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The survival rate from out-of-hospital cardiac arrest has remained essentially unchanged in the United States for the past several decades, hovering in the 7% to 10% range overall.1 In communities with more frequent bystander performance of cardiopulmonary resuscitation (CPR), short emergency medical services response times, and hospitalbased hypothermia, there is significantly better survival, particularly for patients whose cardiac arrests are witnessed and in those for whom ventricular tachycardia or ventricular fibrillation is the first recorded rhythm.2 Unfortunately, among the many randomized trials in resuscitation from cardiac arrest, few demonstrate improved survival to the point of hospital discharge.3 In-hospital hypothermia and use of an automated external defibrillator by a bystander are 2 of the few interventions shown to improve survival.4–6 Examples of prehospital interventions that failed to demonstrate improved survival to hospital discharge in clinical trials include antiarrhythmic and vasoactive drugs, as well as agents intended to provide cerebral protection or improved metabolism. In fact, a recent study reported no benefit from drugs versus no drugs used during the initial out-of-hospital resuscitative maneuvers.7

Toward Definitive Trials and Improved Outcomes of Cardiac Arrest