title: Cardiac arrest survival did not increase in the Resuscitation Outcomes Consortium after implementation of the 2005 AHA CPR and ECC guidelines.
abstract: BACKGROUND
  We examined the effect of the 2005 American Heart Association guidelines on survival in the Resuscitation Outcomes Consortium (ROC) Cardiac Arrest Epistry.
  
  
  METHODS
  We surveyed 174 EMS agencies from 8 of 10 ROC sites to determine 2005 AHA guideline implementation, or crossover, date. Two sites with 2005 compatible treatment algorithms prior to guideline release, and agencies that did not adopt the new guidelines during the study period were excluded. Non-traumatic adult cardiac arrests that were not witnessed by EMS, and did not have do not resuscitate orders were included. A linear mixed effects model was applied for survival controlling for time and agency. The "crossover" date was added to the model to determine the effect of the 2005 guidelines.
  
  
  RESULTS
  Of 174 agencies, 85 contributed cases to both cohorts during the 18 month period between 2005/12/01 and 2007/05/31. Of 7779 cases, 5054 occurred during the 13 month (median) interval before crossover and 2725 occurred in the five month (median) interval after crossover. The overall survival rate was 6.1%; 5.8% in the old cohort vs. 6.5%, p=0.23. For VF/VT patients, survival was 14.6% vs. 18.0%, p=0.063. Our model estimated no increase in survival over time (monthly OR 1.014, 95% CI 0.988, 1.041, p=0.28).
  
  
  CONCLUSIONS
  This study found no significant change in survival rate over time in the early months after implementation. Further longitudinal study is needed to determine the full impact of the guidelines on survival and methods to translate knowledge quickly and effectively in EMS.
authors.affiliation: Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B1W8, Canada. bighamb@smh.ca
authors.forename: Blair L
authors.initials: BL
authors.lastname: Bigham
authors.forename: Kent
authors.initials: K
authors.lastname: Koprowicz
authors.forename: Tom
authors.initials: T
authors.lastname: Rea
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
authors.forename: Judy
authors.initials: J
authors.lastname: Powell
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000368:Aged; D000465:Algorithms; D000572:American Heart Association; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004059:Diffusion of Innovation; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology