CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Cardiac Arrest – mechanical chest compressions, gender differences and coronary angiography
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiac arrest is a major health problem with over 6000 cases of out-of-hospital cardiac arrest (OHCA) and 2500 cases of in-hospital cardiac arrest (IHCA) per year in Sweden. Survival are low. Many factors affect the chances of survival, including effective cardiopulmonary resuscitation and optimal post resuscitation care. These thesis involve these areas. Paper I+II describe a randomized clinical trial (n=2589). We compared a novel CPR algorithm with defibrillations during ongoing chest compressions delivered with a mechanical chest compression device and manual CPR according to guidelines. We found no difference in 4-hour survival, 23.6% with mechanical CPR and 23.7% with manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. Paper III is a registry study (n=1498). We investigated impact of gender in performance and findings of early coronary angiography (CAG) and percutaneous coronary intervention (PCI), comorbidity and outcome among OHCA victims with an initially shockable rhythm. We found no difference between men and women in rates of ST-elevation/left bundle branch block (LBBB), 40% vs. 38% or rates of CAG, 45% vs. 40%. Among patients without ST-elevation/LBBB more men than women had CAG followed by PCI, 59% vs. 42% (P=0.03) and more advanced coronary artery disease. We found no association between gender and use of early CAG. Paper IV is a retrospective observational single centre study (n=423) of ICU treated victims of cardiac arrest. OHCA and IHCA were compared regarding comorbidity, characteristics of the arrest, treatment including CAG and CAG findings and outcome. OHCA patients had less preexisting comorbidity, lower rates of bystander CPR 71% vs 100% (p<0.001) and longer time to return of spontaneous circulation, 20 vs 10 minutes (p<0.001). OHCA patients more often had a shockable first rhythm, 47% vs 13% (p<0.001) and CA without any obvious non-cardiac origin, 77% vs 50% (p<0.001). OHCA patients more often underwent early CAG, 52% vs 25% (p<0.001) but no difference in rates of subsequent PCI or angiogram with at least one significant stenosis was seen. OHCA and IHCA did not differ in 30-days survival, 42% vs 41% or 1-year survival, 39% vs 33% 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. , p. 60
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1631
Keywords [en]
cardiac arrest, OHCA, IHCA, CPR, coronary angiography, percutaneous coronary intervention, PCI, mechanical chest compressions, lucas
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-402521ISBN: 978-91-513-0856-2 (print)OAI: oai:DiVA.org:uu-402521DiVA, id: diva2:1386072
Public defence
2020-03-05, Holmdahlsalen, ingång 100, Akademiska sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-02-13 Created: 2020-01-16 Last updated: 2020-02-14
List of papers
1. The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation
Open this publication in new window or tab >>The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation
Show others...
2013 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, p. 5-Article in journal (Refereed) Published
Abstract [en]

Background: The LUCAS (TM) device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS (TM) device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. Methods/design: This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials. gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). Results: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. Conclusion: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS (TM) device when used in association with defibrillation during on-going CPR.

Keywords
Cardiac arrest, Mechanical chest compression, Defibrillation, External chest compressions, Ventricular fibrillation, Asystole, Pulseless electrical activity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-197667 (URN)10.1186/1757-7241-21-5 (DOI)000315588600001 ()
Available from: 2013-04-02 Created: 2013-04-02 Last updated: 2020-01-16Bibliographically approved
2. Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest The LINC Randomized Trial
Open this publication in new window or tab >>Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest The LINC Randomized Trial
Show others...
2014 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 311, no 1, p. 53-61Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. OBJECTIVE To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months. INTERVENTIONS Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289). MAIN OUTCOMES AND MEASURES Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome. RESULTS Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, -0.05%; 95% CI, -3.3% to 3.2%; P > .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, -0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, -1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, -1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, -1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2. CONCLUSIONS AND RELEVANCE Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-216731 (URN)10.1001/jama.2013.282538 (DOI)000329161400018 ()
Available from: 2014-01-27 Created: 2014-01-24 Last updated: 2020-01-16Bibliographically approved
3. Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study
Open this publication in new window or tab >>Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study
Show others...
2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, p. 189-195Article in journal (Refereed) Published
Abstract [en]

Introduction: We investigated the impact of gender in performance and findings of early coronary angiography (CAG) and percutaneous coronary intervention (PCI), comorbidity and outcome in a large population of out-of-hospital cardiac arrest (OHCA) patients with an initially shockable rhythm.

Methods: Retrospective cohort study. Data retrieved 2008-2013 from the Swedish Register for Cardio-Pulmonary Resuscitation, Swedeheart Registry and National Patient Register.

Results: We identified 1498 patients of whom 78% were men. Men and women had the same pathology on the first registered electrocardiogram (ECG): 30% vs. 29% had ST-elevation and 10% vs. 9% had left bundle branch block (LBBB) (P=0.97). Proportions of performed CAG did not differ between genders. Among patients without ST-elevation/LBBB men more often had at least one significant stenosis, 78% vs. 54% (P= 0.001), more multi-vessel disease (P= 0.01), had normal coronary angiography less often, 22% vs. 46% and PCI more often, 59% vs. 42% (P= 0.03). Among patients without STelevation/LBBB on the initial ECG, more men had previously known ischaemic heart disease, 27% vs. 19% (P=0.02) and a presumed cardiac origin of the cardiac arrest, 86% vs. 72% (P< 0.001). Multivariable analysis showed no association between gender and evaluation by early CAG. In men and women, 1-year survival was 56% vs. 50% (P= 0.22) in patients with ST-elevation/LBBB and 48% vs. 51% (P= 0.50) in patients without.

Conclusion: Despite no gender differences in ECG findings indicating an early CAG, men had more severe coronary artery disease while women more frequently had normal coronary angiography. However, this did not influence 1-year survival.

Keywords
Cardiac arrest, Gender differences, Out-of-hospital cardiac arrest, Coronary angiography, Percutaneous coronary intervention, Ventricular fibrillation, CPR, Registry study
National Category
Cardiac and Cardiovascular Systems Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-395786 (URN)10.1016/j.resuscitation.2019.07.015 (DOI)000487197500028 ()31330199 (PubMedID)
Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2020-01-16Bibliographically approved
4. A study comparing victims of out-of-hospital and in-hospital cardiac arrest admitted alive to the ICU.
Open this publication in new window or tab >>A study comparing victims of out-of-hospital and in-hospital cardiac arrest admitted alive to the ICU.
(English)Manuscript (preprint) (Other academic)
Keywords
Cardiac arrest, OHCA, IHCA, CPR, coronary angiography, percutaneous coronary intervention, PCI
National Category
Anesthesiology and Intensive Care
Research subject
Internal Medicine
Identifiers
urn:nbn:se:uu:diva-402517 (URN)
Available from: 2020-01-16 Created: 2020-01-16 Last updated: 2020-01-16

Open Access in DiVA

fulltext(1210 kB)15 downloads
File information
File name FULLTEXT01.pdfFile size 1210 kBChecksum SHA-512
31ec7164dd4e5f3db158cfe2a6105a7e2ee86f31cabb3b39f822fe91cfb57bd904f62f9e515d5bf2804a292449b705f71cd22f7846b7626a8453a0e57080e888
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Lindgren, Erik
By organisation
Department of Surgical Sciences
Anesthesiology and Intensive Care

Search outside of DiVA

GoogleGoogle Scholar
Total: 15 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 54 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf