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  • 1. Ambjörnsson, Joakim
    et al.
    Jonsson, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Strömsöe, Annelie
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital suspicion and identification of adult septic patients:Experiences of a screening tool2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction:  Sepsis  is life threatening  and  requires  urgent healthcare  to reduce  suffering  and death. Therefore it is important that septic patients are identified early to enable treatment.

     

    Aim: To investigate to what extent EMS personnel identified patients with sepsis using the "BAS

    90-30-90"  model, and to describe assessments and medical procedures that were  undertaken by the personnel.

     

    Methods: This was a retrospective study where  185 EMS medical records were  reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

     

    Results: A physician assessed the patients  in 74 of the EMS cases, which lead to exclusion  of these  records  in  regard  to  the  EMS  personnel's  ability  to  identify  sepsis.  The  personnel documented  suspicion  of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion  of patients  065 years  of age was 73% (n=135)  of which  37% (n=50) were over 80 years  old. Thirty-nine percent  (39%,  n=72)  were  females. The  personnel  documented blood pressure   in  91%  (n=168),  respiratory   rate  in  76%  (n=140),   saturation   in  100%  (n=185), temperature  in 76%  (n=141),  and  heart  rate  in  94%  (n=174)  of  the  records.  Systolic  blood pressure  <90 mmHg  was  documented  in 14,2%  (n=24),  respiratory  rate  030 in 36%  (n=50), saturation <90 in 49%   (n=91). temperature >38°C in 37.6% (n=53), and heart rate 090 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous  lines (70%, n=130), intravenous  fluids (10%, n=19) and administration  of oxygen (72%, n=133).

     

    Conclusion:  The EMS personnel identified  only a few septic patients  with the help of the BAS

    90-30-90  model when  all three criteria  would  be met for severe  sepsis. Either  advanced age (>65  years),   fever   (>38°C)   or  tachypnea (020  breaths/min)   appeared   to   increase  the personnel's suspicion  of sepsis. Oxygen, but not intravenous  fluids, was given in an adequate way.

  • 2. Andréassob, A-Ch
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Bång, A
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Ekström, L
    Lindqvist, J
    Lundström, G
    Holmberg, S
    Characteristics and outcome among patients with a suspected in hospital cardiac arrest1998Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 39, nr 1-2, s. 23-31Artikkel i tidsskrift (Fagfellevurdert)
    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. Aune, S
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Bång, A
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Characteristics of patients who die in hospital with no attempt at resuscitation.2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 291-299Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4. Aune, S
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics of patients who die in hospital with no attempt at resuscitation2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 291-299Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Anders
    Sjöberg, Henrik
    Jiménez-Herrera, Maria
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jonsson, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gellerstedt, Martin
    Ljungström, Lars
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, nr 3, s. 1-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose:  There is a lack of knowledge  about the early phase of severe infection. This reportdescribes the early chain of care in bacteraemia as follows:  (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start ofintravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.

    Basic Procedures: All  patients  in the Municipality of Gothenburg  (Sweden) with apositive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.

    Main Findings/Results:  In all, 696 patients fulfilled the inclusion criteria. Their mean agewas 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms  and signs.The EMS nurse  suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes  versus three hours and 21 minutes among the remaining patients (P = .0006). The corresponding figures for cases with “true pathogens” were one hour and19 minutes  versus three hours and 15 minutes  (P = .009).

    Conclusion:  Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms  and signs. The EMS nurse  suspected sepsis in six percent of cases. Regardless  of whether or not patients with true pathogens  were isolated,  a suspicion of sepsis by the EMS clinician at thescene was associated with a shorter delay to the start of antibiotic treatment.

  • 6.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herrera, Maria Jimenez
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    How the context of ambulance care influences learning to become a specialist ambulance nurse a Swedish perspective.2015Inngår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Ambulance emergency care is multifaceted with extraordinary challenges to implement accurate assessment and care. A clinical learning environment providing opportunities for mastering these essential skills is a key component in ensuring that prehospital emergency nurse (PEN) students acquire the necessary clinical competence.

    AIM: The aim is to understand how PEN students experience their clinically based training, focusing on their learning process.

    METHOD: We applied content analysis with its qualitative method to our material that consisted of three reflections each by 28 PEN students over their learning process during their 8weeks of clinical ambulance practice. The research was carried out at the Center for Prehospital Care, University of Borås, Sweden.

    RESULTS: The broad spectrum of ambulance assignments seems to awaken great uncertainty and excessive respect in the students. Student vulnerability appears to decrease when the clinical supervisor behaves calmly, knowledgeably, confidently and reflectively. Early traumatic incidents on the other hand may increase the students' anxiety. Each student is offered a unique opportunity to learn how to approach patients and relatives in their own environments, and likewise an opportunity to gather information for assessment. Infrequency of missions seems to make PEN students less active in their student role, thereby preventing them from availing themselves of potential learning situations. Fatigue and hunger due to lack of breaks or long periods of transportation also inhibit learning mode.

    CONCLUSION: Our findings suggest the need for appraisal of the significance of the clinical supervisor, the ambulance environment, and student vulnerability. The broad spectrum of conditions in combination with infrequent assignments make simulation necessary. However, the unique possibilities provided for meeting patients and relatives in their own environments offer the PEN student excellent opportunities for learning how to make assessments.

  • 7.
    Bremer, Anders
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Vårdvetenskaplig analys2016Inngår i: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, s. 318-321Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 8.
    Bång, A
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Biber, B
    Isaksson, L
    Lindqvist, J
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Evaluation of dispatcher assisted cardiopulmonary resuscitation1999Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 6, nr 3, s. 175-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The outcome of out-of-hospital cardiac arrest (CA) following cardiopulmonary resuscitation (CPR) initiated by dispatcher-provided telephone instructions (T-CPR) in the area of Gothenburg, Sweden was studied. During a period of 27 months, 475 cases categorized by the dispatchers at the Emergency Co-ordination and Dispatch Centre as being suspected CA were offered T-CPR and were included in one of the following groups: (1) T-CPR completed (caller without previous CPR training); (2) T-CPR completed (caller with previous CPR training); (3) T-CPR started, but not completed; (4) T-CPR declined by caller due to previous CPR training; (5) T-CPR declined by caller due to other reasons; or, (6) T-CPR not offered. Of the patients, 473 could be followed up and of them 427 fulfilled the criteria for CA on ambulance arrival. Among the latter cases, 10% were hospitalized alive, 4% could be discharged from hospital, and the distribution among groups was: (1) 7%; (2) 18%; (3) 5%; (4) 11%; (5) 3%; and (6) 1%. The study concludes that although more attention should be paid to the detection of CA patients by the dispatchers, when the dispatchers suspected CA, their accuracy was high. Half of the witnesses accepted the offer of T-CPR and one-third completed T-CPR. More efforts and research are needed, however, to increase the percentages of callers completing CPR. The impact of T-CPR on survival might be limited. Indeed, the comparison of 'resuscitable' patients in whom T-CPR played an important role in supporting bystanders (i.e. groups 1 and 2) with 'resuscitable' patients in whom T-CPR was not performed (i.e. groups 3, 5 and 6) suggests an increase in survival from 6% (groups 3, 5 and 6) to 9% (groups 1 and 2).

  • 9.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Castrén, M
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, B-O
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, L
    Svensson, L ()
    Forskning och utveckling2009Inngår i: Prehospital akutsjukvård, Liber AB , 2009, s. 461-468Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 10.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kihlgren, S
    Karlsson, T
    Caidahl, K
    Hartford, M
    Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.2008Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 129, nr 3, s. 325-332Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.

  • 11.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gustavsson, M
    Larsson, C
    Holmberg, S
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Are patients who are found deeply unconscious, without having suffered a cardiac arrest, always breathing normally?2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, nr 2, s. 116-118Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 12.
    Bång, A
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    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.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 56, nr 1, s. 25-34Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 13.
    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 experiences2002Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 2, s. 135-151Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 14.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bra bemötande kan påverka smärta och sjukdomsförlopp2007Inngår i: Samverkan 112, ISSN 1650-7487, nr 1, s. 56-57Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 15.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Emergency medical dispatch: the first medical response for life-threatening conditions : assessment and intervention of patients with chest pain and/or suspected cardiac arrest2002Doktoravhandling, monografi (Annet vitenskapelig)
  • 16.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Rätt prehospital vård centralt vid akut hjärtinfarkt2007Inngår i: Samverkan 112, ISSN 1650-7487, Vol. 5, s. 52-53Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 17.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Castrén, Maaret
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif
    Forskning och utveckling2009Inngår i: Prehospital akutsjukvård / [ed] Leif Svensson, Stockholm: Liber AB , 2009, s. 461-469Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 18.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, Lars
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kihlgren, Stefan
    Karlsson, Thomas
    Caidahl, Kenneth
    Hartford, Marianne
    Lower mortality after prehospital recognition and treatment by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction2008Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 129, nr 3, s. 325-332Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.

  • 19.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gustavsson, Mikael
    Larsson, Carina
    Holmberg, Stig
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Are patients who are found deeply unconscious without having suffered a cardiac arrest, always breathing normally?2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, nr 2, s. 116-118Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 20.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, L
    Caidahl, K
    Karlsson, T
    Kihlgren, S
    Hartford, M
    The Relative Influence of Age, Previous History and Therapeutic Strategies Prior to Hospital Admission among Ambulance Transported Patients with ST-elevation Myocardial Infarction2009Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 136, nr 2, s. 213-214Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Among 388 patients with ST-elevation and myocardial infarction admitted to hospital with ambulance, we found the following to be independent predictors of the short term (30 days) mortality rate; Age and treatment with aspirin prior to hospital admission. The following were associated with long term (30 days to 5 years) mortality rate; age, a history of diabetes and fast track to CCU.

  • 21.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, Lars
    Caidahl, Kenneth
    Karlsson, Thomas
    Kihlgren, Stefan
    Hartford, Marianne
    The relative influence of age, previous history and therapeutic strategies prior to hospital admission among ambulance transported patients with ST-elevation myocardial infarction2008Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 136, nr 2, s. 213-214Artikkel i tidsskrift (Fagfellevurdert)
  • 22. 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 cases2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 2003, nr 56, s. 25-34Artikkel i tidsskrift (Fagfellevurdert)
    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

  • 23. Bång, Angela
    et al.
    Ortgren, P-O
    Herlitz, Johan
    Währborg, P
    Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 1, s. 135-151Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 24.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindra och behandla bröstsmärta/hjärtproblem hos patienter som söker ambulanssjukvård. LINDRA: en klinisk interventionsstudie2007Inngår i: Samverkan 112, ISSN 1650-7487Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 25.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Smärta och ångest engagerar forskare i ambulanssjukvård2007Inngår i: Samverkan 112, ISSN 1650-7487, Vol. 6, nr 4, s. 70-71Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 26. 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 Göteborg2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 43, nr 3, s. 201-211Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 27. Engdahl, J
    et al.
    Axelsson, Å
    Bång, A
    [external].
    Karlson, BW
    Herlitz, Johan
    [external].
    The epidemiology of cardiac arrest in children and young adults.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, nr 2, s. 131-138Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 28. Engdahl, J
    et al.
    Bång, A
    [external].
    Lindqvist, J
    Herlitz, Johan
    [external].
    Can we define patients with no and those with some chance of survival when found in asystole out of hospital?2000Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 86, nr 6, s. 610-614Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We describe the epidemiology, prognosis, and circumstances at resuscitation among a consecutive population of patients with out-of-hospital cardiac arrest (OHCA) with asystole as the arrhythmia first recorded by the Emergency Medical Service (EMS), and identify factors associated with survival. We included all patients in the municipality of Göteborg, regardless of age and etiology, who experienced an OHCA between 1981 and 1997. There were a total of 4,662 cardiac arrests attended by the EMS during the study period. Of these, 1,635 (35%) were judged as having asystole as the first-recorded arrhythmia: 156 of these patients (10%) were admitted alive to hospital, and 32 (2%) were discharged alive. Survivors were younger (median age 58 vs 68 years) and had a witnessed cardiac arrest more often than nonsurvivors (78% vs 50%). Survivors also had shorter intervals from collapse to arrival of ambulance (3.5 vs 6 minutes) and the mobile coronary care unit (MCCU) (5 vs 10 min), and they received atropine less often on scene. There were also a greater proportion of survivors with noncardiac etiologies of cardiac arrest (48% vs 27%). Survivors to discharge also displayed higher degrees of consciousness on arrival to the emergency department in comparison to nonsurvivors. Multivariate analysis among all patients with asystole indicated age (p = 0.01) and witnessed arrest (p = 0.03) as independent predictors of an increased chance of survival. Multivariate analysis among witnessed arrests indicated short time to arrival of the MCCU (p < 0.001) and no treatment with atropine (p = 0.05) as independent predictors of survival. Fifty-five percent of patients discharged alive had none or small neurologic deficits (cerebral performance categories 1 or 2). No patients > 70 years old with unwitnessed arrests (n = 211) survived to discharge.

  • 29. 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 activity2001Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 51, nr 1, s. 17-25Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 30. Engdahl, J
    et al.
    Bång, A
    [external].
    Lindqvist, J
    Herlitz, Johan
    [external].
    Time trends in long-term mortality after out-of-hospital cardiac arrest in 1980-1998 and predictors for death2003Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 145, nr 5, s. 826-833Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract Background We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors for death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time. Methods We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Göteborg, Sweden, from 1980 to 1998 and divided the data into 2 time periods, 1980 to 1991 and 1991 to1998, with an equal number of patients. Results A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with time. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time; the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio [RR] 1.06, 95% CI 1.05–1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51–2.72), history of smoking (RR 1.77, 95% CI 1.29–2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44–2.02). The prescription of β-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95% CI 0.46–0.85). Conclusion The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of β-blockers were independent predictors of outcome.

  • 31. Fredriksson, M
    et al.
    Aune, S
    Bång, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Thorén, A-B
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac arrest outside and inside hospital in a community: mechanisms behind the differences in outcome and outcome in relation to time of arrest.2010Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 159, nr 5, s. 749-756Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The aim was to compare characteristics and outcome after cardiac arrest where cardiopulmonary resuscitation was attempted outside and inside hospital over 12 years. METHODS: All out-of-hospital cardiac arrests (OHCAs) in Göteborg between 1994 and 2006 and all in-hospital cardiac arrests (IHCAs) in 1 of the city's 2 hospitals for whom the rescue team was called between 1994 and 2006 were included in the survey. RESULTS: The study included 2,984 cases of OHCA and 1,478 cases of IHCA. Patients with OHCA differed from those with an IHCA; they were younger, included fewer women, were less frequently found in ventricular fibrillation, and were treated later. If patients were found in a shockable rhythm, survival to 1 month/discharge was 18% after OHCA and 61% after IHCA (P < .0001). Corresponding values for a nonshockable rhythm were 3% and 21% (P < .0001). Survival was higher on daytime and weekdays as compared with nighttime and weekends after IHCA but not after OHCA. Among patients found in a shockable rhythm, a multivariate analysis considering age, gender, witnessed status, delay to defibrillation, time of day, day of week, and location showed that IHCA was associated with increased survival compared with OHCA (adjusted odds ratio 3.18, 95% CI 2.07-4.88). CONCLUSION: Compared with OHCA, the survival of patients with IHCA increased 3-fold for shockable rhythm and 7-fold for nonshockable rhythm in our practice setting. If patients were found in a shockable rhythm, the higher survival after IHCA was only partly explained by a shorter treatment delay. The time and day of CA were associated with survival in IHCA but not OHCA.

  • 32. Fredriksson, M
    et al.
    Aune, S
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Thorén, A-B
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac arrest outside and inside hospital in a community. Mechanisms behind the differences in outcome and outcome in relation to time of arrest2010Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 159, nr 5, s. 749-756Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The aim was to compare characteristics and outcome after cardiac arrest where cardiopulmonary resuscitation was attempted outside and inside hospital over 12 years. Methods All out-of-hospital cardiac arrests (OHCAs) in Göteborg between 1994 and 2006 and all in-hospital cardiac arrests (IHCAs) in 1 of the city's 2 hospitals for whom the rescue team was called between 1994 and 2006 were included in the survey. Results The study included 2,984 cases of OHCA and 1,478 cases of IHCA. Patients with OHCA differed from those with an IHCA; they were younger, included fewer women, were less frequently found in ventricular fibrillation, and were treated later. If patients were found in a shockable rhythm, survival to 1 month/discharge was 18% after OHCA and 61% after IHCA (P < .0001). Corresponding values for a nonshockable rhythm were 3% and 21% (P < .0001). Survival was higher on daytime and weekdays as compared with nighttime and weekends after IHCA but not after OHCA. Among patients found in a shockable rhythm, a multivariate analysis considering age, gender, witnessed status, delay to defibrillation, time of day, day of week, and location showed that IHCA was associated with increased survival compared with OHCA (adjusted odds ratio 3.18, 95% CI 2.07-4.88). Conclusion Compared with OHCA, the survival of patients with IHCA increased 3-fold for shockable rhythm and 7-fold for nonshockable rhythm in our practice setting. If patients were found in a shockable rhythm, the higher survival after IHCA was only partly explained by a shorter treatment delay. The time and day of CA were associated with survival in IHCA but not OHCA.

  • 33. 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?2010Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, nr 8, s. 922-927Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 34. Gellerstedt, M
    et al.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?2006Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 13, nr 5, s. 290-294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. METHODS: Patients in the Municipality of Göteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. RESULTS: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). CONCLUSION: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.

  • 35. Gellerstedt, M
    et al.
    Bång, Angela
    Herlitz, Johan
    Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?2006Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 13, nr 5, s. 290-294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. Methods: Patients in the Municipality of Göteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. Results: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). Conclusion: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.

  • 36. Gellerstedt, Martin
    et al.
    Rawshani, Nina
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gelang, Carita
    Andersson, Jan-Otto
    Larsson, Anna
    Rawshani, Araz
    Could prioritisation by emergency medicine dispatchers be improved by using computer-based decision support? A cohort of patients with chest pain.2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, s. 734-738Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity.

    METHODS: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model.

    RESULTS: A total of 2048 patients answered all 10 questions. Among the 235 patients with ACS, 194 were allocated the highest prioritisation by dispatchers (sensitivity 82.6%) and 41 patients were given a lower prioritisation (17.4% false negatives). The allocation suggested by the model used the highest prioritisation in 212 of the patients with ACS (sensitivity of 90.2%), while 23 patients were underprioritised (9.8% false negatives). The results were similar when the two systems were compared with regard to LTC and 30-day mortality. This indicates that computer-based decision support could be used either for increasing sensitivity or for saving resources. Three questions proved to be most important in terms of predicting ACS/LTC, [1] the intensity of pain, [2] the localisation of pain and [3] a history of ACS.

    CONCLUSION: Among patients with acute chest pain, computer-based decision support with a model based on a few fundamental questions could improve sensitivity and reduce the number of cases with the highest prioritisation without endangering the patients.

  • 37. 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 status1997Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 35, nr 2, s. 117-121Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 38.
    Herlitz, Johan
    et al.
    [external].
    Andersson, E
    Bång, A
    [external].
    Engdahl, J
    Holmberg, M
    Lindqvist, J
    Karlson, BW
    Waagstein, L
    Experiences from treatment of out-of-hospital cardiac arrest during 17 years in Göteborg2000Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, nr 15, s. 1251-1258Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: To describe changes in different factors at resuscitation and survival in a 17-year survey of patients suffering from out-of-hospital cardiac arrest. METHOD: The investigation was carried out in the community of Göteborg with 450 000 inhabitants during 1981-1997 on all patients suffering out-of-hospital cardiac arrest in whom resuscitation was attempted. RESULTS: The number of cases per year, the proportion of witnessed arrests and the proportion of arrests of cardiac aetiology remained similar over time. There was an increase in median age from 68 to 73 years (P<0.0001), in the proportion of females from 27% to 33% (P=0.035) and in the proportion of patients receiving bystander cardiopulmonary resuscitation from 14% to 28% (P<0.0001) with time. There was a shortening of the median interval from collapse until defibrillation from 9 min to 6 min (P<0.0001) over time but a decrease in the occurrence of ventricular fibrillation as the initially recorded arrhythmia from 39% to 32% (P=0.022). There was an increase in the proportion of patients having a bystander witnessed cardiac arrest of cardiac aetiology being hospitalized alive from 32% to 45% (P<0. 0001 for change over time). The proportion of patients discharged alive from hospital increased from 16% to 29% until 1993, but thereafter decreased to 13% in 1997 (P=0.002 for change over time). CONCLUSION: In a survey covering 17 years of resuscitation of out-of-hospital cardiac arrest patients we found that the occurrence of ventricular fibrillation as the initially recorded arrhythmia decreased. There was an increase in age, in the proportion of females and in the use of bystander cardiopulmonary resuscitation. The interval between collapse and defibrillation was shortened. Survival changed over time with an increase until 1993 but with a decrease thereafter.

  • 39.
    Herlitz, Johan
    et al.
    [external].
    Andréasson, A-C
    Bång, A
    [external].
    Aune, S
    Lindqvist, J
    Long-term prognosis among survivors after in-hospital cardiac arrest2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 45, nr 3, s. 167-171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe mortality and morbidity in the 2 years after discharge from hospital among patients surviving an in-hospital cardiac arrest. PATIENTS: All patients over a 2-year period who survived in-hospital cardiac arrest and could be discharged from hospital. SETTING: Sahlgrenska University Hospital in Göteborg. METHODS: The patients were followed prospectively for 2 years after discharge from hospital and evaluated in terms of mortality and morbidity and cerebral performance categories (CPC) score. CPC score was estimated by reference to the case notes. RESULTS: In all, 216 patients suffered in-hospital cardiac arrest and the resuscitation team was alerted: 79 patients (36.6%) were discharged alive. Among these 79 patients, 26.6% died, 7.8% developed a confirmed myocardial infarction and 1.3% developed a stroke during the subsequent 2 years. Among patients with a CPC score >1 at discharge (n=15), mortality was 66.7% as compared with 17.5% among patients with a CPC score of 1 (P=0.0008). Among patients aged >68 years (median) mortality was 39.5 versus 14.6% among patients < or =68 years of age (P=0.002). In all, 71% required rehospitalization for any reason and 51% required rehospitalization due to a cardiac cause. At hospital discharge 81% of all survivors had a CPC score of 1 and among survivors 2 years later 89% had a CPC score of 1. CONCLUSION: Among survivors of in-hospital arrest approximately 75% survived the subsequent 2 years. Survival was related to age and CPC score at discharge. Among survivors after 2 years the vast majority had a relatively good cerebral performance.

  • 40.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Bröstkompressioner lämpligare behandling för teleinstruktion än HLR2001Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, nr 4, s. 4458-4461Artikkel i tidsskrift (Fagfellevurdert)
  • 41.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Alsén, B
    Aune, S
    Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours2002Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 2, s. 127-133Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. PATIENTS: All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. METHODS: Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. RESULTS: Among patients in whom the arrest took place during office hours (08:00-16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients (P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% (P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40-3.06) as compared with patients who had an arrest outside office hours. CONCLUSION: Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.

  • 42.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Aune, S
    Ekström, L
    Lundström, G
    Holmberg, S
    Characteristics and outcome among patients suffering in hospital cardiac arrest in monitored and non monitored areas2001Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 48, nr 2, s. 125-135Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients suffering in-hospital cardiac arrest in relation to whether the arrest took place in a ward with monitoring facilities. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4-year period in Sahlgrenska Hospital, Göteborg, Sweden and in whom resuscitative efforts were attempted, were prospectively recorded and described in terms of characteristics and outcome. RESULTS: Among 557 patients, 292 (53%) had a cardiac arrest in wards with monitoring facilities. Those in a monitored location more frequently had a confirmed or possible acute myocardial infarction (AMI) as judged to be the cause of arrest (P < 0.0001), and the arrest was witnessed more frequently (96 vs. 79%; P < 0.0001). Ventricular fibrillation/tachycardia was observed more often as initial arrhythmia in monitored wards (56 vs. 44%; P = 0.006). The median interval between collapse and first defibrillation was 1 min in monitored wards and 5 min in non-monitored wards (P < 0.0001). Among patients with arrest in monitored wards 43.2% were discharged alive compared with 31.1% of patients in non-monitored wards (P = 0.004). Cerebral performance category (CPC-score) at discharge was somewhat better among survivors in monitored wards. CONCLUSION: In a Swedish University Hospital 47% of in-hospital cardiac arrests in which resuscitation was attempted took place in wards without monitoring facilities. These patients differed markedly from those having arrest in wards with monitoring facilities in terms of characteristics, interval to defibrillation and outcome. A shortening of the interval between collapse and defibrillation in these patients might increase survival even further.

  • 43.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Aune, S
    Ekström, L
    Lundström, G
    Holmberg, S
    Holmberg, M
    Lindqvist, J
    A comparison between patients suffering in-hospital and out-of-hospital cardiac arrest in terms of treatment and outcome2000Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, nr 1, s. 53-60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To compare treatment and outcome amongst patients suffering in-hospital and out-of-hospital cardiac arrest in the same community. PATIENTS: All patients suffering in-hospital cardiac arrest in Sahlgrenska University Hospital covering half the catchment area of the community of Göteborg (500 000 inhabitants) and all patients suffering out-of-hospital cardiac arrest in the community of Göteborg. Criteria for inclusion were that resuscitation efforts should have been attempted. TIME OF SURVEY: From 1 November 1994 to 1 November 1997. METHODS: Data were recorded both prospectively and retrospectively. RESULTS: In total, 422 patients suffered in-hospital cardiac arrest and 778 patients suffered out-of-hospital cardiac arrest. Patients with in-hospital cardiac arrest included more women and were more frequently found in ventricular fibrillation. The median interval between collapse and defibrillation was 2 min in in-hospital cardiac arrest compared with 7 min in out-of-hospital cardiac arrest (< 0.001). The proportion of patients being discharged from hospital was 37.5% after in-hospital cardiac arrest, compared with 8.7% after out-of-hospital cardiac arrest (P < 0.001). Corresponding figures for patients found in ventricular fibrillation were 56.9 vs. 19.7% (P < 0.001) and for patients found in asystole 25.2 vs. 1.8% (P < 0.001). CONCLUSION: In a survey evaluating patients with in-hospital and out-of-hospital cardiac arrest in whom resuscitation efforts were attempted, we found that the former group had a survival rate more than four times higher than the latter. Possible strong contributing factors to this observation are: (i) shorter time interval to start of treatment, and (ii) a prepared selection for resuscitation efforts.

  • 44.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Axelsson, Å
    Graves, JR
    Lindqvist, J
    Experience with use of automated external defibrillators in out of hospital cardiac arrest1998Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 37, nr 1, s. 3-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the sequences of arrhythmias, number of shocks delivered and the number of failures in a consecutive series of patients with out-of-hospital cardiac arrest attended by our emergency medical service (EMS) and in whom cardio-pulmonary resuscitation (CPR) was initiated and in whom automated external defibrillators (AEDs) were used. PATIENTS: All patients with out-of-hospital cardiac arrest attended by the EMS and in whom AEDs were used. Time for inclusion in the study: January 1st, 1987 to December 31st, 1992. RESULTS: In all there were 1781 out of hospital cardiac arrests during the study period. Among them AEDs were used in 383 cases (22%). The total number of interpreted rhythms delivered in these patients was 2719. Among all rhythm sequences coarse ventricular fibrillation (VF) was found on 375 occasions (14%); fine VF on 107 occasions (4%) and ventricular tachycardia (VT) on 12 occasions (0.4%). In ten cases with coarse VF (nine patients) the AED did not advise a shock (2.7%). In five of those nine patients a human error was interpreted as the explanation and in four there was a possible technical error. In these four patients defibrillation was delayed by 33-43 s, respectively. Among the 2225 rhythm sequences not judged as VF/VT the AED advised a shock on one occasion (0.04%). CONCLUSION: Among patients with coarse VF AED gave inaccurate instructions in 2.7%. However, the majority of the failures were judged to be caused by human errors.

  • 45.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Ekström, L
    Ågård, A
    Holmberg, M
    Lundström, G
    Holmberg, S
    Förbättrad överlevnad efter hjärtstopp på sjukhus2000Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, nr 30-31, s. 3363-3368Artikkel i tidsskrift (Fagfellevurdert)
  • 46.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Gunnarsson, J
    Engdahl, J
    Karlson, BW
    Lindqvist, J
    Waagstein, L
    Factors associated with survival to hospital discharge among patients hospitalized alive after out-of-hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg2003Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 89, nr 1, s. 25-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive. Patients: All patients hospitalised alive in the community of Göteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included. Methods: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded. Patients were divided into two groups (the first and second 10 year periods). Setting: Community of Göteborg, Sweden. Results: 5505 patients suffered from cardiac arrest during the time of the survey. Among them 1310 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% CI 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% CI 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% CI 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% CI 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% CI 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% CI 0.47 to 0.88); atropine required in the emergency department (OR 0.35, 95% CI 0.16 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0.59, 95% CI 0.43 to 0.81). Conclusion: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine in the emergency department, and chronic treatment with diuretics before cardiac arrest.

  • 47.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Holmberg, M
    Axelsson, Å
    Lindqvist, J
    Holmberg, S
    Rhythm changes during resuscitation from ventricular fibrillation in relation to delay until defibrillation, number of shocks delivered and survival1997Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 34, nr 1, s. 17-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe rhythm changes during the initial phase of resuscitation from ventricular fibrillation in relation to the interval between collapse and defibrillation, to survival and to bystander-initiated cardiopulmonary resuscitation (CPR). PATIENTS: All patients who suffered out-of-hospital cardiac arrest between 1980 and 1992, who were reached by the emergency medical service system (EMS), in whom resuscitation attempts were initiated and who were found in ventricular fibrillation. RESULTS: In all, 1216 patients were included in the study. Among patients who converted to a pulse-generating rhythm after the first defibrillation (n = 119) were 56% discharged from hospital as compared with 6% among patients who converted to asystole. The corresponding figures after the third defibrillation were 49% and 2%, respectively, and after the fifth defibrillation 28% and 7%, respectively. Among patients in whom the first defibrillation took place less than 5 min after collapse, 28% directly converted to a pulse-generating rhythm as compared with 3% when the first defibrillation took place 12 min or more after collapse. CONCLUSION: Among patients who suffer out-of-hospital cardiac arrest and are found in ventricular fibrillation, there is a strong relationship between survival and initial rhythm changes after defibrillation. These rhythm changes are directly related to the interval between collapse and the first defibrillation.

  • 48.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Isaksson, L
    Karlsson, T
    Outcome for patients who call for an ambulance for chest pain in relation to dispatcher's initial suspicion of acute myocardial infarction1995Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 2, nr 2, s. 75-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The very early handling of patients with suspected acute myocardial infarction (AMI) is of critical importance to the outcome. The aim of this study was to relate the dispatcher's initial suspicion of AMI, among patients who call for an ambulance due to chest pain, to the subsequent diagnosis and outcome. All patients who called for an ambulance in Gothenburg due to acute chest pain during a 2-month period were included in the study. In all, 503 patients fulfilled the inclusion criteria, and information on the dispatcher's initial suspicion of AMI was available in 484 patients. There was at least a strong suspicion of AMI in 36%, a moderate suspicion of AMI in 34% and only a vague or no suspicion in 30%. Among patients with at least a strong suspicion of AMI, 29% subsequently developed infarcation, compared with 18% among patients with a moderate suspicion of AMI and 15% among patients with only a vague or no suspicion (p < 0.001). However, the priority level was similar in patients with and without a life-threatening condition, and the mortality rate remained similar in patients with a strong suspicion and those without a strong suspicion of AMI. Thus, among patients who called for an ambulance due to acute chest pain there was a direct relationship between the dispatcher's suspicion of AMI and the subsequent diagnosis, but the mortality rate was similar in the different groups.

  • 49.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Karlson, BW
    Five-year prognosis after AMI in relation to a history of hypertension1996Inngår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 9, nr 1, s. 70-76Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study described the prognosis during 5 years of follow-up after acute myocardial infarction (AMI) for patients with a history of hypertension. All patients, regardless of age and whether or not they were admitted to the coronary care unit, were hospitalized in a single hospital due to AMI during a period of 21 months. Overall, 290 (34%) of the 862 AMI patients had a history of hypertension. Hypertensive patients had an overall 5-year mortality rate of 58% v 49% among nonhypertensive patients (P < .05). In a multivariate analysis considering age, gender, and a previous history of cardiovascular diseases, a history of hypertension was not an independent predictor of either the total mortality or mortality after discharge from hospital. The mode of death and the place of death appeared to be similar in hypertensive and nonhypertensive patients. Reinfarction developed in 43% of hypertensive patients versus 31% of nonhypertensive patients (P < .01) and a history of hypertension was an independent predictor of reinfarction (P < .05). In consecutive patients admitted to a single hospital due to AMI, a history of hypertension did not appear as an independent predictor of mortality, but it did appear as an independent predictor of reinfarction during 5 years of follow-up.

  • 50.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Karlson, BW
    Mortality, place and mode of death and reinfarction during a period of five years after acute myocardial infarction in diabetic and non diabetic patients1996Inngår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 87, nr 5, s. 423-428Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We describe the prognosis during a 5-year follow-up of 858 consecutive patients with confirmed acute myocardial infarction (AMI), of which 97 (11%) had a history of diabetes mellitus. Diabetic patients had a 5-year mortality of 72% versus 50% for non-diabetic patients (p < 0.001). In a multivariate analysis considering age, sex, diabetes and a history of cardiovascular disease, diabetes was an independent predictor of death (p < 0.001) together with age (p < 0.001), previous AMI (p < 0.001) and a history of congestive heart failure (p < 0.05). Among diabetic patients, 55% developed a reinfarction versus 22% among non-diabetic patients (p < 0.001). Mode and place of death appeared to be similar in diabetic and non-diabetic patients.

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