| 1. |
- Bohm, Katarina, et al.
(författare)
-
Dispatcher-assisted telephone-guided cardiopulmonary resuscitation: an underused lifesaving system.
- 2007
-
Ingår i: Eur J Emerg Med. - 0969-9546. ; 14:5, s. 256-9
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Our purpose with this investigation was to (i) estimate how often telephone-guided cardiopulmonary resuscitation was offered from emergency medical service dispatchers in Stockholm, (ii) study the willingness to perform cardiopulmonary resuscitation, and (iii) assess factors that could mislead the dispatcher in identifying the patient as a cardiac arrest victim. METHODS: In this prospective study, 313 consecutive emergency calls of out-of-hospital cardiac arrest were obtained from the Swedish Cardiac Arrest Register. Seventy-six cases of out-of-hospital cardiac arrest fulfilled the inclusion criteria. All alarm calls were tape-recorded and analyzed according to a standardized protocol. RESULTS: Dispatchers offered bystanders telephone instructions for cardiopulmonary resuscitation in 47% (n=36) of the cases and, among these, cardiopulmonary resuscitation instructions were given in 69% (n=25). Only 6% (n=2) of bystanders were not willing to perform cardiopulmonary resuscitation. Signs of breathing (suspected agonal breathing) were described in 45% of the cases. Cardiopulmonary resuscitation was offered to 23% (n=10) of patients with signs of breathing versus 92% (n=23) of those who were not breathing (P<0.001). CONCLUSIONS: Despite the fact that the vast majority of bystanders are willing to take part in telephone-guided cardiopulmonary resuscitation, emergency medical service dispatchers offer telephone-guided cardiopulmonary resuscitation in about only half of cases. Signs of breathing (agonal breathing) are often mistaken for normal breathing and are a cause of delay in the diagnosis of cardiac arrest.
|
|
| 2. |
- Herlitz, Johan, et al.
(författare)
-
Fler kan räddas efter hjärtstopp utanför sjukhus
- 2009
-
Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 106:8, s. 502-505
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 3. |
- Hollenberg, Jacob, et al.
(författare)
-
Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?
- 2005
-
Ingår i: J Intern Med. - : Wiley. - 0954-6820 .- 1365-2796. ; 257:3, s. 247-54
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dramatic differences in survival after out-of-hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome. SETTING: All patients suffering an OHCA in Stockholm and Goteborg between 1 January 2000 and 30 June 2001, in whom cardiopulmonary resuscitation (CPR) was attempted were included in this retrospective analysis. RESULTS: All together, 969 OHCA in Stockholm and 398 in Goteborg were registered during the 18-month study period. There were no differences in terms of age, gender, and percentage of witnessed cases or percentage of patients who had received bystander CPR. However, the percentage of patients with ventricular fibrillation (VF) at arrival of the ambulance crew was 18% in Stockholm versus 31% in Goteborg (P <0.0001). The percentage of patients who were alive 1 month after cardiac arrest was 2.5% in Stockholm versus 6.8% in Goteborg (P=0.0008). Various time intervals such as cardiac arrest to calling for an ambulance, cardiac arrest to the start of CPR and calling for an ambulance to its arrival were all significantly longer in Stockholm than in Goteborg. CONCLUSION: Survival was almost three times higher in Goteborg than in Stockholm amongst patients suffering an OHCA. This is primarily explained by a higher occurrence of VF at the time of arrival of the ambulance crew, which in turn probably is explained by shorter delays in Goteborg. The reason for the difference in time intervals is most likely multifactorial, with a significantly higher ambulance density in Goteborg as one possible explanation.
|
|
| 4. |
- Hollenberg, Jacob, et al.
(författare)
-
Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot
- 2009
-
Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 30:14, s. 1781-9
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. The objective of this study is to explore the effects of a dual dispatch early defibrillation programme. METHODS AND RESULTS: In this pilot study, automated external defibrillators (AEDs) were provided to all 43 fire stations in Stockholm during 2005. Fire-fighters were dispatched in parallel with traditional emergency medical responders (EMS) to all suspected cases of OHCA. Additionally, 65 larger public venues were equipped with AEDs. All 863 OHCA from December 2005 to December 2006 were included during the intervention, whereas all 657 OHCA from 2004 served as historical controls. Among dual dispatches, fire-fighters assisted with cardiopulmonary resuscitation (CPR) in 94% of the cases and arrived first on scene in 36%. The median time from call to arrival of first responder decreased from 7.5 min during the control period to 7.1 min during the intervention (P = 0.004). The proportion of patients in shockable rhythm remained unchanged. The proportion of patients alive 1 month after OHCA rose from 4.4 to 6.8% [adjusted odds ratio (OR): 1.6; 95% confidence interval (CI): 0.9-2.9]. One-month survival in witnessed cases rose from 5.7 to 9.7% (adjusted OR: 2.0; 95% CI: 1.1-3.7). Survival after OHCA in the rest of Sweden (Stockholm excluded) declined from 8.3 to 6.6% during the corresponding time period (unadjusted OR: 0.8; 95% CI: 0.6-1.0). Only three OHCA occurred at public venues equipped with AEDs. CONCLUSION: An introduction of a dual dispatch early defibrillation programme in Stockholm has shortened response times and is likely to have improved survival in patients with OHCA, especially in the group of witnessed cardiac arrests. The increase in survival is believed to be associated with improved CPR and shortened time intervals.
|
|
| 5. |
- Hollenberg, Jacob, et al.
(författare)
-
Hjärtstopp
- 2009
-
Ingår i: Prehospital akutsjukvård. - : Stockholm: Liber. - 9789147084487 ; , s. 295-304
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 6. |
- Hollenberg, Jacob, et al.
(författare)
-
Hjärtstopp
- 2009. - 1
-
Ingår i: Prehospital akutsjukvård. - : Liber. - 9789147084487 ; , s. 295-304
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 7. |
- Hollenberg, Jacob, et al.
(författare)
-
Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew--witnessed cases and bystander cardiopulmonary resuscitation.
- 2008
-
Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 1524-4539 .- 0009-7322. ; 118:4, s. 389-96
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. We sought to describe changes in 1-month survival after OHCA in patients given cardiopulmonary resuscitation (CPR) during the last 14 years in Sweden. METHODS AND RESULTS: All patients experiencing OHCA in whom CPR was attempted between 1992 and 2005 and who were reported to the Swedish Cardiac Arrest Register were included in the study. In all, 38,646 patients were included in this survey. The proportion of patients who were admitted alive to a hospital increased from 15.3% in 1992 to 21.7% in 2005 (P for trend <0.0001). The corresponding values for patients being alive after 1 month were 4.8% and 7.3%, respectively (P for trend <0.0001). The increase in 1-month survival was particularly evident among patients found with a shockable rhythm (increase from 12.7% in 1992 to 22.3% in 2005; P for trend <0.0001). The corresponding figures for patients found with a nonshockable rhythm were 1.2% in 1992 and 2.3% in 2005 (P for trend=0.044). Factors that potentially contributed to the improved survival rate were an increase in emergency medical crew-witnessed cases from 9% in 1992 to 15% in 2005 (P for trend <0.0001) and, to a lesser degree, an increase in bystander CPR from 31% in 1992 to 50% in 2005 (P for trend <0.0001). After adjustment for potential risk factors, the increase in survival remained significant. CONCLUSIONS: We found a significant increase in survival after OHCA in Sweden over the last 14 years. The increase was particularly marked among patients found with a shockable rhythm and was associated with an increase in the proportion of crew-witnessed cases and, to a lesser degree, an increase in the performance of bystander CPR.
|
|
| 8. |
- Hollenberg, Jacob
(författare)
-
Out-of-hospital cardiac arrest : a study on factors associated with cardiopulmonary resuscitation, early defibrillation and survival
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cardiac disease is the most common cause of mortality in the Western World and the majority of these cardiac deaths is due to out-of-hospital cardiac arrest (OHCA). In Sweden, an estimated 5,000-10,000 people suffer an OHCA annually. The objective of this thesis is to study patient characteristics and survival in patients with OHCA, to explore the importance of pre-hospital factors and in-hospital factors and to investigate the benefits of an early defibrillation program. Methods and results: Most data in this thesis are based on patient material collected by the Swedish Cardiac Arrest Register. Other data come from case records from patients admitted alive and time measurements from the emergency dispatch centre and defibrillators. In Study I, 969 cases of OHCA in Stockholm and 398 cases of OHCA in Göteborg between January 2000 and June 2001 were compared. The two groups were similar in terms of age, gender and various factors at resuscitation. All pre-hospital time intervals were longer in Stockholm and the proportion of patients found in ventricular fibrillation (VF) was 18% compared to 31% in Göteborg (p<0.0001). 1-month survival was significantly lower in Stockholm (2.5% vs. 6.8%; p<0.001). To evaluate the relative roles of pre-hospital and in-hospital factors, 1,542 OHCA in Stockholm and 546 in Göteborg between January 2000 and June 2002 were investigated in Study II. Survival after OHCA was again lower in Stockholm (3.3% vs. 6.1%; p=0.01). Significantly longer time intervals and a lower proportion of VF OHCA were found in Stockholm compared to Göteborg. Patient demography, medical history, in-hospital investigations and interventions as well as in-hospital mortality (78% in Göteborg, 80% in Stockholm) did not differ between the two groups. To describe temporal trends in 1-month survival after OHCA in Sweden, 38,646 patients between 1992-2005 were investigated in Study III. The proportion of patients surviving to hospital admission increased from 15.3% in 1992 to 21.7% in 2005 (p for trend<0.0001). The corresponding figures for patients being alive after 1 month were 4.8% and 7.3% (p for trend<0.0001). Factors related to the improved survival were an increase in crew-witnessed cases from 9% in 1992 to 15% in 2005 (p for trend <0.0001) and, to a lesser degree, more frequent bystander CPR which rose from 31% in 1992 to 50% in 2005 (p for trend <0.0001). In Study IV, specially trained fire-fighters equipped with automated external defibrillators were dispatched in addition to traditional medical responders to suspected cases of OHCA in Stockholm from December 2005 to December 2006. 863 OHCA patients were enrolled during the intervention and 657 OHCA from 2004 served as historical controls. Among dual dispatches, fire-fighters assisted with CPR in 94% of cases and arrived first on scene in 36% of cases. The median time from call to arrival of first responder decreased from 7.5 to 7.1 minutes (p=0.004). 1-month survival rose from 4.4% to 6.8% (p=0.047; adjusted OR: 1.6; 95% C.I: 0.9-2.9). 1-month survival among witnessed cases of OHCA rose from 5.7% to 9.7% (p=0.029; adjusted OR: 2.0; 95% C.I: 1.1-3.7). Conclusions: Survival after OHCA was significantly lower in Stockholm than in Göteborg during 2000-2002 and this difference was associated with pre-hospital factors only rather than with in-hospital factors or patient characteristics. Survival after OHCA in Sweden increased significantly from 1992 to 2005. The increase was particularly marked among patients found with a shockable rhythm and is associated with an increase in the proportion of crew-witnessed cases and, to a lesser degree, an increase in bystander CPR. A dual dispatch early defibrillation program in Stockholm has decreased response times and is likely to have improved survival in patients with OHCA. This increase in survival is believed to be associated with improved CPR and shortened time intervals.
|
|
