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  • 51.
    Herlitz, Johan
    [external].
    Consent for research in emergency situations.2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 3, s. 239-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients suffering from cardiac arrest cannot give informed consent for participation in interventional trials. This requirement would stop the process of improving survival through research among such patients.

  • 52.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Post resuscitation care. Letter to editor2007Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 73, nr 1, s. 163-164Artikel i tidskrift (Övrigt vetenskapligt)
  • 53.
    Herlitz, Johan
    [external].
    Stig Holmberg: A visionary giant in cardiopulmonary resuscitation2006Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 68, nr 1, s. 5-7Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    “How does it feel to be so small?” This question was addressed to Stig on the day of his retirement, when a couple of hundred people had assembled to acknowledge his skilful work over the years. “I don’t understand what you mean”, was the reply. “It's you guys who are unnecessarily tall.” Stig was born in 1927 and started his medical career as a surgeon in the north of Sweden. He came to Sahlgrenska University Hospital in Göteborg in 1962 at the age of 35. Here, he started working in internal medicine but switched to cardiology in 1963 and continued as a cardiologist at this hospital until he retired in 1992.

  • 54.
    Herlitz, Johan
    et al.
    [external].
    Andréasson, A-C
    Bång, A
    [external].
    Aune, S
    Lindqvist, J
    Long-term prognosis among survivors after in-hospital cardiac arrest2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 45, nr 3, s. 167-171Artikel i tidskrift (Refereegranskat)
    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.

  • 55.
    Herlitz, Johan
    et al.
    [external].
    Aune, S
    Bång, A
    Fredriksson, M
    Thorén, A-B
    Ekström, L
    Holmberg, S
    Very high survival among patients defibrillated at an early stage after in-hospital ventricular fibrillation on wards with and without monitoring facilities.2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 66, nr 2, s. 159-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The association between the interval between collapse and defibrillation and outcome is well described in out of hospital cardiac arrest but not as well in in-hospital cardiac arrest. We report the outcome among patients who suffered an in-hospital cardiac arrest and were found in ventricular fibrillation (VF) with the emphasis on the delay to defibrillation. METHODS AND RESULTS: In patients who suffered an in-hospital cardiac arrest at Sahlgrenska University Hospital in Göteborg between 1994 and 2002 there were 1.570 calls for the rescue team of which 71% had suffered a cardiac arrest. Among cardiac arrests 47% took place on monitored wards. The proportion of patients found in VF was 59% on wards with monitoring facilities and 45% on wards without (p<0.0001). Approximately 90% of these patients were defibrillated <or=3 min after collapse on monitored wards compared with 54% on non-monitored wards (p<0.0001). Among all patients, there was a strong relationship between the interval between collapse to the first defibrillation and survival to discharge from hospital (p<0.0001): 66% were discharged alive if defibrillated <or=3 min compared with 20% if defibrillated >12 min. On monitored wards, the survival was 63% if defibrillated <or=3 min compared with 60% if defibrillated >3 min after collapse (NS). The corresponding values for non-monitored wards were 72% and 35%, respectively (p=0.0003). Cerebral function among survivors at discharge appeared to be good among the majority of patients both in monitored and non monitored wards. CONCLUSION: If patients with in hospital VF were defibrillated early in both monitored and non monitored wards survival to hospital discharge was high. This highlights the importance of being prepared for the rapid defibrillation on wards without monitoring facilities.

  • 56.
    Herlitz, Johan
    et al.
    [external].
    Bahr, J
    Fischer, M
    Kuisma, M
    Lexow, K
    Thorgeirsson, G
    Resuscitation in Europe: a Tale of five European Regions1999Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 41, nr 2, s. 121-131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe cardiac arrest data from five emergency medical services (EMS) systems in Europe with regard to survival from an out-of-hospital cardiac arrest. Methods: Based on recommendations from various countries in Europe EMS systems were approached with regard to survival from out-of-hospital cardiac arrest. Five EMS systems were asked to report their cardiac arrest data according to the Utstein style. Results: The five selected EMS systems were: Bonn (Germany), Göttingen (Germany), Helsinki (Finland), Reykjavik (Iceland) and Stavanger (Norway). For patients with a bystander witnessed arrest of cardiac aetiology the percentage of patients being discharged alive from hospital in these regions were: 21, 33, 23, 23 and 35. The corresponding percentages for patients fulfilling criteria as above and being found in ventricular fibrillation were: 32, 42, 32, 27 and 55. Conclusions: Many EMS systems in Europe show extremely good results in terms of survival after an out-of-hospital cardiac arrest. Some of the results should be interpreted with caution since they were based on relatively small sample sizes. Furthermore, the results from one of the regions (Stavanger) was unit based and not community based.

  • 57.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    Alsén, B
    Aune, S
    Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to the interval between collapse and start of CPR2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 1, s. 21-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe survival after in-hospital cardiac arrest in relation to the interval between collapse and start of cardiopulmonary resuscitation (CPR). 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 interval between collapse and start of CPR was known. METHODS: Prospective recording of various factors at resuscitation including the interval between collapse and start of CPR. Retrospective evaluation via medical records of patients' previous history, clinical situation prior to cardiac arrest and final outcome. RESULTS: Survival to discharge was 33% among the 344 patients in whom CPR was started within the first minute as compared with 14% among the 88 patients in whom CPR started more than 1 min after collapse (P=0.008). The corresponding figures for patients found in ventricular fibrillation was 50 versus 32% (NS); for patients found in pulseless electrical activity 9 versus 3% (NS) and for patients found in asystole 19 versus 0% (NS). Correcting for dissimililarties in the previous history and factors at resuscitation, the adjusted odds ratio and 95% confidence limits for being discharged from hospital when CPR was started within 1 min compared with a later start was 3.06 with 95% confidence limits of 1.59-6.31. CONCLUSION: Among patients with in-hospital cardiac arrest in whom the interval between collapse and start of CPR was known, we found that in 80% of the cases CPR was started within the first minute after collapse. Among these patients, survival to discharge was twice that of patients in whom CPR was started later. These results highlight the importance of immediate CPR after in-hospital cardiac arrest.

  • 58.
    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 hours2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 2, s. 127-133Artikel i tidskrift (Refereegranskat)
    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.

  • 59.
    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 areas2001Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 48, nr 2, s. 125-135Artikel i tidskrift (Refereegranskat)
    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.

  • 60.
    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 arrest1998Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 37, nr 1, s. 3-7Artikel i tidskrift (Refereegranskat)
    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.

  • 61.
    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 survival1997Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 34, nr 1, s. 17-22Artikel i tidskrift (Refereegranskat)
    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.

  • 62.
    Herlitz, Johan
    et al.
    [external].
    Castren, M
    Friberg, H
    Nolan, J
    Skrifvars, M
    Sunde, K
    Steen, P-A
    Post resuscitation care: what are the therapeutic alternatives and what do we know?2006Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 69, nr 1, s. 15-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A large proportion of deaths in the Western World are caused by ischaemic heart disease. Among these patients a majority die outside hospital due to sudden cardiac death. The prognosis among these patients is in general, poor. However, a significant proportion are admitted to a hospital ward alive. The proportion of patients who survive the hospital phase of an out of hospital cardiac arrest varies considerably. Several treatment strategies are applicable during the post resuscitation care phase, but the level of evidence is weak for most of them. Four treatments are recommended for selected patients based on relatively good clinical evidence: therapeutic hypothermia, beta-blockers, coronary artery bypass grafting, and an implantable cardioverter defibrillator. The patient's cerebral function might influence implementation of the latter two alternatives. There is some evidence for revascularisation treatment in patients with suspected myocardial infarction. On pathophysiological grounds, an early coronary angiogram is a reasonable alternative. Further randomised clinical trials of other post resuscitation therapies are essential.

  • 63.
    Herlitz, Johan
    et al.
    [external].
    Eek, M
    Engdahl, J
    Holmberg, M
    Holmberg, S
    Factors at resuscitation and outcome among patients suffering from out of hospital cardiac arrest in relation to age.2003Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, nr 3, s. 309-317Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe various factors at resuscitation and outcome among patients suffering from out-of-hospital cardiac arrest in relation to age. PATIENTS: All patients included in the Swedish Cardiac Arrest Registry during the period 1990-1999. The registry covers about 60% of all ambulance organisations in Sweden. METHODS: All patients reached by the ambulance crew and in whom resuscitative efforts were attempted. Crew witnessed cases were excluded. Only patients aged over 18 years were included. Patients were divided into three age groups: less than 65 years (n=7810), 65-75 years (n=7261) and over 75 years (n=8390). RESULTS: The proportion of cases with a cardiac aetiology increased with increasing age (P<0.0001). The proportion of witnessed cases increased with increasing age among those with a non-cardiac aetiology (P<0.0001) and decreased with increasing age among cases with a cardiac aetiology (P=0.02). The proportion of patients exposed to bystander CPR decreased with increasing age (P<0.0001). The proportion of patients found in ventricular fibrillation (VF) decreased with increasing age among patients with a cardiac aetiology (P<0.0001) but was not related to age in those with a non-cardiac aetiology. The proportion of patients being alive after 1 month in the three age groups (youngest first) were: 4.5, 3.2 and 2.5% (P<0.0001). The corresponding figures for patients with a cardiac aetiology found in VF were: 10.7, 7.6 and 6.6% (P<0.0001). After multiple regression analysis controlling for other factors increasing age was still associated with decreased survival to 1 month (odds ratio 0.85; 95% confidence limits 0.80-0.91). CONCLUSION: Among patients suffering from out-of-hospital cardiac arrest various factors at resuscitation, including initial rhythm, aetiology and bystander CPR, are strongly related to age. The chance of survival diminishes with increasing age. When correcting for the dissimilarities in terms of factors at resuscitation, age is still significantly associated with survival, being lower among the elderly.

  • 64.
    Herlitz, Johan
    et al.
    [external].
    Eek, M
    Holmberg, M
    Holmberg, S
    Diurnal, weekly and seasonal rhythm of out of hospital cardiac arrest in Sweden2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 54, nr 2, s. 133-138Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the diurnal, weekly and seasonal rhythm among patients suffering from out of hospital cardiac arrest in Sweden. METHODS: All patients in Sweden between 1990 and 1999 participating in a National Registry covering 65% of all patients suffering from out of hospital cardiac arrest where cardiopulmonary resuscitation (CPR) was attempted. Only patients with a cardiac arrest of a cardiac aetiology and aged > 18 years were included in the survey. RESULTS: 10,868 patients fulfilled inclusion criteria. In terms of the diurnal rhythm, there was a progressive increase in the development of cardiac arrest from 06:00 h, reaching a peak at about 10:00 h. Thereafter, there was a progressive decline until 05:00 h. The diurnal rhythm was more marked among patients aged > 65 years and among patients in whom the arrest occurred outside home. There was a weekly rhythm with an increased incidence of cardiac arrest on Mondays. This was particularly evident among patients aged < 66 years and among men. A cardiac arrest occurred most frequently in January and December. This was particularly observed in the large cities. CONCLUSION: We found that out of hospital cardiac arrest of a cardiac etiology has a diurnal, weekly and seasonal rhythm occurring most frequently in the morning hours, on Mondays and in December and January. Age, sex and place of arrest influence these rhythms.

  • 65.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Axelsson, Å
    Bång, A
    Wennerblom, B
    Waagstein, L
    Dellborg, M
    Holmberg, S
    Continuation of CPR on admission to Emergency Department after out-of-hospital cardiac arrest. Occurence, characteristics and outcome1997Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, nr 3, s. 223-231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the occurrence, characteristics and outcome among patients with out-of-hospital cardiac arrest who required continuation of cardiopulmonary resuscitation (CPR) on admission to the emergency department. PATIENTS: all patients in the municipality of Göteborg who suffered out-of-hospital cardiac arrest, were reached by the emergency medical service (EMS) system and in whom CPR was initiated. Period for inclusion in study: 1 Oct. 1980-31 Dec. 1992. RESULTS: of 334 out-of-hospital cardiac arrests, 2,319 (68%) were receiving on-going CPR at the time of admission to hospital. Of these, 137 patients (6%) were hospitalized alive and 28 (1.2%) could be discharged from hospital. Of these patients, 39% had a cerebral performance categories (CPC) score of 1 (no cerebral deficiency), 18% had a CPC score of 2 (moderate cerebral deficiency), 36% had a CPC score of 3 (severe cerebral deficiency) and 7% had a CPC score of 4 (coma) at discharge. Among patients discharged. 76% were alive after 1 year. CONCLUSION: among consecutive patients with out-of-hospital cardiac arrest, CPR was ongoing in 68% of them on admission to hospital. Among these patients, 6% were hospitalized alive and 1.2% were discharged from hospital. Thus, among patients with ongoing CPR on admission to hospital, survivors can be found but they are few in numbers and extensive cerebral damage is frequently present.

  • 66.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, D
    Predictors of early and late survival after out of hospital cardiac arrest in which asystole was the first recorded arrhythmia on scene1994Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 28, nr 1, s. 27-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A large proportion of patients who suffer out-of-hospital cardiac arrest have asystole as the initial recorded arrhythmia. Since they have a poor prognosis, less attention has been paid to this group of patients. Aim: To describe a consecutive population of patients with out-of-hospital cardiac arrest with asystole as the first recorded arrhythmia and to try to define indicators for an increased chance of survival in this population. Setting: The community of Gothenburg. Patients: All patients who suffered out-of-hospital cardiac arrest during 1981 to 1992 and were reached by our emergency medical service (EMS) system and where cardiopulmonary resuscitation (CPR) was attempted. Results: In all there were 3434 cardiac arrests of which 1222 (35%) showed asystole as the first recorded arrhythmia. They differed from patients with ventricular fibrillation by being younger, including more women and having a longer interval between collapse and arrival of the first ambulance. In all 90 patients (7%) were hospitalized alive and 20 (2%) could be discharged from hospital. Independent predictors for an increased chance of survival were: (a) a short interval between the collapse and arrival of the first ambulance (P < 0.001) and the time the collapse occurred (P < 0.05). Initial treatment given in some cases with adrenaline, atropine and tribonate were not associated with an increased survival. Conclusions: Of all the patients with out-of-hospital cardiac arrest, 35% were found in asystole. Of these, 7% were hospitalized alive and 2% could be discharged from hospital. Efforts should be made to improve still further the interval between collapse and arrival of the first ambulance.

  • 67.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?1995Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, nr 3, s. 195-201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role of treatment with adrenaline in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with adrenaline prior to hospital admission. PATIENTS AND TREATMENT: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1981 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1360 patients were found in ventricular fibrillation and detailed information was available in 1203 cases (88%). Adrenaline was given in 417 cases (35%). Among patients with sustained ventricular fibrillation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P < 0.001) and were hospitalized alive more frequently (P < 0.01). However, the rate of discharge from hospital did not differ significantly between the 2 groups. Among patients who converted to asystole or electromechanical dissociation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P < 0.001) and were hospitalised alive more frequently (P < 0.001). However, the rate of discharge from hospital did not differ significantly between the 2 groups. CONCLUSIONS: On the basis of 2 treatment regimens during a 12-year survey, we explored the usefulness of adrenaline in out-of-hospital ventricular fibrillation. Both patients with sustained ventricular fibrillation and those who converted to asystole or electromechanical dissociation had an initially more favourable outcome if treated with adrenaline. However, the final outcome was not significantly affected. This study does not confirm the hypothesis that adrenaline increases survival among patients with out-of-hospital cardiac arrest who are found in ventricular fibrillation.

  • 68.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Survival among patients with out of hospital cardiac arrest found in electromechanical dissociation1995Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, nr 2, s. 97-106Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest are found in electromechanical dissociation at the time the Emergency Medical Service (EMS) arrives. Since they have a poor prognosis, less attention has been paid to them. AIM: To describe a consecutive population of patients with out-of-hospital cardiac arrest found in electromechanical dissociation and to try to define indicators for an increased chance of survival in this patient population. SETTING: The municipality of Göteborg. PATIENTS: All the patients who suffered an out-of-hospital cardiac arrest between 1981-1992 and were reached by our EMS system and in whom cardiopulmonary resuscitation (CPR) was attempted. RESULTS: In all, there were 3434 patients with cardiac arrest of whom 748 (22%) were found in electromechanical dissociation. They differed from patients found in ventricular fibrillation as there were more women, a higher frequency of cardiac arrest during the night, a lower frequency of witnessed cardiac arrest and consequently a lower frequency of bystander-initiated CPR. In all, 96 patients (13%) were hospitalized alive and only 16(2%) could be discharged from hospital. In a multivariate analysis relating to age, sex, time of cardiac arrest, interval between collapse and the arrival of the first ambulance, bystander-initiated CPR and treatment with adrenaline, atropine and tribonate, no independent predictor of survival was found. CONCLUSION: Of all the patients with out-of hospital cardiac arrest in whom CPR was attempted by our EMS, 22% were found in electromechanical dissociation. Of these, 13% were hospitalized alive and 2% could be discharged from the hospital. No independent predictor of an increased chance of survival was found.

  • 69.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    [external].
    Lindqvist, J
    Persson, N-G
    Holmberg, S
    Lidocaine in out-of-hospital ventricular fibrillation. Does it improve the survival?1997Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, nr 3, s. 199-205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role for treatment with lidocaine in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with lidocaine prior to hospital admission. Patients and treatment: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1980 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1,360 patients were found in ventricular fibrillation, with detailed information being available in 1,212 cases (89%). Lidocaine was given in 405 of these cases (33%). Among patients with sustained ventricular fibrillation, those who received lidocaine had a return of spontaneous circulation (ROSC) more frequently (P < 0.001) and were hospitalized alive more frequently (38% vs. 18%, P < 0.01). However, the rate of discharge from hospital did not significantly differ between the two groups. Among patients who were converted to a pulse-generating rhythm, those who received lidocaine on that indication were more frequently alive than those who did not receive such treatment (94% vs. 84%; P < 0.05). However, the rate of discharge did not significantly differ between the two groups. CONCLUSION: In a retrospective analysis comparing patients who received lidocaine with those who did not in sustained ventricular fibrillation and after conversion to a pulse-generating rhythm, such treatment was associated with a higher rate at ROSC and hospitalization but was not associated with an increased rate of discharge from hospital.

  • 70.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden.2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 64, nr 1, s. 37-40Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate the characteristics, outcome and prognostic factors among children suffering from out of hospital cardiac arrest in Sweden. METHODS: Patients aged below 18 years suffering from out of hospital cardiac arrest which were not crew witnessed and included in the Swedish cardiac arrest registry were included in the survey. This survey included the period 1990-2001 and 60 ambulance organisations covering 85% of the Swedish population (8 million inhabitants). RESULTS: In all 457 children participated in the survey of which 32% were bystander witnessed and 68% received bystander CPR. Ventricular fibrillation was found in 6% of the cases. The overall survival to 1 month was 4%. The aetiology was sudden infant death syndrome in 34% and cardiac in 11%. When in a multivariate analysis considering age, sex, witnessed status, bystander CPR, initial rhythm, aetiology and the interval between call for, and arrival of, the ambulance and place of arrest only one appeared as an independent predictor of an increased chance of surviving cardiac arrest occurring outside home (adjusted odds ratio 8.7; 95% CL 2.2-58.1). CONCLUSION: Among children suffering from out of hospital cardiac arrest in Sweden that were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.

  • 71.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden2004Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 60, nr 3, s. 283-290Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. Patients: All patients included in the Swedish cardiac arrest registry between 1991 until 2001. The registry covers 85% of the population in Sweden. Methods: All patients with bystander witnessed out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1991 and 2001 from the same ambulance organisation each year were included in the survey. Results: Over 11 years, among patients in Sweden with a bystander witnessed out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n = 9666), the occurrence of ventricular fibrillation as the initially obseved arrhythmia decreased from 45% in 1991 to 28% in 2001 (P < 0.0001) if the arrest occurred at home, and from 57% to 41% if the arrest occurred outside home (P < 0.0001). This was found despite the fact that the proportion who received bystander CPR increased from 29% in 1991 to 39% in 2001 if the arrest occurred at home (P < 0.0001) and from 54% to 60% if the arrest occurred outside home (NS). There was a significant increase in age among patients with out-of-hospital cardiac arrest at home, no change in the estimated interval between collapse and call but an increase in the interval between call and arrival of the ambulance among patients with out-of-hospital cardiac arrest outside home. Conclusion: During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings.

  • 72.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, K-A
    Holmberg, S
    Is female sex associated with increased survival after out-of-hospital cardiac arrest?2004Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 60, nr 2, s. 197-203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate survival after out-of-hospital cardiac arrest in relation to sex. METHODS: All patients with out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1990 and 2000 in whom cardiopulmonary resuscitation (CPR) was attempted and who did not have a crew witnessed arrest were included. The registry covers 85% of the inhabitants of Sweden (approximately 8 million inhabitants). P-values were adjusted to differences in age. Survival was defined as patients being hospitalised alive and being alive one month after cardiac arrest. In all, 23,797 patients participated in the survey of which 27.9% were women. RESULTS: Among women 16.4% were hospitalised alive versus 13.2% among men ( P<0.001). After one month 3.0% among women were alive versus 3.4% among men (NS). In a multivariate analysis considering differences in age and various factors at resuscitation female sex was an independent predictor for patients being hospitalised alive (odds ratio 1.66; 95% confidence limits 1.49-1.84) and for being alive after one month (odds ratio 1.27; 95% confidence limits 1.03-1.56). Women differed from men as they were older ( P<0.001 ), had a lower prevalence of witnessed cardiac arrest ( P=0.01), a lower occurrence of bystander CPR (P<0.001), a lower occurrence of ventricular fibrillation as initial arrhythmia (P<0.001) and a lower occurrence of cardiac disease judged to be the cause of cardiac arrest ( P<0.0001 ). On the other hand they had a cardiac arrest at home more frequently ( P<0.001 ). CONCLUSION: Among patients suffering out-of-hospital cardiac arrest in Sweden which was not crew witnessed and in whom resuscitation efforts were attempted, female sex was associated with an increased survival.

  • 73.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Ängquist, K-A
    Silfverstolpe, J
    Holmberg, S
    Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest.2006Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 73, nr 3, s. 404-409Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To explore the rate of survival to hospital discharge among patients who were brought to hospital alive after an out-of-hospital cardiac arrest in different hospitals in Sweden. PATIENTS AND METHODS: All patients who had suffered an out-of-hospital cardiac arrest which was not witnessed by the ambulance crew, in whom cardiopulmonary resuscitation (CPR) was started and who had a palpable pulse on admission to hospital were evaluated for inclusion. Each participating ambulance organisation and its corresponding hospital(s) required at least 50 patients fulfilling these criteria. RESULTS: Three thousand eight hundred and fifty three patients who were brought to hospital by 21 different ambulance organisations fulfilled the inclusion criteria. The number of patients rescued by each ambulance organisation varied between 55 and 900. The survival rate, defined as alive 1 month after cardiac arrest, varied from 14% to 42%. When correcting for dissimilarities in characteristics and factors of the resuscitation, the adjusted odds ratio for survival to 1 month among patients brought to hospital alive in the three ambulance organisations with the highest survival versus the three with the lowest survival was 2.63 (95% CI: 1.77-3.88). CONCLUSION: There is a marked variability between hospitals in the rate of 1-month survival among patients who were alive on hospital admission after an out-of-hospital cardiac arrest. One possible contributory factor is the standard of post-resuscitation care.

  • 74.
    Herlitz, Johan
    et al.
    [external].
    Fredriksson, M
    Engdahl, J
    Nineteen years' experience of out-of-hospital cardiac arrest in Gothenburg--reported in Utstein style.2003Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, nr 1, s. 37-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the outcome in the Utstein style for out of hospital cardiac arrest in Gothenburg, over a period of 19 years. METHODS: All consecutive cases of cardiac arrest between 1980 and 1999 in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed up for 1 year. RESULTS: In all, there were 5270 attempts. 3871 (73%) of which were regarded as being of a cardiac aetiology. In these cases, information on witnessed status was missing in 782 cases (20%). Of the remaining 3089 cases, 2066 (67%) were bystander witnessed, 791 (26%) were unwitnessed and 232 (8%) crew witnessed. The median interval between a call for the ambulance and the arrival of the first ambulance was 5 min. Thirteen percent of the bystander-witnessed cases were discharged from hospital. Of the unwitnessed cases, only 2% were discharged from hospital, whereas 22% of the crew-witnessed cases were discharged. Of the patients with a bystander-witnessed cardiac arrest of a cardiac aetiology found in ventricular fibrillation (VF), 20% were discharged from hospital. CONCLUSION: In this large Utstein style study of out of hospital cardiac arrest stretching over almost 19 years, we report high survival rates both for patients suffering a bystander-witnessed cardiac arrest, and for the subgroup suffering a bystander-witnessed cardiac arrest with VF as the first recorded rhythm. These high survival rates can in part be explained by the short time intervals from calls being received by the emergency dispatch centre (EDC) to the arrival of the emergency medical service at the scene.

  • 75.
    Herlitz, Johan
    et al.
    [external].
    Rosenfelt, M
    Bång, A
    Axelsson, Å
    Ekström, L
    Wennerblom, B
    Lövhagen, O
    Palmqvist, M
    Holmberg, S
    Prognosis among patients with out of hospital cardiac arrest judged as being caused by deterioration of obstructive pulmonary disease1996Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 32, nr 3, s. 177-184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe the prognosis of patients with out-of-hospital cardiac arrest judged to be caused by the deterioration of obstructive pulmonary disease. Patients: All patients in the community of Göteborg Sweden who suffered out-of-hospital cardiac arrest between 1980 and 1992 attended by our emergency medical service and in whom cardiopulmonary resuscitation was initiated. Methods: The etiology of cardiac arrest was determined according to clinical history, observations at resuscitation and findings at autopsy. Results: There were 3434 cardiac arrests of which 130 (4%) were judged to have been caused by deterioration of obstructive pulmonary disease. Of these patients 50% were found in asystole, 40% in pulseless electrical activity, and only 7% in ventricular fibrillation. Among patients with cardiac arrest caused by obstructive pulmonary disease 21 (16%) were hospitalized alive and six (5%) were discharged from hospital. Among patients who developed cardiac arrest after arrival of the ambulance, 16% were discharged from hospital versus 0% among patients who had arrest prior to arrival of the ambulance. Conclusion: Among patients with out-of-hospital cardiac arrest caused by deterioration of obstructive pulmonary disease, half were found in asystole. Overall, the survival rate was low. This highlights the importance of effective treatment early in the course of deterioration of obstructive pulmonary disease in order to avoid cardiac arrest.

  • 76.
    Herlitz, Johan
    et al.
    [external].
    Rundqvist, S
    Bång, A
    [external].
    Aune, S
    Ekström, L
    Lindqvist, J
    Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?2001Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 49, nr 1, s. 15-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients suffering from an in-hospital cardiac arrest in women and men. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4 year period in Sahlgrenska Hospital Göteborg, Sweden, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. RESULTS: There were 557 patients suffering in-hospital cardiac arrest in whom the CPR-team was alerted. Among them, 217 (39%) were women. Women differed from men having a lower prevalence of earlier myocardial infarction, angina pectoris, renal disease and a higher prevalence of rheumatic disease. In terms of aetiology of the cardiac arrest, 47% men and 48% women were judged to have had a confirmed or possible AMI. More men than women were found in ventricular fibrillation/ventricular tachycardia (VF/VT) (57 vs. 41%; P<0.001), whereas more women were found in pulseless electrical activity (30 vs. 15%; P<0.0001). Cerebral performance categories (CPC)-score at discharge did not differ between men and women. Among women, 36.4% survived to discharge as compared with 38.0% among men (NS). Survival from VF/VT was 64.3% in women and 52.7% in men (NS). When correcting for dissimilarities at baseline, the adjusted odd ratio for being discharged alive from hospital among women as compared with men was 1.66 (95% confidence limit 1.06-2.62; P=0.028).

  • 77.
    Herlitz, Johan
    et al.
    [external].
    Svensson, L
    Engdahl, J
    Silfverstolpe, J
    Characteristics and outcome in out-of-hospital cardiac arrest when patients are found in a non-shockable rhythm.2008Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, nr 1, s. 31-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) who were found in a non-shockable rhythm. PATIENTS: All the patients included in the Swedish OHCA registry between 1990 and 2005 in whom resuscitation was attempted, who were found in a non-shockable rhythm and where either the OHCA was witnessed by a bystander or was not witnessed. RESULTS: In all, 22,465 patients fulfilled the inclusion criteria. Their mean age was 67 years, 32% were women, 57% were witnessed, 64% had a cardiac aetiology, 71% occurred at home and 34% received bystander cardiopulmonary resuscitation (CPR). Survival to 1 month was 1.3%. The following were independently associated with an increased chance of survival: 1/Decreasing age, 2/Witnessed arrest, 3/Bystander CPR, 4/Cardiac arrest outside home, 5/Shorter ambulance response time and 6/Need for defibrillatory shock. If these six criteria were fulfilled (age and ambulance response time below the median), survival to 1 month increased to 12.6%. If no criteria were fulfilled, survival was 0.15%. CONCLUSION: The overall survival among patients with an OHCA found in a non-shockable rhythm is very low (1.3%). Six factors associated with survival can be defined. When they are taken into account, survival varies between 12.6 and 0.15%.

  • 78.
    Herlitz, Johan
    et al.
    [external].
    Svensson, L
    Engdahl, J
    Ängquist, K-A
    Silfverstolpe, J
    Holmberg, S
    Association between interval between call for ambulance and return of spontaneous circulation and survival in out-of-hospital cardiac arrest.2006Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 71, nr 1, s. 40-46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the association between the interval between the call for ambulance and return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest. PATIENTS: All patients suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was started, included in the Swedish Cardiac Arrest Registry (SCAR) for whom information about the time of calling for an ambulance and the time of ROSC was available. RESULTS: Among 26,192 patients who were included in SCAR and were not witnessed by the ambulance crew, information about the time of call for an ambulance and the time of ROSC was available in 4847 patients (19%). There was a very strong relationship between the interval between call for an ambulance and ROSC and survival to one month. If the interval was less than or equal to 5 min, 47% survived to one month. If the interval exceeded 30 min, only 5% (n = 35) survived to one month. The vast majority of the latter survivors had a shockable rhythm either on admission of the rescue team or at some time during resuscitation. CONCLUSION: Among patients who have ROSC after an out-of-hospital cardiac arrest, there is a very strong association between the interval between the call for ambulance and ROSC and survival to one month. However, even if this delay is very long (> 30 min after calling for an ambulance), a small percentage will ultimately survive; they are mainly patients who at some time during resuscitation have a shockable rhythm. The overall percentage of patients for whom CPR continued for more than 30 min who are alive one month later can be assumed to be extremely low.

  • 79.
    Herlitz, Johan
    et al.
    [external].
    Svensson, L
    Holmberg, S
    Ängquist, K-A
    Young, M
    Efficacy of bystander CPR: intervention by lay people and by health care professionals.2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 66, nr 3, s. 291-295Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Early cardiopulmonary resuscitation (CPR) by bystanders prior to the arrival of the rescue team has been shown to be associated with increased survival after out-of-hospital cardiac arrest. The aim of this survey was to evaluate the impact on survival of no bystander CPR, lay bystander CPR and professional bystander CPR. METHODS: Patients suffering an out-of-hospital cardiac arrest in Sweden between 1990 and 2002 who were given CPR and were not witnessed by the ambulance crew were included. RESULTS: In all, 29,711 patients were included, 36% of whom received bystander CPR prior to the arrival of the rescue team. Among the latter, 72% received CPR from lay people and 28% from professionals. Survival to 1 month was 2.2% among those who received no bystander CPR, 4.9% among those who received bystander CPR from lay people (p<0.0001) and 9.2% among those who received bystander CPR from professionals (p<0.0001 compared with bystander CPR by lay people). In a multivariate analysis, lay bystander CPR was associated with improved survival compared to no bystander CPR (OR: 2.04; 95% CI: 1.72-2.42), and professional bystander CPR was associated with improved survival compared to lay bystander CPR (OR: 1.37; 95% CI: 1.12-1.67). CONCLUSION: Among patients suffering an out-of-hospital cardiac arrest, bystander CPR by lay persons (excluding health care professionals) is associated with an increased chance of survival. Furthermore, there is a distinction between lay persons and health care providers; survival is higher when the latter perform bystander CPR. However, these results may not be explained by differences in the quality of CPR.

  • 80. Herlitz, Johan
    et al.
    Svensson, Leif
    Engdahl, J
    Silfverstolpe, J
    Characteristics and outcome in out of hopsital cardiac arrest when patients are found in a non shockable rhythm2008Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, nr 1, s. 31-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) who were found in a non-shockable rhythm. PATIENTS: All the patients included in the Swedish OHCA registry between 1990 and 2005 in whom resuscitation was attempted, who were found in a non-shockable rhythm and where either the OHCA was witnessed by a bystander or was not witnessed. RESULTS: In all, 22,465 patients fulfilled the inclusion criteria. Their mean age was 67 years, 32% were women, 57% were witnessed, 64% had a cardiac aetiology, 71% occurred at home and 34% received bystander cardiopulmonary resuscitation (CPR). Survival to 1 month was 1.3%. The following were independently associated with an increased chance of survival: 1/Decreasing age, 2/Witnessed arrest, 3/Bystander CPR, 4/Cardiac arrest outside home, 5/Shorter ambulance response time and 6/Need for defibrillatory shock. If these six criteria were fulfilled (age and ambulance response time below the median), survival to 1 month increased to 12.6%. If no criteria were fulfilled, survival was 0.15%. CONCLUSION: The overall survival among patients with an OHCA found in a non-shockable rhythm is very low (1.3%). Six factors associated with survival can be defined. When they are taken into account, survival varies between 12.6 and 0.15%.

  • 81.
    Hirlekar, G
    et al.
    Sahlgrenska University Hospital.
    Karlsson, T
    Sahlgrenska University Hospital.
    Aune, S
    Sahlgrenska University Hospital.
    Ravn-Fischer, A
    Sahlgrenska University Hospital.
    Albertsson, P
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Libungan, B
    Sahlgrenska University Hospital.
    Survival and neurological outcome in the elderly after in-hospital cardiac arrest.2017Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 118, s. 101-106, artikel-id S0300-9572(17)30294-0Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There have been few studies of the outcome in elderly patients who have suffered in-hospital cardiac arrest (IHCA) and the association between cardiac arrest characteristics and survival.

    AIM: The aim of this large observational study was to investigate the survival and neurological outcome in the elderly after IHCA, and to identify which factors were associated with survival.

    METHODS: We investigated elderly IHCA patients (≥70years of age) who were registered in the Swedish Cardiopulmonary Resuscitation Registry 2007-2015. For descriptive purposes, the patients were grouped according to age (70-79, 80-89, and ≥90years). Predictors of 30-day survival were identified using multivariable analysis.

    RESULTS: Altogether, 11,396 patients were included in the study. Thirty-day survival was 28% for patients aged 70-79 years, 20% for patients aged 80-89 years, and 14% for patients aged ≥90years. Factors associated with higher survival were: patients with an initially shockable rhythm, IHCA at an ECG-monitored location, IHCA was witnessed, IHCA during daytime (8 a.m.-8 p.m.), and an etiology of arrhythmia. A lower survival was associated with a history of heart failure, respiratory insufficiency, renal dysfunction and with an etiology of acute pulmonary oedema. Patients over 90 years of age with VF/VT as initial rhythm had a 41% survival rate. We found a trend indicating a less aggressive care with increasing age during cardiac arrest (fewer intubations, and less use of adrenalin and anti-arrhythmic drugs) but there was no association between age and delay in starting cardiopulmonary resuscitation (CPR). In survivors, there was no significant association between age and a favourable neurological outcome (CPC score: 1-2) (92%, 93%, and 88% in the three age groups, respectively).

    CONCLUSIONS: Increasing age among the elderly is associated with a lower 30-day survival after IHCA. Less aggressive treatment and a worse risk profile might contribute to these findings. Relatively high survival rates among certain subgroups suggest that discussions about advanced directives should be individualized. Most survivors have good neurological outcome, even patients over 90 years of age.

  • 82.
    Hirlekar, Geir
    et al.
    Department of Cardiology, Sahlgrenska University Hospital.
    Jonsson, Martin
    Karolinska Institutet, Department of Medicine, Centre for Resuscitation Science.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Hollenberg, Jacob
    Karolinska Institutet, Department of Medicine, Centre for Resuscitation Science.
    Albertsson, Per
    Department of Cardiology, Sahlgrenska University Hospital.
    Herlitz, Johan
    Comorbidity and survival in out-of-hospital cardiac arrest.2018Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 133, s. 118-123, artikel-id S0300-9572(18)30988-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Patients suffering out-of-hospital cardiac arrest (OHCA) have a poor prognosis but survival among subgroups differs greatly. Previous studies have shown conflicting results on whether patient comorbidity affects outcome. The aim of this national study was to investigate the effect of comorbidity on outcome after OHCA in Sweden.

    METHODS: We included all patients with bystander-witnessed OHCA from 2011 to 2015 in the national Swedish Registry of Cardiopulmonary Resuscitation. In order to assess comorbidity, the database was merged with the comprehensive National Patient Registry, which includes all out-patient and in-patient care in Sweden. The Charlson comorbidity index (CCI) and the specific comorbidity conditions constituting the CCI was used to identify whether comorbidity was associated with outcome.

    RESULTS: A total of 12,012 patients were included in the study. Of these, 1598 patients survived to 30 days (13%). The most common comorbidities were a history of congestive heart failure (29%), myocardial infarction (24%), and diabetes without complications (23%). Renal disease (odds ratio [OR] 0.53; 95% CI 0.53‒0.72), diabetes with complications (OR 0.65; 95% CI 0.49‒0.84), diabetes without complications (OR 0.63; 95% CI 0.52‒0.75), congestive heart failure (OR 0.84; 95% CI 0.71‒0.99), and metastatic carcinoma (OR 0.61; 95% CI 0.40‒0.93) were significantly associated with a reduced chance of 30-day survival when adjusted for demographic characteristics and also resuscitation-associated factors such as shockable initial rhythm, bystander cardiopulmonary resuscitation (CPR), and place of arrest. With increasing comorbidity, the chance of 30-day survival decreased: adjusted OR was 0.82 (59% CI 0.68-0.99) for CCI 3-4, 0.62 (95% CI 0.47-0.83) for CCI 5-6, and 0.51 (95% CI 0.36-0.72) for CCI > 6, respectively, all in relation to those with CCI 0-2. Additionally, increasing morbidity was associated with reduced odds of return of spontaneous circulation (ROSC) and ROSC at hospital admission.

    CONCLUSION: This large national study showed that increasing comorbidity decreased the chance of survival to 30 days in OHCA. This association remained after covariate adjustment.

  • 83. Holmberg, M
    et al.
    Holmberg, S
    Herlitz, Johan
    [external].
    Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden.2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, nr 1, s. 59-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Information from the Swedish Cardiac Arrest Registry was used to investigate: (a) The proportion of patients suffering an out-of-hospital cardiac arrest who were given bystander cardiopulmonary resuscitation (B-CPR). (b) Where and by whom B-CPR was given. (c) The effect of B-CPR on survival. METHOD: a prospective, observational study of cardiac arrests reported to the Swedish Cardiac Arrest Registry. Analyses were based on standardised reports of out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. From 1983 to 1995 approximately 15-20% of the population had been trained in CPR. RESULTS: Of 9877 patients, collected between January 1990 and May 1995, B-CPR was attempted in 36%. In 56% of these cases, the bystanders were lay persons and in 25% they were medical personnel. Most of the arrests took place at home (69%) and only 23% of these patients were given B-CPR in contrast to cardiac arrest in other places where 53% were given CPR. Survival to 1 month was significantly higher in all cases that received B-CPR (8.2 vs. 2.5%). The odds ratio for survival to 1 month with B-CPR was in a logistic regression analysis 2.5 (95% CI 1.9-3.1). CONCLUSIONS: In Sweden, the willingness and ability to perform B-CPR appears to be relatively widespread. More than half of B-CPR was performed by laypersons. B-CPR resulted in a two to threefold increase in survival.

  • 84. Holmberg, M
    et al.
    Holmberg, S
    Herlitz, Johan
    [external].
    Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, nr 1, s. 7-17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The chance of survival from ventricular fibrillation (VF) is up to ten times higher than those with other cardiac arrest rhythms. To calculate the effect of out-of-hospital resuscitation organisations on survival, it is necessary to know the percentage of cardiac arrest patients initially in VF and the relationship between delay time to defibrillation and survival. AIM: To study the incidence of VF at the time of cardiac arrest and on first ECG, the duration of VF and the relation between time to defibrillation and survival. METHOD: The Swedish Cardiac Arrest Registry has collected standardised reports on out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. RESULTS: In 14065 cases of out-of-hospital cardiac arrest collected between 1990 and 1995, resuscitation was attempted in 10966 cases. INCIDENCE: The first ECG showed VF in 43% of all patients. The incidence of VF at the time of cardiac arrest was estimated to be 60-70% in all patients and 80-85% in the cases with probable heart disease. DURATION: The estimated disappearance rate of VF was slow. Thirty minutes after collapse approximately 40% of the patients were in VF. SURVIVAL: Overall survival to 1 month was only 1.6% for patients with non-shockable rhythms and 9.5% for patients found in VF. With increasing time to defibrillation, the survival rate fell rapidly from approximately 50% with a minimal delay to 5% at 15 min. CONCLUSIONS: This study suggests a high initial incidence of VF among out-of-hospital cardiac arrest patients and a slow rate of transformation into a non-shockable rhythm. The survival rate with very short delay times to defibrillation was approximately 50%, but decreased rapidly as the delay increased.

  • 85. Holmberg, S
    et al.
    Holmberg, M
    Herlitz, Johan
    [external].
    An alternative estimate of the disappearance rate of ventricular fibrillation in out-of-hospital cardiac arrest2001Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 49, nr 2, s. 219-220Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We have made an alternative estimation of the disappearance rate of ventricular fibrillation (VF) in out-of-hospital cardiac arrest based on data collected from the first 10.966 cardiac arrests in Sweden. In our original analysis published in Resuscitation (2000;4:7–17) we defined VF on arrival of the ambulance crew either based on the initially recorded rhythm or on information that the patient was defibrillated. The latter was included in the definition since we judged information from ambulance crew using automated external defibrillators less reliable with regard to interpretation of the initial rhythm. An alternative approach would be to define initial rhythm only on the basis of information from the initial rhythm regardless whether an automated external defibrillators was used or not. When taking the ‘new’ approach there was missing information in 21% of the cases as compared with 0% in the ‘old’ approach. When estimating occurrence of VF in the remaining 79% we found that 37% had VF on admission ECG. This figure is somewhat lower than the 43% reported in the previous article. According to this ‘new’ approach the disappearance rate of VF would be slightly higher as compared with our previous estimation. This is illustrated in the Fig. 1 where the disappearance rate according to our initial definition of VF is shown as the ‘old’ bars and the disapperance rate according to our new definition of VF is shown as the ‘new’ bars. All patients with probable heart disease (HD). Old and new definition of VF. However, as shown in the figure the estimated occurrence of VF at the time of cardiac arrest remained similar regardless of definition of VF being used.

  • 86. Holmberg, S
    et al.
    Holmberg, M
    Herlitz, Johan
    [external].
    Low chance of survival among patients requiring adrenaline (epinephrine) or intubation after out-of-hospital cardiac arrest in Sweden.2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 54, nr 1, s. 37-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To relate the outcome of out-of-hospital cardiac arrest to whether medication with adrenaline (epinephrine) was given and whether patients were intubated. PATIENTS: A national survey in Sweden between 1990-1995 among patients suffering out-of-hospital cardiac arrest and in whom resuscitation was attempted. Sixty per cent of ambulance organisations in Sweden participated. DESIGN: Prospective evaluation. Survival was defined as survival 1 month after cardiac arrest. RESULTS: In all, 14065 patients were included in the evaluation. Of these, resuscitation was attempted in 10966 cases. Among these adrenaline (epinephrine) was given in 42.4 and 47.5% were intubated. In an univariate analysis treatment with adrenaline (epinephrine) and intubation was associated with a lower survival when all patients were evaluated. In a multivariate analysis including age, sex, place of arrest, bystander-CPR, initial arrhythmia, arrest being witnessed and aetiology, treatment with adrenaline (epinephrine) (OR 0.43, CI 0.27-0.66) and intubation (OR 0.71, CI 0.51-0.99) were both independent predictors of a lower chance of survival. When separately analysing patients with bystander witnessed cardiac arrest found in ventricular fibrillation and requiring more than 3 defibrillatory shocks neither treatment with adrenaline (epinephrine) nor intubation was associated with survival. Among patients with a non-shockable rhythm treatment with adrenaline (epinephrine) was a significant independent predictor for lower survival (OR 0.30, CI 0.07-0.82). CONCLUSION: In a national survey in Sweden including 10966 cases of out-of-hospital cardiac arrest the outcome was related to whether medication with adrenaline (epinephrine) was given and whether patients were intubated. Neither in total nor in any subgroup did we find results indicating beneficial effects of any of these two interventions. Whether treatment with adrenaline (epinephrine) or intubation will increase survival after out-of-hospital cardiac arrest needs to be confirmed in prospective randomised trials.

  • 87. Holmberg, S
    et al.
    Holmberg, M
    Herlitz, Johan
    [external].
    Gårdelöv, B
    Survival after cardiac arrest outside hospital in Sweden1998Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 36, nr 1, s. 29-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The voluntary Swedish Cardiac Arrest Registry has collected and analyzed 14,065 standardised reports on cardiac arrests up until May 1995. The reports have been collected from approximately half of Sweden's ambulance districts, which cover 60% of the population. Resuscitation was attempted in 10,966 cases. The median age was 70 years. In 70.0% the arrest was witnessed, and in 43.3% the first recorded rhythm was VT/VF. Bystander-CPR was initiated in 32.3% of the cases. Most cardiac arrests took place at home (65.8%) and 67.1% were judged to be of cardiac origin. In 1692 cases (15.4%), the patient was admitted alive in hospital and 544 patients (5.0%) were alive after 1 month. Survival to 1 month in the subgroup which presented with VT/VF was 9.5%. We found no significant difference between survival in large cities and smaller communities. The survivors were analysed in relation to time to defibrillation and we found a strong correlation between a short time and increased survival.

  • 88.
    Holmén, Johan
    et al.
    Department of Prehospital and Emergency Care, Department of Anaesthesiology and Intensive Care, Queen Silvia's Children's Hospital Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jimenez-Herrera, Maria
    Department of Nursing, Universitat Rovira i Virgili Spain.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Passive leg raising in out-of-hospital cardiac arrest.2019Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 137, s. 94-101, artikel-id S0300-9572(18)30888-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The use of passive leg raising (PLR) in cardiopulmonary resuscitation (CPR) is sometimes discussed and even recommended. The effect of this intervention has never been properly addressed. We planned to determine whether PLR in out-of-hospital cardiac arrest (OHCA) is associated with an improved survival to 30 days.

    METHODS: In eight districts in western Sweden, we introduced PLR within five minutes after the start of CPR, among patients with OHCA. Patients in whom PLR was not performed, within the same district, served as a control group. Thirty-day survival was the primary endpoint. A propensity score analysis, as well as a standard multivariate analysis, was used to assess possible differences between the two groups.

    RESULTS: We identified 3554 patients with OHCA from the eight districts. Forty-four percent were treated with PLR during CPR. Patients who received PLR differed from those who did not, by having more risk factors for an adverse outcome (fewer crew-witnessed cases, more OHCA at home, a greater need for medication and prolonged delays to treatment). The overall survival to 30 days was 7.9% among patients who received PLR versus 13.5% among those who did not. A comparison of the groups, using propensity score matching, revealed a 30 -day survival of 8.6% in the PLR group versus 8.2% in the control group (odds ratio 1.07; 95% confidence interval 0.80-1.44).

    CONCLUSION: In an observational study, we introduced PLR as an addition to standard treatment in patients with OHCA. We did not find any evidence that this treatment improves survival to 30 days.

  • 89.
    Holmén, Johan
    et al.
    Sahlgrenska University Hospital.
    Hollenberg, Jacob
    Karolinska Institutet.
    Claesson, Andreas
    Karolinska Institutet.
    Herrera, Maria Jiménez
    Sistema Emergències Mèdiques de Catalunya.
    Azeli, Youcef
    Sistema Emergències Mèdiques de Catalunya.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Survival in ventricular fibrillation with emphasis on the number of defibrillations in relation to other factors at resuscitation.2017Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 113, s. 33-38, artikel-id S0300-9572(17)30017-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Mortality after out of hospital cardiac arrest (OHCA) is high and a shockable rhythm is a key predictor of survival. A concomitant need for repeated shocks appears to be associated with less favorable outcome.

    AIM: To, among patients found in ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) describe: (a) factors associated with 30-day survival with emphasis on the number of defibrillatory shocks delivered; (b) the distribution of and the characteristics of patients in relation to the number of defibrillatory shocks that were delivered.

    METHODS: Patients who were reported to The Swedish Register for Cardiopulmonary Resuscitation (SRCR) between January 1 1990 and December 31 2015 and who were found in VF/pVT took part in the survey.

    RESULTS: In all there were 19,519 patients found in VF/pVT. The 30-day survival decreased with an increasing number of shocks among all patients regardless of witnessed status and regardless of time period in the survey. In a multivariate analysis there were 12 factors that were associated with the chance of 30-day survival one of which was the number of shocks that was delivered. For each shock that was added the chance of survival decreased. Factors associated with an increased 30-day survival included CPR before arrival of EMS, female sex, cardiac etiology and year of OHCA (increasing survival over years). Factors associated with a decreased chance of 30-day survival included: increasing age, OHCA at home, the use of adrenaline and intubation and an increased delay to CPR, defibrillation and EMS arrival.

    CONCLUSION: Among patients found in VF/pVT, 7.5% required more than 10 shocks. For each shock that was added the chance of 30-day survival decreased. There was an increase in 30-day survival over time regardless of the number of shocks. On top of the number of defibrillations, eleven further factors were associated with 30-day survival.

  • 90.
    Israelsson, Johan
    et al.
    Kalmar Maritime Academy.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Åsa B
    The Sahlgrenska Academy, Gothenburg.
    Cronberg, Tobias
    Lund University.
    Djärv, Therese
    Karolinska Institutet.
    Kristofferzon, Marja-Leena
    Uppsala University.
    Larsson, Ing-Marie
    Uppsala University.
    Lilja, Gisela
    Lund University.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    Wallin, Ewa
    Uppsala University.
    Ågren, Susanna
    Linköping University.
    Åkerman, Eva
    Karolinska Institutet.
    Årestedt, Kristofer
    Kalmar County Hospital.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender.2017Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, s. 27-33, artikel-id S0300-9572(17)30059-XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 91. Jacobs, I
    et al.
    Nadkarni, V
    Bahr, J
    Berg, RA
    Billi, JE
    Bossaert, L
    Cassan, P
    Coovadia, A
    D'este, K
    Finn, J
    Halperin, H
    Handley, A
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Hickey, R
    Idris, A
    Kloeck, W
    Larkin, GL
    Mancini, ME
    Mason, P
    Mears, G
    Monsieur, K
    Montgomery, W
    Morley, P
    Nichol, G
    Nolan, J
    Okada, K
    Perlman, J
    Shuster, M
    Steen, PA
    Sterz, S
    Tibballs, J
    Timerman, S
    Truitt, T
    Zidenman, D
    Update and Simplification of the Utstein Templates for Resuscitation Registries: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation2004Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 63, nr 3, s. 233-249Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002 a task force of ILCOR met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conference. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community.

  • 92. Langhelle, A
    et al.
    Nolan, J
    Herlitz, Johan
    [external].
    Castren, M
    Wenzel, V
    Soreide, E
    Engdahl, J
    Steen, PA
    Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 66, nr 3, s. 271-283Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this report is to establish recommendations for reviewing, reporting, and conducting research during the post-resuscitation period in hospital. It defines data that are needed for research and more specialised registries and therefore supplements the recently updated Utstein template for resuscitation registries. The updated Utstein template and the out-of-hospital "Chain of Survival" describe factors of importance for successful resuscitation up until return of spontaneous circulation (ROSC). Several factors in the in-hospital phase after ROSC are also likely to affect the ultimate outcome of the patient. Large differences in survival to hospital discharge for patients admitted alive are reported between hospitals. Therapeutic hypothermia has been demonstrated to improve the outcome, and other factors such as blood glucose, haemodynamics, ventilatory support, etc., might also influence the result. No generally accepted, scientifically based protocol exists for the post-resuscitation period in hospital, other than general brain-oriented intensive care. There is little published information on this in-hospital phase. This statement is the result of a scientific consensus development process started as a symposium by a task force at the Utstein Abbey, Norway, in September 2003. Suggested data are defined as core and supplementary and include the following categories: pre-arrest co-morbidity and functional status, cause of death, patients' quality of life, in-hospital system factors, investigations and treatment, and physiological data at various time points during the first three days after admission. It is hoped that the publication of these recommendations will encourage research into the in-hospital post-resuscitation phase, which we propose should be included in the chain-of-survival as a fifth ring. Following these recommendations should enable better understanding of the impact of different in-hospital treatment strategies on outcome.

  • 93. Larsson, M
    et al.
    Thorén, A-B
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    A history of diabetes is associated with an adverse outcome among patients admitted to hospital alive after an out-of-hospital cardiac arrest.2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 66, nr 3, s. 303-307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Factors of importance for the outcome among patients who are admitted to hospital alive after an out-of-hospital cardiac arrest are not well described in the literature. The importance of a history of diabetes for the outcome among these patients has not been reported in detail previously. This survey aims to describe the outcome among patients who were admitted to hospital after an out-of-hospital cardiac arrest in relation to whether they had a history of diabetes. METHODS: All patients who were admitted to hospital alive after an out-of-hospital cardiac arrest in the two city hospitals in the Municipality of Göteborg between 1980 and 2002 were included in the survey. RESULTS: In all, 1377 patients fulfilled the inclusion criteria and 187 (14%) of them had a history of diabetes. Patients with diabetes differed from those without diabetes by having a previous history of myocardial infarction, angina pectoris, hypertension and heart failure more frequently. Furthermore, they were older, with a mean age of 70 years versus 66 years for patients without diabetes. Among patients with diabetes, 25% were discharged alive, as compared with 37% of patients without diabetes (p=0.002). When adjusting for differences at baseline, the adjusted odds ratio for diabetic patients being discharged alive (versus no diabetes) was 0.57 (95% confidence interval, 0.39-0.80). CONCLUSION: Among patients admitted to hospital after an out-of-hospital cardiac arrest, 14% had a history of diabetes. These patients had a lower survival rate compared with those without diabetes, even after correcting for dissimilarities at baseline. It remains to be determined whether an early metabolic intervention in these patients will improve survival.

  • 94.
    Libungan, Berglind
    et al.
    Sahlgrenska University Hospital.
    Lindqvist, Jonny
    Sahlgrenska University Hospital.
    Strömsöe, Anneli
    University of Dalarna.
    Nordberg, Per
    Karolinska Institutet.
    Hollenberg, Jacob
    Karolinska Institutet.
    Albertsson, Per
    Sahlgrenska University Hospital.
    Karlsson, Thomas
    Sahlgrenska Academy at University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Out-of-hospital cardiac arrest in the elderly: A large-scale population-based study.2015Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA).

    AIM: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

    METHODS: OHCA patients ≥ 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and ≥ 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

    RESULTS: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

    CONCLUSIONS: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age.

  • 95. Libungan, Berglind
    et al.
    Lindqvist, Jonny
    Strömsöe, Anneli
    Nordberg, Per
    Hollenberg, Jacob
    Albertsson, Per
    Karlsson, Thomas
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Out-of-hospital cardiac arrest in the elderly: A large-scale population-based study.2015Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94, nr September 2015, s. 28-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA).

    AIM: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

    METHODS: OHCA patients ≥ 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and ≥ 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

    RESULTS: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

    CONCLUSIONS: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age.

  • 96.
    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
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lundgren, Peter
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. peter.lundgren@hb.se.
    Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest.2019Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 140, s. 64-71, artikel-id S0300-9572(18)30800-1Artikel i tidskrift (Refereegranskat)
    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.

  • 97. Martinell, L
    et al.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindqvist, J
    Gottfridsson, C
    Factors influencing the decision to ICD implantation in survivors of OHCA and its influence on long term survival.2013Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, nr 2, s. 213-217Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Knowledge is insufficient of the long-term benefit of an implantable cardioverter defibrillator (ICD) after out of hospital cardiac arrest (OHCA). AIM: To describe the use and factors of importance for outcome in relation to ICD use among survivors of ventricular fibrillation (VF). METHODS: In consecutive patients discharged alive after OHCA in Gothenburg between 1988 and 2008 the long-term prognosis was followed. RESULTS: In all, there were 5443 OHCAs of which 1489 (27%) were hospitalized alive. Of those, 495 (33%) were discharged alive, of which 390 (79%) had shockable rhythm. The use of ICDs increased, but only 58 of 390 (15%) had an ICD. Among patients who received an ICD, the 2-year mortality was 2%, versus 25% of those who did not (p<0.0001). In follow-up (mean 5.5 years; maximum 10 years), the use of an ICD showed a borderline association with mortality (adjusted hazard ratio 0.49; 95% confidence interval, 024-1.01; p=0.052). Patients who had ICD were younger and had better cerebral function compared with patients without. Predictors for mortality were cerebral function at discharge, age, history of heart failure and myocardial infarction and no coronary angiography during hospitalization. CONCLUSION: Among survivors of OHCA caused by VT/VF who had ICD during hospitalization only 2% died during the subsequent 2 years. The use of ICDs was low but increasing. Factors of importance for mortality were cerebral function at the time of discharge, age, history of heart failure and myocardial infarction and no coronary angiography during hospitalization.

  • 98.
    Maurer, H
    et al.
    University Hospital Schleswig-Holstein.
    Masterson, S
    National University of Ireland Galway.
    Tjelmeland, I B
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS).
    Gräsner, J T
    University Hospital Schleswig-Holstein.
    Lefering, R
    Institute for Research in Operative Medicine, Faculty of Medicine, University Witten/Herdecke.
    Böttiger, B W
    University Hospital of Cologne.
    Bossaert, L
    University of Antwerp.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Koster, R
    Academic Medical Center.
    Rosell-Ortiz, F
    Empresa Pública de Emergencias Sanitarias.
    Perkins, G D
    University of Warwick and Heartlands Hospital.
    Wnent, J
    When is a bystander not a bystander any more? A European Survey.2018Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, artikel-id S0300-9572(18)30979-1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: There is international variation in the rates of bystander cardiopulmonary resuscitation (CPR). 'Bystander CPR' is defined in the Utstein definitions, however, differences in interpretation may contribute to the variation reported. The aim of this cross-sectional survey was to understand how the term 'bystander CPR' is interpreted in Emergency Medical Service (EMS) across Europe, and to contribute to a better definition of 'bystander' for future reference.

    METHODS: During analysis of the EuReCa ONE study, uncertainty about the definition of a 'bystander' emerged. Sixty scenarios were developed, addressing the interpretation of 'bystander CPR'. An electronic version of the survey was sent to 27 EuReCa National Coordinators, who distributed it to EMS representatives in their countries. Results were descriptively analysed.

    RESULTS: 362 questionnaires were received from 23 countries. In scenarios where a layperson arrived on scene by chance and provided CPR, up to 95% of the participants agreed that 'bystander CPR' had been performed. In scenarios that included community response systems, firefighters and/or police personnel, the percentage of agreement that 'bystander CPR' had been performed ranged widely from 16% to 91%. Even in scenarios that explicitly matched examples provided in the Utstein template there was disagreement on the definition.

    CONCLUSION: In this survey, the interpretation of 'bystander CPR' varied, particularly when community response systems including laypersons, firefighters, and/or police personnel were involved. It is suggested that the definition of 'bystander CPR' should be revised to reflect changes in treatment of OHCA, and that CPR before arrival of EMS is more accurately described.

  • 99. Mäkinen, M
    et al.
    Aune, S
    Niemi-Murola, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Varpula, T
    Nurmi, J
    Castrén, M
    Assessment of CPR-D skills of nurses in Göteborg, Sweden and Espoo, Finland: teaching leadership makes a difference.2007Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 72, nr 2, s. 264-269Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Construction of an effective in-hospital resuscitation programme is challenging. To document and analyse resuscitation skills assessment must provide reliable data. Benchmarking with a hospital having documented excellent results of in-hospital resuscitation is beneficial. The purpose of this study was to assess the resuscitation skills to facilitate construction of an educational programme. MATERIALS AND METHODS: Nurses working in a university hospital Jorvi, Espoo (n=110), Finland and Sahlgrenska University Hospital, Göteborg (n=40), Sweden were compared. The nurses were trained in the same way in both hospitals except for the defining and teaching of leadership applied in Sahlgrenska. Jorvi nurses are not trained to be, nor do they act as, leaders in a resuscitation situation. Their cardiopulmonary resuscitation (CPR) skills using an automated external defibrillator (AED) were assessed using Objective Structured Clinical Examination (OSCE) which was build up as a case of cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. The subjects were tested in pairs, each pair alone. Group-working skills were registered. RESULTS: All Sahlgrenska nurses, but only 49% of Jorvi nurses, were able to defibrillate. Seventy percent of the nurses working in the Sahlgrenska hospital (mean score 35/49) and 27% of the nurses in Jorvi (mean score 26/49) would have passed the OSCE test. Statistically significant differences were found in activating the alarm (P<0.001), activating the AED without delay (P<0.01), setting the lower defibrillation electrode correctly (P<0.001) and using the correct resuscitation technique (P<0.05). The group-working skills of Sahlgrenska nurses were also significantly better than those of Jorvi nurses. CONCLUSIONS: Assessment of CPR-D skills gave valuable information for further education in both hospitals. Defining and teaching leadership seems to improve resuscitation performance.

  • 100. Nichol, G
    et al.
    Steen, P
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Morrison, L
    Jacobs, I
    Ornato, J
    O'Connor, R
    Nadkarni, V
    International Resuscitation Network Registry: design, rationale and preliminary results.2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 265-277Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies. A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or movement in individuals for whom the EMS system is activated for whom an arrest record is completed. All data were collated via a secure and confidential web-based method by using automated forms processing software with appropriate variable range checks, logic checks and skip rules. Median number of missing responses for each variable was 0 (interquartile range 0, 0). Twenty-seven percent of the patients had a first recorded rhythm of ventricular fibrillation or ventricular tachycardia, 60% had a witnessed arrest, and 34% received bystander CPR. Mean time from call to arrival on scene was 7.1+/-5.1 min. Six percent of the patients survived to hospital discharge. The resuscitation process was highly variable across centers, and survival and neurological outcome were also significantly and independently different across centers. This study shows that it is possible to collect data prospectively describing the structure, process and outcome associated with cardiac arrest in multiple international sites via the internet. Therefore, it is feasible to conduct adequately powered randomized trials of resuscitation therapies in international settings.

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