Ian R Drennan1, Ryan P Strum2, Adam Byers2, Jason E Buick2, Steve Lin2, Sheldon Cheskes2, Samantha Hu2, Laurie J Morrison2. 1. Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont. drennani@smh.ca. 2. Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
Abstract
BACKGROUND: The increasing number of people living in high-rise buildings presents unique challenges to care and may cause delays for 911-initiated first responders (including paramedics and fire department personnel) responding to calls for out-of-hospital cardiac arrest. We examined the relation between floor of patient contact and survival after cardiac arrest in residential buildings. METHODS: We conducted a retrospective observational study using data from the Toronto Regional RescuNet Epistry database for the period January 2007 to December 2012. We included all adult patients (≥ 18 yr) with out-of-hospital cardiac arrest of no obvious cause who were treated in private residences. We excluded cardiac arrests witnessed by 911-initiated first responders and those with an obvious cause. We used multivariable logistic regression to determine the effect on survival of the floor of patient contact, with adjustment for standard Utstein variables. RESULTS: During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria, of which 5998 (76.5%) occurred below the third floor and 1844 (23.5%) occurred on the third floor or higher. Survival was greater on the lower floors (4.2% v. 2.6%, p = 0.002). Lower adjusted survival to hospital discharge was independently associated with higher floor of patient contact, older age, male sex and longer 911 response time. In an analysis by floor, survival was 0.9% above floor 16 (i.e., below the 1% threshold for futility), and there were no survivors above the 25th floor. INTERPRETATION: In high-rise buildings, the survival rate after out-of-hospital cardiac arrest was lower for patients residing on higher floors. Interventions aimed at shortening response times to treatment of cardiac arrest in high-rise buildings may increase survival.
BACKGROUND: The increasing number of people living in high-rise buildings presents unique challenges to care and may cause delays for 911-initiated first responders (including paramedics and fire department personnel) responding to calls for out-of-hospital cardiac arrest. We examined the relation between floor of patient contact and survival after cardiac arrest in residential buildings. METHODS: We conducted a retrospective observational study using data from the Toronto Regional RescuNet Epistry database for the period January 2007 to December 2012. We included all adult patients (≥ 18 yr) with out-of-hospital cardiac arrest of no obvious cause who were treated in private residences. We excluded cardiac arrests witnessed by 911-initiated first responders and those with an obvious cause. We used multivariable logistic regression to determine the effect on survival of the floor of patient contact, with adjustment for standard Utstein variables. RESULTS: During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria, of which 5998 (76.5%) occurred below the third floor and 1844 (23.5%) occurred on the third floor or higher. Survival was greater on the lower floors (4.2% v. 2.6%, p = 0.002). Lower adjusted survival to hospital discharge was independently associated with higher floor of patient contact, older age, male sex and longer 911 response time. In an analysis by floor, survival was 0.9% above floor 16 (i.e., below the 1% threshold for futility), and there were no survivors above the 25th floor. INTERPRETATION: In high-rise buildings, the survival rate after out-of-hospital cardiac arrest was lower for patients residing on higher floors. Interventions aimed at shortening response times to treatment of cardiac arrest in high-rise buildings may increase survival.
Authors: Ian Jacobs; Vinay Nadkarni; Jan Bahr; Robert A Berg; John E Billi; Leo Bossaert; Pascal Cassan; Ashraf Coovadia; Kate D'Este; Judith Finn; Henry Halperin; Anthony Handley; Johan Herlitz; Robert Hickey; Ahamed Idris; Walter Kloeck; Gregory Luke Larkin; Mary Elizabeth Mancini; Pip Mason; Gregory Mears; Koenraad Monsieurs; William Montgomery; Peter Morley; Graham Nichol; Jerry Nolan; Kazuo Okada; Jeffrey Perlman; Michael Shuster; Petter Andreas Steen; Fritz Sterz; James Tibballs; Sergio Timerman; Tanya Truitt; David Zideman Journal: Resuscitation Date: 2004-12 Impact factor: 5.262
Authors: Justin J Boutilier; Steven C Brooks; Alyf Janmohamed; Adam Byers; Jason E Buick; Cathy Zhan; Angela P Schoellig; Sheldon Cheskes; Laurie J Morrison; Timothy C Y Chan Journal: Circulation Date: 2017-03-02 Impact factor: 29.690
Authors: Aaron M Orkin; Chun Zhan; Jason E Buick; Ian R Drennan; Michelle Klaiman; Pamela Leece; Laurie J Morrison Journal: PLoS One Date: 2017-04-26 Impact factor: 3.240