title: Improved out-of-hospital cardiac arrest survival after the sequential implementation of 2005 AHA guidelines for compressions, ventilations, and induced hypothermia: the Wake County experience.
abstract: OBJECTIVE
  We assess survival from out-of-hospital cardiac arrest after community-wide implementation of 2005 American Heart Association guidelines.
  
  
  METHODS
  This was an observational multiphase before-after cohort in an urban/suburban community (population 840,000) with existing advanced life support. Included were all adults treated for cardiac arrest by emergency responders. Excluded were patients younger than 16 years and trauma patients. Intervention phases in months were baseline 16; phase 1, new cardiopulmonary resuscitation 12; phase 2, impedance threshold device 6; and phase 3, full implementation including out-of-hospital-induced hypothermia 12. Primary outcome was survival to discharge. Other survival and neurologic outcomes were compared between study phases, and adjusted odds ratios with 95% confidence intervals (CIs) for survival by phase were determined by multivariate regression.
  
  
  RESULTS
  One thousand three hundred sixty-five cardiac arrest patients were eligible for inclusion: baseline n=425, phase 1 n=369, phase 2 n=161, phase 3 n=410. Across phases, patients had similar demographic, clinical, and emergency medical services characteristics. Overall and witnessed ventricular fibrillation and ventricular tachycardia survival improved throughout the study phases: respectively, baseline 4.2% and 13.8%, phase 1 7.3% and 23.9%, phase 2 8.1% and 34.6%, and phase 3 11.5% and 40.8%. The absolute increase for overall survival from baseline to full implementation was 7.3% (95% CI 3.7% to 10.9%); witnessed ventricular fibrillation/ventricular tachycardia survival was 27.0% (95% CI 13.6% to 40.4%), representing an additional 25 lives saved annually in this community.
  
  
  CONCLUSIONS
  In the context of a community-wide focus on resuscitation, the sequential implementation of 2005 American Heart Association guidelines for compressions, ventilations, and induced hypothermia significantly improved survival after cardiac arrest. Further study is required to clarify the relative contribution of each intervention to improved survival outcomes.
authors.affiliation: WakeMed Health and Hospitals, Raleigh, NC, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Hinchey
authors.forename: J Brent
authors.initials: JB
authors.lastname: Myers
authors.forename: Ryan
authors.initials: R
authors.lastname: Lewis
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: De Maio
authors.forename: Eric
authors.initials: E
authors.lastname: Reyer
authors.forename: Daniel
authors.initials: D
authors.lastname: Licatese
authors.forename: Joseph
authors.initials: J
authors.lastname: Zalkin
authors.forename: Graham
authors.initials: G
authors.lastname: Snyder
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006336:Heart Massage / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000401:mortality / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000628:therapy; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy