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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)31125581 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
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)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-07Bibliographically 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)31295275 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
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)31510918 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
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)30898569 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
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)
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-29Bibliographically approved
Viktorisson, A., Sunnerhagen, K. S., Johansson, D., Herlitz, J. & Axelsson, Å. (2019). One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest.. BMJ Open, 9(7), Article ID e029756.
Open this publication in new window or tab >>One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest.
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e029756Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Few studies have investigated the psychological and health-related outcome after out-of-hospital cardiac arrest (OHCA) over time. This longitudinal study aims to evaluate psychological distress in terms of anxiety and depression, self-assessed health and predictors of these outcomes in survivors of OHCA, 3 and 12 months after resuscitation.

METHODS: Recruitment took place from 2008 to 2011 and survivors of OHCA were identified through the national Swedish Cardiopulmonary Resuscitation Registry. Inclusion criteria were age ≥18 years, survival ≥12 months and a Cerebral Performance Category score ≤2. Questionnaires containing the Hospital Anxiety and Depression Scale and European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) were administered at 3 and 12 months after the OHCA. Participants were also asked to report treatment-requiring comorbidities.

RESULTS: Of 298 survivors, 85 (29%) were eligible for this study and 74 (25%) responded. Clinically relevant anxiety was reported by 22 survivors at 3 months and by 17 at 12 months, while clinical depression was reported by 10 at 3 months and 4 at 12 months. The mean EQ-5D-3L index value increased from 0.82 (±0.26) to 0.88 (±0.15) over time. There were significantly less symptoms of psychological distress (p=0.01) and better self-assessed health (p=0.003) at 12 months. Treatment-requiring comorbidity predicted anxiety (OR 4.07, p=0.04), while being female and young age predicted poor health (OR 6.33, p=0.04; OR 0.91, p=0.002) at 3 months. At 12 months, being female was linked to anxiety (OR 9.23, p=0.01) and depression (OR 14.78, p=0.002), while young age predicted poor health (OR 0.93, p=0.003).

CONCLUSION: The level of psychological distress and self-assessed health improves among survivors of OHCA between 3 and 12 months after resuscitation. Higher levels of psychological distress can be expected among female survivors and those with comorbidity, while survivors of young age and who are female are at greater risk of poor health.

Keywords
anxiety, cardiac arrest, follow-up, outcome, quality of life
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22159 (URN)10.1136/bmjopen-2019-029756 (DOI)31272987 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
Frisk Torell, M., Strömsöe, A., Herlitz, J., Claesson, A., Svensson, L. & Börjesson, M. (2019). Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.. PLoS ONE, 14(2), Article ID e0211723.
Open this publication in new window or tab >>Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.
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2019 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 2, article id e0211723Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas.

METHODS: Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs.

RESULTS: 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009).

CONCLUSION: The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.

National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22172 (URN)10.1371/journal.pone.0211723 (DOI)30707745 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
Nyström, T., James, S. K., Lindahl, B., Östlund, O., Erlinge, D., Herlitz, J., . . . Hofmann, R. (2019). Oxygen Therapy in Myocardial Infarction Patients With or Without Diabetes: A Predefined Subgroup Analysis From the DETO2X-AMI Trial.. Diabetes Care, 42(11), 2032-2041
Open this publication in new window or tab >>Oxygen Therapy in Myocardial Infarction Patients With or Without Diabetes: A Predefined Subgroup Analysis From the DETO2X-AMI Trial.
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2019 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 11, p. 2032-2041Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To determine the effects of oxygen therapy in myocardial infarction (MI) patients with and without diabetes.

RESEARCH DESIGN AND METHODS: In the Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction (DETO2X-AMI) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 L/min for 6-12 h or ambient air. In this prespecified analysis involving 5,010 patients with confirmed MI, 934 had known diabetes. Oxidative stress may be of particular importance in diabetes, and the primary objective was to study the effect of supplemental oxygen on the composite of all-cause death and rehospitalization with MI or heart failure (HF) at 1 year in patients with and without diabetes.

RESULTS: = 0.81). There was no statistically significant difference for the individual components of the composite end point or the rate of cardiovascular death up to 1 year. Likewise, corresponding end points in patients without diabetes were similar between the treatment groups.

CONCLUSIONS: Despite markedly higher event rates in patients with MI and diabetes, oxygen therapy did not significantly affect 1-year all-cause death, cardiovascular death, or rehospitalization with MI or HF, irrespective of underlying diabetes, in line with the results of the entire study.

National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22154 (URN)10.2337/dc19-0590 (DOI)31473600 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
Andell, P., James, S., Östlund, O., Yndigegn, T., Sparv, D., Pernow, J., . . . Hofmann, R. (2019). Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial.. European heart journal. Acute cardiovascular care, Article ID 2048872619848978.
Open this publication in new window or tab >>Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial.
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2019 (English)In: European heart journal. Acute cardiovascular care, ISSN 2048-8734, article id 2048872619848978Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction.

METHODS AND RESULTS: =0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions.

CONCLUSIONS: Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings.

CLINICAL TRIALS REGISTRATION: NCT02290080.

Keywords
Acute myocardial infarction, chronic obstructive pulmonary disease, oxygen, registry-based randomised clinical trial
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22161 (URN)10.1177/2048872619848978 (DOI)31081342 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4139-6235

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