title: Are new resuscitation guidelines better? Experience of an Asian metropolitan hospital.
abstract: BACKGROUND
  Cardiopulmonary resuscitation (CPR) guidelines were revised in 2005 based on new evidence and expert consensus. However, the benefits of the new guidelines remain undetermined and their influence has not been published in Asia. This study aimed to evaluate the impact of implementing the new resuscitation guidelines and identify factors that influence the discharge survival of out-of-hospital cardiac arrest (OHCA) patients in an Asian metropolitan city.
  
  
  METHODS
  This was an observational cohort study of all OHCA patients seen by the emergency medical service during the period before (Nov 2003 to Oct 2005) and after (May 2006 to Oct 2008) implementing the new resuscitation guidelines. Detailed clinical information was recorded using the Ustein style template. Statistical analysis was done using X2 test or t-test for univariate analysis and the logistic regression model for multivariate analysis.
  
  
  RESULTS
  There were 463 patients before and 430 patients after the new guidelines who received resuscitation. The rate of recovery of spontaneous circulation (ROSC), survival-to-intensive care unit (ICU) admission, and survival-to-hospital discharge all showed no benefits regarding the new resuscitation guidelines (ROSC: 42% vs 39%, P = 0.32; Survival-to-ICU admission: 33% vs 30%, P = 0.27; survival-to-hospital discharge: 10% vs 7%, P = 0.09). The rate of ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT), rate of witnessed arrest, and rate of bystander CPR were much lower than in Western studies. After multivariate logistic regression, factors related to discharge survival were witnessed arrest and initial rhythm with VF/pulseless VT. The new resuscitation guidelines did not significantly influence the discharge survival.
  
  
  CONCLUSIONS
  We did not observe any improvement in survival after implementing the new guidelines. Independent factors of survival-to-hospital discharge are witnessed arrest and initial rhythm with VF/pulseless VT. Because the rates of VF/pulseless VT and bystander CPR in Asia are low, popularising CPR training programmes and increasing the rate of bystander CPR may be more important for improving OHCA survival rates than frequent guideline changes.
authors.affiliation: Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Shih Wen
authors.initials: SW
authors.lastname: Hung
authors.forename: Chien Chih
authors.initials: CC
authors.lastname: Chen
authors.forename: Hsin Chin
authors.initials: HC
authors.lastname: Shih
authors.forename: Chang Feng
authors.initials: CF
authors.lastname: Huang
authors.forename: Kuo Chih
authors.initials: KC
authors.lastname: Chen
authors.forename: Chee Fah
authors.initials: CF
authors.lastname: Chong
authors.forename: Tzong Luen
authors.initials: TL
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology