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Abstract
In December 2005, updated resuscitation Guidelines (G) were introduced worldwide and
will be revised again in 2010. This study sought to elucidate how long it takes to
implement new guidelines.
This was a prospective observational study. From July 2005 to January 2008, we included
all patients with an out-of-hospital cardiac arrest of suspected cardiac cause. We
analyzed Emergency Medical System (EMS) Guideline usage via defibrillator recordings
of the continuous ECG and impedance signals. We excluded patients with missing or
otherwise unusable ECGs. All shocks and CPR cycles were individually classified. The
same Guideline needed to be applied for at least 75% of all shocks and CPR cycles.
If no shocks had been given, continuous ECGs were classified by its CPR status only.
Continuous ECGs were classified as G1992, G2000 or G2005. If at least 75% of the shocks
were given according to G2000 and at least 75% of the CPR was according to G2005,
the Guideline protocol was classified as intermediate. All analyses that did not fulfil
any Guideline criteria were classified as indeterminate.
Of 1672 analyzable resuscitations, 31 (2%) used G1992, 826 (49%) G2000, 608 (36%)
G2005, and 125 (7%) intermediate Guidelines. The Guideline protocol could not be identified
for the remaining 81 (5%) patients. It took 17 months (from publication) until EMS
personnel applied GL2005 in over 80% of cases.
Our experience shows it took one-and-a-half years to effectively implement new resuscitation
Guidelines. We believe improvements in implementation can shorten this to six months.