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  • 1. Aasa, M
    et al.
    Henriksson, MF
    Dellborg, M
    Grip, L
    Herlitz, Johan
    [external].
    Levin, L-Å
    Svensson, L
    Janzon, M
    Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial.2010Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 160, nr 2, s. 322-328Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. METHODS: Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. RESULTS: Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be <$0, $50,000, and $100,000 respectively. CONCLUSION: In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.

  • 2. Abdon, Nils Johan
    et al.
    Bergfeldt, Lennart
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjärtstopp utlöst av läkemedel kanske vanligare än vi tror2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 8, s. 521-525Artikkel i tidsskrift (Fagfellevurdert)
  • 3. Abdon, NJ
    et al.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Andrersson, B
    Peripartumcardiomyopathi an often mised diagnosis2013Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 23-24, s. 1152-1154Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Peripartumkardiomyopati är en sällsynt form av hjärtsvikt. Diagnostiska kriterier är nytillkommen hjärtsvikt från sen graviditet och upp till fem månader efter förlossning, avsaknad av annan förklaring till hjärtsvikt och nedsatt systolisk vänsterkammarfunktion Orsaken till tillståndet tros vara omvandling av prolaktin till en kardiotoxisk variant. Terapin är den etablerade, men ACE-hämmare och ARB får inte ges till ammande mödrar. Hjärttransplantation har tillgripits. Maligna hjärtarytmier har krävt behandling med implanterbar defibrillator och pacemaker. Hämning av produktionen av prolaktin med bromokriptin har gett goda resultat i en liten studie. Resultaten har inte bekräftats.

  • 4. Adielsson, A
    et al.
    Hollenberg, J
    Karlsson, T
    Lindqvist, J
    Lundin, S
    Silfverstolpe, J
    Svensson, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective2011Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 97, nr 17, s. 1391-1396Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives In a national perspective, to describe survival among patients found in ventricular fibrillation or pulseless ventricular tachycardia witnessed by a bystander and with a presumed cardiac aetiology and answer two principal questions: (1) what are the changes over time? and (2) which are the factors of importance? Design Observational register study. Setting Sweden. Patients All patients included in the Swedish Out of Hospital Cardiac Arrest Register between 1 January 1990 and 31 December 2009 who were found in bystander-witnessed ventricular fibrillation with a presumed cardiac aetiology. Interventions Bystander cardiopulmonary resuscitation (CPR) and defibrillation. Main outcome measures Survival to 1 month. Results In all, 7187 patients fulfilled the set criteria. Age, place of out-of-hospital cardiac arrest (OHCA) and gender did not change. Bystander CPR increased from 46% to 73%; 95% CI for OR 1.060 to 1.081 per year. The median delay from collapse to defibrillation increased from 12 min to 14 min (p for trend 0.0004). Early survival increased from 28% to 45% (95% CI 1.044 to 1.065) and survival to 1 month increased from 12% to 23% (95% CI 1.058 to 1.086). Strong predictors of early and late survival were a short interval from collapse to defibrillation, bystander CPR, female gender and OHCA outside the home. Conclusion In a long-term perspective in Sweden, survival to 1 month after ventricular fibrillation almost doubled. This was associated with a marked increase in bystander CPR. Strong predictors of outcome were a short delay to defibrillation, bystander CPR, female gender and place of collapse.

  • 5.
    Adielsson, Anna
    et al.
    Sahlgrenska University Hospital.
    Aune, Solveig
    Sahlgrenska University Hospital.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Measurements of time intervals after in-hospital cardiac arrest give important information but can be further improved.2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754Artikkel i tidsskrift (Fagfellevurdert)
  • 6.
    Adielsson, Anna
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Danielsson, Christian
    Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Forkman, Pontus
    Department of Adult Psychiatry, Mora Hospital, Mora, Sweden.
    Karlsson, Thomas
    Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pettersson, Linda
    Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lundin, Stefan
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Outcome prediction for patients assessed by the medical emergency team: a retrospective cohort study2022Inngår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, nr 1, artikkel-id 200Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Medical emergency teams (METs) have been implemented to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to establish a clinically useful association between clinical variables and mortality risk, among patients assessed by the MET, and further to design an easy-to-use risk score for the prediction of death within 30 days.

    Methods: Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the outcome variable. Predictors of outcome were defined from age, gender, type of ward for admittance, previous medical history, acute medical condition, vital parameters and laboratory biomarkers. Identified factors independently associated with mortality were then used to develop a prognostic risk score for mortality.

    Results: The overall 30-day mortality was high (29.0%). We identified thirteen factors independently associated with 30-day mortality concerning; age, type of ward for admittance, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. A MET risk score for mortality based on the impact of these individual thirteen factors in the model yielded a median (range) AUC of 0.780 (0.774-0.785) with good calibration. When corrected for optimism by internal validation, the score yielded a median (range) AUC of 0.768 (0.762-0.773).

    Conclusions: Among clinical variables available at the time of MET assessment, thirteen factors were found to be independently associated with 30-day mortality. By applying a simple risk scoring system based on these individual factors, patients at higher risk of dying within 30 days after the MET assessment may be identified and treated earlier in the process.

     

  • 7.
    Adielsson, Anna
    et al.
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Djärv, Therese
    Department of Medicine, K2, Solna Karolinska Institutet, SE-171 77 Stockholm, Sweden.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, SE-413 45 Gothenburg, Sweden.
    Lundin, Stefan
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest - A population-based registry study of nearly 24,000 cases.2020Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 157, s. 135-140, artikkel-id S0300-9572(20)30522-0Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

    Fulltekst (pdf)
    fulltext
  • 8.
    Adielsson, Anna
    et al.
    Sahlgrenska University Hospital.
    Karlsson, Thomas
    University of Gothenburg.
    Aune, Solveig
    Sahlgrenska University Hospital.
    Lundin, Stefan
    Sahlgrenska University Hospital.
    Hirlekar, Geir
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital.
    A 20-year perspective of in hospital cardiac arrest: Experiences from a university hospital with focus on wards with and without monitoring facilities.2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 216, s. 194-199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Knowledge about change in the characteristics and outcome of in hospital cardiac arrests (IHCAs) is insufficient.

    AIM: To describe a 20year perspective of in hospital cardiac arrest (IHCA) in wards with and without monitoring capabilities.

    SETTINGS: Sahlgrenska University Hospital (800 beds). The number of beds varied during the time of survey from 850-746 TIME: 1994-2013.

    METHODS: Retrospective registry study. Patients were assessed in four fiveyear intervals.

    INCLUSION CRITERIA: Witnessed and nonwitnessed IHCAs when cardiopulmonary resuscitation (CPR) was attempted.

    EXCLUSION CRITERIA: Age below 18years.

    RESULTS: In all, there were 2340 patients with IHCA during the time of the survey. 30-Day survival increased significantly in wards with monitoring facilities from 43.5% to 55.6% (p=0.002) for trend but not in wards without such facilities (p=0.003 for interaction between wards with/without monitoring facilities and time period). The CPC-score among survivors did not change significantly in any of the two types of wards. In wards with monitoring facilities there was a significant reduction of the delay time from collapse to start of CPR and an increase in the proportion of patients who were defibrillated before the arrival of the rescue team. In wards without such facilities there was a significant reduction of the delay from collapse to defibrillation. However, the latter observation corresponds to a marked decrease in the proportion of patients found in ventricular fibrillation.

    CONCLUSION: In a 20year perspective the treatment of in hospital cardiac arrest was characterised by a more rapid start of treatment. This was reflected in a significant increase in 30-day survival in wards with monitoring facilities. In wards without such facilities there was a decrease in patients found in ventricular fibrillation.

  • 9.
    Agerström, Jens
    et al.
    Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University.
    Carlsson, Magnus
    Department of Economics and Statistics, School of Business and Economics, Linnaeus University.
    Bremer, Anders
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Cardiology, Sahlgrenska University Hospital.
    Israelsson, Johan
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Årestedt, Kristofer
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Discriminatory cardiac arrest care? Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest.2021Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, nr 8, s. 861-869Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.

    METHODS AND RESULTS: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay.

    CONCLUSION: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

    Fulltekst (pdf)
    fulltext
  • 10.
    Agerström, Jens
    et al.
    Linnéuniversitetet.
    Carlsson, Magnus
    Linnéuniversitetet.
    Bremer, Anders
    Linnéuniversitetet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    Göteborgs universitet.
    Årestedt, Kristofer
    Linnéuniversitetet.
    Israelsson, Johan
    Linnéuniversitetet.
    Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?2021Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, artikkel-id zvab079Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS : Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context.

    METHODS AND RESULTS: In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team's reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52).

    CONCLUSION: Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

  • 11.
    Albert, Malin
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Forsberg, Sune
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Ringh, Mattias
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Claesson, Andreas
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Thuccani, Meena
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jonsson, Martin
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Nordberg, Per
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden; Functional Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Aetiology and outcome in hospitalized cardiac arrest patients.2023Inngår i: European Heart Journal Open, E-ISSN 2752-4191, Vol. 3, nr 4, artikkel-id oead066Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

    Fulltekst (pdf)
    fulltext
  • 12.
    Albert, Malin
    et al.
    Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska academy, Gothenburg, Sweden.
    Ringh, Mattias
    Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Claesson, Andreas
    Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Djärv, Therese
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Nordberg, Per
    Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Cardiac arrest after pulmonary aspiration in hospitalised patients: a national observational study.2020Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 3, artikkel-id e032264Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study characteristics and outcomes among patients with in-hospital cardiac arrest (IHCA) due to pulmonary aspiration.

    DESIGN: A retrospective observational study based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).

    SETTING: The SRCR is a nationwide quality registry that covers 96% of all Swedish hospitals. Participating hospitals vary in size from secondary hospitals to university hospitals.

    PARTICIPANTS: The study included patients registered in the SRCR in the period 2008 to 2017. We compared patients with IHCA caused by pulmonary aspiration (n=127), to those with IHCA caused by respiratory failure of other causes (n=2197).

    PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was 30-day survival. Secondary outcome was sustained return of spontaneous circulation (ROSC) defined as ROSC at the scene and admitted alive to the intensive care unit.

    RESULTS: In the aspiration group 80% of IHCA occurred on general wards, as compared with 63.6% in the respiratory failure group (p<0.001). Patients in the aspiration group were less likely to be monitored at the time of the arrest (18.5% vs 38%, p<0.001) and had a significantly lower rate of sustained ROSC (36.5% vs 51.6%, p=0.001). The unadjusted 30-day survival rate compared with the respiratory failure group was 7.9% versus 18.0%, p=0.024. In a propensity score analysis (including variables; year, age, gender, location of arrest, initial heart rhythm, ECG monitoring, witnessed collapse and a previous medical history of; cancer, myocardial infarction or heart failure) the OR for 30-day survival was 0.46 (95% CI 0.19 to 0.94).

    CONCLUSIONS: In-hospital cardiac arrest preceded by pulmonary aspiration occurred more often on general wards among unmonitored patients. These patients had a lower 30-day survival rate compared with IHCA caused by respiratory failure of other causes.

    Fulltekst (pdf)
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  • 13. Albertsson, P
    et al.
    Emanuelsson, H
    Karlsson, T
    Lamm, C
    Sandén, W
    Lagerberg, G
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Morbidity and use of medical resources in patients with chest pain and normal or near normal coronary arteries. Influences of the diagnostic angiogram1997Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 79, nr 3, s. 299-304Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To evaluate morbidity and use of medical resources in patients with chest pain and normal or near-normal coronary angiograms: 2,639 consecutive patients who underwent coronary angiograms due to chest pain were registered. Two years thereafter all patients who showed normal or near-normal coronary angiograms were approached with a questionnaire regarding hospitalization during the last 4 years (2 years before and 2 years after angiography). All medical files were also examined. Of the patients who underwent angiography, 163 (6%) had no significant stenoses, and of these, 113 showed complete normal angiograms and 50 showed mild (i.e. <50%) stenoses. During the 2 years before diagnostic angiogram, 66% of the patients were hospitalized compared with only 35% during 2 years after angiography (p <0.001). The reduction in hospitalization was due to curtailed utilization of medical resources for cardiac reasons; mean days in hospital was 6.6 days before angiography versus 2.8 days after (p <0.001). There were no significant differences in hospitalization when comparing patients with mild stenoses and completely normal angiograms. There were, furthermore, no differences between patients with positive or negative exercise tests. Thus, the need for hospitalization is significantly reduced after a diagnostic angiogram reveals normal or near-normal coronary arteries.

  • 14.
    Al-Dury, Nooraldeen
    et al.
    University of Gothenburg, Sweden;Ostfold Hosp Kalnes, Norway.
    Ravn-Fischer, Annica
    University of Gothenburg, Sweden;Sahlgrenska university hospital, Sweden.
    Hollenberg, Jacob
    Karolinska Institutet, Sweden.
    Israelsson, Johan
    Linnéuniversitetet, Sjöfartshögskolan (SJÖ).
    Nordberg, Per
    Södersjukhuset, Sweden;Karolinska Institutet, Sweden.
    Stromsoe, Anneli
    Mälardalen University, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. University of Gothenburg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Identifying the relative importance of predictors of survival in out of hospital cardiac arrest: a machine learning study2020Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 28, nr 1, s. 1-8, artikkel-id 60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Studies examining the factors linked to survival after out of hospital cardiac arrest (OHCA) have either aimed to describe the characteristics and outcomes of OHCA in different parts of the world, or focused on certain factors and whether they were associated with survival. Unfortunately, this approach does not measure how strong each factor is in predicting survival after OHCA. Aim: To investigate the relative importance of 16 well-recognized factors in OHCA at the time point of ambulance arrival, and before any interventions or medications were given, by using a machine learning approach that implies building models directly from the data, and arranging those factors in order of importance in predicting survival. Methods: Using a data-driven approach with a machine learning algorithm, we studied the relative importance of 16 factors assessed during the pre-hospital phase of OHCA We examined 45,000 cases of OHCA between 2008 and 2016. Results: Overall, the top five factors to predict survival in order of importance were: initial rhythm, age, early Cardiopulmonary Resuscitation (CPR, time to CPR and CPR before arrival of EMS), time from EMS dispatch until EMS arrival, and place of cardiac arrest The largest difference in importance was noted between initial rhythm and the remaining predictors. A number of factors, including time of arrest and sex were of little importance. Conclusion: Using machine learning, we confirm that the most important predictor of survival in OHCA is initial rhythm, followed by age, time to start of CPR, EMS response time and place of OHCA. Several factors traditionally viewed as important e.g. sex, were of little importance.

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  • 15.
    Al-Dury, Nooraldeen
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Rawshani, Araz
    Sahlgrenska Academy, University of Gothenburg.
    Israelsson, Johan
    Linnaeus University.
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Västerås.
    Aune, Solveig
    Sahlgrenska University Hospital.
    Agerström, Jens
    Linnaeus University.
    Karlsson, Thomas
    Sahlgrenska Academy.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital, University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.2017Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, nr 12, s. 1839-1844, artikkel-id S0735-6757(17)30451-5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 16.
    Al-Dury, Nooraldeen
    et al.
    University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Karlsson, Thomas
    Health Metrics at the Sahlgrenska Academy, University of Gothenburg, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ravn-Fischer, Annica
    University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    The influence of age and gender on delay to treatment and its association with survival after out of hospital cardiac arrest.2021Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 42, s. 198-202Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
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  • 17.
    Alfredsson, J.
    et al.
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    James, S. K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Erlinge, D.
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Fröbert, O.
    Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dworeck, C.
    Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg, Gothenburg, Sweden.
    Redfors, B.
    Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg, Gothenburg, Sweden.
    Arefalk, G.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Östlund, O.
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Jernberg, T.
    Department of Clinical Sciences, Cardiology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Mars, K.
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet-Södersjukhuset, Stockholm, Sweden.
    Haaga, U.
    Department of Cardiology, Karlstad Central Hospital, Karlstad, Sweden.
    Lindahl, B.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Swahn, E.
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    Lawesson, S. S.
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    Hofmann, R.
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet-Södersjukhuset, Stockholm, Sweden.
    Investigators, for the DETO2X-SWEDEHEART
    Randomized comparison of early supplemental oxygen versus ambient air in patients with confirmed myocardial infarction: Sex-related outcomes from DETO2X-AMI2021Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 237, s. 13-24Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The purpose of this study is to investigate the impact of oxygen therapy on cardiovascular outcomes in relation to sex in patients with confirmed myocardial infarction (MI).

    Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction trial randomized 6,629 patients to oxygen at 6 L/min for 6-12 hours or ambient air. In the present subgroup analysis including 5,010 patients (1,388 women and 3,622 men) with confirmed MI, we report the effect of supplemental oxygen on the composite of all-cause death, rehospitalization with MI, or heart failure at long-term follow-up, stratified according to sex.

    Results: Event rate for the composite endpoint was 18.1% in women allocated to oxygen, compared to 21.4% in women allocated to ambient air (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.65-1.05). In men, the incidence was 13.6% in patients allocated to oxygen compared to 13.3% in patients allocated to ambient air (HR 1.03, 95% CI 0.86-1.23). No significant interaction in relation to sex was found (P=.16). Irrespective of allocated treatment, the composite endpoint occurred more often in women compared to men (19.7 vs 13.4%, HR 1.51; 95% CI, 1.30-1.75). After adjustment for age alone, there was no difference between the sexes (HR 1.06, 95% CI 0.91-1.24), which remained consistent after multivariate adjustment.

    Conclusion: Oxygen therapy in normoxemic MI patients did not significantly affect all-cause mortality or rehospitalization for MI or heart failure in women or men. The observed worse outcome in women was explained by differences in baseline characteristics, especially age

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  • 18.
    Alsholm, Linda
    et al.
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Niva, My
    Department of Ambulance Care, Jönköping County Hospital.
    Claesson, Lisa
    Department of Ambulance Care, Halland County Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Magnusson, Carl
    Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital.
    Rosengren, Lars
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Jood, Katarina
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.2019Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, artikkel-id e01266Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA.

    AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend.

    METHODS: Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS.

    RESULTS: Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache.

    CONCLUSION: From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.

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  • 19.
    Andell, Pontus
    et al.
    Unit of Cardiology, Karolinska Institutet,.
    James, Stefan
    Uppsala Clinical Research Center, Uppsala University.
    Östlund, Ollie
    Uppsala Clinical Research Center, Uppsala University.
    Yndigegn, Troels
    Department of Cardiology, Lund University.
    Sparv, David
    Department of Cardiology, Lund University.
    Pernow, John
    Unit of Cardiology, Karolinska Institutet.
    Jernberg, Tomas
    Department of Clinical Sciences, Karolinska Institutet.
    Lindahl, Bertil
    Department of Medical Sciences, Uppsala University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Erlinge, David
    Department of Cardiology, Lund University.
    Hofmann, Robin
    Department of Clinical Science and Education, Karolinska Institutet.
    Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial.2020Inngår i: European Heart Journal: Acute Cardiovascular Care, ISSN 2048-8726, E-ISSN 2048-8734, Vol. 9, nr 8, s. 984-992Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction.

    METHODS AND RESULTS: =0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions.

    CONCLUSIONS: Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings.

    CLINICAL TRIALS REGISTRATION: NCT02290080.

  • 20.
    Andersson, Elin
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bohlin, Linda
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Fekete, Zoltán
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke.2018Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, s. 63-70Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.

    METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.

    RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.

    CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.

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  • 21.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Magnusson, Carl
    University of Gothenburg and Sahlgrenska University Hospital,.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Seffel, Elin
    Department of Ambulance Care, Södra Älvsborg Hospital.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Munters, Monica
    Department of Ambulance Care, Region of Dalarna.
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Mälardalens högskola.
    Nilsson, Lena
    Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University.
    Adverse events in prehospital emergency care: a trigger tool study2019Inngår i: BMC Emergency Medicine, Vol. 19, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care.

    Fulltekst (pdf)
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  • 22.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nilsson, Lena
    Linköping University.
    Strömsöe, Anneli
    Mälardalens högskola.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kängström, Anna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Patient safety and patient assessment in pre-hospital care: a study protocol2016Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 24, nr 1, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to

    survey patient safety problems in pre-hospital care in Sweden.

    Methods/Design: The study is a retro-perspective structured medical record review based on the use of 11 screening

    criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for

    pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with

    the final hospital assessment. Three different ambulance organisations are participating in the study. Every month,

    one rater in each organisation randomly collects 30 medical records for review. With guidance from the review

    instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of

    problematic reviews. The results will be analysed with descriptive statistics and logistic regression.

    Discussion: The findings will make an important contribution to knowledge about patient safety issues in prehospital

    care.

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  • 23.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, P
    Högskolan väst.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, P-O
    University of Gothenburg.
    A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.2018Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: We compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke.

    MATERIALS & METHODS: The Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital.

    RESULTS: Of 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital.

    CONCLUSIONS: Patients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.

  • 24.
    Andersson, Henrik
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Larsson, Anna
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gellerstedt, Martin
    Bång, Angela
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ljungström, Lars
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care2018Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 25.
    Andersson, Jan-Otto
    et al.
    Ambulance Service, Skaraborg Hospital.
    Nasic, Salmir
    Research and Development Centre, Skaraborg Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hjertonsson, Erik
    Department of Medicine, Skövde County Hospital.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    The intensity of pain in the prehospital setting is most strongly reflected in the respiratory rate among physiological parameters.2019Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 37, nr 12, s. 2125-2131, artikkel-id S0735-6757(19)30038-5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In order to treat pain optimally, the Emergency Medical Service (EMS) clinician needs to be able to make a reasonable estimation of the severity of the pain. It is hypothesised that various physiological parameters will change as a response to pain.

    AIM: In a cohort of patients who were seen by EMS clinicians, to relate the patients' estimated intensity of pain to various physiological parameters.

    METHODS: Patients who called for EMS due to pain in a part of western Sweden were included. The intensity of pain was assessed according to the visual analogue scale (VAS) or the Numerical Rating Scale (NRS). The following were assessed the same time as pain on EMS arrival: heart rate, systolic and diastolic blood pressure, respiratory rate, moist skin and paleness.

    RESULTS: In all, 19,908 patients (≥18 years), were studied (51% women). There were significant associations between intensity of pain and the respiratory rate (r = 0.198; p < 0.0001), heart rate (r = 0.037; p < 0.0001), systolic blood pressure (r = -0.029; p < 0.0001), moist skin (r = 0.143; p < 0.0001) and paleness (r = 0.171; p < 0.0001). The strongest association was found with respiratory rate among patients aged 18-64 years (r = 0.258; p < 0.0001).

    CONCLUSION: In the prehospital setting, there were significant but weak correlations between intensity of pain and physiological parameters. The most clinically relevant association was found with an increased respiratory rate and presence of pale and moist skin among patients aged < 65 years. Among younger patients, respiratory rate may support in the clinical evaluation of pain.

  • 26. Andréassob, A-Ch
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Bång, A
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Ekström, L
    Lindqvist, J
    Lundström, G
    Holmberg, S
    Characteristics and outcome among patients with a suspected in hospital cardiac arrest1998Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 39, nr 1-2, s. 23-31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 27.
    Aune, E
    et al.
    Univ Gothenburg, Inst Med, Gothenburg, Sweden.
    McMurray, J
    Univ Glasgow, British Heart Fdn BHF Cardiovasc Res Ctr, Glasgow, Lanark, Scotland.
    Lundgren, P
    Univ Gothenburg, Inst Med, Gothenburg, Sweden.
    Sattar, N
    Univ Glasgow, British Heart Fdn BHF Cardiovasc Res Ctr, Glasgow, Lanark, Scotland.
    Israelsson, J
    Kalmar Cty Hosp, Reg Kalmar Cty, Div Cardiol, Dept Internal Med, Kalmar, Sweden.
    Nordberg, P
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, A
    Univ Gothenburg, Inst Med, Gothenburg, Sweden; Swedish Registry Cardiopulm Resuscitat, Gothenburg, Sweden.
    Clinical characteristics and survival in patients with heart failure experiencing in hospital cardiac arrest2022Inngår i: Scientific Reports, E-ISSN 2045-2322, Vol. 12, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In patients with heart failure (HF) who suffered in-hospital cardiac arrest (IHCA), little is known about the characteristics, survival and neurological outcome. We used the Swedish Registry of Cardiopulmonary Resuscitation to study this, including patients aged >= 18 years suffering IHCA (2008-2019), categorised as HF alone, HF with acute myocardial infarction (AMI), AMI alone, or other. Odds ratios (OR) for 30-day survival, trends in 30-day survival, and the implication of HF phenotype was studied. 6378 patients had HF alone, 2111 had HF with AMI, 4210 had AMI alone. Crude 5-year survival was 9.6% for HF alone, 12.9% for HF with AMI and 34.6% for AMI alone. The 5-year survival was 7.9% for patients with HF and left ventricular ejection fraction (LVEF) >= 50%, 15.4% for LVEF < 40% and 12.3% for LVEF 40-49%. Compared with AMI alone, adjusted OR (95% CI) for 30-day survival was 0.66 (0.60-0.74) for HF alone, and 0.49 (0.43-0.57) for HF with AMI. OR for 30-day survival in 2017-2019 compared with 2008-2010 were 1.55 (1.24-1.93) for AMI alone, 1.37 (1.00-1.87) for HF with AMI and 1.30 (1.07-1.58) for HF alone. Survivors with HF had good neurological outcome in 92% of cases.

    Fulltekst (pdf)
    fulltext
  • 28. Aune, S
    et al.
    Eldh, M
    Engdahl, J
    Holmberg, S
    Lindqvist, J
    Svensson, L
    Oddby, E
    Herlitz, Johan
    [external].
    Improvement in the hospital organisation of CPR training and outcome after cardiac arrest in Sweden during a 10-year period2011Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, ISSN 0300-9572, Vol. 82, nr 4, s. 431-435Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 29. Aune, S
    et al.
    Fredriksson, M
    Thorén, A-B
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    In-hospital cardiac arrest--an Utstein style report of seven years experience from the Sahlgrenska University Hospital.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 68, nr 3, s. 351-358Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 30. Aune, S
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Bång, A
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Characteristics of patients who die in hospital with no attempt at resuscitation.2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 291-299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

  • 32. Aune, S
    et al.
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Evaluation of 2 different instruments for exposing the chest in conjunction with a cardiac arrest2010Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 29, nr 5, s. 549-553Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 33.
    Axelsson, C
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Axelsson, Å
    Nestin, J
    Svensson, L
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest-a pilot study.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 71, nr 1, s. 47-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 34.
    Axelsson, C
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Axelsson, Å
    Svensson, L
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Characteristics and outcome among patients suffering from out-of-hospital cardiac arrest with the emphasis on availability for intervention trials.2007Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 75, nr 3, s. 460-468Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 35.
    Axelsson, C
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Borgström, J
    Karlsson, T
    Axelsson, Å
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dispatch codes of out-of-hospital cardiac arrest should be diagnosis related rather than symptom related2010Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 17, nr 5, s. 265-269Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe the characteristics and outcome in out-of-hospital cardiac arrest (OHCA) in relation to (i) whether OHCA was coded by the dispatcher as a diagnosis or as a symptom and (ii) the delay until the first unit was alerted at the dispatch centre. Methods: OHCA patients in Göteborg, during 17 months, excluding OHCA after calling the rescue team. Results: Among 250 cases, 20% were coded as a diagnosis (i.e. CA) with or without ongoing cardiopulmonary resuscitation (CPR). Dispatch codes for the remaining 200 patients (80%) were mostly symptom related (unconsciousness in 61%, codes related to breathing problems in 10%, other codes in 24% and missing in 5%). Patients in whom the dispatchers coded the call as CA had an earlier start to CPR after collapse (median 2 vs. 10 min; P<0.0001) and a higher rate of bystander CPR (86% vs. 42%; P<0.0001). Furthermore, they tended to have a higher rate of survival to hospital discharge (14.0% vs. 6.5%; P  = 0.09). The median delay until the first unit was alerted was 1.8 min. Survival to hospital discharge was 10.0% if the delay was below median and 6.7% if the delay was above median (P = 0.48). Conclusion: Patients with OHCA who were not coded by dispatchers as such had a long delay to the start of CPR and a low survival. Dispatching according to diagnosis, that is, CA seems to improve these parameters most likely reflecting a more optimal communication between the dispatcher and the caller as well as the rescue team.

  • 36.
    Axelsson, C
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herrera, MJ
    Fredriksson, M
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Implementation of mechanical chest compression in out-of-hospital carfdiac arrest in an emergency medical service system2013Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 8, s. 1196-1200Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 37.
    Axelsson, C
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Holmberg, S
    Axelsson, ÅB
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Passive leg raising during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: Does it improve circulation and outcome?2010Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, nr 12, s. 1615-1620Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 38.
    Axelsson, C
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jimenez, M
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    PCI de Lucs. A safety and feasibility study on a pathway to the cath lab for patients with OHCA2014Konferansepaper (Fagfellevurdert)
  • 39.
    Axelsson, C
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Karlsson, T
    Axelsson, ÅB
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA).2009Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, nr 10, s. 1099-1103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 40.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nationella regler krävs för ambulanssjukvård2011Inngår i: Svenska Dagbladet, ISSN 1101-2412Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Ambulanssjukvården i Sverige saknar nationella riktlinjer. En konsekvens av detta är brister i tillgängligheten vilket fått allvarliga konsekvenser för flera personer under den senaste tiden. En av dem är Maximilian och hans mamma som blev påkörda på trottoaren av en 23-årig förare som hade tappat kontrollen över sin bil. Det tog nästan en timme innan pojken flögs till sjukhus med helikopter från olycksplatsen på Tjörn utanför Stenungsund. Maximilian blev bara tio veckor.

  • 41.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Englund, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Så skapas världens bästa ambulanssjukvård2011Inngår i: Göteborgsposten, ISSN 1103-9345Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Tiden från larm till dess att ambulans kommer har ökat dramatiskt de senaste tio åren i Västra Götaland. Samtidigt bedöms allt fler i behov av snabb utryckning. Kompetens finns att råda bot på detta – om den tillåts styra utvecklingen, skriver bland andra professor Johan Herlitz.

  • 42.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Claesson, Andreas
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Engdahl, J
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hollenberg, J
    Lindqvist, J
    Rosenqvist, M
    Svensson, L
    Outcome after out-of-hospital cardiac arrest witnessed by EMS: changes over time and factors of importance for outcome in Sweden.2012Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, nr 10, s. 1253-1258Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 43.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Anders
    Sjöberg, Henrik
    Jiménez-Herrera, Maria
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jonsson, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gellerstedt, Martin
    Ljungström, Lars
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, nr 3, s. 1-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 44.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmen, Johan
    Herreira, Maria
    Canardo, Guillermo
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    PCI De Lucs.: A clinical pathway directly to the PCI lab in out of hospital cardiac arrest2016Inngår i: American Heart Association, 2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Purpose: In Sweden, the ambulance response time from call to arrival is 11 minutes in patients with an out-of-hospital cardiac arrest (OHCA). However, there is a small group of OHCA patients (20%) in whom this delay is minimized, namely those that occur minutes before or after the arrival of the ambulance. Despite CPR and/or defibrillation within one minute, only 20% survive to hospital discharge. The objective was therefore to determine whether a pathway with direct transportation to the cath lab, using mechanical chest compression (LUCAS), could improve survival in this selected group.

    Aim: To describe characteristics, feasibility and outcome among a selected group of OHCA patients transported directly to the cath lab by the ambulance in a new pathway

    Method: A prospective observational study from November 2013 to November 2015

    Inclusion criteria: 1. Crew-witnessed cardiac arrest (CA) of cardiac origin or CA immediately defibrillated to return of spontaneous circulation (ROSC) by public access. 2. CA occurring two to three minutes before ambulance arrival where the patient had immediate bystander CPR of high quality. 4. CA occurring two to three minutes before ambulance arrival where the patient was still breathing at ambulance arrival.

    Exclusion criteria: Non-cardiac origin CA or high physiologic age (hospice patients)

    Result: Sixty-four patients fulfilled the inclusion criteria and 14 were excluded. Of the remaining 50 patients, 25 were transported with mechanical CPR to the cath lab. The time from CA to hospital was a median of 38 minutes. Survival to 30 days was 38% among all patients, 47% among VF (N=34) and 12% (N=25) among those who were transported with mechanical CPR.

    Conclusion: The pathway appears safe and feasible, but the inclusion criteria need to be less complex. The vast majority of survivors were found in the VF population. There were survivors (12%) among patients transported with ongoing CPR (N=25) directly to the cath lab by the ambulance.

  • 45.
    Axelsson, Christer
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Thomas
    Pande, Katarina
    Wigertz, Kristin
    Örtenwall, Per
    Nordanstig, Joakim
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    A description of the prehospital phase of aortic dissection in terms of early suspicion and treatment.2015Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 30, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Aortic dissection is difficult to detect in the early phase due to a variety of symptoms. This report describes the prehospital setting of aortic dissection in terms of symptoms, treatment, and suspicion by the Emergency Medical Service (EMS) staff.

    BASIC PROCEDURES: All patients in the Municipality of Gothenburg, Sweden, who, in 2010 and 2011, had a hospital discharge diagnosis of aortic dissection (international classification of disease (ICD) I 71,0) were included. The exclusion criteria were: age<18 years of age and having a planned operation. This was a retrospective, descriptive study based on patient records. In the statistical analyses, Fisher's exact test and the Mann-Whitney U test were used for analyses of dichotomous and continuous/ordered variables.

    MAIN FINDINGS: Of 92 patients, 78% were transported to the hospital by the EMS. The most common symptom was pain (94%). Pain was intensive or very intensive in 89% of patients, with no significant difference in relation to the use of the EMS. Only 47% of those using the EMS were given pain relief with narcotic analgesics. Only 12% were free from pain on admission to the hospital. A suspicion of aortic dissection was reported by the EMS staff in only 17% of cases. The most common preliminary diagnosis at the dispatch center (31%) and by EMS clinicians (52%) was chest pain or angina pectoris. In all, 79% of patients were discharged alive from the hospital (75% of those that used the EMS and 95% of those that did not).

    CONCLUSION: Among patients who were hospitalized due to aortic dissection in Gothenburg, 78% used the EMS. Despite severe pain in the majority of patients, fewer than half received narcotic analgesics, and only 12% were free from pain on admission to the hospital. In fewer than one-in-five patients was a suspicion of aortic dissection reported by the EMS staff.

  • 46. Axelsson, Å
    et al.
    Stibrant Sunnerhagen, K
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Comparision of respondents and non-respondents in a follow-upsurvey after cardiac arrest2013Konferansepaper (Fagfellevurdert)
  • 47. Axelsson, ÅB
    et al.
    Herlitz, Johan
    [external].
    Holmberg, S
    Thorén, A-B
    A nationwide survey of CPR training in Sweden: foreign born and unemployed are not reached by training programmes.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 70, nr 1, s. 90-97Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 48. Axelsson, Åsa B
    et al.
    Sunnerhagen, Katharina S
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101, s. 44-49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 49.
    Axelsson, Åsa B
    et al.
    University of Gothenburg.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 50. Axelsson, Åsa
    et al.
    Sunnerhagen, Katrina
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Post-traumatic stress among survivors of out of hospital cardic arrest2012Konferansepaper (Fagfellevurdert)
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