Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review.

Ming Xuan Han,Shalini Arulanandam,Norman Huangyu Lin,Marcus Eng Hock Ong,Amelia Natasha Wen Ting Yeo,Yu Liang Lim,Bobo Tan,Karen Smith,Andrew Fu Wah Ho,Qin Xiang Ng

doi:10.3390/jcm10204684

Abstract

Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge (n = 3) and neurologically favourable survival (n = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients.

Highlights

Emergencies occurring in high-rise buildings are becoming increasingly prevalent due to rapid urbanisation globally and they present significant challenges to prehospital emergency care
This scoping review protocol was guided by recommendations from Arksey and O’Malley’s framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [13,14] As the study designs and definition of high-rise differed across contexts with no clear indication of homogeneity in the literature, a scoping review, instead of a systematic review, was chosen to give an overarching perspective of the challenges, prognoses, unique approaches, and solutions in caring for of-hospital cardiac arrests (OHCAs) occurring in high-rise settings
return of spontaneous circulation (ROSC): Significantly lower likelihood of ROSC in a vertical location of cardiac arrest (OR: 0.40, 95% CI 0.17–0.98, p = 0.044) Survival to hospital admission: No statistically significant differences between OHCA patients from ground floors vs. nonground floors Qualitative survey: 85.2% felt there was a lower quality of chest compressions for patients above ground floor, and 93.1% felt that mechanical cardiopulmonary resuscitation (CPR) devices could circumvent this

Summary

Introduction

Emergencies occurring in high-rise buildings are becoming increasingly prevalent due to rapid urbanisation globally and they present significant challenges to prehospital emergency care. A study from Singapore went on to demonstrate a dose–response effect in the highly urbanised Southeast Asian city, with survival being lower with incremental floors above the ground [7]. The reasons for this effect are unclear, but the findings of delayed access to patients, increased transport times, and reduced rate of bystander cardiopulmonary resuscitation (CPR) shown in several studies suggest that disruption in the chain of survival ( early CPR) is part of the causal pathway [4,5,6]. Rapid urbanisation and densification, which are happening at an increasing pace [9,10], further complicate this issue of vertical access and care delivery for EMS systems

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