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(Circulation. 2007;115:1503.)
© 2007 American Heart Association, Inc.

Issue Highlights

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	BIPHASIC TRIAL: A RANDOMIZED COMPARISON OF FIXED LOWER VERSUS ESCALATING HIGHER ENERGY LEVELS FOR DEFIBRILLATION IN OUT-OF-HOSPITAL CARDIAC ARREST, by Stiell et al.

 
Current resuscitation guidelines for cardiac arrest specify 360-J shocks with monophasic waveform external defibrillators and 150- to 200-J shocks with biphasic waveform defibrillators. Whether to increase shock strength with biphasic waveform defibrillators when the initial shock fails is not clear. Stiell and colleagues used automatic external defibrillators with recording capabilities to conduct a randomized trial of biphasic waveform shocks fixed at 150 J for initial and 2 subsequent shocks versus a 200 J initial shock followed by escalating shock strengths of 300 J and 360 J in out-of-hospital cardiac arrest victims. First shock conversion was similar with either energy, but escalating shock strengths improved conversion to a stable rhythm after a failed first shock with no evidence of additional myocardial damage. Although the trial was not powered to assess long-term outcome, the findings support increasing shock strength after initial failed defibrillation and will inform future guidelines. See p 1511.

	COMPARISON OF CLINICAL AND ADMINISTRATIVE DATA SOURCES FOR HOSPITAL CORONARY ARTERY BYPASS GRAFT SURGERY REPORT CARDS, by Shahian et al.

 
Cardiac surgeons have consistently led the effort to collect, analyze, and apply outcome data for the benefit of patients. Cardiac surgery is also the paradigm for public performance reporting. Public performance report cards and consumer demand for reliable, transparent outcomes data must be based on the highest quality, validated information that is rigorously analyzed with appropriate statistical methodology. The gold standard is a prospectively maintained, clinical database containing core clinical variables. Using both standard logistic regression and hierarchical models, the results of hospitals can be compared. There has always been debate about the use of administrative databases, designed for financial . . . [Full Text of this Article]

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