title: Utstein style analysis of rural out-of-hospital cardiac arrest [OOHCA]: total cardiopulmonary resuscitation (CPR) time inversely correlates with hospital discharge rate.
abstract: OBJECTIVE
  Survival after out-of-hospital cardiac arrest (OOHCA) in an urban environment is directly proportional to speed of defibrillation and effective bystander cardiopulmonary resuscitation (CPR). We hypothesized that the hospital discharge rate from rural OOHCA was affected by the same factors.
  
  
  METHODS
  We studied all OOHCAs in 1998 for rural Alachua County, Florida, with one emergency medical system (EMS) transport provider and three hospitals. All EMS identified OOHCA were reviewed retrospectively, as were EMS and hospital records. The 1998 County population was 211403; 1495 deaths from all causes occurred (70.7/10(4) pop). Of 167 OOHCAs (7.9/10(4) pop), 145 were of cardiac etiology; 22 were excluded (13 scene deaths, four traumatic, one intraoperative and three respiratory arrests, one arrest during a hospital-to-hospital transfer) and in eight outcome data were not available in any form. A total of 137/145 (94.5%) OOHCA patients had analyzable data. Data were analyzed using Student's t-test and ANOVA. Alpha was set at 0.05.
  
  
  RESULTS
  Of 25 patients (18.2% of OOHCA) with restoration of spontaneous circulation (ROSC), six survived (4.4% of total, 24% of those with ROSC) to discharge from hospital (four to a skilled nursing facility, one each home with and without assistance). Four patients were still alive at >or=1 year post arrest. Asystole as the initial rhythm (P=0.014), and emergency department (ED) CPR time (8 vs. 15.5 min, P=0.042 for survivors vs. non-survivors) were the only factors statistically affecting survival. While bystander CPR was not significantly different between groups, there was a significantly higher proportion of patients surviving in the ED who had ROSC, and a higher proportion who had ROSC after bystander CPR. Time to defibrillation in nonsurvivors, while not statistically different between city and county patient groups, was clinically different. Statistical significance would likely have been achieved with a larger study population.
  
  
  CONCLUSIONS
  Our data suggest improvement in response time and bystander CPR might further improve survival in a rural setting.
authors.affiliation: Department of Anesthesiology, College of Medicine, University of Florida, PO Box 100254, Gainesville, FL 32610-0254, USA.
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Layon
authors.forename: Andrea
authors.initials: A
authors.lastname: Gabrielli
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Goldfeder
authors.forename: Armando
authors.initials: A
authors.lastname: Hevia
authors.forename: Ahamed H
authors.initials: AH
authors.lastname: Idris
mesh_terms: D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012424:Rural Population; D013997:Time Factors