Care and outcomes of urban and non-urban out-of-hospital cardiac arrest patients during the HeartRescue Project in Washington state and North Carolina

Kristian Kragholm; Carolina Malta Hansen; Matthew E Dupre; Benjamin Strauss; Clark Tyson; Lisa Monk; David A Pearson; R Darrell Nelson; Emil L Fosbøl; Monique Starks; James G Jollis; Jenny Shin; Thomas Rea; Bryan McNally; Christopher B Granger

doi:10.1016/j.resuscitation.2020.04.030

Care and outcomes of urban and non-urban out-of-hospital cardiac arrest patients during the HeartRescue Project in Washington state and North Carolina

Resuscitation. 2020 Jul:152:5-15. doi: 10.1016/j.resuscitation.2020.04.030. Epub 2020 May 8.

Authors

Affiliations

¹ Duke Clinical Research Institute, Durham, NC, USA; Department of Cardiology, Aalborg University Hospital, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark. Electronic address: kristian.d.sorensen@dm.duke.edu.
² Duke Clinical Research Institute, Durham, NC, USA.
³ Duke Clinical Research Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA.
⁴ Nicholas School of the Environment, Duke University, Durham, NC, USA.
⁵ Duke Clinical Research Institute, Durham, NC, USA; Center for Educational Excellence, Durham, NC, USA.
⁶ Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
⁷ WFU Health Sciences, Winston-Salem, NC, USA.
⁸ Duke Clinical Research Institute, Durham, NC, USA; The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark.
⁹ Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, WA, USA.
¹⁰ Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.

PMID: 32430288
DOI: 10.1016/j.resuscitation.2020.04.030

Abstract

Aim: We examined overall and temporal differences in out-of-hospital cardiac arrest (OHCA) care and outcomes by urban versus non-urban setting separately for North Carolina (NC) and Washington State (WA) during HeartRescue initiatives and associations of urban/non-urban settings with outcome by state.

Methods: OHCAs of presumed cardiac etiology from counties with complete registry enrollment in NC during 2010-2014 (catchment population = 3,143,809) and WA during 2011-2014 (catchment population = 3,653,506) were identified. Geospatial arrest location data and US Census classification were used to categorize urban areas with ≥50,000 versus non-urban <50,000 people.

Results: Included were 7731 NC cases (78.9% urban) and 4472 WA cases (85.8% urban). Bystander cardiopulmonary resuscitation (CPR) increased from 36.9% (2010) to 50.3% (2014) in NC non-urban areas versus 58.2% (2011) to 69.2% (2014) in WA; and from 39.3% to 51.1% in NC urban areas versus 52.4% to 61.8% in WA. Crude discharge survival odds ratio (OR) was 2.49 (95%CI 1.96-3.16) for urban versus non-urban NC cases not declared dead in field (N = 4241). Adjusted for age, sex, public location, bystander-witness status, time between emergency call and emergency medical service (EMS) arrival, calendar-year, bystander and first-responder CPR and defibrillation and direct PCI-center transport, OR was 1.30 (95%CI 0.98-1.73). In WA, corresponding crude and adjusted ORs were 1.38 (95%CI 0.99-1.93) and 1.46 (95%CI 1.00-2.13). In both states, bystander and first-responder CPR and defibrillation and direct PCI-hospital transport were associated with increased survival.

Conclusions: During HeartRescue initiatives, bystander CPR increased in urban and non-urban locations. Bystander and first-responder interventions and direct PCI-hospital transport were associated with improved outcomes, including in non-urban areas.

Keywords: Bystander; CPR; Defibrillation; First-responder; Out-of-hospital cardiac arrest; Outcomes; PCI-hospital; Urban rural.

MeSH terms

Cardiopulmonary Resuscitation*
Emergency Medical Services*
Humans
North Carolina / epidemiology
Out-of-Hospital Cardiac Arrest* / epidemiology
Out-of-Hospital Cardiac Arrest* / therapy
Percutaneous Coronary Intervention*
Washington / epidemiology