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.
- 1. Sexton PT, Sexton T-LH. Excess coronary mortality among Australian men and women living outside the capital city statistical divisions. Med J Aust 2000; 172: 370-374. <MJA full text>
- 2. Voss T, Begg S. The Victorian burden of disease study. Melbourne: Victorian Government Department of Human Services, 1999.
- 3. Hayes LJ, Quine S, Taylor R. New South Wales trends in mortality differentials between small rural and urban communities over a 25-year period, 1970–1994. Aust J Rural Health 2005; 13: 71-76.
- 4. Bernard S. Outcome from prehospital cardiac arrest in Melbourne, Australia. Emerg Med 1998; 10: 25-29.
- 5. Bett JH. Experience with a mobile coronary care unit in Brisbane. Ann Emerg Med 1989; 18: 969-974.
- 6. Brennan RJ, Luke C. Failed prehospital resuscitation following out-of-hospital cardiac arrest: are further efforts in the emergency department warranted? Emerg Med 1995; 7: 131-138.
- 7. Finn JC, Jacobs IG, Holman CD, Oxer HF. Outcomes of out-of-hospital cardiac arrest patients in Perth, Western Australia, 1996–1999. Resuscitation 2001; 51: 247-255.
- 8. Jackson T, Cameron P. Prehospital defibrillation in Geelong. Emerg Med 1993; 5: 184-187.
- 9. Jacobs IG, Oxer HF. A review of pre-hospital defibrillation by ambulance officers in Perth, Western Australia. Med J Aust 1990; 153: 662-664.
- 10. Jennings P, Pasco J. Survival from out-of-hospital cardiac arrest in the Geelong region of Victoria, Australia. Emerg Med (Fremantle) 2001; 13: 319-325.
- 11. Sammel NL, Taylor K, Selig M, O’Rourke MF. New South Wales intensive care ambulance system. Med J Aust 1981; 2: 546-550.
- 12. Scott IA, Fitzgerald GJ. Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience. Arch Emerg Med 1993; 10: 1-7.
- 13. Wassertheil J, Keane G, Fisher N, Leditschke JF. Cardiac arrest outcomes at the Melbourne Cricket Ground and Shrine of Remembrance using a tiered response strategy — a forerunner to public access defibrillation. Resuscitation 2000; 44: 97-104.
- 14. Australian Institute of Health and Welfare. Rural, regional and remote health: a study on mortality. Rural Health Series No. 2. Canberra: AIHW, 2003. (AIHW Cat. No. PHE45.)
- 15. Rural Ambulance Victoria, Metropolitan Ambulance Service. Clinical practice guidelines. http://www.rav.vic.gov.au/CPGindex.asp (accessed Dec 2005).
- 16. Australian Resuscitation Council. Guidelines. http://www.resus.org.au (accessed Apr 2006).
- 17. Smith KL, McNeill JJ; Emergency Medical Response Steering Committee. Cardiac arrests treated by ambulance paramedics and fire fighters. Med J Aust 2002; 177: 305-309. <MJA full text>
- 18. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991; 84: 960-975.
- 19. Australian Bureau of Statistics. Australian Standard Geographical Classification (ASGC), 2001. Canberra: ABS, 2001. (ABS Cat. No. 1216.0.)
- 20. Vukmir RB. The influence of urban, suburban, or rural locale on survival from refractory prehospital cardiac arrest. Am J Emerg Med 2004; 22: 90-93.
- 21. Layon AJ, Gabrielli A, Goldfeder BW, et al. Utstein style of rural out-of-hospital cardiac arrest [OOHCA]: total cardiopulmonary resuscitation (CPR) time inversely correlates with hospital discharge rate. Resuscitation 2003; 56: 59-66.
- 22. Lyon RM, Cobbe SM, Bradley JM, Grubb NR. Surviving out of hospital cardiac arrest at home: a postcode lottery? Emerg Med J 2004; 21: 619-624.
- 23. Langhelle A, Nolan J, Herlitz J, et al. Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style. Resuscitation 2005; 66: 271-283.
- 24. Heward A, Damiani M, Hartley-Sharpe C. Does the use of the Advanced Medical Priority Dispatch System affect cardiac arrest detection? Emerg Med J 2004; 21: 115-118.
- 25. Smith KL, Peeters A, McNeil JJ. Results from the first 12 months of a fire first-responder program in Australia. Resuscitation 2001; 49: 143-150.
- 26. White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation 2005; 65: 279-283.
- 27. Hallstrom AP, Ornato JP, Weisfeldt M, et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004; 351: 637-646.
- 28. Portner ME, Pollack ML, Schirk SK, Schlenker MK. Out-of-hospital cardiac arrest locations in a rural community: where should we place AEDs? Prehospital Disaster Med 2004; 19: 352-355.
- 29. Seattle Institute for Cardiac Research. The Home AED Trial (HAT). http://www.sicr.org/hatmain.html (accessed May 2006).
- 30. Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004; 351: 647-656.
- 31. Shy BD, Rea TD, Becker LJ, Eisenberg MS. Time to intubation and survival in prehospital cardiac arrest. Prehosp Emerg Care 2004; 8: 394-399.
- 32. Casner M, Anderson D, Isaacs SM. The impact of a new CPR assist device on rate of return of spontaneous circulation in out-of-hospital cardiac arrest. Prehosp Emerg Care 2005; 9: 61-67.
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