title: Survival from prehospital cardiac arrest is critically dependent upon response time.
abstract: OBJECTIVE
  This study correlated the delay in initiation of bystander cardiopulmonary resuscitation (ByCPR), basic (BLS) or advanced cardiac (ACLS) life support, and transport time (TT) to survival from prehospital cardiac arrest. This was a secondary endpoint in a study primarily evaluating the effect of bicarbonate on survival.
  
  
  METHODS
  Prospective multicenter trial.
  
  
  METHODS
  Patients treated by urban, suburban, and rural emergency medical services (EMS) services.
  
  
  METHODS
  Eight hundred and seventy-four prehospital cardiac arrest patients.
  
  
  METHODS
  This group underwent conventional ACLS intervention followed by empiric early administration of sodium bicarbonate noting resuscitation times. Survival was measured as the presence of vital signs on emergency department (ED) arrival. Data analysis utilized Student's t-test and logistic regression (p<0.05).
  
  
  RESULTS
  Survival was improved with decreased time to BLS (5.52 min versus 6.81 min, p=0.047) and ACLS (7.29 min versus 9.49 min, p=0.002) intervention, as well as difference in time to return of spontaneous circulation (ROSC). The upper limit time interval after which no patient survived was 30 min for ACLS time, and 90 min for transport time. There was no overall difference in survival except at longer arrest times when considering the primary study intervention bicarbonate administration.
  
  
  CONCLUSIONS
  Delay to the initiation of BLS and ACLS intervention influenced outcome from prehospital cardiac arrest negatively. There were no survivors after prolonged delay in initiation of ACLS of 30 min or greater or total resuscitation and transport time of 90 min. This result was not influenced by giving bicarbonate, the primary study intervention, except at longer arrest times.
authors.affiliation: University of Pittsburgh Medical Center Northwest, 100 Fairfield Drive, Seneca, PA 16346, USA. rbvmd@comcast.net
authors.forename: Rade B
authors.initials: RB
authors.lastname: Vukmir
mesh_terms: D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods*; D006323:Heart Arrest / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D015996:Survival Rate; D013997:Time Factors
chemical_list: D017693:Sodium Bicarbonate