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Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?

https://arctichealth.org/en/permalink/ahliterature11388
Source
Resuscitation. 1995 Jun;29(3):195-201
Publication Type
Article
Date
Jun-1995
Author
J. Herlitz
L. Ekström
B. Wennerblom
A. Axelsson
A. Bång
S. Holmberg
Author Affiliation
Division of Cardiology, Sahlgrenska Hospital, Göteborg, Sweden.
Source
Resuscitation. 1995 Jun;29(3):195-201
Date
Jun-1995
Language
English
Publication Type
Article
Keywords
Aged
Cardiopulmonary Resuscitation
Case-Control Studies
Comparative Study
Emergencies
Emergency medical services
Epinephrine - therapeutic use
Female
Heart Arrest - drug therapy - mortality - therapy
Humans
Male
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Ventricular Fibrillation - drug therapy - mortality - therapy
Abstract
BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role of treatment with adrenaline in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with adrenaline prior to hospital admission. PATIENTS AND TREATMENT: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1981 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1360 patients were found in ventricular fibrillation and detailed information was available in 1203 cases (88%). Adrenaline was given in 417 cases (35%). Among patients with sustained ventricular fibrillation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P
PubMed ID
7667549 View in PubMed
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Ambulance despatchers' estimation of intensity of pain and presence of associated symptoms in relation to outcome in patients who call for an ambulance because of acute chest pain.

https://arctichealth.org/en/permalink/ahliterature54720
Source
Eur Heart J. 1995 Dec;16(12):1789-94
Publication Type
Article
Date
Dec-1995
Author
J. Herlitz
A. Bång
L. Isaksson
T. Karlsson
Author Affiliation
Division of Cardiology, Sahlgrenska Hospital, University of Göteborg, Sweden.
Source
Eur Heart J. 1995 Dec;16(12):1789-94
Date
Dec-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ambulances
Chest Pain - classification - etiology - mortality
Death, Sudden, Cardiac - epidemiology - etiology
Female
Humans
Male
Middle Aged
Myocardial Infarction - diagnosis - mortality
Pain Measurement
Risk factors
Survival Analysis
Sweden - epidemiology
Abstract
BACKGROUND: A large number of patients who call for an ambulance because of acute chest pain have an acute ischaemic event, but some do not. AIM. To relate the ambulance despatcher's estimated severity of pain and presence of associated symptoms, in patients who call for an ambulance because of acute chest pain, to whether they develop acute myocardial infarction (AMI) and to the risk of early death. PATIENTS: All those with acute chest pain who contacted the despatch centre in Göteborg over a 2-month period. RESULTS: In all, 503 patients fulfilled the inclusion criteria. Patients judged as having severe chest pain (68%) developed AMI during the first 3 days in hospital on 26% of occasions as compared with 13% among patients judged as having only vague chest pain (P = 0.0004). The difference was less marked among the elderly and women. The presence of any of the following associated symptoms, dyspnoea, nausea, vertigo, cold sweat or syncope, tended to be associated with a higher infarction rate (24%) than if none of these symptoms was present (17%, P = 0.06). Mortality during the pre-hospital and the hospital phase was not associated with the estimated severity of pain or the presence of associated symptoms. CONCLUSIONS: The despatcher's estimation of the severity of pain and the presence of associated symptoms appears to be associated with the development of AMI but not with early mortality.
Notes
Comment In: Eur Heart J. 1995 Dec;16(12):1747-88681995
PubMed ID
8682008 View in PubMed
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Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden.

https://arctichealth.org/en/permalink/ahliterature29973
Source
Resuscitation. 2005 Jan;64(1):37-40
Publication Type
Article
Date
Jan-2005
Author
J. Herlitz
J. Engdahl
L. Svensson
M. Young
K-A Angquist
S. Holmberg
Author Affiliation
Division of Cardiology, Sahlgrenska University Hospital, Göteborg SE-41345, Sweden. johan.herlitz@hjl.gu.se
Source
Resuscitation. 2005 Jan;64(1):37-40
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Child
Emergency Medical Services - statistics & numerical data
Female
Heart Arrest - diagnosis - epidemiology - therapy
Humans
Male
Multivariate Analysis
Outcome Assessment (Health Care)
Prognosis
Resuscitation - statistics & numerical data
Risk factors
Survival Analysis
Sweden - epidemiology
Abstract
AIM: To evaluate the characteristics, outcome and prognostic factors among children suffering from out of hospital cardiac arrest in Sweden. METHODS: Patients aged below 18 years suffering from out of hospital cardiac arrest which were not crew witnessed and included in the Swedish cardiac arrest registry were included in the survey. This survey included the period 1990-2001 and 60 ambulance organisations covering 85% of the Swedish population (8 million inhabitants). RESULTS: In all 457 children participated in the survey of which 32% were bystander witnessed and 68% received bystander CPR. Ventricular fibrillation was found in 6% of the cases. The overall survival to 1 month was 4%. The aetiology was sudden infant death syndrome in 34% and cardiac in 11%. When in a multivariate analysis considering age, sex, witnessed status, bystander CPR, initial rhythm, aetiology and the interval between call for, and arrival of, the ambulance and place of arrest only one appeared as an independent predictor of an increased chance of surviving cardiac arrest occurring outside home (adjusted odds ratio 8.7; 95% CL 2.2-58.1). CONCLUSION: Among children suffering from out of hospital cardiac arrest in Sweden that were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.
PubMed ID
15629553 View in PubMed
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Characteristics and outcome among patients having out of hospital cardiac arrest at home compared with elsewhere.

https://arctichealth.org/en/permalink/ahliterature31287
Source
Heart. 2002 Dec;88(6):579-82
Publication Type
Article
Date
Dec-2002
Author
J. Herlitz
M. Eek
M. Holmberg
J. Engdahl
S. Holmberg
Author Affiliation
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. johan.herlitz@hjl.gu.se
Source
Heart. 2002 Dec;88(6):579-82
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation - methods
Child
Child, Preschool
Comparative Study
Emergency Medical Services - statistics & numerical data
Female
Heart Arrest - mortality - therapy
Humans
Infant
Infant, Newborn
Male
Middle Aged
Multivariate Analysis
Prognosis
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden - epidemiology
Abstract
OBJECTIVE: To describe the characteristics and outcome of patients who have a cardiac arrest at home compared with elsewhere out of hospital. PATIENTS: Subjects were patients included in the Swedish cardiac arrest registry between 1990 and 1999. The registry covers about 60% of all ambulance organisations in Sweden. METHODS: The study sample comprised patients reached by the ambulance crew and in whom resuscitation was attempted out of hospital. There was no age limit. Crew witnessed cases were excluded. The patients were divided into two groups: cardiac arrest at home and cardiac arrest elsewhere. RESULTS: Among a study population of 24 630 patients the event took place at home in 16 150 (65.5%). Those in whom the arrest took place at home differed from the remainder in that they were older, were more often women, less often had a witnessed cardiac arrest, were less often exposed to bystander cardiopulmonary resuscitation (CPR), were less often found in ventricular fibrillation, and had a longer interval between collapse and call for ambulance, arrival of ambulance, start of CPR, and first defibrillation. Of patients in whom the arrest took place at home, 11.3% were admitted to hospital alive, v 19.4% in the elsewhere group (p
PubMed ID
12433883 View in PubMed
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Characteristics and outcome among patients suffering in-hospital cardiac arrest in monitored and non-monitored areas.

https://arctichealth.org/en/permalink/ahliterature32112
Source
Resuscitation. 2001 Feb;48(2):125-35
Publication Type
Article
Date
Feb-2001
Author
J. Herlitz
A. Bång
S. Aune
L. Ekström
G. Lundström
S. Holmberg
Author Affiliation
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. johan.herlitz@hjl.gu.se
Source
Resuscitation. 2001 Feb;48(2):125-35
Date
Feb-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation - methods - mortality
Cause of Death
Child
Comparative Study
Female
Heart Arrest - epidemiology - etiology - therapy
Hospitalization
Humans
Male
Middle Aged
Monitoring, Physiologic - methods
Multivariate Analysis
Myocardial Infarction - complications - epidemiology - therapy
Probability
Proportional Hazards Models
Prospective Studies
Reference Values
Research Support, Non-U.S. Gov't
Risk factors
Sex Distribution
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Abstract
AIM: To describe the characteristics and outcome among patients suffering in-hospital cardiac arrest in relation to whether the arrest took place in a ward with monitoring facilities. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4-year period in Sahlgrenska Hospital, Göteborg, Sweden and in whom resuscitative efforts were attempted, were prospectively recorded and described in terms of characteristics and outcome. RESULTS: Among 557 patients, 292 (53%) had a cardiac arrest in wards with monitoring facilities. Those in a monitored location more frequently had a confirmed or possible acute myocardial infarction (AMI) as judged to be the cause of arrest (P
PubMed ID
11426474 View in PubMed
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Comparison of medical care and one- and 12-month mortality of hospitalized patients with acute myocardial infarction in Minneapolis-St. Paul, Minnesota, United States of America and Göteborg, Sweden.

https://arctichealth.org/en/permalink/ahliterature54472
Source
Am J Cardiol. 1997 Sep 1;80(5):557-62
Publication Type
Article
Date
Sep-1-1997
Author
P G McGovern
J. Herlitz
J S Pankow
T. Karlsson
M. Dellborg
E. Shahar
R V Luepker
Author Affiliation
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA.
Source
Am J Cardiol. 1997 Sep 1;80(5):557-62
Date
Sep-1-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Comparative Study
Delivery of Health Care - statistics & numerical data
Female
Hospitalization
Humans
Male
Middle Aged
Minnesota - epidemiology
Myocardial Infarction - diagnosis - mortality - therapy
Research Support, U.S. Gov't, P.H.S.
Survival Analysis
Sweden - epidemiology
Thrombolytic Therapy
Abstract
We compared medical care and mortality through 1-year of hospitalized acute myocardial infarction (AMI) patients in 2 large metropolitan areas in the United States and Sweden. All hospitalized AMI discharges (International Classification of Diseases, 9th revision [ICD9] codes 410) occurring among 30 to 74-year-old residents of the Minneapolis-St. Paul metropolitan area in 1990 and Göteborg, Sweden, in 1990 to 1991 were identified and their medical records examined. There were dramatic differences in medical care during the index hospitalization of AMI patients between Minneapolis-St. Paul and Göteborg. Use of thrombolytic therapy, coronary angioplasty, bypass surgery, calcium antagonists and lidocaine was more common in Minneapolis-St. Paul; beta blockers were more frequently used in Göteborg, and aspirin use was similar. Despite these large differences, neither 28-day nor 1-year mortality of hospitalized AMI patients differed significantly. The marked differences found in the early treatment of AMI between Minneapolis-St. Paul and Göteborg, combined with the negligible differences observed in short- and long-term mortality, raise questions about the most effective and efficient allocation of medical resources.
PubMed ID
9294981 View in PubMed
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Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?

https://arctichealth.org/en/permalink/ahliterature51905
Source
J Intern Med. 2005 Mar;257(3):247-54
Publication Type
Article
Date
Mar-2005
Author
J. Hollenberg
A. Bång
J. Lindqvist
J. Herlitz
R. Nordlander
L. Svensson
M. Rosenqvist
Author Affiliation
Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden. jacob.hollenberg@sos.ki.se
Source
J Intern Med. 2005 Mar;257(3):247-54
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Ambulances
Cardiopulmonary Resuscitation - mortality
Comparative Study
Female
Heart Arrest - complications - mortality
Humans
Incidence
Male
Retrospective Studies
Survival Analysis
Sweden - epidemiology
Time Factors
Transportation of Patients
Ventricular Fibrillation - complications - mortality
Abstract
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. SETTING: All patients suffering an OHCA in Stockholm and Goteborg between 1 January 2000 and 30 June 2001, in whom cardiopulmonary resuscitation (CPR) was attempted were included in this retrospective analysis. RESULTS: All together, 969 OHCA in Stockholm and 398 in Goteborg were registered during the 18-month study period. There were no differences in terms of age, gender, and percentage of witnessed cases or percentage of patients who had received bystander CPR. However, the percentage of patients with ventricular fibrillation (VF) at arrival of the ambulance crew was 18% in Stockholm versus 31% in Goteborg (P
PubMed ID
15715681 View in PubMed
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Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden.

https://arctichealth.org/en/permalink/ahliterature54033
Source
Resuscitation. 2000 Sep;47(1):59-70
Publication Type
Article
Date
Sep-2000
Author
M. Holmberg
S. Holmberg
J. Herlitz
Author Affiliation
Department of Cardiology, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden. mholmberg50@hotmail.com
Source
Resuscitation. 2000 Sep;47(1):59-70
Date
Sep-2000
Language
English
Publication Type
Article
Keywords
Cardiopulmonary Resuscitation
Electrocardiography
Health Personnel
Heart Arrest - physiopathology - therapy
Hospitalization
Humans
Incidence
Odds Ratio
Prospective Studies
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden
Time Factors
Treatment Outcome
Ventricular Fibrillation - epidemiology
Abstract
BACKGROUND: Information from the Swedish Cardiac Arrest Registry was used to investigate: (a) The proportion of patients suffering an out-of-hospital cardiac arrest who were given bystander cardiopulmonary resuscitation (B-CPR). (b) Where and by whom B-CPR was given. (c) The effect of B-CPR on survival. METHOD: a prospective, observational study of cardiac arrests reported to the Swedish Cardiac Arrest Registry. Analyses were based on standardised reports of out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. From 1983 to 1995 approximately 15-20% of the population had been trained in CPR. RESULTS: Of 9877 patients, collected between January 1990 and May 1995, B-CPR was attempted in 36%. In 56% of these cases, the bystanders were lay persons and in 25% they were medical personnel. Most of the arrests took place at home (69%) and only 23% of these patients were given B-CPR in contrast to cardiac arrest in other places where 53% were given CPR. Survival to 1 month was significantly higher in all cases that received B-CPR (8.2 vs. 2.5%). The odds ratio for survival to 1 month with B-CPR was in a logistic regression analysis 2.5 (95% CI 1.9-3.1). CONCLUSIONS: In Sweden, the willingness and ability to perform B-CPR appears to be relatively widespread. More than half of B-CPR was performed by laypersons. B-CPR resulted in a two to threefold increase in survival.
PubMed ID
11004382 View in PubMed
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Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg, Sweden.

https://arctichealth.org/en/permalink/ahliterature31232
Source
Heart. 2003 Jan;89(1):25-30
Publication Type
Article
Date
Jan-2003
Author
J. Herlitz
A. Bång
J. Gunnarsson
J. Engdahl
B W Karlson
J. Lindqvist
L. Waagstein
Author Affiliation
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. johan.herlitz@hjl.gu.se
Source
Heart. 2003 Jan;89(1):25-30
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation - methods - statistics & numerical data
Child
Child, Preschool
Emergency Medical Services - organization & administration - statistics & numerical data
Emergency Service, Hospital - organization & administration - statistics & numerical data
Epidemiologic Methods
Female
Health status
Heart Arrest - mortality - therapy
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Middle Aged
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden - epidemiology
Time Factors
Urban health
Abstract
OBJECTIVE: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive. PATIENTS: All patients hospitalised alive in the community of Göteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included. METHODS: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded. Patients were divided into two groups (the first and second 10 year periods). SETTING: Community of Göteborg, Sweden. RESULTS: 5505 patients suffered from cardiac arrest during the time of the survey. Among them 1310 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% CI 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% CI 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% CI 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% CI 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% CI 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% CI 0.47 to 0.88); atropine required in the emergency department (OR 0.35, 95% CI 0.16 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0.59, 95% CI 0.43 to 0.81). CONCLUSION: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine in the emergency department, and chronic treatment with diuretics before cardiac arrest.
PubMed ID
12482785 View in PubMed
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Five-year mortality after acute myocardial infarction in relation to previous history, level of initial care, complications in hospital, and medication at discharge.

https://arctichealth.org/en/permalink/ahliterature48264
Source
Cardiovasc Drugs Ther. 1996 Sep;10(4):485-90
Publication Type
Article
Date
Sep-1996
Author
J. Herlitz
A. Bång
M. Sjölin
B W Karlson
Author Affiliation
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Source
Cardiovasc Drugs Ther. 1996 Sep;10(4):485-90
Date
Sep-1996
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Adult
Age Factors
Aged
Diabetes Complications
Female
Follow-Up Studies
Heart Failure, Congestive - complications
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - complications - drug therapy - mortality
Questionnaires
Risk factors
Survival Analysis
Sweden
Abstract
The purpose of this study was to describe the prognosis during 5 years of follow-up in a consecutive population of patients discharged from hospital after acute myocardial infarction (AMI) in relation to clinical history, level of initial care, complications during hospitalization, and medication at discharge. All patients admitted to a single hospital from February 15, 1986 to November 9, 1987 due to AMI, regardless of age and whether or not they were treated in the coronary care unit, and who were discharged alive from hospital were included in the study. There were 862 patients with AMI, 740 of whom were discharged alive. Information on medication at discharge was available in 713 patients (96%). In a multivariate analysis taking into account age, sex, history of cardiovascular diseases, whether patients were admitted to coronary care unit or not, complications during hospitalization, and medication at discharge, the following factors appeared to be independent predictors of mortality: age (p
PubMed ID
8924064 View in PubMed
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21 records – page 1 of 3.