title: Out-of-hospital cardiac arrest in Victoria: rural and urban outcomes.
abstract: OBJECTIVE
  To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences.
  
  
  METHODS
  Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry.
  
  
  METHODS
  All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service.
  
  
  METHODS
  1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003.
  
  
  RESULTS
  Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew.
  
  
  CONCLUSIONS
  Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.
authors.affiliation: Rural Ambulance Victoria, Geelong, Victoria. paul.jennings@rav.vic.gov.au
authors.forename: Paul A
authors.initials: PA
authors.lastname: Jennings
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.forename: Tony
authors.initials: T
authors.lastname: Walker
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data*; D015996:Survival Rate; D014504:Urban Health / Q000706:statistics & numerical data*; D014739:Victoria / Q000453:epidemiology