Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
In Reply: We are comfortable that the data
support our conclusion: "An inexpensive, multifaceted system optimization
approach to rapid defibrillation can lead to significant improvements in survival
after cardiac arrest in a large BLS-D EMS [basic life support and defibrillation
emergency medical service] system."
Our primary goal was to assess the impact among all cardiac arrest cases
rather than only among patients with VF or VT, because we believe that an
EMS system has the potential and the obligation to help all patients with
OHCA. Our study did not have adequate sample size to assess rhythm subgroups.
Even though we showed a 20% relative improvement in survival for the subgroup
with VF, the P value was .17, perhaps due to a lack
Stiell IG, Wells GA, Spaite DW, . Improving Survival Following Out-of-Hospital Cardiac Arrest—Reply. JAMA. 1999;282(11):1033-1034. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-11-jac90008