Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation

• Published in: Resuscitation 2011-06, Vol.82 (6), p.674-679
• Main Authors: Sasson, Comilla, Keirns, Carla C, Smith, Dylan M, Sayre, Michael R, Macy, Michelle L, Meurer, William J, McNally, Bryan F, Kellermann, Arthur L, Iwashyna, Theodore J
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - statistics & numerical data; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Health services research; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - therapy; Residence Characteristics - statistics & numerical data; Socioeconomic Factors
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2011.02.002

Abstract Objective To understand the association between neighborhood and individual characteristics in determining whether or not bystanders perform cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest (OHCA). Methods Between October 1, 2005 to November 30, 2008, 1108 OHCA cases from Fulton County (Atlanta), GA, were eligible for bystander CPR. We conducted multi-level non-linear regression analysis and derived Empirical Bayes estimates for bystander CPR by census tract. Results 279 (25%) cardiac arrest victims received bystander CPR. Provision of bystander CPR was significantly more common in witnessed events (odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21–2.22, p < 0.001) and those that occurred in public locations (OR 1.67; 95% CI 1.16–2.40, p < 0.001). Other individual-level characteristics were not significantly associated with bystander CPR. Cardiac arrests in the census tracts that rank in the highest income quintile, as compared to the lowest income quintile were much more likely (OR 4.98; 95% CI 1.65–15.04) to receive bystander CPR. Conclusion Cardiac arrest victims in the highest income census tracts were much more likely to receive bystander CPR than in the lowest income census tracts, even after controlling for individual and arrest characteristics. Low-income neighborhoods may be particularly appropriate targets for community-based CPR training and awareness efforts.