title: Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Three million people in Sweden are trained in cardiopulmonary resuscitation (CPR). Whether this training increases the frequency of bystander CPR or the survival rate among persons who have out-of-hospital cardiac arrests has been questioned.
  
  
  METHODS
  We analyzed a total of 30,381 out-of-hospital cardiac arrests witnessed in Sweden from January 1, 1990, through December 31, 2011, to determine whether CPR was performed before the arrival of emergency medical services (EMS) and whether early CPR was correlated with survival.
  
  
  RESULTS
  CPR was performed before the arrival of EMS in 15,512 cases (51.1%) and was not performed before the arrival of EMS in 14,869 cases (48.9%). The 30-day survival rate was 10.5% when CPR was performed before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (P<0.001). When adjustment was made for a propensity score (which included the variables of age, sex, location of cardiac arrest, cause of cardiac arrest, initial cardiac rhythm, EMS response time, time from collapse to call for EMS, and year of event), CPR before the arrival of EMS was associated with an increased 30-day survival rate (odds ratio, 2.15; 95% confidence interval, 1.88 to 2.45). When the time to defibrillation in patients who were found to be in ventricular fibrillation was included in the propensity score, the results were similar. The positive correlation between early CPR and survival rate remained stable over the course of the study period. An association was also observed between the time from collapse to the start of CPR and the 30-day survival rate.
  
  
  CONCLUSIONS
  CPR performed before EMS arrival was associated with a 30-day survival rate after an out-of-hospital cardiac arrest that was more than twice as high as that associated with no CPR before EMS arrival. (Funded by the Laerdal Foundation for Acute Medicine and others.).
authors.affiliation: From the Center for Resuscitation Science, Solna (I.H.-A., G.R., J. Hollenberg, P.N., M. Ringh, M.J., L.S.), and the Department of Clinical Sciences, Section of Cardiology, Danderyd Hospital, Danderyd (M. Rosenqvist), Karolinska Institutet, Stockholm, the Center for Pre-Hospital Research in Western Sweden (J. Herlitz) and the School of Health Sciences (C.A.), University of Borås, Borås, and Sahlgrenska University Hospital (J. Herlitz), the Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital (J.L.), and the Center for Applied Biostatistics, Sahlgrenska Academy at the University of Gothenburg (T.K.), Gothenberg - all in Sweden.
authors.forename: Ingela
authors.initials: I
authors.lastname: Hasselqvist-Ax
authors.forename: Gabriel
authors.initials: G
authors.lastname: Riva
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.forename: Jacob
authors.initials: J
authors.lastname: Hollenberg
authors.forename: Per
authors.initials: P
authors.lastname: Nordberg
authors.forename: Mattias
authors.initials: M
authors.lastname: Ringh
authors.forename: Martin
authors.initials: M
authors.lastname: Jonsson
authors.forename: Christer
authors.initials: C
authors.lastname: Axelsson
authors.forename: Jonny
authors.initials: J
authors.lastname: Lindqvist
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D057216:Propensity Score; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D017216:Telemedicine; D013689:Telephone; D061665:Time-to-Treatment