Good News From Sweeden

Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective

Anna Adielsson1, Jacob Hollenberg2, Thomas Karlsson3, Jonny Lindqvist3, Stefan Lundin1, Johan Silfverstolpe4, Leif Svensson4, Johan Herlitz3,5
+ Author Affiliations

1Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
2Stockholm Pre-hospital Centre, South Hospital, Stockholm, Sweden
3Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
4Emergency Medical Services, KAMBER, Regionhuset, Lund, Sweden
5The Centre for Pre-hospital Research in Western Sweden, University College of Borås, Borås, Sweden
Correspondence to
Johan Herlitz, Institution of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden; johan.herlitz@gu.se
Accepted 5 May 2011
Published Online First 29 June 2011

Abstract
Objectives In a national perspective, to describe survival among patients found in ventricular fibrillation or pulseless ventricular tachycardia witnessed by a bystander and with a presumed cardiac aetiology and answer two principal questions: (1) what are the changes over time? and (2) which are the factors of importance?

Design Observational register study.

Setting Sweden.

Patients All patients included in the Swedish Out of Hospital Cardiac Arrest Register between 1 January 1990 and 31 December 2009 who were found in bystander-witnessed ventricular fibrillation with a presumed cardiac aetiology.

Interventions Bystander cardiopulmonary resuscitation (CPR) and defibrillation.

Main outcome measures Survival to 1 month.

Results In all, 7187 patients fulfilled the set criteria. Age, place of out-of-hospital cardiac arrest (OHCA) and gender did not change. Bystander CPR increased from 46% to 73%; 95% CI for OR 1.060 to 1.081 per year. The median delay from collapse to defibrillation increased from 12 min to 14 min (p for trend 0.0004). Early survival increased from 28% to 45% (95% CI 1.044 to 1.065) and survival to 1 month increased from 12% to 23% (95% CI 1.058 to 1.086). Strong predictors of early and late survival were a short interval from collapse to defibrillation, bystander CPR, female gender and OHCA outside the home.

Conclusion In a long-term perspective in Sweden, survival to 1 month after ventricular fibrillation almost doubled. This was associated with a marked increase in bystander CPR. Strong predictors of outcome were a short delay to defibrillation, bystander CPR, female gender and place of collapse.