Neurological outcomes after an out-of-hospital cardiac arrest among people living in high-rise buildings in South Korea

Abstract

Objective Living in high-rise buildings may cause delays in reaching a hospital after an out-of-hospital cardiac arrest. This study aimed to compare neurological outcomes in people who had had an out-of-hospital cardiac arrest, according to their floor of residence. Methods We conducted a retrospective study of 1541 patients aged ≥20 years who had out-of-hospital cardiac arrest between 1 October 2015 and 30 June 2018, using data from a central registry. We compared the outcomes of patients living on the first (ground) or second floor and those living on the third floor or above, using multiple logistic regression. Results Those living on higher floors were more likely to have been at home (88.1% vs. 58.0%); to have had bystander cardiopulmonary resuscitation (57.9% vs. 45.2%); and experienced a significantly longer emergency medical service response time [median interquartile range (IQR): 7 min (6–10 min) vs. 7 min (5–9 min), P = 0.001] and on-scene time [median (IQR): 16 min (11–23 min) vs. 12 min (8–19 min), P < 0.001]. The strongest predictors of a good neurological outcome were younger age [odds ratio (OR): 0.96, 95% confidence interval (CI): 0.94–0.97], being on a lower floor at the time of the cardiac arrest (OR: 1.82, 95% CI: 1.09–3.12) and having a shockable rhythm (OR: 21.97, 95% CI: 12.81–39.47). Conclusion People living on higher floors have poorer outcomes after an out-of-hospital cardiac arrest. Further studies are required to assess factors causing a delay in the emergency medical service response time, and placement of automated external defibrillators in high-rise buildings.

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

“…A further seven articles were removed after review of full texts. Finally, 23 articles were included in the scoping review [ 4 , 5 , 6 , 7 , 8 , 11 , 12 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. The characteristics of included studies are summarised in Table 1 .…”

“…Four studies reported similar findings of the negative impact of higher floors on neurologically intact survival measured at hospital discharge or at 1 month. Kobayashi et al and Sohn et al both reported significantly lower unadjusted rates of neurologically intact survival for OHCA patients living 3 floors or higher above ground [ 25 , 30 ]. Choi et al found that patients residing on a high floor of 3 storeys or more had significantly lower unadjusted rates of neurologically intact survival compared to if the OHCA took place in a public area [ 18 ].…”

“…Five studies reported on the outcomes of prehospital ROSC in their results. Chi et al, Kobayashi et al, and Sohn et al showed a consistent detrimental effect of higher floors on patient ROSC [ 16 , 25 , 30 ]. These three studies reported a significantly lower rate of prehospital ROSC for patients living on the third floor and higher, compared to lower floors.…”

System-based interventions to improve outcome in out-of-hospital cardiac arrest patients: a Dutch experience

“…The annual incidence of Out of Hospital Cardiac Arrest (OHCA) is not exactly known and varies largely between countries from 28 to 160 per 100 000 inhabitants [1]. Quality of early cardiopulmonary resuscitation (CPR) by bystanders and ambulance staff can lead to a significant improvement in Return of Spontaneous Circulation (ROSC) and good neurological outcomes [2,3].…”

“…Quality of early cardiopulmonary resuscitation (CPR) by bystanders and ambulance staff can lead to a significant improvement in Return of Spontaneous Circulation (ROSC) and good neurological outcomes [2,3].…”