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  • 1. Andréassob, A-Ch
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Bång, A
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Ekström, L
    Lindqvist, J
    Lundström, G
    Holmberg, S
    Characteristics and outcome among patients with a suspected in hospital cardiac arrest1998In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 39, no 1-2, p. 23-31Article in journal (Refereed)
    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.

  • 2. Atwood, C
    et al.
    Eisenberg, MS
    Herlitz, Johan
    Sahlgrenska University Hospital.
    Rea, TD
    Incidence of EMS-treated out-of-hospital cardiac arrest in Europe.2005In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 67, no 1, p. 75-80Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The potential impact of efforts in Europe to improve survival from out-of-hospital cardiac arrest is unclear, in part, because estimates of incidence and survival are uncertain. The aim of the investigation was to determine a representative European incidence and survival from cardiac arrest in all-rhythms and in ventricular fibrillation treated by the emergency medical services (EMS). METHODS AND RESULTS: We used Medline to identify peer-reviewed articles published between 1 January 1980 and 30 June 2004 that reported a European community's EMS cardiac arrest experience. Inclusion criteria required the study to include at least 25 cases, report of the total number of all-rhythm and/or ventricular fibrillation arrests, and information about population size and study duration. The incidence was computed by dividing the total number of events by the product of the community's population and the study duration. Reports from 37 communities met the inclusion criteria. A total of 18,105 all-rhythm EMS-treated cardiac arrests occurred during 48 million person-years of observation, resulting in an overall incidence for all-rhythm arrests of 37.72 per 100,000 person-years. Incidence of ventricular fibrillation arrest was 16.84 per 100,000 person-years. Survival was 10.7% for all-rhythm and 21.2% for ventricular fibrillation cardiac arrest. Applying these results to the European population, approximately, 275,000 persons would experience, all-rhythm cardiac arrest treated by the EMS with 29,000 persons surviving to hospital discharge. CONCLUSION: The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of cardiac arrest in Europe.

  • 3. 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 period2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, ISSN 0300-9572, Vol. 82, no 4, p. 431-435Article in journal (Refereed)
    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.

  • 4. Aune, S
    et al.
    Fredriksson, M
    Thorén, A-B
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    In-hospital cardiac arrest--an Utstein style report of seven years experience from the Sahlgrenska University Hospital.2006In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 68, no 3, p. 351-358Article in journal (Refereed)
    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.

  • 5. Aune, S
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Bång, A
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Characteristics of patients who die in hospital with no attempt at resuscitation.2005In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, no 3, p. 291-299Article in journal (Refereed)
    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.

  • 6. Aune, S
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Characteristics of patients who die in hospital with no attempt at resuscitation2005In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, no 3, p. 291-299Article in journal (Refereed)
    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.

  • 7. Axelsson, A
    et al.
    Herlitz, J
    Fridlund, Bengt
    Högskolan i Halmstad.
    How bystanders perceive their cardiopulmonary resuscitation intervention: a qualitative study2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, no 1, p. 71-81Article in journal (Refereed)
  • 8.
    Axelsson, C
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Axelsson, Å
    Nestin, J
    Svensson, L
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [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.2006In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 71, no 1, p. 47-55Article in journal (Refereed)
    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

  • 9.
    Axelsson, C
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Axelsson, Å
    Svensson, L
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Characteristics and outcome among patients suffering from out-of-hospital cardiac arrest with the emphasis on availability for intervention trials.2007In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 75, no 3, p. 460-468Article in journal (Refereed)
    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.

  • 10.
    Axelsson, C
    et al.
    University of Borås, School of Health Science.
    Holmberg, S
    Axelsson, ÅB
    Herlitz, Johan
    University of Borås, School of Health Science.
    Passive leg raising during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: Does it improve circulation and outcome?2010In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, no 12, p. 1615-1620Article in journal (Refereed)
    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.

  • 11.
    Axelsson, C
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Karlsson, T
    Axelsson, ÅB
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [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).2009In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, no 10, p. 1099-1103Article in journal (Refereed)
    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.

  • 12.
    Axelsson, Christer
    et al.
    University of Borås, School of Health Science.
    Azeli, Youcef
    Jiminez, Maria
    Ordonez Campana, A
    Might the bainbridge reflex have a role in resuscitation when chest compression is combined with passive leg raising?2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 1, p. e21-Article in journal (Refereed)
    Abstract [en]

    The effect of passive leg raising (PLR) in cardiac arrest is not clearly established but PLR has been associated with increased coronary perfusion pressure and increase in End tidal carbon dioxide (EtCO2) during cardiopulmonary resuscitation (CPR).1 A case in which PLR was used successfully has recently been published.

  • 13.
    Axelsson, Christer
    et al.
    University of Borås, School of Health Science.
    Claesson, Andreas
    University of Borås, School of Health Science.
    Engdahl, J
    Herlitz, Johan
    University of Borås, School of Health Science.
    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.2012In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, no 10, p. 1253-1258Article in journal (Refereed)
    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.

  • 14. Axelsson, Å
    et al.
    Herlitz, Johan
    [external].
    Ekström, L
    Holmberg, S
    Bystander-initiated cardiopulmonary resuscitation out-of-hospital. A first description of the bystanders and their experiences1996In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, no 1, p. 3-11Article in journal (Refereed)
    Abstract [en]

    Abstract At present there are about 1 million trained cardiopulmonary resuscitation (CPR) rescuers in Sweden. CPR out-of-hospital is initiated about 2000 times a year in Sweden. However, very little is known about the bystanders' experiences and reactions. The aim of this study was to describe bystander-initiated CPR, the circumstances, the bystander and his experiences. All CPR bystanders in Sweden who reported their resuscitation attempts between 1990 and 1994 were approached with a phone interview and a postal questionnaire, resulting in 742 questionnaires. Bystander-initiated CPR most frequently took place in public places such as the street. The rescuer most frequently had problems with mouth-to-mouth ventilation (20%) and vomiting (18%). More than half (53%) of the rescuers experienced CPR without problems. Ninety-two percent of the bystanders had no hesitation because of fear of contracting the acquired immunodeficiency syndrome (AIDS) virus. Ninety-three percent of the rescuers regarded their intervention as a mainly positive experience. Of 425 interviewed rescuers, 99.5% were prepared to start CPR again.

  • 15. Axelsson, Å
    et al.
    Herlitz, Johan
    [external].
    Fridlund, B
    How bystanders perceive their cardiopulmonary resuscitation intervention. A qualitative study2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, no 1, p. 71-81Article in journal (Refereed)
    Abstract [en]

    The importance of bystander cardiopulmonary resuscitation (CPR) prior to arrival of the emergency medical service is well documented. In Sweden, CPR is initiated prior to emergency medical services (EMS) arrival in about 30% of cardiac arrests out-of-hospital, a figure which should be improved urgently. To do so, it is of interest to know more about the bystanders’ perceptions of their intervention. A qualitative method inspired by the phenomenographic approach was applied to 19 bystanders who had performed CPR. In the analysis, five main categories and 14 subcategories emerged. The main categories were: to have a sense of humanity, to have competence, to feel an obligation, to have courage and to feel exposed. Interviews described how humanity and concern for another human being were the foundation of their intervention. CPR training offers the possibility to give appropriate help in this emergency. If the aim of CPR training was extended beyond teaching the skill of CPR to include preparation of the rescuer for the intervention and his/her reactions, this might increase the number of people able to take action in the cardiac arrest situation.

  • 16. Axelsson, Å
    et al.
    Herlitz, Johan
    [external].
    Karlsson, T
    Lindqvist, J
    Graves, JR
    Ekström, L
    Holmberg, S
    Factors surrounding cardiopulmonary resuscitation influencing bystanders psycholocigal reactions1998In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 37, no 1, p. 13-20Article in journal (Refereed)
    Abstract [en]

    The incidence of Sweden's out-of-hospital cardiac arrests averages 10000 annually. Each year bystanders initiate cardiopulmonary resuscitation (CPR) approximately 2000 times prior to arrival of emergency medical service (EMS). The aim of this study was to identify factors influencing the bystanders psychological reactions to performing CPR. We mailed a questionnaire to all bystanders who reported performing CPR to the CPR Centre of Sweden from autumn 1992 to 1995. The study included 544 bystander reports. Nine factors were found to be associated with bystanders experience in a univariate analysis. Among these were victim outcome (p < 0.0001), CPR duration (p = 0.0009) and their experience of the attitude of the EMS personnel (p = 0.004). In a multivariate logistic regression model, lack of debriefing following the intervention (p = 0.0001) and fatal victim outcome (p = 0.03) were independent predictors of a negative bystander psychological reaction. The importance of having someone to talk to following an intervention and the EMS personnel concern for the rescuer should be emphasised. The goal should be that critical incident debriefing is available to every bystander following his or her CPR attempt.

  • 17. Axelsson, Å
    et al.
    Thorén, AB
    Holmberg, S
    Herlitz, Johan
    [external].
    Attitudes of trained lay rescuers toward cardiopulmonary resuscitation performance in an actual emergency. A survery of 1012 recently trained CPR rescuers2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, no 1, p. 27-36Article in journal (Refereed)
    Abstract [en]

    There are currently 1.5 million trained cardiopulmonary resuscitation (CPR) rescuers in Sweden. Bystander CPR is performed on ≈30% of out-of-hospital cardiac arrests. The aim of this study was to analyse trained CPR rescuers’ attitudes and beliefs in terms of CPR performance in an emergency and differences with regard to gender, age, residential area and occupation. In a nation wide survey 1410, randomly selected, recently trained CPR rescuers were approached with a postal questionnaire, resulting in 1012 respondents. The mean age was 36.9 years and only 3% of the respondents were >59 years old. Only 1% had attended the course because of their own or a relative’s cardiac disease. Ninety-four per cent believed there was a minor to major risk of serious disease transmission while performing CPR. When predicting their willingness to perform CPR in six scenarios, 17% would not start CPR on a young drug addict, 7% would not perform CPR on an unkempt man, while 97% were sure about starting CPR on a relative and 91% on a known person. In four of six scenarios, respondents from rural areas were significantly more positive than respondents from metropolitan areas about starting CPR. In conclusion, readiness to perform CPR on a known person is high among trained CPR rescuers, while hesitation about performing CPR on a stranger is evident. Respondents from rural areas are more frequently positive about starting CPR than those from metropolitan areas.

  • 18. 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.2006In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 70, no 1, p. 90-97Article in journal (Refereed)
    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.

  • 19. Axelsson, Åsa B
    et al.
    Sunnerhagen, Katharina S
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101, p. 44-49Article in journal (Refereed)
    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.

  • 20.
    Axelsson, Åsa B
    et al.
    University of Gothenburg.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101Article in journal (Refereed)
    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.

  • 21.
    Axelsson, Åsa
    et al.
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Sahlgrenska University Hospital.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    How bystanders perceive their cardiopulmonary resuscitation intervention: a qualitative study2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, no 1, p. 71-81Article in journal (Refereed)
    Abstract [en]

    The importance of bystander cardiopulmonary resuscitation (CPR) prior to arrival of the emergency medical service is well documented. In Sweden, CPR is initiated prior to emergency medical services (EMS) arrival in about 30% of cardiac arrests out-of-hospital, a figure which should be improved urgently. To do so, it is of interest to know more about the bystanders' perceptions of their intervention. A qualitative method inspired by the phenomenographic approach was applied to 19 bystanders who had performed CPR. In the analysis, five main categories and 14 subcategories emerged. The main categories were: to have a sense of humanity, to have competence, to feel an obligation, to have courage and to feel exposed. Interviews described how humanity and concern for another human being were the foundation of their intervention. CPR training offers the possibility to give appropriate help in this emergency. If the aim of CPR training was extended beyond teaching the skill of CPR to include preparation of the rescuer for the intervention and his/her reactions, this might increase the number of people able to take action in the cardiac arrest situation.

  • 22.
    Basu, Samar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Mutschler, Diana K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Larsson, Anders O.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Kiiski, Ritva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Nordgren, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Eriksson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Propofol (Diprivan-EDTA) counteracts oxidative injury and deterioration of the arterial oxygen tension during experimental septic shock2001In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 50, no 3, p. 341-348Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Human septic shock can be replicated in the endotoxaemic pig. Endotoxaemia causes a multitude of events, including reduced PaO(2) and increased lipid peroxidation. This study was designed to evaluate the possible effects of a commonly used anaesthetic drug with known antioxidant properties (propofol) during porcine endotoxaemia.

    METHODS: Ten pigs were anaesthetised and given a 6 h E. coli endotoxin infusion. The animals received, randomly, a supplementary continuous infusion of propofol emulsion (containing 0.005% EDTA) or the corresponding volume of vehicle (controls). Pathophysiologic responses were determined. Non-enzymatic (by measuring plasma 8-iso-PGF(2 alpha) and enzymatic (by measuring plasma 15-keto-dihydro-PGF(2 alpha)) lipid peroxidations were evaluated. Plasma levels of the endogenous antioxidants alpha- and gamma-tocopherols, were also analysed.

    RESULTS: Endotoxaemia increased plasma levels of 8-iso-PGF(2 alpha) (1st-4th h) and 15-keto-dihydro-PGF(2 alpha) (1st-4th h) significantly more in controls than in the propofol+endotoxin group. PaO(2) was significantly less affected by endotoxin in the propofol treated animals (2nd-4th h). Mean arterial pressure (4th-6th h) and systemic vascular resistance (6th h) were reduced significantly more by endotoxin among the propofol-treated animals. Vitamin E (alpha-tocopherol) increased in all animals, significantly more in the propofol+endotoxin group (1/2-6th h) than in the control group.

    CONCLUSIONS: Propofol reduced endotoxin-induced free radical mediated and cyclooxygenase catalysed lipid peroxidation significantly. The implication is that propofol counteracts endotoxin-induced deterioration of PaO(2).

  • 23.
    Bergström, Mattias
    et al.
    Lund University.
    Schmidbauer, Simon
    Lund University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    University of Gothenburg.
    Friberg, Hans
    Lund University.
    Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 133, p. 147-152, article id S0300-9572(18)31010-4Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm.

    METHODS: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990-2016 were analyzed.

    RESULTS: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26-1.88).

    CONCLUSION: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.

  • 24.
    Bertilsson, Emelie
    et al.
    Kalmar County Hospital.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e93-e94Article in journal (Refereed)
  • 25.
    Blomberg, Hans
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Gedeborg, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Karlsten, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Johansson, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Poor chest compression quality with mechanical compressions in simulated cardiopulmonary resuscitation: A randomized, cross-over manikin study2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 10, p. 1332-1337Article in journal (Refereed)
    Abstract [en]

    Introduction: Mechanical chest compression devices are being implemented as an aid in cardiopulmonary resuscitation (CPR), despite lack of evidence of improved outcome. This manikin study evaluates the CPR-performance of ambulance crews, who had a mechanical chest compression device implemented in their routine clinical practice 8 months previously. The objectives were to evaluate time to first defibrillation, no-flow time, and estimate the quality of compressions. Methods: The performance of 21 ambulance crews (ambulance nurse and emergency medical technician) with the authorization to perform advanced life support was studied in an experimental, randomized cross-over study in a manikin setup. Each crew performed two identical CPR scenarios, with and without the aid of the mechanical compression device LUCAS. A computerized manikin was used for data sampling. Results: There were no substantial differences in time to first defibrillation or no-flow time until first defibrillation. However, the fraction of adequate compressions in relation to total compressions was remarkably low in LUCAS-CPR (58%) compared to manual CPR (88%) (95% confidence interval for the difference: 13-50%). Only 12 out of the 21 ambulance crews (57%) applied the mandatory stabilization strap on the LUCAS device. Conclusions: The use of a mechanical compression aid was not associated with substantial differences in time to first defibrillation or no-flow time in the early phase of CPR. However, constant but poor chest compressions due to failure in recognizing and correcting a malposition of the device may counteract a potential benefit of mechanical chest compressions. 

  • 26.
    Blomberg, Hans
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Johansson, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Reply to Letter: Technical factors weaken the clinical relevance of manikin measurements of mechanical chest compression depth2012In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, no 4, p. E99-E99Article in journal (Refereed)
  • 27.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Dahné, Tova
    Linköping University.
    Stureson, Lovisa
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Thylén, Ingela
    Linköping University.
    Lived experiences of surviving in-hospital cardiac arrest2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e122-e122Article in journal (Refereed)
  • 28.
    Bång, A
    et al.
    University of Borås, School of Health Science.
    Gustavsson, M
    Larsson, C
    Holmberg, S
    Herlitz, Johan
    University of Borås, School of Health Science.
    Are patients who are found deeply unconscious, without having suffered a cardiac arrest, always breathing normally?2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, no 2, p. 116-118Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. METHODS: Patients with Glasgow Coma Scale (GCS) 3 (1+1+1) and without cardiac arrest were retrospectively evaluated, via ambulance records, for signs of abnormal breathing. RESULTS: Of 45 patients who fulfilled inclusion criteria, 24 (53%) had signs of abnormal breathing, as reported by the ambulance crew. CONCLUSION: Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.

  • 29. Bång, A
    et al.
    Herlitz, Johan
    [external].
    Holmberg, S
    Possibilities of implementing dispatcher-assisted cardiopulmonary resuscitation in the community2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    Aim: By evaluating tape recordings of true cardiac arrest calls, to judge the dispatchers ability to (a) identify cases as suspected cardiac arrest (CA), (b) give the case the right priority, (c) identify CA cases suitable for dispatcher-assisted, telephone-guided cardiopulmonary resuscitation (T-CPR) and (d) accomplish T-CPR. Methods: Evaluation of 99 tape recordings of consecutive cases that had been admitted to the two city hospitals in Göteborg after out-of-hospital CA. Results: In 70% of the interviews, the dispatcher demonstrated impeccable behaviour with short, distinct questions, quickly resulting in a decision on how to handle the case. In 30%, serious criticism could be voiced as the dispatcher displayed very stressful behaviour, or omitted to ask important questions such as whether the patient was conscious and breathing. In 21%, the interviews indicated a clear opportunity to perform T-CPR. In another 10%, there was a possibility of performing T-CPR. Only in 8% was T-CPR actually accomplished. Conclusions: (1) In the majority of the interviews, the quality was very high, while in one-third, serious criticism could be voiced. (2) In our study, only one-third (95% confidence interval, 22–41) of CA cases were suitable for T-CPR, and T-CPR was performed in only 8% of the 99 cases. (3) To optimise the dispatcher ability to identify suspected CA and initiate T-CPR, both medical knowledge and practical training are needed, preferably with protocols for pre-arrival instructions.

  • 30.
    Bång, A
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Martinell, S
    Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases.2003In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 56, no 1, p. 25-34Article in journal (Refereed)
    Abstract [en]

    AIM: One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. METHODS: Prospective study evaluating 100 tape recordings of the EMD calls of emergency medical service (EMS)-provided advanced life support- (ALS) cases, of out-of-hospital cardiac arrest. RESULTS: The quality of EMD-performed interviews was highly commended in 63% of cases, but insufficient or unapproved in the remaining 37%. The caller's state of mind was not a major problem for co-operation. Among the 100 cases, 24 were suspected to be unconscious and in respiratory arrest. A further 38 cases were presented as unconscious with abnormal breathing. In only 14 cases dispatcher-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the cases were unconscious patients with abnormal breathing. The incidence of suspected agonal breathing was estimated to be approximately 30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional breathing. CONCLUSIONS: Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.

  • 31.
    Bång, A
    et al.
    [external].
    Ortgren, P-O
    Herlitz, Johan
    [external].
    Währborg, P
    Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2002In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, no 2, p. 135-151Article in journal (Refereed)
    Abstract [en]

    Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.

  • 32.
    Bång, Angela
    et al.
    University of Borås, School of Health Science.
    Gustavsson, Mikael
    Larsson, Carina
    Holmberg, Stig
    Herlitz, Johan
    University of Borås, School of Health Science.
    Are patients who are found deeply unconscious without having suffered a cardiac arrest, always breathing normally?2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, no 2, p. 116-118Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. METHODS: Patients with Glasgow Coma Scale (GCS) 3 (1+1+1) and without cardiac arrest were retrospectively evaluated, via ambulance records, for signs of abnormal breathing. RESULTS: Of 45 patients who fulfilled inclusion criteria, 24 (53%) had signs of abnormal breathing, as reported by the ambulance crew. CONCLUSION: Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.

  • 33. Bång, Angela
    et al.
    Martinell, S
    Herlitz, Johan
    Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases2003In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 2003, no 56, p. 25-34Article in journal (Refereed)
    Abstract [en]

    Aim: One of the objectives of this study was to assess the previous termemergency medical dispatchersnext term (EMDs) ability for the identification and prioritisation of previous termcardiac arrestnext term (CA) previous termcases,next term and offering and achievements of previous termdispatchernext term-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of previous termagonalnext term respiration in previous termcardiac arrest calls and the caller'snext term descriptions of previous termbreathing.next term Methods: Prospective study evaluating previous term100 tape recordingsnext term of the EMD previous termcalls of emergency medicalnext term service (EMS)-provided advanced life support- (ALS) previous termcases, of out-of-hospital cardiac arrest.next term Results: The quality of EMD-performed interviews was highly commended in 63% of previous termcases,next term but insufficient or unapproved in the remaining 37%. The previous termcaller'snext term state of mind was not previous termanext term major problem for co-operation. Among the previous term100 cases,next term 24 were previous termsuspectednext term to be unconscious and in respiratory previous termarrest. Anext term further 38 previous termcasesnext term were presented as unconscious with abnormal previous termbreathing.next term In only 14 previous termcases dispatchernext term-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the previous termcasesnext term were unconscious patients with abnormal previous termbreathing.next term The incidence of previous termsuspected agonal breathingnext term was estimated to be not, vert, similar30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional previous termbreathing.next term Conclusions: Among previous termsuspected cardiac arrest cases,next term EMDs offer CPR instruction to only previous termanext term small fraction of previous termcallers. Anext term major obstacle was the presentation of previous termagonal breathing.next term Patients with previous termanext term combination of unconsciousness and previous termagonal breathingnext term should be offered previous termdispatchernext term-assisted CPR instruction. This might improve survival in previous termout-of hospital cardiac arrest.next term

  • 34. Bång, Angela
    et al.
    Ortgren, P-O
    Herlitz, Johan
    Währborg, P
    Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2000In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, no 1, p. 135-151Article in journal (Refereed)
    Abstract [en]

    Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.

  • 35. Castren, M.
    et al.
    Bohm, K.
    Kvam, A. M.
    Bovim, E.
    Christensene, E. F.
    Steen-Hansen, J. -E
    Karlsten, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Reporting of data from out-of-hospital cardiac arrest has to involve emergency medical dispatching: Taking the recommendations on reporting OHCA the Utstein style a step further2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 12, p. 1496-1500Article in journal (Refereed)
    Abstract [en]

    Objectives: As a part of the chain of survival, the emergency medical communication centre (EMCC) and the emergency medical dispatcher (EMD) has an important role in early identification of out-of-hospital cardiac arrests (OHCA). The EMD may provide instructions to the caller and thereby initiate cardiopulmonary resuscitation in a substantial number of subjects and thus contribute to increased survival. The EMCC provides a response with first responders, ambulances, physician manned units and potentially other health care providers. EMCC in many cases initiates the communication with experts in the referral hospital and provide added value to the post resuscitation care by providing advanced transport, logistics and follow up. In research there is a growing focus on the EMCC/EMDs impact on survival in OHCA. The lack of standards in reporting results from medical dispatching is an obstacle for thorough evaluation of results in this area and comparison of data. The objective for this paper is to introduce a framework for uniform reporting of the dispatching process for quality improvement, collecting and reporting data and exchanging information regarding OHCA.

  • 36. Castrén, M.
    et al.
    Karlsten, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Lippert, F.
    Christensen, E. F.
    Bovim, E.
    Kvam, A. M.
    Robertson-Steel, I.
    Overton, J.
    Kraft, T.
    Engerström, L.
    Garcia-Castrill Riego, L.
    Recommended guidelines for reporting on emergency medical dispatch when conducting research in emergency medicine: The Utstein style2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 79, no 2, p. 193-197Article in journal (Refereed)
    Abstract [en]

    Objectives: To establish a uniform framework describing the system and organisation of emergency medical response centres and the process of emergency medical dispatching (EMD) when reporting results from studies in emergency medicine and prehospital care. Design and results: In September 2005 a task force of 22 experts from 12 countries met in Stavanger; Norway at the Utstein Abbey to review data and establish a common terminology for medical dispatch centres including core and optional data to be used for health monitoring, benchmarking and future research.

  • 37.
    Claesson, A.
    et al.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Djarv, T.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Nordberg, P.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Ringh, M.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Hollenberg, J.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Axelsson, C.
    The Prehospital Research Centre, University College of Borås, Borås, Sweden.
    Ravn-Fischer, A.
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Medical versus non medical etiology in out-of-hospital cardiac arrest—Changes in outcome in relation to the revised Utstein template2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55Article in journal (Refereed)
    Abstract [en]

    Introduction The Utstein-style recommendations for reporting etiology and outcome in out-of-hospital cardiac arrest (OHCA) from 2004 have recently been revised. Among other etiologies a medical category is now introduced, replacing the cardiac category from Utstein template 2004. Aim The aim of this study is to describe characteristics and temporal trends from reporting OHCA etiology according to the revised Utstein template 2014 in regards to patient characteristics and 30-day survival rates. Methods This registry study is based on consecutive OHCA cases reported from the Emergency medical services (EMS) to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) 1992–2014. Characteristics, including a presumed cardiac etiology in Utstein template 2004, were transcribed to a medical etiology in Utstein template 2014. Results Of a total of n = 70,846 cases, 92% were categorized as having a medical etiology and 8% as having a non-medical cause. Using the new classifications, the 30-day survival rate has significantly increased over a 20-year period from 4.7% to 11.0% in the medical group and from 3% to 9.9% in the non-medical group (p ≤ 0.001). Trauma was the most common cause in OHCA of a non-medical etiology (26%) with a 30-day survival rate of 3.4% whilst drowning and drug overdose had the highest survival rates (14% and 10% respectively). Conclusion Based on Utstein 2014 categories of etiology, overall survival after OHCA with a medical etiology has more than doubled in a 20-year period and tripled for non-medical cases. Patients with a medical etiology found in a shockable rhythm have the highest chance of survival. There is great variability in characteristics among non-medical cases.

  • 38. Claesson, A
    et al.
    Lindqvist, J
    Herlitz, J
    University of Borås, School of Health Science.
    Cardiac arrest due to drowning-changes over time and factors of importance for survival2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 5, p. 644-648Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. METHOD: Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n=529. The data were clustered into three seven-year intervals for comparisons of changes over time. RESULTS: There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992-1998, versus 74% in interval 2006-2012 (p=0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p=0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place-home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival. CONCLUSION: In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month.

  • 39. Claesson, Andreas
    et al.
    Djärv, Therese
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nordberg, Pär
    Ring, Mattias
    Hollenberg, Jacob
    Ravn-Fischer, Annika
    Strömsöe, Annelie
    Medical versus non medical etiology in out-of-hospital cardiac arrest-Changes in outcome in relation to the revised Utstein template.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    The Utstein-style recommendations for reporting etiology and outcome in out-of-hospital cardiac arrest (OHCA) from 2004 have recently been revised. Among other etiologies a medical category is now introduced, replacing the cardiac category from Utstein template 2004.

    AIM:

    The aim of this study is to describe characteristics and temporal trends from reporting OHCA etiology according to the revised Utstein template 2014 in regards to patient characteristics and 30-day survival rates.

    METHODS:

    This registry study is based on consecutive OHCA cases reported from the Emergency medical services (EMS) to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) 1992-2014. Characteristics, including a presumed cardiac etiology in Utstein template 2004, were transcribed to a medical etiology in Utstein template 2014.

    RESULTS:

    Of a total of n=70,846 cases, 92% were categorized as having a medical etiology and 8% as having a non-medical cause. Using the new classifications, the 30-day survival rate has significantly increased over a 20-year period from 4.7% to 11.0% in the medical group and from 3% to 9.9% in the non-medical group (p≤0.001). Trauma was the most common cause in OHCA of a non-medical etiology (26%) with a 30-day survival rate of 3.4% whilst drowning and drug overdose had the highest survival rates (14% and 10% respectively).

    CONCLUSION:

    Based on Utstein 2014 categories of etiology, overall survival after OHCA with a medical etiology has more than doubled in a 20-year period and tripled for non-medical cases. Patients with a medical etiology found in a shockable rhythm have the highest chance of survival. There is great variability in characteristics among non-medical cases.

  • 40. Claesson, Andreas
    et al.
    Djärv, Therese
    Norberg, Per
    Ring, Mattias
    Hollenberg, Jacob
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ravn-Fisher, Annica
    Stromsoe, Annelie
    Medicalversus non medical etiology in out-of-hospital cardiac arrest-Changes inoutcome in relation to the revised Utstein template2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The Utstein-style recommendations for reporting etiology and outcome in out-of-hospital cardiac arrest (OHCA) from 2004 have recently been revised. Among other etiologies a medical category is now introduced, replacing the cardiac category from Utstein template 2004. AIM: The aim of this study is to describe characteristics and temporal trends from reporting OHCA etiology according to the revised Utstein template 2014 in regards to patient characteristics and 30-day survival rates. METHODS: This registry study is based on consecutive OHCA cases reported from the Emergency medical services (EMS) to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) 1992-2014. Characteristics, including a presumed cardiac etiology in Utstein template 2004, were transcribed to a medical etiology in Utstein template 2014. RESULTS: Of a total of n=70,846 cases, 92% were categorized as having a medical etiology and 8% as having a non-medical cause. Using the new classifications, the 30-day survival rate has significantly increased over a 20-year period from 4.7% to 11.0% in the medical group and from 3% to 9.9% in the non-medical group (p</=0.001). Trauma was the most common cause in OHCA of a non-medical etiology (26%) with a 30-day survival rate of 3.4% whilst drowning and drug overdose had the highest survival rates (14% and 10% respectively). CONCLUSION: Based on Utstein 2014 categories of etiology, overall survival after OHCA with a medical etiology has more than doubled in a 20-year period and tripled for non-medical cases. Patients with a medical etiology found in a shockable rhythm have the highest chance of survival. There is great variability in characteristics among non-medical cases.

  • 41.
    Claesson, Andreas
    et al.
    University of Borås, School of Health Science.
    Lindqvist, J
    Ortenwall, P
    Herlitz, Johan
    University of Borås, School of Health Science.
    Characteristics of lifesaving from drowning as reported by the Swedish Fire and Rescue Services 1996-2010.2012In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, no 9, p. 1072-1077Article in journal (Refereed)
    Abstract [en]

    Aim We aimed to describe characteristics associated with rescue from drowning as reported by the Swedish Fire and Rescue Services (SFARS) and their association with survival from the Out of Hospital Cardiac Arrest (OHCA) registry. Method This retrospective study is based on the OHCA registry and the Swedish Civil Contingencies Agency (SCCA) registry. All emergency calls (1996–2010) where the SFARS were dispatched were included (n = 7175). For analysis of survival, OHCAs that matched events from the SCCA registry were included (n = 250). Results Calls to lakes and ponds were predominant (35% of all calls reported). Rescues were more likely in cold water, <10 °C (45%), in open water (80%) and in April–September (68%). Median delay from a call to arrival of rescue services was 8 min, while it was 9 min for rescue diving units. Of all OHCA cases, the victim was found at the surface in 47% and underwater in 38%. In events where rescue divers were used, victims were significantly younger than in non-diving cardiac arrests and the mean diving depth was 6.3 ± 5.8 m. Overall survival to one month was 5.6% (13% in diving and 4.7% in non-diving cases; p = 0.07). Conclusion In half of more than 7000 drowning-related calls to the SFARS during 15 years of practice, water rescue was needed. In all treated OHCA cases, the majority were found at the surface. Only in a small percentage did rescue diving take place. In these cases, survival did not appear to be poorer than in non-diving cases.

  • 42. Claesson, Andreas
    et al.
    Svensson, Leif
    Silfverstolpe, J
    Herlitz, Johan
    Characteristics and outcome among patients suffering out of hospital cardiac arrest due to drowning2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, no 3, p. 381-387Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.

  • 43.
    Claesson, Andreas
    et al.
    [external].
    Svensson, Leif
    Silfverstolpe, Johan
    Herlitz, Johan
    [external].
    Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning.2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, no 3, p. 381-387Article in journal (Refereed)
    Abstract [en]

    Abstract AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.

  • 44.
    Covaciu, Lucian
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Allers, M.
    Enblad, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Lunderquist, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wieloch, T.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Intranasal selective brain cooling in pigs2008In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, no 1, p. 83-88Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Special clinical situations where general hypothermia cannot be recommended but can be a useful treatment demand a new approach, selective brain cooling. The purpose of this study was to selectively cool the brain with cold saline circulating in balloon catheters introduced into the nasal cavity in pigs. MATERIAL AND METHODS: Twelve anaesthetised pigs were subjected to selective cerebral cooling for a period of 6 h. Cerebral temperature was lowered by means of bilaterally introduced nasal balloon catheters perfused with saline cooled by a heat exchanger to 8-10 degrees C. Brain temperature was measured in both cerebral hemispheres. Body temperature was measured in rectum, oesophagus and the right atrium. The pigs were normoventilated and haemodynamic variables were measured continuously. Acid-base and electrolyte status was measured hourly. RESULTS: Cerebral hypothermia was induced rapidly and within the first 20 min of cooling cerebral temperature was lowered from 38.1+/-0.6 degrees C by a mean of 2.8+/-0.6 to 35.3+/-0.6 degrees C. Cooling was maintained for 6 h and the final brain temperature was 34.7+/-0.9 degrees C. Concomitantly, the body temperature, as reflected by oesophageal temperature was decreased from 38.3+/-0.5 to 36.6+/-0.9 degrees C. No circulatory or metabolic disturbances were noted. CONCLUSIONS: Inducing selective brain hypothermia with cold saline via nasal balloon catheters can effectively be accomplished in pigs, with no major disturbances in systemic circulation or physiological variables. The temperature gradients between brain and body can be maintained for at least 6 h.

  • 45. Cronberg, Tobias
    et al.
    Brizzi, Marco
    Liedholm, Lars Johan
    Rosén, Ingmar
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rylander, Christian
    Friberg, Hans
    Neurological prognostication after cardiac arrest: Recommendations from the Swedish Resuscitation Council2013In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 7, p. 867-872Article in journal (Refereed)
    Abstract [en]

    Cardiopulmonary resuscitation is started in 5000 victims of out-of-hospital cardiac arrest in Sweden each year and the survival rate is approximately 10%. The subsequent development of a global ischaemic brain injury is the major determinant of the neurological prognosis for those patients who reach the hospital alive. Induced hypothermia is a recommended treatment after cardiac arrest and has been implemented in most Swedish hospitals.

    Recent studies indicate that induced hypothermia may affect neurological prognostication and previous international recommendations are therefore no longer valid when hypothermia is applied. An expert group from the Swedish Resuscitation Council has reviewed the literature and made recommendations taking into account the effects of induced hypothermia and concomitant sedation.

    A delayed neurological evaluation at 72h after rewarming is recommended for hypothermia treated patients. This evaluation should be based on several independent methods and the possibility of lingering pharmacological effects should be considered.

  • 46.
    Druwé, Patrick
    et al.
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Monsieurs, Koenraad G.
    Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium.
    Piers, Ruth
    Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
    Gagg, James
    Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom.
    Nakahara, Shinji
    Teikyo University School of Medicine, Tokyo, Japan.
    Alpert, Evan Avraham
    Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
    van Schuppen, Hans
    Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Élö, Gabor
    Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
    Truhlar, Anatolij
    Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic.
    Huybrechts, Sofie A.
    Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium.
    Mpotos, Nicolas
    Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium..
    Joly, Luc-Marie
    Department of Emergency Medicine, Rouen University Hospital, Rouen, France.
    Xanthos, Theodoros
    European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
    Roessler, Markus
    Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany.
    Paal, Peter
    Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria.
    Cocchi, Michael N.
    Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, United States.
    Björshol, Conrad
    Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Norway.
    Paulikova, Monika
    Department of Anesthesiology and Intensive Care, East Slovak Institute of Oncology, Košice, Slovakia.
    Nurmi, Jouni
    Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
    Salmeron, Pascual Pinera
    Hospital General Universitario Reina Sofia, Murcia, Spain.
    Owczuk, Radoslaw
    Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland.
    Svavarsdottir, Hildigunnur
    Akureyri Hospital and University of Akureyri, Akureyri, Iceland.
    Deasy, Conor
    Department of Emergency Medicine, Cork University Hospital, Cork, Ireland.
    Cimpoesu, Diana
    University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania.
    Ioannides, Marios
    Nicosia General Hospital, Nicosia, Cyprus.
    Aguilera Fuenzalida, Pablo
    Pontificia Universidad Católica de Chile, Santiago, Chile.
    Kurland, Lisa
    Örebro University, School of Medical Sciences. Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden.
    Raffay, Violetta
    Municipal Institute for Emergency Medicine, Novi Sad, Serbia.
    Pachys, Gal
    Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
    Gadeyne, Bram
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Steen, Johan
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Vansteelandt, Stijn
    Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    De Paepe, Peter
    Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.
    Benoit, Dominique D.
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 112-119Article in journal (Refereed)
    Abstract [en]

    Introduction: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome.

    Methods: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models.

    Results: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients > 79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26 - 0.41]; P < 0.0001 and 0.25 [0.15 - 0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14 - 0.44]; P < 0.0001 for patients > 79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P < 0.0001).

    Conclusions: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.

  • 47. Dyson, Kylie
    et al.
    Brown, Siobhan P
    May, Susanne
    Smith, Karen
    Koster, Rudolph W
    Beesems, Stefanie G
    Kuisma, Markku
    Salo, Ari
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Nichol, Graham
    International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein template2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 138, p. 168-181Article in journal (Refereed)
    Abstract [en]

    Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival.

    Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232).

    Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85–0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival.

    Conclusions: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

  • 48. Ekström, L
    et al.
    Herlitz, Johan
    [external].
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Survival after cardiac arrest outside hospital over a 12-year period in Göteborg1994In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 27, no 3, p. 181-187Article in journal (Refereed)
    Abstract [en]

    Background: A two-tiered ambulance system with a mobile coronary care unit and standard ambulance has operated in Gothenburg (population 434 000) since 1980. Mass education in cardiopulmonary resuscitation (CPR) commenced in 1985 and in 1988 semiautomatic defibrillators were introduced. Aim: To describe early and late survival after cardiac arrest outside hospital over a 12-year period. Target population: All patients with prehospital cardiac arrest in Gothenburg reached by mobile coronary care unit or standard ambulance between 1980 and 1992. Results: The number of patients with cardiac arrest remained fairly steady over time. Among patients with witnessed ventricular fibrillation, the time to defibrillation decreased over time. The proportion of patients in whom bystander initiated CPR was increased only moderately over time. The proportion of patients given medication such as lignocaine and adrenaline successively increased. The number of patients with cardiac arrest who were discharged from hospital per year remained steady between 1981 and 1990 (20 per year), but increased during 1991 and 1992 to 41 and 31 respectively. Conclusions: Improvements in the emergency medical service in Gothenburg over a 12-year period have lead to: (1) a shortened delay time between cardiac arrest and first defibrillation and (2) an improved survival of patients with cardiac arrest outside hospital probably explained by this shortened delay time.

  • 49. Ekström, L
    et al.
    Wennerblom, B
    Herlitz, Johan
    [external].
    Axelsson, Å
    Bång, A
    [external].
    Holmberg, S
    Hospital mortality after out of hospital cardiac arrest among patients found in ventricular fibrillation1995In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, no 1, p. 11-21Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe factors associated with in-hospital mortality among patients being hospitalised after out-of-hospital cardiac arrest and who were found in ventricular fibrillation. The study was set in the community of Göteborg, Sweden. The subjects consisted of all patients who were hospitalised alive after out-of-hospital cardiac arrest, being reached by our mobile coronary care unit and who were found in ventricular fibrillation, between 1981 and 1992. In all, 488 patients fulfilled the inclusion criteria of which 262 (54%) died during initial hospitalization. In a multivariate analysis including age, sex, history of cardiovascular disease, chronic medication prior to arrest and circumstances at the time of arrest, the following appeared as independent predictors of hospital mortality: (1) interval between collapse and first defibrillation (P < 0.001); (2) on chronic medication with diuretics (P < 0.01); (3) age (P < 0.01); (4) bystander initiated CPR (P < 0.05); and (5) a history of diabetes (P < 0.05). In a multivariate analysis considering various aspects of status on admission to hospital, the following were independently associated with death: (1) degree of consciousness (P < 0.001) and (2) systolic blood pressure (P < 0.05). In conclusion, among patients with out of hospital cardiac arrest found in ventricular fibrillation and being hospitalised alive, 54% died in hospital. The in-hospital mortality was related to patient characteristics before the cardiac arrest as well as to factors at the resuscitation itself.

  • 50.
    Elfwen, Ludvig
    et al.
    Karolinska Inst, Soder Sjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.
    Lagedal, Rickard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nordberg, Per
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Bohm, Felix
    Karolinska Inst, Karolinska Univ Hosp, Dept Med, Div Cardiol, Stockholm, Sweden.
    Lundgren, Peter
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden;Univ Boras, Prehospen Ctr Prehosp Res, Boras, Sweden.
    Rylander, Christian
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Anaesthesiol & Intens Care Med, Gothenburg, Sweden.
    van der Linden, Jan
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Hollenberg, Jacob
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    Erlinge, David
    Lund Univ, Clin Sci, Dept Cardiol, Lund, Sweden.
    Cronberg, Tobias
    Lund Univ, Skane Univ Hosp, Dept Clin Sci, Div Neurol, Lund, Sweden.
    Jensen, Ulf
    Karolinska Inst, Soder Sjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.
    Friberg, Hans
    Lund Univ, Skane Univ Hosp, Dept Anesthesiol & Intens Care Med, Lund, Sweden.
    Lilja, Gisela
    Lund Univ, Skane Univ Hosp, Dept Clin Sci, Div Neurol, Lund, Sweden.
    Larsson, Ing-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wallin, Ewa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Svensson, Leif
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 139, p. 253-261Article in journal (Refereed)
    Abstract [en]

    Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151). Methods: Resuscitated bystander witnessed OHCA patients > 18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded. Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days. Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.

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