Out-of-hospital cardiac arrest in Victoria: rural and urban outcomes

Paul A Jennings, Peter Cameron, Tony Walker, Stephen Bernard and Karen Smith
Med J Aust 2006; 185 (3): 135-139.


Objective: To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences.

Design: Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry.

Setting: All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service.

Participants: 1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003.

Results: Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65–5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09–34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82–0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49–4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38–0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56–0.95) on arrival of the first ambulance crew.

Conclusions: Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.

  • Paul A Jennings1
  • Peter Cameron2
  • Tony Walker1
  • Stephen Bernard3,2
  • Karen Smith3

  • 1 Rural Ambulance Victoria, Geelong, VIC.
  • 2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 3 Metropolitan Ambulance Service, Melbourne, VIC.


We would like to thank the following for their contribution to this study: Jason Muller, Geospatial Information System analyst, RAV, for coding geographical data and developing maps; Vanessa Barnes, Research Officer, Victorian Ambulance Cardiac Arrest Registry, for assisting with data acquisition; and Michael Bailey, for statistical assistance.

Competing interests:

None identified.

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