Comparative Analysis of Out-of-Hospital Cardiac Arrest Outcomes in Health Clinics, Nursing Homes, and Public Places: Implications for Optimizing Automated External Defibrillator Strategies

Abstract

Yi-Chia Su,1 Chip-Jin Ng,1– 3 Liang-Tien Chien,4,5 Li-Heng Tsai,1,2 Cheng-Yu Chien,1,2,6,7 Shou-Chien Hsu1,2,8 1Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan; 3Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; 4Graduate Institute of Management, College of Management, Chang Gung University, Taoyuan, Taiwan; 5Taoyuan Fire Department, Taoyuan, Taiwan; 6Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan; 7Department of Senior Service Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan; 8Department of Occupational Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, TaiwanCorrespondence: Shou-Chien Hsu, Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing Street, Gueishan District, Taoyuan City, 333, Taiwan, Tel [phone] # 2505, Fax [phone], Email [email protected]: Various factors, such as event location and response time, influence the outcomes of out-of-hospital cardiac arrest (OHCA). Very few studies have explored the delivery of basic life support (BLS) to patients having OHCA at health clinics or nursing homes—settings with professional BLS providers. Thus, in this study, we compared prognostic and survival outcomes between health clinics, nursing homes, and other public places (eg, workplaces and sports facilities/recreational areas) to offer insights for optimizing OHCA outcomes.Patients: This study included adults who had nontraumatic OHCA in Taoyuan City between January 2017 and December 2022.Methods: We collected data on patient characteristics, emergency medical service parameters, onsite patient management, automated external defibrillator (AED) locations, OHCA prognosis, and survival outcomes. Multivariate analyses were performed to predict survival to discharge (primary outcome) and neurological outcomes at discharge (secondary outcome).Results: During the study period, the numbers of OHCA events at health clinics, nursing homes, and other public places were 158, 208, and 1986, respectively. The mean age of OHCA in health medical clinics, nursing home and other public places were 63.4, 81.5 and 64.7, respectively (P value< 0.001). The proportion of witnessed events, rate of bystander resuscitation, and frequency of AED utilization were the highest for health clinics (53.2% (84/158), 83.4% (132/158), and 13.3% (21/158), respectively, P value< 0.001). The average AED–scene distances and response times were the lowest for health clinics (388.8 m and 5.4 min, respectively). In initial shockable rhythm group, the probabilities of survival to discharge at discharge were the highest for health clinics (aOR=1.41, 95% CI=1.04– 1.81, P value=0.041)) and lowest for nursing homes (aOR=0.84, 95% CI=0.76– 0.93, P value=0.024).Conclusion: Our research shows that OHCA patients at medical health clinics have higher rates of witnessing and bystander CPR and AED usage than other public places. However, while survival rates for patients with shockable rhythms are slightly better at health clinics, the neurological outcomes are not significantly different. The AED–scene distances are too far to be used effectively.Keywords: public access defibrillators, geographic information system, out-of-hospital cardiac arrest, automated external defibrillators, emergency medical services

Keywords

• public access defibrillators
• geographic information system
• out-of-hospital cardiac arrest
• automated external defibrillators
• emergency medical services