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- Skrifvars, M. B., et al.
(author)
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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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In: J Intern Med. - : Wiley. - 0954-6820 .- 1365-2796. ; 262:4, s. 488-95
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Journal article (peer-reviewed)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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| 2. |
- Skrifvars, M. B., et al.
(author)
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Variability in survival after in-hospital cardiac arrest depending on the hospital level of care
- 2007
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 73:1, s. 73-81
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Journal article (peer-reviewed)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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| 3. |
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| 4. |
- Thorén, Ann-Britt, 1952
(author)
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How can we optimize bystander basic life support in cardiac arrest?
- 2007
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to describe various aspects of cardiopulmonary resuscitation (CPR) and CPR training in order to find approaches for enhancing bystander interventions. Cardiac care patients (n=401) were interviewed with regard to their attitude toward CPR and CPR training (II). Among those who were co-habiting (n=268), possibilities for and obstacles in relation to training were investigated (III). An instrument for measuring quality of CPR performance was tested in a pilot study using a suitable selection of cardiac care nurses (I, n=10). Quality of performance was studied among laypersons after CPR training and three months later (IV, n=32). A qualitative method was used to describe spouses? experiences during the cardiac arrest (CA) at home. Fifteen spouses were interviewed (V). Most of the cardiac care patients had a positive attitude towards CPR and many had trained or wished to undergo training in CPR (II). Two-thirds of patients who were co-habiting were unsure or doubted that their co-habitant had CPR training. More than half of these wanted their co-habitant to attend a course. Younger patients were more willing to participate in CPR training than those who were older. Major obstacles for CPR training were their own medical condition, and doubts concerning co-habitants physical ability or interest in participation (III). Measurements of the quality of CPR performance revealed several points of concern regarding CPR training and skill-retention; the difficulties in making the pauses for ventilations short enough, leading to low number of chest compressions per minute and poor performance regarding ventilations (I, IV). Immediately after training the laypersons performed relatively high proportions of chest compressions correctly, which after three months decreased significantly. ?Too shallow? chest compressions were common whilst the cardiac care nurses often made chest compressions ?too deep?. Spouses? experience of CA included two time domains and seven themes. Prior to the CA the themes deal with spouses? perceptions and interpretations of early warning signs. When a CA developed spouses quickly perceived the seriousness of the situation. Some lacked the ability to intervene whilst others did everything in their power to influence the outcome. The Emergency call services played an important supportive role and guided spouses in performing CPR (V). Conclusion: CPR training for cardiac care patients and co-habitants is important and feasible. The outcome of training has to be enhanced. Simplification of the message and reduction in number of skills taught seems urgent. Symptoms and signs regarding myocardial infarction have to be communicated more clearly.
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| 5. |
- Werling, Malin, 1967, et al.
(author)
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Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced
- 2007
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 73:1, s. 40-5
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Journal article (peer-reviewed)abstract
- BACKGROUND: The outcome among patients who are hospitalised alive after out-of-hospital cardiac arrest is still relatively poor. At present, there are no clear guidelines specifying how they should be treated. The aim of this survey was to describe the outcome for initial survivors of out-of-hospital cardiac arrest when a more aggressive approach was applied. PATIENTS: All patients hospitalised alive after out-of-hospital cardiac arrest in the Municipality of Goteborg, Sweden, during a period of 20 months. RESULTS: Of all the patients in the municipality suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n=375), 85 patients (23%) were hospitalised alive and admitted to a hospital ward. Of them, 65% had a cardiac aetiology and 50% were found in ventricular fibrillation. In 32% of the patients, hypothermia was attempted, 28% underwent a coronary angiography and 21% had a mechanical revascularisation. In overall terms, 27 of the 85 patients who were brought alive to a hospital ward (32%) survived to 30 days after cardiac arrest. Survival was only moderately higher among patients treated with hypothermia versus not (37% versus 29%; NS), and it was markedly higher among those who had early coronary angiography versus not (67% versus 18%; p<0.0001). CONCLUSION: In an era in which a more aggressive attitude was applied in post-resuscitation care, we found that the survival (32%) was similar to that in previous surveys. However, early coronary angiography was associated with a marked increase in survival and might be of benefit to many of these patients. Larger registries are important to further confirm the value of hypothermia in representative patient populations.
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