Send to:

Choose Destination
See comment in PubMed Commons below
Ann Emerg Med. 1997 Jul;30(1):76-81.

Cardiac arrest witnessed by prehospital personnel: intersystem variation in initial rhythm as a basis for a proposed extension of the Utstein recommendations.

Author information

  • 1Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY., USA.



To test the hypothesis that intersystem variation in initial rhythm among EMS-witnessed arrests is of sufficient magnitude to warrant standardization of survival by creation of an Utstein-style denominator of EMS-witnessed ventricular fibrillation (VF).


We conducted a planned subset analysis of a prospective observational cohort study of consecutive EMS-witnessed adult cardiac arrests occurring in New York City and meeting Utstein entry criteria. The primary outcome measure was intersystem variation in frequency of EMS-witnessed VF in New York City compared with that in other EMS systems. Secondary outcome measures were variations in survival after EMS-witnessed VF arrests and overall survival after all EMS-witnessed arrests.


Intersystem variation showed a threefold difference in the frequency of EMS-witnessed VF (24% in New York City versus 77% in Scotland; 99% confidence interval [CI] for 53% difference, 43% to 63%; P < 10(-7), a twofold difference in survival after EMS-witnessed VF (25% in NYC versus 48% in King County, WA; 99% CI for 23% difference, 6% to 39%; P < .002), and a fourfold difference in survival after all EMS-witnessed arrests (9% in New York City versus 35% in King County; 99% CI for 26% difference, 18% to 34%; P < 10(-7).


The marked variation in frequency of initial rhythm in EMS-witnessed arrests suggests that a modified Utstein denominator of EMS-witnessed VF would facilitate more uniform intersystem comparison of survival in this unique cohort. However, even after adjustment for initial rhythm, large residual intersystem survival differences remain unexplained.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk