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Post Cardiac Arrest Care: Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 90 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1094
Keyword [en]
cardiac arrest, hypothermia, neurological outcome, cerebral oxygenation, MRI, relatives
National Category
Anesthesiology and Intensive Care
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-248044ISBN: 978-91-554-9225-0 (print)OAI: oai:DiVA.org:uu-248044DiVA: diva2:800098
Public defence
2015-05-22, Grönvallsalen, ing 70, bv., Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-28 Created: 2015-03-26 Last updated: 2015-07-07
List of papers
1. The prognostic value of using a jugular bulb catheter for measuring oxygen saturation in patients treated with target temperature management 33˚C after cardiac arrest: a prospective study.
Open this publication in new window or tab >>The prognostic value of using a jugular bulb catheter for measuring oxygen saturation in patients treated with target temperature management 33˚C after cardiac arrest: a prospective study.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To describe variations in jugular bulb oxygen saturation (SjvO2), differences in oxygen content between central venous oxygen saturation (ScvO2) and SjvO2, and oxygen extraction fraction from the brain (OEFb) during intensive care in relation to neurological outcome at 6 months post-cardiac arrest (CA) in cases where target temperature management to 33°C (TTM) was applied.

Design: Prospective observational study.

Setting: One general intensive care unit in a university hospital.

Patients: Patients over 18 years, comatose immediately after resuscitation from CA, regardless of first registered ECG rhythm or whether the CA occurred in or out of hospital.

Interventions: None.

Measurements and Main Results: One hundred and ten patients were treated with TTM 33°C post-CA and 76 received a single lumen catheter in the right jugular vein. Oxygen saturation from the arterial, jugular bulb and central venous catheter was measured in 75 patients during TTM 33°C and up to 108 hours post-CA. Neurological outcome was assessed using the Cerebral Performance Categories (CPC) and dichotomized into good and poor outcome. Thirty-seven (49%) patients survived with a good outcome (CPC 1-2) at 6 months. Patients with poor outcome showed higher levels of SjvO2 at 6,12, 96 and 108 hours, but this was only significant at 12 (p=0.032), 96 (p=0.018) and 108 hours (p=0.015).Patients with a good outcome showed higher in ScvO2 -SjvO2 values at 6 hours (p=0.001) post-CA. The OEFb was higher in patients with good outcome at 6 (p=0.048), 12 (p=0.015), 96 (p=0.008) and 108 hours (p=0.017).

Conclusions: In the present study, the main differences in the oxygen saturation measures were seen at 6, 12, 96 and 108 hours post-CA. Based on the present findings, we cannot recommend that the values obtained from the jugular bulb catheter post-CA be used to predict outcome, and thus the usefulness of SjvO2 for prognostic purposes is uncertain

Keyword
cardiac arrest, hypothermia treatment, prognostication, jugular bulb saturation, intensive care, neurological outcome
National Category
Anesthesiology and Intensive Care
Research subject
Medical Science; Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-251311 (URN)
Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2015-06-05
2. Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
Open this publication in new window or tab >>Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
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2015 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl1, 147- p.Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.

Results: MRI of the brain was obtained at a median of 4 days  (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10-6 mm2/s in any region survived to 6 months.

Conclusions: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.

 

Keyword
cardiac arrest, hypothermia, MRI, diffusion brain acute lesions, neurological outcome
National Category
Anesthesiology and Intensive Care Neurology Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medical Science; Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-248025 (URN)
Conference
Congress of European Resuscitation Council 2015, Prag, Czech Republic
Available from: 2015-04-15 Created: 2015-03-26 Last updated: 2017-10-25
3. Cardiac arrest and hypothermia treatment-function and life satisfaction among survivors in the first 6 months
Open this publication in new window or tab >>Cardiac arrest and hypothermia treatment-function and life satisfaction among survivors in the first 6 months
2014 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 4, 538-543 p.Article in journal (Refereed) Published
Abstract [en]

Aim of the study: To describe differences over time in outcome, physical and cognitive function among survivors of cardiac arrest treated with hypothermia and to examine survivors' life satisfaction 6 months after cardiac arrest as well as gender differences. Methods: The study was prospective and included 45 cardiac arrest survivors admitted to three Swedish hospitals between 2008 and 2012. Participants were followed from intensive care unit discharge to one and six months after cardiac arrest. In addition to cerebral performance category (CPC), participants were asked to complete questionnaires regarding activities in daily life (Barthel index), cognitive function (mini mental state examination), and life satisfaction (LiSat-11). Results: Outcome measured using CPC scores improved over time. At 6 months, all participants were classified as having a good outcome. At one month, participants were impaired but improved over time in their activities in daily life and cognitive function. At 6 months satisfaction with "life as a whole" was seen in 70%. Conclusions: Cardiac arrest survivors are satisfied with life as a whole despite a severe illness that has impaired their physical and cognitive function, which seemed to improve over time. Predicting patients' functional outcome in early stages is difficult, and the CPC score alone is not sufficient to assess patients' function. It is a need to reach a consensus to which instruments best reflect physical and cognitive function as well as to specify a rehabilitation plan.

Keyword
Cardiac arrest, Hypothermia treatment, Intensive care, Neurological outcome, Cognitive function, Life satisfaction
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-223881 (URN)10.1016/j.resuscitation.2013.12.020 (DOI)000332778000030 ()
Available from: 2014-05-05 Created: 2014-04-28 Last updated: 2017-12-05Bibliographically approved
4. Relatives' experiences of everyday life six months after hypothermia treatment of a significant other's cardiac arrest
Open this publication in new window or tab >>Relatives' experiences of everyday life six months after hypothermia treatment of a significant other's cardiac arrest
2013 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 11-12, 1639-1646 p.Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES:

To describe relatives' experiences of needing support and information and of the impact on everyday life six months after a significant other survived cardiac arrest treated with therapeutic hypothermia at an intensive care unit.

BACKGROUND:

Being the relative of a cardiac arrest patient has been described as an unexpected chaotic situation. It is a unique experience because the event was unexpected, but also because of the heart disease and the uncertain neurological impact and outcome.

DESIGN:

The design of the study was qualitative.

METHODS:

Interviews with 20 relatives were conducted six months after a significant other's cardiac arrest. The interviews were recorded, transcribed verbatim and analysed using qualitative content analysis.

RESULTS:

Three main themes were identified: 'Difficulties managing a changed life situation', 'Feeling like I come second' and 'Feeling new hope for the future'. The most common support to relatives came from family and friends, but relatives felt abandoned by healthcare personnel when the significant other was discharged from the intensive care unit and hospital. Relatives lacked information concerning prognosis, rehabilitation and follow-up. They wished to meet others in the same situation and share experiences. Relatives also felt people around them did not understand their situation.

CONCLUSIONS:

Everyday life was still affected six months after the event, involving increased domestic responsibilities, restrictions in social life and constant concern for the person stricken by cardiac arrest.

RELEVANCE TO CLINICAL PRACTICE:

The study shows that healthcare personnel need to improve provision of support and information and provide follow-up appointments for relatives to clarify prognosis and rehabilitation issues.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-199848 (URN)10.1111/jocn.12112 (DOI)000317614300017 ()23444838 (PubMedID)
Available from: 2013-05-17 Created: 2013-05-17 Last updated: 2017-12-06Bibliographically approved

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