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  • 1.
    Israelsson, Johan
    et al.
    Kalmar County Hospital, Kalmar, Sweden.
    Bremer, Anders
    University of Borås, Borås, Sweden.
    Axelsson, Åsa
    University of Gothenburg, Gothenburg, Sweden.
    Cronberg, Tobias
    Lund University, Lund, Sweden.
    Djärv, Therese
    Karolinska Institutet, Stockholm, Sweden.
    Herlitz, Johan
    University of Borås, Borås, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Larsson, Ing-Marie
    Uppsala University, Uppsala, Sweden.
    Lilja, Gisela
    Lund University, Lund, Sweden.
    Sunnerhagen, Katarina S.
    University of Gothenburg, Gothenburg, Sweden.
    Wallin, Ewa
    Uppsala University, Uppsala, Sweden.
    Ågren, Susanna
    Linköping University, Linköping, Sweden.
    Åkerman, Eva
    Skane University Hospital, Malmö, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Kalmar, Sweden.
    Neurologic outcome, health-related quality of life, anxiety and symptoms of depression among in-hospital cardiac arrest survivors2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl. 1, p. 101-101, article id AP143Article in journal (Other academic)
    Abstract [en]

    Purpose: Most cardiac arrest research has focused on survival inan out-of-hospital context. The knowledge of health and quality of life is sparse, especially regarding in-hospital cardiac arrest (IHCA) survivors. The aim of the current study was therefore to describe neurologic outcome, health-related quality of life (HRQoL), anxiety and symptoms of depression among IHCA survivors.

    Materials and methods: This study has a cross-sectional design. Data from the Swedish Register of Cardiopulmonary Resuscitation was used. In the register, data is collected 3–6 months after resuscitation by using a questionnaire including two questions about activities in daily life and mental/intellectual recovery, theEQ-5D-5L and the Hospital Anxiety and Depression Scale (HADS). In addition, Cerebral Performance Category (CPC)-scoring is performed.

    Results: Between the 11th of June 2013 and the 7th of May 2015, 488 IHCA survivors with a mean age of 69±13 were included. A majority were men (62%), had a cerebral function of CPC 1 (87%) and no need of assistance from other people in daily life (71%). A large proportion had not made a complete mental/intellectual recovery (27%). Pain/discomfort was the dimension in EQ-5D-5L where most survivors reported problems (64%), while least problems were reported in the dimension self-care (24%). The individual variations of present health state (EQ-VAS) were substantial (range 0–100), with a mean value of 66±22. Anxiety and symptoms of depression were reported by 16% and 15% respectively.

    Conclusions: Although the majority of the IHCA survivors reported good neurologic outcome, satisfactory HRQoL, no anxiety or symptoms of depression, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of structured post resuscitation care and follow-up, in order to identify and support those in need.

  • 2.
    Israelsson, Johan
    et al.
    Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden; Kalmar Maritime Academy, Linnaeus University, Kalmar, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden .
    Bremer, Anders
    Department of Acute and Prehospital Care and Medical Technology and PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden; Division of Emergency Medical Services, Kalmar County Hospital, Kalmar, Sweden .
    Herlitz, Johan
    Department of Acute and Prehospital Care and Medical Technology and PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Axelsson, Åsa B.
    Institute of Health and Care Sciences, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden.
    Cronberg, Tobias
    Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
    Djärv, Therese
    Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Lilja, Gisela
    Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
    Sunnerhagen, Katharina S.
    Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Sweden.
    Wallin, Ewa
    Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Ågren, Susanna
    Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiothoracic Surgery, County Council of Östergötland, Linköping, Sweden .
    Åkerman, Eva
    Department of Perioperative Medicine and Intensive Care, Skane University Hospital, Malmö, Sweden; Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Stockholm, Sweden .
    Årestedt, Kristofer
    Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden; Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Kalmar County Hospital, Kalmar, Sweden .
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 3.
    Larsson, Ing-Marie
    et al.
    Department of Surgical Sciences, Uppsala University.
    Wallin, Ewa
    Department of Surgical Sciences, Uppsala University.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University.
    Niessner, Marion
    Roche Diagnostics GmbH, Penzberg, Germany.
    Zetterberg, Henrik
    Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg; UCL Institute of Neurology, Queen Square, London.
    Rubertsson, Sten
    Department of Surgical Sciences, Uppsala University.
    Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 12, p. 1654-1661Article in journal (Refereed)
    Abstract [en]

    Aim of the study: To investigate serum levels of glial fibrillary acidic protein (GFAP) for evaluation of neurological outcome in cardiac arrest (CA) patients and compare GFAP sensitivity and specificity to that of more studied biomarkers neuron-specific enolas (NSE) and S100B. Method: A prospective observational study was performed in three hospitals in Sweden during 2008-2012. The participants were 125 CA patients treated with therapeutic hypothermia (TH) to 32-34. °C for 24. hours. Samples were collected from peripheral blood (n. =. 125) and the jugular bulb (n. =. 47) up to 108. hours post-CA. GFAP serum levels were quantified using a novel, fully automated immunochemical method. Other biomarkers investigated were NSE and S100B. Neurological outcome was assessed using the Cerebral Performance Categories scale (CPC) and dichotomized into good and poor outcome. Results: GFAP predicted poor neurological outcome with 100% specificity and 14-23% sensitivity at 24, 48 and 72. hours post-CA. The corresponding values for NSE were 27-50% sensitivity and for S100B 21-30% sensitivity when specificity was set to 100%. A logistic regression with stepwise combination of the investigated biomarkers, GFAP, did not increase the ability to predict neurological outcome. No differences were found in GFAP, NSE and S100B levels when peripheral and jugular bulb blood samples were compared. Conclusion: Serum GFAP increase in patients with poor outcome but did not show sufficient sensitivity to predict neurological outcome after CA. Both NSE and S100B were shown to be better predictors. The ability to predict neurological outcome did not increased when combining the three biomarkers.

  • 4.
    Larsson, Ing-Marie
    et al.
    Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
    Wallin, Ewa
    Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 2, p. 215-220Article in journal (Refereed)
    Abstract [en]

    Aim of the study:

    To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH). Method: During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, at hospital discharge, and at one and 6 months after CA. Result: There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0–100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most com-mon complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = −0.44 to −0.71, p ≤ 0.001). Conclusion: HRQoL improves over the first 6 months after a CA. Patients reported lower levels of HRQoL on the physical as compared to mental component. The results indicate that the less anxiety and depression patients perceive, the better HRQoL they have and that time can be an important factor in recovery after CA.

  • 5.
    Wallin, Ewa
    et al.
    Institutionen för kirurgiska vetenskaper, Uppsala universitet.
    Larsson, Ing-Marie
    Institutionen för kirurgiska vetenskaper, Uppsala universitet.
    Rubertsson, Sten
    Institutionen för kirurgiska vetenskaper, Uppsala universitet.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Cardiac arrest and hypothermia treatment: function and life satisfaction among survivors in the first 6 months2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 4, p. 538-543Article in journal (Refereed)
    Abstract [en]

    Aim of the study:

    To describe differences over time in outcome, physical and cognitive function among survivors of cardiac arrest treated with hypothermia and to examine survivors’ life satisfaction 6 months after cardiac arrest as well as gender differences. Methods: The study was prospective and included 45 cardiac arrest survivors admitted to three Swedish hospitals between 2008 and 2012. Participants were followed from intensive care unit discharge to one and six months after cardiac arrest. In addition to cerebral performance category (CPC), participants were asked to complete questionnaires regarding activities in daily life (Barthel index), cognitive function (mini mental state examination), and life satisfaction (LiSat-11). Results: Outcome measured using CPC scores improved over time. At 6 months, all participants were classified as having a good outcome. At one month, participants were impaired but improved over time in their activities in daily life and cognitive function. At 6 months satisfaction with "life as a whole" was seen in 70%. Conclusions: Cardiac arrest survivors are satisfied with life as a whole despite a severe illness that has impaired their physical and cognitive function, which seemed to improve over time. Predicting patients’ functional outcome in early stages is difficult, and the CPC score alone is not sufficient to assess patients’ function. It is a need to reach a consensus to which instruments best reflect physical and cognitive function as well as to specify a rehabilitation plan.

  • 6.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences – Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences – Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences – Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Larsson, Elna-Marie
    Department of Surgical Sciences – Radiology, Uppsala University, Uppsala, Sweden.
    Raininko, Raili
    Department of Surgical Sciences – Radiology, Uppsala University, Uppsala, Sweden.
    Acute brain lesion on MRI in relation to neorological outcome 6 months after cardiac arrest treated with hypothermia2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl. 1, p. 147-147, article id AP254Article in journal (Other academic)
    Abstract [en]

    Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

    Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patientstreated with TH.

    Results: MRI of the brain was obtained at a median of 4 days (3–13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24–30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p= 0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical, and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600×10−6mm2/s in any region survived to 6months.

    Conclusions: In visual analyses of acute MRI, extensive acutelesions were found in the cortical regions and deep gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.

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