Piritta Setälä

Postoperative hyperalgesia does not predict persistent post-sternotomy pain; observational study based on clinical examination.

Persistent post‐sternotomy pain is a common problem, but the risk of developing it varies among patients. We sought to find out whether the risk of persistent post‐sternotomy pain could be predicted by measuring the area of acute sensory dysfunction around the sternotomy wound. The secondary aim was to determine risk factors for persistent post‐sternotomy pain.

Assessment of futility in out‐of‐hospital cardiac arrest

Our aim was to evaluate the impact of futile resuscitation attempts to the outcome calculations of attempted resuscitation in out‐of‐hospital cardiac arrest (OHCA). Defined as partial resuscitations, we focused on a subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated, but further efforts were soon abandoned due to evidence of futility.

Using a simplified pre-hospital ‘MET’ score to predict in-hospital care and outcomes

Medical emergency team (MET) activation criteria serve as a predictor of serious adverse events on hospital wards and in the emergency department (ED). We aimed to determine whether in‐hospital MET activation criteria would be useful in identifying patients at risk in pre‐hospital care.

End-tidal carbon dioxide output in manual cardiopulmonary resuscitation versus active compression-decompression device during prehospital quality controlled resuscitation: a case series study

Background Active compression–decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO2) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO2 output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts. Methods 10 witnessed OHCAs were resuscitated, rotating a 2 min cycle with manual CPR and a 2 min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCO2 values were collected continuously with the defibrillator. Differences in ETCO2 output between manual CPR and ACD-CPR were analysed using a linear mixed model where ETCO2 output produced by a summary of the 2 min cycles was included as the dependent variable, the patient as a random factor and method as a fixed effect. These comparisons were made within each OHCA case to minimise confounding factors between the cases. Results Mean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCO2 output, the interaction between the method and the patient was significant (P<0.001). ETCO2 output was higher with manual CPR in 6 of the 10 cases. Conclusions This study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCO2 is used as a quantitative measure of CPR effectiveness. Trial registration number NCT00951704; Results.

Risk factors for cardiopulmonary resuscitation‐related injuries sustained during out‐of‐hospital cardiac arrests

We aimed to determine the incidence of and associated risk factors for cardiopulmonary resuscitation (CPR)‐related injuries in non‐survivors of out‐of‐hospital cardiac arrests (OHCAs) in an emergency medical service (EMS) system in which all CPR procedures are performed on scene and patients are not routinely transported to the hospital with ongoing CPR.

Out-of-hospital cardiac arrests in nursing homes and primary care facilities in Pirkanmaa, Finland

Dispatching Emergency Medical Services to treat patients with deteriorating health in nursing homes and primary care facilities is common in Finland. We examined the cardiac arrest patients to describe this phenomenon. We had a special interest in patients for whom cardiopulmonary resuscitation was considered futile.