M. Rosenqvist

Adverse Events With Transvenous Implantable Cardioverter-Defibrillators A Prospective Multicenter Study

BACKGROUND A newly developed classification system relates adverse events to the surgical procedure or the function of the implantable defibrillator. METHODS AND RESULTS Adverse events were monitored during prospective clinical evaluation of the Medtronic model 7219 Jewel ICD and were classified according to the definitions of the ISO 14155 standard for device clinical trials into 3 groups: severe and mild device-related and severe non-device-related adverse events. In addition, events were related to the surgical procedure, treatment with the device, or cardiac function. Seven hundred seventy-eight patients were followed up for an average of 4.0 months after ICD implantation. In total, 356 adverse events were observed in 259 patients. At 1, 3, and 12 months after ICD implantation, 99%, 98%, and 97% of the patients, respectively, survived; 95%, 93%, and 92%, respectively, were free of surgical reintervention; and 79%, 68%, and 51%, respectively, were free of any adverse event. Twenty patients died: 6 deaths were related to the surgical procedure, 12 deaths were considered unrelated to ICD treatment, and 2 patients died of an unknown cause. Of 111 nonlethal severe adverse device effects, 47 required surgical intervention, 19 times for correction of a dislodged lead. Inappropriate delivery of therapy was observed 128 times in 111 patients, and the events were typically resolved by reprogramming or drug adjustment. Nine of these required rehospitalization. CONCLUSIONS Approximately 50% of patients experience an adverse event within the first year after ICD implantation. The observed adverse event rate depends on the definitions and the prospective monitoring. The incidence of inappropriate therapy emphasizes the need for improved detection algorithms and for quality-of-life evaluations, especially when considering ICD treatment in high-risk but arrhythmia-free patients.

Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew--witnessed cases and bystander cardiopulmonary resuscitation.

Background— Out-of-hospital cardiac arrest (OHCA) is a major public health problem. We sought to describe changes in 1-month survival after OHCA in patients given cardiopulmonary resuscitation (CPR) during the last 14 years in Sweden. Methods and Results— All patients experiencing OHCA in whom CPR was attempted between 1992 and 2005 and who were reported to the Swedish Cardiac Arrest Register were included in the study. In all, 38 646 patients were included in this survey. The proportion of patients who were admitted alive to a hospital increased from 15.3% in 1992 to 21.7% in 2005 (P for trend <0.0001). The corresponding values for patients being alive after 1 month were 4.8% and 7.3%, respectively (P for trend <0.0001). The increase in 1-month survival was particularly evident among patients found with a shockable rhythm (increase from 12.7% in 1992 to 22.3% in 2005; P for trend <0.0001). The corresponding figures for patients found with a nonshockable rhythm were 1.2% in 1992 and 2.3% in 2005 (P for trend=0.044). Factors that potentially contributed to the improved survival rate were an increase in emergency medical crew–witnessed cases from 9% in 1992 to 15% in 2005 (P for trend <0.0001) and, to a lesser degree, an increase in bystander CPR from 31% in 1992 to 50% in 2005 (P for trend <0.0001). After adjustment for potential risk factors, the increase in survival remained significant. Conclusions— We found a significant increase in survival after OHCA in Sweden over the last 14 years. The increase was particularly marked among patients found with a shockable rhythm and was associated with an increase in the proportion of crew-witnessed cases and, to a lesser degree, an increase in the performance of bystander CPR.

Survival Is Similar After Standard Treatment and Chest Compression Only in Out-of-Hospital Bystander Cardiopulmonary Resuscitation

Background— We sought to compare the 1-month survival rates among patients after out-of-hospital cardiac arrest who had been given bystander cardiopulmonary resuscitation (CPR) in relation to whether they had received standard CPR with chest compression plus mouth-to-mouth ventilation or chest compression only. Methods and Results— All patients with out-of-hospital cardiac arrest who received bystander CPR and who were reported to the Swedish Cardiac Arrest Register between 1990 and 2005 were included. Crew-witnessed cases were excluded. Among 11 275 patients, 73% (n=8209) received standard CPR, and 10% (n=1145) received chest compression only. There was no significant difference in 1-month survival between patients who received standard CPR (1-month survival=7.2%) and those who received chest compression only (1-month survival=6.7%). Conclusions— Among patients with out-of-hospital cardiac arrest who received bystander CPR, there was no significant difference in 1-month survival between a standard CPR program with chest compression plus mouth-to-mouth ventilation and a simplified version of CPR with chest compression only.

Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR.

OBJECTIVES Bystanders cardiopulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest (OHCA). Emergency medical dispatchers (EMDs) can provide even totally inexperienced bystanders with instructions by telephone on how to resuscitate victims (T-CPR) until the emergency medical services (EMS) arrive. Agonal respiration makes it difficult for EMDs to identify cardiac arrests (CAs) which will prevent or delay initiation of T-CPR. The aim of this investigation was to study if tuition of EMDs can improve their ability to identify agonal respiration in OHCA to allow for more frequent offers of T-CPR. METHODS An observational study was made in 2004 and subsequently, a repeat study was made in 2006. All OHCA (n=315 in 2004, n=255 in 2006) in the Stockholm region reported to the Swedish Cardiac Arrest Register were included and all corresponding EMS reports were reviewed. Emergency calls were recorded during the event. Witnessed cases of OHCA (n=76 in both 2004 and 2006) were analyzed using a structured data collection tool. RESULTS The frequency of offered T-CPR to all bystanders of OHCA in 2004 was 47%. After special tuition on agonal respiration in OHCA it rose to 68% in 2006 (p=0.01). An even more marked rise was observed in OHCA cases with agonal respiration. In 2004 T-CPR was offered in 23% of these situations whereas the corresponding figures in 2006 had risen to 56% (p=0.006). CONCLUSIONS Teaching EMDs to understand and recognize bystander descriptions of agonal respiration in patients with OHCA has resulted in a significant increase in offers of T-CPR in these situations.

Aspects on the increase in bystander CPR in Sweden and its association with outcome

AIM To describe changes in the proportion of bystanders performing cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) in Sweden and to study the impact of bystander CPR on ventricular fibrillation and on survival during various times. PATIENTS AND METHODS All patients who suffered from OHCA in Sweden in whom CPR was attempted and who were included in the Swedish cardiac arrest register (SCAR) between 1992 and 2005. Crew witnessed cases were excluded. RESULTS In all 34,125 patients were included in the survey. Among witnessed OHCA the proportion of patients receiving bystander CPR increased from 40% in 1992 to 55% in 2005 (p<0.0001). In non-witnessed OHCA the corresponding proportion increased from 22% to 44% (p<0.0001). There was a significant increase in bystander CPR regardless of age, sex and place. The increase was only found when CPR was performed by lay persons (21% in 1992 to 40% in 2005; p<0.0001). Bystander CPR was associated with an increased proportion of patients found in a shockable rhythm and a lower number of shocks to receive return of spontaneous circulation. Bystander CPR was associated with a similar increase in survival early and late in the evaluation. CONCLUSION There was a marked increase in bystander CPR in OHCA, when performed by lay persons, during the last 14 years in Sweden. Bystander CPR was associated with positive effects both on ventricular fibrillation and survival.

Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?

Background.  Dramatic differences in survival after out‐of‐hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome.

Long‐term prognosis in patients with bifascicular block – the predictive value of noninvasive and invasive assessment

Objectives.  Patients with bifascicular block (BFB) have a high mortality rate. The purpose of the present study was to identify high‐risk patients in a BFB population by performing an extensive cardiac evaluation including noninvasive and invasive tests.

Drones may be used to save lives in out of hospital cardiac arrest due to drowning

BACKGROUND Drowning leading to out-of-hospital cardiac arrest (OHCA) and death is a major public health concern. Submersion with duration of less than 10min is associated with favorable neurological outcome and nearby bystanders play a considerable role in rescue and resuscitation. Drones can provide a visual overview of an accident scene, their potential as lifesaving tools in drowning has not been evaluated. AIM The aim of this simulation study was to evaluate the efficiency of a drone for providing earlier location of a submerged possible drowning victim in comparison with standard procedure. METHOD This randomized simulation study used a submerged manikin placed in a shallow (<2m) 100×100-m area at Tylösand beach, Sweden. A search party of 14 surf-lifeguards (control) was compared to a drone transmitting video to a tablet (intervention). Time from start to contact with the manikin was the primary endpoint. RESULTS Twenty searches were performed in total, 10 for each group. The median time from start to contact with the manikin was 4:34min (IQR 2:56-7:48) for the search party (control) and 0:47min (IQR 0:38-0:58) for the drone-system (intervention) respectively (p<0.001). The median time saved by using the drone was 3:38min (IQR 2:02-6:38). CONCLUSION A drone transmitting live video to a tablet is feasible, time saving in comparison to traditional search parties and may be used for providing earlier location of submerged victims at a beach. Drone search can possibly contribute to earlier onset of CPR in drowning victims.

7 Dispatch of fire-fighters and police officers in out-of-hospital cardiac arrest: a nationwide prospective cohort trial

Aim Dual dispatch of cardiopulmonary resuscitation (CPR) -trained fire-fighters or police officers equipped with automated external defibrillators (AEDs) in addition to emergency medical services (EMS) in out-of-hospital cardiac arrest (OHCA) has in some minor cohort studies been associated with improved survival. The aim of this study was to evaluate the association between dual dispatch and survival in OHCA at a national level. Methods This prospective, cohort study was conducted January 1st, 2012, to December 31st, 2014. OHCA victims in nine Swedish counties covered by dual dispatch and resuscitation by first responders and EMSs were compared with a propensity-matched contemporary control group of OHCA victims in 12 counties where only EMS were dispatched. The primary outcome was survival to 30 days. Results 8698 OHCA were included of which 2786 in each group (intervention and control) were matched. The median time from emergency call to arrival of EMSs or first responder was nine minutes in the intervention group vs. ten minutes in the controls (p<0.001). The proportion of patients admitted alive to hospital was 31.4% in the intervention group versus 24.9% in the controls (adjusted OR 1.40, 95% CI 1.24–1.57). Thirty-day survival was 9.5% in the intervention group versus 7.7% in the controls (adjusted OR 1.27, 95% CI 1.05–1.54). Conclusion Dual dispatch of first responders in addition to EMSs in OHCA was associated with a moderate but significant increase in 30 day survival. References Myerburg RJ, Fenster J, Velez M, Rosenberg D, Lai S, Kurlansky P, Newton S, Knox M and Castellanos A. Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest. Circulation. 2002;106:1058–64. PMID: 12196329 Hollenberg J, Riva G, Bohm K, Nordberg P, Larsen R, Herlitz J, Pettersson H, Rosenqvist M and Svensson L. Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot dagger. European Heart Journal. 2009;30:1781–1789. doi:10.1093/eurheartj/ehp177. Malta Hansen C, Kragholm K, Pearson DA, Tyson C, Monk L, Myers B, Nelson D, Dupre ME, Fosbol EL, Jollis JG, Strauss B, Anderson ML, McNally B and Granger CB. Association of Bystander and First-Responder Intervention With Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010–2013. JAMA: the journal of the American Medical Association. 2015;314:255–64. doi: 10.1001/jama.2015.7938. Conflict of interest None declared. Funding The Swedish Heart–Lung Foundation, the National Board of Health and Welfare, and the Laerdal Foundation for Acute Medicine in Norway.