Out-of-hospital cardiac arrests occurring in southern Ontario health care clinics: bystander cardiopulmonary resuscitation and automated external defibrillator use.

OBJECTIVE: To determine the proportion of public-location out-of-hospital cardiac arrests (OHCAs) that occur in health care clinics and to describe bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use during these episodes.
DESIGN: Our study was a retrospective cohort study of 679 nontraumatic OHCAs recorded in the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database.
SETTING: Out-of-hospital medical clinics and other public locations in Toronto, Ont, and the surrounding municipal regions of Hamilton, Durham, York, Peel, Simcoe, and Muskoka. PARTICIPANTS: A total of 679 consecutive patients suffering nontraumatic OHCAs of presumed cardiac cause in public locations. MAIN OUTCOME MEASURES: The proportion of public-location cardiac arrests occurring in medical clinics and the occurrence of bystander CPR and bystander use of AEDs.
RESULTS: Twenty-two of the 679 public-location cardiac arrests occurred in health care clinics (3.2%, 95% confidence interval 1.9% to 4.6%). Bystander CPR occurred more often in health care clinics (73% of episodes in clinics compared with 46% in other public places, P = .02), but there was no statistically significant difference in AED use between groups. Twenty-seven percent of those suffering cardiac arrests in health care clinics did not receive any bystander CPR, and more than 90% did not have AEDs applied.
CONCLUSION: Although the response to cardiac arrest in out-of-hospital medical clinics is superior to the response to those arrests that occur in other public settings, it remains suboptimal. Increasing CPR training among staff and improving access to AEDs in medical clinics might improve the response to OHCA in medical clinics and ultimately improve outcomes for patients.