RT Journal Article
SR Electronic
T1 Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP cmaj.150544
DO 10.1503/cmaj.150544
A1 Ian R. Drennan
A1 Ryan P. Strum
A1 Adam Byers
A1 Jason E. Buick
A1 Steve Lin
A1 Sheldon Cheskes
A1 Samantha Hu
A1 Laurie J. Morrison
A1 for the Rescu Investigators
YR 2016
UL http://www.cmaj.ca/content/early/2016/01/18/cmaj.150544.abstract
AB Background: increasing number of people living in high-rise buildings presents unique challenges to care and may cause delays for 911-initiated first responders (including paramedics and fire department personnel) responding to calls for out-of-hospital cardiac arrest. We examined the relation between floor of patient contact and survival after cardiac arrest in residential buildings.Methods: We conducted a retrospective observational study using data from the Toronto Regional RescuNet Epistry database for the period January 2007 to December 2012. We included all adult patients (≥ 18 yr) with out-of-hospital cardiac arrest of no obvious cause who were treated in private residences. We excluded cardiac arrests witnessed by 911-initiated first responders and those with an obvious cause. We used multivariable logistic regression to determine the effect on survival of the floor of patient contact, with adjustment for standard Utstein variables.Results: During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria, of which 5998 (76.5%) occurred below the third floor and 1844 (23.5%) occurred on the third floor or higher. Survival was greater on the lower floors (4.2% v. 2.6%, p = 0.002). Lower adjusted survival to hospital discharge was independently associated with higher floor of patient contact, older age, male sex and longer 911 response time. In an analysis by floor, survival was 0.9% above floor 16 (i.e., below the 1% threshold for futility), and there were no survivors above the 25th floor.Interpretation: In high-rise buildings, the survival rate after out-of-hospital cardiac arrest was lower for patients residing on higher floors. Interventions aimed at shortening response times to treatment of cardiac arrest in high-rise buildings may increase survival.