Change search
Link to record
Permanent link

Direct link
Lundgren, Peter
Publications (10 of 17) Show all publications
Jensen, E., Rentzhog, H., Herlitz, J., Axelsson, C. & Lundgren, P. (2024). Changes in temperature in preheated crystalloids at ambient temperatures relevant to a prehospital setting: an experimental simulation study with the application of prehospital treatment of trauma patients suffering from accidental hypothermia. BMC Emergency Medicine, 24(1), Article ID 59.
Open this publication in new window or tab >>Changes in temperature in preheated crystalloids at ambient temperatures relevant to a prehospital setting: an experimental simulation study with the application of prehospital treatment of trauma patients suffering from accidental hypothermia
Show others...
2024 (English)In: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 24, no 1, article id 59Article in journal (Refereed) Published
Abstract [en]

Background

Accidental hypothermia is common in all trauma patients and contributes to the lethal diamond, increasing both morbidity and mortality. In hypotensive shock, fluid resuscitation is recommended using fluids with a temperature of 37–42°, as fluid temperature can decrease the patient’s body temperature. In Sweden, virtually all prehospital services use preheated fluids. The aim of the present study was to investigate how the temperature of preheated infusion fluids is affected by the ambient temperatures and flow rates relevant for prehospital emergency care.

 

Methods

In this experimental simulation study, temperature changes in crystalloids preheated to 39 °C were evaluated. The fluid temperature changes were measured both in the infusion bag and at the patient end of the infusion system. Measurements were conducted in conditions relevant to prehospital emergency care, with ambient temperatures varying between − 4 and 28 °C and flow rates of 1000 ml/h and 6000 ml/h, through an uninsulated infusion set at a length of 175 cm.

 

Results

The flow rate and ambient temperature affected the temperature in the infusion fluid both in the infusion bag and at the patient end of the system. A lower ambient temperature and lower flow rate were both associated with a greater temperature loss in the infusion fluid.

 

Conclusion

This study shows that both a high infusion rate and a high ambient temperature are needed if an infusion fluid preheated to 39 °C is to remain above 37 °C when it reaches the patient using a 175-cm-long uninsulated infusion set. It is apparent that the lower the ambient temperature, the higher the flow rate needs to be to limit temperature loss of the fluid.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
National Category
Anesthesiology and Intensive Care Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-31784 (URN)10.1186/s12873-024-00969-0 (DOI)001201357600001 ()
Available from: 2024-04-29 Created: 2024-04-29 Last updated: 2024-04-29
Albert, M., Herlitz, J., Rawshani, A., Forsberg, S., Ringh, M., Hollenberg, J., . . . Nordberg, P. (2023). Aetiology and outcome in hospitalized cardiac arrest patients.. European Heart Journal Open, 3(4), Article ID oead066.
Open this publication in new window or tab >>Aetiology and outcome in hospitalized cardiac arrest patients.
Show others...
2023 (English)In: European Heart Journal Open, E-ISSN 2752-4191, Vol. 3, no 4, article id oead066Article in journal (Refereed) Published
Abstract [en]

AIMS: To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival.

METHODS AND RESULTS: Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13).

CONCLUSION: In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.

Keywords
AED, Aetiology, CPR, IHCA
National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care; The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-31214 (URN)10.1093/ehjopen/oead066 (DOI)37564102 (PubMedID)2-s2.0-85168924109 (Scopus ID)
Available from: 2024-01-11 Created: 2024-01-11 Last updated: 2024-02-01Bibliographically approved
Schierbeck, S., Nord, A., Svensson, L., Ringh, M., Nordberg, P., Hollenberg, J., . . . Claesson, A. (2023). Drone delivery of automated external defibrillators compared with ambulance arrival in real-life suspected out-of-hospital cardiac arrests: a prospective observational study in Sweden. The Lancet Digital Health, 5(12), e862-e871
Open this publication in new window or tab >>Drone delivery of automated external defibrillators compared with ambulance arrival in real-life suspected out-of-hospital cardiac arrests: a prospective observational study in Sweden
Show others...
2023 (English)In: The Lancet Digital Health, ISSN 2589-7500, Vol. 5, no 12, p. e862-e871Article in journal (Refereed) Published
Abstract [en]

Background: A novel approach to improve bystander defibrillation for out-of-hospital cardiac arrests is to dispatch and deliver an automated external defibrillator (AED) directly to the suspected cardiac arrest location by drone. The aim of this study was to investigate how often a drone could deliver an AED before ambulance arrival and to measure the median time benefit achieved by drone deliveries. Methods: In this prospective observational study, five AED-equipped drones were placed within two separate controlled airspaces in Sweden, covering approximately 200 000 inhabitants. Drones were dispatched in addition to standard emergency medical services for suspected out-of-hospital cardiac arrests and flight was autonomous. Alerts concerning children younger than 8 years, trauma, and emergency medical services-witnessed cases were not included. Exclusion criteria were air traffic control non-approval of flight, unfavourable weather conditions, no-delivery zones, and darkness. Data were collected from the dispatch centres, ambulance organisations, Swedish Registry for Cardiopulmonary Resuscitation, and the drone operator. Core outcomes were the percentage of cases for which an AED was delivered by a drone before ambulance arrival, and the median time difference (minutes and seconds) between AED delivery by drone and ambulance arrival. Explorative outcomes were percentage of attached drone-delivered AEDs before ambulance arrival and the percentage of cases defibrillated by a drone-delivered AED when it was used before ambulance arrival. Findings: During the study period (from April 21, 2021 to May 31, 2022), 211 suspected out-of-hospital cardiac arrest alerts occurred, and in 72 (34%) of those a drone was deployed. Among those, an AED was successfully delivered in 58 (81%) cases, and the major reason for non-delivery was cancellation by dispatch centre because the case was not an out-of-hospital cardiac arrest. In cases for which arrival times for both drone and ambulance were available (n=55), AED delivery by drone occurred before ambulance arrival in 37 cases (67%), with a median time benefit of 3 min and 14 s. Among these cases, 18 (49%) were true out-of-hospital cardiac arrests and a drone-delivered AED was attached in six cases (33%). Two (33%) had a shockable first rhythm and were defibrillated by a drone-delivered AED before ambulance arrival, with one person achieving 30-day survival. No adverse events occurred. AED delivery (not landing) was made within 15 m from the patient or building in 91% of the cases. Interpretation: AED-equipped drones dispatched in cases of suspected out-of-hospital cardiac arrests delivered AEDs before ambulance arrival in two thirds of cases, with a clinically relevant median time benefit of more than 3 min. This intervention could potentially decrease time to attachment of an AED, before ambulance arrival. Funding: Swedish Heart Lung Foundation. © 2023 The Author(s). 

National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-31003 (URN)10.1016/s2589-7500(23)00161-9 (DOI)001124282400001 ()2-s2.0-85177787238 (Scopus ID)
Available from: 2023-12-13 Created: 2023-12-13 Last updated: 2024-01-08Bibliographically approved
Berglund, E., Hollenberg, J., Jonsson, M., Svensson, L., Claesson, A., Nord, A., . . . Ringh, M. (2023). Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests: The SAMBA Randomized Clinical Trial. JAMA cardiology, 8(1), 81-88
Open this publication in new window or tab >>Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests: The SAMBA Randomized Clinical Trial
Show others...
2023 (English)In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 8, no 1, p. 81-88Article in journal (Refereed) Published
Abstract [en]

Importance  Smartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs).

Objective  To evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR).

Design, Setting, and Participants  This randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services.

Interventions  Volunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR.

Main Outcomes and Measures  Overall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application.

Results  Volunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, −0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR.

Conclusions and Relevance  In this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant.

Trial Registration  ClinicalTrials.gov Identifier: NCT02992873

National Category
Nursing
Research subject
The Human Perspective in Care; The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29460 (URN)10.1001/jamacardio.2022.4362 (DOI)000919577800016 ()2-s2.0-85146193060 (Scopus ID)
Available from: 2023-02-20 Created: 2023-02-20 Last updated: 2024-02-01Bibliographically approved
Hessulf, F., Bhatt, D. L., Engdahl, J., Lundgren, P., Omerovic, E., Rawshani, A., . . . Rawshani, A. (2023). Predicting survival and neurological outcome in out-of-hospital cardiac arrest using machine learning: the SCARS model. eBioMedicine, 89, Article ID 104464.
Open this publication in new window or tab >>Predicting survival and neurological outcome in out-of-hospital cardiac arrest using machine learning: the SCARS model
Show others...
2023 (English)In: eBioMedicine, ISSN 2352-3964, Vol. 89, article id 104464Article in journal (Refereed) Published
Abstract [en]

Background: A prediction model that estimates survival and neurological outcome in out-of-hospital cardiac arrest patients has the potential to improve clinical management in emergency rooms.

Methods: We used the Swedish Registry for Cardiopulmonary Resuscitation to study all out-of-hospital cardiac arrest (OHCA) cases in Sweden from 2010 to 2020. We had 393 candidate predictors describing the circumstances at cardiac arrest, critical time intervals, patient demographics, initial presentation, spatiotemporal data, socioeconomic status, medications, and comorbidities before arrest. To develop, evaluate and test an array of prediction models, we created stratified (on the outcome measure) random samples of our study population. We created a training set (60% of data), evaluation set (20% of data), and test set (20% of data). We assessed the 30-day survival and cerebral performance category (CPC) score at discharge using several machine learning frameworks with hyperparameter tuning. Parsimonious models with the top 1 to 20 strongest predictors were tested. We calibrated the decision threshold to assess the cut-off yielding 95% sensitivity for survival. The final model was deployed as a web application.

Findings: We included 55,615 cases of OHCA. Initial presentation, prehospital interventions, and critical time intervals variables were the most important. At a sensitivity of 95%, specificity was 89%, positive predictive value 52%, and negative predictive value 99% in test data to predict 30-day survival. The area under the receiver characteristic curve was 0.97 in test data using all 393 predictors or only the ten most important predictors. The final model showed excellent calibration. The web application allowed for near-instantaneous survival calculations.

Interpretation: Thirty-day survival and neurological outcome in OHCA can rapidly and reliably be estimated during ongoing cardiopulmonary resuscitation in the emergency room using a machine learning model incorporating widely available variables.

Keywords
Machine learning, Out-of-hospital cardiac arrest, Prediction model, Web application
National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29456 (URN)10.1016/j.ebiom.2023.104464 (DOI)2-s2.0-85147657303 (Scopus ID)
Funder
Swedish Research Council, 2019–02019
Note

Funding: Swedish Research Council (2019–02019); Swedish state under the agreement between the Swedish government, and the county councils (ALFGBG-971482); The Wallenberg Centre for Molecular and Translational Medicine

Available from: 2023-02-20 Created: 2023-02-20 Last updated: 2024-02-01Bibliographically approved
Jerkeman, M., Lundgren, P., Omerovic, E., Strömsöe, A., Riva, G., Hollenberg, J., . . . Rawshani, A. (2022). Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study. Resuscitation Plus, 10, Article ID 100245.
Open this publication in new window or tab >>Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study
Show others...
2022 (English)In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 10, article id 100245Article in journal (Refereed) Published
Abstract [en]

Aim

In the event of an out of hospital cardiac arrest (OHCA) it is recommended for a sole untrained bystander to perform compression only CPR (CO-CPR). However, it remains unknown if CO-CPR is inferior to standard CPR (S-CPR), including both compressions and ventilation, in terms of survival. One could speculate that due to the current pandemic, bystanders may be more hesitant performing mouth-to-mouth ventilation. The aim of this study is to assess the association between type of bystander CPR and survival in OHCA.

Methods

This study included all patients with a bystander treated OHCA between year 2015–2019 in ages 18–100 using The Swedish Registry for Cardiopulmonary Resuscitation (SRCR). We compared CO-CPR to S-CPR in terms of 30-day survival using a propensity score approach based on machine learning adjusting for a large number of covariates.

Results

A total of 13,481 patients were included (5,293 with S-CPR and 8,188 with CO-CPR). The matched subgroup consisted of 2994 cases in each group.

Gradient boosting were the best models with regards to predictive accuracy (for type of bystander CPR) and covariate balance. The difference between S-CPR and CO-CPR in all 30 models computed on covariate adjustment and 1-to-1 matching were non-significant. In the 30 weighted models, three comparisons (S-CPR vs. CO-CPR) were significant in terms of improved survival; odds ratio for men was 1.21 (99% confidence interval (CI) 1.02–1.43; Average treatment effect (ATE)); for patients ≥73 years 1.57 (99% CI 1.17–2.12) for Average treatment effect on treated (ATT) and 1.63 (99% CI 1.18–2.25) for ATE. Remaining 27 models showed no differences. No significances remain after adjustment for multiple testing.

Conclusion

We found no significant differences between S-CPR and CO-CPR in terms of survival, supporting current recommendations for untrained bystanders regarding CO-CPR.

Keywords
Cardiac arrest, OHCA, Compression only CPR
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-28236 (URN)10.1016/j.resplu.2022.100245 (DOI)000817005700001 ()9207566 (PubMedID)2-s2.0-85131969594 (Scopus ID)
Funder
Swedish Research Council, 2019-02019Swedish Heart Lung Foundation, 20200261
Note

Also funded by: Swedish state under the agreement between the Swedish government and he county councils (ALFGBG-971482)

Available from: 2022-07-08 Created: 2022-07-08 Last updated: 2023-01-18Bibliographically approved
Schierbeck, S., Hollenberg, J., Nord, A., Svensson, L., Nordberg, P., Ringh, M., . . . Claesson, A. (2022). Automated external defibrillators delivered by drones to patients with suspected out-of-hospital cardiac arrest. European Heart Journal, 1478-1487
Open this publication in new window or tab >>Automated external defibrillators delivered by drones to patients with suspected out-of-hospital cardiac arrest
Show others...
2022 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, p. 1478-1487Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims Early defibrillation is critical for the chance of survival in out-of-hospital cardiac arrest (OHCA). Drones, used to deliver automated external defibrillators (AEDs), may shorten time to defibrillation, but this has never been evaluated in real-life emergencies. The aim of this study was to investigate the feasibility of AED delivery by drones in real-life cases of OHCA. Methods and results In this prospective clinical trial, three AED-equipped drones were placed within controlled airspace in Sweden, covering approximately 80 000 inhabitants (125 km(2)). Drones were integrated in the emergency medical services for automated deployment in beyond-visual-line-of-sight flights: (i) test flights from 1 June to 30 September 2020 and (ii) consecutive real-life suspected OHCAs. Primary outcome was the proportion of successful AED deliveries when drones were dispatched in cases of suspected OHCA. Among secondary outcomes was the proportion of cases where AED drones arrived prior to ambulance and time benefit vs. ambulance. Totally, 14 cases were eligible for dispatch during the study period in which AED drones took off in 12 alerts to suspected OHCA, with a median distance to location of 3.1 km [interquartile range (IQR) 2.8-3.4). AED delivery was feasible within 9 m (IQR 7.5-10.5) from the location and successful in 11 alerts (92%). AED drones arrived prior to ambulances in 64%, with a median time benefit of 01:52 min (IQR 01:35-04:54) when drone arrived first. In an additional 61 test flights, the AED delivery success rate was 90% (55/61). Conclusion In this pilot study, we have shown that AEDs can be carried by drones to real-life cases of OHCA with a successful AED delivery rate of 92%. There was a time benefit as compared to emergency medical services in cases where the drone arrived first. However, further improvements are needed to increase dispatch rate and time benefits.

Keywords
OHCA, AED, UAV, Drone, PUBLIC-ACCESS DEFIBRILLATION, BASIC LIFE-SUPPORT, CARDIOPULMONARY-RESUSCITATION, SURVIVAL, OUTCOMES, GUIDELINES, defibrillator, automatic externalout-of-hospital cardiac arrestunmanned aerial devices
National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-27670 (URN)10.1093/eurheartj/ehab498 (DOI)000767704800001 ()2-s2.0-85128489416 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20180418
Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2023-01-18Bibliographically approved
Högstedt, Å., Thuccani, M., Carlstrom, E., Claesson, A., Bremer, A., Ravn-Fischer, A., . . . Lundgren, P. (2022). Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1)
Open this publication in new window or tab >>Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests
Show others...
2022 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1Article in journal (Refereed) Published
Abstract [en]

Background: There has been in increase in the use of systems for organizing lay responders for suspected out-of-hospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people's commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. Methods: In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey "Volunteer Motivation Inventory" (VMI). The statements in the VMI, ranked on a Likert scale (1-5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. Results: A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). Conclusion: This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment.

Keywords
Volunteer, Lay volunteer, Lay responder, OHCA, Bystander, CPR, AED, Motivation, Self-determination theory, CARDIOPULMONARY-RESUSCITATION, TRAINED VOLUNTEERS, COMMUNITY, SURVIVAL, WORLD, RATES, LIFE
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hb:diva-27718 (URN)10.1186/s13049-022-01009-1 (DOI)000772810500001 ()2-s2.0-85127067302 (Scopus ID)
Note

Times Cited in Web of Science Core Collection: 0 Total Times Cited: 0 Cited Reference Count: 41

Available from: 2022-04-04 Created: 2022-04-04 Last updated: 2024-01-17Bibliographically approved
Henningsson, A., Lannemyr, L., Angerås, O., Björås, J., Bergh, N., Herlitz, J., . . . Lundgren, P. (2022). Prehospital monitoring of cerebral circulation during out of hospital cardiac arrest ?: A feasibility study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1), Article ID 62.
Open this publication in new window or tab >>Prehospital monitoring of cerebral circulation during out of hospital cardiac arrest ?: A feasibility study
Show others...
2022 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1, article id 62Article in journal (Refereed) Published
Abstract [en]

Background

About two-thirds of the in-hospital deaths after out-of-hospital cardiac arrests (OHCA) are a consequence of anoxic brain injuries, which are due to hypoperfusion of the brain during the cardiac arrests. Being able to monitor cerebral perfusion during cardiopulmonary resuscitation (CPR) is desirable to evaluate the effectiveness of the CPR and to guide further decision making and prognostication.

Methods

Two different devices were used to measure regional cerebral oxygen saturation (rSO2): INVOS™ 5100 (Medtronic, Minneapolis, MN, USA) and Root® O3 (Masimo Corporation, Irvine, CA, USA). At the scene of the OHCA, advanced life support (ALS) was immediately initiated by the Emergency Medical Services (EMS) personnel. Sensors for measuring rSO2 were applied at the scene or during transportation to the hospital. rSO2 values were documented manually together with ETCO2 (end tidal carbon dioxide) on a worksheet specially designed for this study. The study worksheet also included a questionnaire for the EMS personnel with one statement on usability regarding potential interference with ALS.

Results

Twenty-seven patients were included in the statistical analyses. In the INVOS™5100 group (n = 13), the mean rSO2 was 54% (95% CI 40.3–67.7) for patients achieving a return of spontaneous circulation (ROSC) and 28% (95% CI 12.3–43.7) for patients not achieving ROSC (p = 0.04). In the Root® O3 group (n = 14), the mean rSO2 was 50% (95% CI 46.5–53.5) and 41% (95% CI 36.3–45.7) (p = 0.02) for ROSC and no ROSC, respectively. ETCO2 values were not statistically different between the groups. The EMS personnel graded the statement of interference with ALS to a median of 2 (IQR 1–6) on a 10-point Numerical Rating Scale.

Conclusion

Our results suggest that both INVOS™5100 and ROOT® O3 can distinguish between ROSC and no ROSC in OHCA, and both could be used in the pre-hospital setting and during transport with minimal interference with ALS.

 

Keywords
Cardiac arrest, Cerebral oximetry, EMS, Regional cerebral oxygen saturation
National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29103 (URN)10.1186/s13049-022-01044-y (DOI)000912613800001 ()2-s2.0-85143168412 (Scopus ID)
Funder
Region Västra Götaland, Västra Götalandsregionen
Available from: 2022-12-12 Created: 2022-12-12 Last updated: 2024-01-17Bibliographically approved
Thuccani, M., Rawshani, A., Skoglund, K., Bergh, N., Nordberg, P., Albert, M., . . . Lundgren, P. (2022). The association between signs of medical distress preceding in-hospital cardiac arrest and 30-day survival: A register-based cohort study. Resuscitation Plus, 11, Article ID 100289.
Open this publication in new window or tab >>The association between signs of medical distress preceding in-hospital cardiac arrest and 30-day survival: A register-based cohort study
Show others...
2022 (English)In: Resuscitation Plus, ISSN 2666-5204, Vol. 11, article id 100289Article in journal (Refereed) Published
Abstract [en]

Background: Identifying signs of medical distress prior to in-hospital cardiac arrest (IHCA) is important to prevent IHCA and improve survival. The primary objective of this study was to investigate the association between signs of medical distress present within 60 minutes prior to cardiac arrest and survival after cardiac arrest.

Methods: The register-based cohort study included adult patients (≥18 years) with IHCA in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) from 2017-01-01 to 2020-07-15. Signs of distress prior to IHCA were defined as the medical signs arrhythmia, pulmonary oedema, hypotension, hypoxia or seizures present within 60 minutes prior to cardiac arrest (pre-arrest signs). Using multivariable logistic regression, the association between these pre-arrest signs and 30-day survival was analysed in both unadjusted and adjusted models. The covariates used were demographics, comorbidities, characteristics and treatment of cardiac arrest.

Results: In total, 8525 patients were included. After adjusting for covariates, patients with arrhythmia had a 58% higher probability of 30-day survival. The adjusted probability of 30-day survival was 41% and 52% lower for patients with hypotension and hypoxia prior to IHCA, respectively. Pulmonary oedema and seizures were not associated with any change in 30-day survival.

Conclusions: Among signs of medical distress prior to in-hospital cardiac arrest, arrhythmia was associated with a higher 30-day survival. Hypotension and hypoxia were associated with lower survival after IHCA. These findings indicate that future research on survival after cardiac arrest should take pre-arrest signs into account as it impacts the prerequisites for survival.

 

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Epidemiology, In-hospital cardiac arrest, Outcome
National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29228 (URN)10.1016/j.resplu.2022.100289 (DOI)000848226000002 ()PMC9395656 (PubMedID)2-s2.0-85135771766 (Scopus ID)
Available from: 2023-01-11 Created: 2023-01-11 Last updated: 2023-01-13Bibliographically approved
Organisations

Search in DiVA

Show all publications