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  • 1. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    Växjö University.
    Beleuguered by technology: Care in technologically intense environments2008In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 9, no 1, p. 55-61Article in journal (Refereed)
    Abstract [en]

    Modern technology has enabled the use of new forms of information in the care of critically ill patients. In intensive care units (ICUs), technology can simultaneously reduce the lived experience of illness and magnify the objective dimensions of patient care. The aim of this study, based upon two empirical studies, is to find from a philosophical point of view a more comprehensive understanding for the dominance of technology within intensive care. Along with caring for critically ill patients, technology is part of the ICU staff's everyday life. Both technology and caring relationships are of indispensable value. Tools are useful, but technology can never replace the closeness and empathy of the human touch. It is a question of harmonizing the demands of subjectivity with objective signs. The challenge for caregivers in ICU is to know when to heighten the importance of the objective and measurable dimensions provided by technology and when to magnify the patients’ lived experiences, and to live and deal with the ambiguity of the technical dimension of care and the human side of nursing.

  • 2. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    Växjö University.
    Of vigilance and invisibility: being a patient in technologically intense environments2007In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 12, no 3, p. 151-158Article in journal (Refereed)
    Abstract [en]

    Equipment and procedures developed during the past several decades have made the modern intensive care unit (ICU) the hospital’s most technologically advanced environment. In terms of patient care, are these advances unmitigated gains? This study aimed to develop a knowledge base of what it means to be critically ill or injured and cared for in technologically intense environments. A lifeworld perspective guided the investigation. Nine unstructured interviews with intensive care patients comprise its data. The qualitative picture uncovered by a phenomenological analysis shows that contradiction and ambivalence characterized the entire care episode. The threat of death overshadows everything and perforates the patient’s existence. Four inter-related constituents further elucidated the patients’ experiences: the confrontation with death, the encounter with forced dependency, an incomprehensible environment and the ambiguity of being an object of clinical vigilance but invisible at the personal level. Neglect of these issues lead to alienating ‘moments’ that compromised care. Fixed at the end of a one-eyed clinical gaze, patients described feeling marginalized, subjected to rituals of power, a stranger cared for by a stranger. The roar of technology silences the shifting needs of ill people, muffles the whispers of death and compromises the competence of the caregivers. This study challenges today’s caregiving system to develop double vision that would balance clinical competence with a holistic, integrated and comprehensive approach to care. Under such vision, subjectivity and objectivity would be equally honoured, and the broken bonds re-forged between techne, ‘the act of nursing’, and poesis, ‘the art of nursing’.

  • 3.
    Bergström, Mattias
    et al.
    Lund University.
    Schmidbauer, Simon
    Lund University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    University of Gothenburg.
    Friberg, Hans
    Lund University.
    Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 133, p. 147-152, article id S0300-9572(18)31010-4Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm.

    METHODS: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990-2016 were analyzed.

    RESULTS: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26-1.88).

    CONCLUSION: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.

  • 4.
    Djarv, T
    et al.
    Karolinska University Hospital.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Stromsoe, A
    Mälardalen University.
    Israelsson, J
    Linnaeus University.
    Claesson, A
    Linköping University.
    Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA).

    METHODS: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used.

    RESULTS: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p < 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively).

    DISCUSSION: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR.

    CONCLUSION: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

  • 5.
    Elfwén, Ludvig
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute.
    Lagedal, Rickard
    Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University.
    James, Stefan
    Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology.
    Jonsson, Martin
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Jensen, Ulf
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute.
    Ringh, Mattias
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Claesson, Andreas
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Oldgren, Jonas
    Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rubertsson, Sten
    Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University.
    Nordberg, Per
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival.2018In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 200, p. 90-95, article id S0002-8703(18)30081-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The potential benefit of early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST elevation on ECG is unclear. The aim of this study was to evaluate the association between early coronary angiography and survival in these patients.

    METHODS: Nationwide observational study between 2008 and 2013. Included were patients admitted to hospital after witnessed OHCA, with shockable rhythm, age 18 to 80 years and unconscious. Patients with ST-elevation on ECG were excluded. Patients that underwent early CAG (within 24 hours) were compared with no early CAG (later during the hospital stay or not at all). Outcomes were survival at 30 days, 1 year, and 3 years. Multivariate analysis included pre-hospital factors, comorbidity and ECG-findings.

    RESULTS: In total, 799 OHCA patients fulfilled the inclusion criteria, of which 275 (34%) received early CAG versus 524 (66%) with no early CAG. In the early CAG group, the proportion of patients with an occluded coronary artery was 27% and 70% had at least one significant coronary stenosis (defined as narrowing of coronary lumen diameter of ≥50%). The 30-day survival rate was 65% in early CAG group versus 52% with no early CAG (P < .001). The adjusted OR was 1.42 (95% CI 1.00-2.02). The one-year survival rate was 62% in the early CAG group versus 48% in the no early CAG group with the adjusted hazard ratio of 1.35 (95% CI 1.04-1.77).

    CONCLUSION: In this population of bystander-witnessed cases of out-of-hospital cardiac arrest with shockable rhythm and ECG without ST elevation, early coronary angiography may be associated with improved short and long term survival.

  • 6.
    Henricson, Maria
    University of Borås, School of Health Science.
    Tactile touch in intensive care: Nurses’ preparation, patients’ experiences and the effect on stress parameters2008Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.

  • 7.
    Hirlekar, Geir
    et al.
    Department of Cardiology, Sahlgrenska University Hospital.
    Jonsson, Martin
    Karolinska Institutet, Department of Medicine, Centre for Resuscitation Science.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Hollenberg, Jacob
    Karolinska Institutet, Department of Medicine, Centre for Resuscitation Science.
    Albertsson, Per
    Department of Cardiology, Sahlgrenska University Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Analysis of data for comorbidity and survival in out-of-hospital cardiac arrest.2018In: Data in Brief, E-ISSN 2352-3409, Vol. 21, p. 1541-1551Article in journal (Refereed)
    Abstract [en]

    The data presented in this article is supplementary to the research article titled "Comorbidity and survival in out-of-hospital cardiac arrest" (Hirlekar et al., 2018). The data contains information of how Charlson Comorbidity Index (CCI) is calculated and coded from ICD-10 codes. Multivariable logistic regression was used in the analysis of association between comorbidity and return of spontaneous circulation. We present baseline characteristics of patients found in VF/VT. All patients with non-missing data on all baseline variables are analyzed separately. We compare the baseline characteristics of patients with and without complete data set. Analysis of when comorbidity was identified in relation to outcome is also shown.

  • 8.
    Hirlekar, Geir
    et al.
    Department of Cardiology, Sahlgrenska University Hospital.
    Jonsson, Martin
    Karolinska Institutet, Department of Medicine, Centre for Resuscitation Science.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Hollenberg, Jacob
    Karolinska Institutet, Department of Medicine, Centre for Resuscitation Science.
    Albertsson, Per
    Department of Cardiology, Sahlgrenska University Hospital.
    Herlitz, Johan
    Comorbidity and survival in out-of-hospital cardiac arrest.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 133, p. 118-123, article id S0300-9572(18)30988-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients suffering out-of-hospital cardiac arrest (OHCA) have a poor prognosis but survival among subgroups differs greatly. Previous studies have shown conflicting results on whether patient comorbidity affects outcome. The aim of this national study was to investigate the effect of comorbidity on outcome after OHCA in Sweden.

    METHODS: We included all patients with bystander-witnessed OHCA from 2011 to 2015 in the national Swedish Registry of Cardiopulmonary Resuscitation. In order to assess comorbidity, the database was merged with the comprehensive National Patient Registry, which includes all out-patient and in-patient care in Sweden. The Charlson comorbidity index (CCI) and the specific comorbidity conditions constituting the CCI was used to identify whether comorbidity was associated with outcome.

    RESULTS: A total of 12,012 patients were included in the study. Of these, 1598 patients survived to 30 days (13%). The most common comorbidities were a history of congestive heart failure (29%), myocardial infarction (24%), and diabetes without complications (23%). Renal disease (odds ratio [OR] 0.53; 95% CI 0.53‒0.72), diabetes with complications (OR 0.65; 95% CI 0.49‒0.84), diabetes without complications (OR 0.63; 95% CI 0.52‒0.75), congestive heart failure (OR 0.84; 95% CI 0.71‒0.99), and metastatic carcinoma (OR 0.61; 95% CI 0.40‒0.93) were significantly associated with a reduced chance of 30-day survival when adjusted for demographic characteristics and also resuscitation-associated factors such as shockable initial rhythm, bystander cardiopulmonary resuscitation (CPR), and place of arrest. With increasing comorbidity, the chance of 30-day survival decreased: adjusted OR was 0.82 (59% CI 0.68-0.99) for CCI 3-4, 0.62 (95% CI 0.47-0.83) for CCI 5-6, and 0.51 (95% CI 0.36-0.72) for CCI > 6, respectively, all in relation to those with CCI 0-2. Additionally, increasing morbidity was associated with reduced odds of return of spontaneous circulation (ROSC) and ROSC at hospital admission.

    CONCLUSION: This large national study showed that increasing comorbidity decreased the chance of survival to 30 days in OHCA. This association remained after covariate adjustment.

  • 9.
    Jonsson, Martin
    et al.
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Härkönen, Juho
    Department of Political and Social Sciences, European University Institute.
    Ljungman, Petter
    Institute of Environmental Medicine, Karolinska Institutet.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Gothenburg University.
    Nordberg, Per
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Svensson, Leif
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Hollenberg, Jacob
    Center for Resuscitation Science, Department for Medicine, Karolinska Institutet.
    Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status.2018In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, article id heartjnl-2018-313838Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world. In this study we aimed to investigate the relationship between area-level socioeconomic status (SES) and 30-day survival after OHCA. We hypothesised that high SES at an area level is associated with an improved chance of 30-day survival.

    METHODS: Patients with OHCA in Stockholm County between 1 January 2006 and 31 December 2015 were analysed retrospectively. To quantify area-level SES, we linked the patient's home address to 250 × 250/1000 × 1000 meter grids with aggregated information about income and education. We constructed multivariable logistic regression models in which area-level SES measures were adjusted for age, sex, emergency medical services response time, witnessed status, initial rhythm, aetiology, location and year of cardiac arrest.

    RESULTS: We included 7431 OHCAs. There was significantly greater 30-day survival (p=0.003) in areas with a high proportion of university-educated people. No statistically significant association was seen between median disposable income and 30-day survival. The adjusted OR for 30-day survival among patients in the highest educational quintile was 1.70 (95% CI 1.15 to 2.51) compared with patients in the lowest educational quintile. We found no significant interaction for sex. Positive trend with increasing area-level education was seen in both men and women but the trend was only statistically significant among men (p=0.012) CONCLUSIONS: Survival to 30 days after OHCA is positively associated with the average educational level of the residential area. Area-level income does not independently predict 30-day survival after OHCA.

  • 10.
    Maurer, H
    et al.
    University Hospital Schleswig-Holstein.
    Masterson, S
    National University of Ireland Galway.
    Tjelmeland, I B
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS).
    Gräsner, J T
    University Hospital Schleswig-Holstein.
    Lefering, R
    Institute for Research in Operative Medicine, Faculty of Medicine, University Witten/Herdecke.
    Böttiger, B W
    University Hospital of Cologne.
    Bossaert, L
    University of Antwerp.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Koster, R
    Academic Medical Center.
    Rosell-Ortiz, F
    Empresa Pública de Emergencias Sanitarias.
    Perkins, G D
    University of Warwick and Heartlands Hospital.
    Wnent, J
    When is a bystander not a bystander any more? A European Survey.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, article id S0300-9572(18)30979-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There is international variation in the rates of bystander cardiopulmonary resuscitation (CPR). 'Bystander CPR' is defined in the Utstein definitions, however, differences in interpretation may contribute to the variation reported. The aim of this cross-sectional survey was to understand how the term 'bystander CPR' is interpreted in Emergency Medical Service (EMS) across Europe, and to contribute to a better definition of 'bystander' for future reference.

    METHODS: During analysis of the EuReCa ONE study, uncertainty about the definition of a 'bystander' emerged. Sixty scenarios were developed, addressing the interpretation of 'bystander CPR'. An electronic version of the survey was sent to 27 EuReCa National Coordinators, who distributed it to EMS representatives in their countries. Results were descriptively analysed.

    RESULTS: 362 questionnaires were received from 23 countries. In scenarios where a layperson arrived on scene by chance and provided CPR, up to 95% of the participants agreed that 'bystander CPR' had been performed. In scenarios that included community response systems, firefighters and/or police personnel, the percentage of agreement that 'bystander CPR' had been performed ranged widely from 16% to 91%. Even in scenarios that explicitly matched examples provided in the Utstein template there was disagreement on the definition.

    CONCLUSION: In this survey, the interpretation of 'bystander CPR' varied, particularly when community response systems including laypersons, firefighters, and/or police personnel were involved. It is suggested that the definition of 'bystander CPR' should be revised to reflect changes in treatment of OHCA, and that CPR before arrival of EMS is more accurately described.

  • 11.
    Piscator, Eva
    et al.
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Karolinska University Hospital.
    Göransson, Katarina
    Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Karolinska University Hospital.
    Bruchfeld, Samuel
    Function of Emergency Medicine Karolinska University Hospital.
    Hammar, Ulf
    Institute of Environmental Medicine (IMM), Biostatistics, Karolinska Institutet.
    El Gharbi, Sara
    Function of Emergency Medicine Karolinska University Hospital.
    Ebell, Mark
    Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Djärv, Therese
    Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Karolinska University Hospital.
    Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 128, p. 63-69, article id S0300-9572(18)30207-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting.

    METHODS: The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013-2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot.

    RESULTS: The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78-0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival.

    CONCLUSION: The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

  • 12.
    Ringh, M
    et al.
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Hollenberg, J
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Palsgaard-Moeller, T
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Svensson, L
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Rosenqvist, M
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Lippert, F K
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Wissenberg, M
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Malta Hansen, C
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Claesson, A
    Department for Medicine, Center for Resuscitation Science, Karolinska Institutet.
    Viereck, S
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Zijlstra, J A
    Department of Cardiology, Heart Center, Academic Medical Center.
    Koster, R W
    Department of Cardiology, Heart Center, Academic Medical Center.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Blom, M T
    Department of Cardiology, Heart Center, Academic Medical Center.
    Kramer-Johansen, J
    Department of Anaesthesiology Oslo University Hospital and University of Oslo.
    Tan, H L
    Department of Cardiology, Heart Center, Academic Medical Center.
    Beesems, S G
    Department of Cardiology, Heart Center, Academic Medical Center,.
    Hulleman, M
    Department of Cardiology, Heart Center, Academic Medical Center.
    Olasveengen, T M
    Department of Anaesthesiology Oslo University Hospital and University of Oslo.
    Folke, F
    Emergency Medical Services Copenhagen, University of Copenhagen.
    The challenges and possibilities of public access defibrillation.2018In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 3, p. 238-256Article in journal (Refereed)
    Abstract [en]

    Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.

  • 13.
    Viktorisson, Adam
    et al.
    1 Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg.
    Sunnerhagen, Katharina S
    Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg.
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Åsa B
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Well-being among survivors of out-of-hospital cardiac arrest: a cross-sectional retrospective study in Sweden.2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e021729Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The psychological outcome of out-of-hospital cardiac arrest (OHCA) has been studied more extensively in recent years. Still, not much is known about the well-being among OHCA survivors. In this retrospective cross-sectional study, we aim to investigate post-OHCA well-being among patients with a good neurological outcome, 3 months after the cardiac event. To assess well-being, we analyse the frequency of anxiety, depression, post-traumatic stress disorder (PTSD) and health within this group. Further, we aim to evaluate the importance of five prognostic factors for post-OHCA well-being.

    METHODS: Data collection took place between 2008 and 2012, and every OHCA survivor within one region of Sweden, with a cerebral performance category (CPC) score of ≤2 at discharge, was asked to participate. Survivors were identified through the Swedish Cardiopulmonary Resuscitation Registry, and postal questionnaires were sent out 3 months after the OHCA. The survey included Hospital Anxiety and Depression scale (HADS), PTSD Checklist Civilian version (PCL-C) and European Quality of Life 5 Dimensions 3 level (EQ-5D-3L).

    RESULTS: Of 298 survivors, 150 were eligible for this study and 94 responded. The mean time from OHCA to follow-up was 88 days. There was no significant difference between respondents and non-respondents in terms of sex, age, cardiac arrest circumstances or in-hospital interventions. 48 participants reported reduced well-being, and young age was the only factor significantly correlated to this outcome (p=0.02). Women reported significantly higher scores in HADS (p=0.001) and PCL-C (p<0.001). Women also reported significantly lower EQ-5D index values (p=0.002) and EQ-visual analogue scale scores (p=0.002) compared with men.

    CONCLUSION: Reduced well-being is experienced by half of OHCA survivors with a CPC score ≤2, and young age is negatively correlated to this outcome. The frequency of anxiety and PTSD is higher among women, who also report worse health.

  • 14.
    Zijlstra, Jolande A
    et al.
    Department of Cardiology, Academic Medical Center.
    Koster, Rudolph W
    Department of Cardiology, Academic Medical Center.
    Blom, Marieke T
    Department of Cardiology, Academic Medical Center.
    Lippert, Freddy K
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Svensson, Leif
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kramer-Johansen, Jo
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital.
    Ringh, Mattias
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet.
    Palsgaard Møller, Thea
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Tan, Hanno L
    Department of Cardiology, Academic Medical Center.
    Beesems, Stefanie G
    Department of Cardiology, Academic Medical Center.
    Hulleman, Michiel
    Department of Cardiology, Academic Medical Center.
    Claesson, Andreas
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Folke, Fredrik
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Olasveengen, Theresa Mariero
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology.
    Wissenberg, Mads
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Hansen, Carolina Malta
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Viereck, Soren
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Hollenberg, Jacob
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.2018In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 104, no 23, p. 1929-1936Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.

    METHODS: We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.

    RESULTS: A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.

    CONCLUSION: Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.

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