1. Primerjava učinkovitosti različnih praktičnih pristopov k učenju temeljnih postopkov oživljanja in uporabe avtomatskega zunanjega defibrilatorja pri osnovnošolcihNadja Pitz Durič, 2024, final research report Abstract: Hitro ukrepanje očividcev ter izvajanje temeljnih postopkov oživljanja (TPO) in uporaba avtomatskega zunanjega defibrilatorja (AED, ang. automatic external defibrillator) je ob nenadnem srčnem zastoju zunaj bolnišnice (OHCA, ang. out-of-hospital cardiac arrest) zelo pomembno, zato bi moral biti o TPO izobražen čim večji odstotek širše javnosti. Ker je v Evropi odstotek očividcev, ki pričnejo s TPO in uporabijo AED, v povprečju nizek, smo želeli ugotoviti kakšna je učinkovitost trenutnih tečajev TPO z AED za osnovnošolce in predlagati najučinkovitejši pristop.
Keywords: zunajbolnišnični srčni zastoj, temeljni postopki oživljanja, avtomatski zunanji defibrilator, osnovnošolci, učenje
Published in DKUM: 20.01.2025; Views: 0; Downloads: 15
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2. Impact of dual dispatch system implementation on response times and survival outcomes in out-of-hospital cardiac arrest in rural areasMatej Strnad, Pia Jerot, Vesna Borovnik Lesjak, 2022, original scientific article Abstract: Objectives: Dual dispatch early defibrillation in out-of-hospital cardiac arrest (OHCA) victims provided by firefighters in addition to Emergency medical services (EMS) has proven to increase rate of return of spontaneous circulation (ROSC) and thus survival in the metropolitan or suburban areas whereas the data in rural areas are scarce.
Methods: This was a retrospective observational cohort study of EMS resuscitated OHCA victims in regions with dual dispatch of volunteer firefighters as first responders (intervention group). Historical group was based on all OHCAs occurring in these regions before the implementation of first responders (EMS response only). Multivariate logistic regression with following variables: intervention, age, gender, witnessed status, bystander cardiopulmonary resuscitation (CPR), first rhythm and etiology were used to control for confounding factors affecting ROSC.
Results: A total of 312 OHCAs were included in the study (historical group, n = 115 and intervention group, n = 197). Median time to arrival of first help shortened significantly for all patients, patients with ROSC and patients with Cerebral Performance Category 1/2 (CPC 1/2) in intervention vs historical group (8 vs 12 min, p < 0.001; 7.5 vs 11 min, p = 0.002; 7 vs 10 min, p = 0.011; respectively). The proportion of patients with ROSC, 30-day survival and CPC 1/2 at hospital discharge remained unchanged in intervention vs historical group (21% vs 23%, p = 0.808; 7% vs 6%, p = 0.914; 6% vs 3%, p = 0.442; respectively). The logistic regression model of adjustment confirms the absence of improvement in the ROSC rate after the implementation of first responders.
Conclusions: Introduction of a dual dispatch of local first responders in addition to EMS in cases of OHCA significantly shortened response times. However, reduced response times were not associated with better survival outcomes.
Keywords: automated external defibrillator, out-of-hospital cardiac arrest, first responder, survival rate, sudden cardiac death, cardiopulmonary resuscitation, firefighters
Published in DKUM: 12.07.2024; Views: 105; Downloads: 18
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3. Dynamics of capillary lactate levels in patients with out-of-hospital cardiac arrestVitka Vujanović, Vesna Borovnik Lesjak, Dušan Mekiš, Matej Strnad, 2023, original scientific article Abstract: Background and Objectives:
An effective strategy for cardiopulmonary resuscitation should be based on tissue perfusion. Our primary aim was to determine the association between capillary lactate values and initial rhythm as well as the probability of the return of spontaneous circulation in out-of-hospital cardiac arrest patients. Materials and
Methods:
This prospective observational cohort study included all patients with non-traumatic out-of-hospital cardiac arrest, older than 18 years, resuscitated by a prehospital emergency medical team between April 2020 and June 2021. Capillary lactate samples were collected at the time of arrival and every 10 min after the first measurement until the time of the return of spontaneous circulation (ROSC) or, if ROSC was not achieved, at the time of declaring death on the scene.
Results:
In total, 83 patients were enrolled in the study. ROSC was achieved in 28 patients (33.7%), 21 were admitted to hospital (26.3%), and 6 (7.23%) of them were discharged from hospital. At discharge, all patients had Cerebral Performance Category Scale 1 or 2. Initial capillary lactate values were significantly higher in patients with a non-shockable rhythm compared to the group with a shockable rhythm (9.19 ± 4.6 versus 6.43 ± 3.81; p = 0.037). A significant difference also persisted in a second value taken 10 min after the initial value (10.03 ± 5,19 versus 5.18 ± 3.47; p = 0.019). Capillary lactate values were higher in the ROSC group and non-ROSC group at the time of restored circulation (11.10 ± 6.59 and 6.77 ± 4.23, respectively; p = 0.047).
Conclusions:
Capillary lactate values are significantly higher in patients with a non-shockable first rhythm in out-of-hospital cardiac arrest (OHCA). There is also a significantly different rise in capillary lactate levels in patients with ROSC.
Keywords: cardiopulmonary resuscitation, out-of-hospital cardiac arrest, lactate, return of spontaneous circulation
Published in DKUM: 16.04.2024; Views: 156; Downloads: 21
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4. Učenje temeljnih postopkov oživljanja z uporabo avtomatskega zunanjega defibrilatorja ter odnos do oživljanja pri osnovnošolcihVesna Borovnik Lesjak, 2023, doctoral dissertation Abstract: Izhodišča: Izobraževanje osnovnošolcev o temeljnih postopkih oživljanja (TPO) in uporabi avtomatskega zunanjega defibrilatorja (AED) je lahko učinkovito, relativno enostavno in ključno za razširjanje poznavanja TPO med laično javnost. Le to je ključno za preživetje žrtev nenadnega srčnega zastoja izven bonišnice, ki ostaja kljub napredku medicine nizko. Namen te raziskave je bil na podlagi podatkov, pridobljenih z zanesljivimi merilnimi instrumenti, predlagati učinkovite modele poučevanja osnovnošolcev, da bi s tem olajšali umestitev tečajev TPO in AED v redne šolske programe.
Metode: V raziskavo je bilo vključenih 783 sedmo- in devetošolcev mariborskih osnovnih šol. Izvedli smo tečaj TPO in AED, ki je zajemal eno šolsko uro interaktivnega predavanja in eno šolsko uro praktične vadbe na lutkah. Razvili smo vprašalnike za preverjanje znanja o TPO in AED, o odnosu do TPO in AED ter o nameri izvajanja TPO in AED. Znanje smo preverjali pred tečajem in po njem (takoj, po 5 mesecih in po 2 letih); odnos in namero pa pred tečajem in po njem. V preverjanje srednjeročne retence znanja in veščin je bilo vključenih 116 učencev, dolgoročne retence znanja po 2 letih pa 96 učencev. V primerjavo z drugimi tečaji je bilo vključenih 148 učencev iz dveh drugih šol iz drugih krajev. Za preverjanje praktičnih veščin smo uporabili prirejen Cardiffov vprašalnik o TPO in AED in didaktične lutke (Little Anne QCPR, Laerdal Medical, Stavanger, Norway).
Rezultati: Vsi vprašalniki so bili validirani za uporabo med osnovnošolci. Izboljšanje znanja takoj po tečaju je bilo znatno (83 % v primerjavi s 60 % pred tečajem), po petih mesecih in po dveh letih pa je značilno upadlo (73 % in 75 %), vendar je ostalo značilno boljše kot pred tečajem (p<0,001). Uspešnost izvajanja praktičnih veščin po petih mesecih je bila okoli 60 %. Končni model obnašanja je bil sestavljen iz treh teoretičnih konstruktov: samozavesti, pozitivne motivacije in amotivacije. Samozavest je imela največji vpliv na namero dejanskega izvajanja TPO in AED, pozitivna motivacija pa je bila močno povezana s samozavestjo. Pri primerjavi z drugimi tečaji je populacija učencev na slovenjgraškem tečaju izstopala z značilno boljšimi rezultati na testu znanja pred tečajem in po njem . Namera nudenja TPO in AED pa je bila po tečaju značilno višja med mariborskimi osnovnošolci v primerjavi z ostalima populacijama.
Zaključek: Razviti instrumenti se lahko uporabijo za zanesljivo oceno uspešnosti tečajev TPO in AED na podlagi meritev spremembe znanja po tečaju ter vpliva tečaja na dejansko namero ukrepanja med osnovnošolci. Ugotovili smo, da odnos do TPO in AED ni tako kompleksen, kot smo predvidevali, kar oljaša delo inštruktorjem, saj poznavanje določenih konstruktov obnašanja ni bistveno. Najpomembnejši vpliv na namero za izvajanje TPO in AED ima samozavest, na katero lahko vplivamo z vsemi oblikami pozitivne motivacije. Zanesljivi podatki, zbrani z validiranimi instrumenti, se tako lahko predstavijo ustreznim institucijam za spodbuditev učinkovite vključitve tečajev TPO in AED med obvezne šolske vsebine.
Keywords: Avtomatski zunanji defibrilator, izvenbolnišnični srčni zastoj, osnovnošolci, poučevanje, temeljni postopki oživljanja
Published in DKUM: 15.02.2024; Views: 421; Downloads: 83
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5. Predictors of mortality and prehospital monitoring limitations in blunt trauma patientsMatej Strnad, Vesna Borovnik Lesjak, Vitka Vujanović, Tine Pelcl, Miljenko Križmarić, 2015, original scientific article Abstract: This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients' charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n=40) and nonsurvivors (n=30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006), with lower initial GCS (P<0.001) and higher ISS (P<0.001), along with higher lactate (P<0.001) and larger base deficit (BD; P=0.006 ), whereas RTS (P=0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P<0.001), for ISS 0.82 (P<0.001), and for BD 0.69 (P=0.006). Lactate level of 3.4mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037), GCS (P=0.033), and age (P=0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.
Keywords: vital signs, nonsurvivors, survivors
Published in DKUM: 14.06.2017; Views: 1116; Downloads: 398
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