Sudden noncardiac arrest out-of-hospital in the Reykjavík area 1987-1999

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenPurpose: The purpose of this investigation was to study specifically those cases of sudden death out-of-hospital in the Reykjavik area that were due to non-cardiac causes the last 13 years, from January 1987 to December 31, 1999. Material and methods: The doctors of the emergency ambulance have kept detailed files for all cases of sudden death according to international system of documentation, the Utstein protocol. The cases were divided into two major groups, i.e. on one hand cases due to outer causes and on the other hand cases due to inner causes. Outer causes included suicide, intoxication by drugs, trauma, drowning and cases due to asphyxia. Inner causes included various types of bleeding, hypoxia, cot death and various diseases other than heart disease. Results: From 738 cases 140 or 19% were thought to be due to sudden non-cardiac death. Ninety-two cases of those 140 or 66% were due to outer causes. Inner causes were diagnosed in 48 (34%) cases. Mean age was 46 years (standard deviation, SD: 24.3 years). Men were 85 of the 140 cases (61%) and women 55 (39%). Mean response time was five minutes. Of the 140 individuals only nine (6%) survived, of those four had sustained near-drowning, four near suffocation and one drug intoxication. Conclusions: In this study the data were reported in accordance with the Utstein protocol and therefore drug intoxication and suicide are not grouped together. However, most if not all cases of drug intoxication appear to have occurred in an attempt of suicide. Except for cardiac disease drug intoxication and suicides were together the most common causes of sudden death out-of-hospital in those instances attended by the crew of the emergency ambulance. The results of resuscitation attempts are much worse when the cause for sudden death is non-cardiac. Survival was relatively best in cases of "suffocation" or "drowning".Tilgangur: Tilgangur þessarar rannsóknar var að kanna sérstaklega þau tilfelli skyndidauða utan sjúkrahúsa á Reykjavíkursvæðinu, sem hafa orðið af öðrum ástæðum en hjartasjúkdómum síðustu 13 ár, frá 1. janúar 1987 til 31. desember 1999. Efniviður og aðferðir: Læknar neyðarbílsins hafa haldið nákvæmar skrár yfir öll tilfelli skyndidauða sem hafa tekið mið af alþjóðlegu skráningarkerfi, Utsteinstaðlinum. Tilfellum var skipt í tvo meginflokka, það er tilfelli sem urðu vegna ytri ástæðna annars vegar og innri ástæðna hins vegar. Til ytri ástæðna töldust sjálfsvíg, lyfjaeitranir, áverkar, drukknanir og tilfelli rakin til köfnunar. Til innri ástæðna töldust einkum ýmiss konar blæðingar, súrefnisþurrð, vöggudauði og ýmsir sjúkdómar aðrir en hjartasjúkdómar. Niðurstöður: Af 738 tilfellum voru 140 eða 19% talin vera skyndidauði af öðrum ástæðum en hjartasjúkdómum. Níutíu og tvö tilfelli af 140 eða 66% reyndust hafa orðið vegna ytri ástæðna. Innri ástæður voru greindar í 48 (34%) tilfellum. Meðalaldur var 46 ár (staðalfrávik (standard deviation, SD): 24,3 ár). Karlar voru 85 af 140 (61%) og konur 55 (39%). Meðalútkallstími var fimm mínútur. Af 140 einstaklingum náðu einungis níu (6%) að lifa áfallið af, þar af fjórir sem voru nær drukknaðir, fjórir nær kafnaðir og einn eftir "lyfjaeitrun". Ályktanir: Í þessari rannsókn var Utsteinstaðli fylgt við birtingu niðurstaðna og eru því lyfjaeitranir og sjálfsvíg ekki flokkuð saman. Svo virðist þó sem flest ef ekki öll tilfelli lyfjaeitrana hafi verið í sjálfsvígstilgangi. Að undanskildum hjartasjúkdómum voru lyfjaeitranir og sjálfsvíg samanlagt algengustu ástæður skyndidauða utan spítala í þeim tilvikum sem áhöfn neyðarbíls var kölluð til. Árangur af endurlífgunartilraunum er mun lakari þegar ástæða skyndidauða er önnur en hjartasjúkdómur. Hlutfallslega flestir lifðu af þegar um "köfnunar-" eða "drukknunartilfelli" var að ræða

Prehospital cardiac life support in the Reykjavík area 1999-2002

Hægt er að lesa af greinina í heild sinni með því að smella á hlekkinn í Additional LinksOBJECTIVES: A physician manned ambulance has provided advanced resuscitation service in the Reykjavík area for over 20 years. Out of hospital resuscitation since 1982 has been done with average response time of 4.6-4.9 minutes, the survival rate to hospital admission has been 31-40% and survival to hospital discharge 16-17%. In the years preceding this study, several changes were done in the service; the service area was enlarged, dispatch was centralized to one emergency number, the training of EMT s and physicians was improved and a two-tier rendezvous system was adopted. Cell phone coverage reached over 90% of the population. The study was done in 1999-2002 with the objective to: 1. measure the results of attempted prehospital resuscitations for cardiac diseases in the area, 2. to monitor the effect of bystander response, 3. to estimate the effect of changes in the service prior to the study period. MATERIALS AND METHODS: A ambulance staffed with EMTs and one with a physician were dispatched to all possible cases of cardiac arrest. Resuscitation was attempted using the AHA guidelines for resuscitation. Prospective data was collected following the Utstein template recorded by the physician on call. RESULTS: A total of 319 resuscitative attempts were made during the years 1999-2002, excluding hanging, SIDS, drowning, suicide, trauma, internal bleeding and other diseases, a total of 232 arrests were considered of cardiac origin giving an incidence of 33/100,000/year. The average response time was 6,1 min. Of 232 cardiac resuscitation attempts 140 patients (60%) were in VF/VT, 53 (23%) in asystole and 39 (17%) in other rhythms. Ninety-six (41%) of all patients survived being admitted to hospital ward and 44 (19%) survived to discharge with 39 being alive at 12 months. Of patients in VF/VT, 79 (56%) survived to hospital admission and 39 (28%) to hospital discharge. Resuscitation was more successful in cases of witnessed arrest and if CPR was attempted by bystanders. CONCLUSION: Despite various changes in the EMS system, the results of resuscitative attempts are similar to previous studies in the area but an increased proportion of survivors is left with neurological damage. In 54% of the cases COR was performed by bystanders. Response time needs to be shortened and CPR training increased.Inngangur: Neyðarbíll hefur sinnt endurlífgunarþjónustu á höfuðborgarsvæðinu síðan 1982. Hefur útkallstími við endurlífganir verið 4,6-4,9 mínútur, lifun að innlögn á sjúkrahús 31-40% og lifun að útskrift frá sjúkrahúsi 16-17%. Í upphafi árs 1996 var fyrirkomulagi breytt þegar þjónustusvæði var stækkað og sama ár var einnig tekið upp stefnumótakerfi, auk þess sem neyðarlínan tók til starfa. Farsímanotkun þjóðarinnar náði yfir 90% í lok rannsóknartímabilsins sem hefur auðveldað tilkynningar um hjartastopp og á tímabilinu var þjálfun neyðarbílslækna og sjúkraflutningamanna aukin. Rannsóknin var gerð á árunum 1999-2002. Tilgangur hennar var að meta: 1) árangur endurlífgunartilrauna utan sjúkrahúsa vegna hjartasjúkdóma á höfuðborgarsvæðinu, 2) áhrif viðbragða og endurlífgunartilrauna nærstaddra á afdrif sjúklinga, 3) hugsanleg áhrif skipulagsbreytinga á þjónustunni. Efniviður og aðferðir: Í öllum tilvikum skyndilegs meðvitundarleysis fer sjúkrabíll og neyðarbílslæknir á vettvang. Endurlífgunartilraunir voru framkvæmdar samkvæmt stöðlum AHA (american heart association) og skýrslur um allar endurlífgunartilraunir fylltar út jafnharðan af neyðarbílslæknum samkvæmt Utsteinstaðli. Niðurstöður: Alls var reynt að endurlífga í 319 tilvikum. Í 87 tilvikum var um að ræða hengingu, drukknun, lyfjaeitrun, innri blæðingu, vöggudauða, áverka eða aðrar ástæður, en í 232 tilvikum var hjartastopp vegna hjartasjúkdóma og miðast uppgjörið við þann hóp. Tíðni hjartaendurlífgunartilrauna var 33 á hverja 100.000 íbúa á ári. Meðalaldur var 68 ár og 77% voru karlar. Meðalútkallstími var 6,1 mínútur. Af 232 hjartasjúkdómaendurlífgunum voru 140 einstaklingar (60%) í sleglatifi eða sleglahraðtakti án blóðflæðis (VF/VT), 53 (23%) í rafleysu og 39 (17%) í öðrum takti. Af öllum sjúklingum þar sem endurlífgun var reynd komust 96 (41%) lifandi inn á legudeild og 44 útskrifuðust (19%). Eftir 12 mánuði voru 39 á lífi. Sé litið sérstaklega á þá sem voru í VF/VT komust 79 (56%) lifandi inn á deild og 39 (28%) útskrifuðust. Þegar vitni var að upphafi hjartastopps var skyndihjálp beitt í 54% tilvika. Ályktanir: Þrátt fyrir lengingu á útkallstíma hefur árangur endurlífgunartilrauna ekki breyst en fjöldi þeirra sem lifa af með heilaskaða hefur aukist. Aðgerðir til þess að stytta útkallstíma og auka fjölda þeirra sem framkvæma hjartahnoð eru nauðsynlegar

Sudden noncardiac arrest out-of-hospital in the Reykjavík area 1987-1999

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenPurpose: The purpose of this investigation was to study specifically those cases of sudden death out-of-hospital in the Reykjavik area that were due to non-cardiac causes the last 13 years, from January 1987 to December 31, 1999. Material and methods: The doctors of the emergency ambulance have kept detailed files for all cases of sudden death according to international system of documentation, the Utstein protocol. The cases were divided into two major groups, i.e. on one hand cases due to outer causes and on the other hand cases due to inner causes. Outer causes included suicide, intoxication by drugs, trauma, drowning and cases due to asphyxia. Inner causes included various types of bleeding, hypoxia, cot death and various diseases other than heart disease. Results: From 738 cases 140 or 19% were thought to be due to sudden non-cardiac death. Ninety-two cases of those 140 or 66% were due to outer causes. Inner causes were diagnosed in 48 (34%) cases. Mean age was 46 years (standard deviation, SD: 24.3 years). Men were 85 of the 140 cases (61%) and women 55 (39%). Mean response time was five minutes. Of the 140 individuals only nine (6%) survived, of those four had sustained near-drowning, four near suffocation and one drug intoxication. Conclusions: In this study the data were reported in accordance with the Utstein protocol and therefore drug intoxication and suicide are not grouped together. However, most if not all cases of drug intoxication appear to have occurred in an attempt of suicide. Except for cardiac disease drug intoxication and suicides were together the most common causes of sudden death out-of-hospital in those instances attended by the crew of the emergency ambulance. The results of resuscitation attempts are much worse when the cause for sudden death is non-cardiac. Survival was relatively best in cases of "suffocation" or "drowning".Tilgangur: Tilgangur þessarar rannsóknar var að kanna sérstaklega þau tilfelli skyndidauða utan sjúkrahúsa á Reykjavíkursvæðinu, sem hafa orðið af öðrum ástæðum en hjartasjúkdómum síðustu 13 ár, frá 1. janúar 1987 til 31. desember 1999. Efniviður og aðferðir: Læknar neyðarbílsins hafa haldið nákvæmar skrár yfir öll tilfelli skyndidauða sem hafa tekið mið af alþjóðlegu skráningarkerfi, Utsteinstaðlinum. Tilfellum var skipt í tvo meginflokka, það er tilfelli sem urðu vegna ytri ástæðna annars vegar og innri ástæðna hins vegar. Til ytri ástæðna töldust sjálfsvíg, lyfjaeitranir, áverkar, drukknanir og tilfelli rakin til köfnunar. Til innri ástæðna töldust einkum ýmiss konar blæðingar, súrefnisþurrð, vöggudauði og ýmsir sjúkdómar aðrir en hjartasjúkdómar. Niðurstöður: Af 738 tilfellum voru 140 eða 19% talin vera skyndidauði af öðrum ástæðum en hjartasjúkdómum. Níutíu og tvö tilfelli af 140 eða 66% reyndust hafa orðið vegna ytri ástæðna. Innri ástæður voru greindar í 48 (34%) tilfellum. Meðalaldur var 46 ár (staðalfrávik (standard deviation, SD): 24,3 ár). Karlar voru 85 af 140 (61%) og konur 55 (39%). Meðalútkallstími var fimm mínútur. Af 140 einstaklingum náðu einungis níu (6%) að lifa áfallið af, þar af fjórir sem voru nær drukknaðir, fjórir nær kafnaðir og einn eftir "lyfjaeitrun". Ályktanir: Í þessari rannsókn var Utsteinstaðli fylgt við birtingu niðurstaðna og eru því lyfjaeitranir og sjálfsvíg ekki flokkuð saman. Svo virðist þó sem flest ef ekki öll tilfelli lyfjaeitrana hafi verið í sjálfsvígstilgangi. Að undanskildum hjartasjúkdómum voru lyfjaeitranir og sjálfsvíg samanlagt algengustu ástæður skyndidauða utan spítala í þeim tilvikum sem áhöfn neyðarbíls var kölluð til. Árangur af endurlífgunartilraunum er mun lakari þegar ástæða skyndidauða er önnur en hjartasjúkdómur. Hlutfallslega flestir lifðu af þegar um "köfnunar-" eða "drukknunartilfelli" var að ræða

Prehospital cardiac life support in the Reykjavík area 1999-2002

Hægt er að lesa af greinina í heild sinni með því að smella á hlekkinn í Additional LinksOBJECTIVES: A physician manned ambulance has provided advanced resuscitation service in the Reykjavík area for over 20 years. Out of hospital resuscitation since 1982 has been done with average response time of 4.6-4.9 minutes, the survival rate to hospital admission has been 31-40% and survival to hospital discharge 16-17%. In the years preceding this study, several changes were done in the service; the service area was enlarged, dispatch was centralized to one emergency number, the training of EMT s and physicians was improved and a two-tier rendezvous system was adopted. Cell phone coverage reached over 90% of the population. The study was done in 1999-2002 with the objective to: 1. measure the results of attempted prehospital resuscitations for cardiac diseases in the area, 2. to monitor the effect of bystander response, 3. to estimate the effect of changes in the service prior to the study period. MATERIALS AND METHODS: A ambulance staffed with EMTs and one with a physician were dispatched to all possible cases of cardiac arrest. Resuscitation was attempted using the AHA guidelines for resuscitation. Prospective data was collected following the Utstein template recorded by the physician on call. RESULTS: A total of 319 resuscitative attempts were made during the years 1999-2002, excluding hanging, SIDS, drowning, suicide, trauma, internal bleeding and other diseases, a total of 232 arrests were considered of cardiac origin giving an incidence of 33/100,000/year. The average response time was 6,1 min. Of 232 cardiac resuscitation attempts 140 patients (60%) were in VF/VT, 53 (23%) in asystole and 39 (17%) in other rhythms. Ninety-six (41%) of all patients survived being admitted to hospital ward and 44 (19%) survived to discharge with 39 being alive at 12 months. Of patients in VF/VT, 79 (56%) survived to hospital admission and 39 (28%) to hospital discharge. Resuscitation was more successful in cases of witnessed arrest and if CPR was attempted by bystanders. CONCLUSION: Despite various changes in the EMS system, the results of resuscitative attempts are similar to previous studies in the area but an increased proportion of survivors is left with neurological damage. In 54% of the cases COR was performed by bystanders. Response time needs to be shortened and CPR training increased.Inngangur: Neyðarbíll hefur sinnt endurlífgunarþjónustu á höfuðborgarsvæðinu síðan 1982. Hefur útkallstími við endurlífganir verið 4,6-4,9 mínútur, lifun að innlögn á sjúkrahús 31-40% og lifun að útskrift frá sjúkrahúsi 16-17%. Í upphafi árs 1996 var fyrirkomulagi breytt þegar þjónustusvæði var stækkað og sama ár var einnig tekið upp stefnumótakerfi, auk þess sem neyðarlínan tók til starfa. Farsímanotkun þjóðarinnar náði yfir 90% í lok rannsóknartímabilsins sem hefur auðveldað tilkynningar um hjartastopp og á tímabilinu var þjálfun neyðarbílslækna og sjúkraflutningamanna aukin. Rannsóknin var gerð á árunum 1999-2002. Tilgangur hennar var að meta: 1) árangur endurlífgunartilrauna utan sjúkrahúsa vegna hjartasjúkdóma á höfuðborgarsvæðinu, 2) áhrif viðbragða og endurlífgunartilrauna nærstaddra á afdrif sjúklinga, 3) hugsanleg áhrif skipulagsbreytinga á þjónustunni. Efniviður og aðferðir: Í öllum tilvikum skyndilegs meðvitundarleysis fer sjúkrabíll og neyðarbílslæknir á vettvang. Endurlífgunartilraunir voru framkvæmdar samkvæmt stöðlum AHA (american heart association) og skýrslur um allar endurlífgunartilraunir fylltar út jafnharðan af neyðarbílslæknum samkvæmt Utsteinstaðli. Niðurstöður: Alls var reynt að endurlífga í 319 tilvikum. Í 87 tilvikum var um að ræða hengingu, drukknun, lyfjaeitrun, innri blæðingu, vöggudauða, áverka eða aðrar ástæður, en í 232 tilvikum var hjartastopp vegna hjartasjúkdóma og miðast uppgjörið við þann hóp. Tíðni hjartaendurlífgunartilrauna var 33 á hverja 100.000 íbúa á ári. Meðalaldur var 68 ár og 77% voru karlar. Meðalútkallstími var 6,1 mínútur. Af 232 hjartasjúkdómaendurlífgunum voru 140 einstaklingar (60%) í sleglatifi eða sleglahraðtakti án blóðflæðis (VF/VT), 53 (23%) í rafleysu og 39 (17%) í öðrum takti. Af öllum sjúklingum þar sem endurlífgun var reynd komust 96 (41%) lifandi inn á legudeild og 44 útskrifuðust (19%). Eftir 12 mánuði voru 39 á lífi. Sé litið sérstaklega á þá sem voru í VF/VT komust 79 (56%) lifandi inn á deild og 39 (28%) útskrifuðust. Þegar vitni var að upphafi hjartastopps var skyndihjálp beitt í 54% tilvika. Ályktanir: Þrátt fyrir lengingu á útkallstíma hefur árangur endurlífgunartilrauna ekki breyst en fjöldi þeirra sem lifa af með heilaskaða hefur aukist. Aðgerðir til þess að stytta útkallstíma og auka fjölda þeirra sem framkvæma hjartahnoð eru nauðsynlegar

Mitochondrial respiration in human viable platelets--methodology and influence of gender, age and storage.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Studying whole cell preparations with intact mitochondria and respiratory complexes has a clear benefit compared to isolated or disrupted mitochondria due to the dynamic interplay between mitochondria and other cellular compartments. Platelet mitochondria have a potential to serve as a source of human viable mitochondria when studying mitochondrial physiology and pathogenic mechanisms, as well as for the diagnostics of mitochondrial diseases. The objective of the present study was to perform a detailed evaluation of platelet mitochondrial respiration using high-resolution respirometry. Further, we aimed to explore the limits of sample size and the impact of storage as well as to establish a wide range of reference data from different pediatric and adult cohorts. Our results indicate that platelet mitochondria are well suited for ex-vivo analysis with the need for minute sample amounts and excellent reproducibility and stability.Swedish Research Council 2011-3470 Royal Physiographic Society Foundation of the Swedish National Board of Health and Welfare Carl og Ellen Hertz' legat til Dansk laege- og naturvidenskab Lippman foundatio

Oxygen consumption in platelets as an adjunct diagnostic method for pediatric mitochondrial disease

Diagnosing mitochondrial disease (MD) is a challenge. In addition to genetic analyses, clinical practice is to perform invasive procedures such as muscle biopsy for biochemical and histochemical analyses. Blood cell respirometry is rapid and noninvasive. Our aim was to explore its possible role in diagnosing MD.MethodsBlood samples were collected from 113 pediatric patients, for whom MD was a differential diagnosis. A respiratory analysis model based on ratios (independent of mitochondrial specific content) was derived from a group of healthy controls and tested on the patients. The diagnostic accuracy of platelet respirometry was evaluated against routine diagnostic investigation.ResultsMD prevalence in the cohort was 16%. A ratio based on the respiratory response to adenosine diphosphate in the presence of complex I substrates had 96% specificity for disease and a positive likelihood ratio of 5.3. None of the individual ratios had sensitivity above 50%, but a combined model had 72% sensitivity.ConclusionNormal findings of platelet respirometry are not able to rule out MD, but pathological results make the diagnosis more likely and could strengthen the clinical decision to perform further invasive analyses. Our results encourage further study into the role of blood respirometry as an adjunct diagnostic tool for MD