mdh.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Cardiopulmonary resuscitation in Sweden – yesterday, today and tomorrow
Högskolan Dalarna.ORCID iD: 0000-0001-6885-991X
2013 (English)Doctoral 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.

Place, publisher, year, edition, pages
Ineko AB , 2013.
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:mdh:diva-32901ISBN: 978-91-628-8665-3 (print)OAI: oai:DiVA.org:mdh-32901DiVA: diva2:955071
Available from: 2017-02-02 Created: 2016-08-24 Last updated: 2017-02-02Bibliographically approved
List of papers
1. Education in cardiopulmonary resuscitation in Sweden and its clinical consequences.
Open this publication in new window or tab >>Education in cardiopulmonary resuscitation in Sweden and its clinical consequences.
2010 (English)In: ResuscitationArticle in journal (Refereed) Published
National Category
Clinical Medicine
Identifiers
urn:nbn:se:mdh:diva-32894 (URN)
Available from: 2016-08-24 Created: 2016-08-24 Last updated: 2017-02-02Bibliographically approved
2. Association between population density and reported incidence, characteristics and outcome after out–of–hospital cardiac arrest in Sweden
Open this publication in new window or tab >>Association between population density and reported incidence, characteristics and outcome after out–of–hospital cardiac arrest in Sweden
Show others...
2011 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 10, 1307-1313 p.Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
London: Elsevier, 2011
Keyword
Cardiac arrest; Population density; Survival; Characteristics
National Category
Clinical Medicine
Identifiers
urn:nbn:se:mdh:diva-32763 (URN)10.1016/j.resuscitation.2011.04.025 (DOI)000296168700013 ()21628082 (PubMedID)
Available from: 2011-08-29 Created: 2016-08-24 Last updated: 2017-02-02Bibliographically approved
3. Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden
Open this publication in new window or tab >>Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden
Show others...
2013 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 7, 952-956 p.Article in journal (Refereed) Published
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. 

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Characteristics; Cardiac arrest; Register; Survival; Validity
National Category
Clinical Medicine
Identifiers
urn:nbn:se:mdh:diva-32761 (URN)10.1016/j.resuscitation.2012.12.026 (DOI)000320997000023 ()23313425 (PubMedID)
Available from: 2013-09-26 Created: 2016-08-24 Last updated: 2017-02-02Bibliographically approved
4. Improvements in logistics could increase survival after out-of-hospital cardiac arrest in Sweden
Open this publication in new window or tab >>Improvements in logistics could increase survival after out-of-hospital cardiac arrest in Sweden
Show others...
2013 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 273, no 6, 622-627 p.Article in journal (Refereed) Published
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.

Keyword
cardiac arrest, emergency medicine, overall survival
National Category
Clinical Medicine
Identifiers
urn:nbn:se:mdh:diva-32760 (URN)10.1111/joim.12041 (DOI)000318986100008 ()23360556 (PubMedID)
Available from: 2013-07-05 Created: 2016-08-24 Last updated: 2017-02-02Bibliographically approved
5. Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival
Open this publication in new window or tab >>Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival
Show others...
2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 14, 863-871 p.Article in journal (Refereed) Published
Abstract [en]

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

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

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

Place, publisher, year, edition, pages
Oxford University Press, 2015
Keyword
Cardiopulmonary resuscitation, Registries, Survival
National Category
Clinical Medicine
Identifiers
urn:nbn:se:mdh:diva-32764 (URN)10.1093/eurheartj/ehu240 (DOI)000353541400009 ()2-s2.0-84928389123 (ScopusID)
Available from: 2014-06-26 Created: 2016-08-24 Last updated: 2017-02-02Bibliographically approved

Open Access in DiVA

No full text

Search in DiVA

By author/editor
Strömsöe, Anneli
Clinical Medicine

Search outside of DiVA

GoogleGoogle Scholar

Total: 4 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf