Spatial Variation and Resuscitation Process Affecting Survival after Out-of-Hospital Cardiac Arrests (OHCA)

• Published in: PloS one 2015-12, Vol.10 (12), p.e0144882-e0144882
• Main Authors: Chen, Chien-Chou, Chen, Chao-Wen, Ho, Chi-Kung, Liu, I-Chuan, Lin, Bo-Cheng, Chan, Ta-Chien
• Format: Article
• Language: English
• Subjects: Aged; Airway management; Automation; Cardiac arrest; Cardiac resuscitation; Cardiopulmonary Resuscitation; Care and treatment; Cohort Studies; CPR; Emergency medical care; Emergency Medical Services; Emergency services; Emergency vehicles; Female; Fires; Geographic information science; Geographic information systems; Health services; Heart diseases; Heart rate; Hospitals; Humanities; Humans; Kriging interpolation; Logistic Models; Male; Mathematical analysis; Methods; Middle Aged; Multivariate Analysis; Network analysis; Odds Ratio; Out-of-Hospital Cardiac Arrest - epidemiology; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Patient outcomes; Patients; Population density; Public health; Regression analysis; Remote sensing; Respiratory tract; Response time; Resuscitation; Retrospective Studies; Risk analysis; Risk Factors; Rural areas; Sex ratio; Social sciences; Spatial analysis; Spatial heterogeneity; Spatial variations; Survival; Survival Rate; Taiwan - epidemiology; Trauma; Urban areas
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0144882

Ambulance response times and resuscitation efforts are critical predictors of the survival rate after out-of-hospital cardiac arrests (OHCA). On the other hand, rural-urban differences in the OHCA survival rates are an important public health issue. We retrospectively reviewed the January 2011-December 2013 OHCA registry data of Kaohsiung City, Taiwan. With particular focus on geospatial variables, we aimed to unveil risk factors predicting the overall OHCA survival until hospital admission. Spatial analysis, network analysis, and the Kriging method by using geographic information systems were applied to analyze spatial variations and calculate the transport distance. Logistic regression was used to identify the risk factors for OHCA survival. Among the 4,957 patients, the overall OHCA survival to hospital admission was 16.5%. In the multivariate analysis, female sex (adjusted odds ratio:, AOR, 1.24 [1.06-1.45]), events in public areas (AOR: 1.30 [1.05-1.61]), exposure to automated external defibrillator (AED) shock (AOR: 1.70 [1.30-2.23]), use of laryngeal mask airway (LMA) (AOR: 1.35 [1.16-1.58]), non-trauma patients (AOR: 1.41 [1.04-1.90]), ambulance bypassed the closest hospital (AOR: 1.28 [1.07-1.53]), and OHCA within the high population density areas (AOR: 1.89 [1.55-2.32]) were positively associated with improved OHCA survival. By contrast, a prolonged total emergency medical services (EMS) time interval was negatively associated with OHCA survival (AOR: 0.98 [0.96-0.99]). Resuscitative efforts, such as AED or LMA use, and a short total EMS time interval improved OHCA outcomes in emergency departments. The spatial heterogeneity of emergency medical resources between rural and urban areas might affect survival rate.