Cardiac Arrest

Worldwide, out-of-hospital cardiac arrest remains a lifelosing proposition for the vast majority of its victims. In the United States, prehospital emergency medical services (EMS) personnel attend an estimated 273 000 persons with out-of-hospital cardiac arrest (defined as circulatory or pulseless collapse) each year. 1 Survival to hospital discharge from all presenting rhythms of cardiac arrest remains strikingly poor (median survival 6.4%) but varies widely across communities.2 The reasons for this wide variation in outcome are likely due in part to community differences in patient characteristics, bystander involvement, and EMS structure and care. This variation is also confounded by the nonuniform manner in which cardiac arrest itself is ascertained and reported. 1 Article p 389 Seventeen years ago, representatives from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council met to establish a uniform means of defining and reporting out-of-hospital resuscitation. The intent of the resulting Utstein Style reporting template was to lay a common foundation that could characterize cardiac arrest, benchmark care within a community, and facilitate comparisons across systems or communities, all in an effort to improve outcomes from out-of-hospital cardiac arrest.3 Using the Utstein schema, one begins with the population served by EMS, tabulates all cardiac arrests attended by EMS, and excludes those in whom resuscitation was not attempted or for whom cardiac arrest was due to obvious noncardiac causes. The focus of the template is the remaining group of patients with cardiac arrest of presumed cardiac origin in whom resuscitation was attempted. These patients serve as the “denominator” in the modified Utstein template for evaluating outcome. 4 Patients who compose this denom