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Biomedical subjects

K Sunde

Publications and source records attributed to K Sunde.

18 recordsLinked to original sources
PubMed2006

Post resuscitation care: what are the therapeutic alternatives and what do we know?

A large proportion of deaths in the Western World are caused by ischaemic heart disease. Among these patients a majority die outside hospital due to sudden cardiac death. The prognosis among these patients is in general, poor. However, a significant proportion are admitted to a hospital ward alive. The proportion of patients who survive the hospital phase of an out of hospital cardiac arrest varies considerably. Several treatment strategies are applicable during the post resuscitation care phase, but the level of evidence is weak for most of them. Four treatments are recommended for selected patients based on relatively good clinical evidence: therapeutic hypothermia, beta-blockers, coronary artery bypass grafting, and an implantable cardioverter defibrillator. The patient's cerebral function might influence implementation of the latter two alternatives. There is some evidence for revascularisation treatment in patients with suspected myocardial infarction. On pathophysiological grounds, an early coronary angiogram is a reasonable alternative. Further randomised clinical trials of other post resuscitation therapies are essential.

Critical Care↗
PubMed2003

In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway.

INTRODUCTION: While pre-hospital factors related to outcome after out-of-hospital cardiac arrest (OHCA) are well known, little is known about possible in-hospitals factors related to outcome. HYPOTHESIS: Some in-hospital factors are associated with outcome in terms of survival. MATERIAL AND METHODS: An historical cohort observational study of all patients admitted to hospital with a spontaneous circulation after OHCA due to a cardiac cause in four different regions in Norway 1995-1999: Oslo, Akershus, Østfold and Stavanger. RESULTS: In Oslo, Akershus, Østfold and Stavanger 98, 84, 91 and 186 patients were included, respectively. Hospital mortality was higher in Oslo (66%) and Akershus (64%) than in Østfold (56%) and Stavanger (44%), P=0.002. By multivariate analysis the following pre-arrest and pre-hospital factors were associated with in-hospital survival: age -3.5 mmol l(-1), body temperature <or=37.8 degrees C, and serum glucose <or=10.6 mmol l(-1) 1-24 h after admittance with OR (95% CI) 2.72 (1.09-8.82, P=0.033), 1.12 (1.02-1.23, P=0.016), 2.67 (1.17-6.20, P=0.019) and 2.50 (1.11-5.65, P=0.028), respectively. Pre-arrest overall function, whether adrenaline was used, body temperature, the occurrence of hypotensive episodes, and the degree of metabolic acidosis differed between the four regions in parallel with the in-hospital survival rates. CONCLUSION: Both pre-arrest, pre- and in-hospital factors were associated with in-hospital survival after OCHA. It seems important also to report in-hospital factors in outcome studies of OCHA. The design of the study precludes a conclusion on causability.

Aged↗
PubMed2001

[Ambulance response intervals in connection with cardiac arrest in Oslo].

INTRODUCTION: An important factor determining survival after out-of-hospital cardiac arrest is how fast the ambulance personnel can reach the patient. MATERIALS AND METHODS: In a two-year period between 1996 and 1998, all ambulance calls to patients with out-of-hospital cardiac arrest in Oslo were evaluated. Of 1,026 cardiac arrests, 130 were excluded because of missing data. RESULTS: The median ambulance response interval was 7.2 min (5.7-9.0 as 25-75% percentiles). There was a tendency to shorter response intervals to the central parts of Oslo with medians between 3 and 4 min, while 14 more peripheral boroughs had median response intervals over 8 min. Of the 627 cases where the ambulance starting point was registered, 76% were from the only ambulance station in Oslo, located downtown. INTERPRETATION: In our opinion, the median ambulance response interval is unsatisfactory in large parts of Oslo, as a long response time gives a dramatically lower survival rate after cardiac arrest. A reorganisation and decentralization of the Oslo Emergency Medical Service System seems necessary.

Ambulances↗
PubMed2001

"Probability of successful defibrillation" as a monitor during CPR in out-of-hospital cardiac arrested patients.

The frequency spectrum of the ECG in ventricular fibrillation (VF) correlates with myocardial perfusion and might predict defibrillation success defined as return of spontaneous circulation (ROSC). The predictive power increases when more spectral variables are combined, but the complex information can be difficult to handle during the intensity of CPR. We therefore developed a method for expressing this multidimensional information in a single reproducible variable reflecting the probability of defibrillation success. This is based on the highest performing predictor for ROSC after 883 shocks given to 156 patients with VF. This was a combination of two decorrelated spectral features based on a principal component analysis of an original feature set with information on centroid frequency, peak power frequency, spectral flatness and energy. The function "Probability of defibrillation success" (P(ROSC)(v)) was developed by a 2-dimensional histogram technique. P(ROSC)(v) discriminated between shocks followed by ROSC and No-ROSC (P<0.0001). The present methodology indicates a possible way to develop a CPR monitor.

Cardiopulmonary Resuscitation↗
PubMed2001

The predictive value of ventricular fibrillation electrocardiogram signal frequency and amplitude variables in patients with out-of-hospital cardiac arrest.

UNLABELLED: We evaluated ventricular fibrillation frequency and amplitude variables to predict successful countershock, defined as pulse-generating electrical activity. We also elucidated whether bystander cardiopulmonary resuscitation (CPR) influences these electrocardiogram (ECG) variables. In 89 patients with out-of-hospital cardiac arrest, ECG recordings of 594 countershock attempts were collected and analyzed retrospectively. By using fast Fourier transformation analysis of the ventricular fibrillation ECG signal in the frequency range 0.333-15 Hz (median [range]), median frequency, dominant frequency, spectral edge frequency, and amplitude were as follows: 4.4 (2.4-7.5) Hz, 4.0 (0.7-7.0) Hz, 7.7 (3.7-13.7) Hz, and 0.94 (0.24-1.95) mV, respectively, before successful countershock (n = 59). These values were 3.8 (0.8-7.7) Hz (P = 0.0002), 3.0 (0.3-9.7) Hz (P < 0.0001), 7.3 (2.0-14.0) Hz (P < 0.05), and 0.53 (0.03-3.03) mV (P < 0.0001), respectively, before unsuccessful countershock (n = 535). In patients in whom bystander CPR was performed (n = 51), ventricular fibrillation frequency and amplitude before the first defibrillation attempt were higher than in patients without bystander CPR (n = 38) (median frequency, 4.4 [2.4-7.5] vs 3.7 [1.8-5.3] Hz, P < 0.0001; dominant frequency, 3.8 [0.9-7.7] vs 2.6 [0.8-5.9] Hz, P < 0.0001; spectral edge frequency, 8.4 [4.8-12.9] vs 7.2 [3.9-12.1] Hz, P < 0.05; amplitude, 0.79 [0.06-4.72] vs 0.67 [0.16-2.29] mV, P = 0.0647). Receiver operating characteristic curves demonstrate that successful countershocks will be best discriminated from unsuccessful countershocks by ventricular fibrillation amplitude (3000-ms epoch). At 73% sensitivity, a specificity of 67% was obtained with this variable. IMPLICATIONS: In patients with out-of-hospital cardiac arrest, successful countershocks will be best discriminated from unsuccessful countershocks by ventricular fibrillation amplitude (3000-ms epoch). At 73% sensitivity, a specificity of 67% was obtained with this variable.

Adolescent↗
PubMed2000

Predicting outcome of defibrillation by spectral characterization and nonparametric classification of ventricular fibrillation in patients with out-of-hospital cardiac arrest.

BACKGROUND: In 156 patients with out-of-hospital cardiac arrest of cardiac cause, we analyzed the ability of 4 spectral features of ventricular fibrillation before a total of 868 shocks to discriminate or not between segments that correspond to return of spontaneous circulation (ROSC). METHODS AND RESULTS: Centroid frequency, peak power frequency, spectral flatness, and energy were studied. A second decorrelated feature set was generated with the coefficients of the principal component analysis transformation of the original feature set. Each feature set was split into training and testing sets for improved reliability in the evaluation of nonparametric classifiers for each possible feature combination. The combination of centroid frequency and peak power frequency achieved a mean+/-SD sensitivity of 92+/-2% and specificity of 27+/-2% in testing. The highest performing classifier corresponded to the combination of the 2 dominant decorrelated spectral features with sensitivity and specificity equal to 92+/-2% and 42+/-1% in testing or a positive predictive value of 0.15 and a negative predictive value of 0.98. Using the highest performing classifier, 328 of 781 shocks not leading to ROSC would have been avoided, whereas 7 of 87 shocks leading to ROSC would not have been administered. CONCLUSIONS: The ECG contained information predictive of shock therapy. This could reduce the delivery of unsuccessful shocks and thereby the duration of unnecessary "hands-off" intervals during cardiopulmonary resuscitation. The low specificity and positive predictive value indicate that other features should be added to improve performance.

Electric Countershock↗
PubMed2000

Airway pressure with chest compressions versus Heimlich manoeuvre in recently dead adults with complete airway obstruction.

In a previous case report a standard chest compression successfully removed a foreign body from the airway after the Heimlich manoeuvre had failed. Based on this case, standard chest compressions and Heimlich manoeuvres were performed by emergency physicians on 12 unselected cadavers with a simulated complete airway obstruction in a randomised crossover design. The mean peak airway pressure was significantly lower with abdominal thrusts compared to chest compressions, 26.4+/-19.8 cmH(2)O versus 40.8+/-16.4 cmH(2)O, respectively (P=0.005, 95% confidence interval for the mean difference 5.3-23.4 cmH(2)O). Standard chest compressions therefore have the potential of being more effective than the Heimlich manoeuvre for the management of complete airway obstruction by a foreign body in an unconscious patient. Removal of the Heimlich manoeuvre from the resuscitation algorithm for unconscious patients with suspected airway obstruction will also simplify training.

Adult↗
PubMed2000

Arterial blood-gases with 500- versus 1000-ml tidal volumes during out-of-hospital CPR.

The correct tidal volume during cardiopulmonary resuscitation (CPR) is presently debated. While the European Resuscitation Council (ERC) and American Heart Association (AHA) previously recommended a tidal volume of 800-1200 ml, the ERC has recently reduced this to 400-600 ml. In a prospective, randomised study of 17 non-traumatic out-of-hospital cardiac arrest patients intubated and mechanically ventilated 12 min(-1) with 100% oxygen, we have therefore compared arterial blood gases generated with tidal volumes of 500 and 1000 ml. Mean time from cardiac arrest to arrival of the ambulance was 13+/-8 and 14+/-8 min in the two groups, respectively. Arterial blood samples were taken percutaneously 5 and 10-15 min after onset of the mechanical ventilation and analysed instantly. Pa(CO(2)) was significantly higher for a tidal volume of 500 than 1000 ml at both 5 and 10-15 min, 7.48+/-2.23 versus 3.70+/-0.83 kPa (P=0.002) and 7. 45+/-1.19 versus 3.98+/-1.58 kPa (P<0.001). The pH was lower for 500 than 1000 ml at 10-15 min, 7.01+/-0.10 versus 7.20+/-0.17 (P=0.034), with a strong trend in the same direction at 5 min (P=0.06). There was adequate oxygenation with no differences in Pa(O(2)) or BE at any time between the two groups, and no significant differences in any blood gas variables between the 5- and 10-15-min samples. We conclude that arterial normocapnia is not achieved with either tidal volume during advanced life support with non-rebreathing ventilation at 12 min(-1). What ventilation volume is required for CO(2) removal and oxygenation during basic life support with mouth-to-mouth ventilation cannot be extrapolated from the present data. In that situation the risk of gastric inflation, regurgitation and aspiration must also be taken into account.

Aged↗
PubMed2000

CPR artifact removal from human ECG using optimal multichannel filtering.

The purpose of this study was to assess whether the artifacts presented by precordial compressions during cardiopulmonary resuscitation could be removed from the human electrocardiogram (ECG) using a filtering approach. This would allow analysis and defibrillator charging during ongoing precordial compressions yielding a very important clinical improvement to the treatment of cardiac arrest patients. In this investigation we started with noise-free human ECGs with ventricular fibrillation (VF) and ventricular tachycardia (VT) records. To simulate a realistic resuscitation situation, we added a weighted artifact signal to the human ECG, where the weight factor was chosen to provide the desired signal-to-noise ratio (SNR) level. As artifact signals we used ECGs recorded from animals in asystole during precordial compressions at rates 60, 90, and 120 compressions/min. The compression depth and the thorax impedance was also recorded. In a real-life situation such reference signals are available and, using an adaptive multichannel Wiener filter, we construct an estimate of the artifact signal, which subsequently can be subtracted from the noisy human ECG signal. The success of the proposed method is demonstrated through graphic examples, SNR, and rhythm classification evaluations.

Biomedical Engineering↗
PubMed1999

Contrasts in memory functions between adolescents with schizophrenia or ADHD.

Previous research on memory and schizophrenia has relied on a limited number of global memory measures instead of a comprehensive assessment of various memory components. In addition, little effort has been directed at examining memory functioning in patients with early-onset schizophrenia. Published research often lacks a relevant neuropsychiatric comparison group to control for attention difficulties. Patients with Attention Deficit Hyperactivity Disorder (ADHD) were included in the present study for this purpose. To our knowledge, a direct comparison of the two patient groups on memory functions has never been made. In the present study, both adolescents with schizophrenia and adolescents with ADHD were compared on a comprehensive memory test battery. Nineteen adolescents with schizophrenia were compared to 20 ADHD adolescents and 30 normally functioning adolescents on measures of working memory and long-term episodic memory, including tests of verbal and visual memory, free recall and recognition memory. The performance of the adolescents with schizophrenia was impaired as compared to the normal group on most of the memory measures. They performed significantly more poorly than the adolescents with ADHD on the visual memory tests. The ADHD group scored more impaired than the schizophrenia group on working memory tests with focus on distractibility. The findings suggest a general memory deficit among adolescents with schizophrenia related to both verbal and visual material. Impairment on the measures of visual memory is specific to schizophrenia and does not characterise the ADHD subjects.

Adolescent↗
PubMed1999

Quality assessment of defribrillation and advanced life support using data from the medical control module of the defibrillator.

What actually occurred during the two last links in the 'chain of survival': defibrillation and advanced life support (ALS), was studied in 156 patients with cardiac arrest of cardiac aetiology using the computer recording of the defibrillator and the Utstein-style data record. Ten patients (6%) survived. The ECG artefacts caused by chest compressions enabled a detailed analysis of compression rates (median 108 min(-1)) and duration of important compression free periods. The time from initiation of monitoring during asystole until chest compressions were initiated was median 29 s, significantly shorter than during electromechanical dissociation (EMD, 109 s; P < 0.001). These times were both significantly longer than the median time from initiation of monitoring until the first shock was given in cases with VF (19 s; P < 0.001). A total of 883 shocks (median six shocks) were administered to 110 patients with a significant difference in number of shocks between survivors and non-survivors, one versus seven, respectively. The success rate for the first shock and all shocks defined as non-VT/VF 5 s after the shock, was 75 and 63%, respectively. However, just 10% of all shocks resulted in a rhythm with a pulse and only 4% resulted in sustained return of spontaneous circulation (ROSC). An isoelectric period followed 38% of the shocks, and in 27% this lasted more than 20 s, with five patients obtaining electrical activity with a pulse after more than 30 s of isoelectric ECG. Thoracic impedance did not affect the shock efficacy. The method of analysing resuscitation we describe may be useful for quality improvement.

Aged↗
PubMed1998

Impact of a child first aid wall calendar on lay people's skills and knowledge of infant CPR.

The aim of the study was to evaluate whether mass-mailing of a 12-month wall calendar which focused on child and infant safety and first aid treatment had any educational effect on lay people. The calendar included algorithms for removal of a foreign body from the airways and infant and child CPR. The knowledge and skills in these procedures were tested in two groups using a previously validated check-list before and after the introduction of the calendar. One group received the calendar by mass mailing, free-of-charge. Six months after calendar distribution the mean result for 52 persons tested was 18% correct, not different from the 19% correct for 65 persons tested before calendar distribution. The other group received the calendar as part of an internal company campaign focusing on infant and child safety with a possibility for borrowing a baby manikin, but with no instruction involved. In this group the mean result improved significantly from 27% precalendar (n = 57) to 47% (n = 125) (P < 0.001) 1 week after calendar distribution with a significant reduction to 38% (n = 52) (P = 0.004) 6 months later, still significantly better than precalendar (P = 0.004). Test persons younger than 50 years old scored better than those older than 50 years (39 vs. 22%, P < 0.001), and the test persons scored better if they had been tested previously (44 vs. 35%, P = 0.04) or had practised with a baby manikin (45 vs. 35%, P = 0.02). Whether the test persons had children 0-8 years old or not, did not affect the results. In conclusion the calendar had no educational effect when distributed by mail, but a safety campaign which included distribution of the calendar and a possibility to borrow a manikin had a positive influence on the first aid skills and knowledge of lay people. Mass mailing of CPR or other first aid material free-of-charge does not seem to further the goal of increasing the rate and proficiency of bystander interventions to save lives.

Adult↗
PubMed1998

Effect of different compression--decompression cycles on haemodynamics during ACD-CPR in pigs.

The haemodynamic effects of variations in the relative duration of the compression and active decompression (4 cm/2 cm) during active compression-decompression cardiopulmonary resuscitation (ACD-CPR), 30/70, 50/50 and 70/30, were tested in a randomized cross-over design during ventricular fibrillation in seven anaesthetized pigs (17-23 kg) using an automatic hydraulic chest compression-decompression device. Duty cycles of 50/50 and 70/30 gave significantly higher values than 30/70 for mean carotid blood flow (32 and 36 vs. 21 ml min-1, transit time flow probe, cerebral blood flow (30 and 34 vs. 19, radionuclide microspheres), mean aortic pressure (35 and 41 vs. 29 mmHg) and mean right atrial pressure (24 and 33 vs. 16 mmHg). A higher mean aortic, mean right atrial and mean left ventricular pressure for 70/30 were the only significant differences between 50/50 and 70/30. There were no differences in myocardial blood flow (radionuclide microspheres) or coronary perfusion pressure (CPP, aortic-right atrial pressure) between the three different duty cycles. CPP was positive in both the early and late compression period and during the whole decompression period. The expired CO2 was significantly higher with 70/30 than 30/70 during the compression phase of ACD-CPR. Beyond that no significant differences in the expired CO2 levels were observed. In conclusion a reduction of the compression period to 30% during ACD-CPR reduced the cerebral circulation, the mean aortic and right atrial pressures with no effect on the myocardial blood flow of varying the compression-decompression cycle.

Animals↗
PubMed1998

Improved haemodynamics with increased compression-decompression rates during ACD-CPR in pigs.

The haemodynamic effects of variations in the compression-decompression frequency, 60, 90 and 120 min(-1) during ACD-CPR, were tested in a randomized cross-over design during ventricular fibrillation (VF) in 12 anaesthetized pigs (17-22 kg) using an automatic hydraulic chest compression-decompression device. There were significant increases with increasing frequency for mean (+/- S.D.) carotid blood flow (17 +/- 5, 25 +/- 9 and 36 +/- 12 ml min(-1), transit time flow probe), cerebral blood flow (17 +/- 7, 30 +/- 17 and 40 +/- 13 ml min(-1) 100 g(-1), radionuclide microspheres) and mean aortic pressure (34 +/- 8, 37 +/- 10 and 43 +/- 7 mmHg), respectively. Myocardial blood flow (radionuclide microspheres) and diastolic coronary perfusion pressure, CPP, increased significantly from 60 to 90 min(-1) with no further significant increase to 120 min(-1) (28 +/- 13, 46 +/- 23 and 49 +/- 19 ml min(-1) 100 g(-1) and 25 +/- 8, 31 +/- 11 and 32 +/- 9 mmHg, respectively). Renal and hepatic blood flow also increased with increasing rate. No significant differences in the expired CO2 levels were observed. In conclusion increasing the compression-decompression frequency from 60 to 90 and 120 min(-1) improved the haemodynamics during ACD-CPR in a pig model with VF.

Analysis of Variance↗
PubMed1997

Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model.

The quality of mechanical CPR (M-CPR) was compared with manual standard CPR (S-CPR) and active compression-decompression CPR (ACD-CPR) performed by paramedics on the site of a cardiac arrest and during manual and ambulance transport. Each technique was performed 12 times on manikins using teams from a group of 12 paramedic students with good clinical CPR experience using a random cross-over design. Except for some lost ventilations the CPR effort using the mechanical device adhered to the European Resuscitation Council guidelines, with an added time requirement of median 40 s for attaching the device compared with manual standard CPR. Throughout the study, in comparison with mechanical CPR the quality of CPR with either manual method was significantly worse. In particular, there were considerable individual variations during stretcher transport. With S-CPR and ACD-CPR the median compression times were 38 and 31%, significantly lower than the recommended 50%, and 46-98% of the decompression efforts with ACD-CPR were too weak, particularly during transport on the stairs. With both manual methods, there were no significant differences in the CPR effort between the site of the arrest and the ambulance transport. However, compression rates were reduced and became more erratic during stretcher transport to the ambulance. When walking horizontally, a median of 19% of S-CPR compressions and 84% of ACD-CPR compressions were to weak. On the stairs, 68% of S-CPR compressions and 100% of ACD-CPR compressions were too weak. In conclusion, when evaluated on a manikin, in comparison with manual standard and ACD-CPR, mechanical CPR adhered more closely to ERC guidelines. This was particularly true when performing CPR during transport on a stretcher.

Cardiopulmonary Resuscitation↗
PubMed1983

Acute poisonings of children in Oslo. A one year prospective study.

A one year prospective study of all children under 15 years of age presenting for acute poisoning in Oslo is reported. There were 181 admissions in 179 children, of which 97 (54%) were boys, giving an annual incidence of 2.3%. All children survived without sequelae. Most poisonings were accidental and only two suicidal attempts were recorded. Of all poisonings 68 per cent occurred between the age of 1 and 2 years. The dominating toxic agents were drugs (44%), tobacco (22%) and petroleum products (9%). Most poisonings were mild and only 7 (4%) classified as severe. Seventy-two per cent of all children were admitted within the second hour after the ingestion of the toxic agent. Therapy should therefore be directed towards emptying the stomach with emetics or gastric lavage, unless corrosives or petroleum products are ingested. Childhood poisonings still call for better preventive measures since the toxic agent was found inappropriately stored in 86% of the accidental poisonings.

Accident Prevention↗