***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Mortality  among patients admitted to hospital after out-of-hospital cardiac arrest ( OHCA ) is high . Based on recent scientific evidence with a main goal of improving survival , we introduced and implemented a st and ardised post resuscitation protocol focusing on vital organ function including therapeutic hypothermia , percutaneous coronary intervention ( PCI ) , control of haemodynamics , blood glucose , ventilation and seizures . METHODS All patients with OHCA of cardiac aetiology admitted to the ICU from September 2003 to May 2005 ( intervention period ) were included in a prospect i ve , observational study and compared to controls from February 1996 to February 1998 . RESULTS In the control period 15/58 ( 26 % ) survived to hospital discharge with a favourable neurological outcome versus 34 of 61 ( 56 % ) in the intervention period ( OR 3.61 , CI 1.66 - 7.84 , p=0.001 ) . All survivors with a favourable neurological outcome in both groups were still alive 1 year after discharge . Two patients from the control period were revascularised with thrombolytics versus 30 ( 49 % ) receiving PCI treatment in the intervention period ( 47 patients ( 77 % ) underwent cardiac angiography ) .  Therapeutic hypothermia  was not used in the control period , but 40 of 52 ( 77 % ) comatose patients received this treatment in the intervention period . CONCLUSIONS Discharge rate from hospital , neurological outcome and 1-year survival improved after st and ardisation of post resuscitation care . Based on a multivariate logistic analysis , hospital treatment in the intervention period was the most important independent predictor of survival BACKGROUND Patients suffering out-of-hospital cardiac arrest ( OOHCA ) are generally transported to the closest ED , presumably to expedite a hospital level of care and improve the chances of return for spontaneous circulation ( ROSC ) or provide post-resuscitative care for patients with prehospital ROSC . As hospital-based therapies for survivors of OOHCA are identified , such as hypothermia and emergency primary coronary interventions ( PCI ) , certain hospitals may be design ated as cardiac arrest receiving facilities . The safety of bypassing non- design ated facilities with such a regional system is not known . OBJECTIVES To explore the potential ED contribution in OOHCA victims without prehospital ROSC and document the relationship between transport time and outcome in patients with prehospital ROSC . METHODS This was a prospect i ve , observational study conducted in a large , urban EMS system over an 18-month period . Data were collected using the Utstein template for OOHCA . The incidence of prehospital ROSC was calculated for patients who were declared dead on scene , transported but died in the ED , died in the hospital , and survived to hospital discharge . The relationship between transport time and survival was also explored for patients with prehospital ROSC . RESULTS A total of 1141 cardiac arrest patients were enrolled over the 18-month period . A strong association between prehospital ROSC and final disposition was observed ( chi-square test for trend p<0.001 ) . Only two patients who survived to hospital discharge did not have prehospital ROSC . Mean transport times were not significantly different for patients with prehospital ROSC who were declared dead in the ED ( 8.3min ) , died following hospital admission ( 7.8min ) , and survived to hospital discharge ( 8.5min ) . Outcomes in patients with prehospital ROSC who had shorter ( 7min or less ) versus longer transport times were similar , and receiver-operator curve analysis indicated no predictive ability of transport time with regard to survival to hospital admission ( area under the curve=0.52 ) . CONCLUSIONS In this primarily urban EMS system , the vast majority of survivors from OOHCA are resuscitated in the field . A relationship between transport time and survival to hospital admission or discharge was not observed . This supports the feasibility of developing a regional cardiac arrest system with design ated receiving facilities STUDY OBJECTIVE This study correlated the delay in initiation of byst and er cardiopulmonary resuscitation ( ByCPR ) , basic ( BLS ) or advanced cardiac ( ACLS ) life support , and transport time ( TT ) to survival from prehospital cardiac arrest . This was a secondary endpoint in a study primarily evaluating the effect of bicarbonate on survival . DESIGN Prospect i ve multicenter trial . SETTING Patients treated by urban , suburban , and rural emergency medical services ( EMS ) services . PATIENTS Eight hundred and seventy-four prehospital cardiac arrest patients . INTERVENTIONS This group underwent conventional ACLS intervention followed by empiric early administration of sodium bicarbonate noting resuscitation times . Survival was measured as the presence of vital signs on emergency department ( ED ) arrival . Data analysis utilized Student 's t-test and logistic regression ( p<0.05 ) . RESULTS Survival was improved with decreased time to BLS ( 5.52 min versus 6.81 min , p=0.047 ) and ACLS ( 7.29 min versus 9.49 min , p=0.002 ) intervention , as well as difference in time to return of spontaneous circulation ( ROSC ) . The upper limit time interval after which no patient survived was 30 min for ACLS time , and 90 min for transport time . There was no overall difference in survival except at longer arrest times when considering the primary study intervention bicarbonate administration . CONCLUSION Delay to the initiation of BLS and ACLS intervention influenced outcome from prehospital cardiac arrest negatively . There were no survivors after prolonged delay in initiation of ACLS of 30 min or greater or total resuscitation and transport time of 90 min . This result was not influenced by giving bicarbonate , the primary study intervention , except at longer arrest times OBJECTIVE This study aim ed to determine whether cardiopulmonary resuscitation ( CPR ) volume is associated with survival to discharge rate for out-of hospital cardiac arrest ( OHCA ) victims . METHODS This study was performed in an emergency medical service ( EMS ) system with single-tiered basic to intermediate service level . A nationwide OHCA cohort data base from January 2006 to December 2007 was used and composed of hospital chart review and ambulance run sheet data . We enrolled data from the 410 emergency departments and excluded cases without available hospital outcome data . From sensitivity analysis , we decided cut-off value for the high volume ( HV ) versus low volume ( LV ) EDs . A matching process based on propensity score was used to equalize potential prognostic factors in both groups . The adjusted odds ratio ( OR ) and its 95 % confidence interval ( 95 % CI ) for survival to admission and to discharge were calculated . RESULTS Of the 34,408 patients with OHCA , 20,457 ( 59.5 % ) were included except cases with unknown outcome ( n=1284 ) , traumatic cause ( n=4894 ) , no CPR attempt by EMS ( n=7779 ) , and cases transferred to non-ED facilities ( n=3885 ) . Overall survival to admission and to discharge was 10.9 % and 3.4 % , respectively . When we performed the sensitivity analysis for deciding the cut-off value for HV versus LV , the number was 68 per two years ( sensitivity 67.0 % , specificity 67.0 % ) . Using propensity score matching , 3533 cases were r and omly assigned to HV and LV group , respectively . The unadjusted and adjusted OR for survival to admission in HV was 1.35 ( 95 % CI 1.19 - 1.54 ) and 1.44 ( 95 % CI 1.24 - 1.66 ) , respectively . The unadjusted and adjusted OR for survival to discharge was 1.71 ( 95 % CI 1.36 - 2.14 ) and 1.81 ( 95 % 1.43 - 2.30 ) , respectively . CONCLUSIONS Emergency departments with high volumes of CPR cases showed significantly better outcomes for OHCA patients than those with low volumes in an EMS system with single-tiered basic to intermediate service level Objective To determine the mode of death in patients admitted to an intensive care unit ( ICU ) after cardiac arrest who died before hospital discharge . Design Prospect ively defined retrospective review of a data base and individual patient medical records and ICU charts . Setting Eleven-bed multidisciplinary intensive care unit in a general hospital in the United Kingdom . Patients and participants All patients admitted to ICU between February 1998 and July 2003 after a cardiac arrest in the previous 24 h. Measurements and results The outcome at hospital discharge and mode of death in non-survivors were recorded . Based on the mode of death , non-survivors were placed in one of three groups : multiple organ failure death , neurological death or cardiovascular death .  Two hundred and five patients were admitted to ICU after a cardiac arrest ; 113 ( 55.1 % ) after out-of-hospital cardiac arrest and 92 ( 44.9 % ) after in-hospital cardiac arrest . One hundred and twenty-six ( 61.5 % ) patients died before hospital discharge and of these 58 ( 46.0 % ) died due to neurological injury . After cardiac arrest , 22.9 % of the in-hospital patients and 67.7 % of the out-of-hospital patients died due to neurological injury , irrespective of the primary cardiac arrest arrhythmia . Conclusions Two-thirds of the patients dying after out-of-hospital cardiac arrest died due to neurological injury and this proportion was approximately the same for ventricular fibrillation/ventricular tachycardia and pulseless electrical activity/asystole . Approximately a quarter of the patients dying after in-hospital cardiac arrest died due to neurological injury STUDY OBJECTIVE To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest . STUDY DESIGN A 22-month case series , collected prospect ively , of out-of-hospital cardiac arrests .  Times of collapse , dispatch , scene arrival , CPR , and initial defibrillation were determined from dispatch records , recordings of arrest events , interviews with byst and ers , and hospital records . SETTING Southwestern city ( population , 400,000 ; area , 390 km2 ) with a two-tiered basic life support-advanced life support emergency medical services system . Emergency medical technician-firefighters without electrical defibrillation capability comprised the first response tier ; firefighter-paramedics were the second tier . PATIENTS One hundred eighteen cases of witnessed , out-of-hospital cardiac arrest in adults with initial ventricular fibrillation . MAIN OUTCOME MEASURES Survival was defined as a patient who was discharged alive from the hospital . RESULTS Eighteen of 118 patients ( 15 % ) survived . Survivors did not differ significantly from nonsurvivors in age , sex , or basic life support or advanced life support response intervals . Survivors had significantly ( P < .05 ) shorter intervals from collapse to CPR ( 1.7 versus 5.2 minutes ) and to defibrillation ( 7.4 versus 9.5 minutes ) . CONCLUSION Collapse-to-intervention intervals , not emergency vehicle response intervals , should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death Background —Whether to perform or not an immediate percutaneous coronary intervention ( PCI ) after out-of-hospital cardiac arrest is still debated . We aim ed to evaluate the impact of PCI on short- and long-term survival in out-of-hospital cardiac arrest patients admitted after successful resuscitation . Methods and Results —Between 2000 and 2013 , all nontrauma out-of-hospital cardiac arrest patients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospect ively included . The association between immediate PCI and short- and long-term mortality was analyzed using logistic regression and Cox multivariate analysis , respectively . Propensity score-matching method was used to assess the influence of PCI on short- and long-term survival . During the study period , 1722 patients ( 71.5 % male , median age 60 [ 49.6 , 72.2 ] years ) were analyzed : 628 ( 35.6 % ) without coronary angiography , 615 ( 35.7 % ) with coronary angiography without PCI  , and 479 ( 27.8 % ) with both . Among these groups , day 30 and year-10 survival rates were 21 % and 11.9 % , 35 % and 29 % , 43 % and 38 % , respectively ( P<0.01 for each ) . PCI as compared with no coronary angiography was associated with a lower day-30 and long-term mortality ( adjORcoro with PCI versus no coro 0.71 , 95 % confidence interval [ 0.54 , 0.92 ] ; P=0.02 and adjHRcoro with PCI versus no coro 0.44 , 95 % confidence interval [ 0.27 , 0.71 ] ; P<0.01 , respectively ) . PCI remained associated with a lower risk of long-term mortality ( adjHR 0.29 ; 95 % confidence interval [ 0.14 , 0.61 ] ; P<0.01 ) in propensity score-matching analysis . Conclusions —Immediate PCI after out-of 
    Output:
    
Paramedic transport time was not associated with survival to hospital discharge or with neurological outcome at hospital discharge in adult OHCA patients .