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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)30587210 (PubMedID)2-s2.0-85059236249 (Scopus ID)
Available from: 2018-12-28 Created: 2018-12-28 Last updated: 2019-01-14Bibliographically 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
Tärnqvist, J., Dahlén, E., Norberg, G., Magnusson, C., Herlitz, J., Strömsöe, A., . . . Andersson Hagiwara, M. (2017). On-scene and final assessments and their interrelationship among patients who use the EMS on multiple occasions. Prehospital and Disaster Medicine, 32(5), 528-535
Open this publication in new window or tab >>On-scene and final assessments and their interrelationship among patients who use the EMS on multiple occasions
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2017 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 5, p. 528-535Article in journal (Refereed) Published
Abstract [en]

Introduction: The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group. Problem: There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis. Method: Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records. Results: In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years. The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent). Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Conclusion:: Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate. 

Place, publisher, year, edition, pages
Cambridge University Press, 2017
Keywords
assessment, diagnosis, Emergency Medical Services, multiple use
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25047 (URN)10.1017/S1049023X17006458 (DOI)000417137600008 ()28478788 (PubMedID)2-s2.0-85018419799 (Scopus ID)
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2018-06-05Bibliographically approved
Strömsöe, A., Svensson, L., Axelsson, Å. B., Claesson, A., Göransson, K. E., Nordberg, P. & Herlitz, J. (2015). Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival. European Heart Journal, 36(14), 863-871
Open this publication in new window or tab >>Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival
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2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 14, p. 863-871Article in journal (Refereed) Published
Abstract [en]

Aims: To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation.

Methods and results: All cases of OHCA (n = 59 926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100 000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P< 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008–2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008–2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm.

Conclusion: From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome.

Place, publisher, year, edition, pages
Oxford University Press, 2015
Keywords
Cardiopulmonary resuscitation, Registries, Survival
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-14534 (URN)10.1093/eurheartj/ehu240 (DOI)000353541400009 ()
Available from: 2014-06-26 Created: 2014-06-26 Last updated: 2017-05-24Bibliographically approved
Gelberg, J., Strömsöe, A., Hollenberg, J., Radell, P., Claesson, A., Svensson, L. & Herlitz, J. (2015). Improving survival and neurologic function for younger age groups after out-of-hospital cardiac arrest in Sweden: a 20-year comparison. Pediatric Critical Care Medicine, 16(8), 750-757
Open this publication in new window or tab >>Improving survival and neurologic function for younger age groups after out-of-hospital cardiac arrest in Sweden: a 20-year comparison
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2015 (English)In: Pediatric Critical Care Medicine, ISSN 1529-7535, E-ISSN 1947-3893, Vol. 16, no 8, p. 750-757Article in journal (Refereed) Published
Abstract [en]

Objective: To describe changes in the epidemiology of out-of-hospital cardiac arrest in Sweden with the emphasis on the younger age groups.

Design: Prospective observational study. Setting: Sweden.

Patients: Patients were recruited from the Swedish Registry of Cardiopulmonary Resuscitation from 1990 to 2012. Only non-crew-witnessed cases were included.

Intervention: Cardiopulmonary resuscitation.

Measurement and Main Results: The endpoint was 30-day survival. Cerebral function among survivors was estimated according to the cerebral performance category scores. In all, 50,879 patients in the survey had an out-of-hospital cardiac arrest, of which 1,321 (2.6%) were 21 years old or younger and 1,543 (3.0%) were 22-35 years old. On the basis of results from 2011 and 2012, we estimated that there are 4.9 cases per 100,000 person-years in the age group 0-21 years. The highest survival was found in the 13- to 21-year age group (12.6%). Among patients 21 years old or younger, the following were associated with an increased chance of survival: increasing age, male gender, witnessed out-of-hospital cardiac arrest, ventricular-fibrillation, and a short emergency medical service response time. Among patients 21 years old or younger, there was an increase in survival from 6.2% in 1992-1998 to 14.0% in 2007-2012. Among 30-day survivors, 91% had a cerebral performance category score of 1 or 2 (good cerebral performance or moderate cerebral disability) at hospital discharge.

Conclusions: In Sweden, among patients 21 years old or younger, five out-of-hospital cardiac arrests per 100,000 person-years occur and survival in this patient group has more than doubled during the past two decades. The majority of survivors have good or relatively good cerebral function.

Keywords
children, out-of-hospital cardiac arrest, outcome
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21203 (URN)10.1097/PCC.0000000000000503 (DOI)000369708000016 ()26218255 (PubMedID)
Available from: 2016-03-04 Created: 2016-03-04 Last updated: 2017-05-24Bibliographically approved
Libungan, B., Lindqvist, J., Strömsöe, A., Nordberg, P., Hollenberg, J., Albertsson, P., . . . Herlitz, J. (2015). Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study. Resuscitation, 94, 28-32
Open this publication in new window or tab >>Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study
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2015 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94, p. 28-32Article in journal (Refereed) Published
Abstract [en]

Background: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA). Aim: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

Methods: OHCA patients >= 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and >= 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

Results: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

Conclusions: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age. 

Keywords
elderly, out-of-hospital cardiac arrest, survival
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-20312 (URN)10.1016/j.resuscitation.2015.05.031 (DOI)000363967900013 ()26073274 (PubMedID)
Available from: 2015-11-27 Created: 2015-11-27 Last updated: 2017-05-24Bibliographically approved
Herlitz, J., Svensson, L. & Strömsöe, A. (2015). Several factors affect the prognosis. Läkartidningen, 112
Open this publication in new window or tab >>Several factors affect the prognosis
2015 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Other academic) Published
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21623 (URN)2-s2.0-84969626538 (Scopus ID)
Available from: 2016-06-08 Created: 2016-06-08 Last updated: 2017-05-24Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6885-991x

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