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  • 1.
    Albert, Malin
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Forsberg, Sune
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Ringh, Mattias
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Claesson, Andreas
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Thuccani, Meena
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jonsson, Martin
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Nordberg, Per
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden; Functional Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Aetiology and outcome in hospitalized cardiac arrest patients.2023In: European Heart Journal Open, E-ISSN 2752-4191, Vol. 3, no 4, article id oead066Article in journal (Refereed)
    Abstract [en]

    AIMS: To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival.

    METHODS AND RESULTS: Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13).

    CONCLUSION: In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.

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  • 2.
    Berglund, Ellinor
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Jonsson, Martin
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Svensson, Leif
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Claesson, Andreas
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Nord, Anette
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Nordberg, Per
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Forsberg, Sune
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden;Prehospen–Centre for Prehospital Research, University of Borås, Sweden;Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Högstedt, Åsa
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden;Prehospen–Centre for Prehospital Research, University of Borås, Sweden.
    Riva, Gabriel
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Ringh, Mattias
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests: The SAMBA Randomized Clinical Trial2023In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 8, no 1, p. 81-88Article in journal (Refereed)
    Abstract [en]

    Importance  Smartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs).

    Objective  To evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR).

    Design, Setting, and Participants  This randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services.

    Interventions  Volunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR.

    Main Outcomes and Measures  Overall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application.

    Results  Volunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, −0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR.

    Conclusions and Relevance  In this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant.

    Trial Registration  ClinicalTrials.gov Identifier: NCT02992873

  • 3.
    Berglund, Ellinor
    et al.
    Södersjukhuset, Stockholm.
    Olsson, Erik
    Uppsala universitet.
    Jonsson, Martin
    Södersjukhuset, Stockholm.
    Svensson, Leif
    Södersjukhuset, Stockholm.
    Hollenberg, Jacob
    Södersjukhuset, Stockholm.
    Claesson, Andreas
    Södersjukhuset, Stockholm.
    Nordberg, Per
    Södersjukhuset, Stockholm.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Högstedt, Åsa
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ringh, Mattias
    Södersjukhuset, Stockholm.
    Wellbeing, emotional response and stress among lay responders dispatched to suspected out-of-hospital cardiac arrests2022In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 170, p. 352-360Article in journal (Refereed)
    Abstract [en]

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

  • 4.
    Henningsson, Anna
    et al.
    Region Västra Götaland, Sahlgrenska University Hospital, Section of Cardiothoracic Anaesthesia and Intensive Care, Göteborg, Sweden.
    Lannemyr, Lukas
    Region Västra Götaland, Sahlgrenska University Hospital, Section of Cardiothoracic Anaesthesia and Intensive Care, Göteborg, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Angerås, Oskar
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Björås, Joakim
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergh, Niklas
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Redfors, Bengt
    Region Västra Götaland, Sahlgrenska University Hospital, Section of Cardiothoracic Anaesthesia and Intensive Care, Göteborg, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Prehospital monitoring of cerebral circulation during out of hospital cardiac arrest ?: A feasibility study2022In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1, article id 62Article in journal (Refereed)
    Abstract [en]

    Background

    About two-thirds of the in-hospital deaths after out-of-hospital cardiac arrests (OHCA) are a consequence of anoxic brain injuries, which are due to hypoperfusion of the brain during the cardiac arrests. Being able to monitor cerebral perfusion during cardiopulmonary resuscitation (CPR) is desirable to evaluate the effectiveness of the CPR and to guide further decision making and prognostication.

    Methods

    Two different devices were used to measure regional cerebral oxygen saturation (rSO2): INVOS™ 5100 (Medtronic, Minneapolis, MN, USA) and Root® O3 (Masimo Corporation, Irvine, CA, USA). At the scene of the OHCA, advanced life support (ALS) was immediately initiated by the Emergency Medical Services (EMS) personnel. Sensors for measuring rSO2 were applied at the scene or during transportation to the hospital. rSO2 values were documented manually together with ETCO2 (end tidal carbon dioxide) on a worksheet specially designed for this study. The study worksheet also included a questionnaire for the EMS personnel with one statement on usability regarding potential interference with ALS.

    Results

    Twenty-seven patients were included in the statistical analyses. In the INVOS™5100 group (n = 13), the mean rSO2 was 54% (95% CI 40.3–67.7) for patients achieving a return of spontaneous circulation (ROSC) and 28% (95% CI 12.3–43.7) for patients not achieving ROSC (p = 0.04). In the Root® O3 group (n = 14), the mean rSO2 was 50% (95% CI 46.5–53.5) and 41% (95% CI 36.3–45.7) (p = 0.02) for ROSC and no ROSC, respectively. ETCO2 values were not statistically different between the groups. The EMS personnel graded the statement of interference with ALS to a median of 2 (IQR 1–6) on a 10-point Numerical Rating Scale.

    Conclusion

    Our results suggest that both INVOS™5100 and ROOT® O3 can distinguish between ROSC and no ROSC in OHCA, and both could be used in the pre-hospital setting and during transport with minimal interference with ALS.

     

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  • 5.
    Herlitz, Johan
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Magnusson, Carl
    Sahlgrenska universitetssjukhuset, Göteborg.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Larsson, Glenn
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    Sahlgrenska universitetssjukhuset, Göteborg.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Den prehospitala akutsjukvården i Sverige har stora utmaningar2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, article id 21119Article, review/survey (Refereed)
  • 6.
    Hessulf, Fredrik
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
    Bhatt, Deepak L.
    Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, United States.
    Engdahl, Johan
    Karolinska Institutet, Department of Medicine, Karolinska University Hospital Danderyd, Stockholm, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. a Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Omerovic, Elmir
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rawshani, Aidin
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; The Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, 413 45, Sweden.
    Helleryd, Edvin
    a Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dworeck, Christian
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Friberg, Hans
    Department of Clinical Sciences, Anesthesia & Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden.
    Redfors, Björn
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Nielsen, Niklas
    Department of Clinical Sciences, Anaesthesia and Intensive Care, Helsingborg Hospital, Lund University, Lund, Sweden.
    Myredal, Anna
    a Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; .
    Frigyesi, Attila
    Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, SE-22185, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; The Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
    Predicting survival and neurological outcome in out-of-hospital cardiac arrest using machine learning: the SCARS model2023In: eBioMedicine, ISSN 2352-3964, Vol. 89, article id 104464Article in journal (Refereed)
    Abstract [en]

    Background: A prediction model that estimates survival and neurological outcome in out-of-hospital cardiac arrest patients has the potential to improve clinical management in emergency rooms.

    Methods: We used the Swedish Registry for Cardiopulmonary Resuscitation to study all out-of-hospital cardiac arrest (OHCA) cases in Sweden from 2010 to 2020. We had 393 candidate predictors describing the circumstances at cardiac arrest, critical time intervals, patient demographics, initial presentation, spatiotemporal data, socioeconomic status, medications, and comorbidities before arrest. To develop, evaluate and test an array of prediction models, we created stratified (on the outcome measure) random samples of our study population. We created a training set (60% of data), evaluation set (20% of data), and test set (20% of data). We assessed the 30-day survival and cerebral performance category (CPC) score at discharge using several machine learning frameworks with hyperparameter tuning. Parsimonious models with the top 1 to 20 strongest predictors were tested. We calibrated the decision threshold to assess the cut-off yielding 95% sensitivity for survival. The final model was deployed as a web application.

    Findings: We included 55,615 cases of OHCA. Initial presentation, prehospital interventions, and critical time intervals variables were the most important. At a sensitivity of 95%, specificity was 89%, positive predictive value 52%, and negative predictive value 99% in test data to predict 30-day survival. The area under the receiver characteristic curve was 0.97 in test data using all 393 predictors or only the ten most important predictors. The final model showed excellent calibration. The web application allowed for near-instantaneous survival calculations.

    Interpretation: Thirty-day survival and neurological outcome in OHCA can rapidly and reliably be estimated during ongoing cardiopulmonary resuscitation in the emergency room using a machine learning model incorporating widely available variables.

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  • 7.
    Högstedt, Åsa
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Thuccani, M
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Carlstrom, E
    Gothenburg Univ, Sahlgrenska Acad, Inst Healthcare Sci, Gothenburg, Sweden.
    Claesson, A
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ravn-Fischer, A
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Berglund, E
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
    Ringh, M
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
    Hollenberg, J
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, A
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests2022In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1Article in journal (Refereed)
    Abstract [en]

    Background: There has been in increase in the use of systems for organizing lay responders for suspected out-of-hospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people's commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. Methods: In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey "Volunteer Motivation Inventory" (VMI). The statements in the VMI, ranked on a Likert scale (1-5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. Results: A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). Conclusion: This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment.

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  • 8.
    Jensen, Emil
    et al.
    University of Borås.
    Rentzhog, Helena
    University of Borås.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Changes in temperature in preheated crystalloids at ambient temperatures relevant to a prehospital setting: an experimental simulation study with the application of prehospital treatment of trauma patients suffering from accidental hypothermia2024In: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 24, no 1, article id 59Article in journal (Refereed)
    Abstract [en]

    Background

    Accidental hypothermia is common in all trauma patients and contributes to the lethal diamond, increasing both morbidity and mortality. In hypotensive shock, fluid resuscitation is recommended using fluids with a temperature of 37–42°, as fluid temperature can decrease the patient’s body temperature. In Sweden, virtually all prehospital services use preheated fluids. The aim of the present study was to investigate how the temperature of preheated infusion fluids is affected by the ambient temperatures and flow rates relevant for prehospital emergency care.

     

    Methods

    In this experimental simulation study, temperature changes in crystalloids preheated to 39 °C were evaluated. The fluid temperature changes were measured both in the infusion bag and at the patient end of the infusion system. Measurements were conducted in conditions relevant to prehospital emergency care, with ambient temperatures varying between − 4 and 28 °C and flow rates of 1000 ml/h and 6000 ml/h, through an uninsulated infusion set at a length of 175 cm.

     

    Results

    The flow rate and ambient temperature affected the temperature in the infusion fluid both in the infusion bag and at the patient end of the system. A lower ambient temperature and lower flow rate were both associated with a greater temperature loss in the infusion fluid.

     

    Conclusion

    This study shows that both a high infusion rate and a high ambient temperature are needed if an infusion fluid preheated to 39 °C is to remain above 37 °C when it reaches the patient using a 175-cm-long uninsulated infusion set. It is apparent that the lower the ambient temperature, the higher the flow rate needs to be to limit temperature loss of the fluid.

  • 9.
    Jerkeman, Matilda
    et al.
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden. .
    Omerovic, Elmir
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Strömsöe, Anneli
    Department of Clinical Science and Education, Center for Resuscitation Science, Solna, Karolinska Institutet, Sweden.
    Riva, Gabriel
    Department of Clinical Science and Education, Center for Resuscitation Science, Solna, Karolinska Institutet, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götalandsregionen, Gothenburg, Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Center for Resuscitation Science, Solna, Karolinska Institutet, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götalandsregionen, Gothenburg, Sweden.
    Nivedahl, Per
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study2022In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 10, article id 100245Article in journal (Refereed)
    Abstract [en]

    Aim

    In the event of an out of hospital cardiac arrest (OHCA) it is recommended for a sole untrained bystander to perform compression only CPR (CO-CPR). However, it remains unknown if CO-CPR is inferior to standard CPR (S-CPR), including both compressions and ventilation, in terms of survival. One could speculate that due to the current pandemic, bystanders may be more hesitant performing mouth-to-mouth ventilation. The aim of this study is to assess the association between type of bystander CPR and survival in OHCA.

    Methods

    This study included all patients with a bystander treated OHCA between year 2015–2019 in ages 18–100 using The Swedish Registry for Cardiopulmonary Resuscitation (SRCR). We compared CO-CPR to S-CPR in terms of 30-day survival using a propensity score approach based on machine learning adjusting for a large number of covariates.

    Results

    A total of 13,481 patients were included (5,293 with S-CPR and 8,188 with CO-CPR). The matched subgroup consisted of 2994 cases in each group.

    Gradient boosting were the best models with regards to predictive accuracy (for type of bystander CPR) and covariate balance. The difference between S-CPR and CO-CPR in all 30 models computed on covariate adjustment and 1-to-1 matching were non-significant. In the 30 weighted models, three comparisons (S-CPR vs. CO-CPR) were significant in terms of improved survival; odds ratio for men was 1.21 (99% confidence interval (CI) 1.02–1.43; Average treatment effect (ATE)); for patients ≥73 years 1.57 (99% CI 1.17–2.12) for Average treatment effect on treated (ATT) and 1.63 (99% CI 1.18–2.25) for ATE. Remaining 27 models showed no differences. No significances remain after adjustment for multiple testing.

    Conclusion

    We found no significant differences between S-CPR and CO-CPR in terms of survival, supporting current recommendations for untrained bystanders regarding CO-CPR.

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  • 10.
    Lilja, L.
    et al.
    Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden..
    Joelsson, S.
    Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nilsson, J.
    Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Thuccani, M.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindgren, S.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rylander, C.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Assessing neurological prognosis in post-cardiac arrest patients from short vs plain text EEG reports: A survey among intensive care clinicians2021In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 159, p. 7-12Article in journal (Refereed)
    Abstract [en]

    bElectroencephalography (EEG) patterns are predictive of neurological prognosis in comatose survivors from cardiac arrest but intensive care clinicians are dependent of neurophysiologist reports to identify specific patterns. We hypothesized that the proportion of correct assessment of neurological prognosis would be higher from short statements confirming specific EEG patterns compared with descriptive plain text reports.

    Methods: Volunteering intensive care clinicians at two university hospitals were asked to assess the neurological prognosis of a fictional patient with high neuron specific enolase. They were presented with 17 authentic plain text reports and three short statements, confirming whether a “highly malignant”, “malignant” or “benign” EEG pattern was present. Primary outcome was the proportion of clinicians who correctly identified poor neurological prognosis from reports consistent with highly malignant EEG patterns. Secondary outcomes were how the prognosis was assessed from reports consistent with malignant and benign patterns.

    Results: Out of 57 participants, poor prognosis was correctly identified by 61% from plain text reports and by 93% from the short statement “highly malignant” EEG patterns. Unaffected prognosis was correctly identified by 28% from plain text reports and by 40% from the short statement “malignant” patterns. Good prognosis was correctly identified by 64% from plain text reports and by 93% from the short statement “benign” pattern.

    Conclusion: Standardized short statement, “highly malignant EEG pattern present”, as compared to plain text EEG descriptions in neurophysiologist reports, is associated with more accurate identification of poor neurological prognosis in comatose survivors of cardiac arrest. © 2020 The Authors

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  • 11.
    Lilja, L.
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Thuccani, M.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Joelsson, S.
    Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nilsson, J.
    Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Redfors, P.
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rylander, C.
    The capacity of neurological pupil index to predict absence of somatosensory evoked potentials after cardiac arrest—A study protocol2021In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 65, no 6, p. 852-858Article in journal (Refereed)
    Abstract [en]

    Background: Anoxic-ischemic brain injury is the most common cause of death after cardiac arrest (CA). Robust methods to detect severe injury with a low false positive rate (FPR) for poor neurological outcome include the pupillary light reflex (PLR) and somatosensory evoked potentials (SSEP). The PLR can be assessed manually or with automated pupillometry which provides the neurological pupil index (NPi). We aim to describe the interrelation between NPi values and the absence of SSEP cortical response and to evaluate the capacity of NPi to predict the absence of cortical SSEP response in comatose patients after CA.

    Methods: A total of 50 patients will be included in an explorative, prospective, observational study of adult (>18 years) comatose survivors of CA admitted to intensive care in a university hospital. NPi assessed with a hand-held pupillometer will be compared to SSEP signals recorded >48 hours after CA. Primary outcomes are sensitivity, specificity, and odds ratio for NPi to predict bilateral absence of the SSEP N20 signal, with NPi values corresponding to <5% FPRs of SSEP absence. Secondary outcomes are the PLR and SSEP sensitivity, specificity, and odds ratio for poor neurological outcome at hospital discharge and death at 30 days.

    Discussion: The PLR and SSEP may have a systematic interrelation, and a certain NPi threshold could potentially predict the absence of cortical SSEP response. If this can be concluded from the present study, SSEP testing could be excluded in certain patients to save resources in the multimodal prognostication after CA.

    Editorial comment The interrelation between loss of the pupillary light reflex (PLR) and the loss of cortical response to a somatosensory evoked potential (SSEP) in comatose cardiac arrest patients is not known. This exploratory prospective study is designed to evaluate whether a specific degree of attenuated PLR, as measured by semiautomated pupillometry, can predict the bilateral loss of cortical SSEP response in severe anoxic/ischemic brain injury. Such an interrelation between the two methods would enable the use of pupillometry rather than the more resource demanding SSEP for neurologic prognostication in post cardiac arrest patients.

    Trial registration: ClinicalTrials.gov, NCT04720482, Registered 21 January 2021, retrospectively registered. 

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  • 12.
    Lundin, Andreas
    et al.
    Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden..
    Karlsson, Thomas
    Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rylander, Christian
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The association between duration of mechanical ventilation and survival in post cardiac arrest patients.2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 148, p. 145-151, article id S0300-9572(20)30035-6Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess the association between the duration of mechanical ventilation during post resuscitation care and 30-day survival after cardiac arrest.

    METHODS: We conducted a retrospective observational study using data from two national registries. Comatose cardiac arrest patients admitted to general intensive care in Swedish hospitals between 2011 and 2016 were eligible. Based on the median duration of mechanical ventilation for patients who did not survive to hospital discharge, used as a proxy for the endurance of post resuscitation care, the hospitals were divided into four ordered groups for which association with 30-day survival was analyzed.

    RESULTS: In total, 5.113 patients in 56 hospitals were included. Median duration of mechanical ventilation for patients who did not survive to hospital discharge ranged from 17 h in hospital group 1-51 hours in hospital group 4. After adjustment for baseline characteristics, 30-day survival in the entire cohort was positively and independently associated with ordered hospital group: (adjusted odds ratio (95%CI); 1.12 (1.02,1.23); p = 0.02). Thus, hospitals with a longer duration of mechanical ventilation among non-survivors had better survival rate among patients admitted to ICU after a cardiac arrest. However, in a secondary analysis restricted to patients with length of stay in the intensive care unit ≥ 48 h, there was no significant association between 30-day survival and ordered hospital group.

    CONCLUSION: A tendency for longer duration of post resuscitation care in the ICU was associated with higher 30-day survival in comatose patients admitted to intensive care after cardiac arrest.

  • 13.
    Lundin, Andreas
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.
    Rylander, Christian
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.
    Karlsson, Thomas
    Health Metrics at Sahlgrenska Academy, University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. peter.lundgren@hb.se.
    Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest.2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 140, p. 64-71, article id S0300-9572(18)30800-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe how administration of adrenaline is associated with return of spontaneous circulation (ROSC) and 30-day survival in patients with in-hospital cardiac arrest (IHCA).

    DESIGN: Retrospective observational study.

    SETTING: Analysis of data extracted from a national cardiac arrest registry.

    STUDY POPULATION: Patients >18 years old with IHCA from January 2015 up to June 2017.

    OUTCOME MEASURES: Primary outcomes were ROSC and 30-day survival. Secondary outcome was survival to hospital discharge with a good neurologic outcome defined as cerebral performance category (CPC) score 1-2.

    RESULTS: Of 6033 patients eligible for inclusion, 4055 (67%) received at least one dose of adrenaline. The rate of ROSC was lower in the adrenaline group (72 vs. 98% for shockable rhythm and 50% versus 65% for non-shockable rhythm; p < 0.0001 for both). Patients who had been treated with adrenaline showed a lower rate of 30-day survival (30 vs. 85% for shockable rhythm and 12 vs. 48% for non-shockable rhythm; p < 0.0001 for both). Survival to hospital discharge with a good neurological outcome was lower in the adrenaline group (22 vs. 80% for shockable rhythm and 8 vs. 41% for non-shockable rhythm; p < 0.0001 for both). There was a marked imbalance between the two groups in median duration of cardiopulmonary resuscitation. Stratification by duration of cardiopulmonary resuscitation attenuated the differences in outcomes between treatment groups and in patients with an initial non-shockable rhythm the association between adrenaline and ROSC was reversed to the benefit for adrenaline.

    CONCLUSIONS: In our cohort of 6033 patients retrieved from a national cardiopulmonary resuscitation registry, administration of adrenaline during resuscitation from IHCA was associated with a lower rate of ROSC and 30-day survival.

  • 14.
    Schierbeck, Sofia
    et al.
    Karolinska insitute.
    Hollenberg, Jacob
    Karolinska insitute.
    Nord, Anette
    Karolinska insitute.
    Svensson, Leif
    Karolinska insitute.
    Nordberg, Per
    Karolinska insitute.
    Ringh, Mattias
    Karolinska insitute.
    Forsberg, Sune
    Karolinska insitute.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, Andreas
    Karolinska insitute.
    Automated external defibrillators delivered by drones to patients with suspected out-of-hospital cardiac arrest2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, p. 1478-1487Article in journal (Refereed)
    Abstract [en]

    Aims Early defibrillation is critical for the chance of survival in out-of-hospital cardiac arrest (OHCA). Drones, used to deliver automated external defibrillators (AEDs), may shorten time to defibrillation, but this has never been evaluated in real-life emergencies. The aim of this study was to investigate the feasibility of AED delivery by drones in real-life cases of OHCA. Methods and results In this prospective clinical trial, three AED-equipped drones were placed within controlled airspace in Sweden, covering approximately 80 000 inhabitants (125 km(2)). Drones were integrated in the emergency medical services for automated deployment in beyond-visual-line-of-sight flights: (i) test flights from 1 June to 30 September 2020 and (ii) consecutive real-life suspected OHCAs. Primary outcome was the proportion of successful AED deliveries when drones were dispatched in cases of suspected OHCA. Among secondary outcomes was the proportion of cases where AED drones arrived prior to ambulance and time benefit vs. ambulance. Totally, 14 cases were eligible for dispatch during the study period in which AED drones took off in 12 alerts to suspected OHCA, with a median distance to location of 3.1 km [interquartile range (IQR) 2.8-3.4). AED delivery was feasible within 9 m (IQR 7.5-10.5) from the location and successful in 11 alerts (92%). AED drones arrived prior to ambulances in 64%, with a median time benefit of 01:52 min (IQR 01:35-04:54) when drone arrived first. In an additional 61 test flights, the AED delivery success rate was 90% (55/61). Conclusion In this pilot study, we have shown that AEDs can be carried by drones to real-life cases of OHCA with a successful AED delivery rate of 92%. There was a time benefit as compared to emergency medical services in cases where the drone arrived first. However, further improvements are needed to increase dispatch rate and time benefits.

  • 15.
    Schierbeck, Sofia
    et al.
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Nord, Anette
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Svensson, Leif
    Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Ringh, Mattias
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm.
    Nordberg, Per
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hollenberg, Jacob
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Folke, Fredrik
    Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark; Copenhagen Emergency Medical Services, Copenhagen, Denmark; Institute of Medicine, University of Copenhagen, Copenhagen, Denmark.
    Jonsson, Martin
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Forsberg, Sune
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Claesson, Andreas
    Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Drone delivery of automated external defibrillators compared with ambulance arrival in real-life suspected out-of-hospital cardiac arrests: a prospective observational study in Sweden2023In: The Lancet Digital Health, ISSN 2589-7500, Vol. 5, no 12, p. e862-e871Article in journal (Refereed)
    Abstract [en]

    Background: A novel approach to improve bystander defibrillation for out-of-hospital cardiac arrests is to dispatch and deliver an automated external defibrillator (AED) directly to the suspected cardiac arrest location by drone. The aim of this study was to investigate how often a drone could deliver an AED before ambulance arrival and to measure the median time benefit achieved by drone deliveries. Methods: In this prospective observational study, five AED-equipped drones were placed within two separate controlled airspaces in Sweden, covering approximately 200 000 inhabitants. Drones were dispatched in addition to standard emergency medical services for suspected out-of-hospital cardiac arrests and flight was autonomous. Alerts concerning children younger than 8 years, trauma, and emergency medical services-witnessed cases were not included. Exclusion criteria were air traffic control non-approval of flight, unfavourable weather conditions, no-delivery zones, and darkness. Data were collected from the dispatch centres, ambulance organisations, Swedish Registry for Cardiopulmonary Resuscitation, and the drone operator. Core outcomes were the percentage of cases for which an AED was delivered by a drone before ambulance arrival, and the median time difference (minutes and seconds) between AED delivery by drone and ambulance arrival. Explorative outcomes were percentage of attached drone-delivered AEDs before ambulance arrival and the percentage of cases defibrillated by a drone-delivered AED when it was used before ambulance arrival. Findings: During the study period (from April 21, 2021 to May 31, 2022), 211 suspected out-of-hospital cardiac arrest alerts occurred, and in 72 (34%) of those a drone was deployed. Among those, an AED was successfully delivered in 58 (81%) cases, and the major reason for non-delivery was cancellation by dispatch centre because the case was not an out-of-hospital cardiac arrest. In cases for which arrival times for both drone and ambulance were available (n=55), AED delivery by drone occurred before ambulance arrival in 37 cases (67%), with a median time benefit of 3 min and 14 s. Among these cases, 18 (49%) were true out-of-hospital cardiac arrests and a drone-delivered AED was attached in six cases (33%). Two (33%) had a shockable first rhythm and were defibrillated by a drone-delivered AED before ambulance arrival, with one person achieving 30-day survival. No adverse events occurred. AED delivery (not landing) was made within 15 m from the patient or building in 91% of the cases. Interpretation: AED-equipped drones dispatched in cases of suspected out-of-hospital cardiac arrests delivered AEDs before ambulance arrival in two thirds of cases, with a clinically relevant median time benefit of more than 3 min. This intervention could potentially decrease time to attachment of an AED, before ambulance arrival. Funding: Swedish Heart Lung Foundation. © 2023 The Author(s). 

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  • 16.
    Thuccani, Meena
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Skoglund, Kristofer
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Bergh, Niklas
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Nordberg, Per
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden.
    Albert, Malin
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden.
    Rosengren, Annika
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Rylander, Christian
    Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    The association between signs of medical distress preceding in-hospital cardiac arrest and 30-day survival: A register-based cohort study2022In: Resuscitation Plus, ISSN 2666-5204, Vol. 11, article id 100289Article in journal (Refereed)
    Abstract [en]

    Background: Identifying signs of medical distress prior to in-hospital cardiac arrest (IHCA) is important to prevent IHCA and improve survival. The primary objective of this study was to investigate the association between signs of medical distress present within 60 minutes prior to cardiac arrest and survival after cardiac arrest.

    Methods: The register-based cohort study included adult patients (≥18 years) with IHCA in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) from 2017-01-01 to 2020-07-15. Signs of distress prior to IHCA were defined as the medical signs arrhythmia, pulmonary oedema, hypotension, hypoxia or seizures present within 60 minutes prior to cardiac arrest (pre-arrest signs). Using multivariable logistic regression, the association between these pre-arrest signs and 30-day survival was analysed in both unadjusted and adjusted models. The covariates used were demographics, comorbidities, characteristics and treatment of cardiac arrest.

    Results: In total, 8525 patients were included. After adjusting for covariates, patients with arrhythmia had a 58% higher probability of 30-day survival. The adjusted probability of 30-day survival was 41% and 52% lower for patients with hypotension and hypoxia prior to IHCA, respectively. Pulmonary oedema and seizures were not associated with any change in 30-day survival.

    Conclusions: Among signs of medical distress prior to in-hospital cardiac arrest, arrhythmia was associated with a higher 30-day survival. Hypotension and hypoxia were associated with lower survival after IHCA. These findings indicate that future research on survival after cardiac arrest should take pre-arrest signs into account as it impacts the prerequisites for survival.

     

  • 17.
    Wibring, Kristoffer
    et al.
    Department of Prehospital Emergency Care, Region Halland, Sweden.
    Magnusson, Carl
    Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Towards definitions of time-sensitive conditions in prehospital care2020In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 28, no 1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Prehospital care has changed in recent decades. Advanced assessments and decisions are made early in the care chain. Patient assessments form the basis of a decision relating to prehospital treatment and the level of care. This development imposes heavy demands on the ability of emergency medical service (EMS) clinicians properly to assess the patient. EMS clinicians have a number of assessment instruments and triage systems available to support their decisions. Many of these instruments are based on vital signs and can sometimes miss time-sensitive conditions. With this commentary, we would like to start a discussion to agree on definitions of temporal states in the prehospital setting and ways of recognising patients with time-sensitive conditions in the most optimal way.

    MAIN BODY:

    There are several articles discussing the identification and management of time-sensitive conditions. In these articles, neither definitions nor terminology have been uniform. There are a number of problems associated with the definition of time-sensitive conditions. For example, intoxication can be minor but also life threatening, depending on the type of poison and dose. Similarly, diseases like stroke and myocardial infarction can differ markedly in terms of severity and the risk of life-threatening complications. Another problem is how to support EMS clinicians in the early recognition of these conditions. It is well known that many of them can present without a deviation from normal in vital signs. It will most probably be impossible to introduce specific decision support tools for every individual time-sensitive condition. However, there may be information in the type and intensity of the symptoms patients present. In future, biochemical markers and machine learning support tools may help to identify patients with time-sensitive conditions and predict mortality at an earlier stage.

    CONCLUSION:

    It may be of great value for prehospital clinicians to be able to describe time-sensitive conditions. Today, neither definitions nor terminology are uniform. Our hope is that this commentary will initiate a discussion on the issue aiming at definitions of time-sensitive conditions in prehospital care and how they should be recognised in the most optimal fashion.

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