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  • 1.
    Adielsson, Anna
    et al.
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Djärv, Therese
    Department of Medicine, K2, Solna Karolinska Institutet, SE-171 77 Stockholm, Sweden.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, SE-413 45 Gothenburg, Sweden.
    Lundin, Stefan
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest - A population-based registry study of nearly 24,000 cases.2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 157, p. 135-140, article id S0300-9572(20)30522-0Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest, from a countrywide perspective.

    METHODS: Patient information from the Swedish Registry for Cardiopulmonary Resuscitation was analysed in relation to monitoring level of ward and initial rhythm. The primary outcome was defined as survival at 30 days. Changes in survival and incidence of shockable rhythms were reported per year from 2008 to 2018. Also, epidemiological data were compared between two time periods, 2008-2013 and 2014-2018.

    RESULTS: In all, 23,186 unique patients (38.6% female) were included in the study. The mean age was 72.6 (SD 13.2) years. Adjusted trends indicated an overall increase in 30-day survival from 24.7% in 2008 to 32.5% in 2018, (on monitoring wards from 32.5% to 43.1% and on non-monitoring wards from 17.6% to 23.1%). The proportion of patients found in shockable rhythms decreased overall from 31.6% in 2008 to 23.6% in 2018, (on monitoring wards from 42.5% to 35.8 % and on non-monitoring wards from 20.1% to 12.9%). Among the patients found in shockable rhythms, the proportion of patients defibrillated before the arrival of cardiac arrest team increased from 71.0% to 80.9%.

    CONCLUSIONS: In an 11-year perspective, resuscitation in in-hospital cardiac arrest in Sweden was characterised by an overall increase in the adjusted 30-day survival, despite a decrease in shockable rhythms. An increased proportion, among the patients found in a shockable rhythm, who were defibrillated before the arrival of a cardiac arrest team may have contributed to the finding.

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  • 2. Andréassob, A-Ch
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Bång, A
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Ekström, L
    Lindqvist, J
    Lundström, G
    Holmberg, S
    Characteristics and outcome among patients with a suspected in hospital cardiac arrest1998In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 39, no 1-2, p. 23-31Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients with a suspected in-hospital cardiac arrest. METHODS: All the patients who suffered from a suspected in-hospital cardiac arrest during a 14-months period, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. RESULTS: There were 278 calls for the CPR team. Of these, 216 suffered a true cardiac arrest, 16 a respiratory arrest and 46 neither. The percentage of patients who were discharged alive from hospital was 42% for cardiac arrest patients, 62% for respiratory arrest and 87% for the remaining patients. Among patients with a cardiac arrest, those found in ventricular fibrillation/ventricular tachycardia had a survival rate of 64%, those found in asystole 24% and those found in pulseless electrical activity 10%. Among patients who were being monitored at the time of arrest, the survival rate was 52%, as compared with 27% for non-monitored patients (P= 0.001). Among survivors of cardiac arrest, a cerebral performance category (CPC) of 1 (no major deficit) was observed in 81% at discharge and in 82% on admission to hospital prior to the arrest. CONCLUSION: We conclude that, during a 14-month period at Sahlgrenska University Hospital in Göteborg, almost half the patients with a cardiac arrest in which the CPR team was called were discharged from hospital. Among survivors, 81% had a CPC score of 1 at hospital discharge. Survival seems to be closely related to the relative effectiveness of the resuscitation organisation in different parts of the hospital.

  • 3. Atwood, C
    et al.
    Eisenberg, MS
    Herlitz, Johan
    Sahlgrenska University Hospital.
    Rea, TD
    Incidence of EMS-treated out-of-hospital cardiac arrest in Europe.2005In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 67, no 1, p. 75-80Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The potential impact of efforts in Europe to improve survival from out-of-hospital cardiac arrest is unclear, in part, because estimates of incidence and survival are uncertain. The aim of the investigation was to determine a representative European incidence and survival from cardiac arrest in all-rhythms and in ventricular fibrillation treated by the emergency medical services (EMS). METHODS AND RESULTS: We used Medline to identify peer-reviewed articles published between 1 January 1980 and 30 June 2004 that reported a European community's EMS cardiac arrest experience. Inclusion criteria required the study to include at least 25 cases, report of the total number of all-rhythm and/or ventricular fibrillation arrests, and information about population size and study duration. The incidence was computed by dividing the total number of events by the product of the community's population and the study duration. Reports from 37 communities met the inclusion criteria. A total of 18,105 all-rhythm EMS-treated cardiac arrests occurred during 48 million person-years of observation, resulting in an overall incidence for all-rhythm arrests of 37.72 per 100,000 person-years. Incidence of ventricular fibrillation arrest was 16.84 per 100,000 person-years. Survival was 10.7% for all-rhythm and 21.2% for ventricular fibrillation cardiac arrest. Applying these results to the European population, approximately, 275,000 persons would experience, all-rhythm cardiac arrest treated by the EMS with 29,000 persons surviving to hospital discharge. CONCLUSION: The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of cardiac arrest in Europe.

  • 4. Aune, S
    et al.
    Eldh, M
    Engdahl, J
    Holmberg, S
    Lindqvist, J
    Svensson, L
    Oddby, E
    Herlitz, Johan
    [external].
    Improvement in the hospital organisation of CPR training and outcome after cardiac arrest in Sweden during a 10-year period2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, ISSN 0300-9572, Vol. 82, no 4, p. 431-435Article in journal (Refereed)
    Abstract [en]

    Aim To describe (a) changes in the organisation of training in cardiopulmonary resuscitation (CPR) and the treatment of cardiac arrest in hospital in Sweden and (b) the clinical achievement, i.e. survival and cerebral function, among survivors after in-hospital cardiac arrest (IHCA) in Sweden. Methods Aspects of CPR training among health care providers (HCPs) and treatment of IHCA in Sweden were evaluated in 3 national surveys (1999, 2003 and 2008). Patients with IHCA are recorded in a National Register covering two thirds of Swedish hospitals. Results The proportion of hospitals with a CPR coordinator increased from 45% in 1999 to 93% in 2008. The majority of co-ordinators are nurses. The proportions of hospitals with local guidelines for acceptable delays from cardiac arrest to the start of CPR and defibrillation increased from 48% in 1999 to 88% in 2008. The proportion of hospitals using local defibrillation outside intensive care units prior to arrival of rescue team increased from 55% in 1999 to 86% in 2008. During the past 4 years in Sweden, survival to hospital discharge has been 29%. Among survivors, 93% have a cerebral performance category (CPC) score of I or II, indicating acceptable cerebral function. Conclusion During the last 10 years, there was a marked improvement in CPR training and treatment of IHCA in Sweden. During the past 4 years, survival after IHCA is high and the majority of survivors have acceptable cerebral function.

  • 5. Aune, S
    et al.
    Fredriksson, M
    Thorén, A-B
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    In-hospital cardiac arrest--an Utstein style report of seven years experience from the Sahlgrenska University Hospital.2006In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 68, no 3, p. 351-358Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In-hospital cardiac arrest is one of the most stressful situations in modern medicine. Since 1997, there has been a uniform way of reporting - the Utstein guidelines for in-hospital cardiac arrest reporting.MATERIAL AND METHODS: We have studied all consecutive cardiac arrest in the Sahlgrenska University Hospital (SU) between 1994 and 2001 for who the rescue team was alerted in all 833 patients. The primary endpoint for this study was survival to discharge.RESULTS: Thirty-seven percent survived to hospital discharge. Among patients who were discharged alive, 86% were alive 1 year later. The survivors have a good cerebral outcome (94% among those who were discharged alive had cerebral performance category (CPC) score 1 or 2). The organization at SU is efficient; 80% of the cardiac arrest had CPR within 1 min. Time from cardiac arrest to first defibrillation is a median of 2 min. Almost two-thirds of the patients were admitted for cardiac related diagnoses.CONCLUSION: The current study is the largest single-centre study of in hospital cardiac arrest reported according to the Utstein guidelines. We report a high survival for in-hospital cardiac arrest. We have pointed out that a functional chain of survival, short intervals before the start of CPR and defibrillation are probably contributing factors for this.

  • 6. Aune, S
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Bång, A
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Characteristics of patients who die in hospital with no attempt at resuscitation.2005In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, no 3, p. 291-299Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. MATERIALS AND METHODS: All patients who died at Sahlgrenska University Hospital in Goteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year. RESULTS: Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of 'do not attempt resuscitation' (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR. CONCLUSION: In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.

  • 7. Aune, S
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Characteristics of patients who die in hospital with no attempt at resuscitation2005In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, no 3, p. 291-299Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. Materials and methods: All patients who died at Sahlgrenska University Hospital in Göteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year. Results: Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24 h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of ‘do not attempt resuscitation’ (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR. Conclusion: In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.

  • 8.
    Axelsson, C
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Axelsson, Å
    Nestin, J
    Svensson, L
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest-a pilot study.2006In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 71, no 1, p. 47-55Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate the outcome among patients suffering from out-of-hospital cardiac arrest (OHCA) after the introduction of mechanical chest compression (MCC) compared with standard cardiopulmonary resuscitation (SCPR) in two emergency medical service (EMS) systems. METHODS: The inclusion criterion was witnessed OHCA. The exclusion criteria were age < 18 years, the following judged etiologies behind OHCA: trauma, pregnancy, hypothermia, intoxication, hanging and drowning or return of spontaneous circulation (ROSC) prior to the arrival of the advanced life support (ALS) unit. Two MCC devices were allocated during six-month periods between four ALS units for a period of two years (cluster randomisation). RESULTS: In all, 328 patients fulfilled the criteria for participation and 159 were allocated to the MCC tier (the device was used in 66% of cases) and 169 to the SCPR tier. In the MCC tier, 51% had ROSC (primary end-point) versus 51% in the SCPR tier. The corresponding values for hospital admission alive (secondary end-point) were 38% and 37% (NS). In the subset of patients in whom the device was used, the percentage who had ROSC was 49% versus 50% in a control group matched for age, initial rhythm, aetiology, bystander-/crew-witnessed status and delay to CPR. The percentage of patients discharged alive from hospital after OHCA was 8% versus 10% (NS) for all patients and 2% versus 4%, respectively (NS) for the patients in the subset (where the device was used and the matched control population). CONCLUSION: In this pilot study, the results did not support the hypothesis that the introduction of mechanical chest compression in OHCA improves outcome. However, there is room for further improvement in the use of the device. The hypothesis that this will improve outcome needs to be tested in further prospective trials

  • 9.
    Axelsson, C
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Axelsson, Å
    Svensson, L
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Characteristics and outcome among patients suffering from out-of-hospital cardiac arrest with the emphasis on availability for intervention trials.2007In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 75, no 3, p. 460-468Article in journal (Refereed)
    Abstract [en]

    AIM: To describe all patients treated for out-of-hospital cardiac arrest (OHCA) according to the Utstein criteria and their characteristics and outcome with emphasis on whether they were available for early intervention trials. DESIGN: Retrospective analysis of a study where data were collected prospectively. SETTING: The Municipality of Göteborg/Mölndal in Sweden. PATIENTS: All patients suffering from out-of-hospital cardiac arrest in the Municipality of Göteborg/Mölndal in whom cardiopulmonary resuscitation (CPR) was attempted between May 2003 and May 2005. INTERVENTIONS: Part of the study cohort, i.e. patients with a witnessed, non-traumatic, out-of-hospital cardiac arrest were distributed (cluster) to mechanical (LUCAS) or manual chest compression. RESULTS: The overall survival to discharge from hospital among the 508 patients was 8.5%. The corresponding value for non-cardiac cases was 5.1% and for cardiac cases if crew witnessed 16.1%, bystander witnessed 12.7% and non-witnessed 1.4%. Fifty-nine percent of the patients fulfilled the inclusion criteria for the trial and had no exclusion criteria and 9.7% of these survived to discharge. Ten percent of patients fulfilled the inclusion criteria but were excluded and 20.4% survived to discharge. Thirty-one percent of patients did not fulfil the inclusion criteria and 2.5% survived. Among patients included in the LUCAS group, many of the survivors, 10/13 (77%), experienced a rapid return of spontaneous circulation (ROSC) before the application of the device. CONCLUSION: Among patients with OHCA in whom CPR was started 8.5% survived to hospital discharge and 59% were theoretically available for an early intervention trial. These patients have a different outcome compared with patients not available. However, among those available, the majority of survivors had a rapid ROSC before the application of the intervention (LUCAS). This raises concerns about the potential for early intervention trials to improve outcome after OHCA.

  • 10.
    Axelsson, C
    et al.
    University of Borås, School of Health Science.
    Holmberg, S
    Axelsson, ÅB
    Herlitz, Johan
    University of Borås, School of Health Science.
    Passive leg raising during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: Does it improve circulation and outcome?2010In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, no 12, p. 1615-1620Article in journal (Refereed)
    Abstract [en]

    Background Passive leg raising (PLR), to augment the artificial circulation, was deleted from cardiopulmonary resuscitation (CPR) guidelines in 1992. Increases in end-tidal carbon dioxide (PETCO2) during CPR have been associated with increased pulmonary blood flow reflecting cardiac output. Measurements of PETCO2 after PLR might therefore increase our understanding of its potential value in CPR. We also observed the alteration in PETCO2 in relation to the return of spontaneous circulation (ROSC) and no ROSC. Methods and results The PETCO2 was measured, subsequent to intubation, in 126 patients suffering an out-of-hospital cardiac arrest (OHCA), during 15min or until ROSC. Forty-four patients were selected by the study protocol to PLR 35cm; 21 patients received manual chest compressions and 23 mechanical compressions. The PLR was initiated during uninterrupted CPR, 5min from the start of PETCO2 measurements. During PLR, an increase in PETCO2 was found in all 44 patients within 15s (p=0.003), 45s (p=0.002) and 75s (p=0.0001). Survival to hospital discharge was 7% among patients with PLR and 1% among those without PLR (p=0.12). Among patients experiencing ROSC (60 of 126), we found a marked increase in PETCO2 1min before the detection of a palpable pulse. Conclusion Since PLR during CPR appears to increase PETCO2 after OHCA, larger studies are needed to evaluate its potential effects on survival. Further, the measurement of PETCO2 could help to minimise the hands-off periods and pulse checks.

  • 11.
    Axelsson, C
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Karlsson, T
    Axelsson, ÅB
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA).2009In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, no 10, p. 1099-1103Article in journal (Refereed)
    Abstract [en]

    AIM: In animal and human studies, measuring the pressure of end tidal carbon dioxide (P(ET)CO2) has been shown to be a practical non-invasive method that correlates well with the pulmonary blood flow and cardiac output (CO) generated during cardiopulmonary resuscitation (CPR). This study aims to compare mechanical active compression-decompression (ACD) CPR with standard CPR according to P(ET)CO2 among patients with out-of-hospital cardiac arrest (OHCA), during CPR and with standardised ventilation. METHODS: This prospective, on a cluster level, pseudo-randomised pilot trial took place in the Municipality of Göteborg. During a 2-year period, all patients aged >18 years suffering an out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology were enrolled. The present analysis included only tracheally intubated patients in whom P(ET)CO2 was measured for 15 min or until the detection of a pulse-giving rhythm. RESULTS: In all, 126 patients participated in the evaluation, 64 patients in the mechanical chest compression group and 62 patients in the control group. The group receiving mechanical ACD-CPR obtained the significantly highest P(ET)CO2 values according to the average (p=0.04), initial (p=0.01) and minimum (p=0.01) values. We found no significant difference according to the maximum value between groups. CONCLUSION: In this hypothesis generating study mechanical ACD-CPR compared with manual CPR generated the highest initial, minimum and average value of P(ET)CO2. Whether these data can be repeated and furthermore be associated with an improved outcome after OHCA need to be confirmed in a large prospective randomised trial.

  • 12.
    Axelsson, Christer
    et al.
    University of Borås, School of Health Science.
    Azeli, Youcef
    Jiminez, Maria
    Ordonez Campana, A
    Might the bainbridge reflex have a role in resuscitation when chest compression is combined with passive leg raising?2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 1, p. e21-Article in journal (Refereed)
    Abstract [en]

    The effect of passive leg raising (PLR) in cardiac arrest is not clearly established but PLR has been associated with increased coronary perfusion pressure and increase in End tidal carbon dioxide (EtCO2) during cardiopulmonary resuscitation (CPR).1 A case in which PLR was used successfully has recently been published.

  • 13.
    Axelsson, Christer
    et al.
    University of Borås, School of Health Science.
    Claesson, Andreas
    University of Borås, School of Health Science.
    Engdahl, J
    Herlitz, Johan
    University of Borås, School of Health Science.
    Hollenberg, J
    Lindqvist, J
    Rosenqvist, M
    Svensson, L
    Outcome after out-of-hospital cardiac arrest witnessed by EMS: changes over time and factors of importance for outcome in Sweden.2012In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, no 10, p. 1253-1258Article in journal (Refereed)
    Abstract [en]

    Background Among patients who survive after out-of-hospital cardiac arrest (OHCA), a large proportion are recruited from cases witnessed by the Emergency Medical Service (EMS), since the conditions for success are most optimal in this subset. Aim To evaluate outcome after EMS-witnessed OHCA in a 20-year perspective in Sweden, with the emphasis on changes over time and factors of importance. Methods All patients included in the Swedish Cardiac Arrest Register from 1990 to 2009 were included. Results There were 48,349 patients and 13.5% of them were EMS witnessed. There was a successive increase in EMS-witnessed OHCA from 8.5% in 1992 to 16.9% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, the survival to one month increased from 13.9% in 1992 to 21.8% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, 51% were found in ventricular fibrillation, which was higher than in bystander-witnessed OHCA, despite a lower proportion with a presumed cardiac aetiology in the EMS-witnessed group. Among EMS-witnessed OHCA overall, 16.0% survived to one month, which was significantly higher than among bystander-witnessed OHCA. Independent predictors of a favourable outcome were: (1) initial rhythm ventricular fibrillation; (2) cardiac aetiology; (3) OHCA outside home and (4) decreasing age. Conclusion In Sweden, in a 20-year perspective, there was a successive increase in the proportion of EMS-witnessed OHCA. Among these patients, survival to one month increased over time. EMS-witnessed OHCA had a higher survival than bystander-witnessed OHCA. Independent predictors of an increased chance of survival were initial rhythm, aetiology, place and age.

  • 14. Axelsson, Å
    et al.
    Herlitz, Johan
    [external].
    Ekström, L
    Holmberg, S
    Bystander-initiated cardiopulmonary resuscitation out-of-hospital. A first description of the bystanders and their experiences1996In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, no 1, p. 3-11Article in journal (Refereed)
    Abstract [en]

    Abstract At present there are about 1 million trained cardiopulmonary resuscitation (CPR) rescuers in Sweden. CPR out-of-hospital is initiated about 2000 times a year in Sweden. However, very little is known about the bystanders' experiences and reactions. The aim of this study was to describe bystander-initiated CPR, the circumstances, the bystander and his experiences. All CPR bystanders in Sweden who reported their resuscitation attempts between 1990 and 1994 were approached with a phone interview and a postal questionnaire, resulting in 742 questionnaires. Bystander-initiated CPR most frequently took place in public places such as the street. The rescuer most frequently had problems with mouth-to-mouth ventilation (20%) and vomiting (18%). More than half (53%) of the rescuers experienced CPR without problems. Ninety-two percent of the bystanders had no hesitation because of fear of contracting the acquired immunodeficiency syndrome (AIDS) virus. Ninety-three percent of the rescuers regarded their intervention as a mainly positive experience. Of 425 interviewed rescuers, 99.5% were prepared to start CPR again.

  • 15. Axelsson, Å
    et al.
    Herlitz, Johan
    [external].
    Fridlund, B
    How bystanders perceive their cardiopulmonary resuscitation intervention. A qualitative study2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, no 1, p. 71-81Article in journal (Refereed)
    Abstract [en]

    The importance of bystander cardiopulmonary resuscitation (CPR) prior to arrival of the emergency medical service is well documented. In Sweden, CPR is initiated prior to emergency medical services (EMS) arrival in about 30% of cardiac arrests out-of-hospital, a figure which should be improved urgently. To do so, it is of interest to know more about the bystanders’ perceptions of their intervention. A qualitative method inspired by the phenomenographic approach was applied to 19 bystanders who had performed CPR. In the analysis, five main categories and 14 subcategories emerged. The main categories were: to have a sense of humanity, to have competence, to feel an obligation, to have courage and to feel exposed. Interviews described how humanity and concern for another human being were the foundation of their intervention. CPR training offers the possibility to give appropriate help in this emergency. If the aim of CPR training was extended beyond teaching the skill of CPR to include preparation of the rescuer for the intervention and his/her reactions, this might increase the number of people able to take action in the cardiac arrest situation.

  • 16. Axelsson, Å
    et al.
    Herlitz, Johan
    [external].
    Karlsson, T
    Lindqvist, J
    Graves, JR
    Ekström, L
    Holmberg, S
    Factors surrounding cardiopulmonary resuscitation influencing bystanders psycholocigal reactions1998In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 37, no 1, p. 13-20Article in journal (Refereed)
    Abstract [en]

    The incidence of Sweden's out-of-hospital cardiac arrests averages 10000 annually. Each year bystanders initiate cardiopulmonary resuscitation (CPR) approximately 2000 times prior to arrival of emergency medical service (EMS). The aim of this study was to identify factors influencing the bystanders psychological reactions to performing CPR. We mailed a questionnaire to all bystanders who reported performing CPR to the CPR Centre of Sweden from autumn 1992 to 1995. The study included 544 bystander reports. Nine factors were found to be associated with bystanders experience in a univariate analysis. Among these were victim outcome (p < 0.0001), CPR duration (p = 0.0009) and their experience of the attitude of the EMS personnel (p = 0.004). In a multivariate logistic regression model, lack of debriefing following the intervention (p = 0.0001) and fatal victim outcome (p = 0.03) were independent predictors of a negative bystander psychological reaction. The importance of having someone to talk to following an intervention and the EMS personnel concern for the rescuer should be emphasised. The goal should be that critical incident debriefing is available to every bystander following his or her CPR attempt.

  • 17. Axelsson, Å
    et al.
    Thorén, AB
    Holmberg, S
    Herlitz, Johan
    [external].
    Attitudes of trained lay rescuers toward cardiopulmonary resuscitation performance in an actual emergency. A survery of 1012 recently trained CPR rescuers2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, no 1, p. 27-36Article in journal (Refereed)
    Abstract [en]

    There are currently 1.5 million trained cardiopulmonary resuscitation (CPR) rescuers in Sweden. Bystander CPR is performed on ≈30% of out-of-hospital cardiac arrests. The aim of this study was to analyse trained CPR rescuers’ attitudes and beliefs in terms of CPR performance in an emergency and differences with regard to gender, age, residential area and occupation. In a nation wide survey 1410, randomly selected, recently trained CPR rescuers were approached with a postal questionnaire, resulting in 1012 respondents. The mean age was 36.9 years and only 3% of the respondents were >59 years old. Only 1% had attended the course because of their own or a relative’s cardiac disease. Ninety-four per cent believed there was a minor to major risk of serious disease transmission while performing CPR. When predicting their willingness to perform CPR in six scenarios, 17% would not start CPR on a young drug addict, 7% would not perform CPR on an unkempt man, while 97% were sure about starting CPR on a relative and 91% on a known person. In four of six scenarios, respondents from rural areas were significantly more positive than respondents from metropolitan areas about starting CPR. In conclusion, readiness to perform CPR on a known person is high among trained CPR rescuers, while hesitation about performing CPR on a stranger is evident. Respondents from rural areas are more frequently positive about starting CPR than those from metropolitan areas.

  • 18. Axelsson, ÅB
    et al.
    Herlitz, Johan
    [external].
    Holmberg, S
    Thorén, A-B
    A nationwide survey of CPR training in Sweden: foreign born and unemployed are not reached by training programmes.2006In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 70, no 1, p. 90-97Article in journal (Refereed)
    Abstract [en]

    AIM: To determine the number of CPR trained adults in Sweden, and the willingness of the non-trained population to attend a CPR course. An additional purpose was to investigate differences related to sex, age, residential area, socio-economic classification and country of origin. METHODS: Five thousand adults in Sweden were surveyed, which yielded 3167 valid responses, a response rate of 63%. The sample was selected at random and stratified to correlate to the geographic distribution of the population. RESULTS: The mean (S.D.) age was 46 (16) years, 54% of the respondents were females and 11% were people of foreign origin. Forty-five percent had participated in some form of CPR training. Younger respondents, those living in rural areas, those born in Sweden, employees, students and military conscripts were trained more frequently in CPR. Of the respondents with no CPR training, 50% expressed a willingness to attend a course. The most common reason for not being trained in CPR was that the respondent did not know such courses existed or that they did not know where to go for training. CONCLUSION: Somewhere between 30 and 45% of the adult population of Sweden had participated in CPR training. Half of the non-trained population was willing to learn CPR but frequently did not know that such courses existed or where they were held. Elderly people, people of foreign origin, or those not included in the workforce were less likely to have participated in CPR training.

  • 19. Axelsson, Åsa B
    et al.
    Sunnerhagen, Katharina S
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101, p. 44-49Article in journal (Refereed)
    Abstract [en]

    AIM: Reports on differences between respondents and non-respondents of out-of-hospital cardiac arrest (OHCA) survivors are sparse. This study compares respondents with non-respondents in a follow-up study of a consecutive sample of OHCA survivors and describes the relation between respondents' self-reported morbidity and health.

    METHODS/DESIGN: Questionnaires were administered within 12 months after the OHCA. The study population was adult patients who had survived an OHCA during 2008 to 2011, with a cerebral performance score of ≤2 at discharge. The patients were identified through the Swedish registry of OHCA. The Self-administered comorbidity questionnaire and EQ VAS (Euroqol questionnaire visual analogue scale) was used to measure morbidity and health status.

    RESULTS: Of 298 survivors, 224 were eligible for the study and 127 responded. Mean time from cardiac arrest (CA) to follow up was 178 days. Comparing the 127 respondents with the 97 lost to follow-up and non-respondents, no significant differences were found in terms of age, sex, factors at resuscitation and in-hospital interventions. The EQ VAS median was 75 (25th,75th percentile 60,80)). Self-rated health differed between respondents reporting 0-2 conditions (n=68) and respondents reporting more than two (n=43), median EQ VAS 78 (68,90) and 65 (50,80)), respectively; p-value 0.0001.

    CONCLUSIONS: Despite a limited response rate, representativeness in terms of patient characteristics among survivors of OHCA with an acceptable cerebral function is achievable. A considerable proportion of the survivors lived with the burden of multi-morbidity which worsened health.

  • 20.
    Axelsson, Åsa B
    et al.
    University of Gothenburg.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101Article in journal (Refereed)
    Abstract [en]

    AIM: Reports on differences between respondents and non-respondents of out-of-hospital cardiac arrest (OHCA) survivors are sparse. This study compares respondents with non-respondents in a follow-up study of a consecutive sample of OHCA survivors and describes the relation between respondents' self-reported morbidity and health.

    METHODS/DESIGN: Questionnaires were administered within 12 months after the OHCA. The study population was adult patients who had survived an OHCA during 2008 to 2011, with a cerebral performance score of ≤2 at discharge. The patients were identified through the Swedish registry of OHCA. The Self-administered comorbidity questionnaire and EQ VAS (Euroqol questionnaire visual analogue scale) was used to measure morbidity and health status.

    RESULTS: Of 298 survivors, 224 were eligible for the study and 127 responded. Mean time from cardiac arrest (CA) to follow up was 178 days. Comparing the 127 respondents with the 97 lost to follow-up and non-respondents, no significant differences were found in terms of age, sex, factors at resuscitation and in-hospital interventions. The EQ VAS median was 75 (25th,75th percentile 60,80)). Self-rated health differed between respondents reporting 0-2 conditions (n=68) and respondents reporting more than two (n=43), median EQ VAS 78 (68,90) and 65 (50,80)), respectively; p-value 0.0001.

    CONCLUSIONS: Despite a limited response rate, representativeness in terms of patient characteristics among survivors of OHCA with an acceptable cerebral function is achievable. A considerable proportion of the survivors lived with the burden of multi-morbidity which worsened health.

  • 21.
    Berglund, Ellinor
    et al.
    Södersjukhuset, Stockholm.
    Olsson, Erik
    Uppsala universitet.
    Jonsson, Martin
    Södersjukhuset, Stockholm.
    Svensson, Leif
    Södersjukhuset, Stockholm.
    Hollenberg, Jacob
    Södersjukhuset, Stockholm.
    Claesson, Andreas
    Södersjukhuset, Stockholm.
    Nordberg, Per
    Södersjukhuset, Stockholm.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Högstedt, Åsa
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ringh, Mattias
    Södersjukhuset, Stockholm.
    Wellbeing, emotional response and stress among lay responders dispatched to suspected out-of-hospital cardiac arrests2022In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 170, p. 352-360Article in journal (Refereed)
    Abstract [en]

    Background: Systems for smartphone dispatch of lay responders to perform cardio-pulmonary resuscitation (CPR) and bring automated external defibrillators to out-of-hospital cardiac arrests (OHCAs) are advocated by recent international guidelines and emerging worldwide. Objectives: This study aimed to investigate the emotional responses, posttraumatic stress reactions and levels of wellbeing among smartphone-alerted lay responders dispatched to suspected OHCAs. Methods: Lay responders were stratified by level of exposure: unexposed (Exp-0), tried to reach (Exp-1), and reached the suspected OHCA (Exp-2). Participants rated their emotional responses online, at 90 minutes and at 4–6 weeks after an incident. Level of emotional response was measured in two dimensions of core affect: “alertness” – from deactivation to activation, and “pleasantness” – from unpleasant to pleasant. At 4–6 weeks, WHO wellbeing index and level of posttraumatic stress (PTSD) were also rated. Results: Altogether, 915 (28%) unexposed and 1471 (64%) exposed responders completed the survey. Alertness was elevated in the exposed groups: Exp-0: 6.7 vs. Exp-1: 7.3 and Exp-2: 7.5, (p < 0.001) and pleasantness was highest in the unexposed group: 6.5, vs. Exp-1: 6.3, and Exp-2: 6.1, (p < 0.001). Mean scores for PTSD at follow-up was below clinical cut-off, Exp-0: 9.9, Exp-1: 8.9 and Exp-2: 8.8 (p = 0.065). Wellbeing index showed no differences, Exp-0: 78.0, Exp-1: 78.5 and Exp-2: 79.9 (p = 0.596). Conclusion: Smartphone dispatched lay responders rated the experience as high-energy and mainly positive. No harm to the lay responders was seen. The exposed groups had low posttraumatic stress scores and high-level general wellbeing at follow-up. © 2021

  • 22.
    Berglund, Sara
    et al.
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Andreasson, Axel
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Rawshani, Aidin
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Hirlekar, Geir
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Lundgren, Peter
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Angeras, Oscar
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Mandalenakis, Zacharias
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Redfors, Björn
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Holm, Astrid
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Hagberg, Eva
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Ricksten, Sven Erik
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Friberg, Hans
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Anesthesia & Intens Care, Malmo, Sweden.
    Gustafsson, Linnea
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Dworeck, Christian
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Cardiorenal function and survival in in-hospital cardiac arrest: A nationwide study of 22,819 cases2022In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 172, p. 9-16Article in journal (Refereed)
    Abstract [en]

    Background: We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital Methods: We included cases aged 18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC). Results: We studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR < 15, 15-29, 30-44, 45-59, 60-89, 90-130 and 130-150 ml/min/1.73 m2, respectively. All eGFR levels below and above 90 ml/min/1.73 m2 were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR < 15 ml/min/1.73 m2, compared with normal kidney function. At every level of eGFR, presence of heart failure increased mortality markedly; patients without heart failure displayed higher mortality only at eGFR below 30 ml/min/1.73 m2. Among survivors with eGFR < 15 ml/min/1.73 m2, good neurological outcome was noted in 87.2%. Survival increased in most groups over time, but most for those with eGFR < 15 ml/min/1.73 m2, and least for those with normal eGFR. Conclusions: All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.

  • 23.
    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.

  • 24.
    Bylow, Helene
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Claesson, Andreas
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Lepp, Margret
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Lindqvist, Jonny
    Centre of Registers Västra Götaland, Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Self-learning training versus instructor-led training for basic life support: A cluster randomised trial.2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 139, p. 122-132, article id S0300-9572(19)30094-2Article in journal (Refereed)
    Abstract [en]

    AIM: To compare the effectiveness of two basic life support (BLS) training interventions.

    METHODS: This experimental trial enrolled 1301 lay people in BLS training. The participants were cluster randomised to either self-learning training or to traditional instructor-led training. Both groups used the Mini-Anne Kit (Laerdal Medical, Stavanger, Norway) and standardised film instructions. After training, the participants practical skills were measured on a Resusci Anne manikin and an AED trainer with the PC SkillReporting system (Laerdal Medical, Stavanger, Norway). The primary outcome was the total score from the modified Cardiff Test of basic life support with automated external defibrillation (19-70 points), six months after training. The secondary outcomes were total score directly after training and quality of individual variables, self-assessed knowledge, confidence and willingness to act, directly and six months after training.

    RESULTS: For primary outcome six months after training there was no statistically significant difference (p = 0.44) between the total score for the self-learning group (n = 670; median 59, IQR 55-62) compared with the instructor-led group (n = 561; median 59, IQR 55-63). The instructor-led training resulted in a statistically significant higher total score (median 61 versus 59, p < 0.0001), self-assessed knowledge and willingness to act, directly after training (secondary outcomes) compared with the self-learning training.

    CONCLUSIONS: There was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.

  • 25.
    Bång, A
    et al.
    University of Borås, School of Health Science.
    Gustavsson, M
    Larsson, C
    Holmberg, S
    Herlitz, Johan
    University of Borås, School of Health Science.
    Are patients who are found deeply unconscious, without having suffered a cardiac arrest, always breathing normally?2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, no 2, p. 116-118Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. METHODS: Patients with Glasgow Coma Scale (GCS) 3 (1+1+1) and without cardiac arrest were retrospectively evaluated, via ambulance records, for signs of abnormal breathing. RESULTS: Of 45 patients who fulfilled inclusion criteria, 24 (53%) had signs of abnormal breathing, as reported by the ambulance crew. CONCLUSION: Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.

  • 26. Bång, A
    et al.
    Herlitz, Johan
    [external].
    Holmberg, S
    Possibilities of implementing dispatcher-assisted cardiopulmonary resuscitation in the community2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    Aim: By evaluating tape recordings of true cardiac arrest calls, to judge the dispatchers ability to (a) identify cases as suspected cardiac arrest (CA), (b) give the case the right priority, (c) identify CA cases suitable for dispatcher-assisted, telephone-guided cardiopulmonary resuscitation (T-CPR) and (d) accomplish T-CPR. Methods: Evaluation of 99 tape recordings of consecutive cases that had been admitted to the two city hospitals in Göteborg after out-of-hospital CA. Results: In 70% of the interviews, the dispatcher demonstrated impeccable behaviour with short, distinct questions, quickly resulting in a decision on how to handle the case. In 30%, serious criticism could be voiced as the dispatcher displayed very stressful behaviour, or omitted to ask important questions such as whether the patient was conscious and breathing. In 21%, the interviews indicated a clear opportunity to perform T-CPR. In another 10%, there was a possibility of performing T-CPR. Only in 8% was T-CPR actually accomplished. Conclusions: (1) In the majority of the interviews, the quality was very high, while in one-third, serious criticism could be voiced. (2) In our study, only one-third (95% confidence interval, 22–41) of CA cases were suitable for T-CPR, and T-CPR was performed in only 8% of the 99 cases. (3) To optimise the dispatcher ability to identify suspected CA and initiate T-CPR, both medical knowledge and practical training are needed, preferably with protocols for pre-arrival instructions.

  • 27.
    Bång, A
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Martinell, S
    Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases.2003In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 56, no 1, p. 25-34Article in journal (Refereed)
    Abstract [en]

    AIM: One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. METHODS: Prospective study evaluating 100 tape recordings of the EMD calls of emergency medical service (EMS)-provided advanced life support- (ALS) cases, of out-of-hospital cardiac arrest. RESULTS: The quality of EMD-performed interviews was highly commended in 63% of cases, but insufficient or unapproved in the remaining 37%. The caller's state of mind was not a major problem for co-operation. Among the 100 cases, 24 were suspected to be unconscious and in respiratory arrest. A further 38 cases were presented as unconscious with abnormal breathing. In only 14 cases dispatcher-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the cases were unconscious patients with abnormal breathing. The incidence of suspected agonal breathing was estimated to be approximately 30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional breathing. CONCLUSIONS: Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.

  • 28.
    Bång, A
    et al.
    [external].
    Ortgren, P-O
    Herlitz, Johan
    [external].
    Währborg, P
    Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2002In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, no 2, p. 135-151Article in journal (Refereed)
    Abstract [en]

    Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.

  • 29.
    Bång, Angela
    et al.
    University of Borås, School of Health Science.
    Gustavsson, Mikael
    Larsson, Carina
    Holmberg, Stig
    Herlitz, Johan
    University of Borås, School of Health Science.
    Are patients who are found deeply unconscious without having suffered a cardiac arrest, always breathing normally?2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, no 2, p. 116-118Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. METHODS: Patients with Glasgow Coma Scale (GCS) 3 (1+1+1) and without cardiac arrest were retrospectively evaluated, via ambulance records, for signs of abnormal breathing. RESULTS: Of 45 patients who fulfilled inclusion criteria, 24 (53%) had signs of abnormal breathing, as reported by the ambulance crew. CONCLUSION: Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.

  • 30. Bång, Angela
    et al.
    Martinell, S
    Herlitz, Johan
    Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases2003In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 2003, no 56, p. 25-34Article in journal (Refereed)
    Abstract [en]

    Aim: One of the objectives of this study was to assess the previous termemergency medical dispatchersnext term (EMDs) ability for the identification and prioritisation of previous termcardiac arrestnext term (CA) previous termcases,next term and offering and achievements of previous termdispatchernext term-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of previous termagonalnext term respiration in previous termcardiac arrest calls and the caller'snext term descriptions of previous termbreathing.next term Methods: Prospective study evaluating previous term100 tape recordingsnext term of the EMD previous termcalls of emergency medicalnext term service (EMS)-provided advanced life support- (ALS) previous termcases, of out-of-hospital cardiac arrest.next term Results: The quality of EMD-performed interviews was highly commended in 63% of previous termcases,next term but insufficient or unapproved in the remaining 37%. The previous termcaller'snext term state of mind was not previous termanext term major problem for co-operation. Among the previous term100 cases,next term 24 were previous termsuspectednext term to be unconscious and in respiratory previous termarrest. Anext term further 38 previous termcasesnext term were presented as unconscious with abnormal previous termbreathing.next term In only 14 previous termcases dispatchernext term-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the previous termcasesnext term were unconscious patients with abnormal previous termbreathing.next term The incidence of previous termsuspected agonal breathingnext term was estimated to be not, vert, similar30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional previous termbreathing.next term Conclusions: Among previous termsuspected cardiac arrest cases,next term EMDs offer CPR instruction to only previous termanext term small fraction of previous termcallers. Anext term major obstacle was the presentation of previous termagonal breathing.next term Patients with previous termanext term combination of unconsciousness and previous termagonal breathingnext term should be offered previous termdispatchernext term-assisted CPR instruction. This might improve survival in previous termout-of hospital cardiac arrest.next term

  • 31. Bång, Angela
    et al.
    Ortgren, P-O
    Herlitz, Johan
    Währborg, P
    Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, no 1, p. 135-151Article in journal (Refereed)
    Abstract [en]

    Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.

  • 32. Claesson, A
    et al.
    Lindqvist, J
    Herlitz, J
    University of Borås, School of Health Science.
    Cardiac arrest due to drowning-changes over time and factors of importance for survival2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 5, p. 644-648Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. METHOD: Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n=529. The data were clustered into three seven-year intervals for comparisons of changes over time. RESULTS: There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992-1998, versus 74% in interval 2006-2012 (p=0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p=0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place-home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival. CONCLUSION: In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month.

  • 33. Claesson, Andreas
    et al.
    Djärv, Therese
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nordberg, Pär
    Ring, Mattias
    Hollenberg, Jacob
    Ravn-Fischer, Annika
    Strömsöe, Annelie
    Medical versus non medical etiology in out-of-hospital cardiac arrest-Changes in outcome in relation to the revised Utstein template.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    The Utstein-style recommendations for reporting etiology and outcome in out-of-hospital cardiac arrest (OHCA) from 2004 have recently been revised. Among other etiologies a medical category is now introduced, replacing the cardiac category from Utstein template 2004.

    AIM:

    The aim of this study is to describe characteristics and temporal trends from reporting OHCA etiology according to the revised Utstein template 2014 in regards to patient characteristics and 30-day survival rates.

    METHODS:

    This registry study is based on consecutive OHCA cases reported from the Emergency medical services (EMS) to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) 1992-2014. Characteristics, including a presumed cardiac etiology in Utstein template 2004, were transcribed to a medical etiology in Utstein template 2014.

    RESULTS:

    Of a total of n=70,846 cases, 92% were categorized as having a medical etiology and 8% as having a non-medical cause. Using the new classifications, the 30-day survival rate has significantly increased over a 20-year period from 4.7% to 11.0% in the medical group and from 3% to 9.9% in the non-medical group (p≤0.001). Trauma was the most common cause in OHCA of a non-medical etiology (26%) with a 30-day survival rate of 3.4% whilst drowning and drug overdose had the highest survival rates (14% and 10% respectively).

    CONCLUSION:

    Based on Utstein 2014 categories of etiology, overall survival after OHCA with a medical etiology has more than doubled in a 20-year period and tripled for non-medical cases. Patients with a medical etiology found in a shockable rhythm have the highest chance of survival. There is great variability in characteristics among non-medical cases.

  • 34. Claesson, Andreas
    et al.
    Djärv, Therese
    Norberg, Per
    Ring, Mattias
    Hollenberg, Jacob
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ravn-Fisher, Annica
    Stromsoe, Annelie
    Medicalversus non medical etiology in out-of-hospital cardiac arrest-Changes inoutcome in relation to the revised Utstein template2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The Utstein-style recommendations for reporting etiology and outcome in out-of-hospital cardiac arrest (OHCA) from 2004 have recently been revised. Among other etiologies a medical category is now introduced, replacing the cardiac category from Utstein template 2004. AIM: The aim of this study is to describe characteristics and temporal trends from reporting OHCA etiology according to the revised Utstein template 2014 in regards to patient characteristics and 30-day survival rates. METHODS: This registry study is based on consecutive OHCA cases reported from the Emergency medical services (EMS) to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) 1992-2014. Characteristics, including a presumed cardiac etiology in Utstein template 2004, were transcribed to a medical etiology in Utstein template 2014. RESULTS: Of a total of n=70,846 cases, 92% were categorized as having a medical etiology and 8% as having a non-medical cause. Using the new classifications, the 30-day survival rate has significantly increased over a 20-year period from 4.7% to 11.0% in the medical group and from 3% to 9.9% in the non-medical group (p</=0.001). Trauma was the most common cause in OHCA of a non-medical etiology (26%) with a 30-day survival rate of 3.4% whilst drowning and drug overdose had the highest survival rates (14% and 10% respectively). CONCLUSION: Based on Utstein 2014 categories of etiology, overall survival after OHCA with a medical etiology has more than doubled in a 20-year period and tripled for non-medical cases. Patients with a medical etiology found in a shockable rhythm have the highest chance of survival. There is great variability in characteristics among non-medical cases.

  • 35.
    Claesson, Andreas
    et al.
    University of Borås, School of Health Science.
    Lindqvist, J
    Ortenwall, P
    Herlitz, Johan
    University of Borås, School of Health Science.
    Characteristics of lifesaving from drowning as reported by the Swedish Fire and Rescue Services 1996-2010.2012In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, no 9, p. 1072-1077Article in journal (Refereed)
    Abstract [en]

    Aim We aimed to describe characteristics associated with rescue from drowning as reported by the Swedish Fire and Rescue Services (SFARS) and their association with survival from the Out of Hospital Cardiac Arrest (OHCA) registry. Method This retrospective study is based on the OHCA registry and the Swedish Civil Contingencies Agency (SCCA) registry. All emergency calls (1996–2010) where the SFARS were dispatched were included (n = 7175). For analysis of survival, OHCAs that matched events from the SCCA registry were included (n = 250). Results Calls to lakes and ponds were predominant (35% of all calls reported). Rescues were more likely in cold water, <10 °C (45%), in open water (80%) and in April–September (68%). Median delay from a call to arrival of rescue services was 8 min, while it was 9 min for rescue diving units. Of all OHCA cases, the victim was found at the surface in 47% and underwater in 38%. In events where rescue divers were used, victims were significantly younger than in non-diving cardiac arrests and the mean diving depth was 6.3 ± 5.8 m. Overall survival to one month was 5.6% (13% in diving and 4.7% in non-diving cases; p = 0.07). Conclusion In half of more than 7000 drowning-related calls to the SFARS during 15 years of practice, water rescue was needed. In all treated OHCA cases, the majority were found at the surface. Only in a small percentage did rescue diving take place. In these cases, survival did not appear to be poorer than in non-diving cases.

  • 36. Claesson, Andreas
    et al.
    Svensson, Leif
    Silfverstolpe, J
    Herlitz, Johan
    Characteristics and outcome among patients suffering out of hospital cardiac arrest due to drowning2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, no 3, p. 381-387Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.

  • 37.
    Claesson, Andreas
    et al.
    [external].
    Svensson, Leif
    Silfverstolpe, Johan
    Herlitz, Johan
    [external].
    Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning.2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, no 3, p. 381-387Article in journal (Refereed)
    Abstract [en]

    Abstract AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.

  • 38.
    Djarv, Therese
    et al.
    Karolinska Inst, Sweden.
    Bremer, Anders
    Linnaeus Univ, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Gothenburg Univ, Sweden.
    Israelsson, Johan
    Linköpings universitet, Avdelningen för omvårdnad och reproduktiv hälsa.
    Cronberg, Tobias
    Lund Univ, Sweden.
    Lilja, Gisela
    Lund Univ, Sweden.
    Rawshani, Araz
    Gothenburg Univ, Sweden; Sahlgrens Univ Hosp, Sweden.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Res Sect, Sweden.
    Health-related quality of life after surviving an out-of-hospital compared to an in-hospital cardiac arrest: A Swedish population-based registry study2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 151, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Background: Health-related quality of life (HRQoL) has been reported for out-hospital (OHCA) and in-hospital cardiac arrest (IHCA) separately, but potential differences between the two groups are unknown. The aim of this study is therefore to describe and compare HRQoL in patients surviving OHCA and IHCA. Methods: Patients &gt;= 18 years with Cerebral Performance Category 1-3 included in the Swedish Registry for Cardiopulmonary Resuscitation between 2014 and 2017 were included. A telephone interview was performed based on a questionnaire sent 3-6 months post cardiac arrest, including EQ-5D-5L and the Hospital Anxiety and Depression Scale. Mann-Whitney U test and multiple linear- and ordinal logistic regression analyses were used to describe and compare HRQoL in OHCA and IHCA survivors. Adjustments were made for sex, age and initial rhythm. Results: In all, 1369 IHCA and 772 OHCA survivors were included. Most OHCA and IHCA survivors reported no symptoms of with anxiety (88% and 84%) or depression (87% and 85%). IHCA survivors reported significantly more problems in the health domains mobility, self-care, usual activities and pain/discomfort (p &lt; 0.001 for all) and scored lower general health measured by EQ-VAS (median 70 vs. 80 respectively, p &lt; 0.001) compared with the OHCA survivors. Conclusion: Survivors of IHCA reported significantly worse HRQoL compared to survivors of OHCA. Consequently, research data gathered from one of these populations may not be generalizable to the other.

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  • 39.
    Dyson, Kylie
    et al.
    Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia.
    Brown, Siobhan P
    University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington.
    May, Susanne
    Centre for Research and Evaluation, Ambulance Victoria.
    Smith, Karen
    Centre for Research and Evaluation, Ambulance Victoria.
    Koster, Rudolph W
    Academic Medical Center, Amsterdam.
    Beesems, Stefanie G
    Academic Medical Center, Amsterdam.
    Kuisma, Markku
    Department of Emergency Medicine and Services, Helsinki University Hospital.
    Salo, Ari
    Department of Emergency Medicine and Services, Helsinki University Hospital.
    Finn, Judith
    School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia; University of Western Australia.
    Sterz, Fritz
    Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna.
    Nürnberger, Alexander
    Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna.
    Morrison, Laurie J
    Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto.
    Olasveengen, Theresa M
    Oslo University Hospital.
    Callaway, Clifton W
    Department of Emergency Medicine, University of Pittsburgh Medical Center.
    Shin, Sang Do
    Seoul National University, College of Medicine, Seoul.
    Gräsner, Jan-Thorsten
    Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel.
    Daya, Mohamud
    Department of Emergency Medicine, Oregon Health and Science University.
    Ma, Matthew Huei-Ming
    Department of Emergency Medicine, National Taiwan University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Strömsöe, Anneli
    School of Health and Social Sciences, University of Dalarna.
    Aufderheide, Tom P
    Department of Emergency Medicine, Medical College of Wisconsin.
    Masterson, Siobhán
    On behalf of the National Out-of-Hospital Cardiac Arrest Register (OHCAR). Discipline of General Practice, National University of Ireland, Galway, Ireland and National Ambulance Service, Health Service Executive, Dublin.
    Wang, Henry
    Department of Emergency Medicine, University of Texas Health Science Center.
    Christenson, Jim
    Department of Emergency Medicine, University of British Columbia.
    Stiell, Ian
    Department of Emergency Medicine, University of Ottawa.
    Vilke, Gary M
    Department of Emergency Medicine, University of California San Diego.
    Idris, Ahamed
    Department of Emergency Medicine, University of Texas Southwester.
    Nishiyama, Chika
    Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science.
    Iwami, Taku
    Kyoto University Health Service.
    Nichol, Graham
    University of Washington - Harborview Center for Prehospital Emergency Care, Departments of Emergency Medicine and Medicine, University of Washington.
    International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template.2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 138, p. 168-181, article id S0300-9572(18)30957-2Article in journal (Refereed)
    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.

  • 40. Ekström, L
    et al.
    Herlitz, Johan
    [external].
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Survival after cardiac arrest outside hospital over a 12-year period in Göteborg1994In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 27, no 3, p. 181-187Article in journal (Refereed)
    Abstract [en]

    Background: A two-tiered ambulance system with a mobile coronary care unit and standard ambulance has operated in Gothenburg (population 434 000) since 1980. Mass education in cardiopulmonary resuscitation (CPR) commenced in 1985 and in 1988 semiautomatic defibrillators were introduced. Aim: To describe early and late survival after cardiac arrest outside hospital over a 12-year period. Target population: All patients with prehospital cardiac arrest in Gothenburg reached by mobile coronary care unit or standard ambulance between 1980 and 1992. Results: The number of patients with cardiac arrest remained fairly steady over time. Among patients with witnessed ventricular fibrillation, the time to defibrillation decreased over time. The proportion of patients in whom bystander initiated CPR was increased only moderately over time. The proportion of patients given medication such as lignocaine and adrenaline successively increased. The number of patients with cardiac arrest who were discharged from hospital per year remained steady between 1981 and 1990 (20 per year), but increased during 1991 and 1992 to 41 and 31 respectively. Conclusions: Improvements in the emergency medical service in Gothenburg over a 12-year period have lead to: (1) a shortened delay time between cardiac arrest and first defibrillation and (2) an improved survival of patients with cardiac arrest outside hospital probably explained by this shortened delay time.

  • 41. Ekström, L
    et al.
    Wennerblom, B
    Herlitz, Johan
    [external].
    Axelsson, Å
    Bång, A
    [external].
    Holmberg, S
    Hospital mortality after out of hospital cardiac arrest among patients found in ventricular fibrillation1995In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, no 1, p. 11-21Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe factors associated with in-hospital mortality among patients being hospitalised after out-of-hospital cardiac arrest and who were found in ventricular fibrillation. The study was set in the community of Göteborg, Sweden. The subjects consisted of all patients who were hospitalised alive after out-of-hospital cardiac arrest, being reached by our mobile coronary care unit and who were found in ventricular fibrillation, between 1981 and 1992. In all, 488 patients fulfilled the inclusion criteria of which 262 (54%) died during initial hospitalization. In a multivariate analysis including age, sex, history of cardiovascular disease, chronic medication prior to arrest and circumstances at the time of arrest, the following appeared as independent predictors of hospital mortality: (1) interval between collapse and first defibrillation (P < 0.001); (2) on chronic medication with diuretics (P < 0.01); (3) age (P < 0.01); (4) bystander initiated CPR (P < 0.05); and (5) a history of diabetes (P < 0.05). In a multivariate analysis considering various aspects of status on admission to hospital, the following were independently associated with death: (1) degree of consciousness (P < 0.001) and (2) systolic blood pressure (P < 0.05). In conclusion, among patients with out of hospital cardiac arrest found in ventricular fibrillation and being hospitalised alive, 54% died in hospital. The in-hospital mortality was related to patient characteristics before the cardiac arrest as well as to factors at the resuscitation itself.

  • 42. Engdahl, J
    et al.
    Abrahamsson, P
    Bång, A
    [external].
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    [external].
    Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 43, no 3, p. 201-211Article in journal (Refereed)
    Abstract [en]

    AIM: To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. SETTING: Municipality of Göteborg, Sweden. PATIENTS: All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. RESULTS: Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P < 0.001). More patients in Sahlgrenska Hospital were still receiving cardiopulmonary resuscitation (CPR) treatment (P = 0.03), but patients in Ostra had a lower systolic blood pressure and higher heart rate on admission. A larger percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. CONCLUSION: Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.

  • 43. Engdahl, J
    et al.
    Axelsson, Å
    Bång, A
    [external].
    Karlson, BW
    Herlitz, Johan
    [external].
    The epidemiology of cardiac arrest in children and young adults.2003In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, no 2, p. 131-138Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the epidemiology of children and young adults suffering from out-of-hospital cardiac arrest. PATIENTS: All patients suffering from out-of-hospital cardiac arrest in whom, resuscitation efforts were attempted in the community of Göteborg between 1980 and 2000. METHODS: Between 31 October 1980 and 31 October 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed-up to discharge from hospital. RESULTS: Among 5505 cardiac arrests information on age was available in 5290 cases (96%). Of these 5290 cases 98 (2%) were children (age 0-17 years), 197 (4%) were young adults (age 18-35 years) and the remaining 4995 (94%) were adults (age >35 years). Children and young adults differed from adults by suffering from a witnessed arrest less frequently, being found by the ambulance crew in ventricular fibrillation/tachycardia less frequently and being judged as having an underlying cardiac aetiology less frequently. Of the children only 5% were discharged from hospital alive compared with 8% for young adults and 9% for adults. Among survivors the cerebral performance categories (CPC) score at discharge tended to differ with 38% of young adults registering a CPC score of 1 (no neurological deficit) compared with 52% among adults. CONCLUSION: Children and young adults suffering from out-of-hospital cardiac arrest differed from adults in terms of aetiology and observed initial arrhythmia. Children had a particularly bad outcome whereas young adults had a similar outcome as adults.

  • 44. Engdahl, J
    et al.
    Bång, A
    Karlson, BW
    Lindqvist, J
    Herlitz, Johan
    [external].
    Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology.2003In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 57, no 1, p. 33-41Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the epidemiology for out of hospital cardiac arrest of a non-cardiac aetiology. PATIENTS: All patients suffering from out of hospital cardiac arrest in whom resuscitation efforts were attempted in the community of Göteborg between 1981 and 2000. METHODS: Between October 1, 1980 and October 1, 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed up to discharge from hospital. RESULTS: In all, 5415 patients participated in the evaluation. Among them 1360 arrests (25%) were judged to be of a non-cardiac aetiology. Among these 24% were caused by a surgical cause or accident, 20% by obstructive pulmonary disease, 13% by drug abuse and the remaining 43% by 'another cause'. Of the patients with out of hospital cardiac arrest of a non-cardiac aetiology 4.0% survived to discharge from hospital as compared with 10.1% of the patients with a cardiac aetiology (P<0.0001). In the various subgroups survival was highest in those with drug abuse (6.8%) and lowest in those with 'another cause' (4.2%). Cerebral performance categories (CPC) score at hospital discharge tended to be worse among survivors from an arrest of non-cardiac than cardiac aetiology. Patients with a cardiac arrest of a non-cardiac aetiology differed from the remaining patients by being younger, including more women, less frequently having a witnessed arrest and less frequently being found in ventricular fibrillation/tachycardia. When simultaneously considering age, sex, witnessed status, presence of bystander cardiopulmonary resuscitation (CPR) and initial arrhythmia, the aetiology (non-cardiac vs. cardiac aetiology) was not an independent predictor of survival. CONCLUSION: Among patients with out of hospital cardiac arrest in whom resuscitation was attempted 25% were judged to be of a non-cardiac aetiology. These patients had a lower survival than patients with a cardiac arrest of cardiac aetiology. However, this was mainly explained by a lower occurrence of ventricular fibrillation and witnessed cardiac arrest.

  • 45. Engdahl, J
    et al.
    Bång, A
    [external].
    Lindqvist, J
    Herlitz, Johan
    [external].
    Factors affecting short and long term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity2001In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 51, no 1, p. 17-25Article in journal (Refereed)
    Abstract [en]

    Aims: To describe the epidemiology, resuscitation factors and prognosis among a consecutive population of patients suffering from out-of-hospital cardiac arrest (OHCA) where pulseless electrical activity (PEA) was the first arrhythmia recorded on emergency medical services (EMS) arrival. Methods: Analysis of data collected prospectively on all patients regardless of age succumbing to OHCA during 1980–1997 in the community of Gothenburg where EMS initiated resuscitative measures. Results: 4662 patients with OHCA were attended by the EMS during the study period. Of these, 1069 (23%) were judged as having PEA as the first recorded arrhythmia; 158 (15%) of these were admitted alive to hospital and 26 (2.4%) were discharged alive. Survivors to discharge had a significantly larger share of bystander cardiopulmonary resuscitation (CPR) (28 vs. 8%, P=0.008), significantly higher levels of consciousness (8% awake vs. 0%, P<0.001) and higher median systolic blood pressure (145 vs. 106 mmHg, P<0.001) on arrival at hospital. No patient with unwitnessed cardiac arrest and PEA over 80 years old survived. Conclusion: Survival among patients suffering from OHCA and PEA is poor, especially among the elderly unwitnessed cases and those who do not receive bystander CPR. The latter seems to be of utmost importance among these patients.

  • 46. Engdahl, J
    et al.
    Herlitz, Johan
    [external].
    Localization of out-of-hospital cardiac arrest in Göteborg 1994: 2002 and implications for public access defibrillation2005In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 64, no 2, p. 171-175Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Göteborg and to identify implications for public access defibrillation (PAD). Methods: Ambulance run reports for the years 1994–2002 were studied retrospectively and manually to establish the location of the cardiac arrest. Results: The location could be identified in 2194 of 2197 patients (99.9%). One thousand four hundred and twenty-nine (65%) of the arrests took place in the victims’ homes. Two hundred eighty-five (13%) were outdoors and 57 (3%) in cars. Fifty-one (2%) took place en route in ambulances. These arrests were regarded not to be generally suitable for PAD. One hundred thirty-five (6%) of the arrests happened in a public building. Eighteen of these 135 were in 15 different general practitioners’ offices. A ferry terminal had 11 cardiac arrests. One hundred fifty (7%) of the arrests took place in different care facilities. Twenty-one (1%) patients had their cardiac arrest in public transport locations. Twenty-two (1%) patients arrested at work in 20 different sites. In total, 17% of the cardiac arrests were regarded as generally suitable for PAD. Several sites with more than one cardiac arrest in five years could be identified and 54 patients (2.5%) had their cardiac arrest in these high-incidence sites. Conclusion: Among patients suffering from out-of-hospital cardiac arrest in Göteborg in whom resuscitation efforts were attempted 17% of all cardiac arrests were regarded as generally suitable for PAD. According to previous suggestions, the indication for public access defibrillation is in a place with a reasonable probability of use of one AED in 5 years. Several high-incidence sites that probably would benefit from defibrillator availability could be identified, and 54 patients (2.5%) arrested in these sites.

  • 47. Engdahl, J
    et al.
    Holmberg, S
    Karlson, BW
    Luepker, R
    Herlitz, Johan
    [external].
    The epidemiology of out-of-hospital "sudden" cardiac arrest2002In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 52, no 3, p. 235-245Article in journal (Refereed)
    Abstract [en]

    It is difficult to assemble data from an previous termout-of-hospital cardiac arrestnext term since there is often lack of objective information. The true incidence of previous termsudden cardiacnext term death previous termout-of-hospitalnext term is not known since far from all of these patients are attended by emergency medical services. The incidence of previous termout-of-hospital cardiac arrestnext term increases with age and is more common among men. Among patients who die, the probability of having a fatal event outside previous termhospitalnext term decreases with age; i. e. younger patients tend to more often die unexpectedly and outside previous termhospital.next term Among the different initial arrhythmias, ventricular fibrillation is the most common among patients with previous termcardiacnext term aetiology. The true distribution of initial arrhythmias is not known since several minutes most often elapse between collapse and rhythm assessment. Most patients with previous termout-of-hospital cardiac arrestnext term have a previous termcardiacnext term aetiology. previous termOut-of-hospital cardiac arrestsnext term most frequently occur in the patient's home, but the prognosis is shown to be better when they occur in a public place. Witnessed previous termarrest,next term ventricular fibrillation as initial arrhythmia and cardiopulmonary resuscitation are important predictors for immediate survival. In the long-term perspective, previous termcardiac arrestnext term in connection with acute myocardial infarction, high left ventricular ejection fraction, moderate age, absence of other heart failure signs and no history of myocardial infarction promotes better prognosis. Still there is much to learn about time trends, the influence of patient characteristics, comorbidity and previous termhospitalnext term treatment among patients with prehospital previous termcardiac arrest.

  • 48.
    Fovaeus, Hannah
    et al.
    Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Holmen, Johan
    Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Mandalenakis, Zacharias
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Medicine, Adult Congenital Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden..
    Castellheim, Albert Gyllencreutz
    Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study2024In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, article id 110103Article in journal (Refereed)
    Abstract [en]

    Objectives: We studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival. SETTING This was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods.

    Results: We found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 minutes. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990-1994), the odds of survival in 2015-2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006).

    Conclusion: Survival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.

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  • 49. Graves, JR
    et al.
    Herlitz, Johan
    [external].
    Bång, A
    [external].
    Axelsson, Å
    Ekström, L
    Holmberg, M
    Holmberg, S
    Lindqvist, J
    Sunnerhagen, K
    Survivors of out-of-hospital cardiac arrest. Their prognosis, longevity, and functional status1997In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 35, no 2, p. 117-121Article in journal (Refereed)
    Abstract [en]

    This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. From 1980 to 1993 Göteborg EMS treated 3754 out-of-hospital cardiac arrests. 9% (n = 324) were discharged from the hospital alive. Survivors' median age was 67 and 21% (n = 67) were women. Mortality rate was: 21% (n = 61) at 1 year; 56% (n = 78) by 5 years; and 82% (n = 32) by 10 years following the arrest. During the first 3 years, 16% (n = 46) experienced another cardiac arrest, 19% (n = 53) had an acute myocardial infraction and a total of 81% (n = 232) were rehospitalized for various conditions. 14% (n = 40) returned to previous employment, and 74% (n = 229) had retired before their arrest occurred. Cerebral performance categories (CPC) scores were: At hospital discharge N = 324; Data available for 320-1 = 53% (n = 171), 2 = 21% (n = 66), 3 = 24% (n = 77), 4 = 2% (n = 6). One year post arrest N = 263; Data available for 212-1 = 73% (n = 156), 2 = 9% (n = 18), 3 = 17% (n = 36), 4 = 1% (n = 2). Overall, 21% (n = 61) of cardiac arrest survivors died during the first year, and an additional 16% (n = 46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.

  • 50.
    Gräsner, J. -T
    et al.
    University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Tjelmeland, I. B. M.
    University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany.
    Wnent, J.
    University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany.
    Masterson, S.
    National Ambulance Service and National University of Ireland, Galway, Ireland.
    Lilja, G.
    Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
    Bein, B.
    Anaesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, GermanyMedical Faculty and University Hospital of Cologne, Germany.
    Böttiger, B. W.
    Medical Faculty and University Hospital of Cologne, Germany.
    Rosell-Ortiz, F.
    Servicio de Urgencias y Emergencias 061 de La Rioja, Spain.
    Nolan, J. P.
    Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
    Bossaert, L.
    University of Antwerp, Antwerp, Belgium.
    Perkins, G. D.
    Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
    European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe2021In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 161, p. 61-79Article in journal (Refereed)
    Abstract [en]

    In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.

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