Incidence Of Out-of-hospital Cardiac Arrest Research Articles

The features and trends of out-of-hospital cardiac arrests in Japanese working generation: long-term aspects of a prospective, nationwide, population-based registry

Abstract Background Despite sudden cardiac death (SCD) in working generation is a crucial issue in terms of public health, social and economic significance, the long-term SCD condition in working generation is unclear. Purpose This study aimed to clarify the features and long-term trends of SCD in working generation from 2005 through 2016 in Japan, using a prospective, nationwide, population based out-of-hospital cardiac arrest (OHCA) registry. Methods We performed data analysis of the nation-wide registry in Japan who experienced OHCA during the 12 years. Working generation was defined as 20 to 69 years and we analyzed only definitive cardiogenic OHCA as an approximation of SCD. Results The number of definitive cardiogenic OHCA of working generation during the period was 66,214 and 31% of the events in whole population was working generation. Definitive cardiogenic OHCA in working generation in terms of both number and percentage of the population had been decreased from 6522 (0.07‰) in 2005 to 4910 (0.06‰) in 2016, bystander cardiopulmonary resuscitation (CPR) and usage of automated external defibrillator (AED) ratio increased from 32.7% in 2005 to 49.6% in 2016, and 0.3% in 2005 to 14.7% in 2016 respectively, and the survival rate after one-month improved year by year, from 12.8% in 2005 to 34.0% in 2016 (picture below). Among non-medical bystanders, CPR was most often performed by colleagues in this generation, while AED use rate by colleague was smaller, and the time from witness to initial defibrillation was significantly longer than by passerby. Good prognosis was observed in terms of one-month survival ratio and neurological outcome for those undergoing CPR by colleague and passerby compared with other bystanders. For 12 years, although the degree varies, all non-medical bystander had same tendency; bystander CPR and usage of AED ratio increased, and the survival rate after one-month and neurological outcome improved year by year. Conclusions Not only the number but the incidence of cardiogenic OHCA in working generation has been decreased in Japan. The positive prognosis of this generation may be related to CPR by colleagues. Figure 1. OHCA number & 1-month survival rate Funding Acknowledgement Type of funding source: None

Out-of-hospital Cardiac Arrest in the Republic of Crimea: Analysis of Epidemiology and Practice of Care

Introduction. Efficient organization of measures aimed at decreasing mortality from out-of-hospital cardiac arrest (OHCA) warrants a clear understanding of OHCA epidemiology and performance of the prehospital care system in such cases. The study was aimed at performing respective analysis and identifying the ways for improving prehospital management of OHCA in the Republic of Crimea.Material and methods. Annual data from the Crimean OHCA and Resuscitation Registry for 2018 were utilized. All OHCA cases attended by emergency medical services (EMS) with attempted cardiopulmonary resuscitation (CPR) were included, regardless of cardiac arrest etiology or patients’ age (n=419). For ensuring conformity and comparability of the study results, data collection and analysis were executed in correspondence with the statements of the Utstein recommendations.Results. The overall incidence of EMS-attended OHCA in the Republic of Crimea was 673.3 per 100,000 population per year, the incidence of OHCA with attempted CPR – 21.9 per 100,000 population per year, the proportion of CPR attempts out of all OHCA cases – 3.3%. Mean patient age was 66.9 years, and 52.7% were male. The etiology was cardiac in 42.5% cases. In 71.8% cases OHCA was witnessed by EMS, in 25.5% – by a bystander before EMS arrival. Bystanders initiated CPR in 5.7% cases. The initial rhythm was asystole in 80.4% of all cases. When excluding EMS-witnessed cases, the mean EMS response time was 13 min. 5.0% patients had a sustained return of spontaneous circulation at hospital admission. Survival was associated with lower EMS response time (p=0.027), administration of shock (p<0.001) and advanced airway management with endotracheal tube or laryngeal mask (p=0.047).Conclusion. High incidence of OHCA, low rates of CPR commencement and low rates of survival from OHCA in the Republic of Crimea determine the necessity of implementing a comprehensive program to improve prehospital care in the region. Considering the critical relevance of early intervention in OHCA and the revealed low bystander CPR rate, the measures for involving community into the process of prehospital care should form the basis of this program.

Spatio-temporal prediction model of out-of-hospital cardiac arrest: Designation of medical priorities and estimation of human resources requirement.

To determine the out-of-hospital cardiac arrest (OHCA) rates and occurrences at municipality level through a novel statistical model accounting for temporal and spatial heterogeneity, space-time interactions and demographic features. We also aimed to predict OHCAs rates and number at municipality level for the upcoming years estimating the related resources requirement. All the consecutive OHCAs of presumed cardiac origin occurred from 2005 until 2018 in Canton Ticino region were included. We implemented an Integrated Nested Laplace Approximation statistical method for estimation and prediction of municipality OHCA rates, number of events and related uncertainties, using age and sex municipality compositions. Comparisons between predicted and real OHCA maps validated our model, whilst comparisons between estimated OHCA rates in different yeas and municipalities identified significantly different OHCA rates over space and time. Longer-time predicted OHCA maps provided Bayesian predictions of OHCA coverages in varying stressful conditions. 2344 OHCAs were analyzed. OHCA incidence either progressively reduced or continuously increased over time in 6.8% of municipalities despite an overall stable spatio-temporal distribution of OHCAs. The predicted number of OHCAs accounts for 89% (2017) and 90% (2018) of the yearly variability of observed OHCAs with prediction error ≤1OHCA for each year in most municipalities. An increase in OHCAs number with a decline in the Automatic External Defibrillator availability per OHCA at region was estimated. Our method enables prediction of OHCA risk at municipality level with high accuracy, providing a novel approach to estimate resource allocation and anticipate gaps in demand in upcoming years.

Incidence, bystander emergency response management and outcomes of out-of-hospital cardiac arrest at exercise and sport facilities in Australia.

Despite growing emphasis on automated external defibrillators (AEDs) at sport venues in Australia, the risk of cardiac events at such locations is unknown. The aim of the present study was to investigate the incidence of out-of-hospital cardiac arrest (OHCA) at exercise and sport facilities (ESF) in Australia and the impact of effective bystander-initiated CPR and AED use on return of spontaneous circulation (ROSC) to hospital admission. Data were obtained from the Queensland Ambulance Service for the 8-year period between January 2007 and January 2015. Data were analysed using descriptive statistics, non-parametric correlational tests and logistic regression. The OHCA incidence rate (IR) for ESF categories was standardised for 100 000 participant-years. Over the 8-year period, there were 250 OHCA events with a median age of 62 years (interquartile range 49-69) comprising mostly males (86.6%, n = 187). The risk of OHCA for 100 000 participants per year was highest at outdoor sports facilities (IR 5.1) followed by indoor sports or fitness facilities (IR 0.8). On arrival of paramedics, bystander-initiated CPR and AED was present at 12.4% (n = 31) of the cases achieving 33.3% (n = 9) ROSC to hospital admission. The odds of ROSC for effective CPR was 2.3 times the odds of ROSC for no CPR (P = 0.01). These findings have implications for policy development by government agencies and major sport and exercise organisations to improve bystander CPR and AED. This can help to ensure that ESF can properly respond to cardiac emergencies to save lives.

Impact of Racial and Gender Variations in Patients With Out-of-hospital Cardiac Arrest: A Nation-Wide Study.

The overall incidence of Out-of-hospital Cardiac Arrest (OHCA) is decreasing worldwide due to emergency responses, but there are gender and racial differences in the incidence of OHCA, which remain under investigation. Our aim was to identify the incidence, gender, and racial disparities in patients admitted with OHCA. The National Inpatient Sample Database is one of the largest all-payer inpatient database. It was queried to identify patients 18 years or older who were hospitalized with the principal diagnosis of OHCA. There was a total of 85,988 patients who were discharged with a diagnosis classified as OHCA using the ICD-9 code for a period of 2 years. The mean age of the patients who had presented to the hospital with OHCA was 64.3 (±18.5 years). Overall, a greater number of males suffered from OHCA were compared with female population of (48,635 vs 37,366; P < 0.0001). The incidence of OHCA was higher among Caucasians as compared with African Americans (54,812, 63.8% vs 13,787, 16%; P < 0.0001). In-hospital deaths after OHCA were 43,024 (50%). But African Americans had higher mortality than Caucasians after hospitalization for OHCA (adjusted odds ratio, 1.23; 95% confidence interval, 1.18-1.26; P < 0.01). We observed significant differences in gender and racial factors in the patients who were admitted to the hospital with a diagnosis of OHCA based on an analysis of the national inpatient database.

Incidence, characteristics, and outcomes of pediatric out-of-hospital cardiac arrest in nursery schools and kindergartens in Japan

BackgroundA better understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring in nursery schools and kindergartens is indispensable to establish an evidence-based strategy for prevention and improved outcomes. This study aimed to describe the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools and kindergartens. MethodsStop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a study to construct and analyze a nationwide registry of pediatric OHCAs occurring in school settings in Japan. Using data from the SPIRITS registry, we assessed the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools/kindergartens between April 2008 and December 2016. ResultsDuring the study period, 37 OHCA patients (31 in certified nursery schools and 6 in kindergartens) were confirmed. The overall incidence rate was 0.13 per 100,000 children per year. Among 37 patients, 57% (21/37) had an OHCA while napping and 35% (13/37) experienced OHCA that was witnessed by bystanders. Although public-access automated external defibrillator pads were applied by bystanders in 24% (9/37) of cases, only 1 patient actually received defibrillation. Overall, the proportion of 1-month survival with favorable neurological outcomes after OHCA was 19% (7/37). Among those with OHCA of non-medical origins, 60% (3/5) of patients experienced arrest caused by suffocation, 60% (3/5) by drowning, and 100% (1/1) by head injury. In contrast, no patient had 1-month favorable neurological outcomes among those with OHCA of medical origins such as presumed cardiac origin (0/17), sudden infant death syndrome (0/6), acute viral myocarditis (0/1), respiratory disease (0/1), and ventricular fibrillation (0/1). ConclusionsIn this population, the majority of pediatric OHCAs occurring in certified nursery schools/kindergartens had non-ventricular fibrillation rhythm, and their outcomes after OHCA of medical origin were poor.

COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests.

AimsAn increase in out-of-hospital cardiac arrest (OHCA) incidence has been reported in the very early phase of the COVID-19 epidemic, but a clear demonstration of a correlation between the increased incidence of OHCA and COVID-19 is missing so far. We aimed to verify whether there is an association between the OHCA difference compared with 2019 and the COVID-19 epidemic curve.Methods and resultsWe included all the consecutive OHCAs which occurred in the Provinces of Lodi, Cremona, Pavia, and Mantova in the 2 months following the first documented case of COVID-19 in the Lombardia Region and compared them with those which occurred in the same time frame in 2019. The cumulative incidence of COVID-19 from 21 February to 20 April 2020 in the study territory was 956 COVID-19/100 000 inhabitants and the cumulative incidence of OHCA was 21 cases/100 000 inhabitants, with a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). A strong and statistically significant correlation was found between the difference in cumulative incidence of OHCA between 2020 and 2019 per 100 000 inhabitants and the COVID-19 cumulative incidence per 100 000 inhabitants both for the overall territory (ρ 0.87, P < 0.001) and for each province separately (Lodi: ρ 0.98, P < 0.001; Cremona: ρ 0.98, P < 0.001; Pavia: ρ 0.87, P < 0.001; Mantova: ρ 0.81, P < 0.001).ConclusionThe increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic and is coupled with a reduction in short-term outcome. Government and local health authorities should seriously consider our results when planning healthcare strategies to face the epidemic, especially considering the expected recurrent outbreaks.

Observational, retrospective analysis of the circadian variability of out-of-hospital cardiac arrest within days of the week

Introduction Previous studies showed a significant difference in out-of-hospital cardiac arrest (OHCA) occurrence between days of the week, with its highest incidence from Saturday to Monday and lowest in the middle of the week (Tuesday to Friday). The aim of this study was to compare the diurnal variability of the occurrence of OHCA on the days with the highest and lowest incidence of the latter. Methods Retrospective analysis of 815 OHCA cases with presumed cardiac etiology in Opole (Poland), covering a 2-year period (2006-2007). Statistical evaluation of the circadian patterns of OHCA occurrence on days with the highest and the lowest OHCA prevalence. Results Circadian variability of OHCA incidence, assessed by comparing consecutive 3-hour intervals, was present on Saturday to Monday (p=0.04), but absent on Tuesday to Friday (p=0.08). Both analyzed periods differed in terms of the morning (09:00-11:00) peak of OHCA occurrence, which was clearly seen on Saturday-Monday, but absent in the mid-week (median 8.0 [7.0-10.0] vs 5.0 [5.0-6.5], p=0.03). Conclusions The occurrence of OHCA follows different patterns on Saturday to Monday versus the mid-week days, with a pronounced morning peak only on Saturday to Monday.

COVID-19: long-term effects on the community response to cardiac arrest?

COVID-19: long-term effects on the community response to cardiac arrest?

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study

SummaryBackgroundAlthough mortality due to COVID-19 is, for the most part, robustly tracked, its indirect effect at the population level through lockdown, lifestyle changes, and reorganisation of health-care systems has not been evaluated. We aimed to assess the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in an urban region during the pandemic, compared with non-pandemic periods.MethodsWe did a population-based, observational study using data for non-traumatic OHCA (N=30 768), systematically collected since May 15, 2011, in Paris and its suburbs, France, using the Paris Fire Brigade database, together with in-hospital data. We evaluated OHCA incidence and outcomes over a 6-week period during the pandemic in adult inhabitants of the study area.FindingsComparing the 521 OHCAs of the pandemic period (March 16 to April 26, 2020) to the mean of the 3052 total of the same weeks in the non-pandemic period (weeks 12–17, 2012–19), the maximum weekly OHCA incidence increased from 13·42 (95% CI 12·77–14·07) to 26·64 (25·72–27·53) per million inhabitants (p<0·0001), before returning to normal in the final weeks of the pandemic period. Although patient demographics did not change substantially during the pandemic compared with the non-pandemic period (mean age 69·7 years [SD 17] vs 68·5 [18], 334 males [64·4%] vs 1826 [59·9%]), there was a higher rate of OHCA at home (460 [90·2%] vs 2336 [76·8%]; p<0·0001), less bystander cardiopulmonary resuscitation (239 [47·8%] vs 1165 [63·9%]; p<0·0001) and shockable rhythm (46 [9·2%] vs 472 [19·1%]; p<0·0001), and longer delays to intervention (median 10·4 min [IQR 8·4–13·8] vs 9·4 min [7·9–12·6]; p<0·0001). The proportion of patients who had an OHCA and were admitted alive decreased from 22·8% to 12·8% (p<0·0001) in the pandemic period. After adjustment for potential confounders, the pandemic period remained significantly associated with lower survival rate at hospital admission (odds ratio 0·36, 95% CI 0·24–0·52; p<0·0001). COVID-19 infection, confirmed or suspected, accounted for approximately a third of the increase in OHCA incidence during the pandemic.InterpretationA transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies.FundingThe French National Institute of Health and Medical Research (INSERM)

Age-specific trends in incidence and survival of out-of-hospital cardiac arrest from presumed cardiac cause in Denmark 2002–2014

BackgroundThe general cardiovascular health has improved throughout the last few decades for middle-aged and older individuals, but the incidence of several cardiovascular diseases is reported to increase in younger people. We aimed to assess the age-specific incidence and mortality rates associated with out-of-hospital-cardiac-arrest (OHCA) between 2002 and 2014. MethodsWe used the Danish Cardiac Arrest Register to identify patients with OHCA of presumed cardiac etiology. We calculated the annual incidence rates (IR) and 30-day mortality rates (MR) in 7 age groups (18–34 years, 35–44 years, 45–54 years, 55–64 years, 65–74 years, 75–84 years and ≥85 years, and ≤50 vs. >50 years). ResultsBetween 2002 and 2014, IR of OHCA decreased in individuals aged 65–74 and 75–84 years (158.08 to 111.2 and 237.5 to 217.09 per 100,000 person-years) and increased in the oldest from 201.01 to 325.4 pr. 100.000 person-years. In 18–34-years incidence of OHCA increased from 1.7 to 2.6 per 100.000 person-years. When stratifying into age ≤50 vs. >50 years, the IR deviated in those >50 years (from 117.8 in 2002 to 91 in 2008 to 117.4 in 2014100,000 person-years). The prevalence of acute myocardial infarction and heart failure prior to OHCA increased in the younger patient group in contrast to the older segment (AMI: ≤50 years: 10% to 16%, vs. >50 years: 25% to 23%, heart failure: ≤50 years 6% to 14%, vs. >50 years: 21% to 24%). ConclusionOver the last decades, incidence rates of OHCA decreased in individuals aged 65–84, but increased in individuals older than 85. An increase was also observed in younger individuals, potentially indicating a need for better cardiovascular disease prevention in younger adults.

Relationship between socioeconomic status and incidence of out-of-hospital cardiac arrest is dependent on age

BackgroundThe association between socioeconomic status (SES) and incidence of out-of-hospital cardiac arrest (OHCA) is not fully understood. The aim of this study was to see if area-level socioeconomic differences, measured...

Association of Fine Particulate Matter Exposure With Bystander-Witnessed Out-of-Hospital Cardiac Arrest of Cardiac Origin in Japan

Out-of-hospital cardiac arrests (OHCAs) are a major public health concern and a leading cause of death worldwide. Exposure to ambient air pollution is associated with increases in morbidity and mortality and has been recognized as a leading contributor to global disease burden. To examine the association between short-term exposure to particulate matter with a diameter of 2.5 μm or smaller (PM2.5) and the incidence of OHCAs of cardiac origin and with the development of initial cardiac arrest rhythm. This case-control study used data from cases registered between January 1, 2005, and December 31, 2016, in the All-Japan Utstein Registry, a prospective, nationwide, population-based database for OHCAs across all 47 Japanese prefectures. These OHCA cases included patients who had bystander-witnessed OHCAs and for whom emergency medical services responders initiated resuscitation before hospital transfer. A case-crossover design was employed for the study analyses. A prefecture-specific, conditional logistic regression model to estimate odds ratios was applied, and a random-effects meta-analysis was used to obtain prefecture-specific pooled estimates. All analyses were performed from May 7, 2019, to January 23, 2020. The main outcome was the association of short-term PM2.5 exposure with the incidence of bystander-witnessed OHCAs of cardiac origin. The differences in the distribution of initial cardiac arrest rhythm in OHCAs among those with exposure to PM2.5 were also examined. In total, 103 189 OHCAs witnessed by bystanders were included in the final analysis. Among the patients who experienced such OHCAs, the mean (SD) age was 75 (15.5) years, and 62 795 (60.9%) were men. Point estimates of the percentage increase for a 10-μg/m3 increase in PM2.5 at lag0-1 (difference in mean PM2.5 concentrations measured on the case day and 1 day before) demonstrated a statistically significantly higher incidence of OHCA across most of the 47 prefectures, without significant heterogeneity (I2 = 20.1%; P = .12). A stratified analysis found an association between PM2.5 exposure and OHCAs (% increase, 1.6; 95% CI, 0.1%-3.1%). An initial shockable rhythm, such as ventricular fibrillation or pulseless ventricular tachycardia (% increase, 0.6; 95% CI, -2.0% to 3.2%), was not associated with PM2.5 exposure. However, an initial nonshockable rhythm, such as pulseless electrical activity and asystole, was associated with PM2.5 exposure (% increase, 1.4; 95% CI, 0.1%-2.7%). Findings from this study suggest that increased PM2.5 concentration is associated with bystander-witnessed OHCA of cardiac origin that commonly presents with nonshockable rhythm. The results support measures to reduce PM2.5 exposure to prevent OHCAs of cardiac origin.

Identification of a morning out-of-hospital cardiac arrest cluster of high-incidence: towards a chrono-preventive care strategy.

The human body is regulated by intrinsic factors which follow a 24-hour biological clock. Implications of a circadian rhythm in the out-of-hospital cardiac arrest (OHCA) are studied but the literature is not consistent. The main objective of our study was to identify temporal cluster of high or low incidence of OHCA occurrence during a day. Multicentre comparative study based on the French national OHCA registry data between 2013 and 2017. After describing the population, the detection of significant temporal clusters of OHCA incidence was achieved using temporal scan statistics based on a Poisson model adjusted for age and gender. Then, comparisons between identified patients clusters and the rest of the population were performed. During the study, 37 163 medical OHCA victims were included. The temporal scan revealed a significant 3-hour high incidence temporal cluster between 8:00 am and 10:59 am (Relative R = 1.76, P < .001). In the identified cluster, OHCA occurred more out of the home with fewer witnesses, and advanced life support was less attempted in the cluster. No difference was observed on the return of spontaneous circulation, survival at hospital admission, and survival 30 days after the OHCA or at hospital discharge. We observed a three-hour morning high incidence peak of OHCA. This high incidence could be explained by different physiological changes in the morning. These changes are well known and the evidence of a morning peak of cardiovascular disease should enable medical teams to adapt care strategy and hospital organization.

Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry.

Out‑of‑hospital cardiac arrest (OHCA) is a severe medical condition. Prehospital care plays an essential role in patient survival. First, the study aimed to evaluate cases of OHCA managed by cardiopulmonary resuscitation (CPR) attempts in Poland in 2018, including their frequency and patient outcomes in terms of survival until hospital admission or transport to the hospital by helicopter emergency medical service (HEMS). Second, the study was performed to identify the predictors of patient survival until hospital admission or transport by HEMS. It was a case‑control study based on medical records. In 2018, 3 400 000 emergency visits were registered. Patients who were treated by emergency medical service (EMS) ambulance staff using defibrillation and / or administering at least 1 dose of 1 mg of epinephrine were considered to have OHCA managed by CPR attempts. A total of 26 783 CPR attempts were reported by EMS in Poland in 2018. The incidence of OHCA with CPR attempts in 2018 was 69.7 per 100 000 inhabitants and it varied from 58.9 per 100 000 to 84.5 per 100 000 inhabitants in 16 Polish provinces. The mean survival rate until hospital admission or transport by HEMS was 36.3% and it ranged from 34.5% to 38.3%. Patient survival until hospital admission or transport by HEMS was related to age, sex, emergency site, defibrillation during CPR, the first recorded rhythm, and procedures performed by the EMS personnel. The rate of OHCA with CPR attempts was similar to that reported in other European countries. Patient survival until hospital admission or transport by HEMS was associated with many well‑‑known, identified nonmodifiable and modifiable factors.

Public access defibrillators: Gender-based inequities in access and application

AimWhile public access automated external defibrillator (AED) programs appear to improve outcomes in out-of-hospital cardiac arrest (OHCA) it is unclear if men and women benefit equally. We examined gender-based differences in OHCA location to determine what proportion were potentially eligible for public access AED application, and if patient gender was associated with AED utilization. MethodsWe analyzed data from the Resuscitation Outcomes Consortium registry (2011–2015). We compared differences in OHCA locations by gender. We fit multivariate logistic regression models, restricted to public location OHCAs and public-location cases with bystander intervention, to calculate the association between gender and public access AED application. ResultsAmong 61 473 cases, 34% were female and 50% had bystander resuscitation. The incidence of public OHCA was 8.8% for women and 18% for men (risk difference 9.2%, 95% CI 8.7–9.7%). Women had significantly fewer OHCAs on roadways, in public buildings, places of recreation, and farms, but more in homes, non-acute healthcare facilities, and residential institutions. Female gender was associated with a lower odds of AED application in public OHCA (adjusted OR 0.76, 95% CI 0.64–0.90) and public-location cases with bystander interventions (adjusted OR 0.83, 95% CI 0.71–0.99). ConclusionWomen had fewer OHCA in public locations that may have public access AEDs. Even among public location OHCA with bystander interventions, women were less likely to have public access AED applied. Initiatives to optimize AED locations and to engage the public with gender-specific resuscitation training may improve outcomes in women with OHCA.

The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis

BackgroundTo quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR).MethodsWe systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis.ResultsA total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6–31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7–23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2–9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1–13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8–9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2–11.7%), who received bystander CPR (11.3%, 95% CI 9.3–13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5–13.0%; North America: 7.7%; 95% CI 6.9–8.6%). The survival to discharge (8.6% in 1976–1999 vs. 9.9% in 2010–2019), 1-month survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019), and 1-year survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger’s test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR.ConclusionsThe global survival rate of OHCA patients who received CPR has increased in the past 40 years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries.

High risk neighbourhoods: The effect of neighbourhood level factors on cardiac arrest incidence

BackgroundNumerous studies have shown significant neighbourhood level variation in out-of-hospital cardiac arrest (OHCA) incidence rates, however, few have provided an explanation for these disparities beyond traditional socioeconomic measures. MethodsThis was a retrospective study using data from a large population-based OHCA database (Rescu Epistry). We included adults ≥20 years who experienced a non-traumatic OHCA and were treated by emergency medical services within Toronto, Canada between 2006–2012. The residential address of each OHCA patient was spatially mapped to 1 of 517 Toronto census tracts (CTs). Patient and CT level characteristics were included in multivariate regression models to assess their association with OHCA incidence per 100,000 persons. ResultsOf the 7775 OHCAs occurring in the study area, 7692 (98.9%) were eligible for inclusion. OHCA incidence rates varied widely across CT quintiles, with rates differing almost 4-fold (109.1 per 100,000 yearly Q5 most deprived vs. 30.0 per 100,000 yearly Q1 least deprived p < 0.0001). Numerous areas of high incidence adjacent to areas of low incidence were observed. After adjustment, all variables except the Activity Friendly Index showed highly significant linear trends, with increasing age, sex ratio, diabetes prevalence, material deprivation and ethnic concentration being independently associated with increasing OHCA incidence. In contrast, we did not observe a linear relationship between high OHCA incidence and median household income. ConclusionsThis study showed almost 4-fold OHCA incidence variability across a large metropolitan area. This variability was partially correlated with population and health data, but not typical socioeconomic predictors, such as median household income.

Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study

BackgroundThe epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes from OHCA in Europe and to improve understanding of the role of the bystander. MethodsThis prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge. ResultsAll 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively). ConclusionIn addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation.

A Survey of the Public’s Ability to Recognize and Willingness to Intervene in Out‐of‐hospital Cardiac Arrest and Opioid Overdose

Out of hospital cardiac arrest (OHCA) and opioid overdose (OD) are two emergencies where prompt recognition and response-typically by untrained bystanders-are critical to ensure positive outcomes. The median incidence of EMS-treated OHCA across ten urban centres in North America is 52 per 100 000, (1) while the US incidence of fatal OD is around 14 per 100 000. (2).