Abstract 208: Out-of-Hospital Cardiac Arrests in High-Rise Buildings: Delays to Patient Care and Survival
Background: In recent years, there has been a dramatic increase in the number of people living in high-rise buildings. This increase in vertical living presents unique barriers and response delays for emergency medical services (EMS) responding to out-of-hospital cardiac arrests (OHCA). Previous research has shown significant delays to general patient care, however, no studies have examined the delay to patient resuscitation in OHCA, and the impact this delay has on survival.
Objective: To examine the relationship between the floor of patient contact (<3 floors vs. ≥3 floors) and survival from OHCA in private residences.
Methods: A retrospective, observational cohort study using data from the Toronto Regional RescuNet Epistry database between January 2007 and December 2012. All adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS in private residences were included. We excluded cardiac arrests witnessed by EMS and of non-cardiac etiology. Bivariate analyses were used to examine the delay from paramedic arrival on scene to patient contact, and differences in patient characteristics based on the floor of patient contact. Additionally we evaluated the associations between the floor of patient contact, the Utstein data elements and survival to hospital discharge.
Results: During the study period, 7,842 OHCA met our inclusion criteria, of which 5,998 (76.5%) occurred < 3 floors and 1,765 (23.5%) occurred ≥ 3 floors. Overall survival was 3.8%; 4.2% for cardiac arrests occurring < 3 floors and 2.6% for ≥ 3 floors, P=0.002. The time from EMS arrival to patient contact was shorter for OHCA that occurred < 3 floors compared to ≥ 3 floors (3.0min ± 2.0 vs. 4.9min ± 2.6, P<0.001). OHCA that occurred < 3 floors were more often male (62.9% vs. 58.5%, P<0.001), and had a higher proportion of initial shockable rhythms (22.8% vs. 13.3%, P<0.001).
Conclusion: Survival rates are lower for OHCA that occur at higher vertical heights (≥3 floors) and are associated with increased time to patient contact by EMS. Interventions aimed at improving access to OHCA in high-rise buildings, such as an improved access to AEDs on higher floors, emergency elevator procedures and emergency alerts to trained building staff may help to increase rates of survival for these patients.
Author Disclosures: I.R. Drennan: None. R.P. Strum: None. J.E. Buick: None. A. Byers: None. S. Lin: Research Grant; Modest; Canadian Association of Emergency Physicians. S.R. Hu: None. S. Cheskes: Research Grant; Significant; National Institutes of Health, Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research. Other Research Support; Significant; National Institutes of Health. L.J. Morrison: Research Grant; Significant; National Institutes of Health, Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research. Other Research Support; Significant; National Institutes of Health.
- © 2014 by American Heart Association, Inc.