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Hessulf, F., Herlitz, J., Lundgren, P., Rawshani, A., Aune, S. & Israelsson, J. (2019). Adherence to guidelines is associated with improved survival after inhospital cardiac arrest. In: : . Paper presented at American Heart Association 2019, Philadelphia, 16–18 November, 2019..
Open this publication in new window or tab >>Adherence to guidelines is associated with improved survival after inhospital cardiac arrest
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22344 (URN)
Conference
American Heart Association 2019, Philadelphia, 16–18 November, 2019.
Available from: 2019-12-31 Created: 2019-12-31 Last updated: 2020-01-10Bibliographically approved
Lundin, A., Rylander, C., Karlsson, T., Herlitz, J. & Lundgren, P. (2019). Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest.. Resuscitation, 140, 64-71, Article ID S0300-9572(18)30800-1.
Open this publication in new window or tab >>Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest.
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 140, p. 64-71, article id S0300-9572(18)30800-1Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe how administration of adrenaline is associated with return of spontaneous circulation (ROSC) and 30-day survival in patients with in-hospital cardiac arrest (IHCA).

DESIGN: Retrospective observational study.

SETTING: Analysis of data extracted from a national cardiac arrest registry.

STUDY POPULATION: Patients >18 years old with IHCA from January 2015 up to June 2017.

OUTCOME MEASURES: Primary outcomes were ROSC and 30-day survival. Secondary outcome was survival to hospital discharge with a good neurologic outcome defined as cerebral performance category (CPC) score 1-2.

RESULTS: Of 6033 patients eligible for inclusion, 4055 (67%) received at least one dose of adrenaline. The rate of ROSC was lower in the adrenaline group (72 vs. 98% for shockable rhythm and 50% versus 65% for non-shockable rhythm; p < 0.0001 for both). Patients who had been treated with adrenaline showed a lower rate of 30-day survival (30 vs. 85% for shockable rhythm and 12 vs. 48% for non-shockable rhythm; p < 0.0001 for both). Survival to hospital discharge with a good neurological outcome was lower in the adrenaline group (22 vs. 80% for shockable rhythm and 8 vs. 41% for non-shockable rhythm; p < 0.0001 for both). There was a marked imbalance between the two groups in median duration of cardiopulmonary resuscitation. Stratification by duration of cardiopulmonary resuscitation attenuated the differences in outcomes between treatment groups and in patients with an initial non-shockable rhythm the association between adrenaline and ROSC was reversed to the benefit for adrenaline.

CONCLUSIONS: In our cohort of 6033 patients retrieved from a national cardiopulmonary resuscitation registry, administration of adrenaline during resuscitation from IHCA was associated with a lower rate of ROSC and 30-day survival.

Keywords
Adrenaline, Cardiac arrest, In-hospital cardiac arrest, Survival
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22160 (URN)10.1016/j.resuscitation.2019.05.004 (DOI)000472733000012 ()31125581 (PubMedID)2-s2.0-85065995705 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-20Bibliographically approved
Andersson Hagiwara, M., Magnusson, C., Herlitz, J., Seffel, E., Axelsson, C., Munters, M., . . . Nilsson, L. (2019). Adverse events in prehospital emergency care: a trigger tool study. BMC Emergency Medicine, 19(1)
Open this publication in new window or tab >>Adverse events in prehospital emergency care: a trigger tool study
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2019 (English)In: BMC Emergency Medicine, Vol. 19, no 1Article in journal (Refereed) Published
Abstract [en]

Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care.

Keywords
Emergency medical service, Adverse events, Patient safety, Trigger tool, Prehospital
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15726 (URN)10.1186/s12873-019-0228-3 (DOI)000462228100001 ()30678636 (PubMedID)2-s2.0-85060553010 (Scopus ID)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2020-01-31Bibliographically approved
Thoren, A., Herlitz, J., Engdahl, J., Rawshani, A. & Djärv, T. (2019). ECG monitoring in inhospital cardiac arrest. In: : . Paper presented at European Resuscitation Council i Ljubljana, September 19-21, 2019..
Open this publication in new window or tab >>ECG monitoring in inhospital cardiac arrest
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22343 (URN)
Conference
European Resuscitation Council i Ljubljana, September 19-21, 2019.
Available from: 2019-12-31 Created: 2019-12-31 Last updated: 2020-01-10Bibliographically approved
James, S. K., Erlinge, D., Herlitz, J., Alfredsson, J., Koul, S., Fröbert, O., . . . Hofmann, R. (2019). Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation.. JACC: Cardiovascular Interventions, Article ID S1936-8798(19)31940-5.
Open this publication in new window or tab >>Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation.
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2019 (English)In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, article id S1936-8798(19)31940-5Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia.

BACKGROUND: In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 hours or ambient air.

METHODS: The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate.

RESULTS: The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35).

CONCLUSIONS: Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110).

Keywords
cardiovascular outcomes, myocardial infarction, oxygen therapy, randomized clinical trial, reactive oxygen species
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22388 (URN)10.1016/j.jcin.2019.09.016 (DOI)31838113 (PubMedID)
Available from: 2020-01-08 Created: 2020-01-08 Last updated: 2020-01-08Bibliographically approved
Bylow, H., Karlsson, T., Lepp, M., Claesson, A., Lindqvist, J. & Herlitz, J. (2019). Effectiveness of web-based education in addition to basic life support learning activities: A cluster randomised controlled trial.. PLoS ONE, 14(7), Article ID e0219341.
Open this publication in new window or tab >>Effectiveness of web-based education in addition to basic life support learning activities: A cluster randomised controlled trial.
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2019 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 7, article id e0219341Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Effective education in basic life support (BLS) may improve the early initiation of high-quality cardiopulmonary resuscitation and automated external defibrillation (CPR-AED).

AIM: To compare the learning outcome in terms of practical skills and knowledge of BLS after participating in learning activities related to BLS, with and without web-based education in cardiovascular diseases (CVD).

METHODS: Laymen (n = 2,623) were cluster randomised to either BLS education or to web-based education in CVD before BLS training. The participants were assessed by a questionnaire for theoretical knowledge and then by a simulated scenario for practical skills. The total score for practical skills in BLS six months after training was the primary outcome. The total score for practical skills directly after training, separate variables and self-assessed knowledge, confidence and willingness, directly and six months after training, were the secondary outcomes.

RESULTS: BLS with web-based education was more effective than BLS without web-based education and obtained a statistically significant higher total score for practical skills at six months (mean 58.8, SD 5.0 vs mean 58.0, SD 5.0; p = 0.03) and directly after training (mean 59.6, SD 4.8 vs mean 58.7, SD 4.9; p = 0.004).

CONCLUSION: A web-based education in CVD in addition to BLS training enhanced the learning outcome with a statistically significant higher total score for performed practical skills in BLS as compared to BLS training alone. However, in terms of the outcomes, the differences were minor, and the clinical relevance of our findings has a limited practical impact.

National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården; Människan i vården
Identifiers
urn:nbn:se:hb:diva-22158 (URN)10.1371/journal.pone.0219341 (DOI)000484951800027 ()31295275 (PubMedID)2-s2.0-85069704152 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-20Bibliographically approved
Wennberg, P., Möller, M., Herlitz, J. & Kenne Sarenmalm, E. (2019). Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures - effects on cognition.. BMC Geriatrics, 19(1), Article ID 252.
Open this publication in new window or tab >>Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures - effects on cognition.
2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, no 1, article id 252Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Impaired cognition is a major risk factor for perioperative delirium. It is essential to provide good pain control in patients with hip fractures and especially important in patients with severely impaired cognitive status, as they receive less pain medication, have poorer mobility, poorer quality of life and higher mortality than patients with intact cognition. The purpose of this study was to examine the association between preoperative pain management with nerve blocks and cognitive status in patients with hip fractures during the perioperative period.

METHODS: One hundred and twenty-seven patients with hip fractures participating in a double-blind, randomised, controlled trial were included in this study. At hospital admission, a low-dose fascia iliaca compartment block (FICB) was administered as a supplement to regular analgesia. Cognitive status was registered on arrival at hospital before FICB and on the first postoperative day using the Short Portable Mental Status Questionnaire.

RESULTS: Changes in cognitive status from arrival at hospital to the first postoperative day showed a positive, albeit not significant, trend in favour of the intervention group. The results also showed that patients with no or a moderate cognitive impairment received 50% more prehospital pain medication than patients with a severe cognitive impairment. FICB was well tolerated in patients with hip fractures.

CONCLUSION: Fascia iliaca compartment block given to patients with hip fractures did not affect cognitive status in this study. Patients with a cognitive impairment may receive inadequate pain relief after hip fracture and this discrimination needs to be addressed in further studies.

TRIAL REGISTRATION: EudraCT number 2008-004303-59 date of registration: 2008-10-24.

Keywords
Cognitive impairment, Cognitive status, Hip fractures, Nerve block, Pain, Pain management, Perioperative care
National Category
Orthopaedics
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22153 (URN)10.1186/s12877-019-1266-0 (DOI)000485322000002 ()31510918 (PubMedID)2-s2.0-85072099268 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-19Bibliographically approved
Djärv, T., Bremer, A., Herlitz, J., Lilja, G., Årestedt, K., Rawshani, A. & Cronstedt, T. (2019). Health related quality of life among survivors of out-of hospital cardiac arrest and in-hospital cardiac arrest - A National Population based Cohort Study. In: : . Paper presented at European Resuscitation Council, Ljubliana, September 19-21, 2019..
Open this publication in new window or tab >>Health related quality of life among survivors of out-of hospital cardiac arrest and in-hospital cardiac arrest - A National Population based Cohort Study
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22345 (URN)
Conference
European Resuscitation Council, Ljubliana, September 19-21, 2019.
Available from: 2019-12-31 Created: 2019-12-31 Last updated: 2020-01-10Bibliographically approved
Dyson, K., Brown, S. P., May, S., Smith, K., Koster, R. W., Beesems, S. G., . . . Nichol, G. (2019). International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template.. Resuscitation, 138, 168-181, Article ID S0300-9572(18)30957-2.
Open this publication in new window or tab >>International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template.
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 138, p. 168-181, article id S0300-9572(18)30957-2Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival.

METHODS: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232).

RESULTS: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival.

CONCLUSIONS: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

Keywords
Emergency Medical Services, Out-of-hospital cardiac arrest, Outcomes, Survival, Utstein
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården; Människan i vården
Identifiers
urn:nbn:se:hb:diva-22169 (URN)10.1016/j.resuscitation.2019.03.018 (DOI)000466837400026 ()30898569 (PubMedID)2-s2.0-85063343143 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2020-01-29Bibliographically approved
Alsholm, L., Axelsson, C., Andersson Hagiwara, M., Niva, M., Claesson, L., Herlitz, J., . . . Jood, K. (2019). Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.. Brain and Behavior, Article ID e01266.
Open this publication in new window or tab >>Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.
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2019 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, article id e01266Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA.

AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend.

METHODS: Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS.

RESULTS: Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache.

CONCLUSION: From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.

Keywords
EMS, stroke/TIA, transport
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-16016 (URN)10.1002/brb3.1266 (DOI)30980519 (PubMedID)2-s2.0-85065760015 (Scopus ID)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2020-01-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4139-6235

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