title: Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients.
abstract: OBJECTIVE
  The impact of prehospital care after the return of spontaneous circulation in out-of-hospital cardiac arrest patients is not known. This study describes adherence to the resuscitation guidelines, factors associated with poor adherence and possible impact of prehospital postresuscitation care on the outcome of out-of-hospital cardiac arrest.
  
  
  METHODS
  One hundred and fifty-seven Finnish out-of-hospital cardiac arrest patients hospitalized during 1 year, were analyzed retrospectively. Patient and arrest characteristics, prehospital postresuscitation care and survival to hospital discharge were analyzed using multivariate logistic regression.
  
  
  RESULTS
  Forty percent of the patients received care accordant with the guidelines. Male sex (P=0.045), witnessed arrest (P=0.031), initial ventricular fibrillation/ventricular tachycardia rhythm (P=0.007) and the presence of an emergency physician (P=0.017) were associated with care in line with the current guidelines. In multivariate logistic regression analysis, age over median (odds ratio=3.6, 95% confidence interval 1.5-8.6), nonventricular fibrillation/ventricular tachycardia initial rhythm (odds ratio=4.0, 95% confidence interval 1.6-9.8), administration of adrenaline (odds ratio=7.0, 95% confidence interval 2.3-21.4) and unsatisfactory prehospital postresuscitation care (odds ratio=2.5, 95% confidence interval 1.1-6.3) were associated with a failure to survive up to hospital discharge.
  
  
  CONCLUSIONS
  Less than 50% of out-of-hospital cardiac arrest patients received prehospital postresuscitation care compatible with the current guidelines. Markers of poor prognosis were associated with unsatisfactory care, which in turn was more frequent among the patients who did not survive to hospital discharge. The importance of the guidelines should be highlighted in the future.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, 00029 HUS, Helsinki, Finland. Hetti.Kirves@hus.fi
authors.forename: Hetti
authors.initials: H
authors.lastname: Kirves
authors.forename: Markus B
authors.initials: MB
authors.lastname: Skrifvars
authors.forename: Marko
authors.initials: M
authors.lastname: Vähäkuopus
authors.forename: Kaj
authors.initials: K
authors.lastname: Ekström
authors.forename: Matti
authors.initials: M
authors.lastname: Martikainen
authors.forename: Maaret
authors.initials: M
authors.lastname: Castren
mesh_terms: D000368:Aged; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005387:Finland; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012151:Resuscitation