Circulation
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Previous animal and clinical studies suggest that bystander-initiated cardiac-only resuscitation may be superior to conventional cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrests. Our hypothesis was that both cardiac-only bystander resuscitation and conventional bystander CPR would improve outcomes from out-of-hospital cardiac arrests of < or = 15 minutes' duration, whereas the addition of rescue breathing would improve outcomes for cardiac arrests lasting > 15 minutes. ⋯ Bystander-initiated cardiac-only resuscitation and conventional CPR are similarly effective for most adult out-of-hospital cardiac arrests. For very prolonged cardiac arrests, the addition of rescue breathing may be of some help.
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Public reports that compare hospital mortality rates for patients with acute myocardial infarction are commonly used strategies for improving the quality of care delivered to these patients. Fair comparisons of hospital mortality rates require thorough adjustments for differences among patients in baseline mortality risk. This study examines the effect on hospital mortality rate comparisons of improved risk adjustment methods using diagnoses reported as present-at-admission. ⋯ Large improvements in statistical performance can be achieved with the use of present-at-admission diagnoses to characterize baseline mortality risk. These improvements are important because models with better statistical performance identify different hospitals as having better or worse than expected mortality.
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We sought to compare the 1-month survival rates among patients after out-of-hospital cardiac arrest who had been given bystander cardiopulmonary resuscitation (CPR) in relation to whether they had received standard CPR with chest compression plus mouth-to-mouth ventilation or chest compression only. ⋯ Among patients with out-of-hospital cardiac arrest who received bystander CPR, there was no significant difference in 1-month survival between a standard CPR program with chest compression plus mouth-to-mouth ventilation and a simplified version of CPR with chest compression only.