Abstract
BackgroundCharacteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied. AimTo describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces. MethodsData on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs. ResultsAmong 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92–12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07–4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16–0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location. ConclusionOut-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.
Highlights
Factors associated with higher survival are described as the of-hospital cardiac arrest (OHCA) being witnessed, if the patient received early cardiopulmonary resuscitation (CPR), had a detectable shockable rhythm and with the early use of a publicly accessible defibrillator (PAD).8À12 In Sweden, both OHCA and in-hospital cardiac arrests where resuscitation is attempted are reported to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).[11]
The patients with OHCAs at workplaces were more frequently defibrillated before the arrival of the EMS if they were found in a shockable rhythm, compared with all other groups
The 30-day survival at workplaces was 30% and 22% after adjustment and this is far higher than the overall survival rate of 10.3% for OHCAs in Sweden in 2018.25 This is in line with a previous metaanalysis presenting a higher survival rate at workplaces compared with elsewhere,[14] no difference when compared with other public places
Summary
Out-of-hospital cardiac arrest (OHCA) in adults is a leading cause of death and needs to be thoroughly elucidated.1À6 Treatment with cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) has been shown to increase survival, but the survival rate after OHCA still remains poor.[3,7] The global annual incidence of OHCA has been estimated at 30À97 per 100,000 person-years[7] and the 30-day survival rate for OHCAs has been reported to be 11%,8 thereby ranging between 3% and 20%.7 Factors associated with higher survival are described as the OHCA being witnessed, if the patient received early CPR, had a detectable shockable rhythm and with the early use of a publicly accessible defibrillator (PAD).8À12In Sweden, both OHCA and in-hospital cardiac arrests where resuscitation is attempted are reported to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).[11]. Factors associated with higher survival are described as the OHCA being witnessed, if the patient received early CPR, had a detectable shockable rhythm and with the early use of a publicly accessible defibrillator (PAD).8À12. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs. Results: Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. In the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92À12.31). Conclusion: Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital.
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