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Rubertsson, Sten
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Publications (10 of 137) Show all publications
Elfwen, L., Lagedal, R., Nordberg, P., James, S., Oldgren, J., Bohm, F., . . . Svensson, L. (2019). Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial. Resuscitation, 139, 253-261
Open this publication in new window or tab >>Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 139, p. 253-261Article in journal (Refereed) Published
Abstract [en]

Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151). Methods: Resuscitated bystander witnessed OHCA patients > 18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded. Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days. Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Out-of-hospital, Cardiac arrest, Coronary angiography, Percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-387925 (URN)10.1016/j.resuscitation.2019.04.027 (DOI)000470076000033 ()31028826 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Note

De 2 sista författarna delar sistaförfattarskapet.

Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27Bibliographically approved
Lindgren, E., Covaciu, L., Smekal, D., Lagedal, R., Nordberg, P., Elfwen, L., . . . Rubertsson, S. (2019). Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study. Resuscitation, 143, 189-195
Open this publication in new window or tab >>Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, p. 189-195Article in journal (Refereed) Published
Abstract [en]

Introduction: We investigated the impact of gender in performance and findings of early coronary angiography (CAG) and percutaneous coronary intervention (PCI), comorbidity and outcome in a large population of out-of-hospital cardiac arrest (OHCA) patients with an initially shockable rhythm.

Methods: Retrospective cohort study. Data retrieved 2008-2013 from the Swedish Register for Cardio-Pulmonary Resuscitation, Swedeheart Registry and National Patient Register.

Results: We identified 1498 patients of whom 78% were men. Men and women had the same pathology on the first registered electrocardiogram (ECG): 30% vs. 29% had ST-elevation and 10% vs. 9% had left bundle branch block (LBBB) (P=0.97). Proportions of performed CAG did not differ between genders. Among patients without ST-elevation/LBBB men more often had at least one significant stenosis, 78% vs. 54% (P= 0.001), more multi-vessel disease (P= 0.01), had normal coronary angiography less often, 22% vs. 46% and PCI more often, 59% vs. 42% (P= 0.03). Among patients without STelevation/LBBB on the initial ECG, more men had previously known ischaemic heart disease, 27% vs. 19% (P=0.02) and a presumed cardiac origin of the cardiac arrest, 86% vs. 72% (P< 0.001). Multivariable analysis showed no association between gender and evaluation by early CAG. In men and women, 1-year survival was 56% vs. 50% (P= 0.22) in patients with ST-elevation/LBBB and 48% vs. 51% (P= 0.50) in patients without.

Conclusion: Despite no gender differences in ECG findings indicating an early CAG, men had more severe coronary artery disease while women more frequently had normal coronary angiography. However, this did not influence 1-year survival.

Keywords
Cardiac arrest, Gender differences, Out-of-hospital cardiac arrest, Coronary angiography, Percutaneous coronary intervention, Ventricular fibrillation, CPR, Registry study
National Category
Cardiac and Cardiovascular Systems Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-395786 (URN)10.1016/j.resuscitation.2019.07.015 (DOI)000487197500028 ()31330199 (PubMedID)
Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-10-28Bibliographically approved
Riva, G., Ringh, M., Jonsson, M., Svensson, L., Herlitz, J., Claesson, A., . . . Hollenberg, J. (2019). Survival in Out-of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscitation or Chest Compressions Only Before Arrival of Emergency Medical Services Nationwide Study During Three Guideline Periods. Circulation, 139(23), 2600-2609
Open this publication in new window or tab >>Survival in Out-of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscitation or Chest Compressions Only Before Arrival of Emergency Medical Services Nationwide Study During Three Guideline Periods
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2019 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 139, no 23, p. 2600-2609Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In out-of-hospital cardiac arrest, chest compression-only cardiopulmonary resuscitation (CO-CPR) has emerged as an alternative to standard CPR (S-CPR), using both chest compressions and rescue breaths. Since 2010, CPR guidelines recommend CO-CPR for both untrained bystanders and trained bystanders unwilling to perform rescue breaths. The aim of this study was to describe changes in the rate and type of CPR performed before the arrival of emergency medical services (EMS) during 3 consecutive guideline periods in correlation to 30-day survival.

METHODS: All bystander-witnessed out-of-hospital cardiac arrests reported to the Swedish register for cardiopulmonary resuscitation in 2000 to 2017 were included. Nonwitnessed, EMS-witnessed, and rescue breathonly CPR cases were excluded. Patients were categorized as receivers of no CPR (NO-CPR), S-CPR, or CO-CPR before EMS arrival. Guideline periods 2000 to 2005, 2006 to 2010, and 2011 to 2017 were used for comparisons over time. The primary outcome was 30-day survival.

RESULTS: A total of 30 445 patients were included. The proportions of patients receiving CPR before EMS arrival changed from 40.8% in the first time period to 58.8% in the second period, and to 68.2% in the last period. S-CPR changed from 35.4% to 44.8% to 38.1%, and CO-CPR changed from 5.4% to 14.0% to 30.1%, respectively. Thirty-day survival changed from 3.9% to 6.0% to 7.1% in the NO-CPR group, from 9.4% to 12.5% to 16.2% in the S-CPR group, and from 8.0% to 11.5% to 14.3% in the CO-CPR group. For all time periods combined, the adjusted odds ratio for 30-day survival was 2.6 (95% CI, 2.4-2.9) for S-CPR and 2.0 (95% CI, 1.8-2.3) for CO-CPR, in comparison with NO-CPR. S-CPR was superior to CO-CPR (adjusted odds ratio, 1.2; 95% CI, 1.1-1.4).

CONCLUSIONS: In this nationwide study of out-of-hospital cardiac arrest during 3 periods of different CPR guidelines, there was an almost a 2-fold higher rate of CPR before EMS arrival and a concomitant 6-fold higher rate of CO-CPR over time. Any type of CPR was associated with doubled survival rates in comparison with NO-CPR. These findings support continuous endorsement of CO-CPR as an option in future CPR guidelines because it is associated with higher CPR rates and overall survival in out-of-hospital cardiac arrest.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
Keywords
cardiopulmonary resuscitation, heart arrest, life support systems, out-of-hospital cardiac arrest
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-387730 (URN)10.1161/CIRCULATIONAHA.118.038179 (DOI)000470002100006 ()30929457 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
May, T. L., Lary, C. W., Riker, R. R., Friberg, H., Patel, N., Soreide, E., . . . Agarwal, S. (2019). Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry. Intensive Care Medicine, 45(5), 637-646
Open this publication in new window or tab >>Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry
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2019 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 45, no 5, p. 637-646Article in journal (Refereed) Published
Abstract [en]

Purpose

Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers.

Methods

Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average.

Results

A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 degrees C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers.

Conclusions

Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.

Keywords
Cardiac arrest, Center variability, Out of hospital arrest
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-383510 (URN)10.1007/s00134-019-05580-7 (DOI)000465981200008 ()30848327 (PubMedID)
Note

Correction in: INTENSIVE CARE MEDICINE, Volume: 45, Issue: 8, Pages: 1176-1176, DOI: 10.1007/s00134-019-05687-x

Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-08-19Bibliographically approved
Wallin, E., Larsson, I.-M., Kristofferzon, M.-L., Larsson, E.-M., Raininko, R. & Rubertsson, S. (2018). Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest. Acta Anaesthesiologica Scandinavica, 62(5), 635-647
Open this publication in new window or tab >>Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 5, p. 635-647Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

METHODS:

A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

RESULTS:

Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

CONCLUSIONS:

Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-340789 (URN)10.1111/aas.13074 (DOI)000429532400007 ()29363101 (PubMedID)
Available from: 2018-02-02 Created: 2018-02-02 Last updated: 2018-06-19Bibliographically approved
Wallin, E., Larsson, I.-M., Nordmark-Grass, J., Rosenqvist, I., Kristofferzon, M.-L. & Rubertsson, S. (2018). Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study. Acta Anaesthesiologica Scandinavica, 62(9), 1237-1245
Open this publication in new window or tab >>Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 9, p. 1237-1245Article in journal (Refereed) Published
Abstract [en]

Background: Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33 degrees C was applied.

Method: Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33 degrees C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).

Results: Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).

Conclusions: Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33 degrees C post-CA.

Keywords
cardiac arrest, intensive care, jugular bulb saturation, neurological outcome, prognostication, target temperature management
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-364137 (URN)10.1111/aas.13162 (DOI)000443673500008 ()29797705 (PubMedID)
Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2018-11-05Bibliographically approved
Elfwen, L., Lagedal, R., James, S. K., Jonsson, M., Jensen, U., Ringh, M., . . . Nordberg, P. (2018). Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival. American Heart Journal, 200, 90-95
Open this publication in new window or tab >>Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival
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2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 200, p. 90-95Article in journal (Refereed) Published
Abstract [en]

Background: The potential benefit of early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST elevation on ECG is unclear. The aim of this study was to evaluate the association between early coronary angiography and survival in these patients.

Methods: Nationwide observational study between 2008 and 2013. Included were patients admitted to hospital after witnessed OHCA, with shockable rhythm, age 18 to 80 years and unconscious. Patients with ST-elevation on ECG were excluded. Patients that underwent early CAG (within 24 hours) were compared with no early CAG (later during the hospital stay or not at all). Outcomes were survival at 30 days, 1 year, and 3 years. Multivariate analysis included pre-hospital factors, comorbidity and ECG-findings.

Results: In total, 799 OHCA patients fulfilled the inclusion criteria, of which 275 (34%) received early CAG versus 524 (66%) with no early CAG. In the early CAG group, the proportion of patients with an occluded coronary artery was 27% and 70% had at least one significant coronary stenosis (defined as narrowing of coronary lumen diameter of >= 50%). The 30-day survival rate was 65% in early CAG group versus 52% with no early CAG (P < .001). The adjusted OR was 1.42 (95% CI 1.00-2.02). The one-year survival rate was 62% in the early CAG group versus 48% in the no early CAG group with the adjusted hazard ratio of 1.35 (95% CI 1.04-1.77).

Conclusion: In this population of bystander-witnessed cases of out-of-hospital cardiac arrest with shockable rhythm and ECG without ST elevation, early coronary angiography may be associated with improved short and long term survival.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-358162 (URN)10.1016/j.ahj.2018.03.009 (DOI)000434948300013 ()29898854 (PubMedID)
Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2018-12-04Bibliographically approved
Lagedal, R., Elfwén, L., James, S. K., Oldgren, J., Erlinge, D., Östlund, O., . . . Nordberg, P. (2018). Design of DISCO-Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study. American Heart Journal, 197, 53-61, Article ID S0002-8703(17)30376-9.
Open this publication in new window or tab >>Design of DISCO-Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study
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2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 197, p. 53-61, article id S0002-8703(17)30376-9Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA presenting with ST elevation, immediate coronary angiography and potential percutaneous coronary intervention (PCI) after return of spontaneous circulation are recommended. However, the evidence for this invasive strategy in patients without ST elevation is limited. Observational studies have shown a culprit coronary artery occlusion in about 30% of these patients, indicating the electrocardiogram's (ECG's) limited sensitivity. The aim of this study is to determine whether immediate coronary angiography and subsequent PCI will provide outcome benefits in OHCA patients without ST elevation.

METHODS/DESIGN: We describe the design of the DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest study (DISCO)-a pragmatic national, multicenter, randomized, clinical study. OHCA patients presenting with no ST elevation on their first recorded ECG will be randomized to a strategy of immediate coronary angiography or to standard of care with admission to intensive care and angiography after 3days at the earliest unless the patient shows signs of acute ischemia or hemodynamic instability. Primary end point is 30-day survival. An estimated 1,006 patients give 80% power (α = .05) to detect a 20% improved 30-day survival rate from 45% to 54%. Secondary outcomes include good neurologic recovery at 30days and 6months, and cognitive function and cardiac function at 6months.

CONCLUSION: This randomized clinical study will evaluate the effect of immediate coronary angiography after OHCA on 30-day survival in patients without ST elevation on their first recorded ECG.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-342766 (URN)10.1016/j.ahj.2017.11.009 (DOI)000425723700007 ()29447784 (PubMedID)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-05-03Bibliographically approved
Johansson, A., Lindstedt, D., Roman, M., Thelander, G., Nielsen, E. I., Lennborn, U., . . . Kugelberg, F. C. (2017). A non-fatal intoxication and seven deaths involving the dissociative drug 3-MeO-PCP. Forensic Science International, 275, 76-82
Open this publication in new window or tab >>A non-fatal intoxication and seven deaths involving the dissociative drug 3-MeO-PCP
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2017 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 275, p. 76-82Article in journal (Refereed) Published
Abstract [en]

Introduction: 3-methoxyphencyclidine (3-MeO-PCP) appeared on the illicit drug market in 2011 and is an analogue of phencyclidine, which exhibits anesthetic, analgesic and hallucinogenic properties. In this paper, we report data from a non-fatal intoxication and seven deaths involving 3-MeO-PCP in Sweden during the period March 2014 until June 2016. Case descriptions: The non-fatal intoxication case, a 19-year-old male with drug problems and a medical history of depression, was found awake but tachycardic, hypertensive, tachypnoeic and catatonic at home. After being hospitalized, his condition worsened as he developed a fever and lactic acidosis concomitant with psychomotor agitation and hallucinations. After 22 h of intensive care, the patient had made a complete recovery. During his hospitalization, a total of four blood samples were collected at different time points. The seven autopsy cases, six males and one female, were all in their twenties to thirties with psychiatric problems and/or an ongoing drug abuse. Methods: 3-MeO-PCP was identified with liquid chromatography (LC)/time-of-flight technology and quantified using LC-tandem mass spectrometry. Results: In the clinical case, the concentration of 3-MeO-PCP was 0.14 mu g/g at admission, 0.08 mu g/g 2.5 h after admission, 0.06 mu g/g 5 h after admission and 0.04 mu g/g 17 h after admission. The half-life of 3-MeO-PCP was estimated to 11 h. In the autopsy cases, femoral blood concentrations ranged from 0.05 mu g/g to 0.38 mu g/g. 3-MeO-PCP was the sole finding in the case with the highest concentration and the cause of death was established as intoxication with 3-MeO-PCP. In the remaining six autopsy cases, other medications and drugs of abuse were present as well. Conclusion: Despite being scheduled in January 2015, 3-MeO-PCP continues to be abused in Sweden. Exposure to 3-MeO-PCP may cause severe adverse events and even death, especially if the user does not receive life-supporting treatment.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Dissociative drugs, Phencyclidine, 3-MeO-PCP, Intoxication, Postmortem blood concentrations
National Category
Forensic Science
Identifiers
urn:nbn:se:uu:diva-330757 (URN)10.1016/j.forsciint.2017.02.034 (DOI)000404011100011 ()28324770 (PubMedID)
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2017-10-03Bibliographically approved
Hardig, B. M., Lindgren, E., Östlund, O., Herlitz, J., Karlsten, R. & Rubertsson, S. (2017). Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial. Resuscitation, 115, 155-162
Open this publication in new window or tab >>Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial
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2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 115, p. 155-162Article in journal (Refereed) Published
Abstract [en]

Introduction: The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3 min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2 min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2 min' algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it. Method: Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients. Results: Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p = 0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p = 0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2-5) min vs manual CPR 3 (2-4) min, P < 0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group. Conclusions: No difference in short-or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Cardiac arrest, Mechanical chest compressions, Ventricular fibrillation, Defibrillation, Adrenaline, Outcome
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-327130 (URN)10.1016/j.resuscitation.2017.04.005 (DOI)000402489400037 ()28385642 (PubMedID)
Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2017-08-30Bibliographically approved
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