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interpreted with caution because the network was dominated byindirect comparisons.

http://dx.doi.org/10.1016/j.resuscitation.2012.08.155

60 Poster Presentations / Res

HCA ‘epistry’ (epidemiologic registry); (c) examine EMS-basedtrategies to improve outcomes from OHCA; (d) build capacity inre-hospital emergency care research.

Conclusion: Despite 50 years since the advent of cardiopul-onary resuscitation, OHCA remains a significant public health

ssue with a high case fatality (>90%). Tackling the problem requiresn interdisciplinary systems approach to research generation andnowledge translation.Funding: NHMRC #1029983.

eferences

].The Australian Resuscitation Outcomes Consortium (Aus-ROC). Available from:www.ausroc.org.au.

].ROC Investigators (North America). Resuscitation Outcomes Consortium. Avail-able from: https://roc.uwctc.org/.

].Nichol G, et al. Regional variation in out-of-hospital cardiac arrest incidence andoutcome. JAMA 2008;300:1423–31.

ttp://dx.doi.org/10.1016/j.resuscitation.2012.08.153

P095

ffects of pre-arrival CPR instruction. Five year nationwide anal-sis in Japan

oshiki Natsume 1,∗, Hideharu Tanaka 2, Hiroshi Takyu 3

KYOTO Tachibana University, Kyoto City, JapanEMS System, Graduate School, Kokushikan University, Tama City,

apanChubu Gakuin University, Seki City, Japan

Background: The number of EMS transportation cases haseached more than 6 million run in the year of 2010 in Japan, and theime to arrival at the scene extend year by year. Therefore necessaryf the layperson bystander CPR become important. Moreover, theRC2010 Guidelines emphasized that necessity of pre-arrival CPRnstruction.

Purpose: To examine the effectiveness of pre-arrival CPRnstruction (as PACPRI) in nationwide Japan.

Subjects and methods: From January 1, 2005 throughecember 31, 2010, a total of 36,690 OHCA patients were extracted

rom the nationwide Utstein style database (n = 670,313). Age lesshan 15 and more than 65years old, non-cardiogenic cause OHCA,on-witnessed, DNR patients were excluded.

Number of pre-arrival CPR instruction, bystander CPR, thencidence of VF/VT, ROSC and CPC1 and 2, CPC3 and above

ere evaluated with/without PACPRI. Statistical analysis was usednpaired t-test Chi square test between the groups.

Results: The number of PACPRI was 34,756 in the year of 2005nd increased 57,002 in 2010. The incidence of VF/VT on initialCG waveform were 44.7% in the PACPRI case and 35.9% in theon-PACPRI, respectively, There was significant difference betweenhe two groups (P < 0.05). However, ROSC was significantly lower20.6%) when bystander CPR was performed under PACPRI thanhat of non-PACPRI (65.7%). One month survival rate was identicaln the PACPRI groups and non- PACPRI groups who received publicccesses AED. In particular, the number of CPC 3 or above was sig-ificantly higher in the PACPRI group than that of the non-PACPRIroup (P < 0.05).

Conclusion: Our findings suggest that PACPRI could not improveHCA survival rates. Therefore, it is important that to improve the

ACPRI skills of Emergency Medical Dispatch and continuously CPRducation for the layperson.

ttp://dx.doi.org/10.1016/j.resuscitation.2012.08.154

tion 83 (2012) e24–e123

CPR SystemsAP096

Assessing the relative effectiveness of emergency medical ser-vices interventions in out of hospital cardiac arrest: A networkanalysis

George Bakalos 1,∗, George Bakalos 2, Komninos Christos 2, Tsanti-las Apostolis 2, Rozenberg Theophilos 2

1 University of Thessaly School of Medicine, Evidence-Based MedicineUnit, Larissa, Greece2 University of Athens Medical School, MSc Program on InternationalMedicine-Health Crisis Management, Athens, Greece

Purpose: The optimal emergency medical services (EMS) inter-ventions in the management of patients with out of hospitalcardiac arrest (OHCA) is not well-defined, since direct compar-isons between therapeutic algorithms is limited. The aim of thisstudy was to estimate the relative effectiveness of the various pre-hospital interventions in the management of patients with OHCA.

Methods: PubMed, EMBASE and Cochrane Central Registerof Controlled Trials were systematically searched to identify allcontrolled trials that compared various EMS interventions for pre-hospital OHCA. The effectiveness of the interventions relative tothe basic life support supported by automated external defibril-lator (BLS-D) provided by emergency medical technicians and/orparamedics (reference algorithm) was estimated by performing anetwork of treatments analysis. The survival at hospital dischargewas considered as the outcome of interest. All controlled trials thatprovided data for calculating the odds ratios (OR) for the selectedoutcome were considered. The network analysis involved direct,indirect and combined analyses. Prognostic parameters (age, gen-der, CPR initiated by bystander, time to EMS access, time on scene)and geographical parameters were evaluated for each intervention.

Results: We identified 14 controlled trials (18,718 patients)that described 6 direct comparisons of different interventions.The most optimal intervention for OHCA was the BLS-D pro-vided by non health professionals upon the arrival of the EMS(ORp 2.714, 0.302–24.415). Advanced life support (ALS) appliedby physician two folds the probability of survival at hospitaldischarge compared to BLS-D provided by emergency medical tech-nicians and/or paramedics (ORp 2.173, 0.379–12.461). Sub-analysisrevealed that the engagement of physician at ALS team increasesfurther the probability of survival at hospital discharge (ORp 1.703,0.314–9.247).

Conclusions: The network meta-analysis revealed that the ini-tial management of OHCA with BLS-D provided by non healthprofessionals upon the arrival of EMS, increases the probability ofsurvival at hospital discharge. These results, however, should be