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September 15, 1999

Improving Survival Following Out-of-Hospital Cardiac Arrest—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(11):1033-1034. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-11-jac90008

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 of power.