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      Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

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          Abstract

          ​Objective

          Cardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference.

          ​Methods

          Patients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome.

          ​Results

          In total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI).

          ​Conclusion

          Patients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.

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          Most cited references16

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          Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

          Three million people in Sweden are trained in cardiopulmonary resuscitation (CPR). Whether this training increases the frequency of bystander CPR or the survival rate among persons who have out-of-hospital cardiac arrests has been questioned.
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            Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in sweden.

            The chance of survival from ventricular fibrillation (VF) is up to ten times higher than those with other cardiac arrest rhythms. To calculate the effect of out-of-hospital resuscitation organisations on survival, it is necessary to know the percentage of cardiac arrest patients initially in VF and the relationship between delay time to defibrillation and survival. To study the incidence of VF at the time of cardiac arrest and on first ECG, the duration of VF and the relation between time to defibrillation and survival. The Swedish Cardiac Arrest Registry has collected standardised reports on out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. In 14065 cases of out-of-hospital cardiac arrest collected between 1990 and 1995, resuscitation was attempted in 10966 cases. The first ECG showed VF in 43% of all patients. The incidence of VF at the time of cardiac arrest was estimated to be 60-70% in all patients and 80-85% in the cases with probable heart disease. The estimated disappearance rate of VF was slow. Thirty minutes after collapse approximately 40% of the patients were in VF. Overall survival to 1 month was only 1.6% for patients with non-shockable rhythms and 9.5% for patients found in VF. With increasing time to defibrillation, the survival rate fell rapidly from approximately 50% with a minimal delay to 5% at 15 min. This study suggests a high initial incidence of VF among out-of-hospital cardiac arrest patients and a slow rate of transformation into a non-shockable rhythm. The survival rate with very short delay times to defibrillation was approximately 50%, but decreased rapidly as the delay increased.
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              • Record: found
              • Abstract: found
              • Article: not found

              Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden.

              To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden.
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                Author and article information

                Journal
                Heart
                Heart
                heartjnl
                heart
                Heart
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1355-6037
                1468-201X
                July 2020
                23 January 2020
                : 106
                : 14
                : 1087-1093
                Affiliations
                [1 ] departmentDepartment of Molecular and Clinical Medicine , Institute of Medicine, Sahlgrenska Academy , Goteborg, Sweden
                [2 ] departmentDepartment of Cardiology , Sahlgrenska University Hospital , Goteborg, Sweden
                [3 ] departmentDepartment of Medicine, Center for Resuscitation Science , Karolinska Institutet , Stockholm, Sweden
                [4 ] departmentBiostatistics, School of Public Health and Community Medicine , Institute of Medicine, Sahlgrenska Academy , Gothenburg, Sweden
                [5 ] departmentDepartment of Occupational Therapy and Physiotherapy , Sahlgrenska University Hospital , Gothenburg, Sweden
                [6 ] departmentCenter for Pre-Hospital Research , University of Borås , Borås, Sweden
                Author notes
                [Correspondence to ] Geir Hirlekar, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg 413 90, Sweden; geir.hirlekar@ 123456vgregion.se
                Author information
                http://orcid.org/0000-0002-0970-8633
                http://orcid.org/0000-0002-3539-8317
                Article
                heartjnl-2019-315954
                10.1136/heartjnl-2019-315954
                7361004
                31974211
                23189497-c3e4-4a8c-a603-1265b80f9b90
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 15 September 2019
                : 07 December 2019
                : 13 December 2019
                Funding
                Funded by: Swedish state;
                Award ID: The study was supported by the Swedish state under
                Categories
                Arrhythmias and Sudden Death
                1506
                Original research
                Custom metadata
                unlocked

                Cardiovascular Medicine
                out-of-hospital cardiac arrest,comorbidity,bystander cardiopulmonary resuscitation,charlson comorbidity index,survival

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