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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.
    Djarv, T.
    et al.
    Karolinska University Hospital, Stockholm, Sweden.
    Axelsson, C.
    University College of Borås, Borås, Sweden.
    Herlitz, J.
    Karolinska University Hospital, Stockholm, Sweden.
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Israelsson, J.
    Linnaeus University, Kalmar, Sweden.
    Claesson, A.
    Karolinska University Hospital, Stockholm, Sweden.
    Traumatic cardiac arrest in Sweden 1990-2016 - A population-based national cohort study2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1Article 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. 

  • 3.
    Gelberg, Jan
    et al.
    Lund Univ, Sweden.
    Strömsöe, Anneli
    University of Dalarna, Falun, Sweden.
    Hollenberg, Jacob
    Södersjukhuset, Sweden.
    Radell, Peter
    Karolinska Univ Hosp, Sweden.
    Claesson, Andreas
    University College of Boras, Borås, Sweden.
    Svensson, Leif
    Sahlgrenska University Hospital, Sweden.
    Herlitz, Johan
    Lund University, Lund, 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.

  • 4.
    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

  • 5.
    Hagiwara, M. A.
    et al.
    Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Nilsson, L.
    Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden.
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Axelsson, C.
    Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Kängström, A.
    Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Herlitz, J.
    Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Patient safety and patient assessment in pre-hospital care: A study protocol2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, Vol. 24, no 1, article id 14Article in journal (Refereed)
    Abstract [en]

    Background: Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden. Methods/Design: The study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with the final hospital assessment. Three different ambulance organisations are participating in the study. Every month, one rater in each organisation randomly collects 30 medical records for review. With guidance from the review instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of problematic reviews. The results will be analysed with descriptive statistics and logistic regression. Discussion: The findings will make an important contribution to knowledge about patient safety issues in pre-hospital care. © 2016 Hagiwara et al.

  • 6.
    Herlitz, Johan
    et al.
    Sahlgrenska akademin vid Göteborgs universitet - Göteborg, Sweden.
    Svensson, Leif
    Karolinska Institutet, Stockholm, Sweden.
    Strömsöe, Anneli
    Högskolan Dalarna, Sweden.
    Several factors affect the prognosis2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Other academic)
  • 7.
    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. 

  • 8.
    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.

  • 9. 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.

  • 10.
    Strömsöe, Anneli
    Högskolan Dalarna.
    .: .2010In: Nationella kvalitetsregister och nationellt kvalitetsregister för hjärtstopp utanför sjukhus: Befolkningstäthet och dess karakteristik och utfall vid hjärtstopp utanför sjukhus, 2010Conference paper (Other academic)
  • 11.
    Strömsöe, Anneli
    Högskolan Dalarna.
    .: .2010In: Befolkningstäthet och dess karakteristik och utfall vid hjärtstopp utanför sjukhus, 2010Conference paper (Other academic)
  • 12.
    Strömsöe, Anneli
    Högskolan Dalarna, Sweden.
    Cardiopulmonary resuscitation in Sweden – yesterday, today and tomorrow2015Conference paper (Other (popular science, discussion, etc.))
  • 13.
    Strömsöe, Anneli
    Högskolan Dalarna.
    Cardiopulmonary resuscitation in Sweden – yesterday, today and tomorrow2014Conference paper (Other academic)
  • 14.
    Strömsöe, Anneli
    Högskolan Dalarna.
    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.

  • 15.
    Strömsöe, Anneli
    Högskolan Dalarna.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences.2010In: ResuscitationArticle in journal (Refereed)
  • 16.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences2009In: XXII Nordic-Baltic Congress of Cardiology, Reykjavik, 2009Conference paper (Other academic)
  • 17.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    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.   

  • 18.
    Strömsöe, Anneli
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Mälardalens högskola.
    Kvalitetsindikatorer i det svenska hjärt-lungräddningsregistret2015Conference paper (Other academic)
  • 19.
    Strömsöe, Anneli
    Högskolan Dalarna, Sweden.
    Långsiktigt förbättrade resultat hos patienter som drabbats av hjärtstopp utanför sjukhus2015Conference paper (Other academic)
  • 20.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    Utbildning i HLR i Sverige och dess kliniska konsekvenser2008In: HLR kongressen, Stockholm, 2008Conference paper (Other academic)
  • 21.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    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.

  • 22.
    Strömsöe, Anneli
    Högskolan Dalarna, Medicinsk vetenskap.
    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.

  • 23.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    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.

  • 24.
    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. 

  • 25.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Medicinsk vetenskap.
    Svensson, L.
    Axelsson, Å.
    Göransson, K.
    Todorova, L.
    Herlitz, J.
    Kvalitetsbedömning - nationella hjärtstoppsregistret 2008-20102012Conference paper (Other academic)
  • 26.
    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.

  • 27.
    Strömsöe, Anneli
    et al.
    Högskolan Dalarna, Sweden.
    Svensson, Leif
    Södersjukhuset, Stockholm, Sweden.
    Axelsson, Åsa B.
    Sahlgrenska Academy at Gothenburg University, Sweden.
    Claesson, Andreas
    Prehospen University College of Borås, Borås; Sweden.
    Göransson, Katarina E.
    Karolinska University Hospital, Stockholm; Sweden.
    Nordberg, Per
    Södersjukhuset, Stockholm, Sweden.
    Herlitz, Johan
    Sahlgrenska University Hospital, Sweden.
    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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