| dc.description.abstract | Cardiac arrest is often divided into a shockable and a non-shockable type according to effective treatment. Patients with shockable rhythms may regain pulse after an electric shock and have significantly better survival than patients with non-shockable rhythms. In addition, we also divide cardiac arrest according to location, in-hospital and out-of-hospital cardiac arrest. In the last decades, shockable rhythms outside the hospital have received far more attention than cardiac arrest inside the hospital.
This thesis focuses on pulseless electrical activity (PEA, one of the two non-shockable rhythms) occurring at the hospital. Based on readily available ECG markers, we have investigated the possibility of predicting the immediate outcome of the patient. In addition, we have also investigated the impact of adrenaline on these markers and looked at the delay between the administration of adrenaline and the return of pulse.
Study I
We investigated 700 episodes of cardiac arrest collected at different hospitals and different periods. PEA was divided into four different groups, and we found different tendencies to regain pulse among these. We also found PEA to be a precursor to the return of pulse in patients with other types of cardiac arrest. A transitioning to PEA may therefore be a sign of improvement.
Study II
In this study we focused on changes in ECG appearance and heart rate (equal to pulse in the healthy) during the resuscitation of patients with PEA. We included 327 episodes and found that changes in ECG could predict pulse return. This is innovative as it could be possible to use the model bedside, a step towards a more individualized treatment of PEA.
Study III
Adrenalin increases the probability of regaining pulse. In this study, we found that adrenaline increased this probability more than three times in patients with PEA. In addition, we observed that patients started to regain pulse immediately after administration and continued to do so for approx.. 4 min. Surprisingly we only found an increase in HR and no changes in ECG appearance.
Conclusion
This thesis shows that readily available markers may identify patients responding to treatment. This may provide an opportunity to adapt treatment to the situation. Adrenaline is important for patients with PEA, and the expected response is within minutes. | en_US |
