. Main results : Overall mortality at day-30 was 68.2%. Immediate percutaneous coronary intervention (PCI) was associated with day-30 mortality (ORcoro w/o PCI vs. no coro 0.79 [0.57,1.08], p=0.14 et ORcoro w/ PCI vs. no coro 0.61 [0.43,0.85], p<0.01). The 466 patients alive at day-30 were followed-up for 3.2 years [IQR : 0.7-6.7]. After adjus- tement for cofounders, immediate PCI remained associated with long-term mor-
tality (HRcoro w/o PCI vs. no coro 0.78 [0.45,1.33], p=0.35 et HRcoro w/ PCI vs. no coro 0.40 [0.23,0.70], p<0.01). Copeptin was assessed in 298/510 patients at ICU admission and in 224 patients at day-3. Median admission copeptin level was 261.3 [125.2,478.6] pmol/L. Survival rates were 38.2, 32.6, 27.7, 31 and 13.6% through admission copeptin quintiles (p<0,01). In multivariate analysis, only the fifth quin-
tile was associated with one-year mortality (HR5ème vs. 1st 1.64 [1.06-2.58], p=0.03). After mutual adjustement of admission and day-3 copeptin levels, admission co- peptin level was not associated anymore with one-year mortality whereas day-3 copeptin level remained associated with one-year mortality in a concentration- dependent manner (HR2nd vs. 1st 1.60 [0.90-3.17], p=0.10; HR3th vs. 1st 1.94 [1.01- 3.71], p=0.05; HR 4th vs. 1st 2.01 [1.04-3.89], p=0.04 et HR5th vs. st 2.38 [1.19-4.74], p=0.01 ; p for trend =0.02). During follow-up, 255 OHCA patients dicharged alive from hospital were phone in- terviewed, after a median duration from cardiac arrest of 50 [22-93] months. 66% of patients kept a good cerebral performance after hospital discharge (n=150/231). Overall physical and mental SF-36 dimensions were similar between OHCA pa- tients and age- and gender-matched individuals from French general population (47.0 vs. 47.1,p=0.88 and 46.4 vs. 46.9, p=0.45, respectively). Physical dimensions were more significantly altered in OHCA patients, especially physical functionning (74.1 vs. 78.4, p=0.02) and vitality (50.7 vs. 56.2, p<0.01). In multivariate analysis, age, male gender, initial shockable rhythm were associated with an improvement in most of the SF-36 dimensions. Immediate PCI was associated with a gain in physical functionning (+7.0, p=0.06), general health (+7.3, p=0.02) and vitality (+4.4, p=0.08). Conclusion : Overall survival in this large cohort of successfully resuscitated OHCA patients was about 20%. Immediate PCI was associated with a decrea- sed short and long-term mortality. HRQOL was similar between OHCA patients and age and gender matched individuals from general population but physical di- mensions appeared significantly altered. Age, male gender and initial shockable rhythm were associated with a better HRQOL. (...)