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  • 1.
    Al-Dury, Nooraldeen
    et al.
    University of Gothenburg, Sweden;Ostfold Hosp Kalnes, Norway.
    Ravn-Fischer, Annica
    University of Gothenburg, Sweden;Sahlgrenska university hospital, Sweden.
    Hollenberg, Jacob
    Karolinska Institutet, Sweden.
    Israelsson, Johan
    Linnéuniversitetet, Sjöfartshögskolan (SJÖ).
    Nordberg, Per
    Södersjukhuset, Sweden;Karolinska Institutet, Sweden.
    Strömsöe, Anneli
    Mälardalen University, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Identifying the relative importance of predictors of survival in out of hospital cardiac arrest: a machine learning study2020In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 28, no 1, p. 1-8, article id 60Article in journal (Refereed)
    Abstract [en]

    Introduction: Studies examining the factors linked to survival after out of hospital cardiac arrest (OHCA) have either aimed to describe the characteristics and outcomes of OHCA in different parts of the world, or focused on certain factors and whether they were associated with survival. Unfortunately, this approach does not measure how strong each factor is in predicting survival after OHCA. Aim: To investigate the relative importance of 16 well-recognized factors in OHCA at the time point of ambulance arrival, and before any interventions or medications were given, by using a machine learning approach that implies building models directly from the data, and arranging those factors in order of importance in predicting survival. Methods: Using a data-driven approach with a machine learning algorithm, we studied the relative importance of 16 factors assessed during the pre-hospital phase of OHCA We examined 45,000 cases of OHCA between 2008 and 2016. Results: Overall, the top five factors to predict survival in order of importance were: initial rhythm, age, early Cardiopulmonary Resuscitation (CPR, time to CPR and CPR before arrival of EMS), time from EMS dispatch until EMS arrival, and place of cardiac arrest The largest difference in importance was noted between initial rhythm and the remaining predictors. A number of factors, including time of arrest and sex were of little importance. Conclusion: Using machine learning, we confirm that the most important predictor of survival in OHCA is initial rhythm, followed by age, time to start of CPR, EMS response time and place of OHCA. Several factors traditionally viewed as important e.g. sex, were of little importance.

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  • 2. Al-Dury, Nooraldeen
    et al.
    Rawshani, Araz
    Israelsson, Johan
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Västerås.
    Aune, Solveig
    Agerström, Jens
    Karlsson, Thomas
    Ravn-Fischer, Annica
    Herlitz, Johan
    Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.2017In: 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)
    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.

  • 3. Baldi, Enrico
    et al.
    Grieco, Niccolò B.
    Ristagno, Giuseppe
    Alihodžić, Hajriz
    Canon, Valentine
    Birkun, Alexei
    Cresta, Ruggero
    Cimpoesu, Diana
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science. Centre for Clinical Research Dalarna, Uppsala University; Department of Prehospital Care, Region of Dalarna.
    Savastano, Simone
    The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 21Article in journal (Refereed)
    Abstract [en]

    Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.

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  • 4.
    Borneskog, Catrin
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Engström, Gabriella
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Islam, Noor
    Dalarna University, Falun.
    Byrskog, Ulrika
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Pedersen, Christina
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science.
    Erlandsson, Kerstin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    MSc student group,
    Public nursing institute in Bangladesh.
    Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100861Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 5. 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.

  • 6. Djarv, T
    et al.
    Axelsson, C
    Herlitz, J
    Strömsöe, Anneli
    School of Health, Care and Social Sciences, Mälardalen University, Västerås.
    Israelsson, J
    Claesson, A
    Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 26, no 1, article id 30Article in journal (Refereed)
    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.

  • 7. 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.

  • 8.
    Frisk Torell, Matilda
    et al.
    Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science.
    Herlitz, Johan
    Caring Science, Faculty of Caring Science, Borås, Sweden.
    Claesson, Andreas
    Center for resuscitation science, Karolinska Institute, Stockholm, Sweden.
    Rawshani, Araz
    University of Gothenburg, Goteborg, Sweden.
    Borjesson, Mats
    Molecular and Clinical Medicine, Goteborgs Universitet Sahlgrenska Akademin, Goteborg, Sweden; Ostra Sjukhuset, Goteborg, Sweden.
    Better outcomes from exercise-related out-of-hospital cardiac arrest in males and in the young: findings from the Swedish Registry of Cardiopulmonary Resuscitation2022In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 56, no 18, article id 105151Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 9. Frisk Torell, Matilda
    et al.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Herlitz, Johan
    Claesson, Andreas
    Svensson, Leif
    Börjesson, Mats
    Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 2, article id e0211723Article in journal (Refereed)
    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.

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  • 10.
    Gelberg, Jan
    et al.
    Lund Univ, Dept Pediat Anesthesia & Intens Care, Skane Univ Hosp, Lund, Sweden..
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    Hollenberg, Jacob
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Dept Educ,Cardiol Sect, Stockholm, Sweden..
    Radell, Peter
    Karolinska Univ Hosp, Astrid Lindgrens Childrens Hosp, Det Pediat Anesthesia & Intens Care, Stockholm, Sweden..
    Claesson, Andreas
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Dept Educ,Cardiol Sect, Stockholm, Sweden..
    Svensson, Leif
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Dept Educ,Cardiol Sect, Stockholm, Sweden..
    Herlitz, Johan
    Univ Coll Boras, Ctr Prehosp Res Western Sweden, Dept Caring Sci, Boras, Sweden.;Sahlgrens Univ Hosp, Inst Med, Dept Med & Mol Biol, Gothenburg, Sweden..
    Improving survival and neurologic function for younger age groups after out-of-hospital cardiac arrest in Sweden: a 20-year comparison2015In: Pediatric Critical Care Medicine, ISSN 1529-7535, E-ISSN 1947-3893, Vol. 16, no 8, p. 750-757Article in journal (Refereed)
    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.

  • 11. 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)
  • 12. 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.

  • 13. 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)
  • 14. Herlitz, Johan
    et al.
    Svensson, Leif
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Several factors affect the prognosis2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Other academic)
  • 15. Hessulf, F.
    et al.
    Karlsson, T.
    Lundgren, P.
    Aune, S.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Södersved Källestedt, M. -L
    Djärv, T.
    Herlitz, J.
    Engdahl, J.
    Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - A population-based register study of more than 18,000 cases2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 255, p. 237-242Article in journal (Refereed)
  • 16. Holmén, Johan
    et al.
    Herlitz, Johan
    Ricksten, Sven-Erik
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Centre for Clinical Research Dalarna, Uppsala University, Falun; Department of Prehospital Care, Region of Dalarna, Falun .
    Hagberg, Eva
    Axelsson, Christer
    Rawshani, Araz
    Shortening Ambulance Response Time Increases Survival in Out-of-Hospital Cardiac Arrest2020In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 9, no 21, article id e017048Article in journal (Refereed)
    Abstract [en]

    Background The ambulance response time in out-of-hospital cardiac arrest (OHCA) has doubled over the past 30 years in Sweden. At the same time, the chances of surviving an OHCA have increased substantially. A correct understanding of the effect of ambulance response time on the outcome after OHCA is fundamental for further advancement in cardiac arrest care. Methods and Results We used data from the SRCR (Swedish Registry of Cardiopulmonary Resuscitation) to determine the effect of ambulance response time on 30-day survival after OHCA. We included 20 420 cases of OHCA occurring in Sweden between 2008 and 2017. Survival to 30 days was our primary outcome. Stratification and multiple logistic regression were used to control for confounding variables. In a model adjusted for age, sex, calendar year, and place of collapse, survival to 30 days is presented for 4 different groups of emergency medical services (EMS)-crew response time: 0 to 6 minutes, 7 to 9 minutes, 10 to 15 minutes, and >15 minutes. Survival to 30 days after a witnessed OHCA decreased as ambulance response time increased. For EMS response times of >10 minutes, the overall survival among those receiving cardiopulmonary resuscitation before EMS arrival was slightly higher than survival for the sub-group of patients treated with compressions-only cardiopulmonary resuscitation. Conclusions Survival to 30 days after a witnessed OHCA decreases as ambulance response times increase. This correlation was seen independently of initial rhythm and whether cardiopulmonary resuscitation was performed before EMS-crew arrival. Shortening EMS response times is likely to be a fast and effective way of increasing survival in OHCA.

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  • 17.
    Jacobsen, Amanda
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Bremer, Anders
    Svensson, Anders
    Rantala, Andreas
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science.
    Hörberg, Anna
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Nilsson, Christina
    Höglund, Erik
    Norberg Boysen, Gabriella
    Andersson, Henrik
    Persson, Johan
    Aléx, Jonas
    Wihlborg, Jonas
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Jepsen, Klara
    Viking, Magnus
    Holmberg, Mats
    Hammarbäck, Staffan
    Lindström, Veronica
    Ambulanssjukvården behöver genomgripande förändringar2021In: Dagens medicin: oberoende nyhetstidning för hela sjukvården, ISSN 1402-1943, article id 2021-06-23Article in journal (Other (popular science, discussion, etc.))
  • 18. Jerkeman, Matilda
    et al.
    Lundgren, Peter
    Omerovic, Elmir
    Strömsöe, Anneli
    Karolinska Institutet.
    Riva, Gabriel
    Hollenberg, Jacob
    Nivedahl, Per
    Herlitz, Johan
    Rawshani, Araz
    Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study.2022In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 10, article id 100245Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 19.
    Jerkeman, Matilda
    et al.
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden.
    Sultanian, Pedram
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden.
    Lundgren, Peter
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden;Department of Cardiology, Sahlgrenska University Hospital , Gothenburg , Sweden.
    Nielsen, Niklas
    Department of Clinical Sciences Lund, Anesthesiology and Intensive care, Lund University, Helsingborg Hospital , Lund , Sweden.
    Helleryd, Edvin
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden.
    Dworeck, Christian
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden;Department of Cardiology, Sahlgrenska University Hospital , Gothenburg , Sweden.
    Omerovic, Elmir
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden;Department of Cardiology, Sahlgrenska University Hospital , Gothenburg , Sweden.
    Nordberg, Per
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet , Stockholm , Sweden.
    Rosengren, Annika
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet , Stockholm , Sweden.
    Claesson, Andreas
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet , Stockholm , Sweden.
    Aune, Solveig
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden.
    Strömsöe, Anneli
    Centre for Clinical Research Dalarna, Uppsala University , Falun , Sweden;Department of Clinical Sciences Lund, Anesthesiology and Intensive care, Lund University , Lund , Sweden.
    Ravn-Fischer, Annica
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden;Department of Cardiology, Sahlgrenska University Hospital , Gothenburg , Sweden.
    Friberg, Hans
    Department of Clinical Sciences Lund, Anesthesiology and Intensive care, Lund University , Lund , Sweden.
    Herlitz, Johan
    Prehospen—Centre for Prehospital Research, University of Borås , Borås , Sweden;The Swedish Registry for Cardiopulmonary Resuscitation, Centre of Registries , Västra Götaland , Sweden.
    Rawshani, Araz
    Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg , Gothenburg , Sweden;Department of Cardiology, Sahlgrenska University Hospital , Gothenburg , Sweden;The Swedish Registry for Cardiopulmonary Resuscitation, Centre of Registries , Västra Götaland , Sweden.
    Trends in survival after cardiac arrest: a Swedish nationwide study over 30 years2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, no 46, p. 4817-4829Article in journal (Refereed)
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  • 20.
    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. 

  • 21. Magnusson, Carl
    et al.
    Axelsson, Christer
    Nilsson, Lena
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Munters, Monica
    Herlitz, Johan
    Andersson Hagiwara, Magnus
    The final assessment and its association with field assessment in patients who were transported by the emergency medical service2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 26, no 1, article id 111Article in journal (Refereed)
    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.

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  • 22. Masterson, Siobhán
    et al.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Cullinan, John
    Deasy, Conor
    Vellinga, Akke
    Apples to apples: can differences in out-of-hospital cardiac arrest incidence and outcomes between Sweden and Ireland be explained by core Utstein variables?2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 26, no 1, article id 37Article in journal (Refereed)
    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.

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  • 23. 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.

  • 24.
    Silverplats, Jennie
    et al.
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing. Region Dalarna, Mora Hospital, Mora.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Falun / Region Dalarna, Falun.
    Äng, Björn
    Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Falun / Karolinska Institutet.
    Södersved Källestedt, Marie-Louise
    Centre for Clinical Research Västmanland, Uppsala University, Västerås.
    Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors: A survey among in-hospital healthcare professionals2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 7, article id e0271686Article in journal (Refereed)
    Abstract [en]

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

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  • 25.
    Silverplats, Jennie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Care Sciences. Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Mora Hospital, Region of Dalarna, Mora.
    Södersved Källestedt, Marie-Louise
    Wagner, Philippe
    Ravn-Fischer, Annica
    Äng, Björn
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet; Centre for Clinical Research Dalarna, Uppsala University, Falun.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Centre for Clinical Research Dalarna, Uppsala University, Falun; Department of Prehospital Care, Region of Dalarna, Falun.
    Theoretical knowledge and self-assessed ability to perform cardiopulmonary resuscitation: a survey among 3044 healthcare professionals in Sweden2020In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 27, no 5, p. 368-372Article in journal (Refereed)
    Abstract [en]

    Objective Theoretical knowledge and ability to perform cardiopulmonary resuscitation (CPR) are unknown with regard to provided training. The aim of this study was to evaluate in-hospital healthcare professionals’ (HCPs) theoretical knowledge of CPR and their self-assessed ability to perform CPR and also to assess possible affecting factors. Method A questionnaire was sent to n = 5323 HCPs containing a nine-question knowledge test and a Likert scale measuring self-assessed ability. A factor score of self-assessed ability and a ratio scale of correct answers were dependent variables in multiple linear regression. Results Only 41% of the responding HCPs passed the knowledge test with seven or more correct answers. Nurses had the highest pass rate (50%) and the highest attendance rate at CPR training (56%). The ability to perform defibrillation was strongly agreed by 43% and the ability of leadership by only 7%. Working on a monitored ward, CPR training 0–6 months ago and being a nurse or physician were factors associated with more correct answers and higher ratings of abilities. Conclusion The overall theoretical knowledge was poor and ratings of self-assessed abilities to perform CPR were low. Working on a monitored ward, recently attended CPR training and being a nurse or physician were factors associated with higher theoretical knowledge and higher ratings of self-assessed ability to perform CPR. These findings imply prioritisation of CPR training.

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  • 26.
    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.

  • 27.
    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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  • 28.
    Stattin, Eva-Lena
    et al.
    Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Hagström, Emil
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Dahl, Niklas
    Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Delgado-Vega, Angelica Maria
    Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Klar, Joakim
    Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Svennblad, Bodil
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Börjesson, Mats
    Department of Molecular and Clinial Medicine, Sahlgrenska Academy, Göteborg university, Göteborg, Sweden; Center for Health and Performance, Department of Food, Nutrition and Sport Science, Göteborg university, Göteborg, Sweden.
    Wisten, Aase
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit, Umeå university, Umeå, Sweden.
    Cohort profile : the Swedish study of SUDden cardiac Death in the Young (SUDDY) 2000-2010: a complete nationwide cohort of SCDs2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 5, article id e055557Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 29.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, Sahlgrenska Academy at University of Gothenburg.
    Cardiopulmonary resuscitation in Sweden – yesterday, today and tomorrow2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In Sweden, the reported incidence and outcome of out-of-hospital cardiac arrest (OHCA) vary between counties. In the mid -1980s, a national programme in cardiopulmonary resuscitation (CPR) was developed and rescuers have been educated in CPR. Since 1990, Swedish OHCA data are to be reported to the Swedish Cardiac Arrest Register (SCAR). 

    The aim of this thesis was to describe and analyse the incidence and outcome of OHCA and the amount of national training in CPR from data reported to the SCAR and to the CPR training register. The data on OHCAs were related to a variety of epidemiological and quality indicators. 

    Methods: this thesis is based on register data from both the SCAR and the CPR training register. The inclusion criteria were treated OHCAs (I-IV), witnessed treated OHCAs (V) and rescuers educated in CPR (I). The number of participants were: 

    I: CPR training register, 1983-2007, n=2 million rescuers, and SCAR, 1990- 2007, n=45,775, II: SCAR, 2008-2009, n=6,457 registered manually or on the web and n=3,522 registered on the web, III: SCAR, 2008-2010, n=2,398 prospectively registered and n=800 retrospectively registered, IV: SCAR, 1992-2011, n=59,926, V: SCAR, 2008-2010, n=11,005. 

    Results: since 1983, 5,000 instructor-trainers have trained more than 50,000 instructors who have trained almost two million of Sweden’s nine million inhabitants to perform adult CPR. The number of bystander CPR attempts for OHCA in Sweden increased from 31% (1992) to 55% (2007) (I). In 2008-2009, the number of reported OHCAs varied between 13 and 52 per 100,000 inhabitants and year. Bystander CPR, cardiac aetiology and longer emergency medical service (EMS) response times were more frequent in less populated areas, but survival was not associated with population density (II). A validation process showed that, there was a 25% missing rate between 2008 and 2010 of OHCAs reported to the SCAR. In the non-reported OHCAs, patients were older and had less frequently received bystander CPR, but, despite this, they also had a higher survival rate (III). From 1992 to 2011, the OHCAs reported to the SCAR increased from 27 to 52 per 100,000 inhabitants and year. Survival to one month increased from 4.8% (1992) to 10.7% (2011), particularly among patients found in a shockable rhythm. This increase in survival was associated with signs of improvement in all four links of the chain of survival (IV). Furthermore, estimates indicate that, if the delay from collapse to 1) calling for an ambulance, 2) the start of CPR, and 3) the time to defibrillation is reduced to <2 min, <2min and <8 min respectively, approximately 300-400 additional lives could be saved (V).

    Conclusions: there has been an impressive development in the preparedness for and treatment of patients suffering from OHCAs in Sweden during the last 30 years. Improvements in various links in the chain of survival have resulted in a marked increase in survival after OHCA. It suggests that this figure will increase further if the delay to the start of treatment can be reduced still further.

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    A Strömsöe avhandling
  • 30.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences2009In: XXII Nordic-Baltic Congress of Cardiology, Reykjavik, 2009Conference paper (Other academic)
  • 31.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Förbättrade resultat för patienter som drabbats hjärtstopp utanför sjukhus – en uppföljning från 1992 till 20112013Conference paper (Refereed)
    Abstract [sv]

    Syfte: Att beskriva patienter som drabbats av hjärtstopp utanför sjukhus och dess resultatsförändringar i behandling och överlevnad.

    Metod: Patienter (n=59 926) som drabbats av hjärtstopp utanför sjukhus i samtliga Sveriges län och som rapporterats till Svenska hjärt-lungräddningsregistret från 1992 till 2011.

    Resultat: Antalet rapporterade hjärtstopp utanför sjukhus ökade från 27 (1992) till 52 (2011) per 100 000 invånare och år. Vidare så ökade bevittnandegraden av hjärtstopp utanför sjukhus av ambulanspersonalen, en ökad förekomst av hjärtlungräddning innan ambulansen kom fram till patienten samt att tiden ökade från larm till dess att ambulansen kom fram till patienten.

    1-månads-överlevnad ökade från 4,8% (1992) till 10,7% (2011). De som framförallt överlevde 1 månad eller mer var de patienter som levde vid ankomst till sjukhus. Av de patienter som drabbats av hjärtstopp utanför sjukhus mellan 2008 till 2010, var det 41% som genomgick kylbehandling på sjukhus samt 28% som behandlades med ballongvidgning av hjärtats kranskärl. De patienter som överlevde (2008-2011), hade 94% en god eller relativ god hjärnfunktion.

    Sammanfattning: De patienter som drabbats av hjärtstopp utanför sjukhus 1992-2011, påvisar en fördubblad överlevnad. De patienter som framförallt överlever, är de som lever vid ankomst till sjukhus och som senare läggs in på vårdavdelning.   

  • 32.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Utbildning i HLR i Sverige och dess kliniska konsekvenser2008In: HLR kongressen, Stockholm, 2008Conference paper (Other academic)
  • 33.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Validity of reported data in the out-of-hospital cardiac arrest register in chosen parts in Sweden2012Conference paper (Refereed)
    Abstract [en]

    Aim: To describe differences and similarities between reported and non reported data in the out-of-hospital cardiac arrest (OHCA) register in Sweden.

    Methods: Prospective and retrospective data of treated OHCA patients in Sweden, 2008-2010 were compared in the Swedish OHCA register. Data were investigated in 4 Swedish counties with various recording models. Prospective data are those reported by the ambulance crew and retrospective data those missed by the ambulance crew but discovered afterwards by crosschecking with the local ambulance register.

    Result: In 2008-2010, the number of prospective reported cases was n=2398 and retrospective cases n=3198 which indicates a 30% missing rate.

    When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years versus 67 years; p=0.003). There was no difference between groups with regard to sex, time of day and year of OHCA, witnessed status or initial rhythm.

    However, bystander CPR was more frequent among patients in who were reported prospectively (65% versus 60%; p= 0.023) where as survival to 1 month was higher among patients who were reported retrospectively (9,2% versus 11,9%;p=0.035)

     

    Conclusion: Among 3198 cases of OHCA in 4 regions in Sweden 800 (30%) were not reported prospectively by the ambulance crew but retrospectively when discovered as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, less frequently receiving bystander CPR but having a higher survival. Our data suggest that patients who suffer OHCA and are prospectively reported to a quality register may be influenced by selection bias.

  • 34.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Validity of reported data in the out-of-hospital cardiac arrest register in chosen parts in Sweden: [HLR-registrets tillförlitlighet]2013Conference paper (Refereed)
    Abstract [en]

    Aim: To describe differences between reported and non reported data in the out-of-hospital cardiac arrest (OHCA) register in Sweden.

    Methods: Prospective and retrospective data of treated OHCA patients in Sweden, 2008-2010 were compared in the Swedish OHCA register. Data were investigated in three Swedish counties with various recording models. Prospective data are those reported by the ambulance crew and retrospective data those missed by the ambulance crew but discovered afterwards by crosschecking with the local ambulance register.

    Result: In 2008-2010, the number of prospective reported cases was n=2, 398 and retrospective cases n=3, 198 which indicates a 25% missing rate.

    When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years versus 67 years; p=0.003). There was no difference between groups with regard to sex, time of day and year of OHCA, witnessed status or initial rhythm.

    However, bystander CPR was more frequent among patients in who were reported prospectively (65% versus 60%; p= 0.023) where as survival to 1 month was higher among patients who were reported retrospectively (9,2% versus 11,9%;p=0.035)

     

    Conclusion: Among 3, 198 cases of OHCA in three regions in Sweden 800 (25%) were not reported prospectively by the ambulance crew but retrospectively when discovered as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, less frequently receiving bystander CPR but having a higher survival. Our data suggest that patients who suffer OHCA and are prospectively reported to a quality register may be influenced by selection bias.

  • 35.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Afzelius, S.
    Axelsson, C.
    Kallestedt, M. L. Sodersved
    Enlund, M.
    Svensson, L.
    Herlitz, J.
    Improvements in logistics could increase survival after out-of-hospital cardiac arrest in Sweden2013In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 273, no 6, p. 622-627Article in journal (Refereed)
    Abstract [en]

    Objectives. In a review based on estimations and assumptions, to report the estimated number of survivors after out-of-hospital cardiac arrest (OHCA) in whom cardiopulmonary resuscitation (CPR) was started and to speculate about possible future improvements in Sweden.

    Design. An observational study. Setting All ambulance organisations in Sweden. Subjects Patients included in the Swedish Cardiac Arrest Registry who suffered an OHCA between January 1, 2008 and December 31, 2010. Approximately 80% of OHCA cases in Sweden in which CPR was started are included. Interventions None

    Results. In 11005 patients, the 1-month survival rate was 9.4%. There are approximately 5000 OHCA cases annually in which CPR is started and 30-day survival is achieved in up to 500 patients yearly (6 per 100000 inhabitants). Based on findings on survival in relation to the time to calling for the Emergency Medical Service (EMS) and the start of CPR and defibrillation, it was estimated that, if the delay from collapse to (i) calling EMS, (ii) the start of CPR, and (iii) the time to defibrillation were reduced to <2min, <2min, and <8min, respectively, 300400 additional lives could be saved.

    Conclusion. Based on findings relating to the delay to calling for the EMS and the start of CPR and defibrillation, we speculate that 300400 additional OHCA patients yearly (4 per 100000 inhabitants) could be saved in Sweden.

  • 36.
    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.

  • 37.
    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. 

  • 38.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Svensson, L.
    Axelsson, Å.
    Göransson, K.
    Todorova, L.
    Herlitz, J.
    Kvalitetsbedömning - nationella hjärtstoppsregistret 2008-20102012Conference paper (Other academic)
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    Kvalitetsbedömning - nationella hjärtstoppsregistret 2008-2010
  • 39.
    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.

  • 40.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Sahlgrenska University Hospital, Gothenburg.
    Svensson, Leif
    South Hospital, Stockholm.
    Axelsson, Åsa B.
    Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Claesson, Andreas
    Prehospen University College of Borås, Borås; Kungälv Ambulance Service, Kungälv.
    Göransson, Katarina
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Nordberg, Per
    Section of Cardiology, Södersjukhuset, Stockholm.
    Herlitz, Johan
    Sahlgrenska University Hospital, Gothenburg; Prehospen University College of Borås.
    Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 14, p. 863-871Article in journal (Refereed)
    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.

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  • 41. Sultanian, Pedram
    et al.
    Lundgren, Peter
    Strömsöe, Anneli
    Centre for Clinical Research Dalarna, Uppsala University, Falun.
    Aune, Solveig
    Bergström, Göran
    Hagberg, Eva
    Hollenberg, Jacob
    Lindqvist, Jonny
    Djärv, Therese
    Rawshani, Araz
    Cardiac arrest in COVID-19: characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation.2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 11, p. 1094-1106Article in journal (Refereed)
    Abstract [en]

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

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

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

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  • 42. Torell, Matilda F
    et al.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Zagerholm, Ellen
    Herlitz, Johan
    Claesson, Andreas
    Svensson, Leif
    Börjesson, Mats
    Higher survival rates in exercise-related out-of-hospital cardiac arrests, compared to non-exercise-related - a study from the Swedish Register of Cardiopulmonary Resuscitation2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 15, p. 1673-1679Article in journal (Refereed)
    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.

  • 43. Tärnqvist, J.
    et al.
    Dahlén, E.
    Norberg, G.
    Magnusson, C.
    Herlitz, J.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Axelsson, C.
    Andersson Hagiwara, M.
    On-scene and final assessments and their interrelationship among patients who use the EMS on multiple occasions2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 5, p. 528-535Article in journal (Refereed)
    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. 

  • 44. 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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