| 1. |
- Riva, Gabriel, et al.
(author)
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Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest: A Nationwide Randomized Trial in Sweden
- 2024
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In: Circulation. Cardiovascular Quality and Outcomes. - 1941-7713 .- 1941-7705. ; 17:3
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Journal article (peer-reviewed)abstract
- BACKGROUND: The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial. METHODS: Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival. RESULTS: Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively. CONCLUSIONS: In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.
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| 2. |
- Riva, Gabriel, et al.
(author)
-
Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest : A Nationwide Randomized Trial in Sweden
- 2024
-
In: Circulation: Cardiovascular Quality and Outcomes. - 1941-7713 .- 1941-7705. ; 17:3, s. 010027-010027
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Journal article (peer-reviewed)abstract
- BACKGROUND: The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial. METHODS: Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival. RESULTS: Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively. CONCLUSIONS: In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.
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| 3. |
- Thorén, Anna, et al.
(author)
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Rapid response team activation prior to in-hospital cardiac arrest: Areas for improvements based on a national cohort study
- 2023
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In: Resuscitation. - 0300-9572 .- 1873-1570. ; 193
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Journal article (peer-reviewed)abstract
- Introduction: Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.Methods: A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.Results: In all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90-0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001).Conclusion: IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.
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| 4. |
- Boberg, Erik
(author)
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Cured but not well : long term survivorship after allogeneic haematopoietic stem cell transplantation
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Improved donor matching and supportive care have reduced short term complications after allogeneic haematopoietic stem cell transplantation (HSCT), leading to a growing number of survivors. However, despite being cured of leukemia many patients struggle to return to a normal life due to persistent chronic graft versus host disease (cGvHD), fatigue and cognitive dysfunction. Failure to develop tolerance to the grafted immune system underlies cGvHD and we thus hypothesized that MSC treatment may be effective when the first lines of treatment has failed. Further, a similar mechanism in the brain may disrupt neural communication and underlie persistent fatigue and cognitive symptoms. Consequently, this thesis aimed to study MSC treatment of cGvHD, as well as central nervous system (CNS) function, neurobiology, and immunology in patients with fatigue after HSCT. In study I, 11 patients that were refractory to or did not tolerate first-line treatment for cGvHD were administered repeated infusions of allogeneic MSC. Responses were seen in six patients according to the National Institutes of Health scale. Responding patients had a pre- treatment immune phenotype with increased naïve lymphocytes and infusion triggered short- term increases in naïve T-cells and regulatory T-cells. Further, CXC-motif Chemokine Ligand 9 and 10 are potential biomarkers of response, as they decreased in responders and increased in non-responders during the study. Study II, III and IV recruited 27 patients in haematological remission with (n=14) or without (n=13) self-reported fatigue confirmed with validated questionnaires, 1-5 years after HSCT. Metabolic, neurological, and psychiatric diseases were excluded. Fatigue associated with worse quality of life and reduced employment. Further, computerized testing focusing on memory and executive function demonstrated cognitive impairments. Subsequent functional near infra-red spectroscopy showed reduced prefrontal cortex activity during cognitive challenges, and impaired responses to a single dose of methylphenidate, compared to the non-fatigued patients. Lumbar punctures were performed and immune activity in the cerebrospinal fluid was assessed by proteomic analyses, mRNA sequencing and flow cytometry. Cognitive dysfunction was associated with reduced factors involved in immune regulation, neurogenesis, and synapse function, supported by mRNA-expression suggestive of reduced cell-cell adhesion and noradrenergic neuron differentiation. Flow cytometry demonstrated increased activated T-cells in patients with fatigue and cognitive dysfunction. In summary, cGvHD is the manifestation of an imbalance between inflammatory and regulatory factors after HSCT, where the stroma plays a major role. MSC treatment can restore this balance by inducing regulatory phenotypes in innate and adaptive immune cells, as demonstrated by the clinical responses seen in study I. We show that dysregulated immune activation after HSCT also occur in the CNS. Deficits in stromal-derived, reparative, and trophic factors in liquor, characterized patients with fatigue and cognitive dysfunction, perhaps by impairing cortical activity. This thesis emphasizes the need to understand the stroma-immune crosstalk, to design targeted therapies for debilitating, currently untreatable inflammatory conditions.
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| 5. |
- Boberg, Erik, et al.
(author)
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Reduced prefrontal cortex and sympathetic nervous system activity correlate with fatigue after aHSCT
- 2022
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In: Bone Marrow Transplantation. - : Macmillan Publishers Ltd.. - 0268-3369 .- 1476-5365. ; 57, s. 360-369
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Journal article (peer-reviewed)abstract
- Long-term fatigue and cognitive dysfunction affects 35% of allogeneic haematopoietic stem cell transplantation (aHSCT) survivors, suggesting a dysfunctional prefrontal cortex. In this study, we assessed prefrontal cortex and sympathetic nervous system activity in aHSCT patients with fatigue (n = 12), non-fatigued patients (n = 12) and healthy controls (n = 27). Measurement of near-infrared spectroscopy and electrodermal activity was carried out at rest and during cognitive performance (Stroop, verbal fluency and emotion regulation tasks). Prefrontal cortex and sympathetic nervous system activity were also analyzed in response to dopamine and noradrenaline increase after a single dose of methylphenidate. Baseline cognitive performance was similar in the two patient groups. However, after methylphenidate, only non-fatigued patients improved in Stroop accuracy and had better verbal fluency task performance compared to the fatigued group. Task-related activation of prefrontal cortex in fatigued patients was lower compared to non-fatigued patients during all cognitive tests, both before and after methylphenidate administration. During the Stroop task, reaction time, prefrontal cortex activation, and sympathetic nervous system activity were all lower in fatigued patients compared to healthy controls, but similar in non-fatigued patients and healthy controls.Reduced prefrontal cortex activity and sympathetic arousal suggests novel treatment targets to improve fatigue after aHSCT.
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| 6. |
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| 7. |
- Boberg, Erik, et al.
(author)
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The role of residence near hazardous waste sites containing benzene in the development of hematologic cancers in upstate New York
- 2011
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In: INTERNATIONAL JOURNAL OF OCCUPATIONAL MEDICINE AND ENVIRONMENTAL HEALTH. - : Nofer Institute of Occupational Medicine. - 1232-1087 .- 1896-494X. ; 24:4, s. 327-338
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Journal article (peer-reviewed)abstract
- Epidemiologic studies suggest an association between environmental exposure to benzene and hematologic cancers, but the relationship is not firmly established. The aim of this study was to assess the potential association between residence near hazardous waste sites containing benzene and hospitalization discharge rates for persons having hematologic cancers. less thanbrgreater than less thanbrgreater thanWe determined the number of hospital discharges of people with hematologic cancers in New York State except for New York City for the years 1993 to 2008.Descriptive statistics and negative binomial regression models were used to compare the rates of hospitalization of residents in zip codes containing hazardous waste sites containing benzene to the rates of discharges from residents in zip codes without waste sites. less thanbrgreater than less thanbrgreater thanWhen adjusting for potential confounders we found a 15% increase in the rate of hospitalization for chronic lymphatic leukemia (CLL) [rate ratio (RR): 1.15; 95% confidence interval (CI): 1.00-1.33], a 22% increase in the rate of discharges for total leukemia (RR: 1.22; 95% CI: 1.04-1.43) and a 17% increase in the rate of discharges for total lymphoma (RR: 1.17; 95% CI: 1.02-1.35) in the benzene exposed sites. We found greater effects of exposure in African Americans compared to Caucasians, females compared to males and people with higher socioeconomic status (SES) compared to those with lower SES for several of the diseases studied. less thanbrgreater than less thanbrgreater thanAfter controlling for major confounders we found statistically significant increases in discharge rates for several hematologic cancers in persons residing in zip codes containing benzene waste sites. These results provide additional support for a relationship between environmental exposure to benzene and risk of hematologic cancers.
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