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To the Editor: Phase 2 of the Ontario Prehospital Advanced Life Support (OPALS) study¹ prospectively assessed the effectiveness of interventions for out-of-hospital cardiac arrest (OHCA). The improvement in survival from phase 1 to phase 2 illustrates the importance of system optimization in the treatment of OHCA.

However, the authors' statement that "phase 2 has clearly shown the effectiveness of an inexpensive program of rapid defibrillation" is not supported by the data. In fact, there was no difference in survival for patients initially found to have ventricular fibrillation (VF) or ventricular tachycardia (VT) (10.0% vs 11.9%; P=.17). The appropriate denominator for assessing the impact of rapid defibrillation is the population that would benefit from this intervention—patients who have VF or VT. It was only after the inclusion of all patients with cardiac arrest (including those with pulseless electrical activity and asystole) that a significant difference in survival was found. Although . . . [Full Text of this Article]

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