scholarly journals LO72: Implementation of an educational program to improve the cardiac arrest diagnostic accuracy of ambulance communication officers: a concurrent control before-after study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S52-S53
Author(s):  
C. Vaillancourt ◽  
A. Kasaboski ◽  
M. Charette ◽  
L. Calder ◽  
L. Boyle ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Educational Program ◽  
Survival Rates ◽  
Control Site ◽  
Chi Square ◽  
Concurrent Control ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Most ambulance communication officers receive minimal education on agonal breathing, often leading to unrecognized out-of-hospital cardiac arrest (OHCA). We sought to evaluate the impact of an educational program on cardiac arrest recognition, and on bystander CPR and survival rates. Methods: Ambulance communication officers in Ottawa, Canada received additional training on agonal breathing, while the control site (Windsor, Canada) did not. Sites were compared to their pre-study performance (before-after design), and to each other (concurrent control). Trained investigators used a piloted-standardized data collection tool when reviewing the recordings for all potential OHCA cases submitted. OHCA was confirmed using our local OHCA registry, and we requested 9-1-1 recordings for OHCA cases not initially suspected. Two independent investigators reviewed medical records for non-OHCA cases receiving telephone-assisted CPR in Ottawa. We present descriptive and chi-square statistics. Results: There were 988 confirmed and suspected OHCA in the “before” (540 Ottawa; 448 Windsor), and 1,076 in the “after” group (689 Ottawa; 387 Windsor). Characteristics of “after” group OHCA patients were: mean age (68.1 Ottawa, 68.2 Windsor); Male (68.5% Ottawa, 64.8% Windsor); witnessed (45.0% Ottawa, 41.9% Windsor); and initial rhythm VF/VT (Ottawa 28.9, Windsor 22.5%). Before-after comparisons were: for cardiac arrest recognition (from 65.4% to 71.9% in Ottawa p=0.03; from 70.9% to 74.1% in Windsor p=0.37); for bystander CPR rates (from 23.0% to 35.9% in Ottawa p=0.0001; from 28.2% to 39.4% in Windsor p=0.001); and for survival to hospital discharge (from 4.1% to 12.5% in Ottawa p=0.001; from 3.9% to 6.9% in Windsor p=0.03). “After” group comparisons between Ottawa and Windsor (control) were not statistically different, except survival (p=0.02). Agonal breathing was common (25.6% Ottawa, 22.4% Windsor) and present in 18.5% of missed cases (15.8% Ottawa, 22.2% Windsor p=0.27). In Ottawa, 31 patients not in OHCA received chest compressions resulting from telephone-assisted CPR instructions. None suffered injury or adverse effects. Conclusion: While all OHCA outcomes improved over time, the educational intervention significantly improved OHCA recognition in Ottawa, and appeared to mitigate the impact of agonal breathing.

scholarly journals Multi-centre implementation of an Educational program to improve the Cardiac Arrest diagnostic accuracy of ambulance Telecommunicators and survival outcomes for sudden cardiac arrest victims: the EduCATe study design and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christian Vaillancourt ◽  
Manya Charette ◽  
Sarika Naidoo ◽  
Monica Taljaard ◽  
Matthew Church ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Educational Program ◽  
Survival Rates ◽  
Sudden Cardiac Arrest ◽  
Interrupted Time Series ◽  
National Study ◽  
Before And After ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Abstract Background Sudden cardiac death remains a leading cause of mortality in Canada, resulting in more than 35,000 deaths annually. Most cardiac arrest victims collapse in their own home (85% of the time) and 50% are witnessed by a family member or bystander. Survivors have a quality of life similar to the general population, but the overall survival rate for out-of-hospital cardiac arrest (OHCA) rarely exceeds 8%. Victims are almost four times more likely to survive when receiving bystander CPR, but bystander CPR rates have remained low in Canada over the past decade, not exceeding 15–25% until recently. Telecommunication-assisted CPR instructions have been shown to significantly increase bystander CPR rates, but agonal breathing may be misinterpreted as a sign of life by 9–1-1 callers and telecommunicators, and is responsible for as much as 50% of missed OHCA diagnoses. We sought to improve the ability and speed with which ambulance telecommunicators can recognize OHCA over the phone, initiate timely CPR instructions, and improve survival. Methods In this multi-center national study, we will implement and evaluate an educational program developed for ambulance telecommunicators using a multiple baseline interrupted time-series design. We will compare outcomes 12 months before and after the implementation of a 20-min theory-based educational video addressing barriers to recognition of OHCA while in the presence of agonal breathing. Participating Canadian sites demonstrated prior ability to collect standardized data on OHCA. Data will be collected from eligible 9–1-1 recordings, paramedic documentation and hospital medical records. Eligible cases will include suspected or confirmed OHCA of presumed cardiac origin in patients of any age with attempted resuscitation. Discussion The ability of telecommunication-assisted CPR instructions to improve bystander CPR and survival rates for OHCA victims is undeniable. The ability of telecommunicators to recognize OHCA over the phone is unequivocally impeded by relative lack of training on agonal breathing, and reluctance to initiate CPR instructions when in doubt. Our pilot data suggests the potential impact of this project will be to increase absolute OHCA recognition and bystander CPR rates by at least 10%, and absolute out-of-hospital cardiac arrest survival by 5% or more. Trial registration Prospectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059.

scholarly journals 60. The Impact of AEDs on Cardiac Survival in an Urban Out-of-Hospital Setting

1996 ◽  
Vol 11 (S2) ◽  
pp. S45-S45
Author(s):  
Harinder S. Dhindsa ◽  
Dennis Fitzgerald ◽  
David Milzman ◽  
Robert R. Bass
Keyword(s):  
Survival Rate ◽  
Response Times ◽  
Survival Rates ◽  
Hospital Setting ◽  
Chi Square ◽  
Bystander Cpr ◽  
Student’S T ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Introduction: Prior studies have documented less than 3% survival for out-of-hospital cardiac arrest (CA) in D.C. EMS intubation has failed to improve extremely poor survival rates for out of hospital CA. This study will investigate whether the addition of automatic external defibrillator (AED) use will improve the negligible survival rate experienced in a system that transports 80,000 pts/yr; Thus replicating success with AED for CA in other centers.Methods: Retrospective review of all CA data from D.C. EMS system from 1-12/91 (no AED) vs. 1-12/93 (AED in use). Supporting data from run sheets and hospital records was compared for years with and without the AED using student's t test, chi-square with p <0.05.Results: In 1991 there were 414 out of hospital CAs arrests with an overall survival rate of 2.3% with a mean EMS arrival time of 10 minutes. There were no significant differences with respect to CA patients’ age, bystander CPR or BLS/ALS response times between two years (1991 and 1993) p = NS. In VF patients who comprised 26% and 24% of presenting rhythms for ’91 and ’93 respectively, the use of AEDs improved survival 3.8% vs. 29% with AEDs in ’93 (p <0.05). There was no difference in percentage of non-VF presenting rhythms or patient outcomes between the two groups.

Abstract 184: AED Application in Non-Shockable Out-of-Hospital Cardiac Arrest Does Not Reduce Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ross A Pollack ◽  
Siobhan P Brown ◽  
Thomas Rea ◽  
Peter J Kudenchuk ◽  
Myron L Weisfeldt
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
Patient Characteristics ◽  
Neurological Status ◽  
Relative Safety ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Rhythm Analysis ◽  
In Transit ◽  
Hospital Cardiac Arrest

Introduction: It is well established that AEDs improve outcome in shockable out-of-hospital cardiac arrest (OHCA). An increasing proportion (now the majority) of OHCAs present with non-shockable rhythms. Survival from non-shockable OHCA depends on high-quality CPR in transit to definitive care. Studies of AED use in non-shockable in-hospital arrest (as opposed to OHCA) have shown reduced survival with AED application possibly due to CPR interruptions to apply pads and perform rhythm analysis. We sought to determine whether AED application in non-shockable public, witnessed OHCA has a significant association with survival to discharge. Methods: This is a retrospective analysis of OHCA from 2010-2015 at 10 Resuscitation Outcomes Consortium centers. All adult, public, witnessed non-shockable OHCAs were included. Non-shockable arrest was defined as no shock delivered by the AED or by review of defibrillator tracings (10%). The initial rhythm on EMS arrival was used to confirm the rhythm. The primary outcome was survival to hospital discharge with favorable neurological status (modified rankin score <3). The OR was adjusted for the Utstein variables. Results: During the study period there were 1,597 non-shockable public, witnessed OHCA, 9.8% of which had an AED applied. The initial rhythm on EMS arrival was PEA or asystole in 86% of cases. Significantly more OHCA in the AED applied group had CPR performed. 6.5% of those without an AED applied survived with favorable neurologic status compared to 9% with an AED. After adjustment for the Utstein variables including bystander CPR, the aOR for survival with favorable neurologic outcome was 1.38 (95% CI:0.72-2.65). Conclusion: After adjusting for patient characteristics and bystander CPR, the application of an AED in non-shockable public witnessed OHCA had no significant association with survival or neurological outcome supporting the relative safety and potential benefit of AED application in non-shockable OHCA.

Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Markus Keferböck ◽  
Philip Datler ◽  
Mario Krammel ◽  
Elisabeth Lobmeyer ◽  
Alexander Nürnberger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Sudden Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Medical Personnel ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michael J Jacobs ◽  
Leo S Derevin ◽  
Sue Duval ◽  
James E Pointer ◽  
Karl A Sporer
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Neurological Function ◽  
Inverse Association ◽  
Advanced Airway ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

scholarly journals The impact of increased chest compression fraction on survival for out-of-hospital cardiac arrest patients with a non-shockable initial rhythm

Resuscitation ◽  
2020 ◽  
Vol 154 ◽  
pp. 93-100
Author(s):  
Christian Vaillancourt ◽  
Ashley Petersen ◽  
Eric N. Meier ◽  
Jim Christenson ◽  
James J. Menegazzi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Initial Rhythm ◽  
The Impact ◽  
Hospital Cardiac Arrest

P4169The crucial role of the bystander in out-of-hospital cardiac arrest resuscitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Campos ◽  
V Baert ◽  
H Hubert ◽  
E Wiel ◽  
N Benameur
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Survival Data ◽  
Health Concern ◽  
Propensity Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France. Purpose Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA. Methods 24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time). Results CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p<0.001). CPR performed by bystanders was associated with an increased 30-day survival rate (odds ratio 1.269; 1.207 to 1.334). The effect of bystander CPR on survival Conclusion Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.

Abstract 110: The Association Between the Timing of Epinephrine (Adrenalin) Administration and Survival from Out-of-Hospital Ventricular Fibrillation Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Gordon A Ewy ◽  
Bentley J Bobrow ◽  
Vatsal Chikani ◽  
Arthur B Sanders ◽  
Charles W Otto ◽  
...  
Keyword(s):  
Time Intervals ◽  
Chi Square ◽  
Epinephrine Administration ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
The Times ◽  
Improvement In Survival ◽  
Hospital Cardiac Arrest ◽  
Retrospective Database

Introduction: The benefit of epinephrine administration by emergency medical services providers (EMS) during resuscitation of patients with out-of-hospital-cardiac arrest (OHCA) is controversial. To address the association of the timing of epinephrine administration and outcome, we accessed the Save Hearts in Arizona Register and Educational (SHARE) program registry, and analyzed the time between 9-1-1 dispatches, the first dose of epinephrine and survival to hospital discharge. Methods: A retrospective analysis of prospectively collected statewide OHCA data using the SHARE database between October 2004 and December 2013. Results: There were 2,213 OHCA with a shockable initial rhythm who received epinephrine by EMS. Logistic regression was performed adjusted for age, gender, witnessed, bystander CPR, arrival time (dispatch to scene), and dispatch to defibrillation time, year, and method of ventilation. Of these, 396 (17.8%) survived to discharge. The times from dispatch to first epinephrine administration were analyzed. Survival progressively decreased with longer time intervals of epinephrine administration: Survival, < 9 min (99/398) 24.8%, 9-13 min (216/1,058) 20.4% and >13 min (81/757) 10.7%. The Adjusted odds ratio for decreased survival for the group receiving epinephrine after 13 minutes was 2.32 (95% CI 1.5-3.4) (p<0.0001). The neurological CPC Scores of the 242 survivors was also related to time delay of epinephrine administration: CPC 1 or 2 were; < 9 min 69 (17.3%), 9-13 min 132 (12.4%), >13 min 47 (6.2%). Survival was significantly less in those receiving epinephrine >13 min after EMS arrival (Chi Square p<0.0001). Conclusion: In this retrospective database analysis, epinephrine administered by EMS to patients with OHCA and a shockable rhythm in <13 min from dispatch was associated with significant improvement in survival compared to epinephrine administered >13 min after dispatch.

Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristian Kragholm ◽  
Monique Anderson ◽  
Carolina Malta Hansen ◽  
Phillip J. Schulte ◽  
Michael C. Kurz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Significant Survival ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

Out-of-Hospital Cardiac Arrest—Review of Demographics in South Australia to Inform Decisions about the Provision of Automatic External Defibrillators within the Community

2010 ◽  
Vol 25 (6) ◽  
pp. 521-526 ◽  
Author(s):  
Kathryn Zeitz ◽  
Hugh Grantham ◽  
Robert Elliot ◽  
Chris Zeitz
Keyword(s):  
Cardiac Arrest ◽  
South Australia ◽  
Mean Value ◽  
Public Access ◽  
Ambulance Service ◽  
Case Review ◽  
Retrospective Case ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

AbstractIntroduction:Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear.Methods:A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded.Results:A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%.During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes.Conclusions:This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.

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