Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden: A nationwide study

•The annual relative increase in 30-days survival is approximately 6%, which has resulted in a 3-fold increase in survival over the past three decades.•88% of all cases in this study now receive bystander CPR, which is the highest figure reported to date.•Almost 20% of the OHCA in the youngest age group are caused by attempted suicide and intoxication/overdose is seen in 30% of individuals between 16–34 years. These etiologies are increasing while heart disease is rapidly diminishing. The aim of this study was to present a comprehensive overview of out-of-hospital cardiac arrests (OHCA) in young adults. The data set analyzed included all cases of OHCA from 1990 to 2020 in the age-range 16–49 years in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). OHCA between 2010 and 2020 were analyzed in more detail. Clinical characteristics, survival, neurological outcomes, and long-time trends in survival were studied. Logistic regression was used to study 30-days survival, neurological outcomes and Utstein determinants of survival. Trends were assessed in 11,180 cases. The annual increase in 30-days survival during 1990–2020 was 5.9% with no decline in neurological function among survivors. Odds ratio (OR) for heart disease as the cause was 0.55 (95% CI 0.44 to 0.67) in 2017–2020 compared to 1990–1993. Corresponding ORs for overdoses and suicide attempts were 1.61 (95% CI 1.23–2.13) and 2.06 (95% CI 1.48–2.94), respectively. Exercise related OHCA was noted in roughly 5%. OR for bystander CPR in 2017–2020 vs 1990–1993 was 3.11 (95% CI 2.57 to 3.78); in 2020 88 % received bystander CPR. EMS response time increased from 6 to 10 minutes. Survival has increased 6% annually, resulting in a three-fold increase over 30 years, with stable neurological outcome. EMS response time increased with 66% but the majority now receive bystander CPR. Cardiac arrest due to overdoses and suicide attempts are increasing.