Annals of emergency medicine
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To enhance comparability in reports on survival from out-of-hospital cardiac arrest, an international task force recently developed a set of guidelines for uniform terminology, definitions, and data collection for outcome research on cardiac arrest--the Utstein style. Because the data collection recommended is limited to information available through emergency medical services systems, the potential for bias in comparisons of cardiac arrest outcomes remains. By expanding data collection to include the identification of all cases of cardiac arrest in the community, including patients who do not present for care by an emergency medical services system, a population-based approach can be achieved. We review the strengths and limitations of both emergency medical services-based and population-based data collection to assess outcomes of cardiac arrest, outline practical steps required to implement a population-based approach, and suggest that extension of the Utstein style guidelines to include all cardiac arrest cases within a defined population is needed to minimize potential bias in comparisons of cardiac arrest outcomes across communities or over time.
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Animal models of resuscitation must be analyzed carefully before applying any interventions to human resuscitation. In addition to statistical concerns, the investigator must assess the clinical significance of the animal experience with an intervention. ⋯ After evaluating the animals used, the design in a series of animal experiments should be clinically applicable and the results reproducible. Finally, both process and outcome variables should be evaluated and improved in animal models before applying a new intervention to clinical care.
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Review Comparative Study
The complexity of comparing different EMS systems--a survey of EMS systems in Europe.
In Europe, emergency medical care has developed since the Middle Ages in each country, even within regions of a country, resulting in a patchwork of definitions, legislations, and systems. As a consequence, emergency medical care was implemented differently according to sociocultural, geographic, political, and religious differences between and within individual European countries. The objective of this survey was to describe the emergency medical services (EMS) systems in place throughout Europe, the type and qualification of the personnel, citizen-CPR knowledge, and experiences with automated external defibrillator programs. ⋯ To describe the EMS system, a uniform nomenclature is required. The Utstein "template" style could be proposed as the guideline to describe individual systems. The European Resuscitation Council could contribute in coordinating and standardizing the various aspects of emergency medical care in Europe, with detailed registration, medical coordination, and medical regulation being the principal working rules.
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To add to our understanding of survival rates in out-of-hospital cardiac arrest studies, we examined the incidence of cardiac arrest in the published literature. We specifically estimated if incidence rates are uniform between communities and if any relationship exists between incidence and the reported survival rates. ⋯ The marked variations in incidence and inverse relationship between incidence and survival could be due to true variation in risk among the populations reported (ie, some populations may be older or sicker than others). Also, different research methodologies may create artifactual differences among studies as standards for designing studies, terminology, and reporting data have not been uniform. Therefore, these findings may reflect methodological differences and true epidemiological differences among communities. Future reports should include a method, such as an incidence/survival nomogram, to analyze survival rates while taking into account the community incidence rate of cardiac arrest. Further analysis of incidence and survival is necessary to improve intersystem comparisons, a prerequisite to sound decisions about cardiac arrest treatment, health policy, and allocation of resources.