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Current evidence demonstrates considerable variability in cardiac arrest survival in and out of hospital and, therefore, substantial opportunity to save many more lives.1–3 The Formula for Survival4 postulates that optimal survival from cardiac arrest requires high-quality science, education of lay providers and healthcare professionals, and a well-functioning Chain of Survival5 (implementation). The Education, Implementation, and Teams (EIT) Task Force of the International Liaison Committee on Resuscitation (ILCOR) set out to define the key PICO (population, intervention, comparator, outcome) questions related to resuscitation education (including teamwork skills) and systems-level implementation that would be reviewed by 2015. The selection of questions was supported through the use of an online anonymous task force member–only voting process where the results were considered in the ultimate consensus decisions of the task force. Topics from the 2010 evidence review process were scrutinized for relevance, the potential to improve outcomes, and the likelihood of new evidence being published since 2010. Finally, PICO questions for which the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was not as well developed at the time of PICO selection were deferred until at least after the 2015 cycle. We planned to reduce the total number of PICO questions reviewed to provide more in-depth and evidence-based reviews of the included questions. New topics were determined on the basis of the evolving literature and changes in resuscitation practice. Input on the selection of PICO questions was sought from the general public through the ILCOR website and from ILCOR member resuscitation councils through their council chairs and individual task force members. The EIT Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies6 and using the methodological approach proposed by the …

Introduction: The overall incidence of ventricular tachycardia/ventricular fibrillation (VT/VF) as the first recorded electrical rhythm in out of hospital cardiac arrest (OOHCA) has declined from ~70% to ~25% over the last 30 years. This change has been attributed to primary and secondary prevention of cardiovascular disease and VT/VF. We evaluated whether the incidence of VT/VF as first recorded rhythm differed by location among bystander AED applied patients and EMS witnessed cardiac arrests. Methods: Prospective cohort study of non-traumatic cardiac arrest from December 2005 to April 2007 in the Resuscitation Outcomes Consortium database from 10 US and Canadian sites. The incidence of an initial shockable rhythm on AED or documented VT/VF was compared among bystander applied AED patients and EMS witnessed arrests in public versus private settings. Results: The first rhythm was known in 13,235 of 14,059 (94%) adult EMS-treated cardiac arrests. Of the 13,235 with known rhythms, 3436 (26%) had VT/VF. Among 1115 EMS-witnessed arrests, 61/161 (38%) had VT/VF in public settings and 224/954 (23%) in private settings. Similarly, for bystander AED applied in the private setting 39/114 (34%) were shocked. But, in contrast, 125/159 (79%) (P Conclusions: The incidence of VT/VF is far greater in the public setting particularly for bystander witnessed AED applied arrests. Patients in the private home setting, even for EMS observed arrests, are far less likely to benefit from AED application than bystander witnessed patients in the public setting. CPR strategies may need to be tailored by arrest location.

Background The Utstein elements provide measures for comparing out-of-hospital cardiac arrest (OHCA) care and outcomes within and across communities. Whether these measures sufficiently predict survival and explain variation in outcome is not well studied. Hypotheses Utstein data elements predict survival to hospital discharge but explain only a portion of survival variation. Methods Design Prospective, population-based cohort using uniform data definitions. Setting Ten North American sites participating in the Resuscitation Outcomes Consortium, a prehospital emergency care network. Population Persons ≥ 20 years with OHCA from 12/1/2005 – 11/30/2006 (n=9582). Analyses We used logistic regression to assess association between Utstein elements and survival and to determine whether they accounted for site survival differences. We evaluated measures of residual variance to assess what proportion of outcome variation the Utstein elements predicted. Results Survival was 7.0% overall. Utstein elements were associated with survival (Table ). Relationships were similar when restricted to those with ventricular fibrillation. In analyses assessing variance of residuals, Utstein elements collectively accounted for 15% of variation in survival. Site was also associated with survival, ranging from 3.7% to 15.6%. In multivariable analyses, site association was not attenuated by adjusting for Utstein elements. Conclusion Although Utstein elements predict survival, they account for a modest portion of variation overall and do not explain survival differences across sites. Additional factors should be investigated to understand and potentially improve OHCA outcome.