A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest

Study objective: More than 1,000 patients experience sudden cardiac arrest each day. Treatment for this includes cardiopulmonary resuscitation (CPR) a nd emergency medical services (EMS) that provide CPR-basic life support (BL S), BLS with defibrillation (BLS-D), or advanced life support (ALS). Our pr evious systematic review of treatments for sudden cardiac arrest was limite d by suboptimal data. Since then, debate has increased about whether bystan der CPR is effective or whether attention should focus instead on rapid def ibrillation. Therefore a cumulative meta-analysis was conducted to determin e the relative effectiveness of differences in the defibrillation response time interval, proportion of bystander CPR, and type of EMS system on survi val after out-of-hospital cardiac arrest. Methods: A comprehensive literature search was performed by using a priori exclusion criteria. We considered EMS systems that provided BLS-D, ALS, BLS plus ALS, or BLS-D plus ALS care. A generalized linear model was used with dispersion estimation for random effects. Results: Thirty-seven eligible articles described 39 EMS systems and includ ed 33,124 patients. Median survival for all rhythm groups to hospital disch arge was 6.4% (interquartile; range, 3.7 to 10.3). Odds of survival were 1. 06 (95% confidence interval [CI], 1.03 to 1.09; P < .01) per 5% increase in bystander CPR. Survival was constant if the defibrillation response time i nterval was less than 6 minutes, decreased as the interval increased from 6 to 11 minutes, and leveled off after 11 minutes (P < .01). Compared with B LS-D, odds of survival were as follows: ALS, 1.71 (95% CI, 1.09 to 2.70; P = .01); BLS plus ALS, 1.47 (95% CI, 0.89 to 2.42; P = .07); and BLS with de fibrillation plus ALS, 2.31 (95% CI, 1.47 to 3.62; P < .01.) Conclusion: We confirm that greater survival after sudden cardiac arrest is associated with provision of bystander CPR, early defibrillation, or ALS. More research is required to evaluate the relative benefit of early defibri llation versus early ALS.