Publications (26) View all
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Article: Early increase in blood glucose in patients resuscitated from out-of-hospital ventricular fibrillation predicts poor outcome.
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ABSTRACT: To describe the trend of blood glucose immediately after successful resuscitation from out-of-hospital ventricular fibrillation. Data from cardiac arrest registry supplemented with blood glucose data were analyzed in this population-based observational study. Between 2005 and 2009, a total of 170 adult patients survived to hospital admission after resuscitation from bystander-witnessed cardiac arrest of cardiac origin and ventricular fibrillation as an initial rhythm. Sufficient data for analysis were available in 134 (79%) patients, of whom 87 (65% [95% CI 57-73]) survived to hospital discharge in Cerebral Performance Category 1 or 2. Blood glucose did not change significantly between prehospital (10.5 ± 4.1 mmol/L) and admission (10.0 ± 3.7 mmol/L) in survivors (P = 0.3483), whereas in nonsurvivors, blood glucose increased from 11.8 ± 4.6 to 13.8 ± 3.3 mmol/L (P = 0.0025). Patients who are resuscitated from out-of-hospital ventricular fibrillation, but whose outcome is unfavorable are characterized by significant increase of blood glucose in the ultraacute postresuscitation phase.Diabetes care 03/2012; 35(3):510-2. · 8.09 Impact Factor -
Article: Does appropriate treatment of the primary underlying cause of PEA during resuscitation improve patients' survival?
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ABSTRACT: We aimed to document how often patients received appropriate treatment of the primary cause underlying pulseless electrical activity (PEA) during cardiopulmonary resuscitation (CPR) and how it affected their outcome. Data were collected between 2003 and 2010 in Finland and Sweden. All adult patients who underwent in-hospital cardiac arrest (IHCA) with PEA as the initial rhythm were included, if CPR was attempted. Patients were divided into two groups: those who received appropriate treatment of the primary cause during CPR (treatment of the primary cause group) and those who received conventional CPR (non-specific treatment group). Survival between groups was compared and a multivariable logistic regression analysis was performed to exclude the effect of possible confounders. Of 104 study patients, 19 (18%) received treatment of the primary cause and 85 (82%) received non-specific treatment. 30-Days survival of patients in treatment of primary cause group was superior compared to patients in the non-specific treatment group: 6 (32%) vs. 9 (11%) were alive 30 days after IHCA, p=0.03. Multivariable analysis suggested that treatment of the primary cause improves the odds of survival 2.5-fold, but this was not statistically significant. Age was the only significant independent prognostic factor for 30-days survival. During CPR, only a fifth of patients received appropriate treatment of the primary cause underlying PEA. Those patients were more likely to be alive 30 days after IHCA, but age turned out to be the only significant individual factor for better survival.Resuscitation 12/2011; 83(7):819-22. · 3.60 Impact Factor -
Article: Strict glucose control after acute stroke can be provided in the prehospital setting.
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ABSTRACT: The objective was to assess the feasibility of insulin infusion and subcutaneous insulin administered in the prehospital setting and their relative effect on hyperglycemia, a predictor of unfavorable outcome, in acute stroke patients. Hyperglycemic patients (plasma glucose >6.0 mmol/L) with stroke symptoms were randomized prior to or during transport to the hospital to receive either 1) a single subcutaneous dose of short-acting insulin (n = 11) or 2) a continuous intravenous (IV) insulin infusion (n = 12) at a rate adjusted by glucose levels measured every 10 minutes and targeted to plasma glucose 4.5-6.0 mmol/L. The changes in plasma glucose concentration were compared with a nonrandomized control group (n = 38) receiving standard care. The baseline characteristics did not differ between the study groups. Plasma glucose concentration was significantly decreased during the prehospital phase in the IV-treated group in comparison to the control group (difference between groups -1.9 mmol/L, 95% confidence interval [CI] = -3.5 to -0.27) with no serious adverse events. In contrast, subcutaneous insulin did not achieve significant lowering of plasma glucose (-0.9 mmol/L, 95% CI = -2.4 to 0.6). This small sample suggests that adjusted insulin infusion efficiently lowers blood glucose in the ultra-acute phase of stroke and is feasible in the prehospital setting.Academic Emergency Medicine 04/2011; 18(4):436-9. · 1.86 Impact Factor -
Article: Effect of peritoneal dialysis on abdominal circumference.
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ABSTRACT: Peritoneal dialysis (PD) is probably underused because of fears concerning the body image of patients. For the purposes of providing exact information for patients when choosing between PD and hemodialysis, we studied the extent of increase in waist circumference by infusing dialysate. The abdominal circumference of 44 PD patients was measured before and after infusion of dialysate. The change in circumference was compared to body mass index (BMI) and length of the abdominal cavity, defined by the distance between the processus xiphoideus and the os pubis. Mean abdominal circumferences at the umbilicus and the iliac crest increased from 92.6 +/- 10.1 to 95.5 +/- 10.0 cm and from 95.2 +/- 8.5 to 96.2 +/- 6.3 cm, respectively, when dialysate was infused (p value for both < 0.01). A dialysate volume of 2000 mL increased the circumference only slightly more than the increase seen with 1500 mL. The change in circumference was not correlated with the circumference before the infusion, BMI, height of the patient, or length of the abdominal cavity. This study shows that normal PD fill volumes increase the waist circumference only a little. This finding should ease the patient's presumption of PD changing the body image.Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 02/2010; 30(2):215-7. -
Article: Assessment of CPR-D skills of nursing students in two institutions: reality versus recommendations in the guidelines.
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ABSTRACT: Significant differences in basic life support skills including cardiopulmonary resuscitation and defibrillation (CPR-D) were detected when nurses working in one Finnish and one Swedish hospital were tested using an Objective Structured Clinical Examination (OSCE). The purpose of this study was to use OSCE test in assessing guideline based CPR-D skills of newly qualified nurses. The CPR-D skills of newly qualified registered nurses studying in Halmstad University (n = 30), Sweden, Helsinki Metropolia University of Applied Sciences (n = 30), and Finland were assessed using an OSCE which was built up with a case of cardiac arrest with ventricular fibrillation as the initial rhythm. The Angoff average, 32.47, was calculated as cutoff point to pass the test. Forty-seven percent of the students in the Swedish group (mean score 32.47/49, range 26-39, SD 3.76) and 13% of the students in the Finnish group (mean score 23.80/49, range 13-35, SD 4.32) passed the OSCE (P<0.0001), the cutoff point being 32.47. Performance grade for the Swedish group was 2.9/5.0 and for the Finnish group 2.1/5.0 (P<0.0001). Good nontechnical skills correlated with high grading of the clinical skills. In conclusion, CPR-D skills of the newly qualified nurses in both the institutes were clearly under par and were not adequate according to the resuscitation guidelines. Current style of teaching is unlikely to result in students being able to perform adequate CPR-D. Standardized testing would help in controlling the quality of learning.European journal of emergency medicine: official journal of the European Society for Emergency Medicine 09/2009; 17(4):237-9. · 0.73 Impact Factor
