Johan Herlitz

An increasing number of lives are saved

Many Swedes have practised cardiopulmonary resuscitation (CPR). It is one of the reasons for double as many people surviving  cardiac arrest now compared to twenty years ago.

There is a lot of murmuring at the entrance of the University of Borås, students who have recently started the term gather with course books in their arms.  On the wall next to the reception there is a box with a green sign and the text defibrillator in big letters. There are three defibrillators at the University, and Johan Herlitz, professor in pre-hospital emergency care, attests that defibrillators are impossible to fail with; it is only about listening and following the pre-recorded voice.

DefibrillatorJohan Herlitz has seen medical care undergo enormous changes during his professional life, first as a cardiologist at Sahlgrenska University Hospital and then as a researcher. In the 1970s the Rescue Services still managed ambulance transport. If someone collapsed on the street then, firemen manned the ambulances. Johan Herlitz smiles and says that medical care was probably not the first priority of the fire brigade.  His teacher Stig Holmberg trained the firemen, who at the start were not very fond of it.

“But when Stig talked about the heart in terms of tubes and flows, then they thought it was fun,” says Johan Herlitz.

500 of 5,000 saved

In 1990 Johan Herlitz started to research cardiac arrests. How was really the situation for those whose heart had stopped, how many survived?  Nobody knew. Together with his teacher Stig Holmberg, Johan Herlitz initiated what is now a national quality register. The Swedish Cardiac Arrest Register collects data from all cases of cardiac arrest in Sweden.
Throughout Sweden every day fourteen people have cardiac arrest outside a hospital. 
In other words, many lives can be saved. Of the roughly 5,000 who have cardiac arrest every year, approximately 500 are saved.

Mass training in CPR, which takes place at many workplaces, in schools and associations, is a strong contributory factor for so many more being saved today than at the start of the 1990s.  The vision of Johan Herlitz is that it should be as common to know CPR as being able to swim, and the development is on a good path.

“Three million people have been trained in CPR in Sweden, now people are acting. You can also learn through an app or video, instead of attending a course which used to take three hours,” says Johan Herlitz, and skims through last year's report from his quality register.
He reads the most important figures out loud: In 1992, 33 per cent of everyone with cardiac arrest got CPR, twenty years later the figure was 70 per cent. Roughly five per cent lived one month after the cardiac arrest in 1992, compared to approximately 11 per cent in 2012.
It is easy to see in the register what functions and to compare regions with each other. Nobody wants to see that they are worse than someone else.

“At the turn of the century Stockholm had terrible results, they had half the survival rate of Gothenburg. There was wailing and gnashing of teeth when they raised the issue, but the politicians listened and they got the resources they needed,” says Johan Herlitz.

Johan Herlitz

Intervened three times in everyday life 

There are four links in the survival chain. It involves warning at an early stage, starting cardiopulmonary resuscitation, using  defibrillators early and providing after-care.

“Time is an important factor. You may have had chest pain for an hour before the heart stops, and therefore you should call the ambulance quickly.”

Naturally as a doctor at Sahlgrenska University Hospital he saved many lives and hearts, after all it is a part of the deal. Intervening in everyday life is different, as Johan Herlitz has done three times. In two of the cases it went well and the persons survived.

One morning in 1995 Johan was sitting in the commuter train from Lerum on the way to Gothenburg when the staff called for a doctor. One man in his 60s was sitting and gasping for air. At that time mobile phones were unusual, but as luck would have it there was a telephone on-board. Johan Herlitz called SOS, and just as he ended the call the man collapsed.

Together with a paediatrician who was also on-board, they started cardiopulmonary resuscitation. 

When the train arrived at the central station the ambulance was there and took over. They gave electroshocks and the man looked up directly. He recovered completely, and sent Christmas cards to Johan every year.  But they met again eight years later. Johan Herlitz was on cardiac duty at Sahlgrenska University Hospital in Gothenburg, on the way to a patient with prostate cancer.

“Is that you?,” asked the man. 

He was dying. Johan Herlitz was called in to switch off the defibrillator inserted by operation into the man after Johan assisted him that morning on the train.

“I remember everything like yesterday,” says Johan Herlitz about the events he intervened in as a private person. 

“It is a stressful experience, while being able to help is fantastic. You can really change a human being's life,” he says. 

Defibrillator and SMS-lifesaver

The development towards even better care is continuing. Defibrillators are placed at strategic places in society. SMS-lifesavers are tested in Stockholm, thus CPR experts who have voluntarily joined a register. When there is a warning about cardiac arrest the emergency service centre can see which mobile phones are within 500 metres of the affected person, and can contact them.  There is also a national test on alerting rescue services at the same time as the ambulance, which goes out with defibrillators.
“In this way the circle is closed,” says Johan Herlitz.

Text: Lina Färm
Photo: Ciprian Gorga