8 April 2016

National Quality Registry for Cardiopulmonary Resuscitation

  • Registry Manager: Region Västra Götaland
  • Registry Centre - affiliation: Registry Centre VGR
  • Start year: 1990 and 2005
  • Classifications used: Does not use any classification
  • This registry contains data on: Pharmaceuticals, Interventions, Inpatient Care, PROM or other patient-reported health effects, Follow-Up Data 3-5 months after the case is registered in the registry, Follow-Up Data 6-11 months after the case is registered in the registry

Description of registry

Contents

The Swedish CPR Registry describes cardiac arrest treated both within and outside of the hospital. Data reported at hospitals is registered by staff at the hospital. Data reported outside hospitals is registered by paramedic (EMC) staff. The registry also describes the Swedish heart start and CPR training registries. Follow-up of the patients who have survived cardiac arrest are described in terms of patient-reported outcome measures (PROM). A description is also provided of the use of registry data in research.

Background

A large percentage of the people who die due to heart disease die before arrival at the hospital due to sudden and unexpected cardiac arrest. People with acute heart disease who are alive upon arrival at the hospital have the benefit of advanced care resources and enormous knowledge and experience on how to reduce the risk of death.

A large percentage of people who die of heart disease suffer from a sudden “electrical chaos” in the heart, ventricular fibrillation, leading to cardiac arrest. If adequate equipment and staff were on the scene, a large percentage of lives could likely be saved. Every minute that passes before help arrives, however, reduces the chances of survival. After only five minutes, the body begins suffering irreparable damage due to lack of oxygen resulting from cardiac arrest. After about fifteen minutes, death is almost inevitable no matter what emergency measures are initiated.

The main treatment for most of these people is an electric shock to the heart using a defibrillator. One or more such shocks can return the heart to normal function. The only way to get a defibrillator to a patient in Sweden in the past was via ambulance transport. Over the past twenty-five years, there has been a rapid development in emergency medical services and today all vehicles carry defibrillators. However, in most cases the period of time from the cardiac arrest to the provision of electrical treatment is too long for the patient to survive. It is therefore necessary to create opportunities for earlier defibrillation treatment through organisational measures.

The likelihood of surviving cardiac arrest increases dramatically if the person’s breathing and circulation is artificially maintained while waiting for the ambulance to arrive. There is a simple method of achieving this – cardiopulmonary respiration (CPR) – which involves alternating chest compressions to maintain circulation and providing mouth-to-mouth resuscitation by blowing air into the lungs. To increase the chances of survival for a person who has suffered a cardiac arrest, there must be someone present who has learned CPR and is willing to apply their knowledge.

For CLP to have any real significance in cardiac arrest survival, a very wide dissemination of training is required, preferably focused on persons who are most likely to be present during an acute heart attack leading to cardiac arrest. For nearly thirty years, a very effective training programme has trained almost three million people in CPR. This means there is now the possibility for people with heart disease to survive a cardiac arrest outside the hospital. There has, however, previously been almost a total lack of knowledge in Sweden about this group of patients in terms of personal characteristics, location of cardiac arrest, how they are cared for when the cardiac arrest occurs, and in particular, the effect of treatment on survival.

Cardiac arrest does not only affect persons with heart disease. There are other patient groups who are affected for other reasons, such as in connection with asthma attacks, traffic accidents or near-drownings. Even in these cases, fast response can prevent a cardiac arrest from becoming fatal. Data is also lacking for these groups of persons concerning to what extent modern treatment can prevent fatalities.

Aims

  • Identify the population affected and the circumstances surrounding the cardiac arrest.
  • Provide a detailed description of the time lapse and treatment outside the hospital.
  • Register the effects of treatment in the form of short- and long-term survival.
  • Through an annual compilation of data and feedback to participating ambulance districts, create a stimulus for continuous improvements in treatment methods and organisations.
  • Through a national registry, create sufficiently great patient data to identify the best treatment methods and communicate this information to participating ambulance districts.

Population

All patients who have a cardiac arrest outside the hospital and where some form of treatment is started by paramedics or before the paramedics arrive should be included. Patients who have a cardiac arrest where no treatment is given either by witnesses or paramedics should not be included. Treatment refers to basic or advanced cardiopulmonary resuscitation.

An exception is made for patients in which a witness began CPR before the ambulance arrived, but the paramedics never performed CPR due to i.e. obvious sign of death (rigor mortis). These patients should not be included in the registry. All patients who have a cardiac arrest outside the hospital (within the walls of the hospital) and where treatment is begun should be included regardless of where the cardiac arrest occurs.

Ages in the registry

All ages.

Total volume of registry

From 1990-2013, a total of 71,871 patients who had a cardiac arrest outside the hospital and lifesaving treatment was started were reported. As of 12 July 2014, a total of 15,956 cases of cardiac arrest at a hospital were reported to the registry. At present, 72 of the country’s 76 (95 percent) hospital emergency wards were connected to the registry, and 70 of these have begun to report.

Volume over the past operating year

Outside the hospital: In 2013, 5210 cases were reported.

Coverage rate

The coverage rate outside the hospital is 100 percent, i.e. all ambulance stations are connected and report to the registry. As for coverage rate at hospitals, 72 hospitals in the country have registered their participation in the registry. These 72 hospitals comprise 95 percent of the hospitals in the country that have a rescue team for cardiac arrest response at the hospital (n=76). In this seventh report, 70 hospitals (92 percent) have begun patient registration.

References on validations

  • Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden. Strömsöe A, Svensson L, Axelsson ÅB, Göransson K, Todorova L, Herlitz J. Resuscitation. 2013 Jul;84(7):952-6. doi: 10.1016/j.resuscitation.2012.12.026. Epub 2013 Jan 8.

Note: Variable lists are updated on a regular basis and should therefore be seen as preliminary. For the latest version, please contact the registry.

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