title: Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival.
abstract: OBJECTIVE
  To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation.
  
  
  RESULTS
  All cases of OHCA (n = 59,926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100,000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P < 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008-2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008-2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm.
  
  
  CONCLUSIONS
  From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome.
authors.affiliation: School of Health and Social Sciences, University of Dalarna, Falun SE-791 88, Sweden Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden ase@du.se.
authors.forename: Anneli
authors.initials: A
authors.lastname: Strömsöe
authors.affiliation: Stockholm Pre-hospital Centre, South Hospital, Stockholm SE-118 83, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.affiliation: Institute of Health and Caring Science, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Åsa B
authors.initials: ÅB
authors.lastname: Axelsson
authors.affiliation: The Prehospital Research Centre Western Sweden, Prehospen University College of Borås, Borås SE-501 90, Sweden Kungälv Ambulance Service, Kungälv SE-442 40, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Claesson
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Medicine, Solna, Karolinska Institutet, Stockholm SE-171 76, Sweden.
authors.forename: Katarina E
authors.initials: KE
authors.lastname: Göransson
authors.affiliation: Department of Clinical Science and Education, Section of Cardiology, Södersjukhuset, Stockholm SE-118 83, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Nordberg
authors.affiliation: Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden The Prehospital Research Centre Western Sweden, Prehospen University College of Borås, Borås SE-501 90, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000368:Aged; D000552:Ambulances / Q000600:supply & distribution; D001927:Brain Diseases / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality / Q000592:standards; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013548:Sweden / Q000453:epidemiology; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data
keywords: Cardiopulmonary resuscitation; Registries; Survival