title: Prehospital cardiac arrest: the impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times.
abstract: OBJECTIVE
  Numerous studies have shown initiation of bystander CPR to significantly improve survival from prehospital cardiac arrest. However, in emergency medical services (EMS) systems with very short response times, bystander CPR has not been shown to impact outcome. The purpose of this study was to determine the effect of bystander CPR on survival from out-of-hospital cardiac arrest in such a system.
  
  
  METHODS
  Prehospital, hospital, and death certificate data from a medium-sized metropolitan area were retrospectively analyzed for adult, nontraumatic cardiac arrest during a 16-month period.
  
  
  RESULTS
  A total of 298 patients met study criteria. One hundred ninety-five arrests (65.4%) were witnessed, and 103 (34.6%) were unwitnessed. Twenty-five witnessed victims (12.8%) were discharged alive, whereas no unwitnessed victims survived (P less than .001). Patients suffering a witnessed episode of ventricular fibrillation/tachycardia (VF/VT) were more likely to survive (21.9%) than were other patients (2.0%, P less than .0001). Among witnessed patients, initiation of bystander CPR was associated with a significant improvement in survival (20.0%) compared with the no-bystander CPR group (9.2%, P less than .05). Bystander CPR was also associated with improved outcome when witnessed patients with successful prehospital resuscitation were evaluated as a group; 18 had bystander CPR, of whom 13 (72.2%) survived compared with only 12 of 38 patients with no bystander CPR (31.6%, P less than .01).
  
  
  CONCLUSIONS
  Our data revealed improved survival rates when bystander CPR was initiated on victims of witnessed cardiac arrest in an EMS system with short response times.
authors.affiliation: Arizona Emergency Medicine Research Center, College of Medicine, Tucson.
authors.forename: D W
authors.initials: DW
authors.lastname: Spaite
authors.forename: T
authors.initials: T
authors.lastname: Hanlon
authors.forename: E A
authors.initials: EA
authors.lastname: Criss
authors.forename: T D
authors.initials: TD
authors.lastname: Valenzuela
authors.forename: A L
authors.initials: AL
authors.lastname: Wright
authors.forename: K T
authors.initials: KT
authors.lastname: Keeley
authors.forename: H W
authors.initials: HW
authors.lastname: Meislin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards*; D005069:Evaluation Studies as Topic; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012151:Resuscitation / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014505:Urban Population