Solveig Aune

CHARACTERISTICS AND OUTCOME AMONG PATIENTS SUFFERING FROM IN HOSPITAL CARDIAC ARREST IN RELATION TO WHETHER THE ARREST TOOK PLACE DURING OFFICE HOURS

AIM To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. PATIENTS All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. METHODS Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. RESULTS Among patients in whom the arrest took place during office hours (08:00-16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients (P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% (P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40-3.06) as compared with patients who had an arrest outside office hours. CONCLUSION Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.

Cardiac arrest outside and inside hospital in a community: Mechanisms behind the differences in outcome and outcome in relation to time of arrest

BACKGROUND The aim was to compare characteristics and outcome after cardiac arrest where cardiopulmonary resuscitation was attempted outside and inside hospital over 12 years. METHODS All out-of-hospital cardiac arrests (OHCAs) in Göteborg between 1994 and 2006 and all in-hospital cardiac arrests (IHCAs) in 1 of the citys 2 hospitals for whom the rescue team was called between 1994 and 2006 were included in the survey. RESULTS The study included 2,984 cases of OHCA and 1,478 cases of IHCA. Patients with OHCA differed from those with an IHCA; they were younger, included fewer women, were less frequently found in ventricular fibrillation, and were treated later. If patients were found in a shockable rhythm, survival to 1 month/discharge was 18% after OHCA and 61% after IHCA (P < .0001). Corresponding values for a nonshockable rhythm were 3% and 21% (P < .0001). Survival was higher on daytime and weekdays as compared with nighttime and weekends after IHCA but not after OHCA. Among patients found in a shockable rhythm, a multivariate analysis considering age, gender, witnessed status, delay to defibrillation, time of day, day of week, and location showed that IHCA was associated with increased survival compared with OHCA (adjusted odds ratio 3.18, 95% CI 2.07-4.88). CONCLUSION Compared with OHCA, the survival of patients with IHCA increased 3-fold for shockable rhythm and 7-fold for nonshockable rhythm in our practice setting. If patients were found in a shockable rhythm, the higher survival after IHCA was only partly explained by a shorter treatment delay. The time and day of CA were associated with survival in IHCA but not OHCA.

A 20-year perspective of in hospital cardiac arrest: Experiences from a university hospital with focus on wards with and without monitoring facilities

BACKGROUND Knowledge about change in the characteristics and outcome of in hospital cardiac arrests (IHCAs) is insufficient. AIM To describe a 20year perspective of in hospital cardiac arrest (IHCA) in wards with and without monitoring capabilities. SETTINGS Sahlgrenska University Hospital (800 beds). The number of beds varied during the time of survey from 850-746 TIME: 1994-2013. METHODS Retrospective registry study. Patients were assessed in four fiveyear intervals. INCLUSION CRITERIA Witnessed and nonwitnessed IHCAs when cardiopulmonary resuscitation (CPR) was attempted. EXCLUSION CRITERIA Age below 18years. RESULTS In all, there were 2340 patients with IHCA during the time of the survey. 30-Day survival increased significantly in wards with monitoring facilities from 43.5% to 55.6% (p=0.002) for trend but not in wards without such facilities (p=0.003 for interaction between wards with/without monitoring facilities and time period). The CPC-score among survivors did not change significantly in any of the two types of wards. In wards with monitoring facilities there was a significant reduction of the delay time from collapse to start of CPR and an increase in the proportion of patients who were defibrillated before the arrival of the rescue team. In wards without such facilities there was a significant reduction of the delay from collapse to defibrillation. However, the latter observation corresponds to a marked decrease in the proportion of patients found in ventricular fibrillation. CONCLUSION In a 20year perspective the treatment of in hospital cardiac arrest was characterised by a more rapid start of treatment. This was reflected in a significant increase in 30-day survival in wards with monitoring facilities. In wards without such facilities there was a decrease in patients found in ventricular fibrillation.

Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden – A population-based register study of more than 18,000 cases

BACKGROUND AND OBJECTIVE In-hospital cardiac arrest (IHCA) constitutes a major contributor to cardiovascular mortality. The aim of the present study was to investigate factors of importance to 30-day survival after IHCA in Sweden. METHODS A retrospective register study based on the Swedish Register of Cardiopulmonary Resuscitation (SRCPR) 2006-2015. Sixty-six of 73 hospitals in Sweden participated. The inclusion criterion was a confirmed cardiac arrest in which resuscitation was attempted among patients aged >18years. RESULTS In all, 18,069 patients were included, 39% of whom were women. The median age was 75years. Thirty-day survival was 28.3%, 93% with a CPC score of 1-2. One-year survival was 25.0%. Overall IHCA incidence in Sweden was 1.7 per 1000 hospital admissions. Several factors were found to be associated with 30-day survival in a multivariable analysis. They included cardiac arrest (CA) at working days during the daytime (08-20) compared with weekends and night-time (20-08) (OR 1.51 95% CI 1.39-1.64), monitored CA (OR 2.18 95% CI 1.99-2.38), witnessed CA (OR 2.87 95% CI 2.48-3.32) and if the first recorded rhythm was ventricular fibrillation/tachycardia, especially in combination with myocardial ischemia/infarction as the assumed aetiology of the CA (OR for interaction 4.40 95% CI 3.54-5.46). CONCLUSION 30-day survival after IHCA is associated with the time of the event, the aetiology of the CA and the degree of monitoring and this should influence decisions regarding the appropriate level of monitoring and care.

Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age

Aim To investigate characteristics and outcome among patients suffering in‐hospital cardiac arrest (IHCA) with the emphasis on gender and age. Methods Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co‐morbidities, etiology, management, 30‐day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18–49 years), middle‐aged (50–64 years) and older (65 years and above). Comparisons between men and women were age adjusted. Results The mean age was 72.7 years and women were significantly older than men. Renal dysfunction was the most prevalent co‐morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30‐day survival but not with poorer cerebral function among survivors. Conclusion When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days after in‐hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

Evaluation of 2 different instruments for exposing the chest in conjunction with a cardiac arrest

BACKGROUND Time between onset of cardiac arrest and start of treatment is of ultimate importance for outcome. The length of time it takes to expose the chest in out-of-hospital cardiac arrest (OHCA) is not known. We aimed to compare the time from onset of OHCA until the time at which the chest was exposed using a new device (S-CUT; ES Equipment, Gothenburg, Sweden) and a pair of scissors. METHODS In a manikin study, the 2 devices were compared in a simulated cardiac arrest where the initial step was exposure of the chest. The tests were performed using ambulance staff from 3 different ambulance organizations in Western Sweden. Six different types of clothing combinations were used. The primary choices of clothing for analyses were a knitted sweater and shirt (indoors) and a jacket with buttons, a shirt, and a college sweater (outdoors). RESULTS The mean difference from onset of OHCA until the chest was exposed when S-CUT was compared with a pair of scissors varied between 6 seconds (P = .006) and 63 seconds (P = .004; shorter with the S-CUT), depending on the type of clothing that was used. The mean differences for the clothing that was chosen for primary analyses were 23 and 63 seconds, respectively. CONCLUSION We found that a new device (S-CUT) used for exposing the chest in OHCA was associated with a marked shortening of procedure time as compared with a pair of scissors.

Epidemiology of cardiac arrest outside and inside hospital experiences from registries in Sweden.

Cardiac arrest is a dramatic condition leading to sudden death if someone cannot perform two interventions, basic life sup-port and early defibrillation, that have been proved to improve long-term survival. The ‘Utstein style’, recently introduced, represents a standard of practice both inside and outside hospital with recommended guidelines for the uniform reporting of clinical data from the patient suffering cardiac arrest. In Sweden the vast majority of patients suffering from cardiac arrest regardless whether inside or outside hospital are included in webbased national registers (one for out-of-hospital cardiac arrest (OHCA) and one for in-hospital-cardiac arrest (IHCA)). In this article we will present our experiences from OHCA and IHCA separately.

Measurements of time intervals after in-hospital cardiac arrest give important information but can be further improved

Measurements of time intervals after in-hospital cardiac arrest give important information but can be further improved.

European cardiovascular nurses and allied professions practical skills in cardiopulmonary resuscitation

Purpose: Approximately 10 000 people in Sweden suffer from sudden cardiac arrest outside the hospital each year. Cardiopulmonary resuscitation (CPR) is started in about half of the cases. Treatment ...Background: Chest pain is one of the most common reasons for hospital admissions and more than 50 % of the patients admitted are diagnosed as non-cardiac and discharged without a clear explanation ...The purpose was to investigate how a negative life event (NLE) affects perceived psychosocial stress, recovery and running economy (RE). Competitive runners were monitored in a prospective non-experimental cohort study over one full training season in which they experienced the same unplanned severe NLE. Sixteen runners recorded stress and recovery scores (RESTQ-Sport) every week. The average scores over 3 weeks before the NLE were used as a baseline and were compared to scores during the week of the NLE (week 0), week 1and week 2. Seven runners completed a submaximal treadmill test before and after the NLE. Repeated measures ANOVA’s revealed that most scores on general stress scales were increased in week 0 and 1. Of the general recovery scales, “general well-being” was decreased in week 0 and 1, “social” and “physical recovery” were decreased in week 0. No changes in the sport-specific stress scales were found. However, two of the sport-specific recovery scales were decreased in week 0. An impaired RE was shown 3 weeks after the NLE. Therefore, it is important to know what is going on in an athlete’s life, because stressful life events alter RE after the stress and recovery already returned to normal levels.