Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden: A nationwide study

Linnea Gustafsson; Araz Rawshani; Truls Råmunddal; Björn Redfors; Petur Petursson; Oskar Angerås; Geir Hirlekar; Elmir Omerovic; Christian Dworeck; Sebastian Völz; Johan Herlitz; Clara Hjalmarsson; Lina Dahlén Holmqvist; Anna Myredal

doi:10.1016/j.resplu.2023.100503

Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden: A nationwide study

Resusc Plus. 2023 Nov 10:16:100503. doi: 10.1016/j.resplu.2023.100503. eCollection 2023 Dec.

Authors

Linnea Gustafsson^{1

2}, Araz Rawshani^{1

3

4}, Truls Råmunddal^{1

3}, Björn Redfors^{1

3}, Petur Petursson^{1

3}, Oskar Angerås^{1

3}, Geir Hirlekar^{1

3}, Elmir Omerovic^{1

3}, Christian Dworeck^{1

3}, Sebastian Völz^{1

3}, Johan Herlitz⁴, Clara Hjalmarsson^{1

3}, Lina Dahlén Holmqvist^{1

2}, Anna Myredal^{1

3}

Affiliations

¹ University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden.
² Sahlgrenska University Hospital, Department of Emergency Medicine, Gothenburg, Sweden.
³ Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
⁴ The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden.

Abstract

Aim: The aim of this study was to present a comprehensive overview of out-of-hospital cardiac arrests (OHCA) in young adults.

Methods: The data set analyzed included all cases of OHCA from 1990 to 2020 in the age-range 16-49 years in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). OHCA between 2010 and 2020 were analyzed in more detail. Clinical characteristics, survival, neurological outcomes, and long-time trends in survival were studied. Logistic regression was used to study 30-days survival, neurological outcomes and Utstein determinants of survival.

Results: Trends were assessed in 11,180 cases. The annual increase in 30-days survival during 1990-2020 was 5.9% with no decline in neurological function among survivors. Odds ratio (OR) for heart disease as the cause was 0.55 (95% CI 0.44 to 0.67) in 2017-2020 compared to 1990-1993. Corresponding ORs for overdoses and suicide attempts were 1.61 (95% CI 1.23-2.13) and 2.06 (95% CI 1.48-2.94), respectively. Exercise related OHCA was noted in roughly 5%. OR for bystander CPR in 2017-2020 vs 1990-1993 was 3.11 (95% CI 2.57 to 3.78); in 2020 88 % received bystander CPR. EMS response time increased from 6 to 10 minutes.

Conclusion: Survival has increased 6% annually, resulting in a three-fold increase over 30 years, with stable neurological outcome. EMS response time increased with 66% but the majority now receive bystander CPR. Cardiac arrest due to overdoses and suicide attempts are increasing.

Keywords: Cardiac arrest; Cardiovascular disease; OHCA; Survival.