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  • 1.
    Claesson, A.
    et al.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Djarv, T.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Nordberg, P.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Ringh, M.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Hollenberg, J.
    Karolinska Institute, Department of Medicine, Solna, Center for Resuscitation Science, Stockholm, Sweden.
    Axelsson, C.
    The Prehospital Research Centre, University College of Borås, Borås, Sweden.
    Ravn-Fischer, A.
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Medical versus non medical etiology in out-of-hospital cardiac arrest—Changes in outcome in relation to the revised Utstein template2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, p. 48-55Article in journal (Refereed)
    Abstract [en]

    Introduction The Utstein-style recommendations for reporting etiology and outcome in out-of-hospital cardiac arrest (OHCA) from 2004 have recently been revised. Among other etiologies a medical category is now introduced, replacing the cardiac category from Utstein template 2004. Aim The aim of this study is to describe characteristics and temporal trends from reporting OHCA etiology according to the revised Utstein template 2014 in regards to patient characteristics and 30-day survival rates. Methods This registry study is based on consecutive OHCA cases reported from the Emergency medical services (EMS) to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) 1992–2014. Characteristics, including a presumed cardiac etiology in Utstein template 2004, were transcribed to a medical etiology in Utstein template 2014. Results Of a total of n = 70,846 cases, 92% were categorized as having a medical etiology and 8% as having a non-medical cause. Using the new classifications, the 30-day survival rate has significantly increased over a 20-year period from 4.7% to 11.0% in the medical group and from 3% to 9.9% in the non-medical group (p ≤ 0.001). Trauma was the most common cause in OHCA of a non-medical etiology (26%) with a 30-day survival rate of 3.4% whilst drowning and drug overdose had the highest survival rates (14% and 10% respectively). Conclusion Based on Utstein 2014 categories of etiology, overall survival after OHCA with a medical etiology has more than doubled in a 20-year period and tripled for non-medical cases. Patients with a medical etiology found in a shockable rhythm have the highest chance of survival. There is great variability in characteristics among non-medical cases.

  • 2.
    Graesner, Jan-Thorsten
    et al.
    Univ Hosp Schleswig Holstein, Inst Emergency Med, Kiel, Germany..
    Lefering, Rolf
    Univ Witten Herdecke, Cologne, Germany..
    Koster, Rudolph W.
    Acad Med Ctr, Amsterdam, Netherlands..
    Masterson, Siobhan
    Natl Univ Ireland Galway, Galway, Ireland..
    Boettiger, Bernd W.
    Univ Hosp Cologne, Cologne, Germany..
    Herlitz, Johan
    Univ Boras, Sahlgrenska Univ Hosp, Boras, Sweden..
    Wnent, Jan
    Univ Hosp Schleswig Holstein, Inst Emergency Med, Kiel, Germany..
    Tjelmeland, Ingvild B. M.
    Norwegian Natl Advisory Unit Prehosp Emergency Me, Oslo, Norway..
    Ortiz, Fernando Rosell
    Empresa Publ Emergencias Sanitarias, Almeria, Spain..
    Maurer, Holger
    Univ Hosp Schleswig Holstein, Dept Anaesthesiol & Intens Care Med, Campus Lubeck, Lubeck, Germany..
    Baubin, Michael
    Univ Innsbruck Hosp, Innsbruck, Austria..
    Mols, Pierre
    Univ Libre Bruxelles, Ctr Hosp Univ St Pierre, Brussels, Belgium..
    Hadzibegovic, Irzal
    Josip Juraj Strossmayer Univ, Med Fac Osijek, Osijek, Croatia..
    Ioannides, Marios
    Nicosia Gen Hosp, Nicosia, Cyprus..
    Skulec, Roman
    Emergency Med Serv Cent Bohemian Reg, Kladno, Czech Republic.;Univ JE Purkyne, Masaryk Hosp Usti Nad Labem, Usti Nad Labem, Czech Republic..
    Wissenberg, Mads
    Univ Copenhagen, Emergency Med Serv Copenhagen, Copenhagen, Denmark..
    Salo, Ari
    Univ Helsinki, Dept Emergency Med, Emergency Med Serv, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Hubert, Herve
    Univ Lille, Lille, France..
    Nikolaous, Nikolaos I.
    Konstantopouleio Gen Hosp, Athens, Greece..
    Loczi, Gerda
    Hlth Care Centers Csongrad Cty Hodmezovasarhely M, Mako, Hungary..
    Svavarsdottir, Hildigunnur
    Univ Akureyri, Akureyri Hosp, Akureyri, Iceland..
    Semeraro, Federico
    AUSL Bologna, Osped Maggiore Carlo Alberto Pizzardi, Bologna, Italy..
    Wright, Peter J.
    Hlth Serv Execut Ballyshannon, Ballyshannon, Ireland..
    Clarens, Carlo
    Luxembourg Resuscitat Council, Luxembourg, Luxembourg..
    Pijls, Ruud
    Maastricht Univ, Maastricht, Netherlands..
    Cebula, Grzegorz
    Jagiellonian Univ, Krakow, Poland..
    Correia, Vitor Gouveia
    Univ Hosp Schleswig Holstein, Dept Anaesthesiol & Intens Care Med, Kiel, Germany.;Serv Emergencia Med Reg SEMER EMIR, Oporto, Portugal..
    Cimpoesu, Diana
    Univ Med & Pharm Gr T Popa, Iasi, Romania.;Univ Cty Hosp Sf Spiridon, Iasi, Romania..
    Raffay, Violetta
    Municipal Inst Emergency Med Novi Sad, Novi Sad, Serbia..
    Trenkler, Stefan
    Safarik Univ, Kosice, Slovakia..
    Markota, Andrej
    Univ Med Ctr Maribor, Maribor, Slovenia..
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Burkart, Roman
    Fdn Ticino Cuore, Breganzona, Switzerland..
    Perkins, Gavin D.
    Univ Warwick, Coventry, W Midlands, England.;Heart England NHS Fdn Trust, Coventry, W Midlands, England..
    Bossaert, Leo L.
    Univ Antwerp, Dept Med & Hlth Sci, Antwerp, Belgium..
    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 (vol 105, pg 188, 2016)2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 109, p. 145-146Article in journal (Refereed)
  • 3.
    Gräsner, J.
    et al.
    University Hospital Schleswig-Holstein, Germany.
    Lefering, R.
    University Witten/Herdecke, Cologne, Germany.
    Koster, R.W.
    Academic Medical Center, Amsterdam, Netherlands.
    Masterson, S.
    National University of Ireland, Galway, Ireland.
    Böttiger, B.W.
    University Hospital of Cologne, Germany .
    Herlitz, J.
    University of Borås, Sahlgrenska University Hospital, Sweden.
    Wnent, J.
    University Hospital Schleswig-Holstein, Germany.
    Tjelmeland, I.B.N.
    Norwegian National Advisory Unit, Prehospital Emergency Medicine (NAKOS), Oslo, Norway.
    Ortiz, F.R.
    Empresa Pública de Emergencias Sanitarias, Almería, Spain.
    Maurer, H.
    University Hospital Schleswig-Holstein, Germany.
    Baubin, M.
    University Hospital Innsbruck, Austria.
    Mols, P.
    Université Libre de Bruxelles, Belgium .
    Hadžibegović, I.
    Josip Juraj Strossmayer University, Osijek, Croatia.
    Ioannides, M.
    Nicosia General Hospital, Cyprus.
    Škulec, R.
    J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Czech Republic.
    Wissenberg, M.
    University of Copenhagen, Denmark.
    Salo, A.
    University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
    Hubert, H.
    University of Lille, France.
    Nikolau, N.I.
    Konstantopouleio General Hospital, Athens, Greece.
    Lóczi, G.
    Health Care Centers, Csongrad County Hódmezővásárhely - Makó, Hungary.
    Svavarsdóttir, H.
    Akureyri Hospital/University of Akureyri, Iceland.
    Semeraro, F.
    Ospedale Maggiore “Carlo Alberto Pizzardi” AUSL Bologna, Italy.
    Wright, P.J.
    Health Service Executive Ballyshannon, Ireland.
    Clarens, C.
    Luxembourg Resuscitation Council, Luxembourg .
    Pijls, R.
    Maastricht University, Netherlands .
    Cebula, G.
    Jagiellonian University, Kraków, Poland.
    Correia, V.G.
    Serviço de Emergência Médica Regional - SEMER/EMIR, Portugal .
    Cimpoesu, D.
    University County Hospital Sf. Spiridon, Iaşi, Romania .
    Raffay, V.
    Municipal Institute for Emergency Medicine Novi Sad, Serbia.
    Trenkler, S.
    P.J.Safarik University, Kosice, Slovakia.
    Markota, A.
    University Medical Centre Maribor, Maribor, Slovenia.
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Burkart, R.
    Fondazione Ticino Cuore, Breganzona, Switzerland.
    Perkins, G.D.
    University of Warwick, U.K.
    Bossaert, L.L.
    University of Antwerp, Belgium.
    EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 105, no 1, p. 188-195Article 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

  • 4.
    Libungan, Berglind
    et al.
    Sahlgrens university hospital, Sweden.
    Lindqvist, Jonny
    Sahlgrens university hospital, Sweden.
    Strömsöe, Anneli
    Univ Dalarna, Sweden.
    Nordberg, Per
    Karolinska institutet, Sweden.
    Hollenberg, Jacob
    Karolinska institutet, Sweden.
    Albertsson, Per
    Sahlgrens university hospital, Sweden.
    Karlsson, Thomas
    Univ Gothenburg, Sweden.
    Herlitz, Johan
    Western Sweden Univ Boras, Sweden.
    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. 

  • 5.
    Mastersong, Siobhan
    et al.
    Natl Univ Ireland Galway, Discipline Gen Practice, 1 Distillery Rd, Galway, Ireland..
    McNally, Bryan
    Emory Univ, Sch Med, Dept Emergency Med, Atlanta, GA 30303 USA..
    Cullinan, John
    Natl Univ Ireland, JE Cairnes Sch Business & Econ, Galway H91 WN80, Ireland..
    Vellano, Kimberly
    Emory Univ, Sch Med, Dept Emergency Med, Atlanta, GA 30303 USA..
    Escutnaire, Josephine
    Univ Lille Law & Hlth, Fac Engn & Hlth Management ILLS, Lille, France..
    Fitzpatrick, David
    Stirling Univ, Scottish Ambulance Serv, NMAHP Res Unit, Unit 13 Scion House, Stirling FK9 4NF, Scotland..
    Perkins, Gavin D.
    Univ Warwick, WMS Warwick Clin Trials Unit, Out Hosp Cardiac Arrest Outcomes OHCAO Trial, Coventry CV4 7AL, W Midlands, England..
    Koster, Rudolph W.
    Acad Med Ctr, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands..
    Nakajima, Yuko
    Emory Univ, Sch Med, Dept Emergency Med, Atlanta, GA 30303 USA..
    Pemberton, Katherine
    Queensland Ambulance Serv, GPO Box 1425, Brisbane, Qld 4001, Australia..
    Quinn, Martin
    Natl Univ Ireland Galway, Natl Out Hosp Cardiac Arrest Register OHCAR Steer, Dept Publ Hlth Med, HSE, Letterkenny F92 XK84, Co Donegal, Ireland..
    Smith, Karen
    Ambulance Victoria Ctr Res & Evaluat, POB 2000, Doncaster, Vic 3108, Australia..
    Jonsson, Bergpor Steinn
    Akureyri Hosp, Eyrarlandsvegur 600, Akureyri, Iceland..
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tandan, Meera
    Natl Univ Ireland Galway, Discipline Gen Practice, 1 Distillery Rd, Galway, Ireland..
    Vellinga, Akke
    Natl Univ Ireland Galway, Discipline Gen Practice, 1 Distillery Rd, Galway, Ireland..
    Out-of-hospital cardiac arrest survival in international airports2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 127, p. 58-62Article in journal (Refereed)
    Abstract [en]

    Background: The highest achievable survival rate following out-of-hospital cardiac arrest is unknown. Data from airports serving international destinations (international airports) provide the opportunity to evaluate the success of pre-hospital resuscitation in a relatively controlled but real-life environment. Methods: This retrospective cohort study included all cases of out-of-hospital cardiac arrest at international airports with resuscitation attempted between January 1st, 2013 and December 31st, 2015. Crude incidence, patient, event characteristics and survival to hospital discharge/survival to 30 days (survival) were calculated. Mixed effect logistic regression analyses were performed to identify predictors of survival. Variability in survival between airports/countries was quantified using the median odds ratio. Results: There were 800 cases identified, with an average of 40 per airport. Incidence was 0.024/100,000 passengers per year. Percentage survival for all patients was 32%, and 58% for patients with an initial shockable heart rhythm. In adjusted analyses, initial shockable heart rhythm was the strongest predictor of survival (odds ratio, 36.7; 95% confidence interval [CI], 15.5-87.0). In the bystander-witnessed subgroup, delivery of a defibrillation shock by a bystander was a strong predictor of survival (odds ratio 4.8; 95% CI, 3.0-7.8). Grouping of cases was significant at country level and survival varied between countries. Conclusions: In international airports, 32% of patients survived an out-of-hospital cardiac arrest, substantially more than in the general population. Our analysis suggested similarity between airports within countries, but differences between countries. Systematic data collection and reporting are essential to ensure international airports continually maximise activities to increase survival.

  • 6. Nishiyama, Chika
    et al.
    Brown, Siobhan P.
    May, Susanne
    Iwami, Taku
    Koster, Rudolph W.
    Beesems, Stefanie G.
    Kuisma, Markku
    Salo, Ari
    Jacobs, Ian
    Finn, Judith
    Sterz, Fritz
    Nuernberger, Alexander
    Smith, Karen
    Morrison, Laurie
    Olasveengen, Theresa M.
    Callaway, Clifton W.
    Do Shin, Sang
    Graesner, Jan-Thorsten
    Daya, Mohamud
    Ma, Matthew Huei-Ming
    Herlitz, Johan
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Aufderheide, Tom P.
    Masterson, Siobhan
    Wang, Henry
    Christenson, Jim
    Stiell, Ian
    Davis, Dan
    Huszti, Ella
    Nichol, Graham
    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.

  • 7.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    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. 

  • 8.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    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 10, p. 1307-1313Article in journal (Refereed)
    Abstract [en]

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

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

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

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