Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Markus B. Skrifvars, Department of Diagnostics and Therapeutics, University of Helsinki, Finland
- Second opponent: Associate Professor Terje Steigen, Faculty of Medicine at UiT, The Arctic University of Norway
- Third member and chair of the evaluation committee: Associate Professor Kristina Haugaa, Faculty of Medicine, University of Oslo
Chair of the Defence
Professor II Pål Aksel Næss, Faculty of Medicine, University of Oslo
Principal Supervisor
Professor II Kjetil Sunde, Faculty of Medicine, University of Oslo
Summary
Cardiac arrest (CA) is the most extreme of medical emergencies. Early access, early CPR, early defibrillation and comprehensive post-resuscitation care are crucial for survival. This PhD thesis comprises three distinct studies, each investigating clinically relevant uncertainties related to early post-resuscitation care. Comatose resuscitated CA patients are treated with target temperature management (TTM), with temperatures between 32-36 ˚C. Slow heart rate (bradycardia) is a common side effect during TTM, but its impact on outcome, or if and how it should be treated, is under debate. We investigated one-hundred and ten out-of-hospital CA (OHCA) patients, and found that development of bradycardia during TTM was associated with better outcome and may be left untreated. The majority of CA patients have underlying coronary artery disease as their cause of arrest, thus an early ECG is taken after successful resuscitation for deciding whether a reperfusion strategy is indicated. However, it is unclear whether the first ECG after resuscitation correctly identifies myocardial ischaemia in need of coronary reperfusion. By investigating 210 comatose OHCA patients all taken to immediate coronary angiography independent of their first ECG, the results showed that this ECG was not reliable in detecting patients with no indication for immediate coronary angiography. Even in the absence of ECG changes indicating myocardial ischaemia, an acute lesion may be present and patients may benefit from emergent revascularization. Little consensus exists in terms of haemodynamic monitoring of unstable, newly resuscitated CA patients. Thus, in 26 newly resuscitated OHCA patients, stroke volume (SV) measured with three different monitoring systems was compared. The results showed wide limits of agreement indicating that the methods were not inter-changeable, but that all systems can be used looking at trends over time to timely monitor haemodynamic development and response to treatment.
Additional information
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