? Admission to a hospital with PCI capability is an independent predictor of discharge with good neurological status, regardless of implementation of either PCI or mild therapeutic find FAQ hypothermia.? The EMS providers substantially influence patient survival directly with their choice of admitting hospital.AbbreviationsCI: confidence interval; CPC: cerebral performance categories; CPR: cardiopulmonary resuscitation; EMS: emergency medical service; OHCA: out-of-hospital cardiac arrest; PCI: percutaneous coronary intervention.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsJW and SS made substantial contributions to conception and design, and drafted the manuscript. RL provided statistical support.

J-TG conceived of the study, participated in its design and coordination, and helped to draft the manuscript. MH, HL, KB, MF, TJ, BB and MM were involved in the internal reviewing process. All authors read and approved the manuscript for publication.Supplementary MaterialAdditional file 1:Table S1 presenting admitting hospital distribution criteria. Table S2 presenting in-hospital therapy and outcome of patient primarily admitted to a hospital without PCI capability. Table S3 presenting factors influencing hospital discharge after OHCA. Table S4 presenting factors influencing neurological outcome after OHCA.Click here for file(184K, PDF)AcknowledgementsJW, MF, MM, TJ and JTG are members of the steering committee of the German Resuscitation Registry. SS is an associated medical student working in the German Resuscitation Registry.

HL is emergency medical director in the Fire Department of Dortmund. KB was involved in product development for Golden Hour Data System in 1997 and 1998. The authors are indebted to all physicians and emergency medical technicians involved in pre-hospital and in-hospital care after OHCA. Furthermore, the authors thank the EMS Dortmund, the hospitals and the general practitioners involved in this study.
For more than 100 years, pronounced extracellular acidosis has been known to depress contractility in the healthy myocardium [1-3]. The mechanisms underlying this negative inotropic effect, however, are complicated by the fact that changing the pH can modify many of the cellular systems involved in the excitation-contraction (EC) coupling pathway, including both the delivery of Ca2+ to the myofilaments and the Ca2+ sensitivity of the myofilaments [4-10].

Dacomitinib Several Ca2+ transport systems are depressed at a low pH, including the SR Ca2+-ATPase (SERCA), the ryanodine receptor (RyR), and the Na+/Ca2+ exchanger (NCX) [6]. Therefore, acidosis has been shown to decrease the cellular Ca2+ transient amplitude [1]. Kohlhardt and co-workers [11] showed a significantly decreased cardiac output induced by acidosis (pH 7.