TY - JOUR
T1 - Pre-hospital factors and survival after out-of-hospital cardiac arrest according to population density, a nationwide study
AU - Møller, Sidsel G
AU - Rajan, Shahzleen
AU - Møller-Hansen, Steen
AU - Kragholm, Kristian
AU - Ringgren, Kristian B
AU - Folke, Fredrik
AU - Hansen, Carolina Malta
AU - Lippert, Freddy K
AU - Køber, Lars
AU - Gislason, Gunnar
AU - Torp-Pedersen, Christian
AU - Wissenberg, Mads
N1 - © 2020 The Author(s).
PY - 2020/12
Y1 - 2020/12
N2 - Aim: This study aimed to examine the impact of population density on bystander cardiopulmonary resuscitation (CPR) and survival after out-of-hospital cardiac arrest (OHCA).Methods: Through the Danish Cardiac Arrest Registry (2001-2013), OHCAs ≥18 years of presumed cardiac cause were identified, and divided according to the OHCA location in four population density groups (inhabitants/km2) based on urban/rural area-definitions: low (<300/km2), medium (300-1499/km2), high (1500-2999/km2), very high (>3000/km2). The association between population density, bystander cardiopulmonary resuscitation (CPR) and survival was examined using logistic regression, adjusted for age, sex, comorbitidies and calendar-year.Results: 18,248 OHCAs were identified. Patients in areas of high compared to low population density were older, more often female, had more comorbidities, more witnessed arrests (very high: 59.6% versus low: 55.0%), shorter response time (very high: 10 min versus low: 14 min), but less bystander CPR (very high: 34.3% versus low: 45.1%). Thirty-day survival was higher in areas of higher population density (very high: 10.2% vs. low 5.3%), also in best-cases of witnessed arrests with bystander CPR and response time <10 min (very high: 33.6% versus low: 13.8%). The same trends were found in adjusted analyses with lower odds for bystander CPR (odds ratio [OR] 0.55 95% confidence interval [CI] 0.46-0.66) and higher odds for 30-day survival (OR 2.78, 95%CI 1.95-3.96) in the highest population density areas compared to low.Conclusions: Having an OHCA in higher populated areas were found associated with less bystander CPR, but higher survival. Identification of area-related factors can help target future pre-hospital care.
AB - Aim: This study aimed to examine the impact of population density on bystander cardiopulmonary resuscitation (CPR) and survival after out-of-hospital cardiac arrest (OHCA).Methods: Through the Danish Cardiac Arrest Registry (2001-2013), OHCAs ≥18 years of presumed cardiac cause were identified, and divided according to the OHCA location in four population density groups (inhabitants/km2) based on urban/rural area-definitions: low (<300/km2), medium (300-1499/km2), high (1500-2999/km2), very high (>3000/km2). The association between population density, bystander cardiopulmonary resuscitation (CPR) and survival was examined using logistic regression, adjusted for age, sex, comorbitidies and calendar-year.Results: 18,248 OHCAs were identified. Patients in areas of high compared to low population density were older, more often female, had more comorbidities, more witnessed arrests (very high: 59.6% versus low: 55.0%), shorter response time (very high: 10 min versus low: 14 min), but less bystander CPR (very high: 34.3% versus low: 45.1%). Thirty-day survival was higher in areas of higher population density (very high: 10.2% vs. low 5.3%), also in best-cases of witnessed arrests with bystander CPR and response time <10 min (very high: 33.6% versus low: 13.8%). The same trends were found in adjusted analyses with lower odds for bystander CPR (odds ratio [OR] 0.55 95% confidence interval [CI] 0.46-0.66) and higher odds for 30-day survival (OR 2.78, 95%CI 1.95-3.96) in the highest population density areas compared to low.Conclusions: Having an OHCA in higher populated areas were found associated with less bystander CPR, but higher survival. Identification of area-related factors can help target future pre-hospital care.
KW - OHCA
KW - Survival Bystander CPR
KW - Population density
KW - Out-of-Hospital Cardiac Arrest
U2 - 10.1016/j.resplu.2020.100036
DO - 10.1016/j.resplu.2020.100036
M3 - Journal article
C2 - 34223313
SN - 2666-5204
VL - 4
JO - Resuscitation plus
JF - Resuscitation plus
M1 - 100036
ER -