Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis.

Objective: In recent years, the costs of epinephrine autoinjectors (EAIs) in the United States have risen substantially. King County Emergency Medical Services implemented the "Check and Inject" program to replace EAIs by teaching emergency medical technicians (EMTs) to manually aspirate epinephrine from a single-use 1 mg/mL epinephrine vial using a needle and syringe followed by prehospital intramuscular administration of the correct adult or pediatric dose of epinephrine for anaphylaxis or serious allergic reaction. Treatment was guided by an EMT protocol that required a trigger and symptoms.

Determining witnessed status for out-of-hospital cardiac arrest.

Objective: Witnessed status is considered a core variable in reporting cardiac arrest data and can be ascertained from either the emergency dispatch recording or the pre-hospital record. The purpose of this study is to compare and assess the quality and consistency of these information sources.

Methods: This retrospective analysis included 1896 cases of out-of-hospital cardiac arrest occurring between September 1, 2012 and December 31, 2014.

Dispatcher-assisted cardiopulmonary resuscitation: time to identify cardiac arrest and deliver chest compression instructions.

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 dispatchers and prevented or delayed the provision of dispatcher-assisted CPR chest compressions.

Methods And Results: We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011.

Cardiac arrest at exercise facilities: implications for placement of automated external defibrillators.

Objectives: This study sought to characterize the relative frequency, care, and survival of sudden cardiac arrest in traditional indoor exercise facilities, alternative indoor exercise sites, and other indoor sites.

Background: Little is known about the relative frequency of sudden cardiac arrest at traditional indoor exercise facilities versus other indoor locations where people engage in exercise or about the survival at these sites in comparison with other indoor locations.

Methods: We examined every public indoor sudden cardiac arrest in Seattle and King County from 1996 to 2008 and categorized each event as occurring at a traditional exercise center, an alternative exercise site, or a public indoor location not used for exercise.

Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation.

Background: Little is known about the long-term survival effects of type-specific bystander cardiopulmonary resuscitation (CPR) in the community. We hypothesized that dispatcher instruction consisting of chest compression alone would be associated with better overall long-term prognosis in comparison with chest compression plus rescue breathing.

Methods And Results: The investigation was a retrospective cohort study that combined 2 randomized trials comparing the short-term survival effects of dispatcher CPR instruction consisting either of chest compression alone or chest compression plus rescue breathing.

Impacting sudden cardiac arrest in the home: a safety and effectiveness study of privately-owned AEDs.

Background: Sudden cardiac arrest (SCA) remains a major public health problem. The majority of SCA events occur in the home; however, scant data has been published regarding the effectiveness of privately owned AEDs.

Methods: The study, initiated in 2002 under prescription labeling, continued with over the counter availability in 2004 and was completed in 2009.

Impact of changes in resuscitation practice on survival and neurological outcome after out-of-hospital cardiac arrest resulting from nonshockable arrhythmias.

Background: Out-of-hospital cardiac arrest (OHCA) claims millions of lives worldwide each year. OHCA survival from shockable arrhythmias (ventricular fibrillation/ tachycardia) improved in several communities after implementation of American Heart Association resuscitation guidelines that eliminated "stacked" shocks and emphasized chest compressions. "Nonshockable" rhythms are now the predominant presentation of OHCA; the benefit of such treatments on nonshockable rhythms is uncertain.

CPR with chest compression alone or with rescue breathing.

Background: The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.

Methods: We conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR.

Procainamide and survival in ventricular fibrillation out-of-hospital cardiac arrest.

Objectives: Procainamide is an antiarrhythmic drug of unproven efficacy in cardiac arrest. The association between procainamide and survival from out-of-hospital cardiac arrest was investigated to better determine the drug's potential role in resuscitation.

Methods: The authors conducted a 10-year study of all witnessed, out-of-hospital, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) cardiac arrests treated by emergency medical services (EMS) in King County, Washington.

A comprehensive investigation of cardiac arrest before and after arrival of emergency medical services.

Objective: Many of the factors that affect survival from out-of-hospital cardiac arrest are not relevant in patients who arrest after arrival of emergency medical services (EMS). Because all arrests that occur after arrival of EMS are witnessed and care is immediate, one might expect survival to be very high. Several studies have described communities' experiences of arrest after arrival but few have compared survival rates stratified by rhythm and witness status.

The relationship between time to arrival of emergency medical services (EMS) and survival from out-of-hospital ventricular fibrillation cardiac arrest.

Aim: We examined the relationship between time from collapse to arrival of emergency medical services (EMS) and survival to hospital discharge for out-of-hospital ventricular fibrillation cardiac arrests in order to determine meaningful interpretations of this association.

Methods: We calculated survival rates in 1-min intervals from collapse to EMS arrival. Additionally, we used logistic regression to determine the absolute probability of survival per minute of delayed EMS arrival.

Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation.

Objective: Although socioeconomic status (SES) has been linked to multiple health outcomes, there have been few studies of the effect of SES on the provision of bystander cardiopulmonary resuscitation (CPR) during cardiac arrest events and no studies that we know of on the effect of SES on the provision of dispatcher-assisted bystander CPR. This study sought to define the relationship between SES and the provision of bystander CPR in an emergency medical system that includes dispatcher-provided CPR instructions.

Methods: This study was a retrospective, cohort analysis of cardiac arrests due to cardiac causes occurring in private residences in King County, Washington, from January 1, 1999, to December 31, 2005.

The effect of paramedic experience on survival from cardiac arrest.

Objective: We hypothesized that paramedics with more experience would be more successful at treating patients in ventricular fibrillation (VF) cardiac arrest than those with less experience. We conducted a study examining the relationship between the years of experience of paramedics and survival from out-of-hospital cardiac arrest.

Methods: This retrospective cohort study examined all witnessed, out-of-hospital VF cardiac arrests (n = 699) that occurred between January 1, 2002, and December 31, 2006.

Prompt advanced life support improves survival from ventricular fibrillation.

Objective: To determine whether the interval between the arrival of basic life support (BLS) providers and the arrival of advanced life support (ALS) providers is associated with patient outcome after cardiac arrest.

Methods: We conducted a retrospective cohort study of all witnessed, out-of-hospital ventricular fibrillation (VF) cardiac arrests between January 1, 1991, and December 31, 2007. Eligible patients (n = 1,781) received full resuscitation efforts from both BLS and ALS providers.