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Ahn C, Oh YT, Park Y, Kim JH, Hwang S, Won M. The Influence of Cardiac Arrest Floor-Level Location within a Building on Survival Outcomes. J Pers Med 2023; 13:1265. [PMID: 37623515 PMCID: PMC10455151 DOI: 10.3390/jpm13081265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
This nationwide, population-based observational study investigated the association between the floor level of out-of-hospital cardiac arrest (OHCA) incidence and survival outcomes in South Korea, notable for its significant high-rise apartment living. Data were collected retrospectively from OHCA patients through the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. The study incorporated cases that included the OHCA's building floor information. The primary outcome assessed was survival to discharge, analyzed using multivariate logistic regression, and the secondary outcome was favorable neurological outcome. Among 36,977 patients, a total of 29,729 patients were included, and 1680 patients were survivors. A weak yet significant correlation between floor level and hospital arrival time was observed. Interestingly, elevated survival rates were noted among patients from higher floors despite extended emergency medical service response times. Multivariate analysis identified age, witnessed OHCA, shockable rhythm, and prehospital return of spontaneous circulation (ROSC) as primary determinants of survival to discharge. The floor level's impact on survival was less substantial than anticipated, suggesting residential emergency response enhancements should prioritize witness interventions, shockable rhythm management, and prehospital ROSC rates. The study underscores the importance of bespoke emergency response strategies in high-rise buildings, particularly in urban areas, and the potential of digital technologies to optimize response times and survival outcomes.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Sojune Hwang
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
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Han MX, Yeo ANWT, Ong MEH, Smith K, Lim YL, Lin NH, Tan B, Arulanandam S, Ho AFW, Ng QX. Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review. J Clin Med 2021; 10:jcm10204684. [PMID: 34682806 PMCID: PMC8539960 DOI: 10.3390/jcm10204684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge (n = 3) and neurologically favourable survival (n = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients.
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Affiliation(s)
- Ming Xuan Han
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
| | - Amelia Natasha Wen Ting Yeo
- Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore 487372, Singapore;
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; (M.E.H.O.); (A.F.W.H.)
- SingHealth Emergency Medicine Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Clayton, VIC 3800, Australia;
| | - Yu Liang Lim
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
- MOH Holdings Pte Ltd., Singapore 099253, Singapore;
| | | | - Bobo Tan
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; (M.E.H.O.); (A.F.W.H.)
- SingHealth Emergency Medicine Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
- MOH Holdings Pte Ltd., Singapore 099253, Singapore;
- Correspondence: ; Tel.: +65-6794-5502
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