1
|
Kelpanides IK, Katzenschlager S, Skogvoll E, Tjelmeland IBM, Grindheim G, Alm-Kruse K, Liberg JP, Kristiansen T, Wnent J, Gräsner JT, Kramer-Johansen J. Out-of-hospital cardiac arrest in children in Norway: A national cohort study, 2016-2021. Resusc Plus 2024; 18:100662. [PMID: 38799717 PMCID: PMC11126965 DOI: 10.1016/j.resplu.2024.100662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Aim Children constitute an important and distinct subgroup of out-of-hospital cardiac arrest (OHCA) patients. This population-based cohort study aims to establish current age-specific population incidence, precipitating causes, circumstances, and outcome of paediatric OHCA, to guide a focused approach to prevention and intervention to improve outcomes. Methods Data from the national Norwegian Cardiac Arrest Registry was extracted for the six-year period 2016-21 for persons aged <18 years. We present descriptive statistics for the population, resuscitation events, presumed causes, treatment, and outcomes, alongside age-specific incidence and total paediatric mortality rates. Results Three hundred and eight children were included. The incidence of OHCA was 4.6 per 100 000 child-years and markedly higher in children <1 year at 20.9 child-years. Leading causes were choking, cardiac and respiratory disease, and sudden infant death syndrome. Overall, 21% survived to 30 days and 18% to one year. Conclusion A registry-based approach enabled this study to delineate the characteristics and trajectories of OHCA events in a national cohort of children. Precipitating causes of paediatric OHCA are diverse compared to adults. Infants aged <1 year are at particularly high risk. Mortality is high, albeit lower than for adults in Norway. A rational community approach to prevention and treatment may focus on general infant care, immediate first aid by caretakers, and identification of vulnerable children by primary health providers. Cardiac arrest registries are a key source of knowledge essential for quality improvement and research into cardiac arrest in childhood.
Collapse
Affiliation(s)
- Inga Katherina Kelpanides
- Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Stephan Katzenschlager
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Eirik Skogvoll
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Beathe Myrhaugen Tjelmeland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
- Norwegian National Advisory Unit for Prehospital Emergency Care, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Guro Grindheim
- Department of Anaesthesiology and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Kristin Alm-Kruse
- Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - John-Petter Liberg
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Kristiansen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesiology and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Jan Wnent
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- School of Medicine, University of Namibia, Windhoek, Namibia
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jo Kramer-Johansen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit for Prehospital Emergency Care, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
2
|
Randjelovic S, Nikolovski S, Selakovic D, Sreckovic M, Rosic S, Rosic G, Raffay V. Time Is Life: Golden Ten Minutes on Scene-EuReCa_Serbia 2014-2023. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:624. [PMID: 38674270 PMCID: PMC11051783 DOI: 10.3390/medicina60040624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: This study analyzed the frequency of factors influencing the course and outcomes of out-of-hospital cardiac arrest (OHCA) in Serbia and the prediction of pre-hospital outcomes and survival. Materials and Methods: Data were collected during the period from 1 October 2014, to 31 September 2023, according to the protocol of the EuReCa_One study (clinical trial ID number NCT02236819). Results: Overall 9303 OHCA events were registered with a median age of 71 (IQR 61-81) years and 59.7% of them being males. The annual OHCA incidence was 85.60 ± 20.73/100,000. Within all bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation in 15.3%. Within the resuscitation-initiated group, return-of-spontaneous circulation (ROSC) on scene (any ROSC) was present in 1037/4053 cases (25.6%) and ROSC on admission to the nearest hospital in 792/4053 cases (19.5%), while 201/4053 patients survived to hospital discharge (5.0%). Predictive potential on pre-hospital outcomes was shown by several factors. Also, of all patients having any ROSC, 89.2% were admitted to the hospital alive. The probability of any ROSC dropped below 50% after 17 min passed after the emergency call and 10 min after the EMS scene arrival. These time intervals were significantly associated with survival to hospital discharge (p < 0.001). Five-minute time intervals between both emergency calls and any ROSC and EMS scene arrival and any ROSC also had a significant predictive potential for survival to hospital discharge (p < 0.001, HR 1.573, 95% CI 1.303-1.899 and p = 0.017, HR 1.184, 95% CI 1.030-1.361, respectively). Conclusions: A 10-min time on scene to any ROSC is a crucial time-related factor for achieving any ROSC, and indirectly admission ROSC and survival to hospital discharge, and represents a golden time interval spent on scene in the management of OHCA patients. A similar effect has a time interval of 17 min from an emergency call. Further investigations should be focused on factors influencing these time intervals, especially time spent on scene.
Collapse
Affiliation(s)
- Suzana Randjelovic
- Department of Emergency Medicine, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia;
| | - Srdjan Nikolovski
- Health Sciences Campus, Loyola University Chicago, Maywood, IL 60153, USA
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragica Selakovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.S.); (G.R.)
| | - Miodrag Sreckovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- Clinic of Cardiology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Sara Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.S.); (G.R.)
| | - Gvozden Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.S.); (G.R.)
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus;
| |
Collapse
|
3
|
Harring AKV, Kramer-Johansen J, Tjelmeland IBM. Resuscitation of older adults in Norway; a comparison of survival and outcome after out-of-hospital cardiac arrest in healthcare institutions and at home. Resuscitation 2023; 189:109871. [PMID: 37327851 DOI: 10.1016/j.resuscitation.2023.109871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Perceptions about expected outcome after out-of-hospital cardiac arrest (OHCA) influence treatment decisions, and there is a need for updated evidence about outcomes for the elderly. METHOD We conducted a cross-sectional study of cases reported to the Norwegian Cardiac Arrest Registry from 2015 through 2021 of patients 60 years and older, suffering cardiac arrest in healthcare institutions or at home. We examined reasons for emergency medical service (EMS) withholding or withdrawing resuscitation. We compared survival and neurological outcome for EMS-treated patients and explored factors associated with survival using multivariate logistic regression. RESULT We included 12,191 cases and the EMS started resuscitation in 10,340 (85%). The incidence per capita of OHCA the EMS were alerted to was 267/100,000 in healthcare institutions and 134/100,000 at home. Resuscitation was most frequently withdrawn due to medical history (n = 1251). In healthcare institutions, 72 of 1503 (4.8%) patients survived to 30 days compared to 752 of 8837 (8.5%) at home (P <.001). We found survivors in all age cohorts both in healthcare institutions and at home, and most of the 824 survivors had a good neurological outcome with a Cerebral Performance Category ≤2 (88%). CONCLUSION Medical history was the most frequent reason for EMS not to start or continue resuscitation, indicating a need for a discussion about, and documentation of, advance directives in this age group. When EMS attempted resuscitation, most survivors had a good neurological outcome, both in healthcare institutions and at home.
Collapse
Affiliation(s)
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild B M Tjelmeland
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Bellini L, Fagoni N, Andreassi A, Sechi GM, Bonora R, Stirparo G. Effectiveness of Cardiopulmonary Resuscitation at the Workplace. LA MEDICINA DEL LAVORO 2023; 114:e2023010. [PMID: 37309884 PMCID: PMC10281073 DOI: 10.23749/mdl.v114i3.13995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/04/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Out-of-Hospital Cardiac Arrest (OHCA) is a medical emergency whose chances of survival can be increased by rapid Cardiopulmonary Resuscitation (CPR) and early use of Public Access Defibrillators (PAD). Basic Life Support (BLS) training became mandatory in Italy to spread knowledge of resuscitation maneuvers in the workplace. Basic Life Support (BLS) training became mandatory according to the DL 81/2008 law. To improve the level of cardioprotection in the workplace, the national law DL 116/2021 increased the number of places required to be provided with PADs. The study highlights the possibility of a Return to spontaneous circulation in OHCA in the workplace. METHODS A multivariate logistic regression model was fitted to the data to extrapolate associations between ROSC and the dependent variables. The associations' robustness was evaluated through sensitivity analysis. RESULTS The chance to receive CPR (OR 2.3; 95% CI:1.8-2.9), PAD (OR 7.2; 95% CI:4.9 - 10.7), and achieve Return to spontaneous circulation (ROSC) (crude OR 2.2; 95% CI:1.7-3.0, adjusted OR 1.6; 95% CI:1.2-2.2) is higher in the workplace compared to all other places. CONCLUSION The workplace could be considered cardioprotective, although further research is necessary to understand the causes of missed CPRs and identify the best places to increase BLS and defibrillation training to help policymakers implement correct programming on the activation of PAD projects.
Collapse
Affiliation(s)
- Lorenzo Bellini
- School of Public Health - University of Vita-Salute San Raffaele, Milano, Italy.
| | - Nazzareno Fagoni
- Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia.
| | | | | | | | - Giuseppe Stirparo
- School of Medicine, University Vita-Salute San Raffaele, Milan - Italy.
| |
Collapse
|
5
|
Alm-Kruse K, Tjelmeland I, Reiner A, Kvåle R, Kramer-Johansen J. Use of healthcare services before and after out-of-hospital cardiac arrest. Resuscitation 2023; 187:109805. [PMID: 37088268 DOI: 10.1016/j.resuscitation.2023.109805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Knowledge about the use of healthcare services in patients experiencing out-of-hospital cardiac arrest (OHCA) is limited. We aimed to describe and compare the use of healthcare by OHCA survivors two years before and one year after cardiac arrest. METHODS Adult patients with OHCA of medical cause, who survived >30 days, were identified in the Norwegian Cardiac Arrest Registry. The Norwegian Patient Registry, The Cause of Death Registry, and The Norwegian Registry for Primary Healthcare provided data on survival and the use of healthcare services. We investigated the use of primary, specialist and mental healthcare, as well as rehabilitation services. RESULTS In 2015-2018, 13,112 OHCA cases were identified; 1435 (14%) patients survived >30 days (6.8/100,000 patients/year). The proportion of patients in the cohort that used primary healthcare each month increased form 43% before to 69% after OHCAto (p<0.001). We found a doubling of monthly healthcare contacts in both specialist healthcare (from 26% to 57%, p<0.001) and mental healthcare (from 3% to 8%, p>0.001). The observed increases in primary, specialist and mental healthcare use started two weeks, six months, and eight months before OHCA, respectively. Half of the patients had contact with primary healthcare services on the same day as the cardiac arrest. Two out of five patients were registered for rehabilitation after OHCA. CONCLUSION The use of primary, specialist and mental healthcare services increased before OHCA and remained significantly higher the year after OHCA. Less than half of the patients surviving cardiac arrest were registered for rehabilitation.
Collapse
Affiliation(s)
- Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
| | - Andrew Reiner
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Rune Kvåle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Health Registry Research and Development, National Institute of Public Health, Bergen, Norway
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
6
|
Harring AKV, Tjelmeland IB, Andenæs R, Kramer-Johansen J. Blir beslutninger om behandlingsbegrensninger respektert utenfor sykehus når man har ringt 113? TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|