Cordi, owner of The Strings Connection, divides her time between running the shop and teaching violin and viola lessons. Cordi has a Bachelor's in Music from the Hartt College of Music where she studied under the Russian master Raphael Bronstein and a Master's Degree in violin performance from The Juilliard School where she studied with Dorothy Delay. She continued studies in string technique with George Neikrug, a proponent of D.C. Dounis's ideas regarding playing with a relaxed technique. As a member of the Madison String Quartet, she was an Artist-in-Residence at Colgate University and Hamilton College, where she conducted the String Orchestra and taught music theory and violin. The quartet recorded for The Musical Heritage Society as well as other labels.
Cordi enjoys teaching students of all ages and as a member of MTAC, is able to offer students the opportunity to participate in the Certificate of Merit program if they wish. Two recitals a year provide more performance experience for the students.
Dana has a Bachelor's degree in music from UCLA and a Masters degree from the Eastman School of Music. He enjoys teaching piano, guitar, bass and composition and song writing.
His produced music is currently heard in five continents and on many programs including Oprah, A&E Biography, VH1, Jimmy Kimmel Live, and Curb Your Enthusiasm. His film scores have been heard at the Tribeca Film Festival, Santa Barbara International Film Festival, Newport Beach Film Festival, and San Diego Asian Film Festival, to name a few. Dana's own choral work, Kyrie, was debuted at Southern California's Marsee Auditorium.
Dana has also served as musical director and arranger for Godspell at the Actors CoOp, performing on keyboard and guitar. He reimagined the score and created additional music for it as well. The production garnered 22 nominations and awards, including Critic's Choice – LA Times, Pick Of The Week – LA Weekly and Critic's Pick – Daily Variety.
Dana is a working bassist who has served on the music faculty of Los Angeles Harbor College and El Camino College, where he taught a community outreach program offering lectures in classical, jazz and world music. An experienced choir director, Dana also directed the cast in a live broadcast on 99.5 FM in Los Angeles.
Dana is currently writing new piano music for his upcoming CD, Programs (Piano Rolls), which is turning out to be as highly melodic as it is ambitious, drawing from theatrical and symphonic influences.
Garrett Griffin has been teaching guitar and bass for over 20 years, and playing for over thirty years. Garrett began performing and recording as a teenager at clubs in Hollywood and frequently performed at such venues as The Cathay, De Grande and Gazzari's. His first recording was as a session player for the SST band "Slovenly" (Black Flag label) – on their EP "Thinking of Empire." He recorded with scratch loops used by rappers Rodney O' and Joe Cooley. In the 1980's and 1990's Garrett and Black Flag's Dez Cadena had the band "Brawl. He has also performed with Mike Watt. Garrett performs in the greater Los Angeles area as a freelance artist. Garrett is a devoted teacher and believes in making learning an instrument an enjoyable experience. He teaches students of all ages and levels of playing.
Randolph Scherp has studied piano with Charles Asche of Santa Barbara, CA, and Hans-Dieter Meyer-Moortgat of Wolfenbüttel, Saxony.
He has performed extensively in his native Santa Barbara, and also on occasion collaborated with singers and chamber ensembles, such as Laurice Kennel Simmons, soprano, and the Quarteto Cromano. His teaching draws extensively on classical pedagogy of masters such as Mozart, Türk, Dussek, and Hummel, and also takes into consideration the particular needs and ambitions of his students. He published a thesis on bimodality in Haydn symphonies, editions of chamber works by the exceptional Beethoven contemporary Anton Eberl (Carus-Verlag), and a book of original songs and piano pieces.


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1. Andréassob, A-Ch
Herlitz, Johan
Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
Bång, A
Ekström, L
Lindqvist, J
Lundström, G
Holmberg, S
Characteristics and outcome among patients with a suspected in hospital cardiac arrest1998Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 39, nr 1-2, s. 23-31Artikkel i tidsskrift (Fagfellevurdert)
AIM: To describe the characteristics and outcome among patients with a suspected in-hospital cardiac arrest. METHODS: All the patients who suffered from a suspected in-hospital cardiac arrest during a 14-months period, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. RESULTS: There were 278 calls for the CPR team. Of these, 216 suffered a true cardiac arrest, 16 a respiratory arrest and 46 neither. The percentage of patients who were discharged alive from hospital was 42% for cardiac arrest patients, 62% for respiratory arrest and 87% for the remaining patients. Among patients with a cardiac arrest, those found in ventricular fibrillation/ventricular tachycardia had a survival rate of 64%, those found in asystole 24% and those found in pulseless electrical activity 10%. Among patients who were being monitored at the time of arrest, the survival rate was 52%, as compared with 27% for non-monitored patients (P= 0.001). Among survivors of cardiac arrest, a cerebral performance category (CPC) of 1 (no major deficit) was observed in 81% at discharge and in 82% on admission to hospital prior to the arrest. CONCLUSION: We conclude that, during a 14-month period at Sahlgrenska University Hospital in Göteborg, almost half the patients with a cardiac arrest in which the CPR team was called were discharged from hospital. Among survivors, 81% had a CPC score of 1 at hospital discharge. Survival seems to be closely related to the relative effectiveness of the resuscitation organisation in different parts of the hospital.
2. Atwood, C
Eisenberg, MS
Sahlgrenska University Hospital.
Rea, TD
Incidence of EMS-treated out-of-hospital cardiac arrest in Europe.2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 67, nr 1, s. 75-80Artikkel i tidsskrift (Fagfellevurdert)
BACKGROUND: The potential impact of efforts in Europe to improve survival from out-of-hospital cardiac arrest is unclear, in part, because estimates of incidence and survival are uncertain. The aim of the investigation was to determine a representative European incidence and survival from cardiac arrest in all-rhythms and in ventricular fibrillation treated by the emergency medical services (EMS). METHODS AND RESULTS: We used Medline to identify peer-reviewed articles published between 1 January 1980 and 30 June 2004 that reported a European community's EMS cardiac arrest experience. Inclusion criteria required the study to include at least 25 cases, report of the total number of all-rhythm and/or ventricular fibrillation arrests, and information about population size and study duration. The incidence was computed by dividing the total number of events by the product of the community's population and the study duration. Reports from 37 communities met the inclusion criteria. A total of 18,105 all-rhythm EMS-treated cardiac arrests occurred during 48 million person-years of observation, resulting in an overall incidence for all-rhythm arrests of 37.72 per 100,000 person-years. Incidence of ventricular fibrillation arrest was 16.84 per 100,000 person-years. Survival was 10.7% for all-rhythm and 21.2% for ventricular fibrillation cardiac arrest. Applying these results to the European population, approximately, 275,000 persons would experience, all-rhythm cardiac arrest treated by the EMS with 29,000 persons surviving to hospital discharge. CONCLUSION: The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of cardiac arrest in Europe.
Forlagets fulltekst
3. Aune, S
Eldh, M
Engdahl, J
Svensson, L
Oddby, E
[external].
Improvement in the hospital organisation of CPR training and outcome after cardiac arrest in Sweden during a 10-year period2011Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, ISSN 0300-9572, Vol. 82, nr 4, s. 431-435Artikkel i tidsskrift (Fagfellevurdert)
Aim To describe (a) changes in the organisation of training in cardiopulmonary resuscitation (CPR) and the treatment of cardiac arrest in hospital in Sweden and (b) the clinical achievement, i.e. survival and cerebral function, among survivors after in-hospital cardiac arrest (IHCA) in Sweden. Methods Aspects of CPR training among health care providers (HCPs) and treatment of IHCA in Sweden were evaluated in 3 national surveys (1999, 2003 and 2008). Patients with IHCA are recorded in a National Register covering two thirds of Swedish hospitals. Results The proportion of hospitals with a CPR coordinator increased from 45% in 1999 to 93% in 2008. The majority of co-ordinators are nurses. The proportions of hospitals with local guidelines for acceptable delays from cardiac arrest to the start of CPR and defibrillation increased from 48% in 1999 to 88% in 2008. The proportion of hospitals using local defibrillation outside intensive care units prior to arrival of rescue team increased from 55% in 1999 to 86% in 2008. During the past 4 years in Sweden, survival to hospital discharge has been 29%. Among survivors, 93% have a cerebral performance category (CPC) score of I or II, indicating acceptable cerebral function. Conclusion During the last 10 years, there was a marked improvement in CPR training and treatment of IHCA in Sweden. During the past 4 years, survival after IHCA is high and the majority of survivors have acceptable cerebral function.
Fredriksson, M
Thorén, A-B
In-hospital cardiac arrest--an Utstein style report of seven years experience from the Sahlgrenska University Hospital.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 68, nr 3, s. 351-358Artikkel i tidsskrift (Fagfellevurdert)
BACKGROUND: In-hospital cardiac arrest is one of the most stressful situations in modern medicine. Since 1997, there has been a uniform way of reporting - the Utstein guidelines for in-hospital cardiac arrest reporting.MATERIAL AND METHODS: We have studied all consecutive cardiac arrest in the Sahlgrenska University Hospital (SU) between 1994 and 2001 for who the rescue team was alerted in all 833 patients. The primary endpoint for this study was survival to discharge.RESULTS: Thirty-seven percent survived to hospital discharge. Among patients who were discharged alive, 86% were alive 1 year later. The survivors have a good cerebral outcome (94% among those who were discharged alive had cerebral performance category (CPC) score 1 or 2). The organization at SU is efficient; 80% of the cardiac arrest had CPR within 1 min. Time from cardiac arrest to first defibrillation is a median of 2 min. Almost two-thirds of the patients were admitted for cardiac related diagnoses.CONCLUSION: The current study is the largest single-centre study of in hospital cardiac arrest reported according to the Utstein guidelines. We report a high survival for in-hospital cardiac arrest. We have pointed out that a functional chain of survival, short intervals before the start of CPR and defibrillation are probably contributing factors for this.
Characteristics of patients who die in hospital with no attempt at resuscitation.2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 291-299Artikkel i tidsskrift (Fagfellevurdert)
OBJECTIVE: To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. MATERIALS AND METHODS: All patients who died at Sahlgrenska University Hospital in Goteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year. RESULTS: Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of 'do not attempt resuscitation' (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR. CONCLUSION: In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.
Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
Bång, Angela
Characteristics of patients who die in hospital with no attempt at resuscitation2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 65, nr 3, s. 291-299Artikkel i tidsskrift (Fagfellevurdert)
Objective: To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. Materials and methods: All patients who died at Sahlgrenska University Hospital in Göteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year. Results: Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24 h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of 'do not attempt resuscitation' (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR. Conclusion: In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.
Axelsson, C
Axelsson, Å
Nestin, J
Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest-a pilot study.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 71, nr 1, s. 47-55Artikkel i tidsskrift (Fagfellevurdert)
AIM: To evaluate the outcome among patients suffering from out-of-hospital cardiac arrest (OHCA) after the introduction of mechanical chest compression (MCC) compared with standard cardiopulmonary resuscitation (SCPR) in two emergency medical service (EMS) systems. METHODS: The inclusion criterion was witnessed OHCA. The exclusion criteria were age < 18 years, the following judged etiologies behind OHCA: trauma, pregnancy, hypothermia, intoxication, hanging and drowning or return of spontaneous circulation (ROSC) prior to the arrival of the advanced life support (ALS) unit. Two MCC devices were allocated during six-month periods between four ALS units for a period of two years (cluster randomisation). RESULTS: In all, 328 patients fulfilled the criteria for participation and 159 were allocated to the MCC tier (the device was used in 66% of cases) and 169 to the SCPR tier. In the MCC tier, 51% had ROSC (primary end-point) versus 51% in the SCPR tier. The corresponding values for hospital admission alive (secondary end-point) were 38% and 37% (NS). In the subset of patients in whom the device was used, the percentage who had ROSC was 49% versus 50% in a control group matched for age, initial rhythm, aetiology, bystander-/crew-witnessed status and delay to CPR. The percentage of patients discharged alive from hospital after OHCA was 8% versus 10% (NS) for all patients and 2% versus 4%, respectively (NS) for the patients in the subset (where the device was used and the matched control population). CONCLUSION: In this pilot study, the results did not support the hypothesis that the introduction of mechanical chest compression in OHCA improves outcome. However, there is room for further improvement in the use of the device. The hypothesis that this will improve outcome needs to be tested in further prospective trials
Characteristics and outcome among patients suffering from out-of-hospital cardiac arrest with the emphasis on availability for intervention trials.2007Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 75, nr 3, s. 460-468Artikkel i tidsskrift (Fagfellevurdert)
AIM: To describe all patients treated for out-of-hospital cardiac arrest (OHCA) according to the Utstein criteria and their characteristics and outcome with emphasis on whether they were available for early intervention trials. DESIGN: Retrospective analysis of a study where data were collected prospectively. SETTING: The Municipality of Göteborg/Mölndal in Sweden. PATIENTS: All patients suffering from out-of-hospital cardiac arrest in the Municipality of Göteborg/Mölndal in whom cardiopulmonary resuscitation (CPR) was attempted between May 2003 and May 2005. INTERVENTIONS: Part of the study cohort, i.e. patients with a witnessed, non-traumatic, out-of-hospital cardiac arrest were distributed (cluster) to mechanical (LUCAS) or manual chest compression. RESULTS: The overall survival to discharge from hospital among the 508 patients was 8.5%. The corresponding value for non-cardiac cases was 5.1% and for cardiac cases if crew witnessed 16.1%, bystander witnessed 12.7% and non-witnessed 1.4%. Fifty-nine percent of the patients fulfilled the inclusion criteria for the trial and had no exclusion criteria and 9.7% of these survived to discharge. Ten percent of patients fulfilled the inclusion criteria but were excluded and 20.4% survived to discharge. Thirty-one percent of patients did not fulfil the inclusion criteria and 2.5% survived. Among patients included in the LUCAS group, many of the survivors, 10/13 (77%), experienced a rapid return of spontaneous circulation (ROSC) before the application of the device. CONCLUSION: Among patients with OHCA in whom CPR was started 8.5% survived to hospital discharge and 59% were theoretically available for an early intervention trial. These patients have a different outcome compared with patients not available. However, among those available, the majority of survivors had a rapid ROSC before the application of the intervention (LUCAS). This raises concerns about the potential for early intervention trials to improve outcome after OHCA.
Högskolan i Borås, Institutionen för Vårdvetenskap.
Axelsson, ÅB
Passive leg raising during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: Does it improve circulation and outcome?2010Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, nr 12, s. 1615-1620Artikkel i tidsskrift (Fagfellevurdert)
Background Passive leg raising (PLR), to augment the artificial circulation, was deleted from cardiopulmonary resuscitation (CPR) guidelines in 1992. Increases in end-tidal carbon dioxide (PETCO2) during CPR have been associated with increased pulmonary blood flow reflecting cardiac output. Measurements of PETCO2 after PLR might therefore increase our understanding of its potential value in CPR. We also observed the alteration in PETCO2 in relation to the return of spontaneous circulation (ROSC) and no ROSC. Methods and results The PETCO2 was measured, subsequent to intubation, in 126 patients suffering an out-of-hospital cardiac arrest (OHCA), during 15min or until ROSC. Forty-four patients were selected by the study protocol to PLR 35cm; 21 patients received manual chest compressions and 23 mechanical compressions. The PLR was initiated during uninterrupted CPR, 5min from the start of PETCO2 measurements. During PLR, an increase in PETCO2 was found in all 44 patients within 15s (p=0.003), 45s (p=0.002) and 75s (p=0.0001). Survival to hospital discharge was 7% among patients with PLR and 1% among those without PLR (p=0.12). Among patients experiencing ROSC (60 of 126), we found a marked increase in PETCO2 1min before the detection of a palpable pulse. Conclusion Since PLR during CPR appears to increase PETCO2 after OHCA, larger studies are needed to evaluate its potential effects on survival. Further, the measurement of PETCO2 could help to minimise the hands-off periods and pulse checks.
Karlsson, T
Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA).2009Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, nr 10, s. 1099-1103Artikkel i tidsskrift (Fagfellevurdert)
AIM: In animal and human studies, measuring the pressure of end tidal carbon dioxide (P(ET)CO2) has been shown to be a practical non-invasive method that correlates well with the pulmonary blood flow and cardiac output (CO) generated during cardiopulmonary resuscitation (CPR). This study aims to compare mechanical active compression-decompression (ACD) CPR with standard CPR according to P(ET)CO2 among patients with out-of-hospital cardiac arrest (OHCA), during CPR and with standardised ventilation. METHODS: This prospective, on a cluster level, pseudo-randomised pilot trial took place in the Municipality of Göteborg. During a 2-year period, all patients aged >18 years suffering an out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology were enrolled. The present analysis included only tracheally intubated patients in whom P(ET)CO2 was measured for 15 min or until the detection of a pulse-giving rhythm. RESULTS: In all, 126 patients participated in the evaluation, 64 patients in the mechanical chest compression group and 62 patients in the control group. The group receiving mechanical ACD-CPR obtained the significantly highest P(ET)CO2 values according to the average (p=0.04), initial (p=0.01) and minimum (p=0.01) values. We found no significant difference according to the maximum value between groups. CONCLUSION: In this hypothesis generating study mechanical ACD-CPR compared with manual CPR generated the highest initial, minimum and average value of P(ET)CO2. Whether these data can be repeated and furthermore be associated with an improved outcome after OHCA need to be confirmed in a large prospective randomised trial.
Axelsson, Christer
Azeli, Youcef
Jiminez, Maria
Ordonez Campana, A
Might the bainbridge reflex have a role in resuscitation when chest compression is combined with passive leg raising?2014Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 1, s. e21-Artikkel i tidsskrift (Fagfellevurdert)
The effect of passive leg raising (PLR) in cardiac arrest is not clearly established but PLR has been associated with increased coronary perfusion pressure and increase in End tidal carbon dioxide (EtCO2) during cardiopulmonary resuscitation (CPR).1 A case in which PLR was used successfully has recently been published.
Claesson, Andreas
Hollenberg, J
Rosenqvist, M
Outcome after out-of-hospital cardiac arrest witnessed by EMS: changes over time and factors of importance for outcome in Sweden.2012Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, nr 10, s. 1253-1258Artikkel i tidsskrift (Fagfellevurdert)
Background Among patients who survive after out-of-hospital cardiac arrest (OHCA), a large proportion are recruited from cases witnessed by the Emergency Medical Service (EMS), since the conditions for success are most optimal in this subset. Aim To evaluate outcome after EMS-witnessed OHCA in a 20-year perspective in Sweden, with the emphasis on changes over time and factors of importance. Methods All patients included in the Swedish Cardiac Arrest Register from 1990 to 2009 were included. Results There were 48,349 patients and 13.5% of them were EMS witnessed. There was a successive increase in EMS-witnessed OHCA from 8.5% in 1992 to 16.9% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, the survival to one month increased from 13.9% in 1992 to 21.8% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, 51% were found in ventricular fibrillation, which was higher than in bystander-witnessed OHCA, despite a lower proportion with a presumed cardiac aetiology in the EMS-witnessed group. Among EMS-witnessed OHCA overall, 16.0% survived to one month, which was significantly higher than among bystander-witnessed OHCA. Independent predictors of a favourable outcome were: (1) initial rhythm ventricular fibrillation; (2) cardiac aetiology; (3) OHCA outside home and (4) decreasing age. Conclusion In Sweden, in a 20-year perspective, there was a successive increase in the proportion of EMS-witnessed OHCA. Among these patients, survival to one month increased over time. EMS-witnessed OHCA had a higher survival than bystander-witnessed OHCA. Independent predictors of an increased chance of survival were initial rhythm, aetiology, place and age.
13. Axelsson, Å
Bystander-initiated cardiopulmonary resuscitation out-of-hospital. A first description of the bystanders and their experiences1996Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, nr 1, s. 3-11Artikkel i tidsskrift (Fagfellevurdert)
Abstract At present there are about 1 million trained cardiopulmonary resuscitation (CPR) rescuers in Sweden. CPR out-of-hospital is initiated about 2000 times a year in Sweden. However, very little is known about the bystanders' experiences and reactions. The aim of this study was to describe bystander-initiated CPR, the circumstances, the bystander and his experiences. All CPR bystanders in Sweden who reported their resuscitation attempts between 1990 and 1994 were approached with a phone interview and a postal questionnaire, resulting in 742 questionnaires. Bystander-initiated CPR most frequently took place in public places such as the street. The rescuer most frequently had problems with mouth-to-mouth ventilation (20%) and vomiting (18%). More than half (53%) of the rescuers experienced CPR without problems. Ninety-two percent of the bystanders had no hesitation because of fear of contracting the acquired immunodeficiency syndrome (AIDS) virus. Ninety-three percent of the rescuers regarded their intervention as a mainly positive experience. Of 425 interviewed rescuers, 99.5% were prepared to start CPR again.
Fridlund, B
How bystanders perceive their cardiopulmonary resuscitation intervention. A qualitative study2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, nr 1, s. 71-81Artikkel i tidsskrift (Fagfellevurdert)
The importance of bystander cardiopulmonary resuscitation (CPR) prior to arrival of the emergency medical service is well documented. In Sweden, CPR is initiated prior to emergency medical services (EMS) arrival in about 30% of cardiac arrests out-of-hospital, a figure which should be improved urgently. To do so, it is of interest to know more about the bystanders' perceptions of their intervention. A qualitative method inspired by the phenomenographic approach was applied to 19 bystanders who had performed CPR. In the analysis, five main categories and 14 subcategories emerged. The main categories were: to have a sense of humanity, to have competence, to feel an obligation, to have courage and to feel exposed. Interviews described how humanity and concern for another human being were the foundation of their intervention. CPR training offers the possibility to give appropriate help in this emergency. If the aim of CPR training was extended beyond teaching the skill of CPR to include preparation of the rescuer for the intervention and his/her reactions, this might increase the number of people able to take action in the cardiac arrest situation.
Graves, JR
Factors surrounding cardiopulmonary resuscitation influencing bystanders psycholocigal reactions1998Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 37, nr 1, s. 13-20Artikkel i tidsskrift (Fagfellevurdert)
The incidence of Sweden's out-of-hospital cardiac arrests averages 10000 annually. Each year bystanders initiate cardiopulmonary resuscitation (CPR) approximately 2000 times prior to arrival of emergency medical service (EMS). The aim of this study was to identify factors influencing the bystanders psychological reactions to performing CPR. We mailed a questionnaire to all bystanders who reported performing CPR to the CPR Centre of Sweden from autumn 1992 to 1995. The study included 544 bystander reports. Nine factors were found to be associated with bystanders experience in a univariate analysis. Among these were victim outcome (p < 0.0001), CPR duration (p = 0.0009) and their experience of the attitude of the EMS personnel (p = 0.004). In a multivariate logistic regression model, lack of debriefing following the intervention (p = 0.0001) and fatal victim outcome (p = 0.03) were independent predictors of a negative bystander psychological reaction. The importance of having someone to talk to following an intervention and the EMS personnel concern for the rescuer should be emphasised. The goal should be that critical incident debriefing is available to every bystander following his or her CPR attempt.
Thorén, AB
Attitudes of trained lay rescuers toward cardiopulmonary resuscitation performance in an actual emergency. A survery of 1012 recently trained CPR rescuers2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, nr 1, s. 27-36Artikkel i tidsskrift (Fagfellevurdert)
There are currently 1.5 million trained cardiopulmonary resuscitation (CPR) rescuers in Sweden. Bystander CPR is performed on ≈30% of out-of-hospital cardiac arrests. The aim of this study was to analyse trained CPR rescuers' attitudes and beliefs in terms of CPR performance in an emergency and differences with regard to gender, age, residential area and occupation. In a nation wide survey 1410, randomly selected, recently trained CPR rescuers were approached with a postal questionnaire, resulting in 1012 respondents. The mean age was 36.9 years and only 3% of the respondents were >59 years old. Only 1% had attended the course because of their own or a relative's cardiac disease. Ninety-four per cent believed there was a minor to major risk of serious disease transmission while performing CPR. When predicting their willingness to perform CPR in six scenarios, 17% would not start CPR on a young drug addict, 7% would not perform CPR on an unkempt man, while 97% were sure about starting CPR on a relative and 91% on a known person. In four of six scenarios, respondents from rural areas were significantly more positive than respondents from metropolitan areas about starting CPR. In conclusion, readiness to perform CPR on a known person is high among trained CPR rescuers, while hesitation about performing CPR on a stranger is evident. Respondents from rural areas are more frequently positive about starting CPR than those from metropolitan areas.
17. Axelsson, ÅB
A nationwide survey of CPR training in Sweden: foreign born and unemployed are not reached by training programmes.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 70, nr 1, s. 90-97Artikkel i tidsskrift (Fagfellevurdert)
AIM: To determine the number of CPR trained adults in Sweden, and the willingness of the non-trained population to attend a CPR course. An additional purpose was to investigate differences related to sex, age, residential area, socio-economic classification and country of origin. METHODS: Five thousand adults in Sweden were surveyed, which yielded 3167 valid responses, a response rate of 63%. The sample was selected at random and stratified to correlate to the geographic distribution of the population. RESULTS: The mean (S.D.) age was 46 (16) years, 54% of the respondents were females and 11% were people of foreign origin. Forty-five percent had participated in some form of CPR training. Younger respondents, those living in rural areas, those born in Sweden, employees, students and military conscripts were trained more frequently in CPR. Of the respondents with no CPR training, 50% expressed a willingness to attend a course. The most common reason for not being trained in CPR was that the respondent did not know such courses existed or that they did not know where to go for training. CONCLUSION: Somewhere between 30 and 45% of the adult population of Sweden had participated in CPR training. Half of the non-trained population was willing to learn CPR but frequently did not know that such courses existed or where they were held. Elderly people, people of foreign origin, or those not included in the workforce were less likely to have participated in CPR training.
18. Axelsson, Åsa B
Sunnerhagen, Katharina S
Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101, s. 44-49Artikkel i tidsskrift (Fagfellevurdert)
AIM: Reports on differences between respondents and non-respondents of out-of-hospital cardiac arrest (OHCA) survivors are sparse. This study compares respondents with non-respondents in a follow-up study of a consecutive sample of OHCA survivors and describes the relation between respondents' self-reported morbidity and health.
METHODS/DESIGN: Questionnaires were administered within 12 months after the OHCA. The study population was adult patients who had survived an OHCA during 2008 to 2011, with a cerebral performance score of ≤2 at discharge. The patients were identified through the Swedish registry of OHCA. The Self-administered comorbidity questionnaire and EQ VAS (Euroqol questionnaire visual analogue scale) was used to measure morbidity and health status.
RESULTS: Of 298 survivors, 224 were eligible for the study and 127 responded. Mean time from cardiac arrest (CA) to follow up was 178 days. Comparing the 127 respondents with the 97 lost to follow-up and non-respondents, no significant differences were found in terms of age, sex, factors at resuscitation and in-hospital interventions. The EQ VAS median was 75 (25th,75th percentile 60,80)). Self-rated health differed between respondents reporting 0-2 conditions (n=68) and respondents reporting more than two (n=43), median EQ VAS 78 (68,90) and 65 (50,80)), respectively; p-value 0.0001.
CONCLUSIONS: Despite a limited response rate, representativeness in terms of patient characteristics among survivors of OHCA with an acceptable cerebral function is achievable. A considerable proportion of the survivors lived with the burden of multi-morbidity which worsened health.
Axelsson, Åsa B
University of Gothenburg.
Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest.2016Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 101Artikkel i tidsskrift (Fagfellevurdert)
Bergström, Mattias
Schmidbauer, Simon
Rawshani, Araz
Friberg, Hans
Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm.2018Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 133, s. 147-152, artikkel-id S0300-9572(18)31010-4Artikkel i tidsskrift (Fagfellevurdert)
OBJECTIVE: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm.
METHODS: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990-2016 were analyzed.
RESULTS: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26-1.88).
CONCLUSION: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.
Bylow, Helene
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
Karlsson, Thomas
Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
Lepp, Margret
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
Lindqvist, Jonny
Centre of Registers Västra Götaland, Gothenburg.
Self-learning training versus instructor-led training for basic life support: A cluster randomised trial.2019Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 139, s. 122-132, artikkel-id S0300-9572(19)30094-2Artikkel i tidsskrift (Fagfellevurdert)
AIM: To compare the effectiveness of two basic life support (BLS) training interventions.
METHODS: This experimental trial enrolled 1301 lay people in BLS training. The participants were cluster randomised to either self-learning training or to traditional instructor-led training. Both groups used the Mini-Anne Kit (Laerdal Medical, Stavanger, Norway) and standardised film instructions. After training, the participants practical skills were measured on a Resusci Anne manikin and an AED trainer with the PC SkillReporting system (Laerdal Medical, Stavanger, Norway). The primary outcome was the total score from the modified Cardiff Test of basic life support with automated external defibrillation (19-70 points), six months after training. The secondary outcomes were total score directly after training and quality of individual variables, self-assessed knowledge, confidence and willingness to act, directly and six months after training.
RESULTS: For primary outcome six months after training there was no statistically significant difference (p = 0.44) between the total score for the self-learning group (n = 670; median 59, IQR 55-62) compared with the instructor-led group (n = 561; median 59, IQR 55-63). The instructor-led training resulted in a statistically significant higher total score (median 61 versus 59, p < 0.0001), self-assessed knowledge and willingness to act, directly after training (secondary outcomes) compared with the self-learning training.
CONCLUSIONS: There was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.
Gustavsson, M
Larsson, C
Are patients who are found deeply unconscious, without having suffered a cardiac arrest, always breathing normally?2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, nr 2, s. 116-118Artikkel i tidsskrift (Fagfellevurdert)
AIM: To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. METHODS: Patients with Glasgow Coma Scale (GCS) 3 (1+1+1) and without cardiac arrest were retrospectively evaluated, via ambulance records, for signs of abnormal breathing. RESULTS: Of 45 patients who fulfilled inclusion criteria, 24 (53%) had signs of abnormal breathing, as reported by the ambulance crew. CONCLUSION: Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.
23. Bång, A
Possibilities of implementing dispatcher-assisted cardiopulmonary resuscitation in the community2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, nr 1, s. 19-26Artikkel i tidsskrift (Fagfellevurdert)
Aim: By evaluating tape recordings of true cardiac arrest calls, to judge the dispatchers ability to (a) identify cases as suspected cardiac arrest (CA), (b) give the case the right priority, (c) identify CA cases suitable for dispatcher-assisted, telephone-guided cardiopulmonary resuscitation (T-CPR) and (d) accomplish T-CPR. Methods: Evaluation of 99 tape recordings of consecutive cases that had been admitted to the two city hospitals in Göteborg after out-of-hospital CA. Results: In 70% of the interviews, the dispatcher demonstrated impeccable behaviour with short, distinct questions, quickly resulting in a decision on how to handle the case. In 30%, serious criticism could be voiced as the dispatcher displayed very stressful behaviour, or omitted to ask important questions such as whether the patient was conscious and breathing. In 21%, the interviews indicated a clear opportunity to perform T-CPR. In another 10%, there was a possibility of performing T-CPR. Only in 8% was T-CPR actually accomplished. Conclusions: (1) In the majority of the interviews, the quality was very high, while in one-third, serious criticism could be voiced. (2) In our study, only one-third (95% confidence interval, 22–41) of CA cases were suitable for T-CPR, and T-CPR was performed in only 8% of the 99 cases. (3) To optimise the dispatcher ability to identify suspected CA and initiate T-CPR, both medical knowledge and practical training are needed, preferably with protocols for pre-arrival instructions.
Martinell, S
Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 56, nr 1, s. 25-34Artikkel i tidsskrift (Fagfellevurdert)
AIM: One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. METHODS: Prospective study evaluating 100 tape recordings of the EMD calls of emergency medical service (EMS)-provided advanced life support- (ALS) cases, of out-of-hospital cardiac arrest. RESULTS: The quality of EMD-performed interviews was highly commended in 63% of cases, but insufficient or unapproved in the remaining 37%. The caller's state of mind was not a major problem for co-operation. Among the 100 cases, 24 were suspected to be unconscious and in respiratory arrest. A further 38 cases were presented as unconscious with abnormal breathing. In only 14 cases dispatcher-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the cases were unconscious patients with abnormal breathing. The incidence of suspected agonal breathing was estimated to be approximately 30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional breathing. CONCLUSIONS: Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.
Ortgren, P-O
Währborg, P
Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2002Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 2, s. 135-151Artikkel i tidsskrift (Fagfellevurdert)
Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.
Gustavsson, Mikael
Larsson, Carina
Holmberg, Stig
Are patients who are found deeply unconscious without having suffered a cardiac arrest, always breathing normally?2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, nr 2, s. 116-118Artikkel i tidsskrift (Fagfellevurdert)
27. Bång, Angela
Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 2003, nr 56, s. 25-34Artikkel i tidsskrift (Fagfellevurdert)
Aim: One of the objectives of this study was to assess the previous termemergency medical dispatchersnext term (EMDs) ability for the identification and prioritisation of previous termcardiac arrestnext term (CA) previous termcases,next term and offering and achievements of previous termdispatchernext term-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of previous termagonalnext term respiration in previous termcardiac arrest calls and the caller'snext term descriptions of previous termbreathing.next term Methods: Prospective study evaluating previous term100 tape recordingsnext term of the EMD previous termcalls of emergency medicalnext term service (EMS)-provided advanced life support- (ALS) previous termcases, of out-of-hospital cardiac arrest.next term Results: The quality of EMD-performed interviews was highly commended in 63% of previous termcases,next term but insufficient or unapproved in the remaining 37%. The previous termcaller'snext term state of mind was not previous termanext term major problem for co-operation. Among the previous term100 cases,next term 24 were previous termsuspectednext term to be unconscious and in respiratory previous termarrest. Anext term further 38 previous termcasesnext term were presented as unconscious with abnormal previous termbreathing.next term In only 14 previous termcases dispatchernext term-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the previous termcasesnext term were unconscious patients with abnormal previous termbreathing.next term The incidence of previous termsuspected agonal breathingnext term was estimated to be not, vert, similar30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional previous termbreathing.next term Conclusions: Among previous termsuspected cardiac arrest cases,next term EMDs offer CPR instruction to only previous termanext term small fraction of previous termcallers. Anext term major obstacle was the presentation of previous termagonal breathing.next term Patients with previous termanext term combination of unconsciousness and previous termagonal breathingnext term should be offered previous termdispatchernext term-assisted CPR instruction. This might improve survival in previous termout-of hospital cardiac arrest.next term
29. Claesson, A
Herlitz, J
Cardiac arrest due to drowning-changes over time and factors of importance for survival2014Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 5, s. 644-648Artikkel i tidsskrift (Fagfellevurdert)
AIM: To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. METHOD: Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n=529. The data were clustered into three seven-year intervals for comparisons of changes over time. RESULTS: There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992-1998, versus 74% in interval 2006-2012 (p=0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p=0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place-home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival. CONCLUSION: In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month.
30. Claesson, Andreas
Djärv, Therese
Nordberg, Pär
Ring, Mattias
Hollenberg, Jacob
Ravn-Fischer, Annika
Strömsöe, Annelie
Medical versus non medical etiology in out-of-hospital cardiac arrest-Changes in outcome in relation to the revised Utstein template.2016Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, s. 48-55Artikkel i tidsskrift (Fagfellevurdert)
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.
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.
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.
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).
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.
Norberg, Per
Ravn-Fisher, Annica
Stromsoe, Annelie
Medicalversus non medical etiology in out-of-hospital cardiac arrest-Changes inoutcome in relation to the revised Utstein template2016Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 110, s. 48-55Artikkel i tidsskrift (Fagfellevurdert)
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.
Ortenwall, P
Characteristics of lifesaving from drowning as reported by the Swedish Fire and Rescue Services 1996-2010.2012Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 83, nr 9, s. 1072-1077Artikkel i tidsskrift (Fagfellevurdert)
Aim We aimed to describe characteristics associated with rescue from drowning as reported by the Swedish Fire and Rescue Services (SFARS) and their association with survival from the Out of Hospital Cardiac Arrest (OHCA) registry. Method This retrospective study is based on the OHCA registry and the Swedish Civil Contingencies Agency (SCCA) registry. All emergency calls (1996–2010) where the SFARS were dispatched were included (n = 7175). For analysis of survival, OHCAs that matched events from the SCCA registry were included (n = 250). Results Calls to lakes and ponds were predominant (35% of all calls reported). Rescues were more likely in cold water, <10 °C (45%), in open water (80%) and in April–September (68%). Median delay from a call to arrival of rescue services was 8 min, while it was 9 min for rescue diving units. Of all OHCA cases, the victim was found at the surface in 47% and underwater in 38%. In events where rescue divers were used, victims were significantly younger than in non-diving cardiac arrests and the mean diving depth was 6.3 ± 5.8 m. Overall survival to one month was 5.6% (13% in diving and 4.7% in non-diving cases; p = 0.07). Conclusion In half of more than 7000 drowning-related calls to the SFARS during 15 years of practice, water rescue was needed. In all treated OHCA cases, the majority were found at the surface. Only in a small percentage did rescue diving take place. In these cases, survival did not appear to be poorer than in non-diving cases.
Svensson, Leif
Silfverstolpe, J
Characteristics and outcome among patients suffering out of hospital cardiac arrest due to drowning2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, nr 3, s. 381-387Artikkel i tidsskrift (Fagfellevurdert)
AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.
Silfverstolpe, Johan
Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning.2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, nr 3, s. 381-387Artikkel i tidsskrift (Fagfellevurdert)
Abstract AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.
Dyson, Kylie
Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia.
Brown, Siobhan P
University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington.
May, Susanne
Centre for Research and Evaluation, Ambulance Victoria.
Smith, Karen
Koster, Rudolph W
Academic Medical Center, Amsterdam.
Beesems, Stefanie G
Kuisma, Markku
Department of Emergency Medicine and Services, Helsinki University Hospital.
Salo, Ari
Finn, Judith
School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia; University of Western Australia.
Sterz, Fritz
Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna.
Nürnberger, Alexander
Morrison, Laurie J
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto.
Olasveengen, Theresa M
Oslo University Hospital.
Callaway, Clifton W
Department of Emergency Medicine, University of Pittsburgh Medical Center.
Shin, Sang Do
Seoul National University, College of Medicine, Seoul.
Gräsner, Jan-Thorsten
Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel.
Daya, Mohamud
Department of Emergency Medicine, Oregon Health and Science University.
Ma, Matthew Huei-Ming
Department of Emergency Medicine, National Taiwan University.
Strömsöe, Anneli
School of Health and Social Sciences, University of Dalarna.
Aufderheide, Tom P
Department of Emergency Medicine, Medical College of Wisconsin.
Masterson, Siobhán
On behalf of the National Out-of-Hospital Cardiac Arrest Register (OHCAR). Discipline of General Practice, National University of Ireland, Galway, Ireland and National Ambulance Service, Health Service Executive, Dublin.
Wang, Henry
Department of Emergency Medicine, University of Texas Health Science Center.
Christenson, Jim
Department of Emergency Medicine, University of British Columbia.
Stiell, Ian
Department of Emergency Medicine, University of Ottawa.
Vilke, Gary M
Department of Emergency Medicine, University of California San Diego.
Idris, Ahamed
Department of Emergency Medicine, University of Texas Southwester.
Nishiyama, Chika
Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science.
Iwami, Taku
Kyoto University Health Service.
Nichol, Graham
University of Washington - Harborview Center for Prehospital Emergency Care, Departments of Emergency Medicine and Medicine, University of Washington.
International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template.2019Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 138, s. 168-181, artikkel-id S0300-9572(18)30957-2Artikkel i tidsskrift (Fagfellevurdert)
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.
36. Ekström, L
Wennerblom, B
Survival after cardiac arrest outside hospital over a 12-year period in Göteborg1994Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 27, nr 3, s. 181-187Artikkel i tidsskrift (Fagfellevurdert)
Background: A two-tiered ambulance system with a mobile coronary care unit and standard ambulance has operated in Gothenburg (population 434 000) since 1980. Mass education in cardiopulmonary resuscitation (CPR) commenced in 1985 and in 1988 semiautomatic defibrillators were introduced. Aim: To describe early and late survival after cardiac arrest outside hospital over a 12-year period. Target population: All patients with prehospital cardiac arrest in Gothenburg reached by mobile coronary care unit or standard ambulance between 1980 and 1992. Results: The number of patients with cardiac arrest remained fairly steady over time. Among patients with witnessed ventricular fibrillation, the time to defibrillation decreased over time. The proportion of patients in whom bystander initiated CPR was increased only moderately over time. The proportion of patients given medication such as lignocaine and adrenaline successively increased. The number of patients with cardiac arrest who were discharged from hospital per year remained steady between 1981 and 1990 (20 per year), but increased during 1991 and 1992 to 41 and 31 respectively. Conclusions: Improvements in the emergency medical service in Gothenburg over a 12-year period have lead to: (1) a shortened delay time between cardiac arrest and first defibrillation and (2) an improved survival of patients with cardiac arrest outside hospital probably explained by this shortened delay time.
Hospital mortality after out of hospital cardiac arrest among patients found in ventricular fibrillation1995Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, nr 1, s. 11-21Artikkel i tidsskrift (Fagfellevurdert)
The aim of this study was to describe factors associated with in-hospital mortality among patients being hospitalised after out-of-hospital cardiac arrest and who were found in ventricular fibrillation. The study was set in the community of Göteborg, Sweden. The subjects consisted of all patients who were hospitalised alive after out-of-hospital cardiac arrest, being reached by our mobile coronary care unit and who were found in ventricular fibrillation, between 1981 and 1992. In all, 488 patients fulfilled the inclusion criteria of which 262 (54%) died during initial hospitalization. In a multivariate analysis including age, sex, history of cardiovascular disease, chronic medication prior to arrest and circumstances at the time of arrest, the following appeared as independent predictors of hospital mortality: (1) interval between collapse and first defibrillation (P < 0.001); (2) on chronic medication with diuretics (P < 0.01); (3) age (P < 0.01); (4) bystander initiated CPR (P < 0.05); and (5) a history of diabetes (P < 0.05). In a multivariate analysis considering various aspects of status on admission to hospital, the following were independently associated with death: (1) degree of consciousness (P < 0.001) and (2) systolic blood pressure (P < 0.05). In conclusion, among patients with out of hospital cardiac arrest found in ventricular fibrillation and being hospitalised alive, 54% died in hospital. The in-hospital mortality was related to patient characteristics before the cardiac arrest as well as to factors at the resuscitation itself.
38. Engdahl, J
Abrahamsson, P
Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 43, nr 3, s. 201-211Artikkel i tidsskrift (Fagfellevurdert)
AIM: To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. SETTING: Municipality of Göteborg, Sweden. PATIENTS: All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. RESULTS: Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P < 0.001). More patients in Sahlgrenska Hospital were still receiving cardiopulmonary resuscitation (CPR) treatment (P = 0.03), but patients in Ostra had a lower systolic blood pressure and higher heart rate on admission. A larger percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. CONCLUSION: Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.
Karlson, BW
The epidemiology of cardiac arrest in children and young adults.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, nr 2, s. 131-138Artikkel i tidsskrift (Fagfellevurdert)
AIM: To describe the epidemiology of children and young adults suffering from out-of-hospital cardiac arrest. PATIENTS: All patients suffering from out-of-hospital cardiac arrest in whom, resuscitation efforts were attempted in the community of Göteborg between 1980 and 2000. METHODS: Between 31 October 1980 and 31 October 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed-up to discharge from hospital. RESULTS: Among 5505 cardiac arrests information on age was available in 5290 cases (96%). Of these 5290 cases 98 (2%) were children (age 0-17 years), 197 (4%) were young adults (age 18-35 years) and the remaining 4995 (94%) were adults (age >35 years). Children and young adults differed from adults by suffering from a witnessed arrest less frequently, being found by the ambulance crew in ventricular fibrillation/tachycardia less frequently and being judged as having an underlying cardiac aetiology less frequently. Of the children only 5% were discharged from hospital alive compared with 8% for young adults and 9% for adults. Among survivors the cerebral performance categories (CPC) score at discharge tended to differ with 38% of young adults registering a CPC score of 1 (no neurological deficit) compared with 52% among adults. CONCLUSION: Children and young adults suffering from out-of-hospital cardiac arrest differed from adults in terms of aetiology and observed initial arrhythmia. Children had a particularly bad outcome whereas young adults had a similar outcome as adults.
Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 57, nr 1, s. 33-41Artikkel i tidsskrift (Fagfellevurdert)
AIM: To describe the epidemiology for out of hospital cardiac arrest of a non-cardiac aetiology. PATIENTS: All patients suffering from out of hospital cardiac arrest in whom resuscitation efforts were attempted in the community of Göteborg between 1981 and 2000. METHODS: Between October 1, 1980 and October 1, 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed up to discharge from hospital. RESULTS: In all, 5415 patients participated in the evaluation. Among them 1360 arrests (25%) were judged to be of a non-cardiac aetiology. Among these 24% were caused by a surgical cause or accident, 20% by obstructive pulmonary disease, 13% by drug abuse and the remaining 43% by 'another cause'. Of the patients with out of hospital cardiac arrest of a non-cardiac aetiology 4.0% survived to discharge from hospital as compared with 10.1% of the patients with a cardiac aetiology (P<0.0001). In the various subgroups survival was highest in those with drug abuse (6.8%) and lowest in those with 'another cause' (4.2%). Cerebral performance categories (CPC) score at hospital discharge tended to be worse among survivors from an arrest of non-cardiac than cardiac aetiology. Patients with a cardiac arrest of a non-cardiac aetiology differed from the remaining patients by being younger, including more women, less frequently having a witnessed arrest and less frequently being found in ventricular fibrillation/tachycardia. When simultaneously considering age, sex, witnessed status, presence of bystander cardiopulmonary resuscitation (CPR) and initial arrhythmia, the aetiology (non-cardiac vs. cardiac aetiology) was not an independent predictor of survival. CONCLUSION: Among patients with out of hospital cardiac arrest in whom resuscitation was attempted 25% were judged to be of a non-cardiac aetiology. These patients had a lower survival than patients with a cardiac arrest of cardiac aetiology. However, this was mainly explained by a lower occurrence of ventricular fibrillation and witnessed cardiac arrest.
Factors affecting short and long term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity2001Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 51, nr 1, s. 17-25Artikkel i tidsskrift (Fagfellevurdert)
Aims: To describe the epidemiology, resuscitation factors and prognosis among a consecutive population of patients suffering from out-of-hospital cardiac arrest (OHCA) where pulseless electrical activity (PEA) was the first arrhythmia recorded on emergency medical services (EMS) arrival. Methods: Analysis of data collected prospectively on all patients regardless of age succumbing to OHCA during 1980–1997 in the community of Gothenburg where EMS initiated resuscitative measures. Results: 4662 patients with OHCA were attended by the EMS during the study period. Of these, 1069 (23%) were judged as having PEA as the first recorded arrhythmia; 158 (15%) of these were admitted alive to hospital and 26 (2.4%) were discharged alive. Survivors to discharge had a significantly larger share of bystander cardiopulmonary resuscitation (CPR) (28 vs. 8%, P=0.008), significantly higher levels of consciousness (8% awake vs. 0%, P<0.001) and higher median systolic blood pressure (145 vs. 106 mmHg, P<0.001) on arrival at hospital. No patient with unwitnessed cardiac arrest and PEA over 80 years old survived. Conclusion: Survival among patients suffering from OHCA and PEA is poor, especially among the elderly unwitnessed cases and those who do not receive bystander CPR. The latter seems to be of utmost importance among these patients.
Localization of out-of-hospital cardiac arrest in Göteborg 1994: 2002 and implications for public access defibrillation2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 64, nr 2, s. 171-175Artikkel i tidsskrift (Fagfellevurdert)
Purpose: The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Göteborg and to identify implications for public access defibrillation (PAD). Methods: Ambulance run reports for the years 1994–2002 were studied retrospectively and manually to establish the location of the cardiac arrest. Results: The location could be identified in 2194 of 2197 patients (99.9%). One thousand four hundred and twenty-nine (65%) of the arrests took place in the victims' homes. Two hundred eighty-five (13%) were outdoors and 57 (3%) in cars. Fifty-one (2%) took place en route in ambulances. These arrests were regarded not to be generally suitable for PAD. One hundred thirty-five (6%) of the arrests happened in a public building. Eighteen of these 135 were in 15 different general practitioners' offices. A ferry terminal had 11 cardiac arrests. One hundred fifty (7%) of the arrests took place in different care facilities. Twenty-one (1%) patients had their cardiac arrest in public transport locations. Twenty-two (1%) patients arrested at work in 20 different sites. In total, 17% of the cardiac arrests were regarded as generally suitable for PAD. Several sites with more than one cardiac arrest in five years could be identified and 54 patients (2.5%) had their cardiac arrest in these high-incidence sites. Conclusion: Among patients suffering from out-of-hospital cardiac arrest in Göteborg in whom resuscitation efforts were attempted 17% of all cardiac arrests were regarded as generally suitable for PAD. According to previous suggestions, the indication for public access defibrillation is in a place with a reasonable probability of use of one AED in 5 years. Several high-incidence sites that probably would benefit from defibrillator availability could be identified, and 54 patients (2.5%) arrested in these sites.
Luepker, R
The epidemiology of out-of-hospital "sudden" cardiac arrest2002Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 52, nr 3, s. 235-245Artikkel i tidsskrift (Fagfellevurdert)
It is difficult to assemble data from an previous termout-of-hospital cardiac arrestnext term since there is often lack of objective information. The true incidence of previous termsudden cardiacnext term death previous termout-of-hospitalnext term is not known since far from all of these patients are attended by emergency medical services. The incidence of previous termout-of-hospital cardiac arrestnext term increases with age and is more common among men. Among patients who die, the probability of having a fatal event outside previous termhospitalnext term decreases with age; i. e. younger patients tend to more often die unexpectedly and outside previous termhospital.next term Among the different initial arrhythmias, ventricular fibrillation is the most common among patients with previous termcardiacnext term aetiology. The true distribution of initial arrhythmias is not known since several minutes most often elapse between collapse and rhythm assessment. Most patients with previous termout-of-hospital cardiac arrestnext term have a previous termcardiacnext term aetiology. previous termOut-of-hospital cardiac arrestsnext term most frequently occur in the patient's home, but the prognosis is shown to be better when they occur in a public place. Witnessed previous termarrest,next term ventricular fibrillation as initial arrhythmia and cardiopulmonary resuscitation are important predictors for immediate survival. In the long-term perspective, previous termcardiac arrestnext term in connection with acute myocardial infarction, high left ventricular ejection fraction, moderate age, absence of other heart failure signs and no history of myocardial infarction promotes better prognosis. Still there is much to learn about time trends, the influence of patient characteristics, comorbidity and previous termhospitalnext term treatment among patients with prehospital previous termcardiac arrest.
44. Graves, JR
Holmberg, M
Sunnerhagen, K
Survivors of out-of-hospital cardiac arrest. Their prognosis, longevity, and functional status1997Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 35, nr 2, s. 117-121Artikkel i tidsskrift (Fagfellevurdert)
This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. From 1980 to 1993 Göteborg EMS treated 3754 out-of-hospital cardiac arrests. 9% (n = 324) were discharged from the hospital alive. Survivors' median age was 67 and 21% (n = 67) were women. Mortality rate was: 21% (n = 61) at 1 year; 56% (n = 78) by 5 years; and 82% (n = 32) by 10 years following the arrest. During the first 3 years, 16% (n = 46) experienced another cardiac arrest, 19% (n = 53) had an acute myocardial infraction and a total of 81% (n = 232) were rehospitalized for various conditions. 14% (n = 40) returned to previous employment, and 74% (n = 229) had retired before their arrest occurred. Cerebral performance categories (CPC) scores were: At hospital discharge N = 324; Data available for 320-1 = 53% (n = 171), 2 = 21% (n = 66), 3 = 24% (n = 77), 4 = 2% (n = 6). One year post arrest N = 263; Data available for 212-1 = 73% (n = 156), 2 = 9% (n = 18), 3 = 17% (n = 36), 4 = 1% (n = 2). Overall, 21% (n = 61) of cardiac arrest survivors died during the first year, and an additional 16% (n = 46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.
45. Gräsner, Jan-Thorsten
Lefering, Rolf
Böttiger, Bernd W
Wnent, Jan
Tjelmeland, Ingvild B M
Ortiz, Fernando Rosell
Maurer, Holger
Baubin, Michael
Mols, Pierre
Hadžibegović, Irzal
Ioannides, Marios
Škulec, Roman
Wissenberg, Mads
Hubert, Hervé
Nikolaou, Nikolaos I
Lóczi, Gerda
Svavarsdóttir, Hildigunnur
Semeraro, Federico
Wright, Peter J
Clarens, Carlo
Pijls, Ruud
Cebula, Grzegorz
Correia, Vitor Gouveia
Cimpoesu, Diana
Raffay, Violetta
Trenkler, Stefan
Markota, Andrej
Burkart, Roman
Perkins, Gavin D
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.2016Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 105, s. 188-195Artikkel i tidsskrift (Fagfellevurdert)
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.
46. Gräsner, JT
Koster, RW
Ortiz, FR
Stamatakis, L
Bossaert, L
Quality management in resuscitation--towards a European cardiac arrest registry (EuReCa).2011Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, nr 8, s. 989-994Artikkel i tidsskrift (Fagfellevurdert)
BACKGROUND: Knowledge about the epidemiology of cardiac arrest in Europe is inadequate. AIM: To describe the first attempt to build up a Common European Registry of out-of-hospital cardiac arrest, called EuReCa. METHODS: After approaching key persons in participating countries of the European Resuscitation Council, five countries or areas within countries (Belgium, Germany, Andalusia, North Holland, Sweden) agreed to participate. A standardized questionnaire including 28 items, that identified various aspects of resuscitation, was developed to explore the nature of the regional/national registries. This comprises inclusion criteria, data sources, and core data, as well as technical details of the structure of the databases. RESULTS: The participating registers represent a population of 35 million inhabitants in Europe. During 2008, 12,446 cardiac arrests were recorded. The structure as well as the level of complexity varied markedly between the 5 regional/national registries. The incidence of attempted resuscitation ranged between registers from 17 to 53 per 100,000 inhabitants each year whilst the number of patients admitted to hospital alive ranged from 5 to 18 per 100,000 inhabitants each year. Bystander CPR varied 3-fold from 20% to 60%. CONCLUSION: Five countries agreed to participate in an attempt to build up a common European Registry for out-of-hospital cardiac arrest. These regional/national registries show a marked difference in terms of structure and complexity. A marked variation was found between countries in the number of reported resuscitation attempts, the number of patients brought to hospital alive, and the proportion that received bystander CPR. At present, we are unable to explain the reason for the variability but our first findings could be a 'wake-up-call' for building up a high quality registry that could provide answers to this and other key questions in relation to the management of out-of-hospital cardiac arrest.
47. Hallstrom, A
Kajino, K
Olasveengen, TM
Treatment of asystole and PEA2009Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, nr 9, s. 975-976Artikkel i tidsskrift (Fagfellevurdert)
Recent reports consistently point to a substantial decline in the incidence of ventricular fibrillation (VF) as the initial rhythm observed by Emergency Medical Service (EMS) responders and a complementary increase in pulseless electrical activity (PEA) and asystole. Historically, efforts at improving survival have focused primarily on patients found in VF. Consequently, the approach for other patients has included frequent pauses in cardiopulmonary resuscitation (CPR) to check for VF followed by shock when VF is observed. However, the "yield" of survivors comes largely from the non-shocked patients. Therefore, it is critical that we start evaluating treatments specifically for the PEA and asystole groups.
Treatment of Asystole and PEA2009Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, nr 9, s. 975-6Artikkel i tidsskrift (Fagfellevurdert)
Hardig, Bjarne Madsen
Physio-Control, Lund.
Lindgren, Erik
Uppsala University.
Östlund, Ollie
Karlsten, Rolf
Rubertsson, Sten
Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial.2017Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 115, s. 155-162, artikkel-id S0300-9572(17)30156-9Artikkel i tidsskrift (Fagfellevurdert)
INTRODUCTION: The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2min' algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it.
METHOD: Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients.
RESULTS: Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p=0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p=0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2-5) min vs manual CPR 3 (2-4) min, P<0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group.
CONCLUSIONS: No difference in short- or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.
50. Hein, A
Characteristics and outcome of false cardiac arrests in hospital.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 69, nr 2, s. 191-197Artikkel i tidsskrift (Fagfellevurdert)
BACKGROUND: Not all hospitalised patients with symptoms of a presumed or threatened cardiac arrest, for whom the rescue team is alerted, eventually suffer a cardiac arrest. This article aims to describe the characteristics and outcome of "false cardiac arrests". METHODS: All patients hospitalised at Sahlgrenska University Hospital for whom the rescue team was alerted between 1 November 1994 and 15 October 2002 were included. RESULTS: In all, there were 1538 calls for the rescue team, of which 70% were caused by cardiac arrest, 9% by respiratory arrest and 21% by "other causes". Survival to discharge was 36% among patients with cardiac arrest, 64% among patients with respiratory arrest and 77% among patients with "other reasons for calling" (p<0.0001 for trend). Among survivors, a cerebral performance categories (CPC) score of 1 at hospital discharge was found in 83% of those with a cardiac arrest, 59% with respiratory arrest and 82% with other reasons for calling (NS for trend). CONCLUSION: Among patients at a Swedish university hospital for whom the rescue team was alerted, about one-third have a "false cardiac arrest". These patients had a survival rate which was about twice that of patients with a "true cardiac arrest". However, among survivors, cerebral function at discharge was similar, regardless of "false" or "true" cardiac arrest.
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Have you ever been to Eko-Idumota on a Saturday to shop? Ever been to the Trade-fair arena at Badagry on any day at that? Even 3rd mainland on a Monday morning! I used to think queues plus large crowds were only found at bus stations(especially on those Monday mornings and at the close of work); Petrol stations (those times of fuel scarcity or when it is rumoured and folks are just reacting to information). The only other times I've seen such long queues are in actual traffic, market places like Mile 12, Yaba and the likes when everyone( cars and pedestrians alike) is practically at a standstill...brushing shoulders as they pass.
Maybe these are not the best scenarios to allow play in your heads as you imagine all the craziness, but what else can be likened to those clustered mills of people at the roadside at every minute of the day, coming out of their expensive autos on major expressways just to buy one thing...corn worth N500 or less! Do you ever wonder? I wonder o. This Corn Craze is a shocker. Every time I travel either long or short stretches, the crowds are always there...towering above 'mama Nkechi', crisp notes stretched out in the droves. Be on the look out henceforth...try observe too. See them in their head gears, suits & ties with absolutely no shame whatsoever- this is not to imply there should be shame attached to buying corn on the road side. After all, I stop to buy fries (what we popularly call dundun and akara) almost every other weekend.
CeeCee, my choice pseudonym for Corn Craze.
Shockingly, it isn't just a 'Nigerian thingy', the Native Americans as well as many other cultures throughout the world love it. Although in this part of the world, we often associate corn with the color yellow, it actually comes in host of different varieties featuring an array of different colors, including red, pink, black, purple, and blue. I'll sure love to eat the pink someday...that's the girly colour for sure and I am female so don't blame me. In my poetic element I wrote this eulogy to a rare one...no rhymes intended, it's a free verse. Enjoy!
Who dares call you plain, staple food or just mere snack?
A sure protection against cardiovascular problems, against risks of high blood pressure and the many 'whatnots' attacking the blood system.
Eat it fresh, while on its cob. Eat it popped or off its cob, mixed with beans as my grandmamma would too.
All key macronutrients for stabilizing the passage of food; steadying sugar uptake into the bloodstream and of course spikes or drops in sugar level is avoided this way.
I bet you didn't know too as I just found out, another fascinating thing about corn...its potential antiHIV activity!
Lectins are considered special proteins found in virtually all foods and for that matter, in virtually all organisms. They have the ability to bind onto carbohydrates or onto carbohydrate receptors that are found on cell membranes. In the case of some micro-organisms (including the HIV virus), the binding of lectins onto sugars has been shown to help inhibit activity of the virus. An example of lectin found in corn which is called GNAmaize has preliminarily been shown to possess this HIV-inhibiting property. Of course, research is still on going so keep the protection-guard on; no needle sharing and all the things we've been warned against.
I know a lady who loves corn so much, i married her. Not because of her love for corn though. I think people are just returning to nature, the hustle and bustle of Lagos offers modernity, "Mama Nkechi and her merchandise are a source of nostalgia drawing the crowd to their roots. I could 'nt agree more about the plenty natural benefits of corn. Isn't that why grandpa and his peers lived for so long? Lots of people do Amala joints these days....depopulating fast food joints......and have you noticed that contemporary fashion has found a new love in Ankara?
Going back to the roots. Like you rightly said, that's why grandpa lived for so long.
What's the big deal about the WORLD CUP?