RESUMO: Introdução: as estatísticas progressivamente preocupantes demonstram que as doenças cardiovasculares são a principal causa de morbimortalidade no Brasil e no mundo e, entre elas, estão as que levam à parada cardiorrespiratória (PCR). O aprimoramento contínuo do ensino do atendimento às vítimas de PCR pré ou intra-hospitalar torna-se fundamental para a boa formação dos profissionais de saúde, incluindo os de Enfermagem. Objetivo: o presente estudo teve por objetivo avaliar o processo de ensino aprendizagem no atendimento pré-hospitalar às vítimas de PCR, utilizando as manobras de Ressuscitação Cardiopulmonar (RCP) e o Desfibrilador Externo Automático (DEA), no aspecto teórico (CONHECIMENTO) e prático (HABILIDADE), seguindo as recomendações do guideline de 2010 da Aliança Internacional dos Comitês de Ressuscitação (ILCOR). Casuística e Método: a amostra foi constituída por 37 alunos do 1º ano, da Escola de Enfermagem da Universidade de São Paulo, que não tiveram nenhuma orientação prévia sobre o tema. A pesquisa foi executada no Laboratório de Enfermagem da EEUSP (LE-EEUSP), em três fases. Na 1ª fase, houve a avaliação prévia desses alunos por meio de prova teórica (avaliação do CONHECIMENTO) constituída por 40 questões e prova prática avaliada pela execução de um check list com 20 itens (avaliação da HABILIDADE). Na 2ª fase, foi realizado um Curso teórico-prático com exposição do assunto em aula teórica e, a seguir, a demonstração prática, em simulação no LE-EEUSP, com manequim e outros materiais e equipamentos específicos. Esse ambiente para simulação, assim organizado, foi disponibilizado, durante um mês, para o treinamento dos alunos sob orientação de instrutores que aferiram o tempo e o número de treinamentos de cada aluno. Após essa etapa, na 3ª fase, esses alunos foram submetidos à nova avaliação, com prova teórica (avaliação do CONHECIMENTO) e prática (avaliação da HABILIDADE), utilizando os mesmos instrumentos da 1ª fase. Os parâmetros avaliados no estudo foram: desempenho dos alunos antes e após Curso teórico-prático; tempo de execução e número de treinamentos de cada aluno. Resultados: observou-se acréscimo de acertos na prova teórica (CONHECIMENTO) em 37 questões, com significado estatístico em 30 delas (p<0,05). Quanto à avaliação da HABILIDADE, houve aumento de acertos em 19 dos 20 itens do check list (p<0,05). Quanto à relação do percentual de acertos e/ou escores com o número de treinamentos, não houve correlação (p>0,05). No entanto, quanto à relação do percentual de acertos e/ou escores com o tempo de execução a correlação foi significativa (p<0,05) e classificada como moderada. Conclusões: após o Curso teórico prático ministrado, utilizando as estratégias de ensino descritas, houve melhora significativa do desempenho dos alunos em ambos os aspectos avaliados: CONHECIMENTO e HABILIDADE. / Abstract: Introduction: Increasingly worrisome statistics show that cardiovascular diseases are the main cause of morbimortality in Brazil and worldwide, among these conditions being those that lead to cardiopulmonary arrest (CPA). Continuous improvement of education on CPA pre or intra-hospital care is essential for the development of health professionals, including nursing professionals. Objective: This study aimed at assessing the teaching/ learning process of pre-hospital care to CPA victims with Cardiopulmonary Resuscitation Maneuvers (CPR) and Automated External Defibrillators (AED), as far as theoretical aspects (KNOWLEDGE) and practical aspects (SKILLS) are concerned, according to the 2010 guidelines of the International Liaison Committee on Resuscitation (ILCOR). Case Description and Method: The sample consisted of 37 first-year students enrolled at the School of Nursing of Universidade de São Paulo, who had not received any previous instruction on the theme. The research was carried out in the Nursing Laboratory of the Schoof of Nursing (LE-EEUSP), in three phases. In the 1st phase, students sat a preliminary theoretical test (KNOWLEDGE assessment), with 40 questions, and took a practical test in which they had to go over a 20-item check list (SKILLS assessment). In the 2nd phase, a theoretical-practical course was offered, based on explanatory theoretical classes and subsequent practical demonstrations, with simulations at the LE-EEUSP laboratory employing dummies and other specific materials and equipment. This specially prepared simulation environment remained available for training during a month, supervised by instructors that were responsible for keeping track of the time spent and the number of training sessions taken by each student. Later on, in the 3rd phase, students were evaluated again by means of a theoretical test (KNOWLEDGE assessment) and a practical test (SKILLS assessment), with the same assessment tools used in the 1st phase. The study then considered the performance of students before and after the course and the number of sessions and time spent on training. Results: An increase in the percentage of correct answers was observed in 37 questions of the theoretical test (KNOWLEDGE), with statistical significance (p<0.05) in 30 of these cases. As to the SKILLS assessment, there was an increase in the percentage of correct answers given to 19 of the 20 items in the check list (p<0.05). As far as the relation between the correct answers percentage and/or test scores and the number of training sessions, no correlation was observed (p>0.05). However, the relation between the correct answers percentage and/or test scores and time spent on training was significant (p<0.05), classified as moderate correlation. Conclusion: After taking the theoretical-practical course, applying the strategies taught, students significantly improved their performance in relation to the aspects that were assessed: KNOWLEDGE and SKILLS.

Introdução: O objetivo do estudo foi avaliar os efeitos da terapia guiada por metas (TGM) sobre desfechos em pacientes de alto risco submetidos à cirurgia cardíaca. Métodos: Estudo prospectivo randomizado que avaliou 126 pacientes submetidos às cirurgias de revascularização do miocárdio ou valvar internados na Unidade de Terapia Intensiva Cirúrgica (UTI) do Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. Os pacientes foram randomizados para um algoritmo de terapia guiada por metas (grupo TGM, n=62) ou grupo controle (n=64). No grupo TGM, um índice cardíaco superior a 3 L/min/m2 foi utilizado como alvo através de fluidos, inotrópicos e transfusão de concentrado de hemácias, com início após desmame da circulação extracorpórea e com término após 8 horas de admissão na UTI. Resultados: O desfecho primário foi um composto de mortalidade e complicações maiores em 30 dias. Os pacientes do grupo TGM receberam maior volume (mediana e intervalo interquartílico) de fluidos em relação ao grupo controle [1000 (625 - 1500) vs. 500 (500 - 1000) mL (P < 0,001)], e não houve diferença na administração de inotrópicos ou hemotransfusão. A incidência do desfecho primário foi menor no grupo TGM (27,4 vs. 45,3%, p=0,037). O grupo TGM apresentou menor incidência de infecção (12,9 vs. 29,7%, P=0,002) síndrome do baixo débito cardíaco (6,5 vs. 26,6%, P=0.002). Foram também observados menor dose acumulada de dobutamina (12 vs. 19 mg/Kg, P=0,003), menor tempo de internação na UTI (3 [3-4] vs. 5 [4-7] dias; P < 0,001) e no hospital (9 [8-16] vs. 12 [9-22] dias, P=0,049) no grupo TGM comparado ao grupo controle. Não houve diferença nas taxas de mortalidade em 30 dias. (4,8% vs. 9,4%, respectivamente; P = 0,492). Conclusão: A estratégia de terapia guiada por metas através de fluidos, inotrópicos e transfusão sanguínea reduziu a incidência de complicações maiores em 30 dias em pacientes de alto risco submetidos a cirurgia cardíaca / Introduction: The objective of the study was to evaluate the effects of goal-directed therapy on outcomes in high-risk patients undergoing cardiac surgery. Methods: A prospective randomized controlled trial that evaluated 126 patients undergoing coronary artery bypass or valve repair in a Surgical Intensive Care Unit (ICU) of the Heart Institute/Faculty of Medicine of University of Sao Paulo. Patients were randomized to a cardiac output-guided hemodynamic therapy algorithm (GDT group, n=62) or to usual care (n=64). In the GDT arm, a cardiac index of greater than 3 L/min/m2 was targeted with intravenous fluids, inotropes and red blood cell transfusion starting from cardiopulmonary bypass and ending eight hours after arrival to the ICU. Results: The primary outcome was a composite endpoint of 30-day mortality and major postoperative complications. Patients from the GDT group received a greater median (interquartile range) volume of intra-venous fluids than the usual care group [1000 (625 - 1500) vs. 500 (500 - 1000) mL (P<0.001)], with no differences in the administration of either inotropes or red blood cell transfusions. The primary outcome was reduced in the GDT group (27.4 vs. 45.3%, p=0.037). The GDT group had a lower incidence of infection (12.9 vs. 29.7%, P=0.002) and low cardiac output syndrome (6.5 vs. 26.6%, P=0.002). We also observed lower ICU cumulative dosage of dobutamine (12 vs. 19 mg/Kg, P=0.003) and a shorter ICU (3 [3-4] vs. 5 [4-7] days; P < 0.001) and hospital length of stay (9 [8-16] vs. 12 [9-22] days, P=0.049) in the GDT compared to the usual care group. There were no differences in 30-day mortality rates (4.8% vs. 9.4%, respectively; P = 0.492). Conclusions: Goal directed therapy using fluids, inotropes and blood transfusion reduced 30-day major complications in high-risk patients undergoing cardiac surgery

Introdução: No panorama mundial, as doenças cardiovasculares configuram-se como principal causa da parada cardiorrespiratória em adultos, cujas chances de sobrevivência são maiores, quando presenciada por pessoas aptas para prover o suporte básico de vida (SBV) na reanimação imediata. Objetivo: Desenvolver e avaliar o curso online Suporte Básico de Vida: aspectos essenciais no atendimento do adulto em parada cardiorrespiratória. Método: Em primeira etapa, trata de pesquisa aplicada, de produção tecnológica acerca do desenvolvimento do curso online sobre SBV, utilizando design instrucional baseado no modelo ADDIE (Analisys-Análise, Design-Desenho, Development-Desenvolvimento, Implementation-Implementação, Evaluation-Avaliação). Nessa perspectiva, foi avaliado por especialistas e estudantes. A segunda etapa configura-se em delineamento quase-experimental, do tipo antes-depois. O curso online foi aplicado aos estudantes da Escola de Enfermagem da Universidade de São Paulo, como intervenção educacional, em 2014-2015. Os estudantes foram avaliados mediante pré-teste, pós-teste e simulação em prática presencial com dispositivos de feedback. Resultados: O curso online foi implementado em ambiente virtual de aprendizagem; 94 (100%) estudantes aceitaram participar da pesquisa, 88 (94%) acessaram ambiente virtual, 67 (71%) finalizaram parte teórica, 62 (66%) concluíram o curso online. A maioria era do sexo feminino (90,4%), do 1º e 2º ano (65%), idade média 21,48 (DP 2,39). Adotando nível de significância 95%, a média das notas no pré-teste foi 6,4 (DP 1,61), pós-teste 9,3 (DP 0,82), p<0,001. ANOVA para medidas repetidas indicou diferenças significativas (p<0,001) entre médias das notas no pré-teste dos estudantes do 1º e 2º ano 6,2 (DP 1,59) e do 3º e 4º ano 7,2 (DP 0,83). Média das notas do pós-teste foi 9,2 (DP 1,60) nos dois primeiros anos e 9,7 (DP 0,61) nos dois últimos anos, p<0,475. Regressão linear múltipla com inclusão progressiva (forward stepwise) para variáveis associadas ao aprendizado mostrou-se significativa (p<0,015) com ano de curso no Bacharelado -0,542 (EP 0,215) e participação anterior em curso de emergência -0,903 (EP 0,437). Na prática simulada, a média das notas foi de 9,1 (DP 0,95). Registros do checklist indicaram que 98% dos estudantes realizaram exposição do tórax, 97% avaliaram respiração, 76% se lembraram de chamar serviço de emergência, 92% solicitaram desfibrilador, 77% verificaram pulso corretamente, 87% posicionaram as mãos no tórax corretamente, 95% efetuaram ciclo de 30 compressões adequadamente, 89% em profundidade mínima 5 cm, 90% liberaram tórax após compressão, 97% alternaram 2 ventilações corretamente, 97% usaram Desfibrilador Externo Automático, 100% posicionaram as pás corretamente. Registros do dispositivo de feedback indicaram percentual de desempenho equivalente a Reanimação Cardiopulmonar Básica 43,7 (DP 26,86), médias de duração ciclo compressões/seg 20,5 (DP 9,47), do número de compressões 167,2 (DP 57,06), da profundidade compressões/mm 48,1 (DP 10,49), do volume de ventilação 742,7 (DP 301,12), do percentual de fração de fluxo 40,3 (DP 10,03). O curso foi bem avaliado pelos estudantes e especialistas, com reações positivas quanto ao conteúdo, objetividade, clareza, didática, organização, acesso e navegação. Conclusão: Confirmou-se a plausibilidade da hipótese do estudo, corroborando a contribuição do curso online no aprendizado sobre SBV. Mostrando-se efetivo no suporte ao ensino em Enfermagem, o curso online permite integrar apresentações em diferentes disciplinas e capacitações, frente a necessidade de inovações tecnológicas e estratégias educacionais ativas, em ações para identificação precoce da parada cardiorrespiratória e sistematização do atendimento na reanimação cardiopulmonar. / Introduction: In the world scene, cardiovascular diseases constitute the main cause of cardiac arrest in adults, whose chances of survival are higher if witnessed by persons able to provide the basic life support (BLS) in immediate resuscitation. Objective: To develop and to evaluate the online course \"Basic Life Support: essential aspects in adult cardiac arrest. Method: In the first stage it refers to the applied research of production technology on the development of online course on BLS, with the instructional design ADDIE (Analisys, Design, Development, Implementation, Evaluation). In the second stage, in quasi-experimental, before and after design, the online course was applied to students of Escola de Enfermagem, Universidade de São Paulo, as an educational intervention in 2014-2015. Pre-test, post-test and simulation with feedback devices were applied. The online course was evaluated by specialists and students. Results: The course was implemented in the virtual environment and 94 (100%) students who agreed to participate of the research, 88 (94%) accessed the virtual environment, 67 (71%) completed the theoretical part and 62 (66%) completed the online course. The majority were women (90.4%), in the 1st and 2nd year (65%), mean age 21.48 (SD 2.39). With 95% significance level, the mean grade in the pre-test 6.4 (SD 1.61), in the post-test 9.3 (SD 0.82), p <0.001. ANOVA for repeated measures showed significant differences (p <0.001) between the average scores in the pre-tests of students in the 1st and 2nd years 6.2 (SD 1.59) and the 3rd and 4th years 7.2 (SD 0, 83). The averages note in the post-test 9.2 (SD 1.60) in the first two years and 9.7 (SD 0.61) in the last two years, p<0,475. In multiple linear regression with progressive inclusion (stepwise forward) for variables associated with learning, it was significant (p <0.015) for year course -0.542 (SE 0.215), previous participation in emergency course -0.903 (SE 0.437). In simulated practice the mean score was 9.1 (SD 0.95). The checklist records showed 98% students performed exposure of the chest, 97% observed the breathing, 76% remembered to call emergency services, 92% requested defibrillator, 77% checked the pulse correctly, 87% positioned their hands properly, 95% effected 30 compressions cycle properly, 89% in minimum depth 5 cm, 90% released after chest compression, 97% correctly applied 2 breaths, 97% used External Automatic Defibrillator, 100% positioned blades correctly. Feedback device records indicated equivalent percentage of performance Basic CPR 43.7 (SD 26.86), the averages of duration compressions cycle / second 20.5 (SD 9.47), compressions number 167.2 (SD 57.06) depth compressions/mm 48.1 (SD 10.49), ventilation volume 742.7 (SD 301.12), percentage flow fraction 40.3 (SD 10.03). The course was evaluated as good quality by participants, with positive reactions about the content, objectivity, clarity, teaching, organization, access and navigation. Conclusion: The plausibility of the hypothesis of this study was confirmed, corroborating the online courses contribution in the BLS learning. In support teaching in Nursing, it lets to compose presentations in different disciplines and training, arising from the need for technological innovations and active educational strategies in action for early identification of cardiac arrest and systematization of care in cardiopulmonary resuscitation.

The main task of providing dispatcher-assisted first aid is to guide bystanders to giving the first aid to the victiim directly in the situation where the incident happened according to the possibilities and conditions. It's one of the basic roles of medical dispatch centre and each dispatcher working on dispatch centre has to manage this role. These basic instructions should be provide in many different situations. One of this situation is pre-hospital cardiac arrest. When the dispatcher detects cardiac arrest during the emergency call, he/she should start providing dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) immediately. It means telephone assistance and guidance of bystander to perform cardiopulmonary resuscitation on the place of incident. The main aim of the research is to find out, whether the dispatchers are able to detect cardiac arrest in time and respond to it appropriately. It means iniciate the bystander to begin cardiopulmonary resuscitation, motivate him/her, instruct him/her correctly and easily, calm the situation and guide the bystander till the ambulance arrives. There are aslo set three sectional goals. Their task is to apprise with the work of the medical dispatch centre, with the dispatcher's job description and with dispatcher-assisted cardiopulmonary...

Legionella pneumophila, l’agent responsable de la légionellose est transmissible à l’Homme par les aérosols environnementaux et infecte les macrophages pulmonaires. Après l’exposition à différents stress L. pneumophila est capable de d’entrer dans un état Viable Non Cultivable (VBNC) qui semble être une stratégie de survie. L’objectif de nos travaux était d’étudier l’état VBNC de différentes souches de L. pneumophila après des traitements thermique et chimique et d’évaluer le pouvoir infectieux des formes VBNC envers les macrophages et les cellules épithéliales alvéolaires. Nous avons étudié les profils physiologiques de L. pneumophila de trois souches différentes. Les résultats montrent que pour chaque souche 3 populations peuvent être identifiées, les légionelles viables cultivables, les VBNC et les bactéries mortes. Lorsque soumises aux stress, chaque souche possède un profil physiologique propre et la présence ou non de bactéries VBNC était dépendante du traitement appliqué et de la souche utilisée. La deuxième partie fut relative à l’étude des traitements thermiques de 70°C pendant 30 min et des chocs au dioxyde de chlore de 4, 6 et 7 mg/L pendant 60 min à température ambiante sur ces VBNC. Aucune légionelle VBNC n’est capable de se développer au sein des cellules et aucune croissance sur milieu BCYE n’a été observée après co-culture. La suite de notre étude a été d’étudier le comportement, envers les macrophages, de L. pneumophila revivifiées après culture sur amibes. Les résultats montrent que les légionelles VBNC induites par choc thermique et revivifiées par co-culture sur Acanthamoeba polyphaga sont capables d’infecter de nouveau les macrophages. En conclusion, ces résultats suggèrent que: (i) les formes VBNC de L. pneumophila ne sont pas spontanément infectieuses pour les macrophages et les cellules épithéliales alvéolaires in vitro et (ii) elles peuvent devenir pathogènes pour les cellules humaines après revivification préalable sur A. polyphaga / Legionella pneumophila, the causative agent of legionellosis is transmitted to human through aerosols from environmental sources and invades lung’s macrophages. It also can replicate within various protozoan species in environmental reservoirs. Following exposures to various stresses, L. pneumophila enters a Viable Non Cultivable state (VBNC) which is likely to be a survival strategy. The objective of our work was to study the VBNC forms of several strains of L. pneumophila serogroup 1 obtained after thermal and chemical treatments and to evaluate the infectivity of these VBNC forms against macrophages and alveolar epithelial cells. First we studied the physiological patterns of the three different strains (Philadelphia GFP 008, 044 clinical and environmental RNN). For all strains we observed the presence of VBNC bacteria in the native (non stressed) state. The results show that for each strain, three populations of Legionella can be identified: viable and culturable, VBNC and dead cells. Once submitted to the various stresses, we observed that each strain had its own physiological pattern and the presence (or not) of VBNC bacteria was dependent on the applied treatment and the strain used. The second part was related to the study of the pathogenicity of these VBNC forms against macrophages or epithelial cells. The study focused on heat shock treatment at 70°C for 30 min and chlorine dioxide treatment at 4, 6 and 7 mg/L for 60 min at room temperature. The results show that no Legionella VBNC forms were able to grow within the cells and no growth on BCYE medium was observed after co-culture. Then we investigated the behavior of L. pneumophila resuscitated after culture on ameba within macrophages. The results shows that Legionella VBNC induced by heat shock treatment and resuscitated by Acanthamoeba polyphaga co-culture are able to infect macrophages. In conclusion, these results suggest that: (i) the VBNC forms of L. pneumophila are not infectious for macrophages and alveolar epithelial cells in vitro and; (ii) they can be pathogenic for human cells after revivification by an amoeba (A. polyphaga)

No description available.

Objetivo: O objetivo do estudo foi avaliar se o uso da terapia hemodinâmica pós-operatória guiada pelo índice cardíaco por método minimamente invasivo reduz o desfecho combinado de mortalidade em 30 dias e de complicações graves durante a internação hospitalar em pacientes com câncer submetidos à cirurgia de alto risco. Desenho: Estudo fase III, de superioridade, unicêntrico, randomizado e controlado realizado no Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Brasil. População: Pacientes adultos submetidos a cirurgia de alto risco para tratamento de câncer e que necessitaram de cuidados pós-operatórios em unidade de terapia intensiva. Intervenção: Um protocolo de terapia hemodinâmica pós-operatória guiada por metas (incluindo reposição volêmica, fármacos vasoativos e transfusão de hemácias para manter índice cardíaco maior ou igual a 2,5 L/min/m2) foi comparado a uma terapia padrão nas primeiras 8 horas de admissão dos pacientes na Unidade de Terapia Intensiva. Desfecho primário: Desfecho composto por mortalidade em 30 dias e complicações graves durante a internação hospitalar (infarto agudo do miocárdio, síndrome do baixo débito cardíaco, isquemia mesentérica, isquemia vascular periférica, embolia pulmonar, síndrome do desconforto respiratório agudo, acidente vascular cerebral, insuficiência renal aguda, infecção de ferida operatória profunda e reoperação). Resultados: Foram incluídos 128 pacientes, 64 no grupo terapia guiada por metas (TGM) e 64 no grupo terapia padrão (TP). Durante as 8 horas de intervenção, não houve diferença entre os grupos TGM e TP na quantidade de fluidos administrada (1295,1 mL ± 613,2 mL vs 1129 mL ± 557,5 mL, P=0,189), no número de pacientes que receberam norepinefrina (65,5% vs 51,6%, P= 0,211) e no número de pacientes expostos a transfusão de hemácias (3,1% vs 0, P=0,496). Um número maior de pacientes do grupo TGM recebeu dobutamina durante a intervenção quando comparado aos pacientes do grupo TP (54,7% vs 15,65%, P < 0,001. Não houve diferença entre os grupos em relação ao desfecho primário (53,1% no grupo TGM vs 43,8% no grupo TP, P= 0,289). Conclusão: A terapia hemodinâmica guiada pelo índice cardíaco aplicada nas primeiras 8h de pós-operatório não reduziu a mortalidade em 30 dias e as complicações graves durante a internação hospitalar quando comparada a estratégia padrão em pacientes com câncer submetidos a cirurgia de alto risco. A terapia hemodinâmica resultou em maior exposição dos pacientes à dobutamina, sem resultar em redução das complicações. Registro no Clinical Trials: NCT01946269 / Objectives: The aim of this study was to determine whether a postoperative hemodynamic therapy guided by the cardiac index based on minimally invasive cardiac output monitoring decreases the incidence of 30-day mortality and postoperative complications in oncologic patients undergoing high-risk non-cardiac surgery. Design: Phase III, single center, superiority, randomized and controlled trial performed at the Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Brazil. Population: Adult patients undergoing high-risk cancer surgery who required intensive care unit admission. Intervention: A hemodynamic goal directed therapy protocol (including fluids, vasoactive agents and red blood cells transfusion to reach a cardiac index equal or higher than 2.5 L/min/m2) was compared to usual care during the first 8 h of postoperative. Primary outcome: The primary outcome was a composite endpoint of 30-day mortality and severe complications during hospital stay (acute myocardial infarction, low cardiac output syndrome, mesenteric ischemia, peripheral vascular ischemia, pulmonary embolism, acute respiratory distress syndrome, stroke, acute kidney injury, deep wound infection and reoperation). Results: 128 patients were included in the study; 64 were allocated to the goal directed therapy group (GDT) and 64 to the usual care group (UC). During the 8-hour intervention, there were no differences between GDT and UC groups in the amount of administered fluid (1295.1 mL ± 613.2 mL) vs (1129 mL ± 557.5 mL), P=0.189), in the number of patients who received norepinephrine (65.5% vs. 51.6%, P= 0.211) and in the number of patients exposed to red blood cells transfusion (3.1% vs. 0, P= 0,496). However, more patients in GDT group needed dobutamine during intervention when compared to patients from the UC group (54.7% vs. 15.65%, P < 0.001). The primary outcome was reached by a similar proportion of patients in both groups (53.1% in GDT group vs. 43.8% in UC group, P=0.289). Conclusion: Postoperative hemodynamic therapy guided by cardiac index monitoring in the first 8-hour of postoperative does not reduce 30-day mortality and severe complications during hospital stay when compared to the usual care in cancer patients undergoing high-risk surgery. Also, hemodynamic therapy resulted in a higher needing of dobutamine without improving outcomes. Clinical Trials Register: NCT01946269.

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.

Sudden death in sport is a tragic event mediated primarily through the media. This thesis deals with sudden cardiac death from non-traumatic causes. The first section provides the overview of the issue, I mentioned specific cases of sudden death and the most common cause of sudden cardiac death among young and old athletes. The thesis focuses on the possibilities of preventive measures. In the second part, as part of my research, preparedness of Czech stadiums is evaluated situations of sudden cardiac death. In the conclusion section, I present the results of a questionnaire survey among representatives of clubs and stadiums and change proposals. The aim of the research is to find out how hockey and football stadiums are prepared for unpredictable situations of sudden cardiac death of athletes. Keywords: Sudden death, sport, sports stadiums, circulation disorder, hypertrophic cardiomyopathy, AED, resuscitation, EKG, prevention

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