title: Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital Arrest Survival Evaluation (PHASE) Study.
abstract: OBJECTIVE
  To determine survival from out-of-hospital cardiac arrest in New York City and to compare this with other urban, suburban, and rural areas.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  New York City.
  
  
  METHODS
  Consecutive out-of-hospital cardiac arrests occurring between October 1, 1990, and April 1, 1991.
  
  
  METHODS
  Trained paramedics performed immediate postarrest interviews with care providers, using a standardized questionnaire.
  
  
  METHODS
  Entry criteria, elapsed time intervals, and nodal events conformed to Utstein recommendations. The single target end point was death or discharge home.
  
  
  RESULTS
  Of 3243 consecutive cardiac arrests on which resuscitation was attempted, 2329 (72%) met entry criteria as primary cardiac events. Overall survival was 1.4% (99% confidence interval [CI], 0.9% to 2.3%). No patients were lost to follow-up. Survival from witnessed ventricular fibrillation was 5.3% (99% CI, 2.9% to 8.8%). Using survival from witnessed ventricular fibrillation for intersystem comparison, our survival rate was similar to that of Chicago, Ill (4.0%; 99% CI, 1.9% to 7.5%; P = .41), the only other large city on which data were available. However, it was significantly lower than that reported from midsized urban/suburban areas (33.0%; 99% CI, 30.4% to 35.6%; P < .0001) and suburban/rural areas (12.6%; 99% CI, 8.9% to 16.3%; P < .0001). Survival rate among arrests occurring after arrival of emergency medical services personnel (8.5%; 99% CI, 4.7% to 14.0%) was comparable with Chicago (6.6%; 99% CI, 3.3% to 11.5%; P = .41) but markedly lower than King County, Washington (36%; 99% CI, 28.6% to 43.8%; P < .0001).
  
  
  CONCLUSIONS
  Survival from out-of-hospital cardiac arrest in New York City was poor. This was partly attributable to lengthy elapsed time intervals at every step in the chain of survival. However, examination of survival among arrests occurring after emergency medical services arrival suggests that other features may predispose residents of large cities to higher cardiac arrest mortality than individuals living in more suburban or rural settings. Since half the US population resides in large metropolitan areas, this represents a public health problem of considerable magnitude.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.forename: J
authors.initials: J
authors.lastname: Gallagher
authors.forename: P
authors.initials: P
authors.lastname: Gennis
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data