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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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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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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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Effect of N-acetylcysteine and therapeutic hypothermia on ischemia-reperfusion injury after experimental cardiac arrest
Pinterová, Nikola ; Škulec, Roman (advisor) ; Kučera, Karel (referee)
Therapeutic hypothermia (TH) is the only clinically used intervention that suppresses nearly all manifestations of ischemia-reperfusion injury after cardiac arrest. Experimental models has proven that exogenous antioxidants have positive impact on ischemia-reperfusion injury and it is able to prevent it as well. Results in this thesis are based on application of high dosages of N-acetylcystein (NAC) on ischemia-reperfusion injury after experimental cardiac arrest in a porcine model. It was used as a form of monoteraphy or in combination with TH. During the experiment animals were randomized into 5 groups: administration of NAC and TH (group A), administration of NAC during cardiac arrest (group B), induction of TH (group C), without any intervention (group D) and administration of NAC after return of spontaneous circulation (group E). We were not able to confirm additive effect of NAC in combination with TH. Administration of NAC during cardiac arrest led to statistically important reduction of oxidative stress but in the same time anafylactic reaction led to higher mortality in group B and changes in hemodynamical parameters in group E. Key words: Therapeutic hypothermia, cardiac arrest, N-acetylcysteine, ischemia-reperfusion injury, cardiopulmonary resuscitation, oxidative stress, oxygen radicals
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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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The effect of hypothermia on outcome and neurologic injury after prolonged cardiac arrest treated by emergency preservation and delayed resuscitation
Drábek, Tomáš ; Jech, Robert (advisor) ; Hess, Ladislav (referee) ; Mareš, Jan (referee)
5 Summary: Currently, the outcomes from traumatic exsanguination cardiac arrest (CA) show that over 50% of deaths due to trauma occur at the scene, where medical care is limited. Less than 10% of patients who become pulseless from trauma survive. However, in an appropriate setting, some of those traumatic injuries could be surgically repairable. Emergency preservation and resuscitation (EPR) is a novel approach for resuscitation of exsanguination CA victims. EPR uses deep hypothermic preservation for prolonged CA to buy time for transport, damage control surgery, and delayed resuscitation with cardiopulmonary bypass (CPB). Initially, we used a dog model to maximize clinical relevance. We showed that the efficacy of EPR is related to the depth of hypothermia and duration of CA. Pharmacologic adjuncts tested to augment hypothermia generally failed. Extended hemorrhagic shock did not prevent the success of EPR vs. conventional resuscitation if extended post-resuscitative hypothermia was provided. Oxygenation of the flush allowed extending of survivable duration of deep hypothermic CA. Because of the lack of molecular tools available for use in dogs, we developed a rat EPR model to study the cellular and molecular mechanisms underlying deep hypothermic neuroprotection to allow us to define specific targets for...
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Therapeutic hypotermia after cardiac arrest
JIRCOVÁ, Danuše
The bachelor thesis deals with the influence of a mild therapeutic hypothermia as a hospital post-resuscitation care of patients after cardiopulmonary resuscitation for non-traumatic cardiac arrest. Therapeutic hypothermia is a relatively new method. It is part of the European Guidelines for resuscitation since 2005. It was reported its positive effects on the neurological status of the patients. Using the method reduces the damage to the brain and cardiac muscle. The theoretical part of the thesis deals with the effect of mild hypothermia on the human body. Specifies the indication and contraindication criteria for initiation of therapeutic hypothermia, describes cooling methods of the patient and ways to terminate the therapeutic hypothermia. Describes the monitoring of physiological functions and nursing care of patients. The practical part of bachelor thesis mapped the procedures used in the administration of therapeutic hypothermia in patients treated in two large hospitals. These were Fakultní nemocnice Kralovske Vinohrady in Prague and Nemocnice Ceske Budejovice, a.s. The applied strategy of the research was qualitative. Content analysis of 10 case reports were carried out, 5 case reports from each hospital. Case reports concerning patients after cardiopulmonary resuscitation, who were treated using the therapeutic hypothermia as a part of hospital care. The aim of this thesis was to map the procedures used in the therapeutic hypothermia administration in patients after cardiopulmonary resuscitation. It was made available by hospitals after approval by ethics committees on the basis of applications submitted. The information was subsequently created into case studies that were analysed in the categorization tables. In the discussion, the results were compared with the published knowledge provided in the theoretical part of the thesis, and were commented. Analysed were: the composition of the group of patients by age and gender, provide the basic life support by witnesses prior to arrival of crew of the emergency medical service on scene, initial ECG rhythm after emergency medical service arrival, the time elapsed since the cardiac arrest appeared to restore of spontaneous circulation, initiation of therapeutic hypothermia in pre-hospital care, time elapsed since the therapeutic hypothermia start up to reaching the target body temperature, duration of the therapeutic hypothermia, the methods used for cooling the patients, the methods used for measuring the body temperature and neurological status at the time of discharge or transfer from the hospital. The results of the research surprisingly showed that general public are well-informed. Witnesses were able to recognize cardiac arrest, early called in professional help and were willing to give heart massage. This shows also the success in implementing the method of medical dispatcher-assisted basic life support in practice, because the witnesses were in many cases instructed by the medical dispatchers to resuscitate the patient. The majority of patient's initial ECG rhythm were diagnosed as ventricular fibrillation. Time to restoration of spontaneous circulation in most cases ranged within 29 minutes. To achieve the target body temperature at the recommended time limit has managed to half of patients. Target body temperature was always kept within the recommended timeframe and core body temperature was monitored. Concerns raised by an absence of the method start up in pre-hospital emergency care. The thesis highlighted the seriousness of sudden cardiac arrest and the high incidence of patients dismissed from the department with severe neurological deficit. Therefore, it is necessary to continue in research of this method, improve it and try to incorporate it already to pre-hospital care.
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