Abstract 11496: Differences in Bystander Cardiopulmonary Resuscitation and First Responder Defibrillation Narrowed to Similar Levels in Urban and Non-urban Out-of-Hospital Cardiac Arrest Patients Following a Quality Improvement Program in North Carolina
Introduction: Differences in care and outcomes between non-urban versus urban out-of-hospital cardiac arrest cases have previously been shown. Therefore, we examined temporal changes in bystander and first responder interventions, direct transport to PCI center and outcomes in non-urban versus urban arrests during Heart Rescue initiatives to improve regional systems of care and outcomes during 2010-2014 in North Carolina.
Hypothesis: Differences in bystander and first responder interventions, direct transport to PCI center, and outcomes have narrowed over time between non-urban and urban cases.
Methods: From the Cardiac Arrest Registry to Enhance Survival, we identified non-emergency medical service witnessed cases from 16 counties (catchment population 3,143,809) in North Carolina with complete case capture during 2010-2014. We used geospatial information on arrest location and US Census classification to categorize urban areas with ≥50,000 versus non-urban with <50,000 people.
Results: Of 7,885 patients, 21.1% of the arrests (n=1667) occurred in non-urban areas and 78.9% (n=6218) occurred in urban areas. Bystander cardiopulmonary resuscitation (CPR), first responder defibrillation and outcomes improved in both groups, but most substantially in non-urban cases (Figure). Overall, bystander defibrillation was 2.9% in non-urban versus 8% in urban cases (P<0.01) and did not change over time. Similarly, no change was seen over time in proportion taken directly to PCI centers (overall 54.2% versus 97.4%, respectively).
Conclusions: Differences in bystander CPR and first responder defibrillation substantially narrowed to similar levels between non-urban and urban cases following Heart Rescue quality improvement program during 2010-2014 in North Carolina. Significant differences in bystander defibrillation and direct transport to PCI center remained and represent future target areas to potentially further reduce differences in outcomes.
Author Disclosures: K. Kragholm: Research Grant; Significant; Laerdal Foundation, The Danish Heart Association. C. Malta Hansen: Research Grant; Significant; Laerdal Foundation, TrygFond Foundation, Helsefonden. M. Dupre: None. B. Strauss: None. C. Tyson: None. L. Monk: None. D. Pearson: None. R. Nelson: None. E. Fosbol: None. M. Anderson: None. J. Jollis: Research Grant; Significant; Medtronic Foundation. T. Rea: None. B. McNally: Research Grant; Significant; American Red Cross, American Heart Association, Medtronic Foundation, ZOLL Corporation. C. Granger: Research Grant; Significant; Medtronic Foundation.
- © 2015 by American Heart Association, Inc.