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Abstract: Objective: Many of the factors that affect survival from out-of-hospital cardiac arrest are not relevant in patients who arrest after arrival of emergency medical services (EMS). Because all arrests that occur after arrival of EMS are witnessed and care is immediate, one might expect survival to be very high. Several studies have described communities’ experiences of arrest after arrival but few have compared survival rates stratified by rhythm and witness status. The purpose of this paper was to describe the characteristics of patients who arrested after arrival of EMS and to compare survival in this population to those who had witnessed and unwitnessed arrests before EMS arrival. Methods: We conducted a retrospective cohort study in King County, WA, USA. Descriptive statistics were calculated in patients whose arrests were not witnessed, in patients whose arrests were witnessed by citizens, and in those whose arrests were witnessed by EMS personnel. Results: The majority of bystander- and EMS-witnessed arrests were initially in ventricular fibrillation (VF), but EMS-witnessed arrests were more likely to initially have been in pulseless electrical activity (PEA) than bystander-witnessed events. Patients whose arrests were witnessed by EMS had the greatest likelihood of survival compared to patients whose arrests were not witnessed or were witnessed by bystanders. Patients whose arrests were witnessed by EMS and were initially in VF had the highest rates of survival (59%). Conclusions: Patients whose arrests were witnessed by EMS were more likely to have survived their cardiac arrests than those who arrested before EMS arrived. We suggest that survival rates from VF arrests that occur after EMS arrival should be widely reported in order to measure overall EMS performance since many factors such as response times, bystander actions, and witness status are equalized in this subset of patients. [Copyright &y& Elsevier]

Abstract: We initiated a program of telephone CPR (cardiopulmonary resuscitation) instruction provided by emergency dispatchers to increase the percentage of bystander-initiated CPR for out-of-hospital cardiac arrest. Cardiac arrests in King County. Washington were studied for 20 months before and after the telephone CPR program began. Bystander-initiated CPR increased from 86 of 191 (45 per ¢) cardiac arrests before the program to 143 of 255 (56 percent) cardiac arrests after the program. During the after period, 58 patients received CPR as a result of telephone instruction, 12 of whom were discharged. We estimate that tour lives may have been saved by the program. A review of hospital records revealed no excess morbidity in the group of patients receiving dispatcher-assisted CPR. [ABSTRACT FROM AUTHOR]