Study objective: This study correlated the delay in initiation of bystander 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: Prospective 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. © 2005 Elsevier Ireland Ltd. All rights reserved.
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