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Out‐of‐hospital cardiac arrest in Victoria: rural and urban outcomes
Author(s) -
Jennings Paul A,
Cameron Peter,
Walker Tony,
Bernard Stephen,
Smith Karen
Publication year - 2006
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2006.tb00498.x
Subject(s) - asystole , medicine , ambulance service , cardiopulmonary resuscitation , emergency medicine , odds ratio , rural area , retrospective cohort study , return of spontaneous circulation , medical emergency , resuscitation , pathology
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 outcome after cardiac arrest require investigation.