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Do neighbourhoods in Vancouver and surrounding areas demonstrate different rates of bystander CPR and survival for out-of-hospital cardiac arrest?

  • David Barbic (a1), Brian Klinkenberg (a2), Brian Grunau (a1) and Jim Christenson (a1)
Abstract</title> <sec secType='general' id='abs1'> <title>Objective</title> <p>No prior work exists examining the relation between the geographic distribution of out-of-hospital cardiac arrest (OHCA) in the city of Vancouver and surrounding areas that may exhibit a clustering of cases. The primary objective of this study was to describe the distribution of OHCA within the Vancouver Coastal Health region using a geographic information system (GIS) analysis and appropriate statistical analyses.</p> </sec> <sec secType='methods' id='abs2'> <title>Methods</title> <p>This study was a post-hoc GIS-based analysis of OHCA patients in the city of Vancouver and surrounding areas, using data collected by the Resuscitation Outcomes Consortium between September 2007 and December 2011. The kernel density techniques and regression tree analysis using binary recursive partitioning were used.</p> </sec> <sec secType='results' id='abs3'> <title>Results</title> <p>We examined 1617 cases of OHCA with a mortality rate of 86.5% (95% CI 84.8-88.2). The mean age of OHCA cases was 66.6 years (95% CI 65.7-67.5), and 33.6% (95% CI 31.3-35.9) were female. The proportion with an initial shockable rhythm (VF or pulseless VT) was 22.2% (95% CI 20.2-24.2); 42.3% (95% CI 39.9-44.7) of all cases received bystander CPR, and 49.7% (95% CI 47.3-52.1) were transported to the hospital by paramedics. The rate of survival to hospital discharge with favourable neurological status (FNS) Cerebral Performance Category (CPC) 1 or 2 was 10.4% (8.9-11.9). Distance of transport to the hospital (less than 2.7 km) was a significant predictor of survival with FNS, but income did not predict survival with FNS. Areas with higher proportions of commuters by car demonstrated lower rates of survival with FNS.</p> </sec> <sec secType='conclusion' id='abs4'> <title>Conclusion
Abstract Objective

No prior work exists examining the relation between the geographic distribution of out-of-hospital cardiac arrest (OHCA) in the city of Vancouver and surrounding areas that may exhibit a clustering of cases. The primary objective of this study was to describe the distribution of OHCA within the Vancouver Coastal Health region using a geographic information system (GIS) analysis and appropriate statistical analyses.

Methods

This study was a post-hoc GIS-based analysis of OHCA patients in the city of Vancouver and surrounding areas, using data collected by the Resuscitation Outcomes Consortium between September 2007 and December 2011. The kernel density techniques and regression tree analysis using binary recursive partitioning were used.

Results

We examined 1617 cases of OHCA with a mortality rate of 86.5% (95% CI 84.8-88.2). The mean age of OHCA cases was 66.6 years (95% CI 65.7-67.5), and 33.6% (95% CI 31.3-35.9) were female. The proportion with an initial shockable rhythm (VF or pulseless VT) was 22.2% (95% CI 20.2-24.2); 42.3% (95% CI 39.9-44.7) of all cases received bystander CPR, and 49.7% (95% CI 47.3-52.1) were transported to the hospital by paramedics. The rate of survival to hospital discharge with favourable neurological status (FNS) Cerebral Performance Category (CPC) 1 or 2 was 10.4% (8.9-11.9). Distance of transport to the hospital (less than 2.7 km) was a significant predictor of survival with FNS, but income did not predict survival with FNS. Areas with higher proportions of commuters by car demonstrated lower rates of survival with FNS.

Conclusion

This is the first GIS-based study to examine OHCA in a single large Canadian centre. Clustering of OHCA consistent with areas of high population density was observed. Distance of transport was a significant predictor of survival with FNS for patients with OHCA. This may have important implications for future emergency medical services deployment and dispatch decision-making, and public policy initiatives.

RÉSUMÉ Objectif

Aucune étude n’a porté jusqu’à maintenant sur la relation entre la répartition géographique des arrêts cardiaques extra-hospitaliers (ACEH) à Vancouver et dans les régions voisines, et de possibles concentrations de cas. L’étude avait pour objectif principal de décrire la répartition des ACEH au sein de la région sanitaire Vancouver Coastal, à l’aide d’une analyse fondée sur des systèmes d’information géographique (SIG) et d’analyses statistiques appropriées.

Méthode

Il s’agit d’une étude analytique, postérieure aux faits et fondée sur des SIG, de patients ayant subi un ACEH à Vancouver et dans les régions voisines; les données ont été recueillies par le Resuscitation Outcomes Consortium, entre septembre 2007 et décembre 2011. Les auteurs ont eu recours à des techniques de densité par noyau et à une analyse de régression arborescente à l’aide d’un compartimentage récursif binaire.

Résultats

Ont été recensés 1617 cas d’ACEH; le taux de mortalité s’élevait à 86,5 % (IC à 95 % : 84,8-88,2), l’âge moyen des patients était de 66,6 ans (IC à 95 % :65,7-67,5) et 33,6 % (IC à 95 % : 31,3-35,9) des personnes touchées étaient des femmes. Dans 22,2 % (IC à 95 % : 20,2-24,2) des cas, le rythme initial (fibrillation ventriculaire ou tachycardie ventriculaire sans pouls) se prêtait au traitement par décharge électrique; dans 42,3 % (IC à 95 % : 39,9-44,7) des cas, des manœuvres de réanimation ont été effectuées par des passants et dans 49,7 % (IC à 95 % : 47,3-52,1) des cas, il y a eu transport à l’hôpital par des ambulanciers paramédicaux. Le taux de survie avec un état neurologique satisfaisant ([ENS]; CPC [Cerebral Performance Category] : 1 ou 2) au moment du congé de l’hôpital atteignait 10,4 % (8,9-11,9). La distance de transport vers l’hôpital (moins de 2,7 km) s’est révélé un facteur prévisionnel important de survie avec un ENS, contrairement aux revenus. Enfin, dans les régions où la proportion de navetteurs utilisant une automobile était élevée, le taux de survie avec un ENS était plus faible qu’ailleurs.

Conclusions

Il s’agit de la première étude reposant sur des SIG et visant à examiner les cas d’ACEH survenus dans un seul centre urbain d’importance au Canada. Des concentrations d’ACEH ont été observées dans les régions densément peuplées. Par ailleurs, la distance de transport s’est révélée un facteur prévisionnel important de survie avec un ENS chez les patients ayant subi un ACEH. Les résultats de l’étude peuvent avoir une incidence importante sur la distribution future des services médicaux d’urgence et les prises de décision relatives à la répartition des ressources ainsi que sur des initiatives en matière de politique publique.

Copyright
Corresponding author
Correspondence to: Dr. David Barbic, Department of Emergency Medicine, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Y 1YZ; Email: David.barbic@ubc.ca
Linked references
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Canadian Journal of Emergency Medicine
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