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Cardiac arrest witnessed by prehospital personnel: intersystem variation in initial rhythm as a basis for a proposed extension of the Utstein recommendations.

Abstract：

STUDY OBJECTIVE:To test the hypothesis that intersystem variation in initial rhythm among EMS-witnessed arrests is of sufficient magnitude to warrant standardization of survival by creation of an Utstein-style denominator of EMS-witnessed ventricular fibrillation (VF). METHODS:We conducted a planned subset analysis of a prospective observational cohort study of consecutive EMS-witnessed adult cardiac arrests occurring in New York City and meeting Utstein entry criteria. The primary outcome measure was intersystem variation in frequency of EMS-witnessed VF in New York City compared with that in other EMS systems. Secondary outcome measures were variations in survival after EMS-witnessed VF arrests and overall survival after all EMS-witnessed arrests. RESULTS:Intersystem variation showed a threefold difference in the frequency of EMS-witnessed VF (24% in New York City versus 77% in Scotland; 99% confidence interval [CI] for 53% difference, 43% to 63%; P < 10(-7), a twofold difference in survival after EMS-witnessed VF (25% in NYC versus 48% in King County, WA; 99% CI for 23% difference, 6% to 39%; P < .002), and a fourfold difference in survival after all EMS-witnessed arrests (9% in New York City versus 35% in King County; 99% CI for 26% difference, 18% to 34%; P < 10(-7). CONCLUSION:The marked variation in frequency of initial rhythm in EMS-witnessed arrests suggests that a modified Utstein denominator of EMS-witnessed VF would facilitate more uniform intersystem comparison of survival in this unique cohort. However, even after adjustment for initial rhythm, large residual intersystem survival differences remain unexplained.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Gallagher EJ,Lombardi G,Gennis P

doi

10.1016/s0196-0644(97)70115-x

subject

Has Abstract

pub_date

1997-07-01 00:00:00

pages

76-81

issue

1

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(97)70115-X

journal_volume

30

pub_type

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