title: Cardiac arrest in private locations: different strategies are needed to improve outcome.
abstract: BACKGROUND
  A tremendous amount of public resources are focused on improving cardiac arrest (OHCA) survival in public places, yet most OHCAs occur in private residences.
  
  
  RESULTS
  A prospective, observational study of patients transported to seven urban and suburban hospitals and the individuals who called 911 at the time of a cardiac arrest (bystander) was performed. Bystanders (N=543) were interviewed via telephone beginning 2 weeks after the incident to obtain data regarding patient and bystander demographics, including cardiopulmonary resuscitation (CPR) training. Of all arrests 80.2% were in homes. Patients who arrested in public places were significantly younger (63.2 vs. 67.2, P<0.02), more often had an initial rhythm of VF (63.0 vs. 37.7%, P<0.001), were seen or heard to have collapsed by a bystander (74.8 vs. 48.1%, P<0.001), received bystander CPR (60.2 vs. 28.6%, P<0.001), and survived to DC (17.5 vs. 5.5%, P<0.001). Patients who arrested at home were older and had an older bystander (55.4 vs. 41.3, P<0.001). The bystander was less likely to be CPR trained (65.0 vs. 47.4%, P<0.001), less likely to be trained within the last 5 years (49.2 vs. 17.9, P<0.001), and less likely to perform CPR if trained (64.2 vs. 30.0%, P<0.001). Collapse to shock intervals for public versus home VF patients were not different.
  
  
  CONCLUSIONS
  Many important characteristics of cardiac arrest patients and the bystander differ in public versus private locations. Fundamentally different strategies are needed to improve survival from these events.
authors.affiliation: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA. raswor@aol.com
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.forename: R E
authors.initials: RE
authors.lastname: Jackson
authors.forename: S
authors.initials: S
authors.lastname: Compton
authors.forename: R
authors.initials: R
authors.lastname: Domeier
authors.forename: R
authors.initials: R
authors.lastname: Zalenski
authors.forename: L
authors.initials: L
authors.lastname: Honeycutt
authors.forename: G J
authors.initials: GJ
authors.lastname: Kuhn
authors.forename: S
authors.initials: S
authors.lastname: Frederiksen
authors.forename: R G
authors.initials: RG
authors.lastname: Pascual
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000706:statistics & numerical data; D004631:Emergency Medical Service Communication Systems; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D019370:Observation; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors