title: Advancing resuscitation science.
abstract: OBJECTIVE
  To describe an alternative approach for improving survival of patients with out-of-hospital cardiac arrest (OHCA). The survival of patients with OHCA has been poor and relatively unchanged for decades in spite of recurrent national and international guidelines. Although there are exceptions, many thought and continue to think that any change in the guidelines for cardiopulmonary resuscitation should be based on randomized controlled trials in humans. However, many factors, including the need for informed consent, the marked variability of patients, and the variability of the type and quality of bystander and advanced resuscitation efforts, all make such studies problematic. Thus, potentially life-saving procedures are often withheld for decades, resulting in unnecessary loss of life.
  
  
  RESULTS
  Many improvements in public health conditions have been made using models of continuous quality improvement. When applied to resuscitation science, once baseline data are obtained, changes based on reliable experimental findings are instituted and outcomes measured. This approach has now been shown to result in significant improvement in neurologically intact survival of patients with OHCA.
  
  
  CONCLUSIONS
  Following this model, we found significant improvement in survival of patients with a witnessed OHCA primary cardiac arrest.
authors.affiliation: University of Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona 85724, USA. GAEWY@aol.com
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Ewy
authors.forename: Michael
authors.initials: M
authors.lastname: Kellum
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D047548:Defibrillators; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D058996:Quality Improvement