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INTRODUCTION The purpose of resuscitation and subsequent hypothermia treatment isto regain the health the patient had before the cardiac arrest. The effect can be classified indifferent ways: survival, time of survival and quality of life (QoL) (1). The life after cardiacarrest survival are affected and described as severe fatigue, feelings of anxiety and/ordepression, increased dependency in activity of daily life (ADL) and decreased QoL. (2)The aim of the study was to describe differences over time regarding functional outcome,physical and cognitive function of survivors after cardiac arrest treated with hypothermiaand also to examine survivors’ life satisfaction 6 months after cardiac arrest and genderdifferences. OBJECTIVES A prospective study including 40 cardiac arrest survivors admitted to threeSwedish hospitals between 2008 and 2012. METHODS Participants were studied from intensive care unit discharge to one and6 months after cardiac arrest. In addition to cerebral performance category (CPC), partic-ipants were asked to answer questionnaires regarding activities in daily life (Barthel Index),cognitive function (Mini Mental State Examination) and life satisfaction (LiSat-11). RESULTS At discharge from intensive care unit 9 (22.5 %) participants were defined withbad functional outcome (CPC 3–4). CPC improved over time and at 6 month all participantswere estimated with good functional outcome (CPC 1–2). At 1 month participants wereimpaired but they improved over time in their activities in daily life and cognitive function.Satisfaction with ‘‘life as a whole’’ was seen in 72.5 %. CONCLUSIONS Cardiac arrest survivors are satisfied with life as a whole despite a severeillness which has impaired their physical and cognitive function but seemed to improve overtime. To predict patients’ functional outcome in early stages is difficult and cerebral per-formance category alone is not sufficient to assess patients function. The healthcare teamneeds to work interdiscipli, Kylhjärtstopp

INTRODUCTION Patients’ quality of life (QoL) after having survived a cardiac arrest hasbeen reported negatively influenced or acceptable to good [1–3]. Feelings of anxiety anddepression are present in CA patients [3] and depressions have been shown to be related toQoL [4]. There is little known, however about changes over time in anxiety, depression and health-related quality of life (HRQoL) after surviving CA treated with therapeutic hypothermia (TH). Therefore, the aim of the study was to investigate if there were any changes and correlation in anxiety, depression and HRQoL from hospital discharge until one and 6 months after CA in patients treated with TH. OBJECTIVES During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. METHODS The patients answered the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form12 (SF12) at three occasions; in connection with hospital discharge, and at one and 6 months after CA. RESULTS There was improvement over time in HRQoL, in EQ5D index (p=0.002) and SF12 physical component score (PCS) (p=0.005). Changes over time in anxiety and depression were not found. Seventy-three percentages scored overall health status with EQ-VAS below 70 (scale 0–100) at discharge from hospital and at 6 months this was found in 41 %. Physical problems were most common cause of affected HRQoL. Correlation was found between depression and HRQoL and this was strongest at 6 months (rs=-0.44 to-0.71,pB0.001). CONCLUSIONS HRQoL are affected negatively in patients after CA treated with TH, but improvement over the first 6 months can be seen. The patients scored lower self-reported levels of HRQoL in physical than in mental components. The result indicates that time is an important factor and patients may require more support the first time after discharge from hospital. REFERENCE(S) 1. Torgersen J, Strand K, Bjelland TW, e, Kylhjärtstopp

INTRODUCTION The aim was to describe the relatives need for support and information during the acute phase when a next of kin has survived cardiac arrest treated with hypothermia at the intensive care unit (ICU). The aim was also to describe how everyday life is affected. OBJECTIVES Twenty relatives were interviewed at the time the person who had suffered acardiac arrest was discharged from hospital, 1.5–6 weeks after the cardiac arrest. METHODS The interviews were recorded and transcribed verbatim and were analyzed with qualitative content analysis. RESULTS Support and information.The relatives emphasized the importance of support from the family but they could also feel loneliness in difficult moments. The staff’s presence in the ICU was supportive but how much of support the relatives experienced varied among the groups of relatives. Several of them experienced that the contact with other relatives and friends was a requirement and that all telephone calls to other relatives and friends took a lot of time and also that they could not cope with it. The relatives described that the information received at the ICU was adequate and correct. They felt, however, difficulties to assimilate the information because of difficulties in concentration and language confusion affecting the interpretation of the information. They appreciated the opportunity to ask questions but felt that the answers they sought for was not available. In comparison with ICU, the relatives experienced less information and contact with the staff in the medical ward. The relatives wished more written information and were missing information about prevention. Impact on daily life. The relatives experienced that every day life was affected through increased responsibility for the home. They also experienced that they had to support other relatives and had difficulty to take care of other relatives’ worries. The injured person’s disease resulted in a lot of practical things to take care of, like certif, Kylhjärtstopp

INTRODUCTION The aim was to describe relatives’ need of support and information whena significant other has survived cardiac arrest and the impact on everyday life 6 months after theevent.OBJECTIVES.Interviews with 20 relatives were conducted 6 months after a significantother’s cardiac arrest. METHODS The interviews were recorded and transcribed verbatim and were analyzed withqualitative content analysis. RESULTS The result illustrated various experiences by relatives. Six months after the sig-nificant other’s cardiac arrest relatives experienced support mainly from other family membersand friends. Relatives stated that the care, support and information in the intensive care unit hadbeen good but that they felt abandoned by the health care when the significant other wasdischarged from the intensive care unit. There were various requests to get more support fromthe health care mainly around issues concerning prognosis, rehabilitation and follow-up care.There were also requests to meet others in same situation, like family groups where they couldshare experiences. They experienced that the everyday life was affected especially withincreased responsibilities and requirements at home, restrictions in social life, a sense ofabandoned and a lack of understanding from the surroundings and a constant concern for thesignificant other. CONCLUSIONS Relatives’ everyday life was still affected 6 months after the event withincreased responsibilities at home and a constant concern for the person stricken by a cardiacarrest. The study illustrates that health care personnel need to offer relatives follow-upappointments to clarify issues concerning support and information.

Udgivelsesdato: 2009-Mar, BACKGROUND AND AIM: Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI). METHODS: Relevant studies were identified after two consensus meetings of the SSAI Task Force on Therapeutic Hypothermia (SSAITFTH) and via literature search of the Cochrane Central Register of Controlled Trials and Medline. Evidence was assessed and consensus opinion was used when high-grade evidence (Grade of Recommendation, GOR) was unavailable. A management strategy was developed as a consensus from the evidence and the protocols in the participating countries. RESULTS AND CONCLUSION: Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic

Feeding tubes are used frequently in the intensive care unit to provide enteral nutrition. For critically ill patients, enteral nutrition is preferable to parenteral in terms of cost, complication and gut mucosal maintenance. Fine bore feeding tubes are always preferred because their soft, flexible construction and narrow diameter enables these tubes to be well tolerated by patients and they rarely contribute to sinus infections or obstruction of breathing. On the other hand it is not uncommon that these tubes are misplaced in the tracheobronchial tree or the pleural cavity, especially in high-risk patients, i.e. sedated patients, patients with weak cough reflex, endotracheally intubated patients and agitated patients (1–3). Malpositioning in the peritoneal cavity or the mediastinum through gastric or esophageal perforation is also possible ( 1, 4–7); even intravascular ( 8, 9) and intracranial misplacement have been reported (10–13). The incidence of misplacement of a feeding tube is difficult to estimate because few studies have been performed. The largest study of 1100 such tubes revealed an overall malposition rate of 1.3% ( 1), but it should be mentioned that this study included only radiographically detected misplacements. Other researchers estimate the occurrence of accidental misplacement and migration out of position as high as 13% to 20% in high-risk patients ( 14, 15).