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IMPORTANCE Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n = 2253), leaving a study population of 19 468 patients. MAIN OUTCOMES AND MEASURES Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival. RESULTS The median age of patients was 72 years; 67.4%were men. Bystander CPR increased significantly during the study period, from 21.1%(95%CI, 18.8%-23.4%) in 2001 to 44.9%(95%CI, 42.6%-47.1%) in 2010 (P < .001), whereas use of defibrillation by bystanders remained low (1.1% [95%CI, 0.6%-1.9%] in 2001 to 2.2%[95%CI, 1.5%-2.9%] in 2010; P = .003). More patients achieved survival on hospital arrival (7.9%[95%CI, 6.4%-9.5%] in 2001 to 21.8% [95%CI, 19.8%-23.8%] in 2010; P < .001). Also, 30-day survival improved (3.5%[95%CI, 2.5%-4.5%] in 2001 to 10.8%[95%CI, 9.4%-12.2%] in 2010; P < .001), as did 1-year survival (2.9% [95%CI, 2.0%-3.9%] in 2001 to 10.2%[95%CI, 8.9%-11.6%] in 2010; P < .001). Despite a decrease in the incidence of out-of-hospital cardiac arrests during the study period (40.4 to 34.4 per 100 000 persons in 2001 and 2010, respectively; P = .002), the number of survivors per 100 000 persons increased significantly (P < .001). For the entire study period, bystander CPR was positively associated with 30-day survival, regardless of witnessed status (30-day survival for nonwitnessed cardiac arrest, 4.3%[95%CI, 3.4%-5.2%] with bystander CPR and 1.0% [95%CI, 0.8%-1.3%] without; odds ratio, 4.38 [95%CI, 3.17-6.06]). For witnessed arrest the corresponding values were 19.4%(95%CI, 18.1%-20.7%) vs 6.1% (95%CI, 5.4%-6.7%); odds ratio, 3.74 (95%CI, 3.26-4.28). CONCLUSIONS AND RELEVANCE In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain. [ABSTRACT FROM AUTHOR]

Aim: With increased survival after out-of-hospital cardiac arrest (OHCA), impact of the post-resuscitation course has become important. Among 30-day OHCA survivors, we investigated associations between organ support therapy in the Intensive Care Unit (ICU) and return to work.Methods: This Danish nationwide cohort-study included 30-day-OHCA-survivors who were employed prior to arrest. We linked OHCA data to information on in-hospital care and return to work. For patients admitted to an ICU and based on renal replacement therapy (RRT), cardiovascular support and mechanical ventilation, we assessed the prognostic value of organ support therapies in multivariable Cox regression models.Results: Of 1087 30-day survivors, 212 (19.5%) were treated in an ICU with 0-1 types of organ support, 494 (45.4%) with support of two organs, 26 (2.4%) with support of three organs and 355 (32.7%) were not admitted to an ICU. Return to work increased with decreasing number of organs supported, from 53.8% (95% CI: 49.5-70.1%) in patients treated with both RRT, cardiovascular support and mechanical ventilation to 88.5% (95% CI: 85.1-91.8%) in non-ICU-patients. In 732 ICU-patients, ICU-patients with support of 3 organs had significantly lower adjusted hazard ratios (HR) of returning to work (0.50 [95% CI: 0.30-0.85] compared to ICU-patients with support of 0-1 organ. The corresponding HR was 0.48 [95% CI: 0.30-0.78] for RRT alone.Conclusions: In 30-day survivors of OHCA, number of organ support therapies and in particular need of RRT were associated with reduced rate of return to work, although more than half of these latter patients still returned to work. [ABSTRACT FROM AUTHOR]

Background: Knowledge about heart rhythm conversion from non-shockable to shockable rhythm during resuscitation attempt after out-of-hospital cardiac arrest (OHCA) and following chance of survival is limited and inconsistent.Methods: We studied 13,860 patients with presumed cardiac-caused OHCA not witnessed by the emergency medical services from the Danish Cardiac Arrest Register (2005-2012). Patients were stratified according to rhythm: shockable, converted shockable (based on receipt of subsequent defibrillation) and sustained non-shockable rhythm. Multiple logistic regression was used to identify predictors of rhythm conversion and to compute 30-day survival chances.Results: Twenty-five percent of patients who received pre-hospital defibrillation by ambulance personnel were initially found in non-shockable rhythms. Younger age, males, witnessed arrest, shorter response time, and heart disease were significantly associated with conversion to shockable rhythm, while psychiatric- and chronic obstructive pulmonary disease were significantly associated with sustained non-shockable rhythm. Compared to sustained non-shockable rhythms, converted shockable rhythms and initial shockable rhythms were significantly associated with increased 30-day survival (Adjusted odds ratio (OR) 2.6, 95% confidence interval (CI): 1.8-3.8; and OR 16.4, 95% CI 12.7-21.2, respectively). From 2005 to 2012, 30-day survival chances increased significantly for all three groups: shockable rhythms, from 16.3% (CI: 14.2%-18.7%) to 35.7% (CI: 32.5%-38.9%); converted rhythms, from 2.1% (CI: 1.6%-2.9%) to 5.8% (CI: 4.4%-7.6%); and sustained non-shockable rhythms, from 0.6% (CI: 0.5%-0.8%) to 1.8% (CI: 1.4%-2.2%).Conclusion: Converting to shockable rhythm during resuscitation attempt was common and associated with nearly a three-fold higher odds of 30-day survival compared to sustained non-shockable rhythms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective was to examine the association of bystander CPR with survival as time to advanced treatment increases. BACKGROUND: Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective was to examine the association of bystander CPR with survival as time to advanced treatment increases. RESULTS: With increasing response times, adjusted 30-day survival chances decreased for both patients with bystander CPR and those without. However, the contrast between the survival chances of patients with versus without bystander CPR increased over time: within 5 minutes, 30-day survival was 14.5% (95% confidence interval [CI]: 12.8-16.4) versus 6.3% (95% CI: 5.1-7.6), corresponding to 2.3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI: 5.4-8.1) versus 2.2% (95% CI: 1.5-3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander CPR. The contrast in 30-day survival became statistically insignificant when response time was >13 minutes (bystander CPR vs no bystander CPR: 3.7% [95% CI: 2.2-5.4] vs 1.5% [95% CI: 0.6-2.7]), but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median response time in this study) to 5 minutes. CONCLUSIONs: The absolute survival associated with bystander CPR declined rapidly with time. Yet bystander CPR while waiting for an ambulance was associated with a more than doubling of 30-day survival even in case of long ambulance response time. Decreasing ambulance response time by even a few minutes could potentially lead to many additional lives saved every year. [ABSTRACT FROM AUTHOR]

Aim: To identify factors associated with a non-shockable rhythm as first recorded heart rhythm.Methods: Patients ≥18 years old suffering out-of-hospital cardiac arrest between 2001 and 2012 were identified in the population-based Danish Cardiac Arrest Registry. Danish administrative registries were used to identify chronic diseases (within 10 years) and drug prescriptions (within 180 days). A multivariable logistic regression model, including patient related and cardiac arrest related characteristics, was used to estimate odds ratios (OR) for factors associated with non-shockable rhythm.Results: A total of 29,863 patients were included: 6600 (22.1%) patients with a shockable rhythm and 23,263 (77.9%) patients with a non-shockable rhythm. A non-shockable rhythm was associated with female gender, arrest in private home, unwitnessed arrest, no bystander CPR, and longer time to first rhythm analysis compared to patients with shockable rhythm. In the adjusted multivariable regression model, pre-existing non-cardiovascular disease and drug prescription were associated with a non-shockable rhythm e.g. chronic obstructive lung disease (OR 1.44 [95% CI: 1.32-1.58]); and the prescription for antidepressants (OR 1.49 [95% CI: 1.35-1.65]), antipsychotics (OR 2.30 [95% CI: 1.96-2.69]) analgesics (OR 1.32 [95% CI: 1.23-1.41]), corticosteroids (OR 1.64 [95% CI: 1.44-1.85]), and antibiotics (OR 1.59 [95% CI: 1.40-1.81]). In contrast, the prescription of cardiovascular drugs and a history of cardiovascular disease e.g. ischemic heart disease was associated with a lower risk of non-shockable rhythm (OR 0.66 [95% CI: 0.60-0.71]).Conclusion: This study demonstrate that non-cardiovascular disease and medication prescription are associated with a non-shockable rhythm while cardiovascular disease and medication prescription are associated with a shockable rhythm as first recorded rhythm in patients with OHCA. [ABSTRACT FROM AUTHOR]

Aim: Survival after out-of-hospital cardiac arrest (OHCA) has tripled during the past decade in Denmark as a likely result of improvements in cardiac arrest management. This study analyzed whether these improvements were applicable for patients with chronic obstructive pulmonary disease (COPD).Methods: Patients ≥18 years with OHCA of presumed cardiac cause were identified through the Danish Cardiac Arrest Registry, 2001-2011. Patients with a history of COPD up to ten years prior to arrest were identified from the Danish National Patient Register and compared to non-COPD patients.Results: Of 21,480 included patients, 3056 (14.2%) had history of COPD. Compared to non-COPD patients, COPD patients were older (75 vs. 71 years), less likely male (61.2% vs. 68.5%), had higher prevalence of other comorbidities, and were less likely to have: arrests outside private homes (17.7% vs. 28.3%), witnessed arrests (48.7% vs. 52.9%), bystander cardiopulmonary resuscitation (25.8% vs. 34.8%), and shockable heart rhythm (15.6% vs. 29.9%), all p<0.001; while no significant difference in the time-interval from recognition of arrest to rhythm analysis by ambulance-crew; p=0.24. From 2001 to 2011, survival upon hospital arrival increased in both patient-groups (from 6.8% to 17.1% in COPD patients and from 8.2% to 25.6% in non-COPD patients, p<0.001). However, no significant change was observed in 30-day survival in COPD patients (from 3.7% to 2.1%, p=0.27), in contrast to non-COPD patients (from 3.5% to 13.0%, p<0.001).Conclusions: Despite generally improved 30-day survival after OHCA over time, no improvement was observed in 30-day survival in COPD patients. [ABSTRACT FROM AUTHOR]

Aim Crude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period. Methods Patients ≥12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation was attempted, were identified through the Danish Cardiac Arrest Registry 2001-2010. A total of 19,372 patients were included. Results One-third were female, with a median age of 75 years (IQR 65-83). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p < 0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p < 0.001. Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR 1.00; CI 0.72-1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR 1.31; CI 1.07-1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm; there was no interaction between sex and calendar-year. Conclusions Temporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm. [ABSTRACT FROM AUTHOR]

Aim To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA). Methods OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59. Results We identified 18,929 OHCA patients, aged ≥18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12 min vs. 11 min and 11 min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p < 0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p < 0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37-0.59; OR 0.51, 95%CI 0.40-0.65, compared to daytime and evening, respectively). Conclusions We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities. [ABSTRACT FROM AUTHOR]

Abstract: Background: The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. Methods: OHCA patients were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001–2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. Results: We identified 16,924 OHCA patients, median age 70.0 years (Q1–Q3: 59–80). OHCA patients had a higher number of hospitalizations and received more pharmacotherapy compared to the control population across all ages (p for difference <0.001). OHCA patients aged 70–79 and 80–89 years had the highest proportion of hospitalizations (70%) and pharmacotherapy (73%), respectively. In general, the association between OHCA and hospitalizations and pharmacotherapy was more pronounced among the youngest OHCA patients compared to controls. OHCA patients in age groups 14–19, 20–29, 30–39 were ∼5 times more likely to be in contact with the healthcare service than the control population (p for difference <0.001). Similarly, OHCA patients in the oldest age groups (60–69, 70–79, 80–89, >89) were <2 times more likely to be in contact with the healthcare services shortly before OHCA compared to the control population (p for difference <0.001). Conclusion: Young OHCA patients are more likely to be in contact with the healthcare services compared with an age and sex matched control population suggestive of traits that make them stand out from the general population. [Copyright &y& Elsevier]

Abstract: Background: For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA. Methods: All patients in Denmark with a registered OHCA June 1, 2001–December 31, 2005 were matched on age and sex with 10 random controls from the entire Danish population. We estimated the association with OHCA by conditional logistic regression analyses, and we determined the proportion of patients in contact with the healthcare system before OHCA from hospital admissions or claimed prescriptions. Results: We identified 12,089 patients with an OHCA. Of these, 62% (7548) and 85% (10,312) were in contact with the healthcare system up to 30 days and 1 year before OHCA, respectively. Association with OHCA up to 30 days before the event pertained to myocardial infarction (odds ratio (OR)=6.4, 95% confidence interval (CI): 4.7–8.6)); heart failure (OR=5.1, CI: 4.1–6.3); ischemic heart disease (OR=1.9, CI: 1.6–2.4); and cardiac dysrhythmia (OR=1.8, CI: 1.4–2.2). Concomitant pharmacotherapy up to 30 days before OHCA with the strongest association was: corticosteroids (systemic) (OR=2.7, CI: 2.5–3.0), bronchial dilators (OR=2.5, CI: 2.3–2.7), anti-psychotic medication (OR=2.1, CI: 1.9–2.3), and digoxin (OR=2.1, CI: 2.0–2.3). Similar results were found for associations up to 1 year before OHCA. Conclusion: Contrary to general belief, the majority of OHCA patients are in contact with the healthcare system shortly before OHCA. [ABSTRACT FROM AUTHOR]

Summary: Background: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during individual training. Aims: To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. Methods: Forty-three second year medical students were included and CPR performance (ERC Guidelines for Resuscitation 2005) was assessed in a 2min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify CPR performance a scoring system based on the Cardiff test was used. Groups were compared with a Mann Whitney rank sum test. Results: There was no statistically significant difference between the two groups when considering change in overall CPR performance score from before training to 3 months after training (P =0.12). However, the IF group performed significantly better than the VAM group in the total score, both immediately after (P =0.0008) and 3 months after training (P =0.02). This difference was primarily related to the BVM skills. Conclusion: Skill retention in CPR using a bag-valve-mask was better after 3 months when training with an instructor than with an automated voice advisory manikin. [Copyright &y& Elsevier]