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Level of knowledge about cardiac arrest in patients after cardiopulmonary resuscitation and their relatives in comparison to general population.
Křečková, Markéta ; Bělohlávek, Jan (advisor) ; Bourková, Kateřina (referee)
Providing emergency basic life support in life threatening situations is a duty of everyone. Adequate knowledge of all recommended procedures is a prerequisite for succesful management of a critical situation including identification of an emergency, activation of rescue system and provision of first help. Cardiac arrest is a significant socioeconomic burden. Survival of cardiac arrest victims depends on the underlying disease and lenght of cardiac arrest. Early CPR (cardiopulmonary resuscitation) is a most important factor of potential survival. However, effectivity of CPR for longterm survival reaches only around 10%. Therefore, ongoing education of general population in all techniques of CPR is justified and necessary. Just the initiation of CPRitself increases the chances for survival 2-3 fold. But, unfortunately, this emergency help is not provided always. This work is focused on evaluation of the quality of informations on recommended procedures and activities during acute setting and provision of lay person basic life support. In a theoretical introduction I describe the history of CPR and education of general population. Empirical part provides quantitative research based on a questionnaire with 100 respondents. Respondents are divided into two groups, persons who survived cardiac arrest...
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Cognitive and psychosocial sequelae following hypoxic brain injury.
Dostálová, Veronika ; Bezdíček, Ondřej (advisor) ; Šonka, Karel (referee) ; Feketeová, Eva (referee)
Cognitive and psychosocial sequelae following hypoxic brain injury Abstract in English Hypoxic brain injury leads to neuronal necrosis and to other cerebral changes which may affect psychosocial functioning. Although the pathophysiology of cerebral hypoxia is multifactorial, and it is not possible to reliably describe the unified clinical picture of hypoxia patients, the most commonly described psychosocial consequences of cerebral hypoxia are cognitive impairment, increased anxiety and depressive symptoms. The aim of the present study is to characterize cognitive functioning and psychosocial changes of the patients exposing mild intermittent cerebral hypoxia (=chronic form of hypoxia, model of obstructive sleep apnea diagnosed by neurologist) and patients after severe one-time cerebral hypoxia (=acute form of hypoxia, model of cardiac arrest diagnosed by cardiologist). Regardless of the different etiology of particular hypoxia forms described in the theoretical part of the thesis, both forms may lead to neuronal death. In the experimental part we test a hypothesis comparing healthy individuals to patients with acute or chronic form of hypoxia in cognitive performance or anxiety and depressive symptoms. We document a decreased cognitive performance and higher level of state anxiety in a group of patients...
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Mild therapeutical hypothermia and oxidative stress after cardiac arrest
Krüger, Andreas ; Ošťádal, Petr (advisor) ; Vízek, Martin (referee) ; Rokyta, Richard (referee)
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...
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A sudden cardiac arrest and use of capnometry in cardiopulmonary resuscitation
Pokorná, Milana ; Nečas, Emanuel (advisor) ; Málek, Jiří (referee) ; Bělohlávek, Jan (referee)
The study is focused on advanced life support (ALS) performed by rescue team physicians in an out-of-hospital setting. The first part of the study analyzes diagnostic possibilities and correctness of assumed aetiology of the sudden cardiac arrest during cardiopulmonary resuscitation (CPR) in the field. It introduces an original method of "Crosscheck Tables" and applies this method to 211 cases of CPR provided by physicians of the Emergency Care Service. The study demonstrates that significantly misleading conclusions can result from a global analysis of a set of cases. It stresses importance of diagnostic analyses applied to individual cases. The second part of the study concentrates on changes in PETCO2 level as related to the return of spontaneous circulation (ROSC - Return of Spontaneous Circulation) as opposed to the circulation fully dependent on chest compressions. The study demonstrates that in constantly ventilated patients undergoing CPR in an out-of-hospital setting, PETCO2 is significantly higher (about 10 mmHg) after ROSC than before ROSC. It demonstrates that a sudden increase in PETCO2 exceeding 10 mmHg is likely to indicate the moment of ROSC. The study also support a view that steadily low levels of PETCO2 values (<10 mmHg) indicate a low chance for a successful resuscitation outcome. Key...
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Cognitive and psychosocial sequelae following hypoxic brain injury.
Dostálová, Veronika ; Bezdíček, Ondřej (advisor) ; Šonka, Karel (referee) ; Feketeová, Eva (referee)
Cognitive and psychosocial sequelae following hypoxic brain injury Abstract in English Hypoxic brain injury leads to neuronal necrosis and to other cerebral changes which may affect psychosocial functioning. Although the pathophysiology of cerebral hypoxia is multifactorial, and it is not possible to reliably describe the unified clinical picture of hypoxia patients, the most commonly described psychosocial consequences of cerebral hypoxia are cognitive impairment, increased anxiety and depressive symptoms. The aim of the present study is to characterize cognitive functioning and psychosocial changes of the patients exposing mild intermittent cerebral hypoxia (=chronic form of hypoxia, model of obstructive sleep apnea diagnosed by neurologist) and patients after severe one-time cerebral hypoxia (=acute form of hypoxia, model of cardiac arrest diagnosed by cardiologist). Regardless of the different etiology of particular hypoxia forms described in the theoretical part of the thesis, both forms may lead to neuronal death. In the experimental part we test a hypothesis comparing healthy individuals to patients with acute or chronic form of hypoxia in cognitive performance or anxiety and depressive symptoms. We document a decreased cognitive performance and higher level of state anxiety in a group of patients...
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Possibilities of organ protection after global ischemia during cardiac arrest.
Mudrochová, Hana ; Ošťádal, Petr (advisor) ; Rokyta, Richard (referee) ; Malý, Jiří (referee)
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...
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The Awareness of South Bohemian Public about Cardiopulmonary Resuscitation
Mikšíčková, Věra ; Vrábelová, Petra (advisor) ; Maffei Svobodová, Ludmila (referee)
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...
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The role of a paramedic in care of cardiac arrest patient in special circumstances
SAMCOVÁ, Markéta
The bachelor thesis is focused on the advanced life support during the cardiac arrest in special circumstances. The thesis is divided in two parts theoretical and research. In the theoretical part, the pre-hospital care is briefly defined and it covers also the anatomy and physiology of a heart. Described are selected heart rhythm disorders and a cardiac arrest. In more detail, the thesis describes the cardiac arrest in special circumstances. In this bachelor thesis, qualitative research was carried out covering medical rescue procedures in patient care with a cardiac arrest in special circumstances in pre-hospital emergency care. Subsequently, their procedure was compared with the current recommended procedures of the European Resuscitation Council for Resuscitation in 2015. The research found that the health rescuers who were questioned were sufficiently oriented in the issue of cardiac arrest in specific circumstances within pre-hospital emergency care. An exception is the advanced life support of a patient burriend by an avalanche. In this part, respondents did not have sufficient knowledge of the guidelines. In all other situations, questioned parademics would follow the suit with the current recommended procedures of the European Resuscitation Council in 2015. The thesis can be used as a study material for the paramedic students and as well as for the lay and professional community.
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Tissue microcirculation in cardiac arrest setting - impact of various methods of circulatory support
Krupičková, Petra ; Bělohlávek, Jan (advisor) ; Widimský, Jiří (referee) ; Rokyta, Richard (referee)
Introduction: This dissertation thesis aims to describe microcirculatory changes in cardiac arrest setting and to assess the impact of circulatory supports (i.e. mechanical chest compressions and extracorporeal membrane oxygenation (ECMO)) on tissue microcirculation. Methods and results: Two separate studies were designed. Microcirculation was monitored sublingually by a recent Sidestream Dark Field (SDF) technique and its parameters were evaluated offline, separately for small (of diameter ≤ 20µm) and other vessels. In order to monitor microcirculation during cardiac arrest (CA) and resuscitation (CPR) an experimental pig model was used; eighteen pigs were commenced to 3 minutes of untreated CA and subsequent 5 minutes of mechanical CPR. During CA the microcirculatory parameters deteriorated, in CPR they improved and reached 59 - 85 % of the prearrest values. The microcirculatory variables correlated neither to parameters of systemic circulation (mean arterial blood pressure and carotid blood flow) nor to lactate. In the second, clinical, study the sublingual microcirculation was monitored 29 (± 17) hours after the CA onset in 15 patients, who were after unsuccessful conventional CPR rescued by ECMO. In comparison to healthy (sex and age matched) volunteers, the patients showed mild but...
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Mild therapeutical hypothermia and oxidative stress after cardiac arrest
Krüger, Andreas ; Ošťádal, Petr (advisor) ; Vízek, Martin (referee) ; Rokyta, Richard (referee)
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...
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