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[Arguments in support of the implementation of the new guidelines for cardio-pulmonary resuscitation in the Netherlands].

The implementation of the new guidelines for cardiopulmonary resuscitation in the Netherlands has been questioned with reference to the expected low cost-effectiveness. The implementation is based on the best available evidence, derived from studies that addressed the specific activities of lay rescuers as well as professionals, but not on studies that integrate all changes in the process, from initial actions of lay rescuers to the last elements of in-hospital management. Therefore, the efficacy of new guidelines cannot be evaluated prior to wide-scale implementation. It is not possible to calculate cost-effectiveness before guidelines are introduced, as controlled studies at population level are not feasible. For this reason, the decision to introduce the new guidelines cannot be based on ideal evidence, with survival as a measure of outcome. Effectiveness can be studied only after full introduction of the procedure, as was demonstrated when the previous guidelines were introduced in 2002. Cost-effectiveness is not a relevant issue, as the cost of implementation of guideline changes to lay rescuers has no impact on the budget for healthcare. In addition, the revision concerns items such as the recognition of circulatory arrest, the balance of thoracic compression versus ventilation and the use of the automatic external defibrillator, which are expected to be very effective. Hence, the implementation of the new guidelines for cardio-pulmonary resuscitation in the Netherlands is justified.