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Amplitude spectrum area to predict defibrillation outcome after recurrent and defibrillation resistant ventricular fibrillation during pre-hospital cardiopulmonary resuscitation
Oral Presentations / Resuscitation 83 (2012) e1–e23
AS023 Are KPI stickers the way forward for cardiac arrests? Qamar Hussein 1,∗ , Nargas Khan 1 , Marc Wittenberg 2 , Chris King 2 , Gareth Grier 2 1 2
University of Cambridge, Cambridge, UK Essex and Hertfordshire Air Ambulance Trust, Essex, UK
Purpose of study: Essex and Hertfordshire Air Ambulance Trust (EHAAT) attend up to ten non-traumatic cardiac arrests (NTCA) per month. As a way of improving documentation and increasing compliance to the gold standard 1 in the management of NTCAs, EHAAT developed key performance indicators (KPIs) in the form of adhesive labels which were attached to patient record forms. These KPIs listed the main interventions for appropriate NTCA management. A previous audit 2 found that with the introduction of the stickers in May 2010, there has been an increase in compliance to the KPIs. The aim of this audit is to assess EHAAT’s documentation of NTCAs since then, and to determine whether this increase in compliance is being maintained. Materials and Methods: Patient record sheets for all NTCAs during the study period were audited retrospectively from May 2010–December 2011. This was compared to the documentation of interventions and ROSC rate prior to the introduction of the stickers from previously audited data. Results: Of the 121 patients, 78% were male and the median age was 56.4. Compliance with cardiac arrest gold standards has increased since the introduction of KPI stickers with the total percentage of KPIs met (which included both pre- and post- ROSC management of NTCA) increasing from 55.8% before the introduction of stickers, to 86.9% after (p < 0.001). There was also an increase in ROSC rate from 24% – 33.1% (p < 0.025). Conclusion: KPI stickers are a simple and reliable way of ensuring best practice in the pre-hospital management of NTCA. This could be associated with an increase in the rate of ROSC.
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to the applied resuscitation guidelines (1998, 2000, 2005) only patients with OHCA within one of three defined periods were enrolled: period I January 1st 1998–July 31st 2000, period II August 1st 2001–October 31st 2005 and period III March 1st –December 31st 2008. Results: 3886 patients sustained OHCA between January 1st –December 31st 2008. 3222 patients were ≥18 years and had no TCPA. 2234 patients with OHCA within the periods I (32 months), II (51 months) and III (34 months) underwent further analysis. Groups did not differ according age, gender, location of OHCA or if OHCA was witnessed. Within the three periods VF/VT as initial rhythm decreased from 34.0%–26.8%–20.6%. No change of the rate of return of spontaneous circulation (ROSC) was observed, while more of patients (8.8% vs. 10.8% vs. 12.1%) were discharged from hospital with good neurologic outcome (CPC 1/2) and less with unfavorable neurologic outcome over the periods. Conclusion: While the circumstances for an OHCA as well as the ROSC rate remained unchanged and despite non-VF/VT has been the initial rhythm with increasing frequency, significantly more patients survived with good neurologic outcome. We hypothesize that this reflects improved efficiency of resuscitation efforts following the guideline changes from 1998–2000 and to 2005 but more detailed analyses are necessary to understand these results. Further reading [1].Robertson C. The 1998 European Resuscitation Council guidelines for adult advanced life support: A statement from the Working Group on Advanced Life Support, and approved by the executive committee of the European Resuscitation Council. Resuscitation 1998;37:81–90. [2].De Latorre F. European Resuscitation Council. European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support. A statement from the Advanced Life Support Working Group and approved by the Executive Committee of the European Resuscitation Council. Resuscitation 2001;48:211–21. [3].Nolan JP. European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 2005;67(Suppl 1):S39–86.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.029 Further reading [1].Nolan J. European Resuscitation Council Guidelines for Resuscitation 2010. Resuscitation 2010;81. [2].Chesters A. Key performance indicators: can stickers improve documentation of pre-hospital cardiac arrests? Oct 2011. Resuscitation 2011;82.
Defibrillation AS025
http://dx.doi.org/10.1016/j.resuscitation.2012.08.028
Amplitude spectrum area to predict defibrillation outcome after recurrent and defibrillation resistant ventricular fibrillation during pre-hospital cardiopulmonary resuscitation
AS024
Giuseppe Ristagno 1,∗ , Weilun Quan 2 , Gary Freeman 2
Outcome from out-of-hospital cardiac arrest in dependency of applied resuscitation guidelines. A regional outcome analysis of 2234 resuscitations between 1998 and 2009
1
Markus Roessler 1,∗ , Alexander Stumpf 1 , Simon Oliver Schmid 1 , Jan Bahr 1 , Michael Quintel 1
Schneider 2 ,
1
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Goettingen, Germany 2 Department of Medical Statistics, University Medicine, Goettingen, Germany Background: ERC guidelines for resuscitation are developed as a consensus of science. Every update has been made with the aim to improve survival with good outcome following cardiac arrest. We investigated if survival did improve after sustained out-of-hospital cardiac arrest (OHCA) between 1998 – 2009. Methods: All patients with OHCA seen by the regional Emergency Medical Services were documented according the Utsein–style. Patients <18 years or with traumatic cardiopulmonary arrest (TCPA) were excluded. For unambiguous allocation
2
Mario Negri Institute for Pharmacological Research, Milan, Italy ZOLL Medical Corporation, Chelmsford, MA, USA
Aim: The delivery of a second or subsequent defibrillation (DF) during CPR, may be due to ventricular fibrillation (VF) reoccurring after an initially successful DF that has achieved ROSC (recurrent VF), or due to VF that has not been terminated by the preceding DF (DF-resistant VF). We evaluated the ability of Amplitude Spectrum Area (AMSA) to predict DF outcome for subsequent DF attempts during pre-hospital CPR. We hypothesized different AMSA thresholds for recurrent compared to DF-resistant VF. Methods: ECG data were obtained from 748 VF patients from multiple areas in the US. A 4.1 sec ECG window ending at 0.5 sec before DF was analyzed using the AMSA algorithm employing fast Fourier transformation. A successful DF attempt was defined as the presence of an organized rhythm ≥ 40 bpm starting within 60 s from the DF. For subsequent DFs, VF was classified as recurrent VF or DF-resistant VF. Receiver operator characteristic (ROC) curves were calculated to assess the ability of the AMSA algorithm to predict outcome of subsequent DFs.
e12
Oral Presentations / Resuscitation 83 (2012) e1–e23
Results: A total of 1226 quality DF events from 609 patients were included. Among the analyzed 578 first DFs, 156 successfully terminated VF (26.9%), while 422 failed (73%). Among the 648 subsequent DFs, 520 were delivered for DF-resistant VF and 128 for recurrent VF. AMSA prior to all subsequent DFs was 9.1 mV-Hz, and AMSA values were higher prior to successful DFs in contrast to failed ones (14.9 vs. 7.3 mV-Hz, p<0.0001). Recurrent VFs presented higher AMSA (15.7 vs. 7.4 mV-Hz, p < 0.0001) and greater DF success (79.7% vs. 8.8%) compared to DF-resistant VFs. However, no difference in AMSA prior to a successful DF in comparison to that prior to a failed one was observed for recurrent VFs (16 vs. 14.6 mV-Hz, p = 0.52). For DF-resistant VFs, AMSA was higher prior to a successful DF than prior to a failed one (13.5 vs. 6.8 mVHz, p < 0.0001). ROC curves demonstrated the ability of AMSA to predict DF outcome for subsequent DFs (AUC 0.867). However, the AMSA approach was accurate only for DF-resistant VFs (AUC 0.82), but not in the case of recurrent VFs (AUC 0.62). Conclusions: For subsequent DFs, AMSA was confirmed to be significantly higher prior to a successful attempt rather than an unsuccessful one. However, the AMSA approach was accurate only in the instance of DF-resistant VFs. Recurrent VFs present high AMSA and DF success and thus should receive immediate DF. http://dx.doi.org/10.1016/j.resuscitation.2012.08.030 AS026 Rapid decreases in Amplitude Spectrum Area after Interruption of chest compression in out-of-hospital cardiac arrest patients Giuseppe Ristagno 1,∗ , Qing Tan 2 , Weilun Quan 2 1 2
Mario Negri Institute for Pharmacological Research, Milan, Italy ZOLL Medical Corporation, Chelmsford, MA, USA
Purpose of the study: Interruptions in chest compression (CC) have been shown to cause rapid decreases in coronary perfusion in animal models. Amplitude spectrum area (AMSA) is an accurate predictor of successful defibrillation (DF) and increases when CPR quality improves. We investigated changes in AMSA occurring after interruption of CC during pre-hospital CPR. We hypothesized that AMSA would rapidly decrease after CC interruption. Materials and methods: Electrocardiographic (ECG) data, including 1410 DF attempts, were obtained from 748 cardiac arrest patients from multiple areas in the US. Starting from the onset of CC interruption and throughout the 16 s pre-DF pause imposed by current AEDs, consecutive 512 point, or 2.05 s, ECG data segments were analyzed and AMSA was calculated. Changes in AMSA values were compared between consecutive 2 s interval pairs during CC interruption. Results: A total of 620 qualified CC interruption events from 352 patients were included in the analyses. AMSA continuously decreased during the early 16 s CC interruption from initially 7.2 to 6.9, 6.5, 6.3, 6.2, 6.2, 6.1 and then 6.0 mVHz in the last 2 s interval. Compared to the preceding 2 s intervals, the p values were 0.0003, 0.0000, 0.045, 0.002, 0.11, 0.12 and 0.36, respectively. Conclusions: AMSA decreased immediately after onset of CC interruption during pre-hospital CPR. Significant decreases occurred during the initial 8 s of interruption and were likely related to the reduced myocardial perfusion. These findings suggest a need for protocols that can significantly reduce pre-shock CC pauses. http://dx.doi.org/10.1016/j.resuscitation.2012.08.031
AS027 Public Access Defibrillation in real-life settings Anne Møller Nielsen 1,∗ , Fredrik Folke 2 , Freddy Lippert 3 , Lars Rasmussen 1 1
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark 2 Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark 3 Emergency Medicine and Emergency Medical Services, Head Office, The Capital Region of Denmark, Denmark
Background: Automated External Defibrillators (AED) are known to increase survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the use and benefit of public-access defibrillation (PAD) in a nation-wide network. We primarily sought to assess survival at 1 month but information about the circumstances of each OHCA is provided as well. We hypothesized that subjects with an initial shockable rhythm would have a higher survival rate at one month. Methods: In this 28–month study, we assessed the use of 807 AEDs in Denmark. When an AED was deployed information about the circumstances of OHCA, the bystander, the AED and the victim’s condition was obtained. Results: An AED was connected to an OHCA victim prior to the arrival of Emergency Medical Services (EMS) in 48 instances. Among the bystanders, 10% were off-duty healthcare professionals. Shockable arrests (N = 31, 70%) were significantly more likely to be witnessed (94% vs. 54%) to occur at sports facilities (74% vs. 31%), in relation to exercise (42% vs. 0%), and with improved 30day survival (69% vs. 15%, P = 0.001). Among those presenting with a shockable rhythm, 8 (26%) were conscious upon arrival of EMS. Survival could be determined in 42 out of 44 patients with OHCA of cardiac origin, and was 52% (n = 22, 95% CI [38–67]) and The Cerebral Performance Category was 1 (Good Cerebral Performance) in all survivors. Conclusion: With a 30–day neurologically intact survival of 69% for patients with shockable rhythms, this study provides further evidence of the lifesaving potential of PAD. http://dx.doi.org/10.1016/j.resuscitation.2012.08.032 AS028 Short message service to alert lay rescuers in out-of-hospital cardiac arrest: How many AEDs are needed to defibrillate within 6 minutes? Jolande Zijlstra ∗ , Remy Stieglis, Rudolph Koster Academic Medical Center, Amsterdam, The Netherlands Purpose: Time from emergency call to first shock is too long in VF out-of-hospital cardiac arrest (OHCA) patients. 1 A short message service (SMS) alert system for lay rescuers has been recently implemented in The Netherlands. This system uses SMS to make EMS alert lay rescuers to go to victims, perform CPR and use an AED located within a circle of 500–1000 m from the victim. We evaluated the relation between the number of AEDs in the system and the time between call and first shock. The aim is to reduce this time to <6 min. Methods: We analyzed all patients with a nontraumatic OHCA where a defibrillator was connected from February 2010–January 2012, in two regions in The Netherlands with total 1.27 million inhabitants. We excluded all EMS-witnessed cardiac arrests. The
AS023 Are KPI stickers the way forward for cardiac arrests? Qamar Hussein 1,∗ , Nargas Khan 1 , Marc Wittenberg 2 , Chris King 2 , Gareth Grier 2 1 2
University of Cambridge, Cambridge, UK Essex and Hertfordshire Air Ambulance Trust, Essex, UK
Purpose of study: Essex and Hertfordshire Air Ambulance Trust (EHAAT) attend up to ten non-traumatic cardiac arrests (NTCA) per month. As a way of improving documentation and increasing compliance to the gold standard 1 in the management of NTCAs, EHAAT developed key performance indicators (KPIs) in the form of adhesive labels which were attached to patient record forms. These KPIs listed the main interventions for appropriate NTCA management. A previous audit 2 found that with the introduction of the stickers in May 2010, there has been an increase in compliance to the KPIs. The aim of this audit is to assess EHAAT’s documentation of NTCAs since then, and to determine whether this increase in compliance is being maintained. Materials and Methods: Patient record sheets for all NTCAs during the study period were audited retrospectively from May 2010–December 2011. This was compared to the documentation of interventions and ROSC rate prior to the introduction of the stickers from previously audited data. Results: Of the 121 patients, 78% were male and the median age was 56.4. Compliance with cardiac arrest gold standards has increased since the introduction of KPI stickers with the total percentage of KPIs met (which included both pre- and post- ROSC management of NTCA) increasing from 55.8% before the introduction of stickers, to 86.9% after (p < 0.001). There was also an increase in ROSC rate from 24% – 33.1% (p < 0.025). Conclusion: KPI stickers are a simple and reliable way of ensuring best practice in the pre-hospital management of NTCA. This could be associated with an increase in the rate of ROSC.
e11
to the applied resuscitation guidelines (1998, 2000, 2005) only patients with OHCA within one of three defined periods were enrolled: period I January 1st 1998–July 31st 2000, period II August 1st 2001–October 31st 2005 and period III March 1st –December 31st 2008. Results: 3886 patients sustained OHCA between January 1st –December 31st 2008. 3222 patients were ≥18 years and had no TCPA. 2234 patients with OHCA within the periods I (32 months), II (51 months) and III (34 months) underwent further analysis. Groups did not differ according age, gender, location of OHCA or if OHCA was witnessed. Within the three periods VF/VT as initial rhythm decreased from 34.0%–26.8%–20.6%. No change of the rate of return of spontaneous circulation (ROSC) was observed, while more of patients (8.8% vs. 10.8% vs. 12.1%) were discharged from hospital with good neurologic outcome (CPC 1/2) and less with unfavorable neurologic outcome over the periods. Conclusion: While the circumstances for an OHCA as well as the ROSC rate remained unchanged and despite non-VF/VT has been the initial rhythm with increasing frequency, significantly more patients survived with good neurologic outcome. We hypothesize that this reflects improved efficiency of resuscitation efforts following the guideline changes from 1998–2000 and to 2005 but more detailed analyses are necessary to understand these results. Further reading [1].Robertson C. The 1998 European Resuscitation Council guidelines for adult advanced life support: A statement from the Working Group on Advanced Life Support, and approved by the executive committee of the European Resuscitation Council. Resuscitation 1998;37:81–90. [2].De Latorre F. European Resuscitation Council. European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support. A statement from the Advanced Life Support Working Group and approved by the Executive Committee of the European Resuscitation Council. Resuscitation 2001;48:211–21. [3].Nolan JP. European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 2005;67(Suppl 1):S39–86.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.029 Further reading [1].Nolan J. European Resuscitation Council Guidelines for Resuscitation 2010. Resuscitation 2010;81. [2].Chesters A. Key performance indicators: can stickers improve documentation of pre-hospital cardiac arrests? Oct 2011. Resuscitation 2011;82.
Defibrillation AS025
http://dx.doi.org/10.1016/j.resuscitation.2012.08.028
Amplitude spectrum area to predict defibrillation outcome after recurrent and defibrillation resistant ventricular fibrillation during pre-hospital cardiopulmonary resuscitation
AS024
Giuseppe Ristagno 1,∗ , Weilun Quan 2 , Gary Freeman 2
Outcome from out-of-hospital cardiac arrest in dependency of applied resuscitation guidelines. A regional outcome analysis of 2234 resuscitations between 1998 and 2009
1
Markus Roessler 1,∗ , Alexander Stumpf 1 , Simon Oliver Schmid 1 , Jan Bahr 1 , Michael Quintel 1
Schneider 2 ,
1
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Goettingen, Germany 2 Department of Medical Statistics, University Medicine, Goettingen, Germany Background: ERC guidelines for resuscitation are developed as a consensus of science. Every update has been made with the aim to improve survival with good outcome following cardiac arrest. We investigated if survival did improve after sustained out-of-hospital cardiac arrest (OHCA) between 1998 – 2009. Methods: All patients with OHCA seen by the regional Emergency Medical Services were documented according the Utsein–style. Patients <18 years or with traumatic cardiopulmonary arrest (TCPA) were excluded. For unambiguous allocation
2
Mario Negri Institute for Pharmacological Research, Milan, Italy ZOLL Medical Corporation, Chelmsford, MA, USA
Aim: The delivery of a second or subsequent defibrillation (DF) during CPR, may be due to ventricular fibrillation (VF) reoccurring after an initially successful DF that has achieved ROSC (recurrent VF), or due to VF that has not been terminated by the preceding DF (DF-resistant VF). We evaluated the ability of Amplitude Spectrum Area (AMSA) to predict DF outcome for subsequent DF attempts during pre-hospital CPR. We hypothesized different AMSA thresholds for recurrent compared to DF-resistant VF. Methods: ECG data were obtained from 748 VF patients from multiple areas in the US. A 4.1 sec ECG window ending at 0.5 sec before DF was analyzed using the AMSA algorithm employing fast Fourier transformation. A successful DF attempt was defined as the presence of an organized rhythm ≥ 40 bpm starting within 60 s from the DF. For subsequent DFs, VF was classified as recurrent VF or DF-resistant VF. Receiver operator characteristic (ROC) curves were calculated to assess the ability of the AMSA algorithm to predict outcome of subsequent DFs.
e12
Oral Presentations / Resuscitation 83 (2012) e1–e23
Results: A total of 1226 quality DF events from 609 patients were included. Among the analyzed 578 first DFs, 156 successfully terminated VF (26.9%), while 422 failed (73%). Among the 648 subsequent DFs, 520 were delivered for DF-resistant VF and 128 for recurrent VF. AMSA prior to all subsequent DFs was 9.1 mV-Hz, and AMSA values were higher prior to successful DFs in contrast to failed ones (14.9 vs. 7.3 mV-Hz, p<0.0001). Recurrent VFs presented higher AMSA (15.7 vs. 7.4 mV-Hz, p < 0.0001) and greater DF success (79.7% vs. 8.8%) compared to DF-resistant VFs. However, no difference in AMSA prior to a successful DF in comparison to that prior to a failed one was observed for recurrent VFs (16 vs. 14.6 mV-Hz, p = 0.52). For DF-resistant VFs, AMSA was higher prior to a successful DF than prior to a failed one (13.5 vs. 6.8 mVHz, p < 0.0001). ROC curves demonstrated the ability of AMSA to predict DF outcome for subsequent DFs (AUC 0.867). However, the AMSA approach was accurate only for DF-resistant VFs (AUC 0.82), but not in the case of recurrent VFs (AUC 0.62). Conclusions: For subsequent DFs, AMSA was confirmed to be significantly higher prior to a successful attempt rather than an unsuccessful one. However, the AMSA approach was accurate only in the instance of DF-resistant VFs. Recurrent VFs present high AMSA and DF success and thus should receive immediate DF. http://dx.doi.org/10.1016/j.resuscitation.2012.08.030 AS026 Rapid decreases in Amplitude Spectrum Area after Interruption of chest compression in out-of-hospital cardiac arrest patients Giuseppe Ristagno 1,∗ , Qing Tan 2 , Weilun Quan 2 1 2
Mario Negri Institute for Pharmacological Research, Milan, Italy ZOLL Medical Corporation, Chelmsford, MA, USA
Purpose of the study: Interruptions in chest compression (CC) have been shown to cause rapid decreases in coronary perfusion in animal models. Amplitude spectrum area (AMSA) is an accurate predictor of successful defibrillation (DF) and increases when CPR quality improves. We investigated changes in AMSA occurring after interruption of CC during pre-hospital CPR. We hypothesized that AMSA would rapidly decrease after CC interruption. Materials and methods: Electrocardiographic (ECG) data, including 1410 DF attempts, were obtained from 748 cardiac arrest patients from multiple areas in the US. Starting from the onset of CC interruption and throughout the 16 s pre-DF pause imposed by current AEDs, consecutive 512 point, or 2.05 s, ECG data segments were analyzed and AMSA was calculated. Changes in AMSA values were compared between consecutive 2 s interval pairs during CC interruption. Results: A total of 620 qualified CC interruption events from 352 patients were included in the analyses. AMSA continuously decreased during the early 16 s CC interruption from initially 7.2 to 6.9, 6.5, 6.3, 6.2, 6.2, 6.1 and then 6.0 mVHz in the last 2 s interval. Compared to the preceding 2 s intervals, the p values were 0.0003, 0.0000, 0.045, 0.002, 0.11, 0.12 and 0.36, respectively. Conclusions: AMSA decreased immediately after onset of CC interruption during pre-hospital CPR. Significant decreases occurred during the initial 8 s of interruption and were likely related to the reduced myocardial perfusion. These findings suggest a need for protocols that can significantly reduce pre-shock CC pauses. http://dx.doi.org/10.1016/j.resuscitation.2012.08.031
AS027 Public Access Defibrillation in real-life settings Anne Møller Nielsen 1,∗ , Fredrik Folke 2 , Freddy Lippert 3 , Lars Rasmussen 1 1
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark 2 Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark 3 Emergency Medicine and Emergency Medical Services, Head Office, The Capital Region of Denmark, Denmark
Background: Automated External Defibrillators (AED) are known to increase survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the use and benefit of public-access defibrillation (PAD) in a nation-wide network. We primarily sought to assess survival at 1 month but information about the circumstances of each OHCA is provided as well. We hypothesized that subjects with an initial shockable rhythm would have a higher survival rate at one month. Methods: In this 28–month study, we assessed the use of 807 AEDs in Denmark. When an AED was deployed information about the circumstances of OHCA, the bystander, the AED and the victim’s condition was obtained. Results: An AED was connected to an OHCA victim prior to the arrival of Emergency Medical Services (EMS) in 48 instances. Among the bystanders, 10% were off-duty healthcare professionals. Shockable arrests (N = 31, 70%) were significantly more likely to be witnessed (94% vs. 54%) to occur at sports facilities (74% vs. 31%), in relation to exercise (42% vs. 0%), and with improved 30day survival (69% vs. 15%, P = 0.001). Among those presenting with a shockable rhythm, 8 (26%) were conscious upon arrival of EMS. Survival could be determined in 42 out of 44 patients with OHCA of cardiac origin, and was 52% (n = 22, 95% CI [38–67]) and The Cerebral Performance Category was 1 (Good Cerebral Performance) in all survivors. Conclusion: With a 30–day neurologically intact survival of 69% for patients with shockable rhythms, this study provides further evidence of the lifesaving potential of PAD. http://dx.doi.org/10.1016/j.resuscitation.2012.08.032 AS028 Short message service to alert lay rescuers in out-of-hospital cardiac arrest: How many AEDs are needed to defibrillate within 6 minutes? Jolande Zijlstra ∗ , Remy Stieglis, Rudolph Koster Academic Medical Center, Amsterdam, The Netherlands Purpose: Time from emergency call to first shock is too long in VF out-of-hospital cardiac arrest (OHCA) patients. 1 A short message service (SMS) alert system for lay rescuers has been recently implemented in The Netherlands. This system uses SMS to make EMS alert lay rescuers to go to victims, perform CPR and use an AED located within a circle of 500–1000 m from the victim. We evaluated the relation between the number of AEDs in the system and the time between call and first shock. The aim is to reduce this time to <6 min. Methods: We analyzed all patients with a nontraumatic OHCA where a defibrillator was connected from February 2010–January 2012, in two regions in The Netherlands with total 1.27 million inhabitants. We excluded all EMS-witnessed cardiac arrests. The