[Sudden noncardiac arrest out-of-hospital in the Reykjavík area 1987-1999.].

PURPOSE: The purpose of this investigation was to study specifically those cases of sudden death out-of-hospital in the Reykjavik area that were due to non-cardiac causes the last 13 years, from January 1987 to December 31, 1999. MATERIAL AND METHODS: The doctors of the emergency ambulance have kept detailed files for all cases of sudden death according to international system of documentation, the Utstein protocol. The cases were divided into two major groups, i.e. on one hand cases due to outer causes and on the other hand cases due to inner causes. Outer causes included suicide, intoxication by drugs, trauma, drowning and cases due to asphyxia. Inner causes included various types of bleeding, hypoxia, cot death and various diseases other than heart disease. RESULTS: From 738 cases 140 or 19% were thought to be due to sudden non-cardiac death. Ninety-two cases of those 140 or 66% were due to outer causes. Inner causes were diagnosed in 48 (34%) cases. Mean age was 46 years (standard deviation, SD: 24.3 years). Men were 85 of the 140 cases (61%) and women 55 (39%). Mean response time was five minutes. Of the 140 individuals only nine (6%) survived, of those four had sustained near-drowning, four near suffocation and one drug intoxication. CONCLUSIONS: In this study the data were reported in accordance with the Utstein protocol and therefore drug intoxication and suicide are not grouped together. However, most if not all cases of drug intoxication appear to have occurred in an attempt of suicide. Except for cardiac disease drug intoxication and suicides were together the most common causes of sudden death out-of-hospital in those instances attended by the crew of the emergency ambulance. The results of resuscitation attempts are much worse when the cause for sudden death is non-cardiac. Survival was relatively best in cases of "suffocation" or "drowning".

[Survival and trends of ocurrence of left ventricular hypertrophy, gender differences during 1967-1992. The Reykjavík Study.].

OBJECTIVE: We estimated the prevalence and incidence of left ventricular hypertrophy (LVH) in this large prospective cohort study of almost 20,000 participants and identified risk factors in them. Predictive factors of its appearance were evaluated along with morbidity and mortality calculations. MATERIAL AND METHODS: LVH was defined as Minnesota Code 310 on ECG. Everyone with this code at first visit was defined as a prevalence case and those who developed it between subsequent visits were incidence cases. Risk factors at the time of the diagnosis of LVH were determined with logistic regression. Predictive factors for acquiring this ECG abnormality were determined by Poisson regression. The comparison cohort were all other participants in the Reykjavík Study stages I-V. RESULTS: Two hundred ninety-seven men and 49 women were found to have LVH or 3.2% and 0.5%, respectively. The incidence was 25/1000/year among men and 6/1000/ year among women. Prevalence in both genders increased with increasing age. Risk factors at the time of diagnosis were systolic blood pressure (odds ratio pr. mmHg (OR) 1.02; 95% confidence interval (CI): 1.01-1.03), age (OR pr. year: 1.04; 95% CI: 1.02-1.05), silent myocardial infarction (MI) (OR: 3.18; 95% CI: 1.39-7.27) and ST-T changes (OR: 3.06; 95% CI: 2.14-4.38) among men and systolic blood pressure and age for women with similar odds ratio. Predictive factors for acquiring LVH were systolic blood pressure (incidence ratio (IR): 1.01; 95% CI: 1.01-1.02) and angina with ECG changes (IR: 2.33; 95% CI: 1.08-5.02) among men and systolic blood pressure among women (IR: 1.03; 95% CI: 1.01-1.04). In men severe smoking seemed to have a protective effect against developing LVH (IR: 0.36; 95% CI: 0.18-0.71). The risk for coronary mortality was significantly increased among women with hypertrophy (hazard ratio (HR): 3.07; 95% CI: 1.5-6.31) and their total survival was poorer with increasing time from diagnosis of LVH (HR: 2.17; 95% CI: 1.36-3.48). CONCLUSIONS: We conclude that the presence of LVH and its appearance is associated with age and increased blood pressure among both genders. Women with LVH have poorer survival than other women and they are at threefold risk of dying of ischemic heart disease. This could indicate that criteria for detecting LVH on ECG detect both mild and severe hypertrophy among men but only the severe hypertrophy cases among women. More sensitive ECG methods may have to be used to detect mild, moderate and severe LVH among both genders in order to differentiate the severity of LVH based on the ECG diagnosis.

[Advanced cardiac life support in the prehospital setting in the Reykjavik area 1991-1996.].

UNLABELLED: Since 1982 an emergency ambulance manned by a physician and two emergency medical technicians has been operated in the Reykjavik area. The physicians have followed guidelines from the American Heart Association (AHA). Until 1986 the AHA guidelines had bicarbonate and in some instances calcium as first line treatment in cardiopulmonary resuscitation (CPR). OBJECTIVE: The purpose of this study was to evaluate the influence of the advanced cardiac life-support (ACLS) service and of bystanders on survival after cardiopulmonary arrest. Also to compare the survival rates to results of previous studies of CPR outside the hospital in the Reykjavik area. MATERIAL AND METHODS: The data was collected prospectively according to the "Utstein Style" form. From 1991-1996 there were 361 attempted resuscitations by the emergency crew. Fifty-three cardiac arrests were secondary to trauma, suicide, drowning, drug overdose and sudden infantile death. In 308 cases of sudden cardiorespiratory arrest cardiac diseases were the presumed cause in accordance with the Utstein protocol. RESULTS: In the 308 cases the mean age was 67.2 years and the male/female ratio was 233:75. The mean response time was 4.6 min. Patients admitted to the intensive or cardiac care units were 98 (31%) and 51 (17%) were discharged from the hospital. Ventricular fibrillation or ventricular tachycardia were the most common initial rhythms seen in 176 (57%) patients, asystole in 91 (30%) and other arrhythmias (EMD, agonal) in 41 (13%). Fourty-six patients (26%) with ventricular fibrillation on the first rhythm strip survived to be discharged from the hospital, three (3%) patients with asystole and two (5%) with other arrhythmias. Bystanders were present in 211 (68%) of cases and it fourfoulded the likelihood of discharge (OR 4.0; 95% CI 1.5-10.4; p=0.0025). There is no statistical difference in mean response time and survival rates between this study and previous studies from 1982-1986 and 1987-1990. CONCLUSIONS: When sudden cardiorespiratory arrest is witnessed the probability of survival is multiplied. We conclude that the results of ACLS outside the hospital in Reykjavik and surrounding area continue to be among the best. Changes in ACLS guidelines do not appear to have increased survival.