S86 Poster Presentations / Resuscitation 84S (2013) S8–S98

AP192

Anxiety and depression levels, self-efficacy andwork-related stress among employees of theNational Medical Rescue System

Grzegorz Nowicki 1, Mariusz Goniewicz 1, BarbaraJurkowska 2, Andrzej Prystupa 1, AnnaTorun-Jurkowska 1, Ewa Chemperek 1,∗, MariuszGawronski 3

1 Medical University, Lulin, Poland2 Institute of Rural Health, Lublin, Poland3 Regional Emergency Medical Services, Lublin,Poland

Introduction: Professional life is connected not only to positiveexperiences like self-fulfillment, personal development, improve-ment of the socio-economical status, although it is associated withnegative situations. Furthermore, there could be the mentionedexperience correlated with occupational stress among the lastgroup.

Objectives: The researchers aim is to assess the level of emo-tional control, especially negative ones among the National MedicalRescue System’s employees as well as the level of anxiety anddepression depending on the variables like gender, place of res-idence, marital status, level of stress, susceptibility to stress,working conditions and an attempt to determine whether the levelof self-efficacy is influenced by the above mentioned emotions.

Materials and methods: The study involved 100 employees ofthe National Medical Rescue System. For the purpose of the worktwo questionnaires were used:

- Scale of Emotions Control (Courtauld Emotional ControlScale–CECS) M. Wats and S. Greera in the adaptation of Z.Juczynskiego and

- Generalized Self–Efficacy Scale–GSES. Schwarzer and M.Jerusalem’s in the adaptation of Z. Juczynskiego.

Results and conclusions: The study data shows a clear tendencyto suppress negative emotions among employees of the NationalMedical Rescue System because of this it is indicated constant psy-chological care for those saving human lives. Moreover, analysisof collected data shows that people living in the city, people sat-isfied with their working conditions cope better with the controlof negative emotions in negative situations, deal better with stress.Additionally, higher self-efficacy has been observed in individualsless susceptible to stress.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.218

AP193

Occupational stress among workers of theNational Medical Rescue System and ways ofcoping with stress

Grzegorz Nowicki 1, Barbara Jurkowska 2, EwaChemperek 1, Katarzyna Zielonka 1,∗, PatrykRzonca 1

1 Medical University, Lublin, Poland2 Institute of Rural Health, Lublin, Poland

Purpose of the study: The study aims at researching specificcorrelation between the preferred styles of coping with stress andoccupational stress, as well as subjective assessment of vulnerabil-ity to stress and its impact on private lives of paramedics and nursesworking in the National Medical Rescue System. Moreover, this

group of health care workers is particularly exposed to work in life-threatening conditions, as well as to verbal and physical aggressionfrom clients or witnesses of accidents.

Materials and methods: The study was conducted using a ques-tionnaire Coping Inventory for Stressful Situations (CISS), as wellas an own survey considering issues connected with occupationalstress. The study involved 121 people: 56 emergency nurses and 65paramedics, 49 are women and 72 men. Their average work expe-rience is 13 years; the shortest is less than a year and the longest34 years.

Results: In the study 55% of respondents had more than onedominant style of coping with stress. Education, work experience,subjective assessment of vulnerability to stress and the impact onemployees’ lives are variables, the results of which significantlydifferentiate emotional and escape-avoidance styles.

Conclusions: Over half of the respondents presented more thanone dominant style, what according to Antonovsky’ theory is thebest way to deal with stress. The most differentiating styles areemotional and escape-avoidance ones, the least task-orientatedstyle. The sphere most vulnerable to preferred styles of coping withstress is the private life of the respondents. Furthermore, the studyshows that these variables are related to preferred styles of copingwith stress.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.219

Prognostication

AP194

Survival after cardiac arrests occurring atnursing homes

Helle Søholm 1,∗, John Bro-Jeppesen 1, Freddy K.Lippert 2, Lars Køber 1, Michael Wanscher 1, JesperKjaergaard 1, Christian Hassager 1

1 Copenhagen University Hospital Rigshospitalet,Copenhagen, Denmark2 Emergency Medical Services, The Capital Region ofDenmark, Ballerup, Denmark

Purpose: Nursing home (NH) residents in general are older andoften have pre-existing comorbidities, which may lead to ethicaldilemmas, i.e. whether resuscitation should be initiated. Previousstudies found very few/none survivors among NH out-of-hospitalcardiac arrests (OHCA).1–5 We studied the outcome after OHCAin NH in the greater Copenhagen area, with a NH-population ofapproximately 3500 (0.3% of the population).

Methods: A total of 2453 consecutive OHCA-patients (incidence0.04%/yr) were during a five-year period treated by physiciansin the Emergency Medical Service in Copenhagen, with 234arrests occurring in NH (incidence 1.3%/yr). Utstein-criteria forpre-hospital data and review of individual patients’ charts for post-resuscitation care were used.

Results: Thirty-day survival rate was 7% in NH-patients and 18%for non-nursing home (NNH). Of the 234 NH-patients 67 (29%)were admitted to hospital and 950 (43%) were admitted fromNNH (p < 0.001). Admitted NH-patients were older (78 ± 13 vs.64 ± 14 yr, p < 0.001) and more often female (66% vs. 27%, p < 0.001)compared to NNH-patients. No differences in pre-hospital factorswere found except for shock-able rhythm being less common inNH-patients (18% vs. 53%, p < 0.001). Pre-existing dementia wasnoted in 38% vs. 4%, p < 0.001 and median Charlson ComorbidityIndex was 2 (IQR: 1–3) vs. 1 (0–2), p < 0.001 in NH and NNH-patients, respectively. Thirty-day survival rate was 24% in theadmitted NH-patients and 42% in NNH-patients, p < 0.001. NH

Poster Presentations / Resuscitation 84S (2013) S8–S98 S87

Fig. 1. Thirty-day mortality in resuscitated nursing home (NH) and non-nursinghome (NNH) patients.

was, however, not associated with a significantly worse progno-sis (HR0.97 (95%CI: 0.67–1.4) p = 0.9) after adjustment for knownprognostic factors. Cerebral Performance Category (CPC) at hospi-tal discharge in survivors was good (1–2) in 47% of NH-patients and81% of NNH-patients (p = 0.002).

Conclusion: Patients suffering a cardiac arrest in nursing homeshave a more severe prognosis compared to arrests occurring out-side nursing homes, however after resuscitation and admission tothe hospital no significant association between survival and nurs-ing home is found after adjustment for known prognostic factors.Ethical issues may arise during resuscitation, but a policy of notattempting resuscitation at nursing homes in general may not bejustified (Fig. 1).

References

1. Benkendorf, et al. Outcomes of cardiac arrest in the nursing home: destiny orfutility? [see comment]. Prehosp Emerg Care 1997;1:68–72.

2. Gordon, et al. Poor outcome of on-site cpr in a multi-level geriatric facility: threeand a half years experience at the baycrest centre for geriatric care. J Am GeriatrSoc 1993;41:163–6.

3. Applebaum, et al. The outcome of cpr initiated in nursing homes. J Am Geriatr Soc1990;38:197–200.

4. Awoke, et al. Outcomes of skilled cardiopulmonary resuscitation in a long-term-care facility: futile therapy? J Am Geriatr Soc 1992;40:593–5.

5. Shah, et al. Cardiac arrests in skilled nursing facilities: continuing room forimprovement? J Am Med Dir Assoc 2007;8:e27–31.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.220

AP195

Prognostic performance of single versus serialmeasurements of neutron-specific enolase(NSE) in post-cardiac arrest survivors treatedwith therapeutic hypothermia

Thibaut vanneste 1,∗, Ingrid Meex 3, CorneliaGenbrugge 1, Frank Jans 1, René Heylen 1, JoDens 2, Cathy De Deyne 1

1 Department of Anesthesiology, Intensive Care,Emergency Medicine & Pain Therapy – ZOL, Genk,Belgium2 Department of Cardiology – ZOL, Genk, Belgium

3 Faculty of Medicine and Lifesciences, HasseltUniversity, Hasselt, Belgium

Purpose of the study: Prognostication of survival after cardiacarrest (CA) remains challenging. NSE has been used to predict out-come although guidelines remain ambiguous. We evaluated thedifference between single versus serial measurements of NSE at 24and 48 h in predicting survival after CA treated with therapeutichypothermia (TH).

Materials and methods: With local IRB approval, 27 post-CA patients treated with TH were included in this prospectivestudy. NSE was measured using an electrochemiluminescenceimmunoassay. The Non-parametric Mann–Whitney test was usedfor comparison of data. Primary outcome was survival at hospitaldischarge.

Results: Median NSE at 48 h in the survival group was 37.7 �g/L(Interquartile range (IQR) 25.4–71) in comparison with 91 �g/l(IQR 60.1–238) in the non-survival group (p-value < 0.001). Whenusing a NSE concentration of 33 �g/l as cut-off value at 48 h wefound an area under the curve of 0.865 (p-value < 0.001) with asensitivity of 100% and a specificity of 48%. The median absolutedifference between NSE at 24 and 48 h was 1 (IQR −8.9–5.9) inthe survival group opposed to 20 (IQR −1.2–81.9) in the non-survival group (p-value = 0.065). The median relative difference wasrespectively +0.02% (IQR −0.27–0.22) and +0.33% (IQR −0.02–0.82)(p-value = 0.065).

Conclusions: When comparing a single versus serial measure-ments of NSE, serial measurements did not significantly differbetween both groups. There was a trend towards a rise in NSE at48 h in the non-survival group. The lack of statistical significancecould be due to the small study population. A single measurementat 48 h did significantly differ between both groups. The optimalcut-off value remains uncertain. These findings indicate that a sin-gle measurement of NSE at 48 h could be used in predicting survivalafter CA treated with TH but further studies are still needed.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.221

AP196

Prognostic value of cell-free DNA in plasma ofout-of-hospital cardiac arrest survivorsquantified at ICU admission and 24 hpost-admission

Ivan Gornik 1,∗, Vladimir Gasparovic 1, DavorMilicic 1, Vesna Degoricija 1, Bosko Skoric 1, HaxiuArita 2, Eva Fortner 1, Jasenka Vagner 3, OlgaGornik 4, Gordan Lauc 5

1 University of Zagreb, School of Medicine, Zagreb,Croatia2 University Hospital Centre Rebro, Zagreb, Croatia3 University J.J. Strossmayer Osijek, School ofMedicine, Osijek, Croatia4 University of Zagreb, Faculty of Pharmacy andBiochemistry, Zagreb, Croatia5 Genos LTD, Molecular Genetics Laboratory, Zagreb,Croatia

Introduction: Cell-free DNA has been associated with outcomein several acute conditions including two reports concerning theoutcomes after cardiac arrest that found association of circulatingDNA quantities at admission with mortality. The origins of cell-freeDNA are primarily necrosis and apoptosis, which in cardiac arrestoccur during ischemia, during reperfusion injury and as a conse-quence of post-arrest inflammatory response. Respecting the factsthat cellular damage occurs during the post-arrest period, and that