Abstract 410: Differences in Survivability of Out-of-Hospital Cardiac Arrest in Rural versus Urban Minnesota

Abstract

Background: Out-of-Hospital Cardiac Arrest (OHCA) survival has improved in North America due to improved awareness, training, and bystander CPR. An important factor complicating OHCA survival is location on initial arrest, due to distance and access to emergency medical services (EMS). Aims: We sought to examine characteristics of OHCA encounters in Minnesota and determine underlying factors for differences in OHCA survival in rural versus urban areas. Methods: We examined data from the Cardiac Arrest Registry to Enhance Survival (CARES) registry between 2013-2021 in Minnesota. The analyses included encounters from 31 EMS services across the state. The Office of Management and Budget (OMB) county rural-urban classification schema was used to designate categories of rural (non-metropolitan counties of less than 50,000 population) versus urban (metropolitan counties with populations of 50,000 or more). Results: We identified 21,257 patient encounters, of which 3,524 (16.6%) of encounters were designated as rural and 17,733 (83.4%) as urban. In our cohort, patients were predominately male. Rural arrest patients tended to be older (mean age, 64.5 vs 60.6 years, p<0.01) and had a higher prevalence of heart disease (32.2% vs 26.9%, p<0.01). Rural arrests were more likely to be witnessed (57.1% vs 51.6%, p<0.01), receive bystander CPR (42.3% vs 35.2%, p<0.01), and have AED use prior to EMS arrival (55.7% vs 53.5%, p<0.01). The average time for EMS arrival at scene of arrest was longer among rural encounters (12.9 vs 10.6 minutes; p<0.01). Overall, survival-to-discharge was significantly lower among rural versus urban communities (9.3% vs 13.1%, p<0.01). Conclusion: In this analysis of the CARES dataset in Minnesota, there were significant differences in survival characteristics between rural vs urban OHCA patients. These findings warrant greater investment in rural EMS agencies and modifiable resuscitation practices to improve survival among rural communities.