Out-of-hospital cardiac arrest: Does rurality decrease chances of survival?

Ringgren, Kristian Bundgaard; Kragholm, Kristian; Lindgren, Filip Lyng; Jacobsen, Peter Ascanius; Jørgensen, Anne Juul; Christensen, Helle Collatz; Mills, Elisabeth Helen Anna; Jakobsen, Louise Kollander; Yonis, Harman; Folke, Fredrik; Lippert, Freddy; Torp‐Pedersen, Christian

doi:10.1016/j.resplu.2022.100208

Cited by 7 publications

(7 citation statements)

References 23 publications

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“… 28 However, another recent Danish study by Ringgren et al found increased EMS response time in rural areas but without any differences in 30‐day survival in witnessed OHCA. 9 Like Ringgren et al, we observed increased EMS response time in rural areas; yet, after adjusting for this, 30‐day survival was still significantly lower in rural areas compared with urban areas. The difference in 30‐day survival between the 2 studies (in a relatively similar cohort) might be explained by differences in categorization of urban and rural areas between the studies.…”

Section: Discussionsupporting

confidence: 72%

“…Of note, we used the standardized Degree of Urbanization Tool, as recommended by the European Commission, whereas Ringgren et al used a different categorization for urbanization. 9 It should be recognized that the observed EMS response times throughout the Danish regions are low when comparing with other countries. Even in rural parts of Denmark, the median EMS response time was 8 minutes, which is what other EMS agencies can provide in urban areas, and EMS response times have been associated with increased survival.…”

Section: Discussionmentioning

confidence: 98%

“… 3 , 4 , 5 , 6 , 7 However, distance to nearest invasive heart center was not associated with poorer survival, and ambulance response times are comparable in urban and rural areas in Denmark. 8 , 9 …”

mentioning

confidence: 99%

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Association of Degree of Urbanization and Survival in Out‐of‐Hospital Cardiac Arrest

Gregers

Møller

Kjoelbye

et al. 2023

JAHA

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Background Survival from out‐of‐hospital cardiac arrest (OHCA) varies across regions. The aim of this study was to evaluate the association between urbanization (rural, suburban, and urban areas), bystander interventions (cardiopulmonary resuscitation and defibrillation), and 30‐day survival from OHCAs in Denmark. Methods and Results We included OHCAs not witnessed by ambulance staff in Denmark from January 1, 2016, to December 31, 2020. Patients were divided according to the Eurostat Degree of Urbanization Tool in rural, suburban, and urban areas based on the 98 Danish municipalities. Poisson regression was used to estimate incidence rate ratios. Logistic regression (adjusted for ambulance response time) tested differences between the groups with respect to bystander interventions and survival, according to degree of urbanization. A total of 21 385 OHCAs were included, of which 8496 (40%) occurred in rural areas, 7025 (33%) occurred in suburban areas, and 5864 (27%) occurred in urban areas. Baseline characteristics, as age, sex, location of OHCA, and comorbidities, were comparable between groups. The annual incidence rate ratio of OHCA was higher in rural areas (1.54 [95% CI, 1.48–1.58]) compared with urban areas. Odds for bystander cardiopulmonary resuscitation were lower in suburban (0.86 [95% CI, 0.82–0.96]) and urban areas (0.87 [95% CI, 0.80–0.95]) compared with rural areas, whereas bystander defibrillation was higher in urban areas compared with rural areas (1.15 [95% CI, 1.01–1.31]). Finally, 30‐day survival was higher in suburban (1.13 [95% CI, 1.02–1.25]) and urban areas (1.17 [95% CI, 1.05–1.30]) compared with rural areas. Conclusions Degree of urbanization was associated with lower rates of bystander defibrillation and 30‐day survival in rural areas compared with urban areas.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 98%

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Association of Degree of Urbanization and Survival in Out‐of‐Hospital Cardiac Arrest

Gregers

Møller

Kjoelbye

et al. 2023

JAHA

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“… 24 , 43 , 44 Further, it was shown that rurality does not decrease the chance of survival from OHCA with a shockable rhythm in Denmark. 24 Similar to the disparities in the factors associated with survival from OHCA, many social disparities have been shown in the distribution of BLS education. It is known that people who have lower education and income levels, living in rural areas, and older age generally have lower BLS course participation rates.…”

Section: Discussionmentioning

confidence: 97%

Geographical Association Between Basic Life Support Courses and Bystander Cardiopulmonary Resuscitation and Survival from OHCA in Denmark

Jensen¹,

Ersbøll²,

Folke³

et al. 2023

OAEM

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Introduction Annually, approximately 4% of the entire adult population of Denmark participate in certified basic life support (BLS) courses. It is still unknown whether increases in BLS course participation in a geographical area increase bystander cardiopulmonary resuscitation (CPR) or survival from out-of-hospital cardiac arrest (OHCA). The aim of the study was to examine the geographical association between BLS course participation, bystander CPR, and 30-day survival from OHCA. Methods This nationwide register-based cohort study includes all OHCAs from the Danish Cardiac Arrest Register. Data concerning BLS course participation were supplied by the major Danish BLS course providers. A total of 704,234 individuals with BLS course certificates and 15,097 OHCA were included from the period 2016–2019. Associations were examined using logistic regression and Bayesian conditional autoregressive analyses conducted at municipality level. Results A 5% increase in BLS course certificates at municipality level was significantly associated with an increased likelihood of bystander CPR prior to ambulance arrival with an adjusted odds ratio (OR) of 1.34 (credible intervals: 1.02;1.76). The same trends were observed for OHCAs in out-of-office hours (4pm-08am) with a significant OR of 1.43 (credible intervals: 1.09;1.89). Local clusters with low rate of BLS course participation and bystander CPR were identified. Conclusion This study found a positive effect of mass education in BLS on bystander CPR rates. Even a 5% increase in BLS course participation at municipal level significantly increased the likelihood of bystander CPR. The effect was even more profound in out-of-office hours with an increase in bystander CPR rate at OHCA.

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“…A previous study found that EMS response time was prolonged in OHCA, particularly in rural communities; however, there were no significant differences in 30-day survival when compared to early hospital arrival times. 4 This research identified several pre-existing comorbidities that predicted scene times greater than eight minutes. Adult trauma patients who had a diagnosis of alcohol use disorder, dementia, and personality disorders were more likely to have a scene time greater than eight minutes.…”

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confidence: 99%

Ambulance Response in Eight Minutes or Less: Are Comorbidities a Factor

Rhodes¹,

Rourke²,

Pepe³

2023

The American Surgeon™

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A recommended emergency medical services ambulance response time to a medical emergency is within eight minutes for at least 90% of calls. This study aimed to evaluate scene times for rural education and outreach to improve the quality of trauma care. This is a single-center study of Trauma Registry data from July 1, 2016 to February 28, 2022. The inclusion criteria were based upon age (≥18 years). A logistic regression was performed to identify predictor variables on the likelihood that an adult trauma patient will experience scene times greater than eight minutes. 19 321 patients were included in the analysis; 7233 (37%) experienced an elapsed scene time within eight minutes. This research identified an opportunity to improve rural trauma team response time, which is only reaching 37% of the patient population within eight minutes. Prehospital cardiac arrest and unique pre-existing comorbidities may play a role in extended response times by EMS.

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Out-of-hospital cardiac arrest: Does rurality decrease chances of survival?

Cited by 7 publications

References 23 publications

Association of Degree of Urbanization and Survival in Out‐of‐Hospital Cardiac Arrest

Association of Degree of Urbanization and Survival in Out‐of‐Hospital Cardiac Arrest

Geographical Association Between Basic Life Support Courses and Bystander Cardiopulmonary Resuscitation and Survival from OHCA in Denmark

Ambulance Response in Eight Minutes or Less: Are Comorbidities a Factor

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