Introduction Since the original description [1], cardiopulmonary re- suscitation has become standardized through the Amer- ican Heart Association cardiac life support guidelines [2]. Time to basic life support, including defibrillation, should be as short as possible to improve survival [3, 4, 5, 6], especially when advanced life support is delayed [7, 8]. On the other hand, basic life support has been identified as a variable predicting poor prognosis [9, 10]. Even early defibrillation demonstrated controver- sial benefit after cardiac arrest [11, 12, 13, 14, 15, 16, 17, 18, 19, 20] and no studies in adults have isolated the im- pact of intubation or intravenous drug therapy on out- come [21, 22, 23]. Each of these emergency cardiac care components produces costs [24, 25, 26]. Adminis- trators seldom take into account the costs of hospitaliza- tion and rehabilitation after cardiac arrest [27] and some still consider the natural course of life to be most benefi- cial for their calculations. The aim of the present study, therefore, was to eval- uate the impact of basic life support, time to first Andreas Bur Harald Kittler Fritz Sterz Michael Holzer Philip Eisenburger Elisabeth Oschatz Julia Kofler AntonN.Laggner Effects of bystander first aid, defibrillation and advanced life support on neurologic outcome and hospital costs in patients after ventricular fibrillation cardiac arrest Received: 12 October 2000 Final revision received: 26 June 2001 Accepted: 27 June 2001 Published online: 8 August 2001  Springer-Verlag 2001 A.Bur ´ F.Sterz  ) )´M.Holzer´ P.Eisenburger ´ E.Oschatz ´ J.Kofler ´ A.N.Laggner University Clinic of Emergency Medicine, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18±20/6/D, 1090 Vienna, Austria E-mail: Fritz.STERZ@AKH-Wien.AC.AT Phone: +43-1-404001964 or 1952 Fax:+43-1-404001965 H.Kittler Department of Dermatology, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18±20/6/D, 1090 Vienna, Austria Abstract Objective: To evaluate the effects of basic life support, time to first defibrillation and emergency medical service arrival time on neu- rologic outcome and expenses for hospital care in patients after cardi- ac arrest. Setting: Large urban emergency medical services system and emer- gency department in a 2000-bed university hospital. Design: Outcome and cost benefit analysis of patients admitted to the hospital after witnessed, out-of-hos- pital, ventricular fibrillation cardiac arrest from October 1, 1991, until December 31, 1997. Patients: Out of 1245 patients with out-of-hospital cardiac arrest, 276 were eligible. Measurements and results: The ef- fects of basic and advanced life sup- port measures on neurologic out- come and hospital expenses were evaluated. In contrast to intubation odds ratio 1.08; 95% CI: 0.51±2.31; p = 0.84), basic life support odds ratio 0.44; 95% CI: 0.24±0.77; p = 0.004) and time to first defibril- lation odds ratio 1.08; 95% CI: 1.03±1.13; p = 0.001) were signifi- cantly correlated with good neuro- logic outcome. Among the patients who did not receive basic life sup- port, the average cost per patient with good neurologic outcome sig- nificantly increased with the delay of the first defibrillation p < 0.001). Conclusions: In contrast to intuba- tion, bystander basic life support and time to first defibrillation were significantly associated with good neurologic outcome and resulted in fewer expenses spent on in-hospital efforts. Keywords Basic life support ´ Cardiopulmonary resuscitation ´ Defibrillation ´ Heart arrest ´ Hospital costs ´ Intubation ´ Outcome assessment ´ Ventricular fibrillation Intensive Care Med 2001) 27: 1474±1480 DOI 10.1007/s001340101045 ORIGINAL