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- Elfwen, Ludvig, et al.
(författare)
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Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial
- 2019
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Ingår i: Resuscitation. - : ELSEVIER IRELAND LTD. - 0300-9572 .- 1873-1570. ; 139, s. 253-261
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151). Methods: Resuscitated bystander witnessed OHCA patients > 18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded. Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days. Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.
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- Lindgren, Erik, et al.
(författare)
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Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest : A registry study
- 2019
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 143, s. 189-195
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: We investigated the impact of gender in performance and findings of early coronary angiography (CAG) and percutaneous coronary intervention (PCI), comorbidity and outcome in a large population of out-of-hospital cardiac arrest (OHCA) patients with an initially shockable rhythm.Methods: Retrospective cohort study. Data retrieved 2008-2013 from the Swedish Register for Cardio-Pulmonary Resuscitation, Swedeheart Registry and National Patient Register.Results: We identified 1498 patients of whom 78% were men. Men and women had the same pathology on the first registered electrocardiogram (ECG): 30% vs. 29% had ST-elevation and 10% vs. 9% had left bundle branch block (LBBB) (P=0.97). Proportions of performed CAG did not differ between genders. Among patients without ST-elevation/LBBB men more often had at least one significant stenosis, 78% vs. 54% (P= 0.001), more multi-vessel disease (P= 0.01), had normal coronary angiography less often, 22% vs. 46% and PCI more often, 59% vs. 42% (P= 0.03). Among patients without STelevation/LBBB on the initial ECG, more men had previously known ischaemic heart disease, 27% vs. 19% (P=0.02) and a presumed cardiac origin of the cardiac arrest, 86% vs. 72% (P< 0.001). Multivariable analysis showed no association between gender and evaluation by early CAG. In men and women, 1-year survival was 56% vs. 50% (P= 0.22) in patients with ST-elevation/LBBB and 48% vs. 51% (P= 0.50) in patients without.Conclusion: Despite no gender differences in ECG findings indicating an early CAG, men had more severe coronary artery disease while women more frequently had normal coronary angiography. However, this did not influence 1-year survival.
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- Hofmann, Robin, et al.
(författare)
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Oxygen therapy in ST-elevation myocardial infarction.
- 2018
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 39:29, s. 2730-2739
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes.Methods and results: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6-12 h or ambient air. In this pre-specified analysis, we included only STEMI patients who underwent percutaneous coronary intervention (PCI). In total, 2807 patients were included, 1361 assigned to receive oxygen, and 1446 assigned to ambient air. The pre-specified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1361) of patients allocated to oxygen compared to 7.5% (108 of 1446) allocated to ambient air [hazard ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64-1.13; P = 0.27]. There was no difference in the rate of death from any cause (HR 0.86, 95% CI 0.61-1.22; P = 0.41), rate of rehospitalization for MI (HR 0.92, 95% CI 0.57-1.48; P = 0.73), rehospitalization for cardiogenic shock (HR 1.05, 95% CI 0.21-5.22; P = 0.95), or stent thrombosis (HR 1.27, 95% CI 0.46-3.51; P = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days and the total duration of follow-up up to 1356 days.Conclusions: Routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis.
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- Svensson, Leif, 1981-
(författare)
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A Theology for the Bildungsbürgertum : Ritschl in Context
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The subject of this historical-theological investigation is the German Lutheran theologian Albrecht Ritschl (1822-1889). Ritschl’s theology is understood in the context of the de-Christianization of the German Bildungsbürgertum (educated middle class). It is demonstrated that an ambition to counteract this tendency runs all through Ritschl’s theological thinking. More specifically, the study argues that Ritschl’s theology can be seen as a response to three intellectual challenges to Christianity in general and Lutheranism in particular – historical criticism, materialism, and anti-Lutheran polemics.Part I concentrates on historical criticism and Ritschl’s interpretation of history. Chapter 1, which presents Leopold von Ranke’s historicist-oriented historical school at the University of Berlin and Ferdinand Christian Baur’s theological Tübingen school, provides the wider setting of Ritschl’s historical analysis. It is argued, in chapter 2, that those schools had a significant impact – albeit in different ways – on Ritschl’s understanding of history. The contribution of Ritschl to the so-called first quest for the historical Jesus is analyzed in chapter 3, which also points out that Johannes Weiss’ and Albert Schweitzer’s apocalyptic critique of the first quest undermined the historical foundation of Ritschl’s theology.In part II, the focus is on materialism and the metaphysical framework of Ritschl’s theology. Chapter 4 discusses anthropological materialism, scientific materialism, and late idealism – three intellectual movements of relevance to Ritschl’s metaphysics. In chapter 5, Ritschl’s metaphysical framework is described as an attempt to safeguard the spiritual dimension of existence against the threat of materialism. This chapter also argues that Ritschl’s metaphysics is indebted to Hermann Lotze’s late idealist philosophy. Chapter 6 highlights the relationship between Ritschl’s metaphysics and his protest against “classical metaphysical theology,” and examines how Ritschl’s metaphysical framework leads him to reject natural theology and the classical Christological and trinitarian dogmas.Part III discusses Ritschl’s theological ethics or understanding of Christian life in the context of the values of the Bildungsbürgertum and against the background of anti-Lutheran polemics. In chapter 7, an overview of the ethos of the educated middle class is provided. The subject of chapter 8 is Ritschl’s defense of Luther’s cultural importance against Paul de Lagarde’s criticism of the Lutheran Reformation. Chapter 9 carries out an analysis of Ritschl’s thinking on Christian life and its modern sources, especially noting the influences of Immanuel Kant and Friedrich Schleiermacher, and exploring the similarities between Ritschl’s ethics and the values of the educated middle class.In the Conclusion, the findings of the investigation are summarized in the claim that Ritschl’s responses to historical criticism, materialism, and anti-Lutheran polemics demonstrate that his theology in many respects was a theology for the Bildungsbürgertum. The concluding chapter also reflects on the implications of the present study for the common characterization of Ritschl as a Kulturprotestant (mediator between the Protestant Reformation and modern culture), problematizes Ritschl’s interpretation of the historical Jesus, and argues that Ritschl’s theological project was essentially abandoned by his most famous students.
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- Zijlstra, Jolande A, et al.
(författare)
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Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.
- 2018
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 104:23, s. 1929-1936
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.METHODS: We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.RESULTS: A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.CONCLUSION: Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.
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