Background-A clinical observational study revealed that rescuers consistently hyperventilated patients during out-ofhospital cardiopulmonary resuscitation (CPR).

Objective-To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry-Cardiac Arrest. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Nonauthor contributions outlined in Online Appendix 1 Methods-The ROC Epistry-Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMS)-attended 9-1-1 calls for patients with out-ofhospital cardiac arrest occurring in the geographical area described by the eight US and three Canadian regions. The data set was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience cardiac arrest outside the hospital, with evaluation by organized EMS personnel and: a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; OR b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry-Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm arrests and 4000 and 5000 ventricular fibrillation arrests annually and approximately 8000 EMS-attended but untreated arrests. Conflict of interest: None NIH Public AccessConclusion-We describe the rationale, development, design and future implications of the ROC Epistry-Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry-Cardiac Arrest and the ROC trials.

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