title: Survival in out-of-hospital cardiac arrest before and after use of advanced postresuscitation care: a survey focusing on incidence, patient characteristics, survival, and estimated cerebral function after postresuscitation care.
abstract: BACKGROUND
  Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia.
  
  
  METHODS
  The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Göteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared.
  
  
  RESULTS
  In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011). For all patients, 1-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in 1-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >or=3) decreased from 28% to 6% (P = .0006) among all patients.
  
  
  CONCLUSIONS
  After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm.
authors.affiliation: Medicine Clinic, NU Hospital Organisation, NAL, 461 85 Trollhättan, Sweden.
authors.forename: Louise
authors.initials: L
authors.lastname: Martinell
authors.forename: Malena
authors.initials: M
authors.lastname: Larsson
authors.forename: Angela
authors.initials: A
authors.lastname: Bång
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.forename: Jonny
authors.initials: J
authors.lastname: Lindqvist
authors.forename: Ann-Britt
authors.initials: AB
authors.lastname: Thorén
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000367:Age Factors; D000368:Aged; D001921:Brain / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation / Q000401:mortality* / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000401:mortality; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D012737:Sex Factors; D016019:Survival Analysis; D013548:Sweden; D014693:Ventricular Fibrillation / Q000401:mortality