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Gräsner, J.-T. -., Wnent, J., Herlitz, J., Perkins, G. D., Lefering, R., Tjelmeland, I., . . . Bossaert, L. (2020). Survival after out-of-hospital cardiac arrest in Europe: Results of the EuReCa TWO study. Resuscitation, 148, 218-226
Open this publication in new window or tab >>Survival after out-of-hospital cardiac arrest in Europe: Results of the EuReCa TWO study
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2020 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 148, p. 218-226Article in journal (Refereed) Published
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-32323 (URN)10.1016/j.resuscitation.2019.12.042 (DOI)000516837300028 ()2-s2.0-85079158573 (Scopus ID)
Available from: 2020-03-18 Created: 2020-03-18 Last updated: 2020-03-26Bibliographically approved
Dyson, K., Brown, S. P., May, S., Smith, K., Koster, R. W., Beesems, S. G., . . . Nichol, G. (2019). International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein template. Resuscitation, 138, 168-181
Open this publication in new window or tab >>International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein template
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 138, p. 168-181Article in journal (Refereed) Published
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.

Keywords
Emergency Medical Services, Out-of-hospital cardiac arrest, Outcomes, Survival, Utstein
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29759 (URN)10.1016/j.resuscitation.2019.03.018 (DOI)000466837400026 ()30898569 (PubMedID)2-s2.0-85063343143 (Scopus ID)
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-05-23Bibliographically approved
Frisk Torell, M., Strömsöe, A., Herlitz, J., Claesson, A., Svensson, L. & Börjesson, M. (2019). Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.. PLoS ONE, 14(2), Article ID e0211723.
Open this publication in new window or tab >>Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 2, article id e0211723Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas.

METHODS: Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs.

RESULTS: 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009).

CONCLUSION: The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.

National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29423 (URN)10.1371/journal.pone.0211723 (DOI)000457742900044 ()30707745 (PubMedID)2-s2.0-85060932603 (Scopus ID)
Available from: 2019-02-05 Created: 2019-02-05 Last updated: 2019-03-14Bibliographically approved
Masterson, S., Strömsöe, A., Cullinan, J., Deasy, C. & Vellinga, A. (2018). Apples to apples: can differences in out-of-hospital cardiac arrest incidence and outcomes between Sweden and Ireland be explained by core Utstein variables?. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), Article ID 37.
Open this publication in new window or tab >>Apples to apples: can differences in out-of-hospital cardiac arrest incidence and outcomes between Sweden and Ireland be explained by core Utstein variables?
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2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 37Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Variation in reported incidence and outcome based on aggregated data is a persistent feature of out-of-hospital cardiac arrest (OHCA) epidemiology.

OBJECTIVE: To investigate the extent to which patient-level analysis using core 'Utstein' variables explains inter-country variation between Sweden and the Republic of Ireland.

METHODS: A retrospective cross-sectional comparative study was performed, including all Swedish and Irish OHCA cases attended by Emergency Medical Services (EMS-attended OHCA) where resuscitation was attempted from 1st January 2012 to 31st December 2014. Incidence rates per 100,000 population were adjusted for age and gender. Two subgroups were extracted: (1) Utstein - adult patients, bystander-witnessed collapse, presumed medical aetiology, initial shockable rhythm and (2) Emergency Medical Service (EMS)-witnessed events. Multivariable logistic regression analysis was used to identify predictors of survival following multiple imputations of data.

RESULTS: Five thousand eight hundred eighty six Irish and 15,303 Swedish patients were included. Swedish patients were older than Irish patients (median age 71 vs. 66 years respectively). Adjusted incidence was significantly higher in Sweden compared to the Republic of Ireland (52.9 vs. 43.1 per 100,000 population per year). Proportionate survival in Sweden was greater for both subgroups and all age categories. Regression analysis of the Utstein subgroup predicted approximately 17% of variation in outcome, but there was a large unexplained 'country effect' for survival in favour of Sweden (OR 4.40 (95% CI 2.55-7.56)).

CONCLUSIONS: Using patient level data, a proportion of inter-country variation was explained, but substantial variation was not explained by the core Utstein variables. Researchers and policy makers should be aware of the potential for unmeasured differences when comparing OHCA incidence and outcomes between countries.

Keywords
Out-of-hospital cardiac arrest, Utstein, incidence, outcomes, pre-hospital resuscitation
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27645 (URN)10.1186/s13049-018-0505-2 (DOI)000431331200001 ()29724238 (PubMedID)2-s2.0-85046482045 (Scopus ID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-05-21Bibliographically approved
Hessulf, F., Karlsson, T., Lundgren, P., Aune, S., Strömsöe, A., Södersved Källestedt, M.-L. -., . . . Engdahl, J. (2018). Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - A population-based register study of more than 18,000 cases. International Journal of Cardiology, 255, 237-242
Open this publication in new window or tab >>Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - A population-based register study of more than 18,000 cases
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 255, p. 237-242Article in journal (Refereed) Published
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26923 (URN)10.1016/j.ijcard.2017.12.068 (DOI)000424516200049 ()2-s2.0-85039155449 (Scopus ID)
Available from: 2018-01-09 Created: 2018-01-09 Last updated: 2018-02-22Bibliographically approved
Magnusson, C., Axelsson, C., Nilsson, L., Strömsöe, A., Munters, M., Herlitz, J. & Andersson Hagiwara, M. (2018). The final assessment and its association with field assessment in patients who were transported by the emergency medical service. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), Article ID 111.
Open this publication in new window or tab >>The final assessment and its association with field assessment in patients who were transported by the emergency medical service
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2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 111Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.

AIM: In a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.

METHODS: Thirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age < 18 years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.

RESULTS: In all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.

CONCLUSION: Among patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.

Keywords
Assessment, Diagnose, Prehospital
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29223 (URN)10.1186/s13049-018-0579-x (DOI)000454440000002 ()30587210 (PubMedID)2-s2.0-85059236249 (Scopus ID)
Available from: 2018-12-28 Created: 2018-12-28 Last updated: 2020-03-04Bibliographically approved
Djarv, T., Axelsson, C., Herlitz, J., Strömsöe, A., Israelsson, J. & Claesson, A. (2018). Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), Article ID 30.
Open this publication in new window or tab >>Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.
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2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA).

METHODS: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used.

RESULTS: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p < 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively).

DISCUSSION: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR.

CONCLUSION: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

Keywords
OHCA, Prevalence, Resuscitation, TCA, Trauma
National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-31444 (URN)10.1186/s13049-018-0500-7 (DOI)29685180 (PubMedID)
Available from: 2019-12-22 Created: 2019-12-22 Last updated: 2020-01-02Bibliographically approved
Al-Dury, N., Rawshani, A., Israelsson, J., Strömsöe, A., Aune, S., Agerström, J., . . . Herlitz, J. (2017). Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.. American Journal of Emergency Medicine, 35(12), 1839-1844, Article ID S0735-6757(17)30451-5.
Open this publication in new window or tab >>Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.
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2017 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 12, p. 1839-1844, article id S0735-6757(17)30451-5Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

Keywords
Cardiac arrest, Cardiopulmonary resuscitation
National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-31445 (URN)10.1016/j.ajem.2017.06.012 (DOI)28624147 (PubMedID)
Available from: 2019-12-22 Created: 2019-12-22 Last updated: 2020-01-02Bibliographically approved
Torell, M. F., Strömsöe, A., Zagerholm, E., Herlitz, J., Claesson, A., Svensson, L. & Börjesson, M. (2017). Higher survival rates in exercise-related out-of-hospital cardiac arrests, compared to non-exercise-related - a study from the Swedish Register of Cardiopulmonary Resuscitation. European Journal of Preventive Cardiology, 24(15), 1673-1679
Open this publication in new window or tab >>Higher survival rates in exercise-related out-of-hospital cardiac arrests, compared to non-exercise-related - a study from the Swedish Register of Cardiopulmonary Resuscitation
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 15, p. 1673-1679Article in journal (Refereed) Published
Abstract [en]

Background: Despite the positive effects of physical activity, the risk of sudden cardiac arrest is transiently increased during and immediately after exercise. The purpose of this study was to assess the incidence of exercise-related out-of-hospital cardiac arrest in the general population and to compare characteristics and prognosis of these cardiac arrests with non-exercise-related out-of-hospital cardiac arrests.

Methods: Data from all cases of treated out-of-hospital cardiac arrest outside of home reported to the Swedish Register of Cardiopulmonary Resuscitation from 2011-2015 in three counties of Sweden were investigated (population 2.1 m). This registry captures almost 100% of all out-of-hospital cardiac arrests in Sweden. Results Of 1825 out-of hospital cardiac arrests, 137 (7.5%) were exercise-related, resulting in an incidence of 1.2 per 100,000 person-years. The 30-day survival rate was significantly higher among exercise-related out-of hospital cardiac arrests compared to non-exercise-related out-of-hospital cardiac arrests (54.3 % vs 19.4%, p < 0.0001). Patients suffering an exercise-related out-of-hospital cardiac arrest were on average 10 years younger than those who had a non-exercise-related out-of-hospital cardiac arrest, 56.4 years compared to 67.2 years. Exercise-related out-of-hospital cardiac arrests were more often witnessed (89.4% vs 78.6%, p = 0.002), had higher rates of bystander cardiopulmonary resuscitation (80.3% vs 61.0%, p < 0.0001) and were more frequently connected to an automated external defibrillator (20.4% vs 4.6%, p < 0.0001).

Conclusions: Cardiac arrests that occur in relation to exercise have a significantly better prognosis and outcome than non-exercise-related cardiac arrests. This may be explained by favourable circumstances but may also reflect that these persons experience a sudden cardiac arrest at a lower degree of coronary artery disease, due to their younger age and to exercise being a trigger.

Keywords
Sudden cardiac death, exercise, resuscitation, sports, sudden cardiac arrest, survival
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25970 (URN)10.1177/2047487317729251 (DOI)000413162000016 ()28870144 (PubMedID)2-s2.0-85031703982 (Scopus ID)
Available from: 2017-09-07 Created: 2017-09-07 Last updated: 2017-11-20Bibliographically approved
Claesson, A., Djarv, T., Nordberg, P., Ringh, M., Hollenberg, J., Axelsson, C., . . . Strömsöe, A. (2017). Medical versus non medical etiology in out-of-hospital cardiac arrest-Changes in outcome in relation to the revised Utstein template.. Resuscitation, 110, 48-55, Article ID S0300-9572(16)30522-6.
Open this publication in new window or tab >>Medical versus non medical etiology in out-of-hospital cardiac arrest-Changes in outcome in relation to the revised Utstein template.
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2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55, article id S0300-9572(16)30522-6Article in journal (Refereed) Published
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.

Keywords
CPR, EMS, Etiology, OHCA, Template, Utstein
National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-31446 (URN)10.1016/j.resuscitation.2016.10.019 (DOI)27826118 (PubMedID)
Available from: 2019-12-22 Created: 2019-12-22 Last updated: 2020-01-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6885-991x

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