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Kathrine Bach Søndergaard, lægeHjertemedicinsk afdeling, Herlev-Gentofte Hospital

Basal hjertelunge redning og overlevelse ved hjertestop i det private

hjem versus i det offentlige rum

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Herlev og Gentofte Hospital

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Herlev og Gentofte Hospital Baggrund Formål Metode Resultater Konklusion Implikationer

T h e n e w e ngl a nd j o u r na l o f m e dic i n e

n engl j med 372;24 nejm.org June 1 1 , 2 0 1 5 2307

From the Center for Resuscitation Sci-ence, Solna (I.H.-A., G.R., J. Hollenberg, P.N., M. Ringh, M.J., L.S.), and the De-partment of Clinical Sciences, Section of Cardiology, Danderyd Hospital, Danderyd (M. Rosenqvist), Karolinska Institutet, Stockholm, the Center for Pre-Hospital Research in Western Sweden (J. Herlitz) and the School of Health Sciences (C.A.), University of Borås, Borås, and Sahlgren-ska University Hospital ( J. Herlitz), the Institute of Internal Medicine, Depart-ment of Metabolism and Cardiovascular Research, Sahlgrenska University Hospi-tal ( J.L.), and the Center for Applied Bio-statistics, Sahlgrenska Academy at the University of Gothenburg (T.K.), Gothen-berg — all in Sweden. Address reprint requests to Dr. Herlitz at the Center for Pre-Hospital Research, University of Borås, SE-50 1 90 Borås, Sweden, or at johan . herlitz@ hb . se.

Ms. Hasselqvist-Ax and Dr. Riva contrib-uted equally to this article.

N Engl J Med 2015;372 :2307-15.DOI: 10 .1056/NEJMoa1405796Copyright © 20 15 Massachusetts Medical Society.

BACKGROUNDThree 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.

METHODSWe analyzed a total of 30,381 out-of-hospital cardiac arrests witnessed in Sweden from January 1, 1990, through December 31, 2011, to determine whether CPR was performed before the arrival of emergency medical services (EMS) and whether early CPR was correlated with survival.

RESULTSCPR was performed before the arrival of EMS in 15,512 cases (51.1%) and was not performed before the arrival of EMS in 14,869 cases (48.9%). The 30-day survival rate was 10.5% when CPR was performed before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (P<0.001). When adjustment was made for a propensity score (which included the variables of age, sex, location of car-diac arrest, cause of cardiac arrest, initial cardiac rhythm, EMS response time, time from collapse to call for EMS, and year of event), CPR before the arrival of EMS was associated with an increased 30-day survival rate (odds ratio, 2.15; 95% confidence interval, 1.88 to 2.45). When the time to defibrillation in patients who were found to be in ventricular fibrillation was included in the propensity score, the results were similar. The positive correlation between early CPR and survival rate remained stable over the course of the study period. An association was also observed between the time from collapse to the start of CPR and the 30-day sur-vival rate.

CONCLUSIONSCPR performed before EMS arrival was associated with a 30-day survival rate after an out-of-hospital cardiac arrest that was more than twice as high as that associ-ated with no CPR before EMS arrival. (Funded by the Laerdal Foundation for Acute Medicine and others.)

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Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

Ingela Hasselqvist-Ax, R.N., Gabriel Riva, M.D., Johan Herlitz, M.D., Ph.D., Mårten Rosenqvist, M.D., Ph.D., Jacob Hollenberg, M.D., Ph.D.,

Per Nordberg, M.D., Ph.D., Mattias Ringh, M.D., Ph.D., Martin Jonsson, B.Sc., Christer Axelsson, R.N., Ph.D., Jonny Lindqvist, M.Sc., Thomas Karlsson, B.Sc.,

and Leif Svensson, M.D., Ph.D.

Original Article

The New England Journal of Medicine nloaded from nejm.org at Det Kongelige Bibliotek: Nationalbibliotek og Københavns Universitetsbibliotek on November 14, 2017. For personal use only. No other uses without perm

Copyright © 2015 Massachusetts Medical Society. All rights reserved.

T h e n e w e ngl a nd j o u r na l o f m e dic i n e

n engl j med 376;18 nejm.org May 4 , 2 0 1 7 1737

From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nu-clear Medicine and PET (M.W.), and Cardi-ology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the De-partment of Cardiology, Copenhagen Uni-versity Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Pub-lic Health, University of Southern Den-mark (G.G.), and the Department of Bio-statistics, University of Copenhagen (T.A.G.), Copenhagen — all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.). Address reprint requests to Dr. Kragholm at the Depart-ment of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 90 0 0 Aalborg, Denmark, or at kdks@ rn . dk.

N Engl J Med 2017;376 :1737-47.DOI: 10 .1056/NEJMoa1601891Copyright © 2017 Massachusetts Medical Society.

BACKGROUNDThe effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied.

METHODSWe linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1 -year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 3 0 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes.

RESULTSAmong the 2 8 5 5 patients who were 3 0 -day survivors of an out-of-hospital cardiac arrest during the period from 2 0 0 1 through 2 0 1 2 , a total of 1 0 .5 % had brain damage or were admitted to a nursing home and 9 .7 % died during the 1 -year follow-up period. During the study period, among the 2 0 8 4 patients who had cardiac arrests that were not wit-nessed by emergency medical services (EMS) personnel, the rate of bystander CPR in-creased from 6 6 .7 % to 8 0 .6 % (P<0 .0 0 1 ), the rate of bystander defibrillation increased from 2 .1% to 1 6 .8 % (P<0 .0 0 1 ), the rate of brain damage or nursing home admission decreased from 1 0 .0 % to 7 .6 % (P<0 .0 0 1 ), and all-cause mortality decreased from 1 8 .0 % to 7 .9 % (P = 0 .0 0 2 ). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that as-sociated with no bystander resuscitation (hazard ratio, 0 .6 2 ; 9 5 % confidence interval [CI], 0 .4 7 to 0 .8 2 ), as well as a lower risk of death from any cause (hazard ratio, 0 .7 0 ; 9 5 % CI, 0 .5 0 to 0 .9 9 ) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0 .6 7 ; 9 5 % CI, 0 .5 3 to 0 .8 4 ). The risks of these outcomes were even lower among patients who received bystander defibrilla-tion as compared with no bystander resuscitation.

CONCLUSIONSIn our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation. (Funded by TrygFonden and the Danish Heart Foundation.)

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Bystander Efforts and 1 -Year Outcomes in Out-of-Hospital Cardiac Arrest

Kristian Kragholm, M.D., Ph.D., Mads Wissenberg, M.D., Ph.D., Rikke N. Mortensen, M.Sc., Steen M. Hansen, M.D.,

Carolina Malta Hansen, M.D., Ph.D., Kristinn Thorsteinsson, M.D., Ph.D., Shahzleen Rajan, M.D., Freddy Lippert, M.D., Fredrik Folke, M.D., Ph.D.,

Gunnar Gislason, M.D., Ph.D., Lars Køber, M.D., D.Sc., Kirsten Fonager, M.D., Ph.D., Svend E. Jensen, M.D., Ph.D.,

Thomas A. Gerds, Ph.D., Christian Torp-Pedersen, M.D., D.Sc., and Bodil S. Rasmussen, M.D., Ph.D.

Original Article

The New England Journal of Medicine ownloaded from nejm.org at Det Kongelige Bibliotek: Nationalbibliotek og Københavns Universitetsbibliotek on June 19, 2017. For personal use only. No other uses without permiss

Copyright © 2017 Massachusetts Medical Society. All rights reserved.

Sandsynlighed for overlevelse, OR 2,15

Risiko for anoksisk hjerneskade/plejehjem, HR 0,63





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Dansk Hjertestopregister Årsrapport 2014

HLR 2001-2014 Overlevelse 2001-2014

3,9%

12,7%

19,4%

65,8%





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3/4vs.

Offentlige rum Private hjem





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Undersøge forskellen over tid i bystander HLR samt forskelle i overlevelse og anoksisk

hjerneskade/indlæggelse på plejehjemfor hjertestop

i det offentlige rum versus i det private hjem

Baggrund Formål Metode Resultater Konklusion Implikationer





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Dansk HjertestopRegister

2001–2014

Lands-Patient-

registeret

Registreover

plejehjemm.fl.

Dødsårsags-registeret





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45.259 hjertestop 2001-2014

i alderen 18-100 år

3.500 manglede lokalisation

19,754 ekskluderet

4.989 ambulance bevidnet

10.757 ikke-kardiogen årsag

6.738 hjertestop

i det offentlige rum

18.767 hjertestop

i det private hjem






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Demografi

58% 36%

70 år67 år

74% 56%

11% 2%





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HLR i det offentlige rum og private hjem 2001-2014

36,4% 61,0%

16,0%

83,1%

Absolut stigning∼ 45%





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30-dages og 1-års overlevelse 2001-2014

10,0%

25,2%

6,4%

2,9%





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Det offentlige rum Det private hjem

Anoksisk hjerneskade/indlæggelse på plejehjem og død hos 30-dages overlevere 2001-2014

18,8%

6,9%

17,1%

13,3%





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Prædiktorer for bystander HLR


19/11/2017 12.18

Side 1 af 1file:///Users/kathrine/Downloads/5_types_of_weather_pictograms.svg





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I perioden 2001-2014:

1. HLR rater mere end fordobledes ved hjertestop i både det offentlige rum og det private hjem.

2. 30-dages overlevelse mere end tredobledes efter hjertestop i både det offentlige rum og det private hjem

3. Andelen med anoksisk hjerneskade/plejehjem indlæggelse hos 30-dages overlevere faldt for hjertestop i det offentlige rum, men var uændret i det private hjem






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1. Nationale initiativer har lige god effekt for hjertestop i

det private hjem som i det offentlige rum

2. Private hjem: Særlige omstændigheder hindrer, at

HLR rater og overlevelses rater, når det samme niveau

som i det offentlige rum.


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