Bakgrund: I Sverige finns det inga lagar som reglerar beslut om livsupphållande behandling. I de etiska riktlinjerna och föreskrifter står läkarens roll tydligt definierat men inte sjuksköterskans. Ett ställningstagande till HLR är ett etiskt svårt beslut och när en patient inte är beslutsförmögen kan sjuksköterskans expertis i omvårdnad bidra med kunskap och väglednings i beslut om HLR Syfte: Att belysa sjuksköterskans upplevelser kring beslutsfattandet av att avstå hjärt- och lungräddning. Metod: Författarna har genomfört en litteraturöversikt vilket betyder att kunskap inom ett specifikt område har identifierats och analyserats. Resultat: I resultatet beskrivs sjuksköterskors attityder och upplevelser om de etiska dilemman som uppstår vid ställningstagandet och hur sjuksköterskor önskar att vara delaktiga i beslutsfattandet om HLR. Brist på information om HLR till patienter, personal emellan och olika synsätt på HLR kan orsaka konflikter. Sjuksköterskorna beskriver även hur vårdrelationen påverkas av HLR-beslut. Tre huvudteman och åtta subteman framkom. Diskussion: De mest framträdande delarna i resultatet visade på de etiska dilemman som kan uppstå vid ställningstagandet till HLR. De aspekter som påverkar är kommunikation, informella aspekter och värdering av livskvalitet. Olika handlingsalternativ diskuteras i förhållande till uppsatsens bakgrund, teoretisk utgångspunkt, vetenskaplig litteratur och vetenskapliga studier. / Background: In Sweden there are no laws governing the decision on life sustaining treatment. The ethical guidelines and regulations are clear about the physicians role but do not clarify the nurses role. A decision on CPR is ethically difficult and when a patient is not lucid nurse's expertise in nursing can contribute with knowledge and guidance in decisions about CPR. Aim: To explore the nurse’s experiences of decision-making regarding do-not-resuscitate orders. Method: The authors conducted a literature review which refers to knowledge in a specific area which was defined and analyzed. Results: The result describes nurses' attitudes and perceptions about ethical dilemmas that arise in the decision-making process of CPR and the wish to be involved in the decision. Lack of information on CPR to patients, between staff and different approaches to CPR can cause conflicts. The nurses also describe how the relationship is affected by the CPR decision. Three main themes and eight subthemes emerged. Discussion: The most prominent elements of the result showed the ethical dilemmas which may arise from the standpoint of CPR. The aspects that affect the decision-making process are communication, informal aspects and estimation of quality of life. Various choices are discussed in relation to the thesis background, theoretical basis, scientific literature- and studies.

<p>Ischemic neuronal injury continues to be a major delimiting factor in achieving successful clinical outcomesafter resuscitation from cardiac arrest. In this thesis, a pig model of cardiopulmonary resuscitation (CPR) wasused to address the effects of different interventions on cerebral blood flow and oxygenation during CPR and theinitial postresuscitation period. A novel technique is presented to quantify the reperfusion oxidative injury.</p><p>Maximization of cerebral blood flow during CPR by open-chest cardiac compression, continuous aortic balloon occlusion, and intra-aortic administration of hypertonic saline-dextran (HSD) did not ameliorate thepostresuscitation hypoperfusion or improve the cerebral oxygen extraction ratio or tissue pH. These findings disaffirm earlier studies suggesting that conserving brain viability after global ischemia is mostly a question ofmaintaining high perfusion pressure.</p><p>Despite an increased cerebral perfusion pressure during CPR, intra-aortic administered epinephrineabove the aortic balloon occlusion did not further improve cerebral blood flow and oxygenation. This findingmay indicate adverse effects of epinephrine on cerebral vascular beds, possibly induced by a relatively highconcentration of epinephrine when administered above the site for aortic balloon occlusion.</p><p>The IV administration of equipotent doses of epinephrine or vasopressin during CPR resulted incomparable hemodynamic changes. The peak increase in cerebral cortical blood flow, however, was reachedapproximately 30 sec later by vasopressin. Furthermore, the second bolus of vasopressin during CPR did notaugment cerebral perfusion, whereas epinephrine did. Consequently, reports suggesting that vasopressin issuperior to epinephrine with respect to its effects on central hemodynamics and vital organ blood flow may bebiased by the pharmacodynamic differences between the drugs, depending on the time point at which blood flowmeasurements are performed.</p><p>In comparison with IV vasopressin, vasopressin administered above the aortic balloon occlusion resulted in a significant increase in cerebral perfusion pressure during CPR, but not after restoration of spontaneous circulation (ROSC). Cerebral cortical blood flow was, however, not improved <i>during</i> CPR, whereas a significant increase was recorded <i>after</i> ROSC. Relatively higher concentrations of vasopressin above the sitefor intra-aortic balloon occlusion may, therefore, predominantly induce cerebral cortical vasoconstriction duringCPR but induce vasodilatation after ROSC.</p><p>Assessment of oxidative stress or inflammation have been extremely difficult to attain. In our pig model of resuscitation, an association wasobserved between the duration of cardiac arrest and jugular bulb levels of 8-iso-PGF_2α, a major isoprostane and a novel index of oxidative injury. 8-iso-PGF_2α, and the prostaglandin 15-K-DH-PGF_2α, increased within 5 min after ROSC and remained so up to 2 h, indicating the interval of time during which cerebral reperfusion oxidative injury and inflammatory response may occur and are potentially preventable.</p>

Ischemic neuronal injury continues to be a major delimiting factor in achieving successful clinical outcomesafter resuscitation from cardiac arrest. In this thesis, a pig model of cardiopulmonary resuscitation (CPR) wasused to address the effects of different interventions on cerebral blood flow and oxygenation during CPR and theinitial postresuscitation period. A novel technique is presented to quantify the reperfusion oxidative injury. Maximization of cerebral blood flow during CPR by open-chest cardiac compression, continuous aortic balloon occlusion, and intra-aortic administration of hypertonic saline-dextran (HSD) did not ameliorate thepostresuscitation hypoperfusion or improve the cerebral oxygen extraction ratio or tissue pH. These findings disaffirm earlier studies suggesting that conserving brain viability after global ischemia is mostly a question ofmaintaining high perfusion pressure. Despite an increased cerebral perfusion pressure during CPR, intra-aortic administered epinephrineabove the aortic balloon occlusion did not further improve cerebral blood flow and oxygenation. This findingmay indicate adverse effects of epinephrine on cerebral vascular beds, possibly induced by a relatively highconcentration of epinephrine when administered above the site for aortic balloon occlusion. The IV administration of equipotent doses of epinephrine or vasopressin during CPR resulted incomparable hemodynamic changes. The peak increase in cerebral cortical blood flow, however, was reachedapproximately 30 sec later by vasopressin. Furthermore, the second bolus of vasopressin during CPR did notaugment cerebral perfusion, whereas epinephrine did. Consequently, reports suggesting that vasopressin issuperior to epinephrine with respect to its effects on central hemodynamics and vital organ blood flow may bebiased by the pharmacodynamic differences between the drugs, depending on the time point at which blood flowmeasurements are performed. In comparison with IV vasopressin, vasopressin administered above the aortic balloon occlusion resulted in a significant increase in cerebral perfusion pressure during CPR, but not after restoration of spontaneous circulation (ROSC). Cerebral cortical blood flow was, however, not improved during CPR, whereas a significant increase was recorded after ROSC. Relatively higher concentrations of vasopressin above the sitefor intra-aortic balloon occlusion may, therefore, predominantly induce cerebral cortical vasoconstriction duringCPR but induce vasodilatation after ROSC. Assessment of oxidative stress or inflammation have been extremely difficult to attain. In our pig model of resuscitation, an association wasobserved between the duration of cardiac arrest and jugular bulb levels of 8-iso-PGF2α, a major isoprostane and a novel index of oxidative injury. 8-iso-PGF2α, and the prostaglandin 15-K-DH-PGF2α, increased within 5 min after ROSC and remained so up to 2 h, indicating the interval of time during which cerebral reperfusion oxidative injury and inflammatory response may occur and are potentially preventable.

Det råder delade meningar angående närståendes närvaro under hjärt-lungräddning på sjukhus. Trots internationella riktlinjer från Emergency Nursing Association som säger att närstående bör erbjudas möjlighet att närvara under hjärt- lungräddning så följs ej dessa generellt på sjukhusen. Syftet: Var att beskriva närståendes upplevelser att närvara under hjärt-lungräddning på sjukhus. Metod: En litteraturstudie har gjorts där 13 vetenskapliga artiklar har granskats. Resultat: Närstående ville ha en valmöjlighet om de skulle närvara eller ej. De flesta närstående var nöjda med sitt beslut att närvara och skulle göra det igen trots att situationen upplevdes som svår. Närstående kände samhörighet med patienten och upplevde att de hanterade situationen bättre om de fick kontinuerlig information om händelseförloppet samt hade en stödperson vid sin sida. Sorgen underlättades då de delat den sista stunden med sin närstående. Slutsats: Närståendes närvaro under hjärt-lungräddning är fortfarande ett relativt outforskat område. Valmöjligheten att närvara är viktig, likaså kontinuerlig information och att ha en stödperson hos sig under hjärt-lungräddningen anses väsentligt. Närstående som varit närvarande under hjärt- lungräddning uppvisar lägre tendens till negativa psykologiska effekter och upplever även att sorgeprocessen underlättas. / A difference of opinion exists regarding the issue of relatives being present during cardiopulmonary resuscitation in hospital. Despite international guidelines from the Emergency Nursing Association stating that relatives should be offered the opportunity to be present during cardiopulmonary resuscitation, this is generally not the case. The aim: of this study was to describe relatives' experiences of being present during cardiopulmonary resuscitation in hospital. Method: A literature review in which 13 scientific papers have been reviewed. Results: Relatives preferred to be given the option to attend the cardiopulmonary resuscitation or not. Most relatives were satisfied with their decision to attend and would do it again even though the situation was perceived as difficult. Relatives experienced an emotional connection with the patient and felt that they handled the situation better if they were given continuous information on the events and had a support person at their side. Relatives also felt it easier to cope with the grieving process when they had shared their loved ones last moment. Conclusion: The attendance of relatives during cardiopulmonary resuscitation is still a relatively unexplored area. To be given the option to attend or not is important, as is continuous information during the resuscitation as well as a support person throughout the process. Relatives who were present during resuscitation showed lower tendency to experience negative psychological effects, and that the grieving process felt easier to go through.

In der vorliegenden Arbeit wurde systematisch der Einfluß verschiedener Volumensubstitutionstherapeutika (Ringer-Lactat, hypertone NaCl 7,5%-Lösung und hyperton -hyperonkotische Kombinationslösung) auf wiederholt gleiche Zustände künstlich herbeigeführter Hypovolämie (Entnahme von 20-25% des Blutvolumens) beim Menschen untersucht. Bei dem 7 köpfigen Probandenkollektiv wurden so an unterschiedlichen Tagen und individuell gleicher Blutmengenentnahme unterschiedlich substituiert und anschließend über einen mehrstündigen Zeitraum kardio-zirkulatorische Parameter, intravasale Volumeneffekte sowie metabolische Größen und Elektrolyte entweder direkt gemessen oder indirekt bestimmt. Abschließend erfogte die Rückgabe des entnommenen Blutes und eine mindestens 10 tägige Pause bis zum nächsten Versuchstag. Neben der exakten Quantifizierung aufgrund der standartisierten Bedingungen bei dieser homogenen Untersuchungsgruppe wurde ein Modell über die Funktionsweise der einzelnen Therapeutika entwickelt und eine Präferenz für die Gabe hypertoner Lösungen, besonders aber das hyperton-hyperonkotische Therapeutikum herausgearbeitet. Die Ergebnisse werden anhand zahlreicher Graphiken dargestellt und vergleichbar, statistisch ausgewertet und teilweise durch zusätzliche Tabellen und Abbildungen erläutert.

This thesis deals with the success of manual and instrumental resuscitation. In the theoretical part of the thesis summarizes the history and organizational structure of emergency medical services Pardubice region, description of the Lucas chest compression and theoretical formulation of the problem. The practical part is focused on the evaluation of a set of data that are selected from the total number of trips EMS crews Pardubice. The selected file refers to cases NZO exits and their distribution in the subsequent resuscitation manual or instrument. Describes the percentage will compare their success with the use of the results of individual bases EMS ambulance crews Pak.

Bakgrund: Omkring 10.000 människor drabbas årligen av hjärtstopp i samhället. För den bästa chansen till överlevnad krävs snabb behandling med HLR och defibrillering. Att medverka som närstående vid en återupplivning beskrivs som den mest traumatiska händelsen en människa kan bevittna, samtidigt ökas förståelsen av situationen och ger ett avslut. Sjuksköterskan har ett stort ansvar över patientens omvårdnad och relaterat till behovet av resurser och otillräckliga riktlinjer så kan sjuksköterskan hamna i en utsatt position. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskors erfarenheter av närståendes närvaro vid återupplivning med HLR efter hjärtstopp. Metod: En beskrivande litteraturstudie innehållande 12 vetenskapliga artiklar med kvalitativ, kvantitativ och mixad ansats. Artiklarna söktes fram genom den vetenskapliga databasen Medline via PubMed. Huvudresultat: Resultatet visade ingen konsensus i sjuksköterskornas erfarenheter. De ville inte ha närstående närvarande på grund av negativ effekt på utförandet. Känslor av otrygghet hos sjuksköterskorna skapades av närstående. Sjuksköterskorna ansåg att närstående blev traumatiserade av händelsen. Resursbehovet blev tydligt då sjuksköterskorna upplevde bemanningen för låg för att avsätta personal till närstående. Sjuksköterskornas professionalism ökade med närvaron och närståendes sorgeprocess främjades. Det var viktigt att beakta patientens egen önskning inom ämnet. Slutsats: Trots positiva effekter ansåg sjuksköterskorna att de negativa aspekterna dominerade. Det är en komplicerad fråga med olika åsikter. Informationen som framkommit ger insikter i hur närståendes närvaro upplevs. Detta behövs för att chefer och HLR-utbildade ska ta ställning, öka kunskapen och starta en diskussion om fenomenet. / Background: Approximately 10.000 people experience cardiac arrest every year. The best opportunity for survival is effective treatment with CPR and defibrillation. To participate as a relative during a resuscitation is described as traumatic, but it increases the understanding and gives a closure. Nurses have a responsibility for the patient’s care and due to resources and vague guidelines, nurses can be in an exposed position. Aim: The purpose of this study was to describe nurses’ experiences of relatives’ presence during resuscitation with CPR after cardiac arrest. Method: A descriptive literature review containing 12 scientific articles with qualitative, quantitative and mixed methods. The articles were identified in the database Medline via PubMed. Result: There was no consensus in the nurses’ experiences. They did not want relatives present due to negative impact on their work. Feelings regarding insecurity arose with relatives’ presence. According to the nurses, relatives became traumatized by the event. The staff level was too low to assign personnel to relatives due to the lack of resources. However, nurses also reported increased professionalism and that the relatives’ grieving process benefited. It was important to consider the patient's wishes on the subject. Conclusion: Despite positive effects, the nurses felt that the negative aspects dominated. It is a complicated question with multiple views. The results provide knowledge on how the presence of relatives is experienced. This is needed for personnel to take a stand, be educated and start to discuss the phenomenon.

Bakgrund: Vid hjärt- och lungräddning (HLR), både hospitalt och prehospitalt, kan närståendevara närvarande. Ett av de globala hållbara målen eftersträvar en god hälsa och välbefinnandeför alla. Detta kan erhållas med personcentrerad vård som syftar bland annat på att stötta,kommunicera och visa lyhördhet till närstående. Tidigare forskning belyser att patientens vårdinte påverkas negativt av närståendes närvaro under pågående HLR och därför har riktlinjerinförts för att involvera närstående under HLR.Syfte: Att beskriva närståendes upplevelser av att närvara vid HLR.Metod: En litteraturöversikt med 15 vetenskapliga artiklar, fem kvalitativa och tio kvantitativa.Resultat: En huvudkategori identifierades, närståendes behov av information ochkommunikation. Denna huvudkategori indelades i fyra underkategorier, mentala effekter av attnärvara eller inte närvara under HLR, att vara fysiskt närvarande, förtroende tillvårdpersonalen samt stöd i sorgeprocessen. Närstående är i behov av kommunikation ochinformation i samband med HLR. Närstående kunde drabbas av psykiska besvär som PTSDoch ångest både av att närvara och att inte närvara. Närvaro under HLR kunde leda till enunderlättad sorgeprocess och ökat förtroende till vårdpersonalen.Slutsats: Ökad kunskap hos vårdpersonalen kring omhändertagandet av närstående i sambandmed HLR kan underlätta för närstående. Närstående är i stort behov av att få möjligheten attnärvara under HLR men behöver då en avsatt personal som kan stötta närstående. / Background: During cardiopulmonary resuscitation (CPR) at the hospital or prehospital thereis a posibility that relatives can be present. One of the sustainable development goals is aboutgood health and well-being for all. With a person-centred approach for communication, supportand sensitivity towards relatives the goal can be reached. Previous research shows how patientcare is not affected in the present of relatives. This has resulted in guidelines and routines forinviting relatives during CPR.Aim: To describe relatives experience of being present during CPR.Method: A literature review including 15 articles, ten quantitative articles and five qualitativearticles.Results: One theme was identified relatives' need for information and communication. Withthe main theme four sub themes were identified: psychological effects from being or not beingpresent during CPR, to be physically present, trust in healthcare personnel and support duringthe grieving period. Relatives are in need for communication and information during CPR andcould suffer from physiological effects such as PTSD and anxiety from being and not beingpresent during CPR. But being present during CPR could ease the stress during the grievingperiod and gain trust in the healthcare personnel.Conclusion: With additional training and knowledge healthcare personnel could supportrelatives during CPR. Since relatives are in need of constant communication and informationduring CPR healthcare personnel are needed to provide this to ease the stress on the relative.

INTRODUCTION: One of the most frequent causes of sudden death in Europe is a sudden cardiac arrest. First above all providing urgent cardio-pulmonary resuscitation (CPR) is necessary for rescue of life. One of preconditions of successful resuscitation is its early start and knowledge of basic techniques. The level of knowledge of urgent resuscitation techniques, its proper performance, skillfulness and willingness of non-professional rescuers can decide about next life of people affected by sudden cardiac arrest. Every minute that the resuscitation is not performed a chance of survival of people affected with sudden cardiac arrest decreases by 10 - 12%. GOALS AND METHODOLOGY: The main research problem was an evaluation of the level of knowledge of techniques of cardio-pulmonary resuscitation with public in South Bohemia. The next goal was to map the interest of the public in South Bohemia in education in CPR. For working out of the empirical part the method of quantitative research was chosen in the form of a questionnaire which I made. The questionnaire contained 35 questions. The research sample was made of nonselected public in South Bohemia and the choice of informants was random. The collection of data was performed by direct questioning of passers-by in streets, shopping centres, in towns and...

<p>Cardiac arrest results in immediate interruption of blood flow. The primary goal of cardiopulmonary resuscitation (CPR) is to re-establish blood flow and hence oxygen delivery to the vital organs. This thesis describes different pharmacological interventions aimed at increasing cerebral blood flow during CPR and after restoration of spontaneous circulation (ROSC).</p><p>In a porcine model of cardiac arrest, continuous infusion of adrenaline generated higher cortical cerebral blood flow during CPR as compared to bolus administration of adrenaline. While bolus doses resulted in temporary peaks in cerebral blood flow, continuous infusion led to a sustained increase in this flow.</p><p>Administration of vasopressin resulted in higher cortical cerebral blood flow and a lower cerebral oxygen extraction ratio as compared to continuous infusion of adrenaline during CPR. In addition, vasopressin generated higher coronary perfusion pressure during CPR and increased the likelihood of achieving ROSC.</p><p>Parameters of coagulation and inflammation were measured after successful resuscitation from cardiac arrest. Immediately after ROSC, thrombin-antithrombin complex, a marker of thrombin generation, was elevated and eicosanoid levels were increased, indicating activation of coagulation and inflammation after ROSC. The thrombin generation was accompanied by a reduction in antithrombin. In addition, there was substantial haemoconcentration in the initial period after ROSC.</p><p>By administration of antithrombin during CPR, supraphysiological levels of antithrombin were achieved. However, antithrombin administration did not increase cerebral circulation or reduce reperfusion injury, as measured by cortical cerebral blood flow, cerebral oxygen extraction and levels of eicosanoids, after ROSC. </p><p>In a clinical study, the adrenaline dose interval was found to be longer than recommended in the majority of cases of cardiac arrest. Thus, the adherence to recommended guidelines regarding the adrenaline dose interval seems to be poor. </p>