Registrerer få hjertestanser

Bakgrunn: Studier fra andre land viser stor variasjon i forekomst og overlevelse etter hjerte- lunge-redning (HLR) på intensivavdelinger. Det foreligger få studier på dette området i Norge. Hensikt: Å kartlegge forekomst og overlevelse etter HLR samt få oversikt over hvordan HLR ble registrert. Metode: Vi foretok en tverrsnittsstudie av 14 intensivavdelinger på Oslo universitetssykehus gjennom hele 2013. Pasienter med diagnoser og prosedyrekoder for hjertestans, ventrikkelarytmier og HLR ble identifisert i pasientadministrative systemer. Vi inkluderte alle tilfellene der diagnoser og prosedyrekoder ble bekreftet i pasientjournalen, i studieutvalget. Deretter sammenliknet vi med de tilfellene som var registrert i det interne kvalitetsregisteret for hjertestans. Resultat: Blant 15 101 intensivinnleggelser fant vi 117 (0,8 prosent) tilfeller av HLR fordelt på 99 pasienter. Av 91 voksne (> 18 år) var 64 (70 prosent) menn. Gjennomsnittsalderen var 63 år. Antall voksne som overlevde til utskrivning fra sykehuset var 44 (48 prosent). Overlevelsen for kvinner var signifikant lavere enn for menn: 8 (30 prosent) kvinner overlevde mot 36 (56 prosent) menn, (p = 0,023). Kun 32 (32 prosent) av alle pasientene var registrert i vårt interne hjertestansregister. Konklusjon: Knapt én av hundre intensivinnleggelser fikk HLR. Halvparten av pasientene overlevde til utskrivning etter HLR. En tredjedel av disse pasientene var registrert i det interne hjertestansregisteret. Forekomst og registrering av HLR er lav, mens overlevelsen er høy sammenliknet med tilsvarende studier fra andre land

Nurse-led implementation of an insulin-infusion protocol in a general intensive care unit: improved glycaemic control with increased costs and risk of hypoglycaemia signals need for algorithm revision

Abstract Background Strict glycaemic control (SGC) has become a contentious issue in modern intensive care. Physicians and nurses are concerned about the increased workload due to SGC as well as causing harm through hypoglycaemia. The objective of our study was to evaluate our existing degree of glycaemic control, and to implement SGC safely in our ICU through a nurse-led implementation of an algorithm for intensive insulin-therapy. Methods The study took place in the adult general intensive care unit (11 beds) of a 44-bed department of intensive care at a tertiary care university hospital. All patients admitted during the 32 months of the study were enrolled. We retrospectively analysed all arterial blood glucose (BG) results from samples that were obtained over a period of 20 months prior to the implementation of SGC. We then introduced an algorithm for intensive insulin therapy; aiming for arterial blood-glucose at 4.4 – 6.1 mmol/L. Doctors and nurses were trained in the principles and potential benefits and risks of SGC. Consecutive statistical analyses of blood samples over a period of 12 months were used to assess performance, provide feedback and uncover incidences of hypoglycaemia. Results Median BG level was 6.6 mmol/L (interquartile range 5.6 to 7.7 mmol/L) during the period prior to implementation of SGC (494 patients), and fell to 5.9 (IQR 5.1 to 7.0) mmol/L following introduction of the new algorithm (448 patients). The percentage of BG samples > 8 mmol/L was reduced from 19.2 % to 13.1 %. Before implementation of SGC, 33 % of samples were between 4.4 to 6.1 mmol/L and 12 patients (2.4 %) had one or more episodes of severe hypoglycaemia ( Conclusion The retrospective part of the study indicated ample room for improvement. Through the implementation of SGC the fraction of samples within the new target range increased from 33% to 45.8%. There was also a significant increase in severe hypoglycaemic episodes. There continues to be potential for improved glycaemic control within our ICU. This might be achieved through an improved algorithm and continued efforts to increase nurses' confidence and skills in achieving SGC.</p

Case completeness in the Norwegian Cardiac Arrest Registry

Introduction This study aimed to assess the case completeness of out-of-hospital cardiac arrests (OHCA) in the Norwegian Cardiac Arrest Registry (NorCAR) and describe the differences between the registered and missing patients identified from the case-control assessment. Methods We identified the relevant patients in the Norwegian Patient Registry and the Norwegian Cause of Death Registry and compared them with the patients in NorCAR. Data processors used patient records to confirm if the potential cardiac arrest cases met the inclusion criteria in NorCAR. Results Between 2015 and 2017, 8612 OHCA patients were registered in NorCAR. Through the Patient Registry and the Cause of Death Registry we identified 11,114 potential OHCA patients, 3469 of these were already registered in NorCAR. After evaluating the patient records for the remaining 7645 patients, we found 344 patients (4%), were eligible for inclusion in NorCAR, giving a case completeness of 96%. The registered and missing patients were similar in age and gender distribution. Initial shockable rhythm and presumed cause were also comparable. However, the missing patients more frequently achieved return of spontaneous circulation, were more often transported to hospital, and had higher survival rates. The already registered patients had more key variables registered than the missing patients. Conclusion Our results indicate high case completeness in NorCAR. The missing patients were too few to introduce significant changes in the distribution of patient characteristics, indicating that NorCAR is representative of the Norwegian OHCA population

Top 5 barriers in cardiac arrest research as perceived by international early career researchers – A consensus study

Aim of the study: Cardiac arrest research has not received as much scientific attention as research on other topics. Here, we aimed to identify cardiac arrest research barriers from the perspective of an international group of early career researchers. Methods: Attendees of the 2022 international masterclass on cardiac arrest registry research accompanied the Global Out-of-Hospital Cardiac Arrest Registry collaborative meeting in Utstein, Norway, and used an adapted hybrid nominal group technique to obtain a diverse and comprehensive perspective. Barriers were identified using a web-based questionnaire and discussed and ranked during an in-person follow-up meeting. After each response was discussed and clarified, barriers were categorized and ranked over two rounds. Each participant scored these from 1 (least significant) to 5 (most significant). Results: Nine participants generated 36 responses, forming seven overall categories of cardiac arrest research barriers. “Allocated research time” was ranked first in both rounds. “Scientific environment”, including appropriate mentorship and support systems, ranked second in the final ranking. “Resources”, including funding and infrastructure, ranked third. “Access to and availability of cardiac arrest research data” was the fourth-ranked barrier. This included data from the cardiac arrest registries, medical devices, and clinical studies. Finally, “uniqueness” was the fifth-ranked barrier. This included ethical issues, patient recruitment challenges, and unique characteristics of cardiac arrest. Conclusion: By identifying cardiac arrest research barriers and suggesting solutions, this study may act as a tool for stakeholders to focus on helping early career researchers overcome these barriers, thus paving the road for future research

Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe

Background Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in Europe is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of out-of-hospital cardiac arrest in Europe but were unable to identify reasons for the reported differences. Therefore, the purpose of this study was to describe European Emergency Medical Systems, particularly from the perspective of country and ambulance service characteristics, cardiac arrest identification, dispatch, treatment, and monitoring. Methods An online questionnaire with 51 questions about ambulance and dispatch characteristics, on-scene management of cardiac arrest and the availability and dataset in cardiac arrest registries, was sent to all national coordinators who participated in the European Registry of Cardiac Arrest studies. In addition, individual invitations were sent to the remaining European countries. Results Participants from 28 European countries responded to the questionnaire. Results were combined with official information on population density. Overall, the number of Emergency Medical Service missions, level of training of personnel, availability of Helicopter Emergency Medical Services and the involvement of first responders varied across and within countries. There were similarities in team training, availability of key resuscitation equipment and permission for ongoing performance of cardiopulmonary resuscitation during transported. The quality of reporting to cardiac arrest registries varied, as well as the data availability in the registries. Conclusions Throughout Europe there are important differences in Emergency Medical Service systems and the response to out-of-hospital cardiac arrest. Explaining these differences is complicated due to significant variation in how variables are reported to and used in registries

Out-of-hospital cardiac arrest in children in Norway: A national cohort study, 2016–2021

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

Cardiac arrest as a reportable condition: A cohort study of the first 6 years of the Norwegian out-of-hospital cardiac arrest registry

Objectives The Norwegian Cardiac Arrest Registry (NorCAR) was established in 2013 when cardiac arrest became a mandatory reportable condition. The aim of this cohort study is to describe how the world’s first mandatory, population-based cardiac arrest registry evolved during its first 6 years. Setting Norway has a total population of 5.3 million inhabitants with a population density that varies considerably. All residents are assigned a unique identifier number, giving nationally approved registries access to information about all births and deaths in the country. Data in the registry are entered by data processors; public employees with close links to the emergency medical services. All data processors undergo a standardised training and meet for yearly retraining and updates. Participants All events of cardiac arrest where bystanders or healthcare professionals have started cardiopulmonary resuscitation or performed defibrillation are included into the NorCAR. Primary and secondary outcome measures Since the establishment of the registry, the number of reporting health trusts, the number of reported events and the corresponding population at risk were followed year by year. Outcome is measured as changes in inclusion rate, incidence per 100 000 inhabitants and survival to 30 days after cardiac arrest. Results In total, 14 849 cases were registered over 6 years, between 2013 and 2018. The number of health trusts reporting rose steadily from 2013. Within 3 years, all trusts reported to the registry with an increasing number of events reported; going from 1101 to 3400 per year. The prevalence of bystander cardiopulmonary resuscitation increased slightly, but the population incidence of survival did not change. Conclusion Declaring cardiac arrest as a reportable condition and close follow-up of all reporting areas is essential when building a national registry

Cardiac arrest as a reportable condition: A cohort study of the first 6 years of the Norwegian out-of-hospital cardiac arrest registry

Objectives The Norwegian Cardiac Arrest Registry (NorCAR) was established in 2013 when cardiac arrest became a mandatory reportable condition. The aim of this cohort study is to describe how the world’s first mandatory, population-based cardiac arrest registry evolved during its first 6 years. Setting Norway has a total population of 5.3 million inhabitants with a population density that varies considerably. All residents are assigned a unique identifier number, giving nationally approved registries access to information about all births and deaths in the country. Data in the registry are entered by data processors; public employees with close links to the emergency medical services. All data processors undergo a standardised training and meet for yearly retraining and updates. Participants All events of cardiac arrest where bystanders or healthcare professionals have started cardiopulmonary resuscitation or performed defibrillation are included into the NorCAR. Primary and secondary outcome measures Since the establishment of the registry, the number of reporting health trusts, the number of reported events and the corresponding population at risk were followed year by year. Outcome is measured as changes in inclusion rate, incidence per 100 000 inhabitants and survival to 30 days after cardiac arrest. Results In total, 14 849 cases were registered over 6 years, between 2013 and 2018. The number of health trusts reporting rose steadily from 2013. Within 3 years, all trusts reported to the registry with an increasing number of events reported; going from 1101 to 3400 per year. The prevalence of bystander cardiopulmonary resuscitation increased slightly, but the population incidence of survival did not change. Conclusion Declaring cardiac arrest as a reportable condition and close follow-up of all reporting areas is essential when building a national registry