Out‐of‐hospital cardiac arrest in Victoria: rural and urban outcomes

Abstract

Objective: To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences. Design: Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry. Setting: All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service. Participants: 1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003. Results: Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew. Conclusions: Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve MJA 2006; 185: 135-139 outcome after cardiac arrest require investigation.

Out-of-hospital cardiac arrest in Cork, Ireland

“…This may be explained by a greater proportion of rural OHCAs being witnessed and receiving bystander CPR. Jennings et al found survival to leave hospital significantly lower in rural Victoria (urban, (7.4%); rural, (1.9%); OR, 4.13; 95% CI 1.09 to 34.91),30 while in Scotland, survival to hospital admission was greater in areas where the median response time was less than 10 min (13.5% vs 8.1%; p<0.05), though the survival to discharge from hospital rate was not significantly different (4.1% vs 3.2%; p=0.42) 31. Novel approaches to compensate for prolonged ambulance response times to rural areas have been developed in certain areas; however, demonstrating improved outcomes on low presentation, high mortality events may not be possible.…”

Hospital characteristics are associated with patient outcomes following out-of-hospital cardiac arrest

“…The role of advanced airways in the management of OHCA is controversial. There are data both supporting timely intubation for patients with OHCA1 36 and studies questioning the efficacy of prehospital intubation by highlighting poorer patient outcomes 37. Clinical trials examining the role, timing and nature of advanced airways are needed.…”

“…Out-of-hospital cardiac arrest (OHCA) is a common manifestation of cardiovascular disease, with an incidence in Australia of 148 per 100 000 persons per year 1. The mortality rate post admission to hospital after successful resuscitation from OHCA is high 2.…”

Cardiopulmonary resuscitation before defibrillation in the out-of-hospital setting: a literature review: Table 1

“…The benefits of CPR before defibrillation in terms of ROSC is further substantiated by Jennings et al ,2 when only 20% (1790 from 8978) of all OHCA attended to by Rural Ambulance Victoria and the Metropolitan Ambulance Service were bystander witnessed in Victoria, Australia. This further underlines the importance of early CPR and defibrillation, with increasing emphasis now being placed on the availability and use of automated external defibrillators (AED) by members of the public.…”