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

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.

Effect of end-stage kidney disease on the return of spontaneous circulation in Taiwanese adults with out-of-hospital cardiac arrest

“…Therefore, this group of ESKD patients with OHCA may share only a part of the mechanism as mentioned above (low blood volume and syncope). In conclusion, the location of arrest was an important confounding factor as arrests in residential areas versus public spaces and high-rise settings were invariably associated with poorer OHCA outcomes 25 , 26 .…”

Management of Out-of-Hospital Cardiac Arrest during COVID-19: A Tale of Two Cities

“…Singapore is heavily urbanized where 90% of its population resides in high-rise apartments. OHCAs occurring in high-rise buildings are a challenge to contemporary EMS [ 29 ]; this is reflected in the doubling of time of scene arrival to patient access in Singapore compared with Atlanta, and greater delays during the pandemic in Singapore. Protocols to override elevator systems and staying on-scene for the delivery of optimal basic and advanced life support to achieve ROSC may help improve OHCA outcomes.…”