| 1. |
- Herlitz, Johan, 1949, et al.
(författare)
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Very high survival among patients defibrillated at an early stage after in-hospital ventricular fibrillation on wards with and without monitoring facilities
- 2005
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 66:2, s. 159-66
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The association between the interval between collapse and defibrillation and outcome is well described in out of hospital cardiac arrest but not as well in in-hospital cardiac arrest. We report the outcome among patients who suffered an in-hospital cardiac arrest and were found in ventricular fibrillation (VF) with the emphasis on the delay to defibrillation. METHODS AND RESULTS: In patients who suffered an in-hospital cardiac arrest at Sahlgrenska University Hospital in Goteborg between 1994 and 2002 there were 1.570 calls for the rescue team of which 71% had suffered a cardiac arrest. Among cardiac arrests 47% took place on monitored wards. The proportion of patients found in VF was 59% on wards with monitoring facilities and 45% on wards without (p<0.0001). Approximately 90% of these patients were defibrillated 12 min. On monitored wards, the survival was 63% if defibrillated 3 min after collapse (NS). The corresponding values for non-monitored wards were 72% and 35%, respectively (p=0.0003). Cerebral function among survivors at discharge appeared to be good among the majority of patients both in monitored and non monitored wards. CONCLUSION: If patients with in hospital VF were defibrillated early in both monitored and non monitored wards survival to hospital discharge was high. This highlights the importance of being prepared for the rapid defibrillation on wards without monitoring facilities.
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| 2. |
- Fredriksson, Martin, 1972, et al.
(författare)
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In-hospital cardiac arrest--an Utstein style report of seven years experience from the Sahlgrenska University Hospital
- 2006
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 68:3, s. 351-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In-hospital cardiac arrest is one of the most stressful situations in modern medicine. Since 1997, there has been a uniform way of reporting - the Utstein guidelines for in-hospital cardiac arrest reporting. MATERIAL AND METHODS: We have studied all consecutive cardiac arrest in the Sahlgrenska University Hospital (SU) between 1994 and 2001 for who the rescue team was alerted in all 833 patients. The primary endpoint for this study was survival to discharge. RESULTS: Thirty-seven percent survived to hospital discharge. Among patients who were discharged alive, 86% were alive 1 year later. The survivors have a good cerebral outcome (94% among those who were discharged alive had cerebral performance category (CPC) score 1 or 2). The organization at SU is efficient; 80% of the cardiac arrest had CPR within 1 min. Time from cardiac arrest to first defibrillation is a median of 2 min. Almost two-thirds of the patients were admitted for cardiac related diagnoses. CONCLUSION: The current study is the largest single-centre study of in hospital cardiac arrest reported according to the Utstein guidelines. We report a high survival for in-hospital cardiac arrest. We have pointed out that a functional chain of survival, short intervals before the start of CPR and defibrillation are probably contributing factors for this.
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| 3. |
- Hein, Andreas, 1972, et al.
(författare)
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Characteristics and outcome of false cardiac arrests in hospital
- 2006
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 69:2, s. 191-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Not all hospitalised patients with symptoms of a presumed or threatened cardiac arrest, for whom the rescue team is alerted, eventually suffer a cardiac arrest. This article aims to describe the characteristics and outcome of "false cardiac arrests". METHODS: All patients hospitalised at Sahlgrenska University Hospital for whom the rescue team was alerted between 1 November 1994 and 15 October 2002 were included. RESULTS: In all, there were 1538 calls for the rescue team, of which 70% were caused by cardiac arrest, 9% by respiratory arrest and 21% by "other causes". Survival to discharge was 36% among patients with cardiac arrest, 64% among patients with respiratory arrest and 77% among patients with "other reasons for calling" (p<0.0001 for trend). Among survivors, a cerebral performance categories (CPC) score of 1 at hospital discharge was found in 83% of those with a cardiac arrest, 59% with respiratory arrest and 82% with other reasons for calling (NS for trend). CONCLUSION: Among patients at a Swedish university hospital for whom the rescue team was alerted, about one-third have a "false cardiac arrest". These patients had a survival rate which was about twice that of patients with a "true cardiac arrest". However, among survivors, cerebral function at discharge was similar, regardless of "false" or "true" cardiac arrest.
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| 4. |
- Larsson, Maria, 1981, et al.
(författare)
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A history of diabetes is associated with an adverse outcome among patients admitted to hospital alive after an out-of-hospital cardiac arrest
- 2005
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 66:3, s. 303-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Factors of importance for the outcome among patients who are admitted to hospital alive after an out-of-hospital cardiac arrest are not well described in the literature. The importance of a history of diabetes for the outcome among these patients has not been reported in detail previously. This survey aims to describe the outcome among patients who were admitted to hospital after an out-of-hospital cardiac arrest in relation to whether they had a history of diabetes. METHODS: All patients who were admitted to hospital alive after an out-of-hospital cardiac arrest in the two city hospitals in the Municipality of Goteborg between 1980 and 2002 were included in the survey. RESULTS: In all, 1377 patients fulfilled the inclusion criteria and 187 (14%) of them had a history of diabetes. Patients with diabetes differed from those without diabetes by having a previous history of myocardial infarction, angina pectoris, hypertension and heart failure more frequently. Furthermore, they were older, with a mean age of 70 years versus 66 years for patients without diabetes. Among patients with diabetes, 25% were discharged alive, as compared with 37% of patients without diabetes (p=0.002). When adjusting for differences at baseline, the adjusted odds ratio for diabetic patients being discharged alive (versus no diabetes) was 0.57 (95% confidence interval, 0.39-0.80). CONCLUSION: Among patients admitted to hospital after an out-of-hospital cardiac arrest, 14% had a history of diabetes. These patients had a lower survival rate compared with those without diabetes, even after correcting for dissimilarities at baseline. It remains to be determined whether an early metabolic intervention in these patients will improve survival.
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| 5. |
- Skrifvars, M. B., et al.
(författare)
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Do patient characteristics or factors at resuscitation influence long-term outcome in patients surviving to be discharged following in-hospital cardiac arrest?
- 2007
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Ingår i: J Intern Med. - : Wiley. - 0954-6820 .- 1365-2796. ; 262:4, s. 488-95
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Few studies have focused on factors influencing long-term outcome following in-hospital cardiac arrest. The present study assesses whether long-term outcome is influenced by difference in patient factors or factors at resuscitation. Methods. An analysis of cardiac arrest data collected from one Swedish tertiary hospital and from five Finnish secondary hospitals supplemented with data on 1 year survival. Multiple logistic regression analysis was used to identify factors associated with survival at 12 months. Results. A total of 441 patients survived to hospital discharge following in-hospital cardiac arrest and 359 (80%) were alive at 12 months. Factors independently associated with survival [odds ratio (OR) >1 indicates increased survival and <1 decreased survival] at 12 months were; age [OR 0.95, 95% confidence interval (CI) 0.93-0.98], renal disease (OR 0.3, CI 0.1-0.9), good functional status at discharge (OR 4.9, CI 1.3-18.9), arrest occurring at (compared with arrests on general wards) emergency wards (OR 4.7, CI 1.4-15.3), cardiac care unit (OR 2.8, CI 1.2-6.4), intensive care unit (OR 2.4, CI 1.1-5.7), ward for thoracic surgery (OR 10.2, CI 2.6-40.1) and unit for interventional radiology (OR 13.3, CI 3.4-52.0). There was no difference in initial rhythm, delay to defibrillation or delay to return of spontaneous circulation between survivors and nonsurvivors. Conclusion. Several patient factors, mainly age, functional status and co-morbid disease, influence long-term survival following cardiac arrest in hospital. The location where the arrest occurred also influences survival, but initial rhythm, delay to defibrillation and to return of spontaneous circulation do not.
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| 6. |
- Skrifvars, M. B., et al.
(författare)
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Variability in survival after in-hospital cardiac arrest depending on the hospital level of care
- 2007
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 73:1, s. 73-81
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Survival after in-hospital cardiac arrest (IHCA) differs considerably between hospitals. This study tries to determine whether this difference is due to patient selection because of the hospital level of care or to effective resuscitation management. METHODS: Prospectively collected data on management of in-hospital cardiac arrests from Sahlgrenska Hospital, a tertiary hospital in Gothenburg, Sweden (cohort one) and from five Finnish secondary hospitals (cohort two). A multiple logistic regression model was created for predicting survival to hospital discharge. RESULTS: A total of 954 cases from Sahlgrenska Hospital and 624 patients from the hospitals in Finland were included. The delay to defibrillation was longer at Sahlgrenska than at the five Finnish secondary hospitals (p=0.045). Significant predictors of survival were: (1) age below median (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.5-2.8); (2) no diabetes (OR 1.9, CI 1.2-2.9); (3) arrests occurring during office hours (OR 1.5, CI 1.1-2.2); (4) witnessed cardiac arrest (OR 6.3, CI 2.6-15.3); (5) ventricular fibrillation or ventricular tachycardia as the initial rhythm (OR 4.9, CI 3.5-6.7); (6) location of the arrest (compared to arrests in general wards, GW): thoracic surgery and heart transplantation ward (OR 2.9, CI 1.5-5.9), interventional radiology (OR 4.8, CI 1.9-12.0) and other in-hospital locations (3.0, CI 1.6-5.7) and (7) hospital (compared to arrests at Sahlgrenska Hospital); arrests at Etela-Karjala Central Hospital [CH] (OR 0.3, CI 0.1-0.7), Paijat-Hame CH (OR 0.3, CI 0.1-0.8) and Seinajoki CH (OR 0.4, CI 0.3-0.7). CONCLUSION: The comparison of survival following IHCA between different hospitals is difficult, there seems to be undefined factors greatly associated with outcome. A great variability in survival within different hospital areas probably because of differences in patient selection, patient surveillance and resuscitation management was also noted. A locally implemented strong in-hospital chain of survival is probably the only way to improve outcome following IHCA.
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| 7. |
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| 8. |
- Thorén, Ann-Britt, 1952, et al.
(författare)
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Measurement of skills in cardiopulmonary resuscitation-do professionals follow given guidelines?
- 2001
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Ingår i: European journal of emergency medicine. - London : Lippincott Williams & Wilkins. - 0969-9546 .- 1473-5695. ; 8:3, s. 169-176
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Tidskriftsartikel (refereegranskat)abstract
- Since it is suggested that only effective cardiopulmonary resuscitation (CPR) improves survival rates, quality control of training outcomes is important and comparisons between different training methods are desirable. The aim of this study was to test a model of quality assurance, consisting of a computer program combined with the Brennan et al. checklist, for evaluation of CPR performance. A small group of trained medical professionals (cardiac care unit nurses) (n = 10) was used in this pilot study. The result points out several points of concern: half of the participants did not open the airway prior to breathing control. Over 90% of all inflations were ‘too fast’ and 71% were ‘too much’. Only 6.5% of the inflations were correct. On average, the participants made 5.4 inflations per minute. Concerning chest compressions, 40% were ‘too deep’ while only 4% were ‘too shallow’. In spite of the fact that the participants had an average rate at 95 compressions per minute the number of compressions varied between 32 and 51 during 1 minute. When new guidelines are discussed, it would be beneficial if they were tested by a number of people to investigate if following the guidelines is at all possible. © 2001 Lippincott Williams & Wilkins, Inc.
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| 9. |
- Thorén, Ann-Britt, 1952, et al.
(författare)
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Possibilities for and obstacles to CPR training among cardiac care patients and their co-habitants.
- 2005
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; :65, s. 337-43
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group. METHODS: All patients admitted to a coronary care unit during a four-month period were considered for participation in an interview study. Out of 401 patients, 268 were co-habiting. This study deals with these subjects. RESULTS: According to the answers given by the patients, 46% of the patients and 33% of the co-habitants had attended a CPR course at some time. Among those who had not previously attended a course, 58% were willing to attend, and 60% of the patients whose co-habitant had not received CPR education, wanted him or her to attend a course. The major obstacle to CPR training was the patient's own medical status. The major obstacle to the co-habitant's participation was the patient's doubts concerning their partner's physical ability or willingness to participate. Younger persons were more often willing to undergo training than older persons (p < 0.0001). Of those patients who had previously attended a course or who were willing to undergo training, 72% were prepared to do so together with their co-habitant. A course specially designed for cardiac patients and their relatives was a possible alternative for 75% of those willing to participate together with their co-habitant. CONCLUSIONS: Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant's willingness or physical ability and their own medical status.
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| 10. |
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