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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. 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
    Mälardalen University, Västerås.
    Bossaert, Leo L.
    Corrigendum to “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” [Resuscitation 105 (2016) 188–195]2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 109, p. 145-146Article in journal (Refereed)
  • 6.
    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. 

  • 7. 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.

  • 8. 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.

  • 9. Piscator, Eva
    et al.
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Bruchfeld, Samuel
    Hammar, Ulf
    el Gharbi, Sara
    Ebell, Mark
    Herlitz, Johan
    Djärv, Therese
    Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 128, p. 63-69Article in journal (Refereed)
    Abstract [en]

    A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting. The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013–2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot. The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78–0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival. The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

  • 10. Piscator, Eva
    et al.
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Forsberg, Sune
    Bottai, Matteo
    Ebell, Mark
    Herlitz, Johan
    Djärv, Therese
    Prearrest prediction of favourable neurological survival following in-hospital cardiac arrest: The Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, p. 92-99Article in journal (Refereed)
    Abstract [en]

    A prearrest prediction tool can aid clinicians in consolidating objective findings with clinical judgement and in balance with the values of the patient be a part of the decision process for do-not-attempt-resuscitation (DNAR) orders. A previous prearrest prediction tool for in-hospital cardiac arrest (IHCA) have not performed satisfactory in external validation in a Swedish cohort. Therefore our aim was to develop a prediction model for the Swedish setting. Model development was based on previous external validation of The Good Outcome Following Attempted Resuscitation (GO-FAR) score, with 717 adult IHCAs. It included redefinition and reduction of predictors, and addition of chronic comorbidity, to create a full model of 9 predictors. Outcome was favourable neurological survival defined as Cerebral Performance Category score 1–2  at discharge. The likelihood of favourable neurological survival was categorised into very low (<1%), low (1–3%) and above low (>3%). We called the model the Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score. The AUROC was 0.808 (95% CI 0.807–0.810) and calibration was satisfactory. With a cutoff of 3% likelihood of favourable neurological survival sensitivity was 99.4% and specificity 8.4%. Although specificity was limited, predictive value for classification into ≤3% likelihood of favorable neurological survival was high (97.4%) and false classification into ≤3% likelihood of favourable neurological survival was low (0.6%). The PIHCA score has the potential to be used as an objective tool in prearrest prediction of outcome after IHCA, as part of the decision process for a DNAR order.

  • 11. Piscator, Eva
    et al.
    Hedberg, Pontus
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Djärv, Therese
    Survival after in-hospital cardiac arrest highly associated to age-adjusted Charlson co-morbidity index a cohort study from a two-sited Swedish University hospital2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, p. 109-110Article in journal (Refereed)
  • 12. Piscator, Eva
    et al.
    Hedberg, Pontus
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Djärv, Therese
    Survival after in-hospital cardiac arrest is highly associated with the Age-combined Charlson Co-morbidity Index in a cohort study from a two-site Swedish University hospital2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 99, p. 79-83Article in journal (Refereed)
    Abstract [en]

    Abstract Background In-hospital cardiac arrest (IHCA) has a poor prognosis and clinicians often write “Do-Not-Attempt-Resuscitation” (DNAR) orders based on co-morbidities. Aim To assess the impact of the Age-combined Charlson Co-morbidity Index (ACCI) on 30-days survival after IHCA. Material and methods All patients suffering IHCA at Karolinska University Hospital between 1st January and 31st December 2014 were included. Data regarding patient characteristics, co-morbidities and survival were drawn from the electronic patient records. Co-morbidities were assessed prior to the IHCA as ICD-10 codes according to the ACCI. Differences in survival were assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI) between patients with an ACCI of 0–4 points versus those with 5–7 points, as well as those with ≥8 points. Adjustments included hospital site, heart rhythm, ECG surveillance, witnessed status and place of IHCA. Results In all, 174 patients suffered IHCA, of whom 41 (24%) survived at least 30 days. Patients with an ACCI of 5–7 points had a minor chance and those with an ACCI of ≥8 points had a minimal chance of surviving IHCA compared to those with an ACCI of 0–4 points (adjusted OR 0.10, 95% CI 0.04–0.26 and OR 0.04, 95% CI 0.03–0.42, respectively). Conclusion Patients with a moderate or severe burden of ACCI have a minor chance of surviving an IHCA. This information could be used as part of the decision tools during ongoing CPR, and could be an aid for clinicians in planning care and discussing DNAR orders.

  • 13.
    Silverplats, Jennie
    et al.
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Södersved Källestedt, Marie-Louise
    Äng, Björn
    Dalarna University, School of Health and Welfare, Medical Science. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge; Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun; Department of Prehospital Care, Region Dalarna, Falun.
    Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards2024In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, article id 110125Article in journal (Refereed)
    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.

  • 14.
    Silverplats, Jennie
    et al.
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Anaesthesiology and Intensive Care, Region Dalarna, Mora.
    Äng, Björn
    Dalarna University, School of Health and Welfare, Medical Science. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Center for Clinical Research Dalarna, Uppsala University, Falun.
    Södersved Källestedt, Marie-Louise
    Centre for Clinical Research Västmanland, Uppsala University, Västerås; Mälardalen University.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Falun; Department of Prehospital Care, Region Dalarna, Falun.
    Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry – a comparison of reported and non-reported events2024In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 195, article id 110119Article in journal (Refereed)
    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.

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  • 15.
    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.

  • 16.
    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. 

  • 17.
    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.

  • 18. Wnent, Jan
    et al.
    Tjelmeland, Ingvild
    Lefering, Rolf
    Koster, Rudolph W
    Maurer, Holger
    Masterson, Siobhán
    Herlitz, Johan
    Böttiger, Bernd W
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University; Department of Prehospital Care, Region of Dalarna, Falun.
    Gräsner, Jan-Thorsten
    To ventilate or not to ventilate during bystander CPR - A EuReCa TWO analysis2021In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 166, p. 101-109Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR).

    METHOD: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed.

    RESULTS: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17-1.83).

    CONCLUSION: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.

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