Out-of-hospital cardiac arrest related to exercise in the general population: Incidence, survival and bystander response.

BACKGROUND: Regular exercise is known to prevent cardiovascular disorders, but it may also trigger acute cardiac events. This study examined the incidence, prognosis, and outcomes of out-of-hospital cardiac arrest (OHCA) related to exercise in the general population of Denmark. METHODS: This retrospective cohort study examined all the OHCAs in the Danish Cardiac Arrest Registry from 2016 to 2019. OHCA related to exercise was identified in a nationwide electronic database and coupled to the patient register. Descriptive statistics were used in combination with a multivariate logistic regression model to assess predefined factors. RESULTS: A total of 20,470 OHCAs were identified, of which 459 (2.2%) were related to exercise. Most were male (75.3%), with a median age of 61 years. Further, 95% of exercise-related OHCA received bystander cardiopulmonary resuscitation, compared to 77.4% in non-exercise-related OHCA (p < 0.001), and 38.3% received defibrillation by bystanders versus 7.5% in the non-exercise group (p < 0.001). Exercise-related OHCAs had a 30-day survival rate of 57.7% compared to 12.6% in the non-exercise group, yielding an adjusted odds ratio of 5.56. The 30-day survival rate of exercise-related subjects aged 15-35 years was 80.0%, compared to 25.0% in the non-exercise group. When comparing sports categories, team sports were associated with the greatest chance of survival (odds ratio of 18.5 versus a non-exercise odds ratio of 0.09). CONCLUSION: Exercise-related OHCA has a low incidence and is related to a significantly better prognosis when compared to non-exercise OHCA. Furthermore, many patients experiencing exercise-related OHCA received defibrillation and cardiopulmonary resuscitation by bystanders. These findings could help plan and execute campaigns and education.

Socio-demographic characteristics of basic life support course participants in Denmark.

BACKGROUND: Bystander-initiated basic life support (BLS) plays an important role in improving survival after out-of-hospital cardiac arrest. In 2009, laws mandating BLS course participation when acquiring a driver's licence were implemented in Denmark. The aim of this study was to characterise Danish BLS course participants. METHODS: This study is a Danish, registry-based, follow-up study that examined all Danish BLS course participants from 2016 to 2019. Data concerning BLS course participation were supplied by the major Danish BLS course providers. Socio-economic and healthcare data on all Danish inhabitants were assessed using national registers from Statistics Denmark. RESULTS: Between January 1, 2016, and January 1, 2020, 3.6% of the entire adult population of Denmark attended certified BLS courses annually. Since the implementation of a law mandating BLS course participation when acquiring a driver licence in 2009, approximately 44% of the adult population has participated in a BLS course. BLS course participants were commonly younger and healthier than the general population (mean 31.3 years old vs. 51.3 years old, P < 0.001). Furthermore, law-mandated BLS course participants had a lower disposable income (adjusted OR: 0.23; 95% CI: 0.23-0.23; P < 0.001) and were more likely to live in rural areas (adjusted OR: 0.57; 95% CI: 0.57-0.58; P < 0.001). CONCLUSION: In Denmark, 3.6% of the entire adult population attend certified courses annually. BLS participants are commonly male, younger, healthier, less likely to have small children in the household, and more likely to live in rural areas. Law-mandated BLS course participation prior to acquiring a driver's licence has been successful in reaching segments of the society that are known to have limited participation.

The Danish prehospital emergency healthcare system and research possibilities.

The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes.Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system.Since 2007, Denmark has been divided into five regions each responsible for health services, including the prehospital services. Each region may contract their own ambulance service providers. The Danish emergency medical services in general include ambulances, rapid response vehicles, mobile emergency care units and helicopter emergency medical services. All calls to the national emergency number, 1-1-2, are answered by the police, or the Copenhagen fire brigade, and since 2011 forwarded to an Emergency Medical Coordination Centre when the call relates to medical issues. At the Emergency Medical Coordination Centre, healthcare personnel assess the situation guided by the Danish Index for Emergency Care and determine the level of urgency of the situation, while technical personnel dispatch the appropriate medical emergency vehicles. In Denmark, all healthcare services, including emergency medical services are publicly funded and free of charge. In addition to emergency calls, other medical services are available for less urgent health problems around the clock. Prehospital personnel have since 2015 utilized a nationwide electronic prehospital medical record. The use of this prehospital medical record combined with Denmark's extensive registries, linkable by the unique civil registration number, enables new and unique possibilities to do high quality prehospital research, with complete patient follow-up.

Clinical predictors of shockable versus non-shockable rhythms in patients with out-of-hospital cardiac arrest.

AIM: To identify factors associated with a non-shockable rhythm as first recorded heart rhythm. METHODS: Patients ≥18 years old suffering out-of-hospital cardiac arrest between 2001 and 2012 were identified in the population-based Danish Cardiac Arrest Registry. Danish administrative registries were used to identify chronic diseases (within 10 years) and drug prescriptions (within 180 days). A multivariable logistic regression model, including patient related and cardiac arrest related characteristics, was used to estimate odds ratios (OR) for factors associated with non-shockable rhythm. RESULTS: A total of 29,863 patients were included: 6600 (22.1%) patients with a shockable rhythm and 23,263 (77.9%) patients with a non-shockable rhythm. A non-shockable rhythm was associated with female gender, arrest in private home, unwitnessed arrest, no bystander CPR, and longer time to first rhythm analysis compared to patients with shockable rhythm. In the adjusted multivariable regression model, pre-existing non-cardiovascular disease and drug prescription were associated with a non-shockable rhythm e.g. chronic obstructive lung disease (OR 1.44 [95% CI: 1.32-1.58]); and the prescription for antidepressants (OR 1.49 [95% CI: 1.35-1.65]), antipsychotics (OR 2.30 [95% CI: 1.96-2.69]) analgesics (OR 1.32 [95% CI: 1.23-1.41]), corticosteroids (OR 1.64 [95% CI: 1.44-1.85]), and antibiotics (OR 1.59 [95% CI: 1.40-1.81]). In contrast, the prescription of cardiovascular drugs and a history of cardiovascular disease e.g. ischemic heart disease was associated with a lower risk of non-shockable rhythm (OR 0.66 [95% CI: 0.60-0.71]). CONCLUSION: This study demonstrate that non-cardiovascular disease and medication prescription are associated with a non-shockable rhythm while cardiovascular disease and medication prescription are associated with a shockable rhythm as first recorded rhythm in patients with OHCA.

The use of ultrasound to identify veins for peripheral venous access in morbidly obese patients.

INTRODUCTION: Peripheral intravenous access (PIA) is a necessity in the treatment and monitoring of the majority of hospitalised patients. Patients with an increased body mass index (BMI) more often than normal-weight patients have a difficult PIA. Identifying veins with ultrasonography has proven helpful when facing a difficult intravenous (IV) access. We hypothesise that, with the help of ultrasonography (US), it is possible to identify at least one vein suitable for IV access in morbidly obese patients (BMI > 40 kg/m(2)). METHODS: We included 55 morbidly obese patients with a BMI > 40 kg/m(2). We performed a detailed US of seven anatomic areas routinely used for PIA. We present a description of parameters that are relevant when attempting PIA. RESULTS: In our study group, all patients had a minimum of one peripheral vein that was suitable for peripheral venous access, including seven patients (12.7%) who did not have clinically detectable veins. CONCLUSIONS: With the aid of US it is possible to identify a minimum of one peripheral vein suitable for IV access in morbidly obese patients. FUNDING: none. TRIAL REGISTRATION: not relevant.

Return to Work in Out-of-Hospital Cardiac Arrest Survivors: A Nationwide Register-Based Follow-Up Study.

BACKGROUND: Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as a proxy of preserved function without major neurologic deficits in survivors. METHODS AND RESULTS: In Denmark, out-of-hospital cardiac arrests have been systematically reported to the Danish Cardiac Arrest Register since 2001. During 2001-2011, we identified 4354 patients employed before arrest among 12 332 working-age patients (18-65 years), of whom 796 survived to day 30. Among 796 survivors (median age, 53 years [quartile 1-3, 46-59 years]; 81.5% men), 610 (76.6%) returned to work in a median time of 4 months [quartile 1-3, 1-19 months], with a median time of 3 years spent back at work. A total of 74.6% (N=455) remained employed without using sick leave during the first 6 months after returning to work. This latter proportion of survivors returning to work increased over time (66.1% in 2001-2005 versus 78.1% in 2006-2011; P=0.002). In multivariable Cox regression analysis, factors associated with return to work with ≥6 months of sustainable employment were as follows: (1) arrest during 2006-2011 versus 2001-2005, hazard ratio (HR), 1.38 (95% CI, 1.05-1.82); (2) male sex, HR, 1.48 (95% CI, 1.06-2.07); (3) age of 18 to 49 versus 50 to 65 years, HR, 1.32 (95% CI, 1.02-1.68); (4) bystander-witnessed arrest, HR, 1.79 (95% CI, 1.17-2.76); and (5) bystander cardiopulmonary resuscitation, HR, 1.38 (95% CI, 1.02-1.87). CONCLUSIONS: Of 30-day survivors employed before arrest, 76.6% returned to work. The percentage of survivors returning to work increased significantly, along with improved survival during 2001-2011, suggesting an increase in the proportion of survivors with preserved function over time.