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  • 1.
    Al-Dury, Nooraldeen
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Rawshani, Araz
    Sahlgrenska Academy, University of Gothenburg.
    Israelsson, Johan
    Linnaeus University.
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Västerås.
    Aune, Solveig
    Sahlgrenska University Hospital.
    Agerström, Jens
    Linnaeus University.
    Karlsson, Thomas
    Sahlgrenska Academy.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital, University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.2017Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, nr 12, s. 1839-1844, artikel-id S0735-6757(17)30451-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.

    METHODS: Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18-49years), middle-aged (50-64years) and older (65years and above). Comparisons between men and women were age adjusted.

    RESULTS: The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.

    CONCLUSION: When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

  • 2.
    Andersson, Henrik
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Larsson, Anna
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gellerstedt, Martin
    Bång, Angela
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ljungström, Lars
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care2018Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

    Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

    Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

    Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

  • 3. Aune, S
    et al.
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Evaluation of 2 different instruments for exposing the chest in conjunction with a cardiac arrest2010Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 29, nr 5, s. 549-553Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Time between onset of previous termcardiac arrestnext term and start of treatment is of ultimate importance for outcome. The length of time it takes to expose the previous termchestnext term in out-of-hospital previous termcardiac arrestnext term (OHCA) is not known. We aimed to compare the time from onset of OHCA until the time at which the previous termchestnext term was exposed using previous termanext term new device (S-CUT; ES Equipment, Gothenburg, Sweden) and previous termanext term pair of scissors. Methods In previous termanext term manikin study, the previous term2next term devices were compared in previous termanext term simulated previous termcardiac arrestnext term where the initial step was exposure of the previous termchest.next term The tests were performed using ambulance staff from 3 previous termdifferentnext term ambulance organizations in Western Sweden. Six previous termdifferentnext term types of clothing combinations were used. The primary choices of clothing for analyses were previous termanext term knitted sweater and shirt (indoors) and previous termanext term jacket with buttons, previous termanext term shirt, and previous termanext term college sweater (outdoors). Results The mean difference from onset of OHCA until the previous termchestnext term was exposed when S-CUT was compared with previous termanext term pair of scissors varied between 6 seconds (P = .006) and 63 seconds (P = .004; shorter with the S-CUT), depending on the type of clothing that was used. The mean differences for the clothing that was chosen for primary analyses were 23 and 63 seconds, respectively. Conclusion We found that previous termanext term new device (S-CUT) used for previous termexposing the chestnext term in OHCA was associated with previous termanext term marked shortening of procedure time as compared with previous termanext term pair of scissors.

  • 4.
    Axelsson, C
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herrera, MJ
    Fredriksson, M
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Implementation of mechanical chest compression in out-of-hospital carfdiac arrest in an emergency medical service system2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 8, s. 1196-1200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study is to describe the outcome changes after out-of-hospital cardiac arrest (OHCA) in Gothenburg, Sweden, after introduction of mechanical chest compression (MCC). METHODS: Following introduction of MCC, 1183 OHCA patients were treated from November 1, 2007, to December 31, 2011 (period 2). They were compared with 1218 OHCA patients before MCC was introduced from January 1, 1998, to May 30, 2003 (period 1). Patients in period 2 were evaluated for survival in relation to MCC use. RESULTS: The percentage of patients admitted to hospital alive increased from 25.4% to 31.9% (P < .0001). Survival to 1 month increased from 7.1% to 10.7% (P = .002) from period 1 to period 2. The proportion of ventricular fibrillation/ventricular tachycardia decreased in period 2 (P = .002). However, bystander cardiopulmonary resuscitation (P < .0001), crew-witnessed cases (P = .04), percutaneous coronary intervention (P < .0001), therapeutic hypothermia (P < .0001), and implantable cardioverter-defibrillator use (P = .01) increased, as did time from call to emergency medicine service arrival (P < .0001) and to defibrillation (P = .006). In period 2, 60% of OHCA patients were treated with MCC. The percentages admitted alive to hospital (MCC vs no MCC) were 28.6% and 36.1% (P = .008). Corresponding figures for survival to 1 month were 5.6% and 17.6% (P < .0001). In the MCC group, we found increase in the delay from collapse to defibrillation (P < .0001), greater use of adrenaline (P < .0001), and fewer crew-witnessed cases (P < .0001). CONCLUSION: Survival to 1 month after implementation of MCC was higher than before introduction. However, patients receiving MCC had low survival. Although case selection might play a role, results do not support a widespread use of MCC after OHCA.

  • 5. Beillon, Lena Marie
    et al.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlberg, Ingvar
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Does ambulance use differ between geographic areas? A survey of ambulance use in sparsely and densely populated areas2009Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 27, nr 2, s. 202-211Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to analyze possible differences in the use of ambulance service between densely and sparsely populated areas. Methods: This study was designed as a 2-step consecutive study that included the ambulance service in 4 different areas with different geographical characteristics. A specific questionnaire was distributed to the enrolled ambulance services. Completion of one questionnaire was required for each ambulance mission, that is, I per patient, during the study periods. For calculations of P values, geographic area was treated as a 4-graded ordered variable, from the most densely populated to the most sparsely populated (ie, urban-suburban-rural-remote rural area). Statistical tests used were Mann-Whitney U test and Spearman rank statistic, when appropriate. All P values are 2 tailed and considered significant if below .01. Results: The medical status of the patients in the prehospital care situation was more often severe in the sparsely populated areas. In addition, drugs were more often used in the ambulances in these areas. In the sparsely populated areas, ambulance use was more frequently judged as the appropriate mode of transportation compared with the more densely populated areas. Conclusions: Our study suggests that the appropriateness of the use of ambulance is not optimal. Furthermore, our data suggest that geographical factors, that is, population density, is related to inappropriate use. Thus, strategies to improve the appropriateness of ambulance use should probably take geographical aspects into consideration. (C) 2009 Published by Elsevier Inc.

  • 6. Blohm, M
    et al.
    Hartford, M
    Karlson, BW
    Karlsson, T
    Herlitz, Johan
    [external].
    A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI1994Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, ISSN 0735-6757, Vol. 12, nr 3, s. 315-318Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To improve the prognosis in patients with acute myocardial infarction (AMI) if treatment by early instituting treatment, we initiated a media campaign during 1 year with the intention to reduce delay times and increase ambulance use in patients with acute chest pain. This article describes the outcome during 3 years after the campaign was finished. The median delay time in patients with AMI was reduced from 3 hours 0 min before the campaign to 2 hours 20 minutes during the year of the campaign (P < .001). The median delay time remained at a similar level (2 hours 20 min) during the 3 years after the campaign. Ambulance use was not affected during or after the campaign. It can be concluded that a media campaign resulted in a reduction of delay times not only during the campaign, but also during 3 years after its pertormance, whereas ambulance use was not affected.

  • 7. Claesson, A
    et al.
    Druid, H
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac disease and probable intent after drowning2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 7, s. 1073-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study is to determine the prevalence of cardiac disease and its relationship to the victim's probable intent among patients with cardiac arrest due to drowning. METHOD: Retrospective autopsied drowning cases reported to the Swedish National Board of Forensic Medicine between 1990 and 2010 were included, alongside reported and treated out-of-hospital cardiac arrests due to drowning from the Swedish Out of Hospital Cardiac Arrest Registry that matched events in the National Board of Forensic Medicine registry (n = 272). RESULTS: Of 2166 drowned victims, most (72%) were males; the median age was 58 years (interquartile range, 42-71 years). Drowning was determined to be accidental in 55%, suicidal in 28%, and murder in 0.5%, whereas the intent was unclear in 16%. A contributory cause of death was found in 21%, and cardiac disease as a possible contributor was found in 9% of all autopsy cases. Coronary artery sclerosis (5%) and myocardial infarction (2%) were most frequent. Overall, cardiac disease was found in 14% of all accidental drownings, as compared with no cases (0%) in the suicide group; P = .05. Ventricular fibrillation was found to be similar in both cardiac and noncardiac cases (7%). This arrhythmia was found in 6% of accidents and 11% of suicides (P = .23). CONCLUSION: Among 2166 autopsied cases of drowning, more than half were considered to be accidental, and less than one-third, suicidal. Among accidents, 14% were found to have a cardiac disease as a possible contributory factor; among suicides, the proportion was 0%. The low proportion of cases showing ventricular fibrillation was similar, regardless of the presence of a cardiac disease.

  • 8.
    Claesson, A
    et al.
    Karolinska Institutet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Svensson, L
    Karolinska Institute.
    Ottosson, L
    Sahlgrenska University Hospital.
    Bergfeldt, L
    Sahlgrenska University Hospital.
    Engdahl, J
    Karolinska Institutet.
    Ericson, C
    Sahlgrenska University Hospital.
    Sandén, P
    Sahlgrenska University Hospital.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Defibrillation before EMS arrival in western Sweden.2017Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, nr 8, s. 1043-1048, artikel-id S0735-6757(17)30117-1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

    METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

    RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

    CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

  • 9.
    Claesson, Andreas
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, Tomas
    Thorén, Ann-Britt
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Delay and performance of cardiopulmonary resuscitation in surf lifeguards after simulated cardiac arrest due to drowning.2011Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 29, nr 9, s. 1044-1050Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract PURPOSE: To describe time delay during surf rescue and compare the quality of cardiopulmonary resuscitation (CPR) before and after exertion in surf lifeguards. METHODS: A total of 40 surf lifeguards at the Tylösand Surf Lifesaving Club in Sweden (65% men; age, 19-43 years) performed single-rescuer CPR for 10 minutes on a Laerdal SkillmeteÔ Resusci Anne manikin. The test was repeated with an initial simulated surf rescue on an unconscious 80-kg victim 100 m from the shore. The time to victim, to first ventilation, and to the start of CPR was documented. RESULTS: The mean time in seconds to the start of ventilations in the water was 155 ± 31 (mean ± SD) and to the start of CPR, 258 ± 44. Men were significantly faster during rescue (mean difference, 43 seconds) than women (P = .002). The mean compression depth (millimeters) at rest decreased significantly from 0-2 minutes (42.6 ± 7.8) to 8-10 minutes (40.8 ± 9.3; P = .02). The mean compression depth after exertion decreased significantly (44.2 ± 8.7 at 0-2 minutes to 41.5 ± 9.1 at 8-10 minutes; P = .0008). The compression rate per minute decreased after rescue from 117.2 ±14.3 at 0 to 2 minutes to 114.1 ± 16.1 after 8 to 10 minutes (P = .002). The percentage of correct compressions at 8 to 10 minutes was identical before and after rescue (62%). CONCLUSION: In a simulated drowning, 100 m from shore, it took twice as long to bring the patient back to shore as to reach him; and men were significantly faster. Half the participants delivered continuous chest compressions of more than 38 mm during 10 minutes of single-rescuer CPR. The quality was identical before and after surf rescue. Copyright © 2011 Elsevier Inc. All rights reserved.

  • 10. Fredriksson, M
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Nichol, G
    Variation in outcome in studies of out-of-hospital cardiac arrest: a review of studies conforming to the Utstein guidelines2003Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 21, nr 4, s. 276-281Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study was to systematically review studies on out-of-hospital cardiac arrest published according to the Utstein guidelines to describe the variability in factors of resuscitation and outcome. Articles that reported primary data on survival after out-of-hospital cardiac arrest in the Utstein style were included. Forty-seven articles were identified using Medline. Fourteen studies met our criteria for inclusion. The number of patients in whom resuscitation was attempted varied between 78 and 3,243. The proportion of bystander-witnessed cases varied between 38% and 89%; bystander CPR was performed in 21% to 56% of the cases. Patients with a bystander-witnessed cardiac arrest of cardiac etiology were discharged alive in 2% to 49% of the cases. Even when data are reported in a uniform way as suggested by the Utstein template, there is a tremendous variability in outcome. This did not appear to be entirely explained by variability in the traditional risk factors for a low chance of survival. One cannot exclude the possibility of other factors being of ultimate importance for the outcome.

  • 11. Gellerstedt, M
    et al.
    Bång, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Andréasson, E
    Johansson, A
    Does sex influence the allocation of life support level by dispatchers in acute chest pain?2010Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, nr 8, s. 922-927Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL. PATIENTS: All patients in Göteborg, Sweden, who called the dispatch center because of chest pain during 3 months (n = 503) were included in this study. METHODS: Age, sex, and symptom profile were background variables. Based on these, we studied allocation of LSL by the dispatchers and its relationship to AMI, LTC, and death. All evaluations were made from a sex perspective. Finally, we studied the potential benefit of using a statistical model for allocating LSL. RESULTS: The advanced life support level (ALSL) was used equally frequently for men and women. There was no difference in age or symptom profile between men and women in relation to allocation. However, the allocation of ALSL was predictive of AMI and LTC only in men. The sensitivity was far lower for women than for men. When a statistical model was used for allocation, the ALSL was predictive for both men and women. Using a separate model for men and women respectively, sensitivity increased, especially for women, and specificity was kept at the same level. CONCLUSION: This exploratory study indicates that women would benefit most from the allocation of LSL using a statistical model and computer-based decision support among patients who call for an ambulance because of acute chest pain. This needs further evaluation.

  • 12.
    Hagiwara Andersson, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Henricson, Maria
    Sjökvist, Bengt-Arne
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Decision support system in prehospital care: a randomized controlled simulation study2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 1, s. 143-153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Prehospital emergency medicine is a challenging discipline characterized by a high level of acuity, a lack of clinical information and a wide range of clinical conditions. These factors contribute to the fact that prehospital emergency medicine is a high-risk discipline in terms of medical errors. Prehospital use of Computerized Decision Support System (CDSS) may be a way to increase patient safety but very few studies evaluate the effect in prehospital care. The aim of the present study is to evaluate a CDSS. Methods In this non-blind block randomized, controlled trial, 60 ambulance nurses participated, randomized into 2 groups. To compensate for an expected learning effect the groups was further divided in two groups, one started with case A and the other group started with case B. The intervention group had access to and treated the two simulated patient cases with the aid of a CDSS. The control group treated the same cases with the aid of a regional guideline in paper format. The performance that was measured was compliance with regional prehospital guidelines and On Scene Time (OST). Results There was no significant difference in the two group's characteristics. The intervention group had a higher compliance in the both cases, 80% vs. 60% (p < 0.001) but the control group was complete the cases in the half of the time compare to the intervention group (p < 0.001). Conclusion The results indicate that this CDSS increases the ambulance nurses' compliance with regional prehospital guidelines but at the expense of an increase in OST.

  • 13.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    [external].
    Holmberg, S
    Type of arrhythmia at EMS arrival scene in out of hospital cardiac arrest in relation to interval from collapse and whether a bystander initiated CPR1996Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 14, nr 2, s. 119-123Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Outcome after cardiac arrest is strongly related to whether the patient has ventricular fibrillation at the time the emergency medical service (EMS) arrives on the scene. The occurrence of various arrhythmias at the time of EMS arrival among patients with out-of-hospital cardiac arrest was studied in relation to the interval from collapse and whether cardiopulmonary resuscitation (CPR) was initiated by a bystander. The patients studied were all those with out-of-hospital cardiac arrest in Goteborg, Sweden, between 1980 and 1992 in whom CPR was attempted by the arriving EMS and for whom the interval between collapse and the arrival of EMS was known. In all, information on the time of collapse and the arrival of EMS was available for 1,737 patients. Among patients for whom EMS arrived within 4 minutes of collapse, 53% were found in ventricular fibrillation/tachycardia. There was a successive decline in occurrence of such arrhythmias with time. However, when the interval exceeded 20 minutes, ventricular fibrillation/tachycardia was still observed in 27% of cases. Bystander CPR increased the occurrence of such arrhythmias regardless of the interval between collapse and EMS arrival.

  • 14.
    Herlitz, Johan
    et al.
    [external].
    Hansson, E
    Ringvall, E
    Starke, M
    Karlson, BW
    Waagstein, L
    Predicting a life-threatening disease and death among ambulance transported patients with chest pain or other symptoms raising suspicion of an acute coronary syndrome2002Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 20, nr 7, s. 588-594Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to evaluate the possibility to predict in the prehospital phase the occurrence of a life-threatening disease or death among ambulance transported patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome. All patients transported by ambulance during 3 months in the community of Göteborg because of symptoms raising any suspicion of an acute coronary syndrome were included in the study. In all, 930 transports (of 859 patients) fulfilled the inclusion criteria, of which 235 (25.3%) fulfilled the criteria for a life-threatening disease. The overall 30-day mortality was 8.8%, and the 1-year mortality was 18.0%. Independent predictors for a life-threatening disease were a low oxygen saturation on admission of the ambulance crew, patient being clammy on admission of the ambulance crew, a history of myocardial infarction and ST elevation and T-wave inversion on admission to the emergency department. Independent predictors for 30-day mortality were age greater than 70 years, symptoms of dyspnoea, a low oxygen saturation, hypotension and decreased consciousness on admission of the ambulance crew, and ST-depression on electrocardiogram (ECG) on admission to the emergency department. Predictors of 1 year mortality were age greater than 70 years, a history of myocardial infarction, symptoms of dyspnoea, a low oxygen saturation on admission of the ambulance crew and ST-depression, and no sinus rhythm on admission to the emergency department. Among patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome, factors associated with a life-threatening disease and death could be defined. Predictors for the risk of death during the first 30 days were age greater than 70 years, symptoms of dyspnoea, a low oxygen saturation, hypotension and decreased consciousness on admission of the ambulance crew, and ST-depression on ECG on admission to the emergency department.

  • 15.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjälte, L
    Karlson, BW
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, T
    Characteristics and outcome of patients with acute chest pain in relation to the use of ambulance in an urban and rural area2006Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 24, nr 7, s. 775-781Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose The aim of the study was to evaluate the rate of ambulance use and the long-term prognosis in acute chest pain in an urban and a rural area and whether there is a difference between an urban and a rural area. Procedures Patients with acute chest pain consecutively admitted to Sahlgrenska University Hospital (a city hospital) and Uddevalla County Hospital between November 1996 and April 1997 were followed up prospectively for 5 years. Results In the city hospital, 688 (36%) of 1907 patients were transported by ambulance as compared with 369 (44%) of 842 patients in the county hospital. The patients transported by ambulance were much older (mean, 71 vs 59 years in both areas), and the comorbidity was more severe among patients transported by ambulance in both areas. In the city hospital, the 5-year mortality was 41.8% among those transported by ambulance and 15.8% among those transported by other means (P < .0001). The corresponding figures for the county hospital were 38.7% and 11.0% with a P value of less than .0001. Conclusions During the 1990s, patients with acute chest pain who were transported to a hospital by ambulance differed markedly in characteristics and outcome when compared with patients transported by other means. Results did not differ with regard to area.

  • 16.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjälte, L
    Karlson, BW
    Suserud, BO
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, T
    Characteristics and outcome of patients with acute chest pain in relation to the use of ambulances in an urban and a rural area.2006Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 24, nr 7, s. 775-781Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The aim of the study was to evaluate the rate of ambulance use and the long-term prognosis in acute chest pain in an urban and a rural area and whether there is a difference between an urban and a rural area. PROCEDURES: Patients with acute chest pain consecutively admitted to Sahlgrenska University Hospital (a city hospital) and Uddevalla County Hospital between November 1996 and April 1997 were followed up prospectively for 5 years. RESULTS: In the city hospital, 688 (36%) of 1907 patients were transported by ambulance as compared with 369 (44%) of 842 patients in the county hospital. The patients transported by ambulance were much older (mean, 71 vs 59 years in both areas), and the comorbidity was more severe among patients transported by ambulance in both areas. In the city hospital, the 5-year mortality was 41.8% among those transported by ambulance and 15.8% among those transported by other means (P < .0001). The corresponding figures for the county hospital were 38.7% and 11.0% with a P value of less than .0001. CONCLUSIONS: During the 1990s, patients with acute chest pain who were transported to a hospital by ambulance differed markedly in characteristics and outcome when compared with patients transported by other means. Results did not differ with regard to area.

  • 17.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Richter, A
    Liljeqvist, J-Å
    Strömbom, U
    Holmberg, S
    Early identification of acute myocardial infarction and prognosis in relation to mode of transport1992Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 10, nr 5, s. 406-412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Of 2,840 consecutive patients who were admitted to the emergency department of a Swedish university hospital due to suspected acute myocardial infarction (AMI), only 25% were reached by the mobile coronary care unit (MCCU), and only 4% simultaneously fulfilled traditional criteria for prehospital thrombolysis (ie, had ST-segment elevation on admission electrocardiogram and a delay time of less than 6 hours). In the subset of patients who fulfilled criteria for a confirmed AMI, 31% were reached by an MCCU and 11% fulfilled criteria for prehospital thrombolysis. Among patients with confirmed AMI, the hospital mortality rate was highest in patients transported by standard ambulance (19%) versus 15% in those transported by an MCCU and 8% in those transported by other means. The authors conclude that AMI patients transported by ambulance are high-risk patients for early death. Prehospital thrombolysis might reduce their rate of mortality. However, according to the authors' experience only a minor fraction of patients are available for prehospital thrombolysis.

  • 18.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Wiklund, I
    Bengtson, A
    Prognosis and gender differences in chest pain patients discharged from ED1995Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 13, nr 2, s. 127-132Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A large proportion of patients evaluated for chest pain in the emergency department (ED) will be sent home because the probability of acute myocardial infarction, unstable angina, or other severe disease processes is determined to be sufficiently low. Patients who came to the ED at Sahlgrenska Hospital, Göteborg during a 21-month period because of chest pain were registered and followed up for one year. Survivors after one year were asked to complete a mailed questionnaire regarding different kinds of symptoms. Of 5,362 patients evaluated in the ED, 2,175 were sent home on their first visit. Fifty-four percent were men and 46% were women. The one-year mortality rate was 3% in men and 3% in women. Recurrent chest pain, dyspnea, and psychological symptoms were more frequently reported by patients with known cardiac disease than by patients without cardiac disease. Female patients with and without cardiac disease reported significantly more frequent recurrent chest pain, dyspnea, and psychological and psychosomatic complaints than male patients with and without cardiac disease. These data suggest that there are specific gender differences between men and women who are discharged from the ED after being evaluated for chest pain. In particular, psychological gender differences may exist and need to be addressed when evaluating patients with chest pain.

  • 19.
    Herlitz, Johan
    et al.
    [external].
    Starke, M
    Hansson, E
    Ringvall, E
    Karlson, BW
    Waagstein, L
    Early identification of patients with an acute coronary syndrome as assessed by dispatchers and the ambulance crew2002Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 20, nr 3, s. 196-201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study was performed to evaluate the possibility of early identification of patients with an acute coronary syndrome who are transported by ambulance. All patients in the community of Göteborg who were transported by ambulance over a period of 3 months owing to symptoms raising any suspicion of an acute coronary syndrome were studied. In all 930 cases that were included in the survey, 130 (14%) had a final diagnosis of acute myocardial infarction (AMI) and 276 (30%) had a final diagnosis of an acute coronary syndrome. Independent risk indicators for development of AMI were: male sex (odds ratio 1.70; 95% confidence limits 1.02-2.84), cold and clammy on admission of the ambulance crew (odds ratio 2.07; 95% confidence limits 1.23-3.49) and showing electrocardiogram (ECG) signs of myocardial ischemia on admission to the emergency department (odds ratio 8.78; 95%confidence limits 5.28-14.61). Independent predictors for development of an acute coronary syndrome were: male sex (odds ratio 1.97; 95% confidence limits 1.30-2.99), a history of angina pectoris (odds ratio 3.41; 95% confidence limits 2.24-5.26), cold and clammy on admission of the ambulance crew (odds ratio 1.95; 95% confidence limits 1.21-3.15), and ECG signs of myocardial ischemia on admission to the emergency department (odds ratio 5.55; 95% confidence limits 3.63-8.58). Among patients seen by the ambulance crew with symptoms raising any suspicion of an acute coronary syndrome, predictors for that diagnosis included male sex, a history of angina pectoris, patients being cold and clammy on admission of the ambulance crew, and ECG signs of myocardial ischemia on admission to the emergency department.

  • 20.
    Herlitz, Johan
    et al.
    [external].
    Svensson, L
    Engdahl, J
    gelberg, J
    Silfverstolpe, J
    Wisten, A
    Ängquist, K-A
    Holmberg, S
    Characteristics of cardiac arrest and resuscitation by age group: an analysis from the Swedish Cardiac Arrest Registry.2007Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 25, nr 9, s. 1025-1031Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The objective of this study was to describe patients who experienced an out-of-hospital cardiac arrest (OHCA) by age group. METHODS: All patients who suffered from an OHCA between 1990 and 2005 and are included in the Swedish Cardiac Arrest Registry (n = 40,503) were classified into the following age groups: neonates, younger than 1 year; young children, between 1 and 4 years; older children, between 5 and 12 years; adolescents, between 13 and 17 years; young adults, between 18 and 35 years; adults not retired, between 36 and 64 years; adults retired, between 65 and 79 years; and older adults, 80 years or older. RESULTS: Ventricular fibrillation was lowest in young children (3%) and highest in adults (35%). Survival to 1 month was lowest in neonates (2.6%) and highest in older children (7.8%). Children (<18 years), young adults (18-35 years), and adults (>35 years) survived to 1 month 24.5%, 21.2%, and 13.6% of cases, respectively (P = .0003 for trend) when found in a shockable rhythm. The corresponding figures for nonshockable rhythms were 3.8%, 3.2%, and 1.6%, respectively (P < .0001 for trend). CONCLUSIONS: There is a large variability in characteristics and outcome among patients in various age groups who experienced an OHCA. Among the large age groups, there was a successive decline in survival with increasing age in shockable and nonshockable rhythms.

  • 21.
    Herlitz, Johan
    et al.
    [external].
    Svensson, L
    Karlsson, T
    Nordlander, R
    Wahlin, M
    Zedigh, C
    Safety and delay time in prehospital thrombolysis of acute myocardial infarction in urban and rural areas in Sweden2003Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 21, nr 4, s. 263-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sixteen hospitals in Sweden, including those in urban and more sparsely populated areas, and the associated ambulance organizations were enrolled in a prospective evaluation of the feasibility of treating patients with a ST-elevation infarction with a thrombolytic agent (reteplase) before hospital admission. A physician staffed the ambulances in 1% of cases, a nurse in 67%, and a staff nurse in 32% of cases. In all, 64 patients in urban areas and 90 patients in rural areas were included. The occurrence of complications before hospital admission was low and similar in the 2 groups. The median interval between the onset of symptoms and the start of thrombolysis was 1 hour 44 minutes in urban areas versus 2 hours 14 minutes in rural areas (P = 0.03). The median arrival time (interval between onset of symptoms and arrival of the ambulance) tended to be shorter in urban areas (1 hr 10 min vs 1 hr 33 min; not significant) and the median interval between the arrival of the ambulance and the start of thrombolysis was shorter in urban areas (27 min vs 36 min; P < 0.0001). When comparing urban areas with the least-populated rural areas, differences in various delay times became even more marked. Patients in urban areas had a higher ejection fraction and fewer symptoms of heart failure after 30 days and a lower 1-year mortality.

  • 22.
    Hulldin, Martin
    et al.
    Southern Älvsborg Emergency Medical Services.
    Kängström, Jonas
    Southern Älvsborg Emergency Medical Services.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Claesson, Andreas
    Karolinska Institute.
    Perceived exertion using two different EMS stretcher systems, report from a Swedish study.2018Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, artikel-id S0735-6757(18)30157-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Emergency medical services (EMS) facilitate out of hospital care in a wide variety of settings on a daily basis. Stretcher-related adverse events and long term musculoskeletal injuries are commonly reported. Novel stretcher mechanisms may facilitate enhanced movement of patients and reduce workload for EMS personnel.

    AIM: To describe EMS personnel's perceived exertion using two different stretcher systems.

    METHODS: The methodology of this explorative simulation study included enrolling twenty (n=20) registered nurses and paramedics who worked in ten pairs (n=10) to transport a conscious, 165lb. (75kg) patient using two different EMS stretcher systems: the Pensi stretcher labeled A and the ALLFA stretcher labeled B. The ten pairs (n=10) were randomized to use either an A stretcher or a B stretcher with subsequent crossover. The pairs performed six identical tasks with each stretcher, including conveying stretchers from an ambulance up to the first floor of a building via a staircase, loading a patient on to the stretcher, and using the stretcher to transport the patient back to the ambulance. The subjective Rating of Perceived Exertion (RPE) survey (Borg scale) was used to measure perceived exertion at predefined intervals during transport.

    RESULTS: No significant differences in workload were seen between stretcher groups A and B regarding unloading the stretcher (7.4 vs 8.2 p=0.3), transporting up a stairway (13.7 vs 12.5 p=0.06), lateral lift (12.1 vs 11.2 p=0.5), or flat ground transportation (10.4 vs 11.1 p=0.13). Pairs using stretcher A showed significantly less workload with regards to transporting down a stairway (11.0 vs 14.5 p<0.001) and loading into ambulance (11.1 vs 13.0 p<0.001).

    CONCLUSION: A structured methodology may be used for testing the exertion levels experienced while using different stretcher systems. The use of supporting stretcher system mechanisms may reduce perceived exertion in EMS personnel mainly during transports down stairs and during loading into ambulance vehicles.

  • 23. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Strömbom, U
    Lindqvist, J
    Odén, A
    Hjalmarson, A
    Improvement of ED prediction of cardiac mortality among patients with symptoms suggestive of acute myocardial infarction1997Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 15, nr 1, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A study was undertaken to evaluate the 1-year risk of cardiac death for patients with chest pain/suspected acute myocardial infarction in the emergency department (ED) and express the prognosis in a statistical model. Clinical variables and electrocardiogram were correlated to cardiac death during 1 year. Cox regression model was used to estimate the risk of death as a continuous function of a risk score and the time interval. From these, the prognosis for each patient can be calculated. There were 6,794 visits by 5,303 patients followed for 1 year, during which 604 patients died. The absolute risk of cardiac death can be calculated from the independent predictors for cardiac death: age; sex; histories of diabetes mellitus, hypertension, and congestive heart failure; and symptoms, electrocardiographic pattern, and degree of suspicion of acute myocardial infarction on admission. This model allows estimation of the prognosis for every patient with chest pain/suspected acute myocardial infarction from data easily available in the ED.

  • 24. Källestedt, ML
    et al.
    Berglund, A
    Enlund, M
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    In-hospital cardiac arrest characteristics and outcome after defibrillator implementation and education: from 1 single hospital in Sweden.2012Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 30, nr 9, s. 1712-1718Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Survival after in-hospital cardiac arrest (CA) has been reported to be surprisingly low without any major improvement during the last decade. AIMS: The aim of this study is to evaluate the clinical impact (delay to defibrillation and survival after CA) of an intervention within 1 single hospital (Västerås, Sweden), including (1) a systematic education of all health care professionals in cardiopulmonary resuscitation and (2) the implementation of 18 automated external defibrillators. METHODS: Information was retrieved from the Swedish National Register of Cardiopulmonary Resuscitation. The differences between the 2 calendar periods were evaluated by χ(2) and Fisher exact tests. Logistic regression was used to control for potential confounders. RESULTS: In total, there were 73 in-hospital CAs before (12 months) and 133 after (18 months) the intervention. The overall delay to defibrillation was not reduced after the intervention, and the proportion of survivors to hospital discharge was 26% before and 32% after the intervention (P =.51). Cerebral function, however, was improved after the intervention (as judged by the cerebral performance categories score; P < .001). Thus, the proportion of survivors among all CA patients discharged with a cerebral performance scale score of 1 or 2 (good or acceptable cerebral function) increased from 20% to 32%. CONCLUSION: An intervention within 1 single hospital (systematic training of all health care professionals in cardiopulmonary resuscitation and implementation of automated external defibrillators) did not reduce treatment delay or increase overall survival. Our results, however, suggest indirect signs of an improved cerebral function among survivors.

  • 25. Källestedt, ML
    et al.
    Leppert, J
    Enlund, M
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Development of a reliable questionnaire in resuscitation knowledge2008Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 26, nr 6, s. 723-728Artikel i tidskrift (Refereegranskat)
  • 26. Martinell, L
    et al.
    Larsson, M
    Bång, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, T
    Lindqvist, J
    Thorén, A-B
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Survival in out-of-hospital cardiac arrest before and after use of advanced postresuscitation care: a survey focusing on incidence, patient characteristics, survival, and estimated cerebral function after postresuscitation care.2010Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, nr 5, s. 543-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia. METHODS: The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Göteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared. RESULTS: In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011). For all patients, 1-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in 1-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >or=3) decreased from 28% to 6% (P = .0006) among all patients. CONCLUSION: After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm.

  • 27.
    Martinell, Louise
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Thomas
    Sahlgrenska Academy, University of Gothenburg.
    Nielsen, Niklas
    Lund University.
    Rylander, Christian
    Sahlgrenska Academy, University of Gothenburg.
    Mild induced hypothermia and survival after out-of-hospital cardiac arrest.2017Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, nr 11, s. 1595-1600, artikel-id S0735-6757(17)30335-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015.

    METHODS: Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed.

    RESULTS: Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71-5.29; p<0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83-2.15; p=0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88-2.22; p=0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive.

    CONCLUSION: Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders.

  • 28. Martinell, Louise
    et al.
    Larsson, Malena
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindqvist, Jonny
    Thorén, Ann-Britt
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, Thomas
    Survival in Out of Hospital Cardiac Arrest Before and After Use of Advanced Post Resuscitation Care2010Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, nr 5, s. 543-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia. Methods: The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Goteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared. Results: In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011).For all patients, I-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in I-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >= 3) decreased from 28% to 6% (P = .0006) among all patients. Conclusion: After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm. (C) 2010 Elsevier Inc. All rights reserved.

  • 29. Ravn-Fischer, A
    et al.
    Karlsson, T
    Santos, M
    Bergman, B
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Johanson, P
    Inequalities in the early treatment of women and men with acute chest pain?2012Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 30, nr 8, s. 1515-1521Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The aim of this study was to identify sex differences in the early chain of care for patients with chest pain. DESIGN: This is a retrospective study performed at 3 centers including all patients admitted to the emergency department because of chest pain, during a 3-month period in 2008, in the municipality of Göteborg. Chest pain or discomfort in the chest was the only inclusion criterion. There were no exclusion criteria. DATA SOURCES: Data were retrospectively collected from ambulance and medical records and electrocardiogram (ECG), echocardiography, and laboratory databases. MAIN FINDINGS: A total of 2588 visits (1248 women and 1340 men) made by 2393 patients were included. When adjusting for baseline variables, female sex was significantly associated with a prolonged delay time (defined as above median) between (a) admission to hospital and admission to a hospital ward (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.25-2.03), (b) first physical contact and first dose of aspirin (OR, 2.22; 95% CI, 1.30-3.82), and (c) admission to hospital and coronary angiography (OR, 2.50; 95% CI, 1.29-5.13). Delay time to the first ECG recording did not differ significantly between women and men. PRINCIPAL CONCLUSIONS: Among patients hospitalized due to chest pain, when adjusting for differences at baseline, female sex was associated with a prolonged delay time until admission to a hospital ward, to administration of aspirin, and to performing a coronary angiography. There was no difference in delay to the first ECG recording.

  • 30. Thang, ND
    et al.
    Karlson, BW
    Santos, M
    Bengtson, A
    Johanson, P
    Rawshani, A
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Characteristics of and outcome for patients with chest pain in relation to transport by the emergency medical services in a 20-year perspective.2012Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 30, nr 9, s. 1788-1795Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim The aims of this study were to describe the characteristics of and outcome of patients with chest pain in relation to transport by the emergency medical services (EMS) and to describe possible changes in this relationship in a 20-year perspective. Methods In the 2 periods, 1986 to 1987 and 2008, all patients with chest pain admitted to hospitals in Gothenburg, Sweden, were retrospectively evaluated in terms of previous history, final diagnosis, and mortality. P values were age adjusted. Results In 1986 to 1987 and 2008, 34% of 4270 patients with chest pain and 39% of 2286 patients, respectively, were transported to the hospital by the EMS (P = .0001). In both periods, patients who used EMS were older and had a higher prevalence of previous cardiovascular diseases and more often had a final diagnosis of acute myocardial infarction (AMI) than those who did not use EMS. The EMS users were more frequently hospitalized in 1986 to 1987 than in 2008 (P < .0001). Emergency medical service use was related to a significantly higher age-adjusted 1-year mortality in both periods for all patients with chest pain as well as for those hospitalized. Among hospitalized patients with myocardial ischemia and among patients with a final diagnosis of AMI, EMS use was associated with a higher 30-day mortality in 1986 to 1987. Regardless of the use of EMS, there was a decrease in the proportion of patients developing AMI as well as the rate of death at 30 days and 1 year in 2008 as compared with 1986 to 1987. Conclusions For 20 years, the proportion of patients with chest pain using the EMS increased. EMS users were more frequently hospitalized in 1986 to 1987 than in 2008. In overall terms, mortality was higher among EMS users than among nonusers in both periods. Among hospitalized patients with myocardial ischemia and among patients with a final diagnosis of AMI, EMS use was associated with a higher 30-day mortality only in 1986 to 1987.

  • 31.
    Thang, ND
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, T
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, BW
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    ECG signs of acute myocardial ischemiain the prehospital setting of a suspected acute coronary syndrome and its association with outcomes2014Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 32, nr 6, s. 601-605Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. METHODS: Prospective cohort study using data from an interventional trial in acute chest pain patients transported by the emergency medical services. These patients were classified into 3 groups: patients with ECG showing signs of acute myocardial ischemia, patients with ECG showing other abnormal changes (bundle-branch block, pacemaker rhythm, Q-wave or T-wave inversion) and patients without significant pathologic findings. All P values are age-adjusted. RESULTS: Among 1546 patients, 312 (20%) had ECG signs of acute myocardial ischemia. Of them, 57% had a final diagnosis of AMI versus 26% of those with other abnormal ECGs and 12% of those with ECG without significant pathologic findings (P<.0001). In all, 53% of all AMI cases involved patients without ECG signs of acute myocardial ischemia. Although ECG signs of acute myocardial ischemia predicted heart failure and ventricular tachyarrhythmias both prior to and after hospital admission, there was no significant difference in 30-day mortality between the 3 patient groups (4.3%, 3.7%, and 1.2%, respectively, P=.11). CONCLUSION: Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.

  • 32. Thuresson, M
    et al.
    Haglund, P
    Ryttberg, B
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nilsson, U
    Impact of an information campaign on delays and ambulance use in acute coronary syndrome2014Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 33, nr 2, s. 297-298Artikel i tidskrift (Refereegranskat)
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