Att överleva hjärtstopp utanför sjukhus är en allvarlig komplikation som kan leda till betydande fysiska och psykologiska utmaningar som kan påverka livskvalitén negativt. Den efterföljande vården, särskilt sjuksköterskans roll, är avgörande för att stödja återhämtningsprocessen och möta överlevarnas individuella behov. Denna litteraturöversikt syftade till att belysa erfarenheterna hos människor som har överlevt ett hjärtstopp utanför sjukhus. Genom att bearbeta åtta kvalitativa vetenskapliga artiklar identifierades tre huvudkategorier och sju underkategorier som sammanfattade överlevarnas erfarenheter. Resultatet visade på en komplex förändring av livssituationen för överlevarna, vilket inkluderar både fysiska och psykologiska begränsningar. Det framkom också en ökad existentiell medvetenhet och behovet av stöd från vården, familj och vänner. Bristen på vårdens stöd betonades och behovet av individuellt anpassat stöd och tydlig vägledning för att underlätta återhämtningsprocessen. I litteraturöversikten diskuterades även möjligheten att integrera patientens livskraft och religiösa övertygelser som resurs i vården för att främja återhämtningen. Sammanfattningsvis ger denna litteraturöversikt värdefull information om överlevarnas erfarenheter av att överleva ett hjärtstopp utanför sjukhus och betonar vikten av en helhetssyn i vården för att bemöta deras behov.

Successfull cardiopulmonary resuscitation is an essential life-saving tool; nevertheless, general ischemia during cardiac arrest may trigger different pathways that could turn even into a fatal damage; this condition is called post-cardiac arrest syndrome. It has been repeatedly shown that oxidative stress (OS) plays one of the key roles in the development of ischemia-reperfusion injury. However, current evidence on the possible participation of OS in the pathogenesis of post-cardiac arrest syndrome is insufficient. We tested following hypotheses: (i) ischaemia-reperfusion injury after cardiac arrest is accompanied by OS and (ii) mild therapeutical hypothermia decreases OS cardiac arrest. In the experimental part of our work we studied the effects of hypothermia and normothermia on hemodynamic parameters, markers of organ damage and on the OS burden in porcine model of cardiac arrest. Furthermore, we compared the effects of hypothermia with ischaemic postconditioning and nitric oxide administration in the porcine model of extracorporeal cardiopulmonary resuscitation. We found protective effects of hypothermia on all major endpoints including OS in comparison with normothermia; moreover, hypothermia improved also selected variables compared to ischemic postconditioning and nitric oxide. In the...

Successfull cardiopulmonary resuscitation is an essential life-saving tool; nevertheless, general ischemia during cardiac arrest may trigger different pathways that could turn even into a fatal damage; this condition is called post-cardiac arrest syndrome. It has been repeatedly shown that oxidative stress (OS) plays one of the key roles in the development of ischemia-reperfusion injury. However, current evidence on the possible participation of OS in the pathogenesis of post-cardiac arrest syndrome is insufficient. We tested following hypotheses: (i) ischaemia-reperfusion injury after cardiac arrest is accompanied by OS and (ii) mild therapeutical hypothermia decreases OS cardiac arrest. In the experimental part of our work we studied the effects of hypothermia and normothermia on hemodynamic parameters, markers of organ damage and on the OS burden in porcine model of cardiac arrest. Furthermore, we compared the effects of hypothermia with ischaemic postconditioning and nitric oxide administration in the porcine model of extracorporeal cardiopulmonary resuscitation. We found protective effects of hypothermia on all major endpoints including OS in comparison with normothermia; moreover, hypothermia improved also selected variables compared to ischemic postconditioning and nitric oxide. In the...

Position du problème. L’arrêt cardiaque extra-hospitalier (ACEH), dont la forme clinique la plus caricaturale correspond à la « mort subite », représenterait la première cause de mortalité à travers le monde. Malgré les améliorations apportées à leur prise en charge, le pronostic de ces patients demeure très péjoratif, y compris chez ceux qui ont bénéficié d’une réanimation initiale avec succès. En effet, la longue période d’ischémie suivie du phénomène de reperfusion secondaire au retour d’une activité circulatoire (RACS) est à l’origine d’une cascade de phénomènes physiopathologiques qui caractérisent le syndrome post-arrêt cardiaque. Plusieurs éléments thérapeutiques, telles que la reperfusion coronaire précoce et l’hypothermie thérapeutique, se sont développés ces dernières années afin de diminuer la morbi-mortalité importante observée dans cette situation. L’intérêt de ces interventions précoces sur le pronostic ultérieur demeure cependant débattu, car il a souvent été établi sur des sous-groupes de patients très sélectionnés. Objectif. L’objectif de ce travail était d’évaluer l’influence de ces interventions thérapeutiques précoces sur le devenir des patients victimes d’ACEH et admis vivants en service de réanimation. Méthode. Depuis 2000, une cohorte de patients survivants d’ACR et admis vivants en réanimation a été constituée dans un centre spécialisé. L’ensemble des caractéristiques démographiques, pré-hospitalières et hospitalières ont été analysées. L’analyse multivariée des facteurs pronostiques dans cette cohorte a utilisé principalement les méthodes de régression logistique. Résultats principaux. Entre 2003 et 2008, 435 patients ont été admis, ne présentaient pas d’étiologie extra-cardiaque évidente et ont bénéficié d’une coronarographie immédiate et systématique. Une lésion coronaire récente a été observée chez près de la moitié d’entre eux. Les moyens de détection d’une étiologie cardiaque sont extrêmement limités que ce soit par des modèles prédictifs simples utilisant des paramètres démographiques ou circonstancielles ou par des paramètres para-cliniques tels que l’électrocardiogramme ou les enzymes cardiaques. En effet, ces derniers possèdent des valeurs prédictives médiocres et ne peuvent être considérés comme outil de triage de ces patients. En revanche, la coronarographie immédiate et systématique (suivie d’une reperfusion coronaire si nécessaire) était associée de manière significative et indépendante à la survie hospitalière (OR ajusté= 2.06 (1.16-3.66)) et ceci quelque soit l’aspect électrocardiographique. Entre 2000 et 2009, 1145 patients ont été admis et 2/3 d’entre eux ont été traités par hypothermie thérapeutique. Parmi eux, 708/1145 (62%) avait initialement un rythme cardiaque choquable et 437/1145 (38%) présentait un rythme non choquable. Après ajustement sur les autres facteurs pronostiques, l’hypothermie thérapeutique avait un rôle protecteur sur le pronostic neurologique des patients à la sortie de réanimation dans le groupe présentant initialement un rythme choquable (OR ajusté= 1.90 (1.18-3.06)). En revanche, l’association entre le pronostic et l’intervention dans le groupe « non-choquable » n’était pas significative (OR ajusté=0.71 (0.37-1.36)). Parmi les facteurs susceptibles d’altérer le bénéfice lié à ce traitement, les complications infectieuses chez les patients traités par hypothermie thérapeutique s’avèrent courantes La plus fréquente est la pneumopathie précoce, dont l’apparition est associée de manière significative au traitement par hypothermie (OR ajusté= 1.90 (1.28-2.80)), mais son rôle sur le pronostic n’est pas démontré. / Background: Out-of-Hospital Cardiac Arrest (OHCA), usually clinically described as “sudden death”, is the leading worldwide cause of death. Despite recent improvements in management of OHCA, the prognosis of these patients remains very poor, even in those who benefitted from a successful initial resuscitation. During the period of ischemia following the Return of Spontaneous Circulation (ROSC), several pathophysiological phenomenons occur, characterizing the post cardiac arrest syndrome. Furthermore, different treatments, such as immediate coronary reperfusion or therapeutic hypothermia, are now implemented for the management of this syndrome in order to decrease the morbidities and the mortality involved during this period. However, the influence of these hospital interventions on prognosis is still debatable, since they have been assessed in very selected subgroups of patients.Objectives: The aim of our work was to assess the influence of these early interventions on the outcome of OHCA patients admitted alive in intensive care unit (ICU).Method: We set up an investigation cohort (starting in 2000) of OHCA patients, in whom a successful ROSC had been obtained and who were admitted alive in ICU. We gathered all demographic data, cardiac arrest circumstances, pre-hospital and hospital characteristics. We analyzed the different predictive factors of outcome using multivariate analysis, especially logistical regression.Results: Between 2003 and 2008, 435 patients without obvious extra-cardiac cause were included and benefited from an immediate and systematical coronary angiogram. We observed a recent lesion in nearly half of them. Detecting a cardiac etiology is very challenging even using simple predictive models including patient’s baseline characteristics and circumstances of the cardiac arrest. Moreover, other parameters, such as EKG patterns or cardiac biomarkers, did not seem helpful either. Indeed, these parameters had poor predictive values and consequently could not be considered as triage tools for these patients. Nevertheless, the immediate and systematical coronary angiogram, with percutaneous intervention if appropriate, was independently associated with an improvement of hospital survival (adjusted OR= 2.06 (1.16-3.66)), regardless of the EKG pattern.Between 2000 and 2009, 1145 patients were admitted and two third of them were treated with therapeutic hypothermia. Among them, 708/1145 (62%) had an initial shockable rhythm and 437/1145 (38%) presented a non shockable rhythm. On the one hand, after adjustment with other predictive factors, the therapeutic hypothermia significantly improved the good neurological outcome at ICU discharge (adjusted OR= 1.90 (1.18-3.06)). On the other hand, the influence of this intervention was not associated with prognosis on the “non-shockable” sub-group (adjusted OR=0.71 (0.37-1.36)). Among the undercurrent factors, which could minimize the benefit of this intervention, infectious complications in treated patients were common. The most frequent complication was early onset pneumonia, whose occurrence was significantly associated with hypothermia (adjusted OR= 1.90 (1.28-2.80)), even if its role on prognosis was not determined.Conclusions: Our findings support the international guidelines regarding the management of post-cardiac arrest, identifying the subgroups of patients who may benefit the most. These results encourage further prospective studies and randomized trials and bring helpful information in that way. Finally, ancillary analysis on an investigation cohort of hospital survivors suggests that protective

Hjärtstopp har ett lågt antal överlevare men under de senaste trettio åren har statistiken påvisat signifikant ökning av överlevare. Bakomliggande orsaker innefattar omfattande spektrum av tillstånd och sjukdomar, där kardiologiska och respiratoriska tillstånd påvisats i större utsträckning. Behandling och rehabilitering kan variera utifrån bakomliggande tillstånd och situation. Hjärtstoppsöverlevare har många olika besvär som framkommer i efterförloppet som leder till att patientens upplevelse av livsvärld kan komma att se sig påverkad i relation till en förändrad vardag. Genom att sjuksköterskan har förståelse för patientens upplevelse ökar möjligheten att utgå från en personcentrerad omvårdnad för att öka förutsättningarna för patienten. Syftet med studien var att belysa patienters upplevelse av att ha överlevt hjärtstopp. Metoden som användes innefattar en allmän litteraturöversikt som skapade ökad kunskap om patienternas upplevelse av att överleva hjärtstopp. Datainsamlingen genomfördes via databaser PubMed och CINAHL där det framkom totalt femton artiklar som valdes utifrån inklusions- och exklusionskriterier som besvarar valt syfte och problemformulering. Artiklarna analyserades vidare med hjälp av integrerad analys för att fastställa likheter och skillnader genom att redovisa huvudkategorier med respektive underkategorier. I resultatet redovisas varierande beskrivningar av patienters upplevelse av att överleva hjärtstopp. Resultatet har framställts i tre primära huvudkategorier; Upplevelsen av emotionella och fysiska hinder, Upplevelsen av utomståendes delaktighet samt En ny vardag och svårigheterna att hitta tillbaka. Avslutningsvis kan det konstateras att patienternas upplevelse av att överleva hjärtstopp påverkas utifrån alla aspekter i livet. Stöd från anhöriga och hälso- och sjukvården har visat sig generera en positiv uppfattning under återhämtningsfasen. Patienter är i behov av utökad information om de kommande symtom och besvär, sjuksköterskan bör erbjuda stöd, utbildning och verktyg för att kunna öka välbefinnande i deras nya verklighet. / Cardiac arrest has shown to have a low outcome of survivors but for the past thirty years the statistic of survivors has increased significantly. Underlying causes include a wide range of conditions and diseases where cardiological and respiratory conditions are the most common findings. Treatment and rehabilitation can vary based on the underlying condition and situation. Cardiac arrest can affect patients experience of life world due to the high problems and changes that emerges after surviving. These changes can cause problems in the way that the individual accept the new situation. Through an understanding of the patient's experience, the opportunity to offer a more person-centered nursing increase. The purpose of the study was to elucidate patients' experience of having survived cardiac arrest. The method used includes a general literature review to create knowledge about the patient's experience surviving a cardiac arrest. The data collection was carried out in PubMed and CINAHL where fifteen articles emerged based on the inclusion- and exclusion criteria that answered the purpose and problem formulation. Selected articles were analyzed using integrated analysis to determine similarities and differences by presenting main categories with respective subcategories. During the results, it emerged that patients who experience cardiac arrest have a broad idea of what it is like to survive cardiac arrest. Description of the patient's experience has produced three primary areas: The experience of emotional and physical obstacles, The experience of outsiders' participation and A new everyday life and the difficulties of finding their way back. It can be stated that the experience of surviving is affected by different aspects. Support from relatives and the healthcare system generate positive perception during recovery. Patients are in need of information about the upcoming symptoms and ailments, the nurse should offer support, training and tools to increase well-being in their new reality.

Successful cardiopulmonary resuscitation is the first step to rescue life during cardiac arrest. High mortality even after successful restoration of spontaneous circulation is substantially caused by patophysiological process associated with ischemia-reperfusion injury and it is widely called post-cardiac arrest syndrome (PCAS). There are many patophysiological mechanisms involved in the development and progress of this syndrom; the key role seems to play oxidative stress, triggering the activation cascade of systemic inflammatory reaction. In our study we have tested different possibilities of influencing the post-cardiac arrest syndrom. In the first experimental study we have compared the effect of mild therapeutic hypothermia with controlled normothermia on PCAS in a porcine model of cardiac arrest. In the second study we have compared in the same model the protective effects of mild therapeutic hypothermia, administration of nitric oxide and ischemic postconditioning. Results of the first experiment have revealed that mild therapeutic hypotermia is superior in the resuscitability, maintenance of blood pressure, oxidative stress suppression and organ damage protection than controlled normothermia. In the second experiment we have shown that neither nitric oxide administration, nor ischemic...