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Jerkeman M, Sultanian P, Lundgren P, Nielsen N, Helleryd E, Dworeck C, Omerovic E, Nordberg P, Rosengren A, Hollenberg J, Claesson A, Aune S, Strömsöe A, Ravn-Fischer A, Friberg H, Herlitz J, Rawshani A. Trends in survival after cardiac arrest: a Swedish nationwide study over 30 years. Eur Heart J 2022; 43:4817-4829. [PMID: 35924401 PMCID: PMC9726448 DOI: 10.1093/eurheartj/ehac414] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Trends in characteristics, management, and survival in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) were studied in the Swedish Cardiopulmonary Resuscitation Registry (SCRR). METHODS AND RESULTS The SCRR was used to study 106 296 cases of OHCA (1990-2020) and 30 032 cases of IHCA (2004-20) in whom resuscitation was attempted. In OHCA, survival increased from 5.7% in 1990 to 10.1% in 2011 and remained unchanged thereafter. Odds ratios [ORs, 95% confidence interval (CI)] for survival in 2017-20 vs. 1990-93 were 2.17 (1.93-2.43) overall, 2.36 (2.07-2.71) for men, and 1.67 (1.34-2.10) for women. Survival increased for all aetiologies, except trauma, suffocation, and drowning. OR for cardiac aetiology in 2017-20 vs. 1990-93 was 0.45 (0.42-0.48). Bystander cardiopulmonary resuscitation increased from 30.9% to 82.2%. Shockable rhythm decreased from 39.5% in 1990 to 17.4% in 2020. Use of targeted temperature management decreased from 42.1% (2010) to 18.2% (2020). In IHCA, OR for survival in 2017-20 vs. 2004-07 was 1.18 (1.06-1.31), showing a non-linear trend with probability of survival increasing by 46.6% during 2011-20. Myocardial ischaemia or infarction as aetiology decreased during 2004-20 from 67.4% to 28.3% [OR 0.30 (0.27-0.34)]. Shockable rhythm decreased from 37.4% to 23.0% [OR 0.57 (0.51-0.64)]. Approximately 90% of survivors (IHCA and OHCA) had no or mild neurological sequelae. CONCLUSION Survival increased 2.2-fold in OHCA during 1990-2020 but without any improvement in the final decade, and 1.2-fold in IHCA during 2004-20, with rapid improvement the last decade. Cardiac aetiology and shockable rhythms were halved. Neurological outcome has not improved.
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Affiliation(s)
| | | | - Peter Lundgren
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesiology and Intensive care, Lund University, Helsingborg Hospital, Lund, Sweden
| | - Edvin Helleryd
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Christian Dworeck
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Solveig Aune
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anneli Strömsöe
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden,Department of Clinical Sciences Lund, Anesthesiology and Intensive care, Lund University, Lund, Sweden
| | - Annica Ravn-Fischer
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Friberg
- Department of Clinical Sciences Lund, Anesthesiology and Intensive care, Lund University, Lund, Sweden
| | - Johan Herlitz
- Prehospen—Centre for Prehospital Research, University of Borås, Borås, Sweden,The Swedish Registry for Cardiopulmonary Resuscitation, Centre of Registries, Västra Götaland, Sweden
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