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- Adielsson, A, et al.
(författare)
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Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia : bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective
- 2011
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Ingår i: Heart. - : B M J Group. - 1355-6037 .- 1468-201X. ; 97:17, s. 1391-1396
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Tidskriftsartikel (refereegranskat)abstract
- Objectives In a national perspective, to describe survival among patients found in ventricular fibrillation or pulseless ventricular tachycardia witnessed by a bystander and with a presumed cardiac aetiology and answer two principal questions: (1) what are the changes over time? and (2) which are the factors of importance? Design Observational register study. Setting Sweden. Patients All patients included in the Swedish Out of Hospital Cardiac Arrest Register between 1 January 1990 and 31 December 2009 who were found in bystander-witnessed ventricular fibrillation with a presumed cardiac aetiology. Interventions Bystander cardiopulmonary resuscitation (CPR) and defibrillation. Main outcome measures Survival to 1 month. Results In all, 7187 patients fulfilled the set criteria. Age, place of out-of-hospital cardiac arrest (OHCA) and gender did not change. Bystander CPR increased from 46% to 73%; 95% CI for OR 1.060 to 1.081 per year. The median delay from collapse to defibrillation increased from 12 min to 14 min (p for trend 0.0004). Early survival increased from 28% to 45% (95% CI 1.044 to 1.065) and survival to 1 month increased from 12% to 23% (95% CI 1.058 to 1.086). Strong predictors of early and late survival were a short interval from collapse to defibrillation, bystander CPR, female gender and OHCA outside the home. Conclusion In a long-term perspective in Sweden, survival to 1 month after ventricular fibrillation almost doubled. This was associated with a marked increase in bystander CPR. Strong predictors of outcome were a short delay to defibrillation, bystander CPR, female gender and place of collapse.
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| 2. |
- Axelsson, Christer, et al.
(författare)
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Outcome after out-of-hospital cardiac arrest witnessed by EMS : changes over time and factors of importance for outcome in Sweden.
- 2012
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 83:10, s. 1253-1258
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Tidskriftsartikel (refereegranskat)abstract
- Background Among patients who survive after out-of-hospital cardiac arrest (OHCA), a large proportion are recruited from cases witnessed by the Emergency Medical Service (EMS), since the conditions for success are most optimal in this subset. Aim To evaluate outcome after EMS-witnessed OHCA in a 20-year perspective in Sweden, with the emphasis on changes over time and factors of importance. Methods All patients included in the Swedish Cardiac Arrest Register from 1990 to 2009 were included. Results There were 48,349 patients and 13.5% of them were EMS witnessed. There was a successive increase in EMS-witnessed OHCA from 8.5% in 1992 to 16.9% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, the survival to one month increased from 13.9% in 1992 to 21.8% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, 51% were found in ventricular fibrillation, which was higher than in bystander-witnessed OHCA, despite a lower proportion with a presumed cardiac aetiology in the EMS-witnessed group. Among EMS-witnessed OHCA overall, 16.0% survived to one month, which was significantly higher than among bystander-witnessed OHCA. Independent predictors of a favourable outcome were: (1) initial rhythm ventricular fibrillation; (2) cardiac aetiology; (3) OHCA outside home and (4) decreasing age. Conclusion In Sweden, in a 20-year perspective, there was a successive increase in the proportion of EMS-witnessed OHCA. Among these patients, survival to one month increased over time. EMS-witnessed OHCA had a higher survival than bystander-witnessed OHCA. Independent predictors of an increased chance of survival were initial rhythm, aetiology, place and age.
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| 5. |
- Herlitz, Johan, et al.
(författare)
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Factors associated with survival to hospital discharge among patients hospitalized alive after out-of-hospital cardiac arrest : change in outcome over 20 years in the community of Göteborg
- 2003
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Ingår i: Heart. - : BMJ Group. - 1355-6037 .- 1468-201X. ; 89:1, s. 25-30
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive. Patients: All patients hospitalised alive in the community of Göteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included. Methods: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded. Patients were divided into two groups (the first and second 10 year periods). Setting: Community of Göteborg, Sweden. Results: 5505 patients suffered from cardiac arrest during the time of the survey. Among them 1310 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% CI 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% CI 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% CI 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% CI 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% CI 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% CI 0.47 to 0.88); atropine required in the emergency department (OR 0.35, 95% CI 0.16 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0.59, 95% CI 0.43 to 0.81). Conclusion: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine in the emergency department, and chronic treatment with diuretics before cardiac arrest.
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| 6. |
- Herlitz, Johan, et al.
(författare)
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Factors associated with survival to hospital discharge among patients hospitalized alive after out-of-hospital cardiac arrest and change in outcome over time. Experiences during 20 years in the community of Göteborg
- 2003
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Ingår i: Heart. - : BMJ Group. - 1355-6037 .- 1468-201X .- 0007-0769. ; 89:1, s. 25-30
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive. Patients: All patients hospitalised alive in the community of Göteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included. Methods: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded. Patients were divided into two groups (the first and second 10 year periods). Setting: Community of Göteborg, Sweden. Results: 5505 patients suffered from cardiac arrest during the time of the survey. Among them 1310 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% CI 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% CI 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% CI 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% CI 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% CI 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% CI 0.47 to 0.88); atropine required in the emergency department (OR 0.35, 95% CI 0.16 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0.59, 95% CI 0.43 to 0.81). Conclusion: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine in the emergency department, and chronic treatment with diuretics before cardiac arrest.
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| 8. |
- Aune, S, et al.
(författare)
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Improvement in the hospital organisation of CPR training and outcome after cardiac arrest in Sweden during a 10-year period
- 2011
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 82:4, s. 431-435
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe (a) changes in the organisation of training in cardiopulmonary resuscitation (CPR) and the treatment of cardiac arrest in hospital in Sweden and (b) the clinical achievement, i.e. survival and cerebral function, among survivors after in-hospital cardiac arrest (IHCA) in Sweden. Methods Aspects of CPR training among health care providers (HCPs) and treatment of IHCA in Sweden were evaluated in 3 national surveys (1999, 2003 and 2008). Patients with IHCA are recorded in a National Register covering two thirds of Swedish hospitals. Results The proportion of hospitals with a CPR coordinator increased from 45% in 1999 to 93% in 2008. The majority of co-ordinators are nurses. The proportions of hospitals with local guidelines for acceptable delays from cardiac arrest to the start of CPR and defibrillation increased from 48% in 1999 to 88% in 2008. The proportion of hospitals using local defibrillation outside intensive care units prior to arrival of rescue team increased from 55% in 1999 to 86% in 2008. During the past 4 years in Sweden, survival to hospital discharge has been 29%. Among survivors, 93% have a cerebral performance category (CPC) score of I or II, indicating acceptable cerebral function. Conclusion During the last 10 years, there was a marked improvement in CPR training and treatment of IHCA in Sweden. During the past 4 years, survival after IHCA is high and the majority of survivors have acceptable cerebral function.
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| 9. |
- Axelsson, C, et al.
(författare)
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Implementation of mechanical chest compression in out-of-hospital carfdiac arrest in an emergency medical service system
- 2013
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 31:8, s. 1196-1200
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study is to describe the outcome changes after out-of-hospital cardiac arrest (OHCA) in Gothenburg, Sweden, after introduction of mechanical chest compression (MCC). METHODS: Following introduction of MCC, 1183 OHCA patients were treated from November 1, 2007, to December 31, 2011 (period 2). They were compared with 1218 OHCA patients before MCC was introduced from January 1, 1998, to May 30, 2003 (period 1). Patients in period 2 were evaluated for survival in relation to MCC use. RESULTS: The percentage of patients admitted to hospital alive increased from 25.4% to 31.9% (P < .0001). Survival to 1 month increased from 7.1% to 10.7% (P = .002) from period 1 to period 2. The proportion of ventricular fibrillation/ventricular tachycardia decreased in period 2 (P = .002). However, bystander cardiopulmonary resuscitation (P < .0001), crew-witnessed cases (P = .04), percutaneous coronary intervention (P < .0001), therapeutic hypothermia (P < .0001), and implantable cardioverter-defibrillator use (P = .01) increased, as did time from call to emergency medicine service arrival (P < .0001) and to defibrillation (P = .006). In period 2, 60% of OHCA patients were treated with MCC. The percentages admitted alive to hospital (MCC vs no MCC) were 28.6% and 36.1% (P = .008). Corresponding figures for survival to 1 month were 5.6% and 17.6% (P < .0001). In the MCC group, we found increase in the delay from collapse to defibrillation (P < .0001), greater use of adrenaline (P < .0001), and fewer crew-witnessed cases (P < .0001). CONCLUSION: Survival to 1 month after implementation of MCC was higher than before introduction. However, patients receiving MCC had low survival. Although case selection might play a role, results do not support a widespread use of MCC after OHCA.
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| 10. |
- Axelsson, Åsa B., 1955, et al.
(författare)
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Factors surrounding cardiopulmonary resuscitation influencing bystanders' psychological reactions.
- 1998
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 37:1, s. 13-20
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of Sweden's out-of-hospital cardiac arrests averages 10000 annually. Each year bystanders initiate cardiopulmonary resuscitation (CPR) approximately 2000 times prior to arrival of emergency medical service (EMS). The aim of this study was to identify factors influencing the bystanders psychological reactions to performing CPR. We mailed a questionnaire to all bystanders who reported performing CPR to the CPR Centre of Sweden from autumn 1992 to 1995. The study included 544 bystander reports. Nine factors were found to be associated with bystanders experience in a univariate analysis. Among these were victim outcome (p < 0.0001), CPR duration (p = 0.0009) and their experience of the attitude of the EMS personnel (p = 0.004). In a multivariate logistic regression model, lack of debriefing following the intervention (p = 0.0001) and fatal victim outcome (p = 0.03) were independent predictors of a negative bystander psychological reaction. The importance of having someone to talk to following an intervention and the EMS personnel concern for the rescuer should be emphasised. The goal should be that critical incident debriefing is available to every bystander following his or her CPR attempt.
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