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  • 1.
    Djarv, T.
    et al.
    Karolinska University Hospital, Sweden;Karolinska Institutet, Sweden.
    Axelsson, C.
    University of Borås, Sweden.
    Herlitz, J.
    Karolinska Institutet, Sweden;University of Borås, Sweden.
    Stromsoe, A.
    Mälardalen University, Sweden.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Claesson, A.
    Karolinska Institutet, Sweden;University of Borås, Sweden.
    Traumatic cardiac arrest in Sweden 1990-2016: a population-based national cohort study2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, article id 30Article in journal (Refereed)
    Abstract [en]

    Background: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA). Methods: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used. Results: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p < 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively). Discussion: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR. C onclusion: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

  • 2.
    Herlitz, Johan
    et al.
    University of Borås, Sweden;Sahlgrenska University Hospital, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Wireklint-Sundström, Birgitta
    University of Borås, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Hagiwara, Magnus
    University of Borås, Sweden.
    Jonsson, Anders
    University of Borås, Sweden.
    Lundberg, Lars
    University of Borås, Sweden.
    Suserud, Björn-Ove
    University of Borås, Sweden.
    Ljungström, Lars
    Skövde Central Hospital, Sweden.
    Suspicion and treatment of severe sepsis: An overview of the prehospital chain of care2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, no 42Article in journal (Refereed)
    Abstract [en]

    Background

    Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis.

    Aim

    To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis.

    Methods

    A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.

    Results

    In overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis.Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT.There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers.

    Conclusion

    Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

  • 3.
    Lindstrom, Veronica
    et al.
    Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet.
    Bohm, Katarina
    Karolinska Institutet.
    Castren, Maaret
    Karolinska Institutet.
    Falk, Ann-Charlotte
    Karolinska Institutet.
    Barriers and opportunities in assessing calls to emergency medical communication centre: a qualitative study2014In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, article id 61Article in journal (Refereed)
    Abstract [en]

    Introduction: Previous studies have described the difficulties and the complexity of assessing an emergency call, and assessment protocols intended to support the emergency medical dispatcher's (EMD) assessment have been developed and evaluated in recent years. At present, the EMD identifies about 50-70 % of patients suffering from cardiac arrest, acute myocardial infarction or stroke. The previous research has primarily been focused on specific conditions, and it is still unclear whether there are any overall factors that may influence the assessment of the call to the emergency medical communication centre (EMCC). Aim: The aim of the study was to identify overall factors influencing the registered nurses' (RNs) assessment of calls to the EMCC. Method: A qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis. Results: One hundred calls to the EMCC were analysed. Barriers and opportunities related to the RN or the caller were identified as the main factors influencing the RN's assessment of calls to the EMCC. The opportunities appeared in the callers' symptom description and the communication strategies used by the RN. The barriers appeared in callers' descriptions of unclear symptoms, paradoxes and the RN's lack of communication strategies during the call. Conclusion: Barriers in assessing the call to the EMCC were associated with contradictory information, the absence of a primary problem, or the structure of the call. Opportunities were associated with a clear symptom description that was also repeated, and the RN's use of different communication strategies such as closed loop communication.

  • 4.
    Strandmark, Rasmus
    et al.
    Sahlgrenska University Hospital, Sweden.
    Herlitz, Johan
    Sahlgrenska University Hospital, Sweden;University of Borås, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Claesson, Andreas
    Karolinska Institutet, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Jimenez-Herrera, Maria
    Universitat Rovira i Virgili, Spain.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital, Sweden.
    Determinants of pre-hospital pharmacological intervention and its association with outcome in acute myocardial infarction2015In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 105Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was a) To identify predictors of the use of aspirin in the pre-hospital setting in acute myocardial infarction (AMI) and b) To analyze whether the use of any of the recommended medications was associated with outcome.

    Methods: All patients with a final diagnosis of AMI, transported by the Emergency Medical Services (EMS) and admitted to the coronary care unit at Sahlgrenska University Hospital in Gothenburg, Sweden, in 2009–2011, were included.

    Results: 1,726 patients were included. 58 % received aspirin by the EMS. Ischemic heart disease (IHD) was suspected in 84 %. Among patients who did not receive aspirin IHD was still suspected in 67 %. Among patients in whom IHD was suspected, and who were not on chronic treatment with aspirin the following predicted its pre-hospital use: a) age (odds ratio 0.98; 95 % confidence interval (CI) 0.96–0.99); b) a history of myocardial infarction (2.21; 1.21–4.04); c) priority given by EMS (8.07; 5.42–12.02); d) ST-elevation on ECG on admission to hospital (2.22; 1.50–3.29); e) oxygen saturation > 90 % (3.37; 1.81–6.27). After adjusting for confounders among patients who were not on chronic aspirin, only nitroglycerin of the recommended medications was associated with a reduced risk of death within 1 year (hazard ratio 0.40; 95 % CI 0.23–0.70).

    Conclusions: Less than six out of ten patients with AMI received pre-hospital aspirin. Five clinical factors were independently associated with the pre-hospital administration of aspirin. This suggests that the decision to treat is multifactorial, and it highlights the lack of accurate diagnostic tools in the pre-hospital environment. Nitroglycerin was independently associated with a reduced risk of death, suggesting that we select the use for a low-risk cohort.

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