Annals of emergency medicine
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Patients who suffer an in-hospital cardiac arrest represent a neglected and underutilized resource for resuscitation research. There exists an unwritten, but widely held, belief among resuscitation researchers that the in-hospital arrest population is unsuitable for resuscitation research because it is composed mostly of patients whose cardiac arrest is the terminal event of a fatal illness. Despite the large numbers of hospitalized patients on whom cardiac resuscitation is attempted each year, there are few reports and even less true research devoted to this clinical problem. This article, which is intended to be provocative, reviews and summarizes the existing literature on in-hospital resuscitation from cardiac arrest, considers the advantages of resuscitation research in this setting, and concludes with a challenge to resuscitation researchers.
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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.