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  • 1. Claesson, A
    et al.
    Djarv, T
    Nordberg, P
    Ringh, M
    Hollenberg, J
    Axelsson, C
    Ravn-Fischer, A
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Mälardalen University, Västerås.
    Medical versus non medical etiology in out-of-hospital cardiac arrest-Changes in outcome in relation to the revised Utstein template.2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55, article id S0300-9572(16)30522-6Article 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.

  • 2. 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.

  • 3. Gräsner, J. -T
    et al.
    Wnent, J.
    Herlitz, J.
    Perkins, G. D.
    Lefering, R.
    Tjelmeland, I.
    Koster, R. W.
    Masterson, S.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science. County Council of Dalarna, Falun; Centre for Clinical Research, Falun.
    Bossaert, L.
    Survival after out-of-hospital cardiac arrest in Europe: Results of the EuReCa TWO study2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 148, p. 218-226Article in journal (Refereed)
  • 4. Gräsner, Jan-Thorsten
    et al.
    Lefering, Rolf
    Koster, Rudolph W
    Masterson, Siobhán
    Böttiger, Bernd W
    Herlitz, Johan
    Wnent, Jan
    Tjelmeland, Ingvild B M
    Strömsöe, Anneli
    University Hospital Schleswig-Holstein, Dep. Anasthesiology, Kiel, Germany; University Hospital of Cologne, Germany.
    Bossaert, Leo L
    EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 105, p. 188-95, article id S0300-9572(16)30099-5Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.

    METHODS: This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.

    RESULTS: Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.

    CONCLUSION: The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe. EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.

  • 5.
    Libungan, Berglind
    et al.
    Sahlgrens university hospital.
    Lindqvist, Jonny
    Sahlgrens university hospital.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Nordberg, Per
    Karolinska institutet.
    Hollenberg, Jacob
    Karolinska institutet.
    Albertsson, Per
    Sahlgrens university hospital.
    Karlsson, Thomas
    Göteborgs universitet.
    Herlitz, Johan
    Högskolan Väst.
    Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94, p. 28-32Article in journal (Refereed)
    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. 

  • 6. Masterson, Siobhán
    et al.
    McNally, Bryan
    Cullinan, John
    Vellano, Kimberly
    Escutnaire, Joséphine
    Fitzpatrick, David
    Perkins, Gavin D
    Koster, Rudolph W
    Nakajima, Yuko
    Pemberton, Katherine
    Quinn, Martin
    Smith, Karen
    Jónsson, Bergþór Steinn
    Strömsöe, Anneli
    Mälardalens högskola.
    Tandan, Meera
    Vellinga, Akke
    Out-of-hospital cardiac arrest survival in international airports.2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 127, p. 58-62, article id S0300-9572(18)30134-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The highest achievable survival rate following out-of-hospital cardiac arrest is unknown. Data from airports serving international destinations (international airports) provide the opportunity to evaluate the success of pre-hospital resuscitation in a relatively controlled but real-life environment.

    METHODS: This retrospective cohort study included all cases of out-of-hospital cardiac arrest at international airports with resuscitation attempted between January 1st, 2013 and December 31st, 2015. Crude incidence, patient, event characteristics and survival to hospital discharge/survival to 30 days (survival) were calculated. Mixed effect logistic regression analyses were performed to identify predictors of survival. Variability in survival between airports/countries was quantified using the median odds ratio.

    RESULTS: There were 800 cases identified, with an average of 40 per airport. Incidence was 0.024/100,000 passengers per year. Percentage survival for all patients was 32%, and 58% for patients with an initial shockable heart rhythm. In adjusted analyses, initial shockable heart rhythm was the strongest predictor of survival (odds ratio, 36.7; 95% confidence interval [CI], 15.5-87.0). In the bystander-witnessed subgroup, delivery of a defibrillation shock by a bystander was a strong predictor of survival (odds ratio 4.8; 95% CI, 3.0-7.8). Grouping of cases was significant at country level and survival varied between countries.

    CONCLUSIONS: In international airports, 32% of patients survived an out-of-hospital cardiac arrest, substantially more than in the general population. Our analysis suggested similarity between airports within countries, but differences between countries. Systematic data collection and reporting are essential to ensure international airports continually maximise activities to increase survival.

  • 7. Nishiyama, Chika
    et al.
    Brown, Siobhan P.
    May, Susanne
    Iwami, Taku
    Koster, Rudolph W.
    Beesems, Stefanie G.
    Kuisma, Markku
    Salo, Ari
    Jacobs, Ian
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Apples to apples or apples to oranges?: International variation in reporting of process and outcome of care for out-of-hospital cardiac arrest2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 11, p. 1599-1609Article in journal (Refereed)
    Abstract [en]

    Objectives: Survival after out-of-hospital cardiac arrest (OHCA) varies between communities, due in part to variation in the methods of measurement. The Utstein template was disseminated to standardize comparisons of risk factors, quality of care, and outcomes in patients with OHCA. We sought to assess whether OHCA registries are able to collate common data using the Utstein template. A subsequent study will assess whether the Utstein factors explain differences in survival between emergency medical services (EMS) systems. Study design: Retrospective study.

    Setting: This retrospective analysis of prospective cohorts included adults treated for OHCA, regardless of the etiology of arrest. Data describing the baseline characteristics of patients, and the process and outcome of their care were grouped by EMS system, de-identified, and then collated. Included were core Utstein variables and timed event data from each participating registry. This study was classified as exempt from human subjects' research by a research ethics committee.

    Measurements and main results: Thirteen registries with 265 first-responding EMS agencies in 13 countries contributed data describing 125,840 cases of OHCA. Variation in inclusion criteria, definition, coding, and process of care variables were observed. Contributing registries collected 61.9% of recommended core variables and 42.9% of timed event variables. Among core variables, the proportion of missingness was mean 1.9 +/- 2.2%. The proportion of unknown was mean 4.8 +/- 6.4%. Among time variables, missingness was mean 9.0 +/- 6.3%.

    Conclusions: International differences in measurement of care after OHCA persist. Greater consistency would facilitate improved resuscitation care and comparison within and between communities.

  • 8.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Andersson, B.
    Ekstrom, L.
    Herlitz, J.
    Axelsson, A.
    Goransson, K. E.
    Svensson, L.
    Holmberg, S.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences2010In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, no 2, p. 211-216Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the use of cardiopulmonary resuscitation (CPR) training programmes in Sweden for 25 years and relate those to changes in the percentage of patients with out of hospital cardiac arrest (OHCA) who receive bystander CPR.

    Methods: Information was gathered from (a) the Swedish CPR training registry established in 1983 and includes most Swedish education programmes in CPR and (b) the Swedish Cardiac Arrest Register (SCAR) established in 1990 and currently covers about 70% of ambulance districts in Sweden.

    Results: CPR education in Sweden functions according to a cascade principle (instructor-trainers who train instructors who then train rescuers in CPR). Since 1989, 5000 instructor-trainers have taught more than 50,000 instructors who have taught nearly 2 million of Sweden's 9 million inhabitants adult CPR. This is equivalent to one new rescuer per 100 inhabitants every year in Sweden. In addition, since 1989, there are 51,000 new rescuers in Advanced Life Support (ALS), since 1996, 41,000 new Basic Life Support (BLS) rescuers with Automated External Defibrillation (AED) training, and since 1998, there are 93,000 new rescuers in child CPR. As a result of this CPR training the number of bystander CPR attempts for OHCA in Sweden increased from 31% in 1992 to 55% in 2007.

    Conclusion: By using a cascade principle for CPR education nearly 2 million rescuers were educated in Sweden (9 million inhabitants) between 1989 and 2007. This resulted in a marked increase in bystander CPR attempts. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

  • 9.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Sahlgrens Univ Hosp, Dept Metab & Cardiovasc Res, Inst Internal Med, SE-41345 Gothenburg, Sweden.
    Svensson, L.
    Axelsson, A. B.
    Goransson, K.
    Todorova, L.
    Herlitz, J.
    Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden2013In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 7, p. 952-956Article in journal (Refereed)
    Abstract [en]

    Aim: To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden. 

    Methods: Prospective and retrospective data for treated OHCA patients in Sweden, 2008-2010, were compared in the Swedish Cardiac Arrest Register. Data were investigated in three Swedish counties, which represented one third of the population. The recording models varied. Prospective data are those reported by the emergency medical service (EMS) crews, while retrospective data are those missed by the EMS crews but discovered afterwards by cross-checking with the local ambulance register. 

    Result: In 2008-2010, the number of prospectively (n = 2398) and retrospectively (n = 800) reported OHCA cases was n = 3198, which indicates a 25% missing rate. When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years vs. 67 years; p = 0.003). There was no difference between groups with regard to gender, time of day and year of OHCA, witnessed status or initial rhythm. Bystander cardiopulmonary resuscitation (CPR) was more frequent among patients who were reported prospectively (65% vs. 60%; p = 0.023), whereas survival to one month was higher among patients who were reported retrospectively (9.2% vs. 11.9%; p = 0.035). 

    Conclusion: Among 3198 cases of OHCA in three counties in Sweden, 800 (25%) were not reported prospectively by the EMS crews but were discovered retrospectively as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, having less frequently received bystander CPR but having a higher survival rate. Our data suggest that reports on OHCA from national quality registers which are based on prospectively recorded data may be influenced by selection bias. 

  • 10.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Svensson, L.
    Claesson, A.
    Lindkvist, J.
    Lundström, A.
    Herlitz, J.
    Association between population density and reported incidence, characteristics and outcome after out–of–hospital cardiac arrest in Sweden2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 10Article in journal (Refereed)
    Abstract [en]

    Aim. To describe the reported incidence of out of hospital cardiac arrest (OHCA) and the characteristics and outcome after OHCA in relation to population density in Sweden. Methods All patients participating in the Swedish Cardiac Arrest Register between 2008 and 2009 in (a) 20 of 21 regions (n = 6457) and in (b) 165 of 292 municipalities (n = 3522) in Sweden, took part in the survey.

    Results. The regional population density varied between 3 and 310 inhabitants per km2 in 2009. In 2008–2009, the number of reported cardiac arrests varied between 13 and 52 per 100,000 inhabitants and year. Survival to 1 month varied between 2% and 14% during the same period in different regions. With regard to population density, based on municipalities, bystander CPR (p = 0.04) as well as cardiac etiology (p = 0.002) were more frequent in less populated areas. Ambulance response time was longer in less populated areas (p < 0.0001). There was no significant association between population density and survival to 1 month after OHCA or incidence (adjusted for age and gender) of OHCA.

    Conclusion. There was no significant association between population density and survival to 1 month after OHCA or incidence (adjusted for age and gender) of OHCA. However, bystander CPR, cardiac etiology and longer response times were more frequent in less populated areas.

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