title: 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.
abstract: OBJECTIVE
  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?
  
  
  METHODS
  Observational register study.
  
  
  METHODS
  Sweden.
  
  
  METHODS
  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.
  
  
  METHODS
  Survival to 1&emsp14;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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesiaand Intensive Care Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Adielsson
authors.forename: Jacob
authors.initials: J
authors.lastname: Hollenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.forename: Jonny
authors.initials: J
authors.lastname: Lindqvist
authors.forename: Stefan
authors.initials: S
authors.lastname: Lundin
authors.forename: Johan
authors.initials: J
authors.lastname: Silfverstolpe
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D012737:Sex Factors; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000401:mortality* / Q000628:therapy*