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Silverplats, J., Södersved Källestedt, M.-L., Äng, B. & Strömsöe, A. (2024). Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards. Resuscitation, Article ID 110125.
Open this publication in new window or tab >>Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards
2024 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, article id 110125Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Adherence to cardiopulmonary resuscitation (CPR) guidelines in treatment of in-hospital cardiac arrest (IHCA) have been associated with favourable patient outcome. The aim of this study was to evaluate if compliance with initial CPR guidelines and patient outcome of witnessed IHCA events were associated with the place of arrest defined as monitored versus non-monitored ward.

METHODS: A total of 956 witnessed IHCA events in adult patients at six hospitals during 2018 to 2019, were extracted from the Swedish Registry of Cardiopulmonary Resuscitation. Initial CPR guidelines were: ≤ 1 min from collapse to alert of the rapid response team, ≤ 1 min from collapse to start of CPR, ≤ 3 min from collapse to defibrillation of shockable rhythm.

RESULTS: The odds of compliance with guidelines was higher on monitored wards vs non-monitored wards, even after adjustment for factors that could affect staffing and resources. The place of arrest was not a significant factor for sustained return of spontaneous circulation, survival at 30 days, or neurological status at discharge, when adjusting for clinically relevant confounders. Compliance with initial CPR guidelines remained a significant factor for survival to 30 days and favourable neurological outcome at discharge regardless of other confounders.

CONCLUSION: Compliance with initial CPR guidelines was higher in witnessed IHCA events on monitored wards than on non-monitored wards, which indicates that healthcare professionals in monitored wards are quicker to recognize a cardiac arrest and initiate treatment. When initial CPR guidelines are followed, the place of arrest does not influence patient outcome.

Keywords
compliance, in-hospital cardiac arrest, monitored areas, resuscitation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-47962 (URN)10.1016/j.resuscitation.2024.110125 (DOI)38272386 (PubMedID)2-s2.0-85183987359 (Scopus ID)
Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2024-02-13Bibliographically approved
Silverplats, J., Äng, B., Södersved Källestedt, M.-L. & Strömsöe, A. (2024). Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry – a comparison of reported and non-reported events. Resuscitation, 195, Article ID 110119.
Open this publication in new window or tab >>Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry – a comparison of reported and non-reported events
2024 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 195, article id 110119Article in journal (Refereed) Published
Abstract [en]

Background: Approximately 2,500 in-hospital cardiac arrest (IHCA) events are reported annually to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) with an estimated incidence of 1.7/1,000 hospital admissions. The aim of this study was to evaluate the compliance in reporting IHCA events to the SRCR and to compare reported IHCA events with possible non-reported events, and to estimate IHCA incidence.

Methods: Fifteen diagnose codes, eight Classification of Care Measure codes, and two perioperative complication codes were used to find all treated IHCAs in 2018-2019 at six hospitals of varying sizes and resources. All identified IHCA events were cross-checked against the SRCR using personal identity numbers. All non-reported IHCA events were retrospectively reported and compared with the prospectively reported events.

Results: A total of 3,638 hospital medical records were reviewed and 1,109 IHCA events in 999 patients were identified, with 254 of the events not found in the SRCR. The case completeness was 77% (range 55-94%). IHCA incidence was 2.9/1,000 hospital admissions and 12.4/1,000 admissions to intensive care units. The retrospectively reported events were more often found on monitored wards, involved patients who were younger, had less comorbidity, were often found in shockable rhythm and more often achieved sustained spontaneous circulation, compared with in prospectively reported events.

Conclusion: IHCA case completeness in the SRCR was 77% and IHCA incidence was 2.9/1,000 hospital admissions. The retrospectively reported IHCA events were found in monitored areas where the rapid response team was not alerted, which might have affected regular reporting procedures.

Keywords
cardiac arrest; cardiopulmonary resuscitation; do not resuscitate order; hospitals; incidence; registries
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-47889 (URN)10.1016/j.resuscitation.2024.110119 (DOI)38244762 (PubMedID)2-s2.0-85184015947 (Scopus ID)
Available from: 2024-01-19 Created: 2024-01-19 Last updated: 2024-02-19Bibliographically approved
Borneskog, C., Engström, G., Islam, N., Byrskog, U., Pedersen, C., Strömsöe, A., . . . MSc student group, . (2023). Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh. Sexual & Reproductive HealthCare, 37, Article ID 100861.
Open this publication in new window or tab >>Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh
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2023 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100861Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Objective Structured Clinical Assessment (OSCA) is a way of evaluating students or clinicians in how they are carrying out their duties. The aim of this study was to examine how midwifery educators in Bangladesh perceived using OSCA as an assessment device in midwifery education for student performance in life-saving midwifery interventions.

METHOD: Individual interviews were conducted with 47 academic midwives and clinical midwives using purposive sampling at 38 education institutions in Bangladesh. Content analysis inspired by Elo and Kyngas was used to analyze the data.

RESULTS: The ability of students to perform effectively in the OSCA-evaluated simulation of life-saving skills was related to the educators' understanding of the concept of midwifery. The overarching main category of this study showed that for midwifery educators to be able to effectually teach professional, evidence-based midwifery, they need to be able to synthesize the delivery of practical and theoretical skills with pedagogical skills and knowledge. To implement the OSCA tool more effectively, midwifery educators need to understand the underpinning principles of midwifery values and philosophy including leadership, ownership, responsibility, and personal engagement.

CONCLUSION: There is potential to improve the efficacy of using OSCA to deliver the teaching of life-saving skills. Team sessions with midwives and physicians aiming to practice teamwork and role divisions in life-saving interventions are recommended.

Keywords
Life-saving skills, Midwifery, Objective Structured Clinical Assessment
National Category
Nursing
Identifiers
urn:nbn:se:du-46124 (URN)10.1016/j.srhc.2023.100861 (DOI)001013603600001 ()37267736 (PubMedID)2-s2.0-85160548744 (Scopus ID)
Note

MSc student group - Public nursing institute in Bangladesh (Farida Yeasmin, Rowshon Ara, Jakia Khatun, Mili Khatun, Najmur Nahar, Mafuja Akter, Touheda Khanam, Subarna Rani Talukder, Momtaz Begum, Ranjona Rani Roy, Munni Rani Dev, Sumina Mamtaz)

Available from: 2023-06-07 Created: 2023-06-07 Last updated: 2023-10-03Bibliographically approved
Jerkeman, M., Lundgren, P., Omerovic, E., Strömsöe, A., Riva, G., Hollenberg, J., . . . Rawshani, A. (2022). Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study.. Resuscitation Plus, 10, Article ID 100245.
Open this publication in new window or tab >>Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study.
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2022 (English)In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 10, article id 100245Article in journal (Refereed) Published
Abstract [en]

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

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

RESULTS: A total of 13,481 patients were included (5,293 with S-CPR and 8,188 with CO-CPR). The matched subgroup consisted of 2994 cases in each group.Gradient boosting were the best models with regards to predictive accuracy (for type of bystander CPR) and covariate balance. The difference between S-CPR and CO-CPR in all 30 models computed on covariate adjustment and 1-to-1 matching were non-significant. In the 30 weighted models, three comparisons (S-CPR vs. CO-CPR) were significant in terms of improved survival; odds ratio for men was 1.21 (99% confidence interval (CI) 1.02-1.43; Average treatment effect (ATE)); for patients ≥73 years 1.57 (99% CI 1.17-2.12) for Average treatment effect on treated (ATT) and 1.63 (99% CI 1.18-2.25) for ATE. Remaining 27 models showed no differences. No significances remain after adjustment for multiple testing.

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

Keywords
Cardiac arrest, Compression only CPR, OHCA
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-44959 (URN)10.1016/j.resplu.2022.100245 (DOI)35734307 (PubMedID)
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-01-02Bibliographically approved
Silverplats, J., Strömsöe, A., Äng, B. & Södersved Källestedt, M.-L. (2022). Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors: A survey among in-hospital healthcare professionals. PLOS ONE, 17(7), Article ID e0271686.
Open this publication in new window or tab >>Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors: A survey among in-hospital healthcare professionals
2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 7, article id e0271686Article in journal (Refereed) Published
Abstract [en]

Introduction Attitudes towards cardiopulmonary resuscitation (CPR) among in-hospital healthcare professionals (HCPs) are poorly understood. The aim of this study was to evaluate attitudes towards CPR situations among in-hospital HCPs and assess associations with potential influencing factors. Materials and methods A questionnaire was distributed to 3,085 HCPs in 2009 and 2,970 HCPs in 2015–2016. The associations of influencing factors were analyzed using binary logistic regression. Results In the event of a possible cardiac arrest situation, 61% of the HCPs would feel confident in their CPR knowledge, 86% would know what to do, and 60% would be able to take command if necessary. In the latest real-life CPR situation, 30% had been worried about making mistakes or causing complications, 57% had been stressed, and 27% had been anxious. A short time since the latest real-life CPR performance and a high number of previous real-life CPR performances were associated with lower odds of worrying about making mistakes/causing complications, lower odds of feeling stressed or anxious, and higher odds of feeling calm. Regardless of previous real-life CPR experience, there were differences in attitudes between groups of professions, where physicians showed increased odds of worrying about making mistakes/causing complications and nurses showed increased odds of stress. Working on a non-monitored ward meant increased odds of stress and worrying about making mistakes/causing complications. Twelve months or more having passed since the latest CPR training course was associated with increased odds of anxiety. Conclusions Despite HCPs’ generally positive attitudes towards performing CPR in the event of a possible cardiac arrest situation, feelings of stress and anxiety were common in real-life CPR situations. Regular CPR training among all HCPs is a key factor to maintain competence and reduce anxiety. The possible effects of attitudes on performing CPR need to be studied further.

National Category
Health Sciences
Identifiers
urn:nbn:se:du-42030 (URN)10.1371/journal.pone.0271686 (DOI)000944166200044 ()35839233 (PubMedID)2-s2.0-85134303533 (Scopus ID)
Available from: 2022-08-04 Created: 2022-08-04 Last updated: 2023-03-24Bibliographically approved
Frisk Torell, M., Strömsöe, A., Herlitz, J., Claesson, A., Rawshani, A. & Borjesson, M. (2022). Better outcomes from exercise-related out-of-hospital cardiac arrest in males and in the young: findings from the Swedish Registry of Cardiopulmonary Resuscitation. British Journal of Sports Medicine, 56(18), Article ID 105151.
Open this publication in new window or tab >>Better outcomes from exercise-related out-of-hospital cardiac arrest in males and in the young: findings from the Swedish Registry of Cardiopulmonary Resuscitation
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2022 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 56, no 18, article id 105151Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Survival from out-of-hospital cardiac arrest (OHCA) is higher if the arrest is witnessed and occurs during exercise, however, there is contradicting data on prognosis with regards to sex and age. The purpose of this study was to compare the outcomes and circumstances of exercise-related OHCA in different age groups and between sexes in a large unselected population.

METHODS: Data from exercise-related OHCAs reported to the Swedish Registry of Cardiopulmonary Resuscitation from 2011 to 2014 and from 2016 to 2018 were analysed. All cases of exercise-related OHCA in which emergency medical services attempted resuscitation were included. The primary outcome was survival to 30 days.

RESULTS: In total, 635 cases of exercise-related OHCA outside of the home were identified. The overall 30-day survival rate was 44.5% with highest survival rate in the age group 0-35 years, compared with 36-65 years and >65 years (59.6% vs 46.0% and 40.4%, p=0.01). A subgroup analysis of 0-25 years showed a survival rate of 68.8%. Exercise-related OHCA in females (9.1% of total) were witnessed to a lower extent (66.7% vs 79.6%, p=0.03) and median time to cardiopulmonary resuscitation (CPR) was longer (2.0 vs 1.0 min, p=0.001) than in males. Females also had lower rates of ventricular fibrillation (43.4% vs 64.7%, p=0.003) and a lower 30-day survival rate (29.3% vs 46.0%, p=0.02).

CONCLUSION: In exercise-related OHCA, younger victims have a higher survival rate. Exercise-related OHCA in females was rare, however, survival rates were lower compared with males and partly explained by a lower proportion of witnessed events, longer time to CPR and lower frequency of a shockable rhythm.

Keywords
AED, exercise, physical activity, resuscitation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-39635 (URN)10.1136/bjsports-2021-105151 (DOI)000759020100001 ()35184038 (PubMedID)2-s2.0-85142495917 (Scopus ID)
Available from: 2022-02-22 Created: 2022-02-22 Last updated: 2023-04-14Bibliographically approved
Stattin, E.-L., Hagström, E., Dahl, N., Strömsöe, A., Delgado-Vega, A. M., Klar, J., . . . Wisten, A. (2022). Cohort profile : the Swedish study of SUDden cardiac Death in the Young (SUDDY) 2000-2010: a complete nationwide cohort of SCDs. BMJ Open, 12(5), Article ID e055557.
Open this publication in new window or tab >>Cohort profile : the Swedish study of SUDden cardiac Death in the Young (SUDDY) 2000-2010: a complete nationwide cohort of SCDs
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 5, article id e055557Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The rationale behind the SUDden cardiac Death in the Young (SUDDY) cohort was to provide a complete nationwide, high-quality platform with integrated multisource data, for clinical and genetic research on sudden cardiac death (SCD) in the young, with the ultimate goal to predict and prevent SCD.

PARTICIPANTS: The cohort contains all SCD victims <36 years, in Sweden during the period 2000-2010. We assigned five population-based controls per case, together with parents of cases and controls, in total 15 633 individuals. Data of all individuals were extracted from multiple mandatory registries; the National Patient Registry, the Medical Birth Registry, the Prescribed Drug registry, the Cause of Death registry, the Multigeneration Registry, combined with socioeconomic data from Statistics Sweden. From SCD victims, the autopsy report, medical records, ECGs, parental information and biological samples were gathered.

FINDINGS TO DATE: We identified 903 individuals diagnosed with SCD (67% men, 33% women). The cases comprised 236 infants <1 year of age (26%), 90 individuals aged 1-15 years (10%), 186 individuals aged 15-25 years (21%) and 391 aged 25-35 years (43%). Hospitalisations and outpatient clinic visits due to syncope were significantly more common among cases than controls. DNA obtained from dried blood spots tests (DBS) stored from birth was equally suitable as venous blood samples for high-throughput genetic analysis of SCD cases.

FUTURE PLANS: We will explore the SUDDY cohort for symptoms and healthcare consumption, socioeconomic variables and family history of SCD. Furthermore, we will perform whole exome sequencing analysis on DNA of cases obtained from DBS or postmortem samples together with parental blood samples in search for gene variants associated with cardiac disease. The genetic analysis together with data compiled in the nationwide cohort is expected to improve current knowledge on the incidence, aetiology, clinical characteristics and family history of SCD.

Keywords
CARDIOLOGY, Cardiology, EPIDEMIOLOGY, FORENSIC MEDICINE, Forensic pathology, GENETICS
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-41446 (URN)10.1136/bmjopen-2021-055557 (DOI)000793953700011 ()35537790 (PubMedID)2-s2.0-85129999013 (Scopus ID)
Available from: 2022-05-17 Created: 2022-05-17 Last updated: 2023-08-28Bibliographically approved
Jerkeman, M., Sultanian, P., Lundgren, P., Nielsen, N., Helleryd, E., Dworeck, C., . . . Rawshani, A. (2022). Trends in survival after cardiac arrest: a Swedish nationwide study over 30 years. European Heart Journal, 43(46), 4817-4829
Open this publication in new window or tab >>Trends in survival after cardiac arrest: a Swedish nationwide study over 30 years
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2022 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, no 46, p. 4817-4829Article in journal (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-44960 (URN)10.1093/eurheartj/ehac414 (DOI)
Funder
Swedish Research Council
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-01-02
Jacobsen, A., Bremer, A., Svensson, A., Rantala, A., Strömsöe, A., Hörberg, A., . . . Lindström, V. (2021). Ambulanssjukvården behöver genomgripande förändringar. Dagens medicin: oberoende nyhetstidning för hela sjukvården, Article ID 2021-06-23.
Open this publication in new window or tab >>Ambulanssjukvården behöver genomgripande förändringar
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2021 (Swedish)In: Dagens medicin: oberoende nyhetstidning för hela sjukvården, ISSN 1402-1943, article id 2021-06-23Article in journal, News item (Other (popular science, discussion, etc.)) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:du-37503 (URN)
Available from: 2021-06-23 Created: 2021-06-23 Last updated: 2023-04-14Bibliographically approved
Sultanian, P., Lundgren, P., Strömsöe, A., Aune, S., Bergström, G., Hagberg, E., . . . Rawshani, A. (2021). Cardiac arrest in COVID-19: characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation.. European Heart Journal, 42(11), 1094-1106
Open this publication in new window or tab >>Cardiac arrest in COVID-19: characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation.
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2021 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 11, p. 1094-1106Article in journal (Refereed) Published
Abstract [en]

AIM: To study the characteristics and outcome among cardiac arrest cases with COVID-19 and differences between the pre-pandemic and the pandemic period in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA).

METHOD AND RESULTS: We included all patients reported to the Swedish Registry for Cardiopulmonary Resuscitation from 1 January to 20 July 2020. We defined 16 March 2020 as the start of the pandemic. We assessed overall and 30-day mortality using Cox regression and logistic regression, respectively. We studied 1946 cases of OHCA and 1080 cases of IHCA during the entire period. During the pandemic, 88 (10.0%) of OHCAs and 72 (16.1%) of IHCAs had ongoing COVID-19. With regards to OHCA during the pandemic, the odds ratio for 30-day mortality in COVID-19-positive cases, compared with COVID-19-negative cases, was 3.40 [95% confidence interval (CI) 1.31-11.64]; the corresponding hazard ratio was 1.45 (95% CI 1.13-1.85). Adjusted 30-day survival was 4.7% for patients with COVID-19, 9.8% for patients without COVID-19, and 7.6% in the pre-pandemic period. With regards to IHCA during the pandemic, the odds ratio for COVID-19-positive cases, compared with COVID-19-negative cases, was 2.27 (95% CI 1.27-4.24); the corresponding hazard ratio was 1.48 (95% CI 1.09-2.01). Adjusted 30-day survival was 23.1% in COVID-19-positive cases, 39.5% in patients without COVID-19, and 36.4% in the pre-pandemic period.

CONCLUSION: During the pandemic phase, COVID-19 was involved in at least 10% of all OHCAs and 16% of IHCAs, and, among COVID-19 cases, 30-day mortality was increased 3.4-fold in OHCA and 2.3-fold in IHCA.

Keywords
COVID-19, Cardiac arrest
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-44961 (URN)10.1093/eurheartj/ehaa1067 (DOI)33543259 (PubMedID)
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-01-02Bibliographically approved
Projects
Skillnader i mortalitet och sjuklighet hos patienter som drabbas av ett tidskritiskt tillstånd mellan mark- och luftburen ambulanssjukvård - en beskrivande och jämförande studieEuReCa – European Registries of cardiac arrestComparison of Swedish and Irish OHCA Incidence and Outcome – What are the Key Differences? Out-of-hospital cardiac arrest survival in international airportsPrehospital assessment – Primary Care and Emergency Department, County Council of DalarnaExercise-related out-of-hospital cardiac arrests
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6885-991x

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