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- Axelsson, Christer, et al.
(författare)
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PCI De Lucs. : A clinical pathway directly to the PCI lab in out of hospital cardiac arrest
- 2016
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Ingår i: American Heart Association.
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Konferensbidrag (refereegranskat)abstract
- Purpose: In Sweden, the ambulance response time from call to arrival is 11 minutes in patients with an out-of-hospital cardiac arrest (OHCA). However, there is a small group of OHCA patients (20%) in whom this delay is minimized, namely those that occur minutes before or after the arrival of the ambulance. Despite CPR and/or defibrillation within one minute, only 20% survive to hospital discharge. The objective was therefore to determine whether a pathway with direct transportation to the cath lab, using mechanical chest compression (LUCAS), could improve survival in this selected group.Aim: To describe characteristics, feasibility and outcome among a selected group of OHCA patients transported directly to the cath lab by the ambulance in a new pathwayMethod: A prospective observational study from November 2013 to November 2015Inclusion criteria: 1. Crew-witnessed cardiac arrest (CA) of cardiac origin or CA immediately defibrillated to return of spontaneous circulation (ROSC) by public access. 2. CA occurring two to three minutes before ambulance arrival where the patient had immediate bystander CPR of high quality. 4. CA occurring two to three minutes before ambulance arrival where the patient was still breathing at ambulance arrival.Exclusion criteria: Non-cardiac origin CA or high physiologic age (hospice patients)Result: Sixty-four patients fulfilled the inclusion criteria and 14 were excluded. Of the remaining 50 patients, 25 were transported with mechanical CPR to the cath lab. The time from CA to hospital was a median of 38 minutes. Survival to 30 days was 38% among all patients, 47% among VF (N=34) and 12% (N=25) among those who were transported with mechanical CPR.Conclusion: The pathway appears safe and feasible, but the inclusion criteria need to be less complex. The vast majority of survivors were found in the VF population. There were survivors (12%) among patients transported with ongoing CPR (N=25) directly to the cath lab by the ambulance.
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- Bäck, Maria, 1978, et al.
(författare)
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What variables predict participation in exercise-based cardiac rehabilitation in patients with coronary artery disease?
- 2014
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Ingår i: European Heart Journal. European Society of Cardiology, 30 August - 3 September 2014, Barcelona. ; 35:Suppl 1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose Despite the well-established positive effects of exercise-based cardiac rehabilitation (CR) participation has been shown to be sub-optimal. A significant association between kinesiophobia (fear of movement) and participation in CR has previously been found. Therefore, the aim of this study was to identify predictors of participation in CR in patients with coronary artery disease (CAD), with a special reference to kinesiophobia. Methods In all, 332 patients (75 women; mean age 65±9.1 years) with a diagnosis of CAD were recruited between 2007 and 2009 at Sahlgrenska University Hospital/Sahlgrenska. The patients were tested regarding muscle endurance, level of physical activity, health related quality of life, anxiety, depression and kinesiophobia. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An explorative selection of significant predictors was performed. Results Kinesiophobia (p=.012), waist circumference (p=.023), and a previous history of PCI (p=.037) had direct negative effects on participation in CR, while current incidence of CABG (p<.001), PCI (p=.005) and BMI (p=.008) had positive effects. Compared to patients diagnosed with unstable angina, a diagnosis of myocardial infarction (p=.004) had a positive effect on participation in CR. The following indirect effects on participation in CR were found. Anxiety (p=.001) and previous PCI (p=.025) increased kinesiophobia, while muscle endurance (p=.003), perceptions of general health (p<.001) and physical functioning (p=.009) decreased kinesiophobia. Moreover, men had higher kinesiophobia compared to women (p=.031) and smoking was found to reduce kinesiophobia (p=.004). Conclusions Several important variables with an influence on participation in CR were identified and should be further analysed in relation to clinical practice. A reduction of kinesiophobia can be an efficient way to increase participation in CR and should therefore be given priority in future research.
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