Survival unchanged five months after implementing the 2005 AHA CPR and ECC guidelines for out-of-hospital cardiac arrest.

2686: Survival Unchanged Five Months After Implementing The 2005 AHA CPR And ECC Guidelines For Out-ofhospital Cardiac Arrest Blair L Bigham; Kent Koprowicz; Alex Kiss; Paul Dorian; Scott Emerson; Cathy Zhan; Thomas D Rea; Tom P Aufderheide; Judy Powell; Sheldon Cheskes; Daniel P Davis; John A Stouffer; Jeff Perry; Martin Lees; Laurie J Morrison 1 Univ of Toronto, Toronto, Canada 2 Univ of Washington, Seattle, WA 3 Univ of Toronto, Toronto, Canada 4 Univ of Washington, Seattle, WA 5 Univ of Toronto, Toronto, Canada 6 Univ of Washington, Seattle, WA 7 Med College of Wisconsin, Milwaukee, WI 8 Univ of Washington, Seattle, WA 9 Sunnybrook Osler Cntr for PreHosp Care, Toronto, Canada 10 Univ of California San Diego, San Diego, CA 11 Gresham Fire and Emergency Services, Gresham, OR 12 Univ of Ottawa, Ottawa, Canada 13 Bluewater Healthq, Sarnia, Canada 14 Univ of Toronto, Toronto, Canada Introduction: To improve survival from out of hospital cardiac arrest (OHCA), the American Heart Association released guidelines in 2005. We examined the effect of these guidelines on survival in the Resuscitation Outcomes Consortium (ROC) Epistry Cardiac Arrest. We hypothesized that survival would increase after guideline implementation. Institution: UNIV WASHINGTON | Sign In via User Name/Password Methods: 174 EMS agencies from 8 of 10 ROC sites were surveyed to determine 2005 AHA guideline implementation, or crossover, date. Two sites with 2005 compatible treatment algorithms prior to guideline release were not included. Patients with OHCA secondary to a non cardiac cause, EMS witnessed events, patients <18 years old, and patients with do-not-resuscitate orders were excluded. A linear mixed effects model was applied for survival controlling for time and agency. The "crossover" date was added to the model to determine the effect of the 2005 guidelines. Results: Of 174 agencies, 83 contributed cases to both cohorts during the 18 month period between 2005/12/01 and 2007/05/31. Of 7403 cases, 4897 occurred during the 13 month (median) interval before crossover and 2506 occurred in the 5 month (median) interval after crossover. The overall survival rate was 5.9%. Our model estimated an overall increase in survival over time (monthly OR 1.02, 95% CI 0.99, 1.04, p=0.23), a decrease in survival at crossover (OR 0.92, 95% CI 0.66, 1.26, p=0.59), and a further increase in survival over time after crossover (monthly OR 1.005, 95% CI 0.96, 1.05, p=0.84). Conclusion: This study found a trend towards increased survival over time and no statistically significant effect of the 2005 guidelines early after implementation. This observed increase in survival over time may be attributed to the Hawthorne effect or participation in ROC or improved quality assurance. A delay in knowledge and skill acquisition amongst EMS providers and the need to rechoreograph their cardiac arrest treatment may explain why no significant increase in survival was observed after implementation. EMS providers may require more time to gain proficiency in the guideline changes before the full potential of the guidelines can be realized. Further longitudinal study is needed to determine the full impact of the guidelines on survival. This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Bigham, B. L Articles by Morrison, L. J PubMed Articles by Bigham, B. L Articles by Morrison, L. J