Fewer than 8% of adult out-of-hospital cardiac arrest (OOH-CA) victims survive to hospital discharge despite public education of event recognition, early notification of 9-1-1, bystander cardiopulmonary resuscitation, automated external defibrillator (AED) use, therapeutic hypothermia, and improvements in emergency medical service delivery.1 Densely populated urban areas such as New York, NY, and Chicago, Ill, where a large number of cardiac arrests occur, report even lower (1.4% to 2%) survival rates.2,3 Unlike other areas of cardiovascular health such as myocardial infarction, which has demonstrated a 3-fold decrease in acute mortality,4 the improvements in outcome from OOH-CA have remained modest over the last 25 years.5 Is this dismal survival and lack of progress a result of the biological lethality of the condition, or has inadequate research been done to define its pathogenesis, pathophysiology, and prevention and the optimal implementation of effective treatments? OOH-CA is obviously a life-threatening condition, yet it is a “treatable disease” in the sense that medical interventions can improve survival significantly.6,–,8 Moreover, a nearly 500% difference in survival rates exists across communities in the United States, suggesting that variability in the quality of resuscitation care is driving large differences in community survival rates.9 Collectively, these data suggest the potential for a major improvement in community survival rates that could save tens of thousands of lives. So where is the problem? Improving care and survival requires a commitment to sustained, high-quality, basic scientific and clinical research. Despite the devastating public health consequences of OOH-CA, the randomized clinical trial (RCT) base from which evidence-based resuscitation guidelines are derived is limited compared with that used to derive evidence-based guidelines for other cardiovascular diseases.Table 1 lists the number of MEDLINE English language citations of resuscitation RCTs compared with ST-elevation myocardial infarction, …