title: The formula for survival in resuscitation.
abstract: The International Liaison Committee on Resuscitation (ILCOR) Advisory Statement on Education and Resuscitation in 2003 included a hypothetical formula--'the formula for survival' (FfS)--whereby three interactive factors, guideline quality (science), efficient education of patient caregivers (education) and a well-functioning chain of survival at a local level (local implementation), form multiplicands in determining survival from resuscitation. In May 2006, a symposium was held to discuss the validity of the formula for survival hypothesis and to investigate the influence of each of the multiplicands on survival. This commentary combines the output from this symposium with an updated illustration of the three multiplicands in the FfS using rapid response systems (RRS) for medical science, therapeutic hypothermia (TH) for local implementation, and bystander cardiopulmonary resuscitation (CPR) for educational efficiency. International differences between hospital systems made it difficult to assign a precise value for the multiplicand medical science using RRS as an example. Using bystander CPR as an example for the multiplicand educational efficiency, it was also difficult to provide a precise value, mainly because of differences between compression-only and standard CPR. The local implementation multiplicand (exemplified by therapeutic hypothermia) is probably the easiest to improve, and is likely to have the most immediate improvement in observed survival outcome in most systems of care. Despite the noted weaknesses, we believe that the FfS will be useful as a mental framework when trying to improve resuscitation outcome in communities worldwide.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway. Electronic address: eldar.soreide@sus.no.
authors.forename: Eldar
authors.initials: E
authors.lastname: Søreide
authors.forename: Laurie
authors.initials: L
authors.lastname: Morrison
authors.forename: Ken
authors.initials: K
authors.lastname: Hillman
authors.forename: Koen
authors.initials: K
authors.lastname: Monsieurs
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sunde
authors.forename: David
authors.initials: D
authors.lastname: Zideman
authors.forename: Mickey
authors.initials: M
authors.lastname: Eisenberg
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Soar
authors.forename: Jerry P
authors.initials: JP
authors.lastname: Nolan
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D011361:Professional Competence; D012307:Risk Factors; D016019:Survival Analysis
keywords: Cardiac arrest; Formula for survival; Implementation; Outcome