Idea Transcript
DEPARTMENT OF MEDICINE, SOLNA Center for Resuscitation Science Karolinska Institutet, Stockholm, Sweden
DUAL DISPATCH AND THE IMPORTANCE OF BYSTANDER CPR IN OUT-OFHOSPITAL CARDIAC ARREST Ingela Hasselqvist-Ax
Stockholm 2018
Cover illustration by Gabriel Kotowski (kotowski.se) Number of saved lives in OHCA in Sweden 2016 All previously published papers were reproduced with permission from the publishers Published by Karolinska Institutet Printed by E-Print AB 2017 © Ingela Hasselqvist-Ax, 2018 ISBN 978-91-7676-820-4
Dual dispatch and the importance of bystander CPR in out-of-hospital cardiac arrest THESIS FOR DOCTORAL DEGREE (Ph.D.) This thesis is to be defended in the Aula at Södersjukhuset, Stockholm
Friday, January 19, 2018, at 09:00 a.m. By
Ingela Hasselqvist-Ax Principal Supervisor: Per Nordberg, M.D., Ph.D. Karolinska Institutet Department of Medicine, Solna Center for Resuscitation Science
Opponent: Hans Morten Lossius, M.D., Ph.D. University of Stavanger, Norway Faculty of Health Sciences
Co-supervisors: Eva Joelsson-Alm, MSN., Ph.D. Karolinska Institutet Department of Clinical Science and Education
Examination Board: Jan Jakobsson, M.D., Ph.D. Karolinska Institutet Department of Clinical Sciences, Danderyd Hospital, Stockholm
Leif Svensson, M.D., Ph.D. Karolinska Institutet Department of Medicine, Solna Center for Resuscitation Science
Ingela Rådestad, RNRM., Ph.D. Sophiahemmet University Stockholm
Jacob Hollenberg, M.D., Ph.D. Karolinska Institutet Department of Medicine, Solna Center for Resuscitation Science
Cecilia Linde, M.D., Ph.D. Karolinska Institutet Department of Medicine, Solna
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I keep six honest serving-men (They taught me all I knew); Their names are What and Why and When And How and Where and Who. I send them over land and sea, I send them east and west; But after they have worked for me, I give them all a rest. The Elephant’s Child Rudyard Kipling 1902
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Abstract Background and aim Survival after out-of-hospital cardiac arrest (OHCA) remains low. In Sweden in 2016, of 5312 cases reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR), only 577 (11%) survived to 30-days. The overall objective of the present work was to explore prehospital measures to increase survival for persons suffering OHCA, with special focus on alternative resources such as early bystander cardiopulmonary resuscitation (ByCPR), and dispatch of emergency medical services (EMS) in parallel with first responders (FRs) equipped with defibrillators performing basic life support. Methods and results Study I. A retrospective national register study covering 1990–2011and including 30,381 witnessed OHCA. The primary aim was to evaluate the effect on survival if ByCPR was provided before arrival of EMS. 15,512 (51.1%) patients received ByCPR whereas 14,869 (48.9%) did not. Survival to 30-days was 10.5% in the ByCPR group vs. 4.0% in the no ByCPR group (p