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- Aune, Solveig, 1957, et al.
(författare)
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Characteristics of patients who die in hospital with no attempt at resuscitation
- 2005
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 65:3, s. 291-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. MATERIALS AND METHODS: All patients who died at Sahlgrenska University Hospital in Goteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year. RESULTS: Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of 'do not attempt resuscitation' (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR. CONCLUSION: In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.
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| 2. |
- Aune, Solveig, 1957, et al.
(författare)
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Evaluation of 2 different instruments for exposing the chest in conjunction with a cardiac arrest.
- 2011
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Ingår i: The American journal of emergency medicine. - : Elsevier BV. - 1532-8171 .- 0735-6757. ; 29:5, s. 549-553
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Time between onset of cardiac arrest and start of treatment is of ultimate importance for outcome. The length of time it takes to expose the chest in out-of-hospital cardiac arrest (OHCA) is not known. We aimed to compare the time from onset of OHCA until the time at which the chest was exposed using a new device (S-CUT; ES Equipment, Gothenburg, Sweden) and a pair of scissors. METHODS: In a manikin study, the 2 devices were compared in a simulated cardiac arrest where the initial step was exposure of the chest. The tests were performed using ambulance staff from 3 different ambulance organizations in Western Sweden. Six different types of clothing combinations were used. The primary choices of clothing for analyses were a knitted sweater and shirt (indoors) and a jacket with buttons, a shirt, and a college sweater (outdoors). RESULTS: The mean difference from onset of OHCA until the chest was exposed when S-CUT was compared with a pair of scissors varied between 6 seconds (P = .006) and 63 seconds (P = .004; shorter with the S-CUT), depending on the type of clothing that was used. The mean differences for the clothing that was chosen for primary analyses were 23 and 63 seconds, respectively. CONCLUSION: We found that a new device (S-CUT) used for exposing the chest in OHCA was associated with a marked shortening of procedure time as compared with a pair of scissors.
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| 3. |
- Axelsson, Åsa B., 1955, et al.
(författare)
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European cardiovascular nurses and allied professions’ practical skills in cardiopulmonary resuscitation
- 2009
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Ingår i: Cardiology. - 0008-6312. - 9783805591430 ; 113:S1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this study was to test practical skills of cardiopulmonary resuscitation (CPR) in European cardiovascular nurses and allied professions. Methods: Eighty-six delegates at the Spring Meeting on Cardiovascular Nursing in Malmö, Sweden, in 2008, were recruited for this study. Laerdal Resusci Anne SkillReporter manikins connected to a computer with the Laerdal PC SkillReporting System were used. The participants were told to perform CPR according to the “new”guidelines from 2005; 30:2 for three minutes. Results: 88% of the tested participants were nurses and 79% were female. Mean age were 42 years (range 19–63 years). They came from 14 different European countries, though one third was from Sweden. About two thirds had trained CPR within the last year. Seven per cent had no previous CPR training. According to practical skills the average inflations per minute were five (SD+1.5), average inflation volume 992 ml (SD+423) and average flow rate 857 ml/second (SD+401). According assessment of chest compressions the average compression rate was 121 (SD+22.5), average compression per minute 79.5 (SD+14.4), average compression depth 43.8 mm (SD+9.4) and average compression duty cycle 43.8% (SD+5.7). Hand position “too low”was the most common committed error. Conclusion: The practical skill in CPR among the tested delegates was rather satisfying regarding chest compressions. However, there were wide ranges as shown by large standard deviations. Regarding ventilations, too large volumes together with flow rates as high as those performed by many of these delegates may easily lead to gastric inflation during clinical CPR.
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| 5. |
- 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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| 6. |
- Herlitz, Johan, 1949, et al.
(författare)
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Delay time between onset of myocardial infarction and start of thrombolysis in relation to prognosis.
- 1993
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 82:5, s. 347-53
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Tidskriftsartikel (refereegranskat)abstract
- In 292 patients with suspected acute myocardial infarction given thrombolytic agents, we describe the delay time between the onset of pain and the start of thrombolysis and relate the observations to the prognosis. In 3%, treatment was started 1 h or less and in 22% 2 h or less after onset of symptoms. The median delay time between onset of symptoms and arrival in hospital was 1 h 38 min, and the median delay time between the arrival in hospital and start of thrombolysis was 1 h 25 min. A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.
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| 7. |
- Herlitz, Johan, 1949, et al.
(författare)
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Occurrence of hypotension during streptokinase infusion in suspected acute myocardial infarction, and its relation to prognosis and metoprolol therapy.
- 1993
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Ingår i: The American journal of cardiology. - : Elsevier, Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 71:12, s. 1021-4
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Tidskriftsartikel (refereegranskat)abstract
- In all patients who received streptokinase infusion for strongly suspected acute myocardial infarction in 1 hospital during 1989 to 1990, the occurrence of hypotension during infusion is described and related to prognosis. In 54% of patients, the beta blocker metoprolol was simultaneously administered intravenously. The median systolic blood pressure (BP) before infusion was 135 mm Hg, and the median value for the lowest systolic BP recorded during infusion was 100 mm Hg (p < 0.001). A positive correlation between systolic BP before streptokinase and the lowest systolic BP during infusion was found (r = 0.53; p < 0.001). Among patients administered streptokinase and metoprolol, 23% had systolic BP < 90 mm Hg, and 12% had < 80 mm Hg at any time during infusion; corresponding values for patients administered streptokinase only were 47 and 30%, respectively. Patients with the lowest systolic BP < 80 mm Hg during infusion had a mortality during the first 2 weeks of 22 vs 11% for those with between 80 and 100 mm Hg, and 8% for those with > 100 mm Hg (p < 0.001). However, in a multivariate analysis the systolic BP before infusion rather than the lowest systolic BP during infusion was independently associated with death. It is concluded that although patients with low systolic BP during streptokinase infusion have a high mortality, the level of systolic BP before infusion is more strongly associated with the outcome. Simultaneous use of intravenous beta blockade does not increase the occurrence of hypotension during streptokinase infusion.
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| 10. |
- 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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| 12. |
- 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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| 13. |
- 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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