| 1. |
- Adielsson, Anna, 1973, et al.
(författare)
-
A 20-year perspective of in hospital cardiac arrest : Experiences from a university hospital with focus on wards with and without monitoring facilities.
- 2016
-
Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 216, s. 194-199
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge about change in the characteristics and outcome of in hospital cardiac arrests (IHCAs) is insufficient.AIM: To describe a 20year perspective of in hospital cardiac arrest (IHCA) in wards with and without monitoring capabilities.SETTINGS: Sahlgrenska University Hospital (800 beds). The number of beds varied during the time of survey from 850-746 TIME: 1994-2013.METHODS: Retrospective registry study. Patients were assessed in four fiveyear intervals.INCLUSION CRITERIA: Witnessed and nonwitnessed IHCAs when cardiopulmonary resuscitation (CPR) was attempted.EXCLUSION CRITERIA: Age below 18years.RESULTS: In all, there were 2340 patients with IHCA during the time of the survey. 30-Day survival increased significantly in wards with monitoring facilities from 43.5% to 55.6% (p=0.002) for trend but not in wards without such facilities (p=0.003 for interaction between wards with/without monitoring facilities and time period). The CPC-score among survivors did not change significantly in any of the two types of wards. In wards with monitoring facilities there was a significant reduction of the delay time from collapse to start of CPR and an increase in the proportion of patients who were defibrillated before the arrival of the rescue team. In wards without such facilities there was a significant reduction of the delay from collapse to defibrillation. However, the latter observation corresponds to a marked decrease in the proportion of patients found in ventricular fibrillation.CONCLUSION: In a 20year perspective the treatment of in hospital cardiac arrest was characterised by a more rapid start of treatment. This was reflected in a significant increase in 30-day survival in wards with monitoring facilities. In wards without such facilities there was a decrease in patients found in ventricular fibrillation.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Adielsson, Anna, et al.
(författare)
-
Outcome prediction for patients assessed by the medical emergency team : a retrospective cohort study
- 2022
-
Ingår i: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Medical emergency teams (METs) have been implemented to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to establish a clinically useful association between clinical variables and mortality risk, among patients assessed by the MET, and further to design an easy-to-use risk score for the prediction of death within 30 days.Methods: Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the outcome variable. Predictors of outcome were defined from age, gender, type of ward for admittance, previous medical history, acute medical condition, vital parameters and laboratory biomarkers. Identified factors independently associated with mortality were then used to develop a prognostic risk score for mortality.Results: The overall 30-day mortality was high (29.0%). We identified thirteen factors independently associated with 30-day mortality concerning; age, type of ward for admittance, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. A MET risk score for mortality based on the impact of these individual thirteen factors in the model yielded a median (range) AUC of 0.780 (0.774-0.785) with good calibration. When corrected for optimism by internal validation, the score yielded a median (range) AUC of 0.768 (0.762-0.773).Conclusions: Among clinical variables available at the time of MET assessment, thirteen factors were found to be independently associated with 30-day mortality. By applying a simple risk scoring system based on these individual factors, patients at higher risk of dying within 30 days after the MET assessment may be identified and treated earlier in the process.
|
|
| 5. |
- Adielsson, Anna, 1973
(författare)
-
The epidemiology of cardiac arrest - In-hospital risk assessment, treatment and outcome
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AIM: To describe and analyse sudden cardiac arrest, both in hospital and out of hospital, from an epidemiological perspective, by early prediction, by comparing changes over time in relation to aetiology, characteristics, treatment, survival or mortality and by identifying factors associated with outcome. METHODS: This thesis is based on four observational studies, including patient information from the Swedish Registry for Cardiopulmonary Resuscitation, in and out of hospital, and from a local registry on medical emergency team assessment at Sahlgrenska University Hospital. RESULTS: In Paper I, the 30-day survival after out-of-hospital cardiac arrest in Sweden among patients found in a shockable rhythm increased from 12% in 1992 to 23% in 2009. Strong predictors of survival were a short interval from collapse to defibrillation, bystander cardiopulmonary resuscitation (CPR), female gender and out-of-hospital cardiac arrest outside home. In Paper II, in Sahlgrenska University Hospital, the 30-day survival after an in-hospital cardiac arrest, on monitoring wards, increased significantly from 43.5% in 1994 to 55.6% in 2013. There was a significant reduction in the delay from collapse to the start of CPR and an increase in the proportion of patients defibrillated before the cardiac arrest team arrived. On the non-monitoring wards, there were no significant changes in survival; there was nonetheless a significant decrease in the proportion of patients found in shockable rhythms, from 46% in 1994 to 26% in 2013. In Paper III, adjusted trends indicated an overall increase in 30-day survival after in-hospital cardiac arrest in Sweden, from 24.7% in 2008 to 32.5% in 2018 (monitoring wards, 32.5% to 43.1%, and non-monitoring wards, 17.6% to 23.1%). The proportion of patients found in shockable rhythms decreased in overall terms from 31.6% in 2008 to 23.6% in 2018 (monitoring ward 42.5% to 35.8%, and non-monitoring wards, 20.1% to 12.9%). In Paper IV, the overall 30-day mortality among patients assessed by a medical emergency team in Sahlgrenska University Hospital was high (29.0%) and almost twice as high on medical wards as on surgical wards (37.1% vs 19.8%). Factors associated with increased 30-day mortality were reflected in age, type of ward, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. CONCLUSIONS: Over the past few decades, the overall survival after a sudden cardiac arrest has increased, both in and out of hospital, despite a declining trend in the proportion of shockable cardiac arrests. Part of the reason appears to be a shorter delay from collapse to treatment. Several factors associated with an increased risk of dying of a sudden cardiac arrest have been identified and, if appropriately risk stratified and immediately treated, the fatal outcome may be averted.
|
|
| 6. |
|
|
