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  • 1.
    Bylow, H
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rawshani, A
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Claesson, A
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden.
    Lepp, M
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Østfold University College, Halden, Norway; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Characteristics and outcome after out-of-hospital cardiac arrest with the emphasis on workplaces: an observational study from the Swedish Registry of Cardiopulmonary Resuscitation2021In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 5, article id 100090Article in journal (Refereed)
    Abstract [en]

    Background: Characteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied.

    Aim: To describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces.

    Methods: Data on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs.

    Results: Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92-12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07-4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16-0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location.

    Conclusion: Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.

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  • 2.
    Gustafsson, Linnea
    et al.
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Emergency Medicine, Gothenburg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden.
    Råmunddal, Truls
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Redfors, Björn
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Petursson, Petur
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Angerås, Oskar
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Hirlekar, Geir
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Omerovic, Elmir
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Dworeck, Christian
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Völz, Sebastian
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Herlitz, Johan
    The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden.
    Hjalmarsson, Clara
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Holmqvist, Lina Dahlén
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Emergency Medicine, Gothenburg, Sweden.
    Myredal, Anna
    University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden; Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden: A nationwide study.2023In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 16, article id 100503Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to present a comprehensive overview of out-of-hospital cardiac arrests (OHCA) in young adults.

    METHODS: The data set analyzed included all cases of OHCA from 1990 to 2020 in the age-range 16-49 years in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). OHCA between 2010 and 2020 were analyzed in more detail. Clinical characteristics, survival, neurological outcomes, and long-time trends in survival were studied. Logistic regression was used to study 30-days survival, neurological outcomes and Utstein determinants of survival.

    RESULTS: Trends were assessed in 11,180 cases. The annual increase in 30-days survival during 1990-2020 was 5.9% with no decline in neurological function among survivors. Odds ratio (OR) for heart disease as the cause was 0.55 (95% CI 0.44 to 0.67) in 2017-2020 compared to 1990-1993. Corresponding ORs for overdoses and suicide attempts were 1.61 (95% CI 1.23-2.13) and 2.06 (95% CI 1.48-2.94), respectively. Exercise related OHCA was noted in roughly 5%. OR for bystander CPR in 2017-2020 vs 1990-1993 was 3.11 (95% CI 2.57 to 3.78); in 2020 88 % received bystander CPR. EMS response time increased from 6 to 10 minutes.

    CONCLUSION: Survival has increased 6% annually, resulting in a three-fold increase over 30 years, with stable neurological outcome. EMS response time increased with 66% but the majority now receive bystander CPR. Cardiac arrest due to overdoses and suicide attempts are increasing.

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  • 3.
    Jerkeman, Matilda
    et al.
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden. .
    Omerovic, Elmir
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Strömsöe, Anneli
    Department of Clinical Science and Education, Center for Resuscitation Science, Solna, Karolinska Institutet, Sweden.
    Riva, Gabriel
    Department of Clinical Science and Education, Center for Resuscitation Science, Solna, Karolinska Institutet, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götalandsregionen, Gothenburg, Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Center for Resuscitation Science, Solna, Karolinska Institutet, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götalandsregionen, Gothenburg, Sweden.
    Nivedahl, Per
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study2022In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 10, article id 100245Article in journal (Refereed)
    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.

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  • 4.
    Piscator, Eva
    et al.
    Department of Medicine Solna, Karolinska Institutet and Department of Emergency Medicine, Capio S:t Görans Hospital, Stockholm, Sweden.
    Djärv, Therese
    Department of Medicine Solna, Karolinska Institutet and Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
    Rakovic, Katarina
    Function of Perioperative Medicine and Intensive Care Solna, Karolinska University Hospital, Stockholm, Sweden.
    Boström, Emil
    Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
    Forsberg, Sune
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and Department of Anaesthesiology and Intensive Care, Norrtälje Hospital, Norrtälje, Sweden.
    Holzmann, Martin J.
    Department of Medicine Solna, Karolinska Institutet Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. PreHospen.
    Göransson, Katarina
    Department of Medicine Solna, Karolinska Institutet Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
    Low adherence to legislation regarding Do-Not-Attempt-Cardiopulmonary-Resuscitation orders in a Swedish University Hospital2021In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 6, article id 100128Article in journal (Refereed)
    Abstract [en]

    Background The ethical principles of resuscitation have been incorporated into Swedish legislation so that a decision to not attempt cardiopulmonary resuscitation (DNACPR) entails (1) consultation with patient or relatives if consultation with patient was not possible and documentation of their attitudes; (2) consultation with other licensed caregivers; (3) documentation of the grounds for the DNACPR. Our aim was to evaluate adherence to this legislation, explore the grounds for the decision and the attitudes of patients and relatives towards DNACPR orders. Methods We included DNACPR forms issued after admission through the emergency department at Karolinska University Hospital between 1st January and 31st October, 2015. Quantitative analysis evaluated adherence to legislation and qualitative analysis of a random sample of 20% evaluated the grounds for the decision and the attitudes. Results The cohort consisted of 3583 DNACPR forms. In 40% of these it was impossible to consult the patient, and relatives were consulted in 46% of these cases. For competent patients, consultation occurred in 28% and the most common attitude was to wish to refrain from resuscitation. Relatives were consulted in 26% and they mainly agreed with the decision. Grounds for the DNAR decision was most commonly severe chronic comorbidity, malignancy or multimorbidity with or without an acute condition. All requirements of the legislation were fulfilled in 10% of the cases. Conclusion In 90% of the cases physicians failed to fulfil all requirements in the Swedish legislation regarding DNAR orders. The decision was mostly based on chronic, severe comorbidity or multimorbidity.

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  • 5.
    Strömsöe, A.
    et al.
    School of Health and Welfare, Dalarna University, Falun, S-79188, Sweden; Center for Clinical Research Dalarna, Uppsala University, Falun, S-79182, Sweden; Department of Prehospital Care, Region of Dalarna, Falun, S-79129, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Incidence and percentage of survival after cardiac arrest outside and inside hospital2024In: Resuscitation Plus, E-ISSN 2666-5204, Resuscitation Plus, ISSN 2666-5204, Vol. 17, article id 100594Article in journal (Refereed)
    Abstract [en]

    Aim

    To compare the incidence and percentage of survival after cardiac arrest outside and inside hospital where cardiopulmonary resuscitation (CPR) had been started between two regions in Sweden in a 10-year perspective.

     

    Methods

    A retrospective observational study including CPR treated patients both after out-of-hospital and in-hospital cardiac arrest (OHCA and IHCA) in Sweden, 2013–2022. Data was retrieved from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).

     

    Results

    The overall incidence of OHCA and IHCA events were 2,940 in Dalarna (having a lower population and population density) and 16,187 in Västra Götaland (having a higher population and population density). The overall incidence of survival when OHCA and IHCA were combined was 20 per 100,000 person years in Dalarna and 19 per 100,000 person years in Västra Götaland. The corresponding result for OHCA was 9 versus 7 and for IHCA 11 versus 12. The overall percentage of survival was 20% in Dalarna and 19% in Västra Götaland. The corresponding result for OHCA was 13% versus 10% and for IHCA 37% versus 36%.

     

    Conclusion

    Overall, there was no marked difference neither in incidence nor in percentage of survival after cardiac arrest between the two regions. However, regarding cardiac arrest that took place outside hospital both incidence and percentage of survival was higher in Dalarna than in Västra Götaland despite the fact that the former had lower population density.

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