Community and EMS Interventions to Improve Survival in Cardiac Arrest.

A multifaceted community-and-EMS implementation strategy did not improve survival with good neurologic outcome after out-of-hospital cardiac arrest in North Carolina counties (9.0% vs 9.4%).

• Why it matters: Early CPR and defibrillation help, but it was unclear whether randomized community implementation strategies could improve outcomes beyond usual care.
• What they did: In a registry-based cluster-randomized trial, 28 intervention clusters (11,615 patients) received training for 911 telecommunicators, community CPR training, and expanded automated external defibrillator use; 27 clusters (10,844 patients) received usual care.
• The result: Survival to hospital discharge with Cerebral Performance Category 1–2 was 9.0% (1048/11,608) with the intervention and 9.4% (1017/10,839) with usual care (adjusted odds ratio 0.97; 95% CI 0.75–1.26; P=0.80), indicating no added benefit.

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