Abstract
As the number of people living in high-rise buildings increases, so does the incidence of cardiac arrest in these locations. Changes in cardiac arrest location affect the recognition of patients and emergency medical service (EMS) activation and response. This study aimed to compare the EMS response times and probability of a neurologically favorable discharge among patients who suffered an out-of-hospital cardiac arrest (OHCA) event while on a high or low floor at home or in a public place. This retrospective analysis was based on Smart Advanced Life Support registry data from January 2016 to December 2017. We included patients older than 18 years who suffered an OHCA due to medical causes. A high floor was defined as ≥3rd floor above ground. We compared the probability of a neurologically favorable discharge according to floor level and location (home vs. public place) of the OHCA event. Of the 6,335 included OHCA cases, 4,154 (65.6%) events occurred in homes. Rapid call-to-scene times were reported for high-floor events in both homes and public places. A longer call-to-patient time was observed for home events. The probability of a neurologically favorable discharge after a high-floor OHCA was significantly lower than that after a low-floor OHCA if the event occurred in a public place (adjusted odds ratio (aOR), 0.58; 95% confidence intervals (CI), 0.37–0.89) but was higher if the event occurred at home (aOR, 1.40; 95% CI, 0.96–2.03). Both the EMS response times to OHCA events in high-rise buildings and the probability of a neurologically favorable discharge differed between homes and public places. The results suggest that the prognosis of an OHCA patient is more likely to be affected by the building structure and use rather than the floor height.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a serious public health issue associated with poor outcomes [1]
E Smart Advanced Life Support (SALS) data set includes patient variables, resuscitation status, and outcome variables according to the international Utstein style for cardiac arrest (CA). e patient variables included age, sex, and comorbidities. e resuscitation variables included the initial electrocardiographic rhythm, witnessed CA, bystander cardiopulmonary resuscitation (CPR), and response time. e outcome variables included a return of spontaneous circulation (ROSC), survival admission, and discharge with a Cerebral Performance Category (CPC) score [1, 2]
We found that OHCA events on a high floor in a home were more likely to involve a younger patient with a witness, shockable initial rhythm, and bystander CPR
Summary
Out-of-hospital cardiac arrest (OHCA) is a serious public health issue associated with poor outcomes [1]. Global incidence of this condition is high, and many countries have implemented programs and actions intended to improve the outcomes of affected patients [1, 2]. Previous studies have identified an association between survival after OHCA and emergency medical service (EMS) access time to patients, which is affected by the EMS system, ambulance density, and arrest location [3,4,5]. Is demographic shift has exacerbated the issue of vertical patient access, as demonstrated by several studies reporting the negative outcomes of patients who experience OHCA in high-rise buildings. Significantly longer patient access times have been observed following ambulance calls for events that occurred ≥3 floors above ground, and an event site on a higher floor was associated with a lower 1-month neurologically favorable survival outcome after OHCA, compared to an event site on a lower floor [7, 8]
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