title: Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support.
abstract: BACKGROUND
  Survival rates for out-of-hospital cardiac arrest are low; published survival rates in Ontario are only 2.5%. This study represents phase II of the Ontario Prehospital Advanced Life Support (OPALS) study, which is designed to systematically evaluate the effectiveness and efficiency of various prehospital interventions for patients with cardiac arrest, trauma, and critical illnesses.
  
  
  OBJECTIVE
  To assess the impact on out-of-hospital cardiac arrest survival of the implementation of a rapid defibrillation program in a large multicenter emergency medical services (EMS) system with existing basic life support and defibrillation (BLS-D) level of care.
  
  
  METHODS
  Controlled clinical trial comparing survival for 36 months before (phase I) and 12 months after (phase II) system optimization.
  
  
  METHODS
  Nineteen urban and suburban Ontario communities (populations ranging from 16 000 to 750 000 [total, 2.7 million]).
  
  
  METHODS
  All patients who had out-of-hospital cardiac arrest in the study communities for whom resuscitation was attempted by emergency responders.
  
  
  METHODS
  Study communities optimized their EMS systems to achieve the target response interval from when a call was received until a vehicle stopped with a defibrillator of 8 minutes or less for 90% of cardiac arrest cases. Working both locally and provincially, communities implemented multiple measures, including defibrillation by firefighters, base paging, tiered response agreements with fire departments, continuous quality improvement for response intervals, and province-wide revision and implementation of standard dispatch policies. All response times were obtained from a central dispatch system.
  
  
  METHODS
  Survival to hospital discharge.
  
  
  RESULTS
  The 4690 cardiac arrest patients studied in phase I and the 1641 in phase II were similar for all clinical and demographic characteristics, including age, sex, witnessed status, rhythm, and receipt of bystander cardiopulmonary resuscitation. The proportion of cases meeting the 8-minute response criterion improved (76.7% vs 92.5%; P<.001) as did most median response intervals. Overall survival to hospital discharge for all rhythm groups combined improved from 3.9% to 5.2 % (P = .03). The 33% relative increase in survival represents an additional 21 lives saved each year in the study communities (approximately 1 life per 120000 residents). The charges were estimated to be US $46900 per life saved for establishing the rapid defibrillation program and US $2400 per life saved annually for maintaining the program.
  
  
  CONCLUSIONS
  An inexpensive, multifaceted system optimization approach to rapid defibrillation can lead to significant improvements in survival after cardiac arrest in a large BLS-D EMS system.
authors: Division of Emergency Medicine, University of Ottawa, Ontario, Canada.
authors: I G
authors: IG
authors: Stiell
authors: G A
authors: GA
authors: Wells
authors: B J
authors: BJ
authors: Field
authors: D W
authors: DW
authors: Spaite
authors: V J
authors: VJ
authors: De Maio
authors: R
authors: R
authors: Ward
authors: D P
authors: DP
authors: Munkley
authors: M B
authors: MB
authors: Lyver
authors: L G
authors: LG
authors: Luinstra
authors: T
authors: T
authors: Campeau
authors: J
authors: J
authors: Maloney
authors: E
authors: E
authors: Dagnone
mesh_terms: D000368:Aged; D000552:Ambulances; D004554:Electric Countershock / Q000191:economics / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015397:Program Evaluation; D018709:Statistics, Nonparametric; D016019:Survival Analysis