Kjetil Sunde

• Melberg, Mathias; Rootwelt, Susanne Dunlop; Flaa, Arnljot; Andersen, Geir Øystein; Sunde, Kjetil & Eastwood, Glenn [Show all 8 contributors for this article] (2025). The Effects of Targeted Mild hypercapnia on Right Ventricular Function After Out-of-Hospital Cardiac Arrest. Chest. ISSN 0012-3692. doi: 10.1016/j.chest.2025.11.017. Full text in Research Archive Show summary

  Background Targeting hypercapnia during invasive mechanical ventilation with subsequent respiratory acidosis may impair right ventricular (RV) function and cause RV failure. RV dysfunction is common after cardiac arrest and may be associated with poor outcomes. Research Question Does targeting mild hypercapnia after out-of-hospital cardiac arrest (OHCA) adversely affect RV function, and is RV failure after OHCA associated with increased mortality? Study Design and Methods In this single-center, preplanned substudy of the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial, patients were randomized to mild hypercapnia (Paco2, 50-55 mm Hg) or normocapnia (Paco2, 35-45 mm Hg) for 24 hours. Transthoracic echocardiography was performed shortly after ICU admission, during and after the intervention period. Time-matched right heart catheterization (RHC) was performed when available. RV systolic function was assessed with tricuspid annular plane systolic excursion (TAPSE), S′, and fractional area change (FAC), with 2 of 3 measurements less than abnormal thresholds defined as dysfunction. RV failure was defined as RV systolic dysfunction combined with a cardiac index of < 2.0 L/min/m2 and central venous pressure of > 12 mm Hg. Results A total of 111 patients were randomized and evaluated with echocardiography. RHC was performed in 84 patients. TAPSE similarly was reduced in both treatment groups at ICU admission. During the intervention, TAPSE, S′, and FAC were higher in the hypercapnia group (P < .05). Accordingly, 13 patients (25%) in the hypercapnia group demonstrated RV systolic dysfunction compared with 37 patients (64%) in the normocapnia group (P < .001). RV failure was present in 30 patients: 8 patients in the hypercapnia group and 22 patients in the normocapnia group (P = .011). RV failure was associated with increased 6-month mortality (hazard ratio, 2.89; 95% CI, 1.37-6.10; P = .005). Interpretation Among patients resuscitated from OHCA, targeting mild hypercapnia compared with normocapnia was not associated with worsened RV function, but rather with less RV dysfunction and failure. RV failure was associated with increased 6-month mortality. Clinical Trial Registration ClinicalTrials.gov; No.: NCT03114033; URL: www.clinicaltrials.gov

• Petosic, Antonija; Sunde, Kjetil & Wøien, Hilde (2025). The value of social media for intensive care practice. Intensive and Critical Care Nursing. ISSN 0964-3397. 89. doi: 10.1016/j.iccn.2025.104019. Full text in Research Archive
• Dünser, Martin W.; Leach, Robert; Al-Haddad, Mo; Arafat, Raed; Baker, Tim & Balik, Martin [Show all 41 contributors for this article] (2025). Emergency critical care - life-saving critical care before ICU admission: A consensus statement of a Group of European Experts. Journal of Critical Care. ISSN 0883-9441. 87. doi: 10.1016/j.jcrc.2025.155035. Full text in Research Archive
• Austenå, Mona; Rustøen, Tone; Hagen, Milada; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2025). Hope among patients discharged from an intensive care unit: A prospective cohort study. Nursing in Critical Care. ISSN 1362-1017. 30(4). doi: 10.1111/nicc.13235. Full text in Research Archive Show summary

  Aim To describe the levels of hope in patients during the first year after ICU treatment, and to explore possible associations between hope and selected demographic, clinical and psychosocial factors. Study Design This is a prospective cohort study and a predefined sub-study of a randomized controlled trial. Adults discharged from five mixed ICUs were included. All patients were screened for post-traumatic stress symptoms at baseline, and data on hope, post-traumatic stress and social support were collected 3, 6 and 12 months later. Linear regression analyses and linear mixed models for repeated measurements with hope as the dependent variable were used. Results Median age was 57 years (range 18–94), 47% were women, median length of ICU stay was 3 days (range 1–83), Simplified Acute Physiology Score II was 24 (range 0–78) and 54% received mechanical ventilation. Not having prior mental health problems (B = 1.93, 95% CI [0.90, 2.98]), lower level of post-traumatic stress symptoms (B = −0.08, 95% CI [−0.11, −0.04]) and more social support (B = 0.37, 95% CI [0.31, 0.43]) were all independently associated with higher levels of hope during the first year after critical illness. The levels of hope were higher in the study cohort than in the general Norwegian population and remained unchanged during follow-up. Conclusions Patients maintained a stable level of hope throughout follow-up. Absence of prior mental health problems, lower post-traumatic stress symptoms and more social support after ICU discharge were associated with higher hope. Relevance to Clinical Practice Patients' hope should be strengthened during the ICU stay through psychosocial support and care for patients with previous post-traumatic stress symptoms and mental health problems.

• Karlsen, Hilde; Strand-Amundsen, Runar James; Skaare, Christiane; Eriksen, Morten Tandberg; Skulberg, Vidar Magne & Sunde, Kjetil [Show all 8 contributors for this article] (2024). Cerebral perfusion and metabolism with mild hypercapnia vs. normocapnia in a porcine post cardiac arrest model with and without targeted temperature management. Resuscitation Plus. 18. doi: 10.1016/j.resplu.2024.100604. Full text in Research Archive Show summary

  Aim To determine whether targeting mild hypercapnia (PaCO2 7 kPa) would yield improved cerebral blood flow and metabolism compared to normocapnia (PaCO2 5 kPa) with and without targeted temperature management to 33 °C (TTM33) in a porcine post-cardiac arrest model. Methods 39 pigs were resuscitated after 10 minutes of cardiac arrest using cardiopulmonary bypass and randomised to TTM33 or no-TTM, and hypercapnia or normocapnia. TTM33 was managed with intravasal cooling. Animals were stabilized for 30 minutes followed by a two-hour intervention period. Hemodynamic parameters were measured continuously, and neuromonitoring included intracranial pressure (ICP), pressure reactivity index, cerebral blood flow, brain-tissue pCO2 and microdialysis. Measurements are reported as proportion of baseline, and areas under the curve during the 120 min intervention period were compared. Results Hypercapnia increased cerebral flow in both TTM33 and no-TTM groups, but also increased ICP (199% vs. 183% of baseline, p = 0.018) and reduced cerebral perfusion pressure (70% vs. 84% of baseline, p < 0.001) in no-TTM animals. Cerebral lactate (196% vs. 297% of baseline, p < 0.001), pyruvate (118% vs. 152% of baseline, p < 0.001), glycerol and lactate/pyruvate ratios were lower with hypercapnia in the TTM33 group, but only pyruvate (133% vs. 150% of baseline, p = 0.002) was lower with hypercapnia among no-TTM animals. Conclusion In this porcine post-arrest model, hypercapnia led to increased cerebral flow both with and without hypothermia, but also increased ICP and reduced cerebral perfusion pressure in no-TTM animals. The effects of hypercapnia were different with and without TTM.

• Melberg, Mathias; Flaa, Arnljot; Andersen, Geir Øystein; Sunde, Kjetil; Bellomo, Rinaldo & Eastwood, Glenn [Show all 8 contributors for this article] (2024). Effects of mild hypercapnia on myocardial injury after out-of-hospital cardiac arrest. A sub-study of the TAME trial. Resuscitation. ISSN 0300-9572. 201. doi: 10.1016/j.resuscitation.2024.110295. Full text in Research Archive Show summary

  Purpose Mild hypercapnia did not improve neurological outcomes for resuscitated out-of-hospital cardiac arrest (OHCA) patients in the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. However, the effects of hypercapnic acidosis on myocardial injury in patients with cardiac arrest is unexplored. We investigated whether mild hypercapnia compared to normocapnia, following emergency coronary intervention, increased myocardial injury in comatose OHCA-patients with AMI. Methods Single-centre, prospective, pre-planned sub-study of the TAME trial. Patients were randomised to targeted mild hypercapnia (PaCO2 = 6.7–7.3 kPa) or normocapnia (PaCO2 = 4.7–6.0 kPa) for 24 h. Myocardial injury was assessed with high-sensitive cardiac troponin T (hs-cTnT) measured at baseline, 24, 48 and 72 h. Haemodynamics were assessed with right heart catheterisation and blood-gas analyses every 4th hour for 48 h. Results We included 125 OHCA-patients. 57 (46%) had an AMI, with 31 and 26 patients randomised to hypercapnia and normocapnia, respectively. Median peak hs-cTnT in AMI-patients was 58% lower in the hypercapnia-group: 2136 (IQR: 861–4462) versus 5165 ng/L (IQR: 2773–7519), p = 0.007. Lower average area under the hs-cTnT curve was observed in the hypercapnia-group: 2353 (95% CI 1388–3319) versus 4953 ng/L (95% CI 3566–6341), P-group = 0.002. Hypercapnia was associated with increased cardiac power output (CPO) and lower lactate levels in patients with AMI (P-group < 0.05). hs-cTnT, lactate and CPO were not significantly different between intervention groups in OHCA-patients without AMI (p > 0.05). Conclusions Mild hypercapnia was not associated with increased myocardial injury in resuscitated OHCA-patients. In AMI-patients, mild hypercapnia was associated with lower hs-cTnT and lactate, and improved cardiac performance.

• Melberg, Mathias; Flaa, Arnljot; Andersen, Geir Øystein; Sunde, Kjetil; Bellomo, Rinaldo & Eastwood, Glenn [Show all 8 contributors for this article] (2023). Cardiovascular changes induced by targeted mild hypercapnia after out of hospital cardiac arrest. A sub-study of the TAME cardiac arrest trial. Resuscitation. ISSN 0300-9572. doi: 10.1016/j.resuscitation.2023.109970. Full text in Research Archive Show summary

  Aim Hypercapnia may elicit detrimental haemodynamic effects in critically ill patients. We aimed to investigate the consequences of targeted mild hypercapnia versus targeted normocapnia on pulmonary vascular resistance and right ventricular function in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods Pre-planned, single-centre, prospective, sub-study of the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. Patients were randomised to mild hypercapnia (PaCO2 = 6.7–7.3 kPa) or normocapnia (PaCO2 = 4.7–6.0 kPa) for 24 hours. Haemodynamic assessment was performed with right heart catheterisation and serial blood-gas analyses every 4th hour for 48 hours. Results We studied 84 patients. Mean pH was 7.24 (95% CI 7.22–7.30) and 7.32 (95% CI 7.31–7.34) with hypercapnia and normocapnia, respectively (P-group < 0.001). Pulmonary vascular resistance index (PVRI), pulmonary artery pulsatility index, and right atrial pressure did not differ between groups (P-group > 0.05). Mean cardiac index was higher with mild hypercapnia (P-group < 0.001): 2.0 (95% CI 1.85–2.1) vs 1.6 (95% CI 1.52–1.76) L/min/m2. Systemic vascular resistance index was 2579 dyne-sec/cm-5/ m2 (95% CI 2356–2830) with hypercapnia, and 3249 dyne-sec/cm-5/ m2 (95% CI 2930–3368) with normocapnia (P-group < 0.001). Stroke volumes (P-group = 0.013) and mixed venous oxygen saturation (P-group < 0.001) were higher in the hypercapnic group. Conclusion In resuscitated OHCA patients, targeting mild hypercapnia did not increase PVRI or worsen right ventricular function compared to normocapnia. Mild hypercapnia comparatively improved cardiac performance and mixed venous oxygen saturation.

• Austenå, Mona; Rustøen, Tone; Småstuen, Milada Cvancarova; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2023). Return to work during first year after intensive care treatment and the impact of demographic, clinical and psychosocial factors. Intensive and Critical Care Nursing. ISSN 0964-3397. 76. doi: 10.1016/j.iccn.2023.103384. Full text in Research Archive Show summary

  Objectives To describe work participation in survivors during first year after intensive care unit discharge and examine the impact of selected demographic, clinical and psychosocial factors on return to work 12 months after discharge. Research methodology/Design A predefined sub-study (prospective cohort study) of a randomised controlled trial. Setting A Norwegian single-centre university hospital. Medical and surgical adult intensive care survivors, working/on sick leave before admission, in the intensive care unit ≥24 h, were included. Main outcome measures Return to work three, six and 12 months after discharge, and impact of age, pre-existing comorbidities, previous serious life events, coping ability, hope and social support on return to work 12 months after discharge. Results Included were 284 patients, with mean age 47 years (SD 13.9) and 47 % women. One year after discharge, 69 % were back at work. In the regression analysis, with working at 12 months (yes/no) as the dependent variable, 178 patients, completing questionnaires at three as well as 12 months, were included. Lower age (OR 0.96, 95 % CI [0.93–0.99]), lower pre-existing comorbidities (OR 0.65, 95 % CI [0.43–0.97]), previous serious life events (OR 6.53, 95 % CI [2.14–19.94]), and greater hope at three months (OR 1.09, 95 % CI [1.01–1.17]) were all independently associated with higher odds of returning to work. Conclusion Following intensive care, age, pre-existing comorbidities, experience of previous serious life events and hope all have a significant impact on return to work, and are important variables to consider during intensive care treatment and rehabilitation. Implications for clinical practice Attention must be paid to patients with prior working capability to ensure return to work after intensive care treatment. Older adults with pre-existing comorbidities might benefit from early, individualised rehabilitation to regain previous working capacity. In addition, there is also a need to support patients’ hope during and after critical illness.

• Wimmer, Rolf Henning; Stensønes, Stine Håheim; Benth, Jurate Saltyte; Lundqvist, Christofer; Andersen, Geir Øystein & Drægni, Tomas [Show all 8 contributors for this article] (2023). Outcome prediction in comatose cardiac arrest patients with initial shockable and non-shockable rhythms. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. doi: 10.1111/aas.14337. Full text in Research Archive Show summary

  Abstract Background Prognosis after out‐of‐hospital cardiac arrest (OHCA) is presumed poorer in patients with non‐shockable than shockable rhythms, frequently leading to treatment withdrawal. Multimodal outcome prediction is recommended 72 h post‐arrest in still comatose patients, not considering initial rhythms. We investigated accuracy of outcome predictors in all comatose OHCA survivors, with a particular focus on shockable vs. non‐shockable rhythms. Methods In this observational NORCAST sub‐study, patients still comatose 72 h post‐arrest were stratified by shockable vs. non‐shockable rhythms for outcome prediction analyzes. Good outcome was defined as cerebral performance category 1–2 within 6 months. False positive rate (FPR) was used for poor and sensitivity for good outcome prediction accuracy. Results Overall, 72/128 (56%) patients with shockable and 12/50 (24%) with non‐shockable rhythms had good outcome ( p  &lt; .001). For poor outcome prediction, absent pupillary light reflexes (PLR) and corneal reflexes (clinical predictors) 72 h after sedation withdrawal, PLR 96 h post‐arrest, and somatosensory evoked potentials (SSEP), all had FPR &lt;0.1% in both groups. Unreactive EEG and neuron‐specific enolase (NSE) &gt;60 μg/L 24–72 h post‐arrest had better precision in shockable patients. For good outcome, the clinical predictors, SSEP and CT, had 86%–100% sensitivity in both groups. For NSE, sensitivity varied from 22% to 69% 24–72 h post‐arrest. The outcome predictors indicated severe brain injury proportionally more often in patients with non‐shockable than with shockable rhythms. For all patients, clinical predictors, CT, and SSEP, predicted poor and good outcome with high accuracy. Conclusion Outcome prediction accuracy was comparable for shockable and non‐shockable rhythms. PLR and corneal reflexes had best precision 72 h after sedation withdrawal and 96 h post‐arrest.

• REICHENBACH, ANTJE; Alteheld, Lars Holger; Henriksen, Julia; Nakstad, Espen Rostrup; Andersen, Geir Øystein & Sunde, Kjetil [Show all 8 contributors for this article] (2023). Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes. Frontiers in Neurology. 14. doi: 10.3389/fneur.2023.1222401. Full text in Research Archive Show summary

  Background Early prediction of outcomes in comatose patients after out-of-hospital cardiac arrest is challenging. Prognostication tools include clinical examination, biomarkers, and neuroradiological and neurophysiological tests. We studied the association between transcranial Doppler (TCD) and the outcome. Methods This was a pre-defined sub-study of the prospective observational Norwegian Cardiorespiratory Arrest Study. Patients underwent standardized post-resuscitation care, including target temperature management (TTM) to 33°C for 24 h. TCD was performed at days 1, 3, and 5–7. The primary endpoint was cerebral performance category (CPC) at 6 months, dichotomized into good (CPC 1–2) and poor (CPC 3–5) outcomes. We used linear mixed modeling time-series analysis. Results Of 139 TCD-examined patients, 81 (58%) had good outcomes. Peak systolic velocity in the middle cerebral artery (PSV) was low during TTM (Day 1) and elevated after rewarming (Day 3). Thereafter, it continued to rise in patients with poor, but normalized in patients with good, outcomes. At days 5–7, PSV was 1.0 m/s (95% CI 0.9; 1.0) in patients with good outcomes and 1.3 m/s (95% CI 1.1; 1.4) in patients with poor outcomes (p &amp;lt; 0.001) Conclusion Elevated PSV at days 5–7 indicated poor outcomes. Our findings suggest that serial TCD examinations during the first week after cardiorespiratory arrest may improve our understanding of serious brain injury.

• Oddo, Mauro; Taccone, Fabio S; Petrosino, Matteo; Badenes, Rafael; Blandino-Ortiz, Aaron & Bouzat, Pierre [Show all 20 contributors for this article] (2023). The Neurological Pupil index for outcome prognostication in people with acute brain injury (ORANGE): a prospective, observational, multicentre cohort study. Lancet Neurology. ISSN 1474-4422. 22(10), p. 925–933. doi: 10.1016/S1474-4422(23)00271-5. Full text in Research Archive
• Petosic, Antonija; Berntzen, Helene; Beeckman, Dimitri; Flaatten, Hans Kristian; Sunde, Kjetil & Wøien, Hilde (2023). Use of Facebook in a quality improvement campaign to increase adherence to guidelines in intensive care: A qualitative study of nurses’ and physicians’ experiences. Intensive and Critical Care Nursing. ISSN 0964-3397. 78. doi: 10.1016/j.iccn.2023.103475. Full text in Research Archive Show summary

  Objectives This study aimed to explore intensive care unit nurses' and physicians' experiences with professional content provided through closed Facebook groups, as part of a quality improvement campaign to improve guideline adherence. Research methodology This study used an exploratory qualitative design. In June 2018, data were collected through focus groups of intensive care nurses and physicians who also were members of closed Facebook groups. Data were analysed using reflexive thematic analysis, and the study was reported according to the consolidated criteria for reporting qualitative research. Setting The study’s setting was four intensive care units at Oslo University Hospital, Norway. Professional content on Facebook comprised audit and feedback on quality indicators on intensive care topics with related pictures, videos, and weblinks. Findings Two focus groups of 12 participants were included in this study. Two main themes were identified: 'One size does not fit all ' described that quality improvement and implementation are influenced by several factors related to current recommendations and personal preferences. Various strategies are required to serve different purposes and meet individual needs. 'Matter out of place' described conflicting experiences of being offered or exposed to professional content on Facebook. Conclusion Although the audit and feedback on quality indicators presented on Facebook motivated improvements, professional content on Facebook was perceived as inappropriate. Hospital platforms with applicable features of social media, such as reach, availability, convenience, ease, and possibility for commenting, were suggested to secure professional communication about recommended practices in intensive care units. Implications for clinical practice Social media platforms may be useful for professional communication among ICU personnel, but appropriate hospital applications with available and applicable social media features are recommended and needed. The use of several platforms may still be needed to reach all.

• Flæten, Øystein Øygarden; Stafseth, Siv Anna Ulla-Britt Karlsson; Vinje, Hilde; Johansen, Edda Aslaug; Sunde, Kjetil & Wøien, Hilde [Show all 8 contributors for this article] (2023). Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project. Intensive and Critical Care Nursing. ISSN 0964-3397. 81, p. 1–7. doi: 10.1016/j.iccn.2023.103587. Full text in Research Archive Show summary

  Objectives: To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units. Setting: Four intensive care units in a Norwegian University Hospital. Research methodology: A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals. Results: The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pres- sure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]). Conclusion: The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable. Implications for clinical practice: Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.

• Düring, Joachim; Annborn, Martin; Dankiewicz, Josef; Dupont, Allison; Forsberg, Sune & Friberg, Hans [Show all 16 contributors for this article] (2022). Influence of circulatory shock at hospital admission on outcome after out-of-hospital cardiac arrest. Scientific Reports. 12(1), p. 1–9. doi: 10.1038/s41598-022-12310-5. Full text in Research Archive Show summary

  Hypotension after cardiac arrest could aggravate prolonged hypoxic ischemic encephalopathy. The association of circulatory shock at hospital admission with outcome after cardiac arrest has not been well studied. The objective of this study was to investigate the independent association of circulatory shock at hospital admission with neurologic outcome, and to evaluate whether cardiovascular comorbidities interact with circulatory shock. 4004 adult patients with out-of-hospital cardiac arrest enrolled in the International Cardiac Arrest Registry 2006–2017 were included in analysis. Circulatory shock was defined as a systolic blood pressure below 90 mmHg and/or medical or mechanical supportive measures to maintain adequate perfusion during hospital admission. Primary outcome was cerebral performance category (CPC) dichotomized as good, (CPC 1–2) versus poor (CPC 3–5) outcome at hospital discharge. 38% of included patients were in circulatory shock at hospital admission, 32% had good neurologic outcome at hospital discharge. The adjusted odds ratio for good neurologic outcome in patients without preexisting cardiovascular disease with circulatory shock at hospital admission was 0.60 [0.46–0.79]. No significant interaction was detected with preexisting comorbidities in the main analysis. We conclude that circulatory shock at hospital admission after out-of-hospital cardiac arrest is independently associated with poor neurologic outcome.

• Wimmer, Rolf Henning; Benth, Jurate Saltyte; Lundqvist, Christofer; Andersen, Geir Øystein; Henriksen, Julia & Drægni, Tomas [Show all 10 contributors for this article] (2022). Changes in health status and health related quality of life from six months to five years in out-of-hospital cardiac arrest survivors – A NORCAST sub study. Resuscitation. ISSN 0300-9572. 181, p. 182–189. doi: 10.1016/j.resuscitation.2022.08.019. Full text in Research Archive Show summary

  Background Brain injury in out-of-hospital cardiac arrest (OHCA) survivors affects health status and health-related quality of life (HRQoL). It is unknown how HRQoL evolves over time, and assessments at different time points may lead to different results. Methods In a NORCAST sub study, OHCA survivors eligible for health status (EQ-5D-3L) and HRQoL (SF-36) assessments were examinated six months and five years after OHCA. At five-year follow-up, survivors also retrospectively assessed their health status for each consecutive year following OHCA. The next of kin independently assessed health status and HRQoL of their respective OHCA survivors. Results Among 138 survivors alive after six months and 117 after five years, 80 (88% male) completed both follow-ups. Health status and HRQoL remained stable over time, except for increasing SF-36 mental summary score and decreasing physical functioning and physical component score. Anxiety and depression levels were generally low, although younger survivors stated more anxiety than older survivors. Retrospective assessment showed reduced health status for the first two years, which increased only from the third year. Explorative analyses revealed that younger age, longer time to return of spontaneous circulation (tROSC) and late awakening affected health status, particularly in the first two years post-arrest. Conclusions OHCA survivors showed stable health status and HRQoL with only minor differences between six months and five years. Younger survivors with long tROSC, late awakening, and more anxiety and depression symptoms at six months, had reduced health status the first two years with significant improvements towards the fourth year.

• Hauff, Tonje; Petosic, Antonija; Småstuen, Milada Cvancarova; Wøien, Hilde; Sunde, Kjetil & Stafseth, Siv Anna Ulla-Britt Karlsson (2022). Patient mobilisation in the intensive care unit and evaluation of a multifaceted intervention including Facebook groups: A quasi-experimental study. Intensive and Critical Care Nursing. ISSN 0964-3397. doi: 10.1016/j.iccn.2022.103315. Full text in Research Archive Show summary

  Aims: To describe prevalence and time to mobilisation in intensive care unit patients defined as a minimum sitting in an upright position in bed, and evaluate the impact of a multifaceted quality improvement campaign on likelihood of patients being mobilised. Research methodology/design: Quality improvement project using a quasi-experimental study design, comparing patient cohorts before (Before) and after (Intervention) a campaign including educational sessions, audit and feedback of intensive care unit quality indicators via closed Facebook-groups and e-mail and local opinion leaders. Secondary analysis of mobilisation data from adult intensive care patient stays extracted from electronical medical charts. Likelihood of being mobilised was analysed with Multivariate Cox-regression model and reported as Sub-hazard Ratio (SHR). Setting: Four intensive care units in a university hospital. Main outcome measures: Prevalence and time to first documented mobilisation, defined as at least “sitting in bed” during the intensive care unit stay. Results: Overall, 929 patients were analysed, of whom 710 (76 %) were mobilised; 73 % (356/ 489) in Before vs 81 % (354/ 440) in Intervention (p = 0.007). Median time to mobilisation was 69.9 (IQR: 30.0, 149.8) hours; 71.7 (33.9, 157.9) in Before and 66.0 (27.1, 140.3) in Intervention (p = 0.104). Higher SAPS II-scores were associated with lower likelihood (SHR 0.98, 95 % CI 0.97–0.99), whereas admissions due to gastroenterological failure (SHR 2.1, 95 % CI 1.4–3.0), neurological failure (SHR 1.5, 95 % CI 1.0–2.2) and other causes (intoxication, postoperative care, haematological-, and kidney failure) (SHR 1.7, 95 % CI 1.13–2.6) were associated with higher likelihood of mobilisation vs respiratory failure. Conclusion: A quality improvement campaign including use of Facebook groups is feasible and may improve mobilisation in intensive care unit patients. Most patients were mobilised within 72 hours following intensive care unit admission, and SAPS II scores and causes for intensive care unit admission were both associated with likelihood of being mobilised.

• Chaban, Viktoriia; Nakstad, Espen R.; Stær-Jensen, Henrik; Schjalm, Camilla; Seljeflot, Ingebjørg & Vaage, Ingvar Jarle [Show all 12 contributors for this article] (2021). Complement activation is associated with poor outcome after out-of-hospital cardiac arrest. Resuscitation. ISSN 0300-9572. 166, p. 129–136. doi: 10.1016/j.resuscitation.2021.05.038. Full text in Research Archive Show summary

  Background Cardiopulmonary resuscitation after cardiac arrest initiates a whole-body ischemia-reperfusion injury, which may activate the innate immune system, including the complement system. We hypothesized that complement activation and subsequent release of soluble endothelial activation markers were associated with cerebral outcome including death. Methods Outcome was assessed at six months and defined by cerebral performance category scale (1−2; good outcome, 3−5; poor outcome including death) in 232 resuscitated out-of-hospital cardiac arrest patients. Plasma samples obtained at admission and day three were analysed for complement activation products C3bc, the soluble terminal complement complex (sC5b-9), and soluble CD14. Endothelial cell activation was measured by soluble markers syndecan-1, sE-selectin, thrombomodulin, and vascular cell adhesion molecule. Results Forty-nine percent of the patients had good outcome. C3bc and sC5b-9 were significantly higher at admission compared to day three (p < 0.001 for both) and in patients with poor compared to good outcome (p = 0.03 and p < 0.001, respectively). Unadjusted, higher sC5b-9 at admission was associated with poor outcome (odds ratio 1.08 (95% CI 1.01–1.14), p = 0.024). Adjusted, sC5b-9 was still associated with outcome, but the association became non-significant when time to return-of-spontaneous-circulation above 25 min was included as a covariate. Endothelial cell activation markers increased from admission to day three, but only sE-selectin and thrombomodulin were significantly higher in patients with poor versus good outcome (p = 0.004 and p = 0.03, respectively) and correlated to sCD14 and sC5b-9/C3bc, respectively. Conclusion Complement system activation, reflected by sC5b-9 at admission, leading to subsequent endothelial cell activation, was associated with poor outcome in out-of-hospital cardiac arrest patients.

• Wimmer, Rolf Henning; Lundqvist, Christofer; Benth, Jurate Saltyte; Stavem, Knut; Andersen, Geir Øystein & Henriksen, Julia [Show all 9 contributors for this article] (2021). Health-related quality of life after out-of-hospital cardiac arrest – a five-year follow-up study. Resuscitation. ISSN 0300-9572. 162, p. 372–380. doi: 10.1016/j.resuscitation.2021.01.036. Full text in Research Archive Show summary

  Background Health-related quality of life (HRQoL) is affected after out-of-hospital cardiac arrest (OHCA), but data several years after the arrest are lacking. We assessed long-term HRQoL in OHCA survivors and how known outcome predictors impact HRQoL. Methods In adult OHCA survivors, HRQoL was assessed five years post arrest using Short-form 36 (SF-36), EQ-5D-3 L (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) among others. Results were compared to the next of kins’ estimates and to a Norwegian reference population. Results Altogether 96 survivors were included mean 5.3 (range 3.6–7.2) years after OHCA. HRQoL compared well to the reference population, except for lower score for general health with 67.2 (95%CI (62.1; 72.3) vs. 72.9 (71.9; 74.0)), p = 0.03. Younger (≤58 years) vs. older survivors scored lower for general health with mean (SD) of 62.1 (27.5) vs. 73.0 (19.5), p = 0.03, vitality (55.2 (20.5) vs. 64.6 (17.3), p = 0.02, social functioning (75.3 (28.7) vs. 94.1 (13.5), p < 0.001 and mental component summary (49.0 (9.9) vs. 55.8 (6.7), p < 0.001. They scored higher for HADS-anxiety (4.8 (3.6 vs. 2.7 (2.5), p = 0.001, and had lower EQ-5D index (0.72 (0.34) vs. 0.84 (0.19), p = 0.04. Early vs. late awakeners had higher EQ-5D index (0.82 (0.23) vs. 0.71 (0.35), p = 0.04 and lower HADS-depression scores (2.5 (2.9) vs. 3.8 (2.3), p = 0.04. Next of kin estimated HRQoL similar to the survivors’ own estimates. Conclusions HRQoL five years after OHCA was good and mainly comparable to a matched reference population. Stratified analyses revealed impaired HRQoL among younger survivors and those awakening late, mainly for mental domains.

• Alm-Kruse, Kristin; Sørensen, Gro; Osbakk, Svein Are; Sunde, Kjetil; Bendz, Bjørn & Andersen, Geir Øystein [Show all 9 contributors for this article] (2021). Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol. Resuscitation. ISSN 0300-9572. doi: 10.1016/j.resuscitation.2021.01.038. Full text in Research Archive Show summary

  Aim To compare the outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA) fulfilling the criteria for extracorporeal cardiopulmonary resuscitation (ECPR) before and after implementation of an ECPR protocol, whether the patient received ECPR or not. Methods We compared cardiac arrest registry data before (2014–2015) and after (2016–2019) implementation of the ECPR protocol. The ECPR criteria were presumed cardiac origin, witnessed arrest with ventricular fibrillation, bystander CPR, age 18–65, advanced life support (ALS) within 15 min and ALS > 10 min without return of spontaneous circulation (ROSC). The primary outcome was 30-day survival; the secondary outcomes were sustained ROSC, neurological outcome and the proportion of patients transported with ongoing ALS. Results There were 1086 and 3135 patients in the pre- and post-implementation sample; 48 (4%) and 100 (3%) met the ECPR criteria, respectively. Of these, 21 (44%) vs. 37 (37%) were alive after 30 days, p = 0.4, and 30 (63%) vs. 50 (50%) achieved sustained ROSC, p = 0.2. All survivors in the pre-implementation sample had cerebral performance category 1–2 vs. 30 (81%) in the post-implementation sample, p = 0.03. Of the patients fulfilling the ECPR criteria, 7 (15%) and 26 (26%), p = 0.1, were transported with ongoing ALS in the pre- and post-implementation sample, respectively. Conclusions There were no differences in 30-day survival or prehospital ROSC in patients with refractory OHCA before and after initiation of an ECPR protocol.

• Døving, Mats; Anandan, Steven; Rogne, Kjetil Gunmudson; Utheim, Tor Paaske; Brunborg, Cathrine & Galteland, Pål [Show all 7 contributors for this article] (2021). Cost Analysis of Open Surgical BedsideTracheostomy in Intensive CareUnit Patients. Ear, Nose & Throat Journal. ISSN 0145-5613. doi: 10.1177/01455613211018578. Full text in Research Archive Show summary

  Objectives: Open surgical tracheostomy (OST) is a common procedure performed on intensive care unit (ICU) patients. The procedure can be performed bedside in the ICU (bedside open surgical tracheostomy, BeOST) or in the operating room (operating room open surgical tracheostomy, OROST), with comparable safety and long-term complication rates. We aimed to perform a cost analysis and evaluate the use of human resources and the total time used for both BeOSTs and OROSTs. Methods: All OSTs performed in 2017 at 5 different ICUs at Oslo University Hospital Ullevål were retrospectively evaluated. The salaries of the personnel involved in the 2 procedures were obtained from the hospital’s finance department. The time taken and the number of procedures performed were extracted from annual reports and from the electronic patient record system, and the annual expenditures were calculated. Results: Altogether, 142 OSTs were performed, of which 122 (86%) and 20 (14%) were BeOSTs and OROSTs, respectively. A BeOST cost 343 EUR (95% CI: 241.4-444.6) less than an OROST. Bedside open surgical tracheostomies resulted in an annual cost efficiency of 41.818 EUR. In addition, BeOSTs freed 279 hours of operating room occupancy during the study year. Choosing BeOST instead of OROST made 1 nurse, 2 surgical nurses, and 1 anesthetic nurse redundant. Conclusion: Bedside open surgical tracheostomy appears to be cost-, time-, and resource-effective than OROST. In the absence of contraindications, BeOSTs should be performed in ICU patients whenever possible.

• Petosic, Antonija; Småstuen, Milada C.; Beeckman, Dimitri; Flaatten, Hans; Sunde, Kjetil & Wøien, Hilde (2021). Multifaceted intervention including Facebook-groups to improve guideline-adherence in ICU: A quasi-experimental interrupted time series study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(10), p. 1466–1474. doi: 10.1111/aas.13969. Full text in Research Archive Show summary

  Background: The impact of social media, with its speed, reach and accessibility, in interventions aimed to improve adherence to guidelines such as assessment of Pain, Agitation/Sedation and Delirium (PAD) in intensive care is not described. Therefore, the primary objective of this quality improvement study was to evaluate the impact of a multifaceted intervention including audit and feedback of quality indicators (QI) via Facebook-groups, educational events and engagement of opinion leaders on adherence to PAD-guidelines in four ICUs. Methods: A quasi-experimental interrupted time series study with eight monthly data points in the two phases Before and Intervention was designed. Proportion of nursing shifts with documented PAD-assessment (PAD-QIs) were retrieved from the electronical medical chart from included adult ICU patient-stays in four participating ICUs. Difference between the two time periods was assessed using generalised mixed model for repeated measures with unstructured covariance matrix, and presented as Beta (B) with 95% confidence interval (CI). Results: Finally, 1049 ICU patient-stays were analysed; 534 in Before and 515 in Intervention. All three PAD-QIs significantly increased in Intervention by 31% (B = 30.7, 95%CI [25.7 to 35.8]), 26% (B = 25.8, 95%CI [19.4 to 32.2]) and 34% (B = 33.9, 95%CI [28.4 to 39.4]) in pain, agitation/sedation and delirium, respectively. Conclusion: A multifaceted intervention including use of Facebook-groups was associated with improved guideline-adherence in four ICUs, as measured with process PAD-QIs of PAD assessment. Further research on use of social media to improve guideline adherence is warranted, particularly as social distancing impacts clinical education and training and new approaches are needed.

• Thomas, Anub Mathew; Chaban, Viktoriia; Pischke, Soeren; Orrem, Hilde Lang; Bosnes, Vidar & Sunde, Kjetil [Show all 13 contributors for this article] (2021). Complement ratios C3bc/C3 and sC5b-9/C5 do not increase the sensitivity of detecting acute complement activation systemically. Molecular Immunology. ISSN 0161-5890. 141, p. 273–279. doi: 10.1016/j.molimm.2021.11.016. Full text in Research Archive Show summary

  Background Complement activation plays an important pathogenic role in numerous diseases. The ratio between an activation product and its parent protein is suggested to be more sensitive to detect complement activation than the activation product itself. In the present study we explored whether the ratio between the activation product and the parent protein for C3 (C3bc/C3) and for C5 (sC5b-9/C5) increased the sensitivity to detect complement activation in acute clinical settings compared to the activation product alone. Materials and methods Samples from patients with acute heart failure following ST-elevated myocardial infarction (STEMI) and from patients with out-of-hospital cardiac arrest (OHCA) were used. C3, C3bc and C5, sC5b-9 were analysed in 629 and 672 patient samples, respectively. Healthy controls (n = 20) served to determine reference cut-off values for activation products and ratios, defined as two SD above the mean. Results Increased C3bc/C3- and sC5b-9/C5 ratios were vastly dependent on C3bc and sC5b-9. Thus, 99.5 % and 98.1 % of the increased C3bc/C3- and sC5b-9/C5 ratios were solely dependent on increased C3bc and sC5b-9, respectively. Significantly decreased C3 and C5 caused increased ratios in only 3/600 (0.5 %) and 4/319 (1.3 %) samples, respectively. Strong correlations between C3bc and C3bc/C3-ratio and between sC5b-9 and sC5b-9/C5-ratio were found in the STEMI- (r = 0.926 and r = 0.786, respectively) and the OHCA-population (r = 0.908 and r = 0.843, respectively; p < 0.0001 for all). Importantly, sC5b-9 identified worse outcome groups better than sC5b-9/C5-ratio. Conclusion C3bc and sC5b-9 were sensitive markers of complement activation. The ratios of C3bc/C3 and sC5b-9/C5 did not improve detection of complement activation systemically.

• Valsø, Åse; Rustøen, Tone; Småstuen, Milada Cvancarova; Puntillo, Kathleen; Skogstad, Laila & Bredal, Inger Schou [Show all 8 contributors for this article] (2021). Occurrence and characteristics of pain after ICU discharge: A longitudinal study. Nursing in Critical Care. ISSN 1362-1017. p. 1–10. doi: 10.1111/nicc.12701. Full text in Research Archive
• Skaare, Christiane; Karlsen, Hilde; Strand-Amundsen, Runar James; Eriksen, Morten; Skulberg, Vidar Magne & Sunde, Kjetil [Show all 8 contributors for this article] (2021). Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management. Resuscitation. ISSN 0300-9572. p. 1–10. doi: 10.1016/j.resuscitation.2021.06.011. Full text in Research Archive Show summary

  Aim To determine whether targeting a mean arterial pressure of 90 mmHg (MAP90) would yield improved cerebral blood flow and less ischaemia compared to MAP 60 mmHg (MAP60) with and without targeted temperature management at 33 °C (TTM33) in a porcine post-cardiac arrest model. Methods After 10 min of cardiac arrest, 41 swine of either sex were resuscitated until return of spontaneous circulation (ROSC). They were randomised to TTM33 or no-TTM, and MAP60 or MAP90; yielding four groups. Temperatures were managed with intravasal cooling and blood pressure targets with noradrenaline, vasopressin and nitroprusside, as appropriate. After 30 min of stabilisation, animals were observed for two hours. Cerebral perfusion pressure (CPP), cerebral blood flow (CBF), pressure reactivity index (PRx), brain tissue pCO2 (PbtCO2) and tissue intermediary metabolites were measured continuously and compared using mixed models. Results Animals randomised to MAP90 had higher CPP (p < 0.001 for both no-TTM and TTM33) and CBF (no-TTM, p < 0.03; TH, p < 0.001) compared to MAP60 during the 150 min observational period post-ROSC. We also observed higher lactate and pyruvate in MAP60 irrespective of temperature, but no significant differences in PbtCO2 and lactate/pyruvate-ratio. We found lower PRx (indicating more intact autoregulation) in MAP90 vs. MAP60 (no-TTM, p = 0.04; TTM33, p = 0.03). Conclusion In this porcine cardiac arrest model, targeting MAP90 led to better cerebral perfusion and more intact autoregulation, but without clear differences in ischaemic markers, compared to MAP60.

• Peluso, Lorenzo; Abella, Benjamin S.; Ferrer, Ricard; Kucher, Nils; Sunde, Kjetil & Ne, Fabio S. Tacco (2020). Fever management in COVID-19 patients. Minerva Anestesiologica. ISSN 0375-9393. 87(1), p. 1–3. doi: 10.23736/S0375-9393.20.15195-2. Full text in Research Archive
• Gundem, Trine; Olasveengen, Theresa M.; Hovda, Knut Erik; Gaustad, Knut; Schøndorf, Christina Luise & Rostrup, Morten [Show all 11 contributors for this article] (2020). Ventilasjonsstotte for hypoksemiske intensivpasienter med covid-19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(11), p. 1–10. doi: 10.4045/tidsskr.20.0445. Full text in Research Archive Show summary

  BAKGRUNN Covid-19-pneumoni kan gi alvorlig hypoksemisk respirasjonssvikt som krever intensivmedisinsk behandling. Vi ønsket å beskrive covid-19-intensivpasienter som ble behandlet med og uten invasiv ventilasjonsstøtte. MATERIALE OG METODE Materialet er hentet fra lokalt kvalitetsregister og består av data om pasienter med covid-19 innlagt på intensivavdelingen ved Oslo universitetssykehus, Ullevål i perioden 5.3–28.5.2020. Pasientene ble kategorisert i tre grupper basert på respirasjonssviktbehandlingen (oksygen alene, tillegg av ikke-invasiv ventilasjonsstøtte (NIV) og intubasjon/respirator) og beskrevet med deskriptiv statistikk. RESULTATER Av 165 innlagte covid-19-pasienter ble 26 (16 %) behandlet ved vår intensivavdeling. Fire av disse hadde behandlingsbegrensninger og ble ekskludert. De 22 pasientene inkludert i denne studien hadde gjennomsnittsalder 56 år (spredning 25–78 år), 17 (77 %) var menn. Elleve pasienter fikk respiratorbehandling, syv oksygen på maske og fire tillegg av ikke-invasiv ventilasjonsstøtte. I respiratorgruppen var to døde per 28.5.2020, resten var skrevet ut av intensivavdelingen i live, hvorav én fortsatt lå på sengepost. Alle pasienter behandlet med oksygen og ikke-invasiv ventilasjonsstøtte var i live og utskrevet fra sykehus. FORTOLKNING Mange pasienter med covid-19-respirasjonssvikt og behov for intensivbehandling kan klare seg med økt oksygentilbud og ikke-invasiv ventilasjonsstøtte, men behov for intubasjon må fortløpende vurderes. Over 90 % av aktivt behandlede intensivpasienter overlevde.

• Nakstad, Espen Rostrup; Stær-Jensen, Henrik; Wimmer, Rolf Henning; Henriksen, Julia; Alteheld, Lars Holger & REICHENBACH, ANTJE [Show all 17 contributors for this article] (2020). Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest – results of the prospective Norwegian Cardio-respiratory Arrest Study (NORCAST). Resuscitation. ISSN 0300-9572. 149, p. 170–179. doi: 10.1016/j.resuscitation.2019.12.031. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Småstuen, Milada C; Ekeberg, Øivind; Skogstad, Laila & Bredal, Inger Schou [Show all 9 contributors for this article] (2020). Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms-A Randomized Controlled Trial. Critical Care Medicine. ISSN 0090-3493. 48(12), p. 1218–1225. doi: 10.1097/CCM.0000000000004628. Full text in Research Archive Show summary

  Objectives: To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later. Design: A pragmatic nonblinded randomized controlled trial. Settings: Five surgical and medical ICUs at Oslo University Hospital. Patients: Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study. Intervention: Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care. Measurements and Main Results: Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37–41) versus 37 (95% CI, 35–39), 32 (95% CI, 28–35) versus 32 (95% CI, 29–35), 31 (95% CI, 28–34) versus 30 (95% CI, 27–33), and 31 (95% CI, 28–34) versus 29 (95% CI, 26–33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p = 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months. Conclusions: Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.

• Andersen, Nina Gjerde; Mowinckel, Marie-Christine; Sunde, Kjetil; Sandset, Per Morten & Beitland, Sigrid (2020). Utility of coagulation analyses to assess thromboprophylaxis with dalteparin in intensive care unit patients. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. p. 1–10. doi: 10.1111/aas.13748. Full text in Research Archive Show summary

  Background The aim of this study was to evaluate the utility of coagulation analyses to assess thromboprophylaxis with dalteparin in intensive care unit (ICU) patients. Methods Prospective observational study of ICU patients receiving dalteparin prophylaxis at Oslo University Hospital in Norway. Trough and peak antithrombin, protein C, anti‐factor Xa activity (aFXa), d‐dimer, thromboelastography, calibrated automated thrombogram and microparticles were analysed. Levels were compared in patients with and without venous thromboembolism (VTE), major bleeding, acute kidney injury (AKI) with use of renal replacement therapy (RRT) and variable dalteparin dose. Results Among 50 included patients (76% male, mean age 62 years) five (10%) developed VTE and eight (16%) major bleeding. Median through aFXa level was 0.03 (0.02‐0.05) IU/mL, and 48 (96%) of patients were within and two (4%) above target range. Peak aFXa level was 0.21 (0.13‐0.29) IU/mL, the number of patients below, within and above prophylactic range were 21 (42%), 25 (50%) and four (8%). Peak aFXa levels were similar in patients with and without VTE (0.18 vs 0.21 IU/L, P = .72), major bleeding (0.22 vs 0.21 IU/mL, P = .38) and AKI with RRT (0.18 vs 0.24, P = .13), but lower in patients receiving dalteparin 5000 IU od compared to 7500 IU od (0.19 vs 0.30 IU/mL, P < .01). Conclusions Intensive care unit patients receiving dalteparin prophylaxis had half of patients within prophylactic peak aFXa target range. Peak aFXa levels was affected by administered dalteparin dose, but not presence of VTE, major bleeding or AKI with RRT.

• Petosic, Antonija; Sunde, Kjetil; Beeckman, Dimitri; Flaatten, Hans & Wøien, Hilde (2019). Use of social media for communicating about critical care topics: A Norwegian cross-sectional survey. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 63(10), p. 1398–1405. doi: 10.1111/aas.13449. Full text in Research Archive Show summary

  Background: Social media (SoMe) might be an alternative platform for communicating critical care topics to implement evidence‐based practice in the intensive care unit (ICU). This survey aims to describe ICU nurses’ and physicians’ use of SoMe in general, and their perception of using closed Facebook‐groups for receiving content on critical care topics. Methods: A cross‐sectional, web‐based, anonymous survey was distributed to ICU physicians and nurses in four ICUs in autumn 2017 via an email‐campaign. Descriptive statistics with rates, percentages and median numeric rating scale (NRS) scores, interquartile ranges are presented. Results: The response‐rate was 64% (253/ 394) including 210 nurses and 43 physicians. Overall, 93% had a SoMe‐profile, and 77% had a profile on more than one network site. Facebook was the most used social network site, with 87% having a profile. Totally, 68% were daily users, but more nurses used Facebook daily vs physicians (81% vs 60%, respectively, P = 0.006). Nurses were also more positive toward being members of closed Facebook‐groups aimed to exchange content on critical care topics (median NRS 9 (6‐10) vs 6 (3‐9), respectively, P = 0.014). Conclusion: The majority of ICU nurses and physicians were active SoMe users, mainly for personal purposes, and Facebook was the most popular SoMe. Nurses used Facebook daily more frequent and were more positive toward content on critical care topics on Facebook than physicians. These findings might be relevant to customize future communication about critical care topics via SoMe.

• Søvik, Signe; Isachsen, Marie Susanna; Nordhuus, Kine Marie Byman; Tveiten, Christine Kooy; Eken, Torsten & Sunde, Kjetil [Show all 8 contributors for this article] (2019). Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis. Intensive Care Medicine. ISSN 0342-4642. 45(4), p. 407–419. doi: 10.1007/s00134-019-05535-y. Full text in Research Archive Show summary

  Purpose To perform a systematic review and meta-analysis of acute kidney injury (AKI) in trauma patients admitted to the intensive care unit (ICU). Methods We conducted a systematic literature search of studies on AKI according to RIFLE, AKIN, or KDIGO criteria in trauma patients admitted to the ICU (PROSPERO CRD42017060420). We searched PubMed, Cochrane Database of Systematic Reviews, UpToDate, and NICE through 3 December 2018. Data were collected on incidence of AKI, risk factors, renal replacement therapy (RRT), renal recovery, length of stay (LOS), and mortality. Pooled analyses with random effects models yielded mean differences, OR, and RR, with 95% CI. Results Twenty-four observational studies comprising 25,182 patients were included. Study quality (Newcastle–Ottawa scale) was moderate. Study heterogeneity was substantial. Incidence of post-traumatic AKI in the ICU was 24% (20–29), of which 13% (10–16) mild, 5% (3–7) moderate, and 4% (3–6) severe AKI. Risk factors for AKI were African American descent, high age, chronic hypertension, diabetes mellitus, high Injury Severity Score, abdominal injury, shock, low Glasgow Coma Scale (GCS) score, high APACHE II score, and sepsis. AKI patients had 6.0 (4.0–7.9) days longer ICU LOS and increased risk of death [RR 3.4 (2.1–5.7)] compared to non-AKI patients. In patients with AKI, RRT was used in 10% (6–15). Renal recovery occurred in 96% (78–100) of patients. Conclusions AKI occurred in 24% of trauma patients admitted to the ICU, with an RRT use among these of 10%. Presence of AKI was associated with increased LOS and mortality, but renal recovery in AKI survivors was good.

• Bartlett, Emily S; Valenzuela, Terence; Idris, Ahamed; Deye, Nicolas; Glover, Guy & Gillies, Michael A. [Show all 22 contributors for this article] (2019). Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest. Resuscitation. ISSN 0300-9572. 146, p. 82–95. doi: 10.1016/j.resuscitation.2019.10.035. Full text in Research Archive Show summary

  Cervids are keystone species in ecosystems and are associated with enormous cultural and economic value. Chronic wasting disease (CWD) is a fatal prion disease spreading in North American cervid populations. The 2016 emergence of CWD in Europe makes it urgent to understand the basics of CWD and to assess the extent to which current CWD knowledge is transferable to Europe. CWD is difficult to detect in the early stages due to very low prevalence and slow growth rates. The negative population effect of CWD is mainly due to increased female adult mortality, as infected individuals continue to reproduce. It may take decades before CWD leads to population declines. The population dynamics of mule deer are affected more by CWD than those of white-tailed deer, which in turn are more affected than those of elk, and depending on other factors limiting the populations. Species- and population-specific differences in dynamical consequences are linked to the balance among the rates of transmission, incubation period (linked to the prion protein gene, PRNP), and reproductive rates. This make it difficult to predict effects of CWD in Europe with other cervids, but the dynamic impact may be marked to cervid populations over the long term. The process of spillover across the species barrier is not well understood. Occasional spillover to moose without an apparent epizootic suggests specific conditions can limit CWD. Frequency-dependent transmission or weak density–dependent transmission makes it difficult to control CWD using density reductions through harvest and/or culling. CWD is difficult to eradicate once it becomes endemic, and it calls for immediate management actions. These actions involve extensive culling, fencing, and ceasing of wildlife feeding and are likely to cause significant controversy.

• May, Teresa L.; Lary, Christine W.; Riker, Richard R.; Friberg, Hans; Patel, Nainesh & Søreide, Eldar [Show all 23 contributors for this article] (2019). Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry. Intensive Care Medicine. ISSN 0342-4642. 45(5), p. 637–646. doi: 10.1007/s00134-019-05580-7. Full text in Research Archive Show summary

  Purpose Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers. Methods Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. Results A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11–63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37–0.58) to 0.20 (0.12–0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. Conclusions Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.

• Beitland, Sigrid; Nakstad, Espen Rostrup; Berg, Jens Petter; Siebke, Anne-Marie; Brusletto, Berit Sletbakk & Brunborg, Cathrine [Show all 8 contributors for this article] (2019). Urine β-2-Microglobulin, Osteopontin, and Trefoil Factor 3 May Early Predict Acute Kidney Injury and Outcome after Cardiac Arrest. Critical Care Research and Practice. ISSN 2090-1305. 2019. doi: 10.1155/2019/4384796. Full text in Research Archive Show summary

  Purpose. Acute kidney injury (AKI) is a common complication after out-of-hospital cardiac arrest (OHCA), leading to increased mortality and challenging prognostication. Our aim was to examine if urine biomarkers could early predict postarrest AKI and patient outcome. Methods. A prospective observational study of resuscitated, comatose OHCA patients admitted to Oslo University Hospital in Norway. Urine samples were collected at admission and day three postarrest and analysed for β-2-microglobulin (β2M), osteopontin, and trefoil factor 3 (TFF3). Outcome variables were AKI within three days according to the Kidney Disease Improving Global Outcome criteria, in addition to six-month mortality and poor neurological outcome (PNO) (cerebral performance category 3–5). Results. Among 195 included patients (85% males, mean age 60 years), 88 (45%) developed AKI, 88 (45%) died, and 96 (49%) had PNO. In univariate analyses, increased urine β2M, osteopontin, and TFF3 levels sampled at admission and day three were independent risk factors for AKI, mortality, and PNO. Exceptions were that β2M measured at day three did not predict any of the outcomes, and TFF3 at admission did not predict AKI. In multivariate analyses, combining clinical parameters and biomarker levels, the area under the receiver operating characteristics curves (95% CI) were 0.729 (0.658–0.800), 0.797 (0.733–0.861), and 0.812 (CI 0.750–0.874) for AKI, mortality, and PNO, respectively. Conclusions. Urine levels of β2M, osteopontin, and TFF3 at admission and day three were associated with increased risk for AKI, mortality, and PNO in comatose OHCA patients. This trail is registered with NCT01239420.

• Lund-Kordahl, Inger; Mathiassen, Maria; Melau, Jørgen; Olasveengen, Theresa M.; Sunde, Kjetil & Fredriksen, Knut (2019). Relationship between level of CPR training, self-reported skills, and actual manikin test performance—an observational study. International Journal of Emergency Medicine. ISSN 1865-1372. 12(2). doi: 10.1186/s12245-018-0220-9. Full text in Research Archive Show summary

  <p><i>Background - </i>Quality of bystander cardiopulmonary resuscitation (CPR) skills may influence out of hospital cardiac arrest (OHCA) outcomes. We analyzed how the level of CPR training related to indicators of good CPR quality and also the relationship between self-reported skills and actual CPR performance. <p><i>Methods - </i>Two hundred thirty-seven persons trained in standardized BLS curricula were divided into three groups according to the level of training: <i>group I</i> (40 h basic first aid training), <i>group II</i>, and <i>group III</i> (96 h advanced first aid, group III had also some limited additional life support training courses). We recorded the participants’ real-life CPR experience and self-reported CPR skills, and then assessed selected CPR quality indicators on a manikin. The data were analyzed with multivariate logistic regression. Differences between groups were analyzed with ANOVA/MANOVA. <p><i>Results - </i>Out of 237 participants, 125 had basic training (group I), 84 reported advanced training (group II), and 28 advanced training plus additional courses (group III). Group II and III had shorter start-up time, better compression depth and hand positioning, higher fraction of effective rescue ventilations, shorter hands-off time, and thus a higher chest compression fraction. Chest compression rate did not differ between groups. The participants in group I assessed their own skills and preparedness significantly lower than groups II and III both before and after the test. In addition, group III reported higher confidence in examining the critically ill patient and preparedness in doing CPR before the manikin test than both groups I and II. However, the observed differences between groups II and III in self-reported skills and preparedness were not statistically significant after the test. <p><i>Conclusion - </i>As expected, higher levels of BLS training correlated with better CPR quality. However, this study showed that ventilations and hands-on time were the components of CPR that were most affected by the level of training. Self-assessments of CPR ability correlated well to actual test performance and may have a role in probing CPR skills in students. The results may be important for BLS instructors and program developers.

• Beitland, Sigrid; Wimmer, Rolf Henning; Lorentsen, Torleif; Jacobsen, Dag; Drægni, Tomas & Brunborg, Cathrine [Show all 9 contributors for this article] (2019). Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 63(5), p. 630–638. doi: 10.1111/aas.13316. Full text in Research Archive Show summary

  Background The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients. Methods Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. For detection of VTE, Doppler ultrasound screening of neck, upper and lower extremity veins was used, and computed tomography angiography when clinically indicated for any medical reason. Results Among 70 included patients, 79% were males and mean age was 62 (±12.1) years. All received thromboprophylaxis with dalteparin, and 44 (63%) used graduated compression stockings. VTE was found in 19 (27%) patients; deep vein thrombosis in 15 (21%) and pulmonary embolism in 4 (6%). Among the VTEs, 11 (58%) presented within the first 48 hours after admission, two (11%) were located in the lower limbs and five (26%) were symptomatic. Risk factors for VTE in multivariable analyses were malignancy, abdominal surgery and SAPS II score <41 with an AuROC (95% CI) of 0.72 (0.58‐0.85, P = 0.01). Patients with and without VTE had comparable ICU LOS (13 vs 11 days, P = 0.27) and mortality (16% vs 20%, P = 0.72). Conclusion Venous thromboembolism was observed in 27% of ICU patients receiving thromboprophylaxis. Factors associated with increased risk of VTE were malignancy, abdominal surgery and SAPS II score <41. Presence of VTE did not impact on patient outcome.

• Valsø, Åse; Rustøen, Tone; Skogstad, Laila; Bredal, Inger Schou; Ekeberg, Øivind & Småstuen, Milada Cvancarova [Show all 9 contributors for this article] (2019). Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nursing in Critical Care. ISSN 1362-1017. 25(2), p. 117–125. doi: 10.1111/nicc.12466. Full text in Research Archive
• Karlsen, Hilde; Bergan, Harald Arne; Halvorsen, Per Steinar; Sunde, Kjetil; Qvigstad, Eirik & Andersen, Geir Øystein [Show all 8 contributors for this article] (2019). Esmolol for cardioprotection during resuscitation with adrenaline in an ischaemic porcine cardiac arrest model. Intensive Care Medicine Experimental. 7(65), p. 1–14. doi: 10.1186/s40635-019-0279-5. Full text in Research Archive Show summary

  Background The effectiveness of adrenaline during resuscitation continues to be debated despite being recommended in international guidelines. There is evidence that the β-adrenergic receptor (AR) effects of adrenaline are harmful due to increased myocardial oxygen consumption, post-defibrillation ventricular arrhythmias and increased severity of post-arrest myocardial dysfunction. Esmolol may counteract these unfavourable β-AR effects and thus preserve post-arrest myocardial function. We evaluated whether a single dose of esmolol administered prior to adrenaline preserves post-arrest cardiac output among successfully resuscitated animals in a novel, ischaemic cardiac arrest porcine model. Methods Myocardial infarction was induced in 20 anaesthetized pigs by inflating a percutaneous coronary intervention (PCI) balloon in the circumflex artery 15 min prior to induction of ventricular fibrillation. After 10 min of untreated VF, resuscitation with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated and the animals were randomized to receive an injection of either 1 mg/kg esmolol or 9 mg/ml NaCl, prior to adrenaline. Investigators were blinded to allocation. Successful defibrillation was followed by a 1-h high-flow VA-ECMO before weaning and an additional 1-h stabilization period. The PCI-balloon was deflated 40 min after inflation. Cardiac function pre- and post-arrest (including cardiac output) was assessed by magnetic resonance imaging (MRI) and invasive pressure measurements. Myocardial injury was estimated with MRI, triphenyl tetrazolium chloride (TTC) staining and serum concentrations of cardiac troponin T. Results Only seven esmolol and five placebo-treated pigs were successfully resuscitated and available for post-arrest measurements (p = 0.7). MRI revealed severe but similar reductions in post-arrest cardiac function with cardiac output 3.5 (3.3, 3.7) and 3.3 (3.2, 3.9) l/min for esmolol and control (placebo) groups, respectively (p = 0.7). The control group had larger left ventricular end-systolic and end-diastolic ventricular volumes compared to the esmolol group (75 (65, 100) vs. 62 (53, 70) ml, p = 0.03 and 103 (86, 124) vs. 87 (72, 91) ml, p = 0.03 for control and esmolol groups, respectively). There were no other significant differences in MRI characteristics, myocardial infarct size or other haemodynamic measurements between the two groups. Conclusions We observed similar post-arrest cardiac output with and without a single dose of esmolol prior to adrenaline administration during low-flow VA-ECMO in an ischaemic cardiac arrest pig model.

• Stær-Jensen, Henrik; Sunde, Kjetil; Nakstad, Espen Rostrup; Eritsland, Jan & Andersen, Geir Øystein (2018). Comparison of three haemodynamic monitoring methods in comatose post cardiac arrest patients. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 52(3), p. 141–148. doi: 10.1080/14017431.2018.1450992. Full text in Research Archive
• Kvakkestad, Kristin Marie; Sandvik, Leiv; Andersen, Geir Øystein; Sunde, Kjetil & Halvorsen, Sigrun (2018). Long-term survival in patients with acute myocardial infarction and out-of-hospital cardiac arrest: A prospective cohort study. Resuscitation. ISSN 0300-9572. 122, p. 41–47. doi: 10.1016/j.resuscitation.2017.11.047. Full text in Research Archive Show summary

  Aim: To compare short- and long-term survival in patients admitted to hospital after acute myocardial infarction (AMI) with and without out-of-hospital cardiac arrest (OHCA). Methods: Prospective cohort study of all AMI patients admitted to Oslo University Hospital Ulleval from September 1, 2005 to December 31, 2011. All-cause mortality was obtained from the Norwegian Cause of Death Registry with censoring date December 31, 2013. Cumulative survival was assessed with the Kaplan-Meier and the Life-table method. Logistic- and Cox regression were used for risk comparisons. Results: We identified 404 AMI patients with OHCA and 9425 AMI patients without. AMI patients without OHCA were categorized as ST-elevation myocardial infarction (STEMI, n = 4522) or non-STEMI (NSTEMI, n = 4903). Mean age was 63.6 ± standard deviation (SD) 12.5, 63.8 ± 13.1 and 69.7 ± 13.6 years in OHCA, STEMI and NSTEMI, respectively. Coronary angiography with subsequent percutaneous coronary intervention if indicated, was performed in 87% of OHCA, 97% of STEMI and 80% of NSTEMI patients. Thirty-day survival was 63%, 94% and 94%, and 8-year survival was 49%, 74%, and 57%, respectively. Among patients surviving the first 30 days, no significant difference in risk during long-term follow-up was found (adjusted Hazard Ratio (aHR)OHCAvsSTEMI 1.15 [95% CI 0.82–1.60], aHROHCAvsNSTEMI 0.89 [95% CI 0.64-1.24]). Conclusions: Long-term survival after OHCA due to AMI was good, with 49% of admitted patients being alive after eight years. Although short-term mortality remained high, OHCA patients alive after 30 days had similar long-term risk as AMI patients without OHCA.

• Schjørring, Olav L.; Toft-Petersen, Anne Pernille; Kusk, Kathrine Hoffmann; Mouncey, Paul R.; Sørensen, Erik Elgaard & Berezowicz, Paweł S. [Show all 28 contributors for this article] (2018). Intensive care doctors' preferences for arterial oxygen tension levels in mechanically ventilated patients. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 62(10), p. 1443–1451. doi: 10.1111/aas.13171. Full text in Research Archive
• Nolan, Jerry P.; Berg, Robert A.; Callaway, Clifton W.; Morrison, Laurie J.; Nadkarni, Vinay & Perkins, Gavin D. [Show all 11 contributors for this article] (2018). The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities. Intensive Care Medicine. ISSN 0342-4642. 44(6), p. 823–832. doi: 10.1007/s00134-018-5230-9. Full text in Research Archive
• Nolan, Jerry P.; Berg, Robert A.; Bernard, Stephen; Bobrow, Bentley J.; Callaway, Clifton W. & Cronberg, Tobias [Show all 15 contributors for this article] (2017). Intensive care medicine research agenda on cardiac arrest. Intensive Care Medicine. ISSN 0342-4642. Published ahead of print, p. 1–12. doi: 10.1007/s00134-017-4739-7. Full text in Research Archive
• Nolan, Jerry P.; Soar, Jasmeet; Cariou, Alain; Cronberg, Tobias; Moulaert, Veronique R.M. & Deakin, Charles D. [Show all 10 contributors for this article] (2017). Postreanimationsbehandlung: Kapitel 5 der Leitlinien zur Reanimation 2015 des European Resuscitation Council. Notfall & Rettungsmedizin. ISSN 1434-6222. 20(Suppl 1), p. 90–117. doi: 10.1007/s10049-017-0331-5. Full text in Research Archive
• Hardeland, Camilla; Skaare, Christiane; Kramer-Johansen, Jo; Birkenes, Tonje Søraas; Myklebust, Helge & Hansen, Andreas [Show all 8 contributors for this article] (2017). Targeted simulation and education to improve cardiac arrest recognition and telephone assisted CPR in an emergency medical communication centre. Resuscitation. ISSN 0300-9572. 114, p. 21–26. doi: 10.1016/j.resuscitation.2017.02.013. Full text in Research Archive
• Storm, Christian; Nee, Jens; Sunde, Kjetil; Holzer, Michael; Hubner, Pia & Taccone, Fabio Silvio [Show all 19 contributors for this article] (2017). A survey on general and temperature management of post cardiac arrest patients in large teaching and university hospitals in 14 European countries?The SPAME trial results. Resuscitation. ISSN 0300-9572. 116, p. 84–90. doi: 10.1016/j.resuscitation.2017.03.038. Full text in Research Archive
• Soar, Jasmeet; Nolan, Jerry P.; Böttiger, Bernd W.; Perkins, Gavin D.; Lott, Carsten & Carli, Pierre [Show all 12 contributors for this article] (2017). Adult advanced life support: Section 3 of the European Resuscitation Council Guidelines for Resuscitation 2015 [Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“) : Kapitel 3 der Leitlinien zur Reanimation 2015 des European Resuscitation Council]. Notfall & Rettungsmedizin. ISSN 1434-6222. 20, p. 25–88. doi: 10.1007/s10049-017-0330-6. Full text in Research Archive
• Cariou, Alain; Nolan, Jerry P. & Sunde, Kjetil (2017). Intensive care medicine in 2050: managing cardiac arrest. Intensive Care Medicine. ISSN 0342-4642. Published ahead of print, p. 1–3. doi: 10.1007/s00134-016-4658-z. Full text in Research Archive
• Hardeland, Camilla; Sunde, Kjetil; Ramsdal, Helge Normann; Hebbert, Susan R.; Soilammi, Linda Christina & Westmark, Fredrik [Show all 10 contributors for this article] (2016). Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients. Resuscitation. ISSN 0300-9572. 109, p. 56–63. doi: 10.1016/j.resuscitation.2016.09.027. Full text in Research Archive Show summary

  Aim Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. Methods Mixed-methods design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files. Qualitative data were collected through in-depth interviews and non-participant observations. Results OA-, VT- and Ø-EMCC responded to 1095 OHCAs and 579 of these calls were included for further analysis (333, 143 and 103, respectively). There were significant site differences in their recognition of OHCA (89, 94 and 78%, respectively, p < 0.001), provision of CPR instructions (83, 83 and 61%, respectively, p < 0.001), time from call answered to initial CPR instructions (1.4 min (1.2, 1.6), 1.1 min (0,9, 1.2) and 1.3 (1.2, 1.7) respectively, p = 0.002). The most frequent reason for delayed or failed recognition of OHCA was misinterpretation of agonal breathing. Interviews and observations revealed individual differences in protocol use, interrogation strategy and assessment of breathing. Use of protocol was only part of decision making, dispatchers trusted their own clinical experience and intuition, and used assumptions about the patient and the situation as part of decision making. Conclusion Agonal breathing continues to be the main barrier to recognition of cardiac arrest. Individual differences among dispatchers’ strategies can directly impact on performance, mainly due to the wide definition of cardiac arrest and lack of uniform tools for assessment of breathing.

• Beitland, Sigrid; Nakstad, Espen Rostrup; Stær-Jensen, Henrik; Drægni, Tomas; Andersen, Geir Øystein & Jacobsen, Dag [Show all 9 contributors for this article] (2016). Impact of acute kidney injury on patient outcome in out-of-hospital cardiac arrest: a prospective observational study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 60(8), p. 1170–1181. doi: 10.1111/aas.12753. Full text in Research Archive
• Beitland, Sigrid; Waldum-Grevbo, Bård Endre; Nakstad, Espen Rostrup; Berg, Jens Petter; Siebke, Anne-Marie & Brusletto, Berit Sletbakk [Show all 9 contributors for this article] (2016). Urine biomarkers give early prediction of acute kidney injury and outcome after outof- hospital cardiac arrest. Critical Care. ISSN 1364-8535. 20(1). doi: 10.1186/s13054-016-1503-2. Full text in Research Archive Show summary

  Background Post-resuscitation care after out-of-hospital cardiac arrest (OHCA) is challenging due to the threat of organ failure and difficult prognostication. Our aim was to examine whether urine biomarkers could give an early prediction of acute kidney injury (AKI) and outcome. Methods This was a prospective observational study of comatose OHCA patients at Oslo University Hospital Ullevål, Norway. Risk factors were clinical parameters and biomarkers measured in spot urine (cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and the product of tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7)) at admission and day 3. Outcome variables were AKI within 3 days using the Kidney Disease Improving Global Outcomes definition, 6-month mortality, and poor neurological outcome (PNO) defined as cerebral performance category 3–5. Results Among 195 included patients (85 % males, mean age 60 years), 88 (45 %) died, 96 (49 %) had PNO, and 88 (45 %) developed AKI. In univariate analysis, increased urine cystatin C and NGAL concentration sampled at admission and day 3 were independent risk factors for AKI, mortality and PNO. Increased urine TIMP-2 × IGFBP7 levels was associated with AKI only at admission. In multivariate analyses combining clinical parameters and biomarker concentrations, the area under the receiver operating characteristics curve (AuROC) with 95 % confidence interval (CI) were 0.774 (0.700–0.848), 0.812 (0.751–0.873), and 0.819 (0.759–0.878) for AKI, mortality and PNO, respectively. Conclusions In comatose OHCA patients, urine levels of cystatin C and NGAL at admission and day 3 were independent risk factors for AKI, 6-month mortality and PNO. Trial registration Clinicaltrials.gov NCT01239420 . Registered 10 November 2010.

• Karlsson, Viktor; Dankiewicz, Josef; Nielsen, Niklas; Kern, Karl B.; Mooney, Michael R. & Riker, Richard R. [Show all 13 contributors for this article] (2015). Association of gender to outcome after out-of-hospital cardiac arrest - a report from the International Cardiac Arrest Registry. Critical Care. ISSN 1364-8535. 19:182. doi: 10.1186/s13054-015-0904-y. Full text in Research Archive Show summary

  Introduction Previous studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest (OHCA), but the results are conflicting. We aimed to investigate the association of gender to outcome, coronary angiography (CAG) and adverse events in OHCA survivors treated with mild induced hypothermia (MIH). Methods We performed a retrospective analysis of prospectively collected data from the International Cardiac Arrest Registry. Adult patients with a non-traumatic OHCA and treated with MIH were included. Good neurological outcome was defined as a cerebral performance category (CPC) of 1 or 2. Results A total of 1,667 patients, 472 women (28%) and 1,195 men (72%), met the inclusion criteria. Men were more likely to receive bystander cardiopulmonary resuscitation, have an initial shockable rhythm and to have a presumed cardiac cause of arrest. At hospital discharge, men had a higher survival rate (52% vs. 38%, P <0.001) and more often a good neurological outcome (43% vs. 32%, P <0.001) in the univariate analysis. When adjusting for baseline characteristics, male gender was associated with improved survival (OR 1.34, 95% CI 1.01 to 1.78) but no longer with neurological outcome (OR 1.24, 95% CI 0.92 to 1.67). Adverse events were common; women more often had hypokalemia, hypomagnesemia and bleeding requiring transfusion, while men had more pneumonia. In a subgroup analysis of patients with a presumed cardiac cause of arrest (n = 1,361), men more often had CAG performed on admission (58% vs. 50%, P = 0.02) but this discrepancy disappeared in an adjusted analysis. Conclusions Gender differences exist regarding cause of arrest, adverse events and outcome. Male gender was independently associated with survival but not with neurological outcome.

• Kudenchuk, Peter James; Sandroni, Claudio; Drinhaus, Hendrik R.; Böttiger, Bernd W.; Cariou, Alain & Sunde, Kjetil [Show all 17 contributors for this article] (2015). Breakthrough in cardiac arrest: reports from the 4th Paris International Conference. Annals of Intensive Care. 5:22. doi: 10.1186/s13613-015-0064-x. Full text in Research Archive
• Stær-Jensen, Henrik; Nakstad, Espen Rostrup; Fossum, Eigil; Mangschau, Arild; Eritsland, Jan & Drægni, Tomas [Show all 9 contributors for this article] (2015). Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest. Circulation. Cardiovascular Interventions. ISSN 1941-7640. 8(10). doi: 10.1161/CIRCINTERVENTIONS.115.002784. Full text in Research Archive
• Seder, David B.; Sunde, Kjetil; Rubertsson, Sten; Mooney, Michael; Stammet, Pascal & Riker, Richard R. [Show all 11 contributors for this article] (2015). Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Critical Care Medicine. ISSN 0090-3493. 43(5), p. 965–972. doi: 10.1097/CCM.0000000000000880. Full text in Research Archive
• Gagnon, David J.; Nielsen, Niklas; Fraser, Gilles L.; Riker, Richard R.; Dziodzio, John & Sunde, Kjetil [Show all 12 contributors for this article] (2015). Prophylactic antibiotics are associated with a lower incidence of pneumonia in cardiac arrest survivors treated with targeted temperature management. Resuscitation. ISSN 0300-9572. 92, p. 154–159. doi: 10.1016/j.resuscitation.2015.01.035. Full text in Research Archive
• Nolan, Jerry P.; Soar, Jasmeet; Cariou, Alain; Cronberg, Tobias; Moulaert, Veronique R.M. & Deakin, Charles D. [Show all 10 contributors for this article] (2015). Postreanimationsbehandlung: Kapitel 5 der Leitlinien zur Reanimation 2015 des European Resuscitation Council. Notfall & Rettungsmedizin. ISSN 1434-6222. 18(8), p. 904–931. doi: 10.1007/s10049-015-0094-9. Full text in Research Archive
• Beitland, Sigrid; Sandven, Irene; Kjærvik, Lill-Kristin Krohn; Sandset, Per Morten; Sunde, Kjetil & Eken, Torsten (2015). Thromboprophylaxis with low molecular weight heparin versus unfractionated heparin in intensive care patients: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Medicine. ISSN 0342-4642. 41(7), p. 1209–1219. doi: 10.1007/s00134-015-3840-z. Full text in Research Archive
• Nolan, Jerry P.; Soar, Jasmeet; Cariou, Alain; Cronberg, Tobias; Moulaert, Veronique R.M. & Deakin, Charles D. [Show all 10 contributors for this article] (2015). European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Medicine. ISSN 0342-4642. 41(12), p. 2039–2056. doi: 10.1007/s00134-015-4051-3. Full text in Research Archive
• Soar, Jasmeet; Nolan, Jerry P.; Böttiger, Bernd W.; Perkins, Gavin D.; Lott, Carsten & Carli, Pierre [Show all 12 contributors for this article] (2015). European Resuscitation Council Guidelines for Resuscitation 2015. Section 3. Adult advanced life support. Resuscitation. ISSN 0300-9572. 95, p. 100–147. doi: 10.1016/j.resuscitation.2015.07.016. Full text in Research Archive
• Tvinnereim, Are Bergsvein; Opdahl, Helge; Rostrup, Morten & Sunde, Kjetil (2015). En ung mann med luftveisinfeksjon og intense smerter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(7), p. 658–661. doi: 10.4045/tidsskr.14.1182. Full text in Research Archive
• Cariou, Alain; Nolan, Jerry P. & Sunde, Kjetil (2015). Ten strategies to increase survival of cardiac arrest patients. Intensive Care Medicine. ISSN 0342-4642. 41(10), p. 1820–1823. doi: 10.1007/s00134-015-3788-z. Full text in Research Archive
• Soar, Jasmeet; Nolan, Jerry P.; Böttiger, Bernd W.; Perkins, Gavin D.; Lott, Carsten & Carli, Pierre [Show all 12 contributors for this article] (2015). Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“): Kapitel 3 der Leitlinien zur Reanimation 2015 des European Resuscitation Council [Adult advanced life support: Section 3 of the European Resuscitation Council Guidelines for Resuscitation 2015]. Notfall & Rettungsmedizin. ISSN 1434-6222. 18(8), p. 770–832. doi: 10.1007/s10049-015-0085-x. Full text in Research Archive
• Nolan, Jerry P.; Soar, Jasmeet; Cariou, Alain; Cronberg, Tobias; Moulaert, Veronique R.M. & Deakin, Charles D. [Show all 10 contributors for this article] (2015). European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015. Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. ISSN 0300-9572. 95, p. 202–222. doi: 10.1016/j.resuscitation.2015.07.018. Full text in Research Archive
• Dankiewicz, Jozef; Schmidbauer, Simon; Nielsen, Niklas; Kern, Karl B.; Mooney, Michael & Stammet, Pascal [Show all 14 contributors for this article] (2014). Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large prospective registry. Critical Care Medicine. ISSN 0090-3493. 42(12), p. 2537–2545. doi: 10.1097/CCM.0000000000000543. Full text in Research Archive
• Stær-Jensen, Henrik; Sunde, Kjetil; Olasveengen, Theresa M.; Jacobsen, Dag; Drægni, Tomas & Nakstad, Espen Rostrup [Show all 8 contributors for this article] (2014). Bradycardia during therapeutic hypothermia is associated with good neurologic outcome in comatose survivors of out-of-hospital cardiac arrest. Critical Care Medicine. ISSN 0090-3493. 42(11), p. 2401–2408. doi: 10.1097/CCM.0000000000000515. Full text in Research Archive
• Beitland, Sigrid; Os, Ingrid & Sunde, Kjetil (2014). Primary Injuries and Secondary Organ Failures in Trauma Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy. Scientifica. 2014. doi: 10.1155/2014/235215. Full text in Research Archive Show summary

  Background. Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) is a severe complication in trauma patients. The aim of the study was to assess primary traumatic injuries and secondary organ failures in severe posttraumatic AKI. Methods. Retrospective review of adult trauma patients admitted to the trauma centre at Oslo University Hospital Ullevål. Injury severity score (ISS) was used to assess the severity of primary injuries, and sequential organ failure assessment (SOFA) score was utilized to measure secondary organ failures. Results. Forty-two (8%) of 506 trauma patients admitted to intensive care unit developed AKI treated with CRRT, whereof 40 (95%) suffered blunt trauma mechanisms. Patients had extensive primary organ injuries with median (interquartile range) ISS 36 (27–49). The majority of the patients had respiratory (93% intubated) and cardiovascular (67% with inotropic and/or vasoactive medication) failure within 24 hours after admission. AKI was often part of multiple organ failure, most frequently respiratory and cardiovascular failure, affecting 33 (75%) and 30 (71%) of the patients, respectively. Conclusion. Trauma patients with AKI undergoing CRRT often had severe primary injuries due to blunt trauma. Most of them suffered from secondary multiple organ failure concomitant to AKI.

• Sunde, Kjetil (2014). Terapeutisk hypotermi etter hjertestans - en oppdatering. Hjerteforum. ISSN 0802-1465. 27(3), p. 29–37. Full text in Research Archive
• Beitland, Sigrid; Platou, Eivind S & Sunde, Kjetil (2014). Drug-induced long QT syndrome and fatal arrhythmias in the intensive care unit. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 58(3), p. 266–272. doi: 10.1111/aas.12257. Full text in Research Archive
• Karlis, G.; Iacovidou, N.; Lelovas, P.; Niforopoulou, P.; Zacharioudaki, A. & Papalois, A. [Show all 9 contributors for this article] (2014). Effects of early amiodarone administration during and immediately after cardiopulmonary resuscitation in a swine model. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 58(1), p. 114–122. doi: 10.1111/aas.12226. Full text in Research Archive
• Sunde, Kjetil & Olasveengen, Theresa M. (2014). Towards cardiopulmonary resuscitation without vasoactive drugs. Current Opinion in Critical Care. ISSN 1070-5295. 20(3), p. 234–241. doi: 10.1097/MCC.0000000000000082. Full text in Research Archive
• Sunde, Kjetil (2013). SOPs and the right hospitals to improve outcome after cardiac arrest. Bailliere's Best Practice & Research. Clinical Anaesthesiology. ISSN 1521-6896. 27(3), p. 373–381. doi: 10.1016/j.bpa.2013.07.009. Full text in Research Archive

View all works in NVA

• Steen, Petter Andreas; Sunde, Kjetil; Murray, Michael J; Harrison, Barry A; Mueller, Jeff T & Rose, Steven H [Show all 8 contributors for this article] (2014). Advanced cardiac life support i bok: Faust´s Anesthesiology Review. Elsevier. ISBN 9781437713695. 2 p. Full text in Research Archive

View all works in NVA

• Valsø, Åse; Tøien, Kirsti; Rustøen, Tone; Milada, Cvancarova Småstuen & Sunde, Kjetil (2024). Posttraumatic stress symptoms, sense of coherence and pain after intensive care treatment and the effect of early nurse-led follow-up consultation. Full text in Research Archive
• Behringer, Wilhelm; Abella, Benjamin & Sunde, Kjetil (2021). Meta-analyses of targeted temperature management in adult cardiac arrest studies – The big picture is dependent on study selection. Resuscitation. ISSN 0300-9572. 169, p. 223–224. doi: 10.1016/j.resuscitation.2021.09.040. Full text in Research Archive
• Gundem, Trine; Olasveengen, Theresa M.; Schøndorf, Christina Luise; Hovda, Knut Erik; Rostrup, Morten & Frøyshov, Sten [Show all 11 contributors for this article] (2020). T.M. Gundem og medarbeidere svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(12), p. 1–2. doi: 10.4045/tidsskr.20.0650. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2019). Effect of nurse led follow-up consultations to improve sence of coherence in patients discharged after intensive care treatment. Full text in Research Archive
• May, Teresa L.; Lary, Christine W.; Riker, Richard R.; Friberg, Hans; Patel, Nainesh & Søreide, Eldar [Show all 23 contributors for this article] (2019). Correction to: Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry. Intensive Care Medicine. ISSN 0342-4642. 45(1176). doi: 10.1007/s00134-019-05687-x. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2018). Effect of nurse led intervention to reduce post traumatic stress symptoms in patients discharged after intensive care treatment. Full text in Research Archive
• Alm-Kruse, Kristin; Sunde, Kjetil; Sørensen, Gro; Andersen, Geir Øystein; Osbakk, Svein Are & Kramer-Johansen, Jo (2018). Outcome in potential candidates for extracorporeal cardiopulmonary resuscitation after refractory out-of-hospital cardiac arrest treated with conventional advanced life support. Resuscitation. ISSN 0300-9572. 130, p. e22–e22. doi: 10.1016/j.resuscitation.2018.07.352. Full text in Research Archive
• Søvik, Signe; Isachsen, Marie Susanna; Nordhuus, Kine Marie Byman; Tveiten, Christine Kooy; Eken, Torsten & Sunde, Kjetil [Show all 8 contributors for this article] (2018). Acute kidney injury in trauma patients admitted to the intensive care unit: a systematic review and meta-analysis. Intensive Care Medicine Experimental. 6, p. 474–474. doi: 10.1186/s40635-018-0201-6. Full text in Research Archive
• Tøien, Kirsti; Rustøen, Tone & Sunde, Kjetil (2018). Effect of nurse led intervention to reduce post traumatic stress symptoms in patients discharged after intensive care treatment. Full text in Research Archive
• Beitland, Sigrid; Nakstad, Espen Rostrup; Berg, Jens Petter; Trøseid, Anne-Marie Siebke; Brusletto, Berit Sletbakk & Brunborg, Cathrine [Show all 7 contributors for this article] (2018). Urine biomarkers may early predict acute kidney injury and outcome after out-of-hospital cardiac arrest. Intensive Care Medicine Experimental. 6. doi: 10.1186/s40635-018-0201-6. Full text in Research Archive
• Beitland, Sigrid & Sunde, Kjetil (2018). Guidelines for post-resuscitation care should include management of acute kidney injury and use of renal replacement therapy. Resuscitation. ISSN 0300-9572. 126. doi: 10.1016/j.resuscitation.2018.02.013. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2017). Association between post traumatic stress symptoms and sense of coherence in intensive care unit patients" (Oral presentation). Full text in Research Archive
• Callway, Clifton W. & Sunde, Kjetil (2017). Authors' response: Overcautious adoption of extracorporeal cardiopulmonary resuscitation. Emergency Medicine Journal. ISSN 1472-0205. 34(8), p. 558–558. doi: 10.1136/emermed-2017-206917. Full text in Research Archive
• Sunde, Kjetil & Callaway, Clifton W. (2017). Extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest ? to whom and when, that?s the difficult question! Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 61(4), p. 369–371. doi: 10.1111/aas.12873. Full text in Research Archive
• Callaway, Clifton W. & Sunde, Kjetil (2017). Extracorporeal cardiopulmonary resuscitation probably good, but adoption should not be too fast and furious! Emergency Medicine Journal. ISSN 1472-0205. 34(5), p. 275–276. doi: 10.1136/emermed-2016-206442. Full text in Research Archive
• Tøien, Kirsti; Rustøen, Tone & Sunde, Kjetil (2017). Association between post traumatic stress symptoms and sense of coherence in intensive care unit patients. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2016). "Association between posttraumatic stress symptoms and sense of coherence in intensive care patients". Full text in Research Archive
• Nolan, Jerry P.; Soar, Jasmeet; Cariou, Alain; Cronberg, Tobias; Moulaert, Veronique R.M. & Deakin, Charles D. [Show all 10 contributors for this article] (2016). Erratum to: European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Medicine. ISSN 0342-4642. 42(3), p. 488–489. doi: 10.1007/s00134-015-4158-6. Full text in Research Archive
• Sunde, Kjetil & Andersen, Geir Øystein (2016). Prediction of outcome after out-of-hospital cardiac arrest already on hospital admission-not reliable enough to be true! European Heart Journal. ISSN 0195-668X. 37(42), p. 3229–3231. doi: 10.1093/eurheartj/ehv490. Full text in Research Archive
• Tøien, Kristine; Rustøen, Tone; Skogstad, Laila; Schou-Bredal, Inger; Sunde, Kjetil & Ekeberg, Øivind [Show all 11 contributors for this article] (2016). Association between posttraumatic stress symptoms and sense of coherence in intensive care patients. Full text in Research Archive
• Tøien, Kirsti; Rustøen, Tone; Skogstad, Laila; Hagen, Milada Småstuen; Sunde, Kjetil & Schou-Bredal, Inger [Show all 8 contributors for this article] (2016). Association between posttraumatic stress symptoms and sense of coherence in intensive care patients. Full text in Research Archive
• Gaarder, Christine & Sunde, Kjetil (2016). The multidisciplinary nature of trauma care: Also in the intensive care unit. Current Opinion in Critical Care. ISSN 1070-5295. 22(6), p. 560–562. doi: 10.1097/MCC.0000000000000368. Full text in Research Archive
• Nolan, Jerry P.; Soar, Jasmeet; Cariou, Alain; Cronberg, Tobias; Moulaert, Veronique R.M. & Deakin, Charles D. [Show all 10 contributors for this article] (2016). Erratum zu: Postreanimationsbehandlung: Kapitel 5 der Leitlinien zur Reanimation 2015 des European Resuscitation Council [Erratum to: Post reanimation treatment: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015]. Notfall & Rettungsmedizin. ISSN 1434-6222. p. 1–2. doi: 10.1007/s10049-015-0123-8. Full text in Research Archive
• Stær-Jensen, Henrik; Sunde, Kjetil & Andersen, Geir Øystein (2015). The authors reply. Critical Care Medicine. ISSN 0090-3493. 43(3), p. e98–e98. doi: 10.1097/CCM.0000000000000812. Full text in Research Archive
• Cariou, Alain & Sunde, Kjetil (2014). Cold fluids during cardiac arrest: faster cooling but not better outcome! Intensive Care Medicine. ISSN 0342-4642. 40(12), p. 3536–3539. doi: 10.1007/s00134-014-3536-9. Full text in Research Archive
• Stær-Jensen, Henrik; Nakstad, Espen Rostrup; Fossum, E; Mangschau, Arild; Eritsland, Jan & Jacobsen, Dag [Show all 8 contributors for this article] (2014). Emergency coronary angiography and revascularization in patients with out of hospital cardiac arrest - relation to post - ROSC ECG - a prospective observational study. Full text in Research Archive
• Sunde, Kjetil (2013). Therapeutic hypothermia in cardiac arrest. Revista Española de Cardiología. ISSN 0300-8932. 66(5), p. 346–349. doi: 10.1016/j.rec.2012.10.004. Full text in Research Archive

View all works in NVA