http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_1209-b
Cypress Creek produced neurologically intact results of 17% for ALL presenting rhythms, not just witnessed V-Fib. The inclusion of Wake County in my last post was to demonstrate that there are systems out there that are producing viable improvements in EMS as a whole, not just touting the same line about their cardiac arrest save results. That listing was not complete, nor nearly inclusive of the many great agencies out there that is leading the progression of the challenged industry we call EMS.
That abstract was interesting and impressive on the surface, but it quickly turned out to be not as great as it seems. The abstract doesn't give a specific p value for the before and after difference, but it does say "p=ns" as in p value > 0.05 as in not statistically significant, which is probably why it (the whole study) was never published; their sample size was too small. If they published results that show they averaged 17% over, say, 5 years, then I'd be really impressed. However, their data was collected as part of a larger study (Implementing the 2005 American Heart Association Guidelines improves outcomes after out-of-hospital cardiac arrest. Heart Rhythm. 2010 Oct;7(10):1357-62).
Not true, nor conclusive. Unfortunately, there is no "gold standard" when it comes to EMS research as the medical community still to this day does not place heavy weight on the unproven methods EMS systems use to report data. To validate this point, take another look at the link provided above. There was no utilization of the Utstein criteria.
How many papers on cardiac arrest have you read? Utstein is commonly cited and if not out-right cited, you can determine survival for primary VF/VT patients in order to make an accurate comparison between EMS systems. The lead author of that abstract was the lead author for another study (Lancet. 2011 Jan 22;377(9762):301-11) whereby it is explicitly stated in the abstract: "we assessed outcomes for patients with out-of-hospital cardiac arrest according to Utstein guidelines". I'm willing to bet that he used the Utstein guidelines for his analysis of Cyprus Creek.
The Utstein template/criteria was devised as multinational effort to standardize capturing and reporting of cardiac arrest data. It's promoted by almost all (if not all) the major cardiac care/resuscitation organizations world wide. It is not intended just for prehospital cardiac arrests and is applicable to the inhospital setting, too. I suppose I can concede and throw out the term "gold standard" but I can't think of any standardized template/criteria that is used as an alternate. Again, most systems that track cardiac arrests are using it (see CARES and ROC).
Layperson CPR emphasizes early defibrillation and quality compressions to increase circulation. It isn't rocket science. We know how to get these folks back, the key to advancing the science is developing quality methods to improve the "more stubborn" cases (i.e. the prolonged resuscitation or the non-witnessed, non-VF cases). Regardless, each individual resuscitation will be different. Many variables associated with resuscitation are out of our hands, regardless of the science involved or its advances. If we keep the bar at the Utstein level, I really feel as though we are limiting ourselves and the potential advances that could be made.
Limiting ourselves or being realistic? There has been very little to improve outcomes from nonshockable rhythms. Just about everything that improves outcomes only does so for VF/VT with minimal impact on other rhythms. Ultimately, when someone shows you an improvement for cardiac arrests of all rhythms, you can bet that it was due to changes in outcome for VF/VT (which only comprises about 1/4 of all arrests, yet accounts for half or more of the survivors). For example, the study that included Cyprus Creek had an overall improvement from 10.1 to 13.1% across all rhythms.
The improvement for VF/VT was 20.0 to 32.3% (a 61.5% relative increase), while the change for non VF/VT was 6.78 to 7.12% (a 5.01% relative increase that is likely not statistically significant). I'll bet that the change in survival from 10 to 17% for Cyprus Creek in the abstract you posted was almost solely due to VF/VT.
For better or worse, the focus on VF/VT among some (most?) researchers is that it is the most salvageable of all the CA rhythms and most likely to respond to treatment (as seen above), which is also the reason that many EMS systems only report VF/VT survival and not survival across all rhythms.
Yeah, could be. Honestly don't know, nor do I really care to enter into one's passionate attempt to produce a conspiracy theory that fails to focus on the point of my rebuttal. I get that you think Medic One is the cat's meow. That's fine, you have very right to your opinion. Just as I have the right to mine. I enjoyed your presentation of viable research statistics, up to the dramatic point you seem to include in several of your posts that involve anything to do with cardiac arrest statistics or any mention of King County / Medic One. You lost credibility points from that point forward.
I've been interested in cardiac arrest research for years now and have read many many studies from all over the world. I think when it comes to cardiac arrest, they're one of the best in the world. If one wants to say they suck at everything other than cardiac arrest - fine, I can't necessarily say they don't. But, when it comes down to it, they are very good at managing cardiac arrests. I think most systems have a lot to learn from them when it comes to cardiac arrest management. To suggest that they pad their numbers or manipulate a story is an attempt to cut them down, and, to me, is suggesting that others can't achieve what medic one can and that you can only reach the numbers they produce through manipulation of data. I don't think that is true and I think it silly to try and cut them down for being very good at something. Again, they are very specific about what they measure and they don't hide it at all. It is very easy to compare other systems to them and almost everytime, they're better. Just the way it is.
Now, having again looked at what you said, I see you were turning the conversation in a different direction - to that of whole EMS population and not just cardiac arrest victims. To me, this change in direction is part based on the belief that KCM1 focuses on CA to the detriment of the whole EMS patient population, no? If so, I'd have to disagree. If you were to skim through the annual reports where they document their cardiac arrest outcomes you'd see that they do have programs dedicated to the whole EMS population (e.g. Injury prevention programs for children and senior, community medical technician, etc.) and that they do perform research on other topics. So, while I would agree that they don't do more than many others and that others probably do a lot more, they still do something, which is more than what many EMS systems do.
So yeah, when I comes to cardiac arrest, I'd argue that they are the cats meow (along with places like Wake County). And yeah, if someone is going to insinuate that the researchers at University of Washington, King County M1, etc. (or anywhere else, for that matter) are somehow manipulating data, then you should have more than a simple suspicion to back yourself up. It's a serious accusation in my opinion and one that I might respond to more than just once. (I'm flattered that you'd research my posting history, by the way.)
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