Hospitalised patients with suspected 2009 H1N1 influenza A in a hospital in Norway, July - December 2009.

BACKGROUND: The main objective of this study was to describe the patients who were hospitalised at Oslo University Hospital Aker during the first wave of pandemic Influenza A (H1N1) in Norway. METHODS: Clinical data on all patients hospitalised with influenza-like illness from July to the end of November 2009 were collected prospectively. Patients with confirmed H1N1 Influenza A were compared to patients with negative H1N1 tests. RESULTS: 182 patients were hospitalised with suspected H1N1 Influenza A and 64 (35%) tested positive. Seventeen patients with positive tests (27%) were admitted to an intensive care unit and four patients died (6%). The H1N1 positive patients were younger, consisted of a higher proportion of non-ethnic Norwegians, had a higher heart rate on admission, and fewer had pre-existing hypertension, compared to the H1N1 negative patients. However, hypertension was the only medical condition that was significantly associated with a more serious outcome defined as ICU admission or death, with a univariate odds ratio of the composite endpoint in H1N1 positive and negative patients of 6.1 (95% CI 1.3-29.3) and 3.2 (95% CI 1.2-8.7), respectively. Chest radiography revealed pneumonia in 24/59 H1N1 positive patients. 63 of 64 H1N1 positive patients received oseltamivir. CONCLUSIONS: The extra burden of hospitalisations was relatively small and we managed to admit all the patients with suspected H1N1 influenza without opening new pandemic isolation wards. The morbidity and mortality were similar to reports from comparable countries. Established hypertension was associated with more severe morbidity and patients with hypertension should be considered candidates for vaccination programs in future pandemics.

Time used for ventilation in two-rescuer CPR with a bag-valve-mask device during out-of-hospital cardiac arrest.

INTRODUCTION: Professional rescuers only deliver chest compressions 39% of the available time before intubation during out-of-hospital cardiac arrest. In manikin-studies lay rescuers need approximately 15s to deliver two ventilations. It is not known how much time professional rescuers use for two ventilations and we hypothesised that the time used for two ventilations with a bag-valve-mask device before tracheal intubation is longer than recommended and that the extended time contributes to the high no flow time. METHODS: Quality of CPR was available for analysis in 628 cases of out-of-hospital cardiac arrest in the ambulance service in Oslo, Akershus, London, and Stockholm from 2002 to 2005. The 2000 Guidelines were used as the reference. Ventilations were registered from changes in transthoracic impedance as measured through the standard defibrillation pads. We included episodes only with CPR with a 15:2 pattern for at least 1 min and identified all pauses between chest compressions before intubation. RESULTS: In the remaining 172 episodes we identified 3097 chest compression pauses. In 1587 (51%) of the pauses we identified two ventilations and a mean pause length for each episode was calculated. The median of these means was 5.5s (IQR; 4.5, 7). These pauses comprised a median 9% (IQR; 4%, 15%) of the time before intubation in these episodes. In 892 (29%) of the pauses we identified a different number of ventilations, or other interventions in addition to ventilation. In the remaining 618 pauses (20%) no ventilations were registered. CONCLUSIONS: Professional rescuers delivered two bag-valve-mask ventilations within the 5-6s as indicated in the 2000 Guidelines, slightly longer than the 3-4s recommended in the 2005 Guidelines. However, only half the pauses were used for two ventilations, and the total time for two ventilations accounted for only 27% of the time without chest compressions. Excessive time for ventilation cannot explain the high no-flow time during CPR by professional rescuers before intubation.