Out-of-hospital cardiac arrest : A study on factors associated with cardiopulmonary resuscitation, early defibrillation and survival
Author: Hollenberg, Jacob
Date: 2008-05-23
Location: Aulan, plan 6, Södersjukhuset
Time: 09.00
Department: Institutionen för klinisk forskning och utbildning, Södersjukhuset / Department of Clinical Science and Education, Södersjukhuset
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thesis.pdf (2.312Mb)
Abstract
p>Cardiac disease is the most common cause of mortality in the Western
World and the majority of these cardiac deaths is due to out-of-hospital
cardiac arrest (OHCA). In Sweden, an estimated 5,000-10,000 people suffer
an OHCA annually. The objective of this thesis is to study patient
characteristics and survival in patients with OHCA, to explore the
importance of pre-hospital factors and in-hospital factors and to
investigate the benefits of an early defibrillation program.
Methods and results: Most data in this thesis are based on patient
material collected by the Swedish Cardiac Arrest Register. Other data
come from case records from patients admitted alive and time measurements
from the emergency dispatch centre and defibrillators.
In Study I, 969 cases of OHCA in Stockholm and 398 cases of OHCA in
Göteborg between January 2000 and June 2001 were compared. The two groups
were similar in terms of age, gender and various factors at
resuscitation. All pre-hospital time intervals were longer in Stockholm
and the proportion of patients found in ventricular fibrillation (VF) was
18% compared to 31% in Göteborg (p<0.0001). 1-month survival was
significantly lower in Stockholm (2.5% vs. 6.8%; p<0.001).
To evaluate the relative roles of pre-hospital and in-hospital factors,
1,542 OHCA in Stockholm and 546 in Göteborg between January 2000 and June
2002 were investigated in Study II. Survival after OHCA was again lower
in Stockholm (3.3% vs. 6.1%; p=0.01). Significantly longer time intervals
and a lower proportion of VF OHCA were found in Stockholm compared to
Göteborg. Patient demography, medical history, in-hospital investigations
and interventions as well as in-hospital mortality (78% in Göteborg, 80%
in Stockholm) did not differ between the two groups.
To describe temporal trends in 1-month survival after OHCA in Sweden,
38,646 patients between 1992-2005 were investigated in Study III. The
proportion of patients surviving to hospital admission increased from
15.3% in 1992 to 21.7% in 2005 (p for trend<0.0001). The corresponding
figures for patients being alive after 1 month were 4.8% and 7.3% (p for
trend<0.0001). Factors related to the improved survival were an increase
in crew-witnessed cases from 9% in 1992 to 15% in 2005 (p for trend
<0.0001) and, to a lesser degree, more frequent bystander CPR which rose
from 31% in 1992 to 50% in 2005 (p for trend <0.0001).
In Study IV, specially trained fire-fighters equipped with automated
external defibrillators were dispatched in addition to traditional
medical responders to suspected cases of OHCA in Stockholm from December
2005 to December 2006. 863 OHCA patients were enrolled during the
intervention and 657 OHCA from 2004 served as historical controls. Among
dual dispatches, fire-fighters assisted with CPR in 94% of cases and
arrived first on scene in 36% of cases. The median time from call to
arrival of first responder decreased from 7.5 to 7.1 minutes (p=0.004).
1-month survival rose from 4.4% to 6.8% (p=0.047; adjusted OR: 1.6; 95%
C.I: 0.9-2.9). 1-month survival among witnessed cases of OHCA rose from
5.7% to 9.7% (p=0.029; adjusted OR: 2.0; 95% C.I: 1.1-3.7).
Conclusions: Survival after OHCA was significantly lower in Stockholm
than in Göteborg during 2000-2002 and this difference was associated with
pre-hospital factors only rather than with in-hospital factors or patient
characteristics. Survival after OHCA in Sweden increased significantly
from 1992 to 2005. The increase was particularly marked among patients
found with a shockable rhythm and is associated with an increase in the
proportion of crew-witnessed cases and, to a lesser degree, an increase
in bystander CPR. A dual dispatch early defibrillation program in
Stockholm has decreased response times and is likely to have improved
survival in patients with OHCA. This increase in survival is believed to
be associated with improved CPR and shortened time intervals.
List of papers:
I. Hollenberg J, Bång A, Lindqvist J, Herlitz J, Nordlander R, Svensson L, Rosenqvist M (2005). "Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?" J Intern Med 257(3): 247-54
Pubmed
II. Hollenberg J, Lindqvist J, Ringh M, Engdahl J, Bohm K, Rosenqvist M, Svensson L (2007). "An evaluation of post-resuscitation care as a possible explanation of a difference in survival after out-of-hospital cardiac arrest." Resuscitation 74(2): 242-52. Epub 2007 Mar 23
Pubmed
III. Hollenberg J, Herlitz J, Lindqvist J, Riva G, Bohm K, Rosenqvist M, Svensson L (2008). "Improved survival after out-of-hospital cardiac arrest associated with an increase in proportion of crew-witnessed cases and bystander CPR." (Submitted)
IV. Hollenberg J, Riva G, Bohm K, Larsen R, Herlitz J, Pettersson H, Rosenqvist M, Svensson L (2008). "Dual dispatch early defibrillation program in out-of-hospital cardiac arrest the SALSA-project." (Submitted)
I. Hollenberg J, Bång A, Lindqvist J, Herlitz J, Nordlander R, Svensson L, Rosenqvist M (2005). "Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?" J Intern Med 257(3): 247-54
Pubmed
II. Hollenberg J, Lindqvist J, Ringh M, Engdahl J, Bohm K, Rosenqvist M, Svensson L (2007). "An evaluation of post-resuscitation care as a possible explanation of a difference in survival after out-of-hospital cardiac arrest." Resuscitation 74(2): 242-52. Epub 2007 Mar 23
Pubmed
III. Hollenberg J, Herlitz J, Lindqvist J, Riva G, Bohm K, Rosenqvist M, Svensson L (2008). "Improved survival after out-of-hospital cardiac arrest associated with an increase in proportion of crew-witnessed cases and bystander CPR." (Submitted)
IV. Hollenberg J, Riva G, Bohm K, Larsen R, Herlitz J, Pettersson H, Rosenqvist M, Svensson L (2008). "Dual dispatch early defibrillation program in out-of-hospital cardiac arrest the SALSA-project." (Submitted)
Issue date: 2008-05-02
Rights:
Publication year: 2008
ISBN: 978-91-7409-027-7
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