Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation.
BACKGROUND
The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations.


RESULTS
We studied 4828 OHCAs in Copenhagen between 1994 and 2005. The incidence and characteristics of OHCA were examined in every 100 x 100-m (109.4 x 109.4-yd) residential area according to its underlying demographic characteristics. By combining > or =2 demographic characteristics, it was possible to identify 100 x 100-m (109.4 x 109.4-yd) areas with at least 1 arrest every 5.6 years (characterized by >300 persons per area and lowest income) to 1 arrest every 4.3 years (characterized by >300 persons per area, lowest income, low education, and highest age). These areas covered 9.0% and 0.8% of all residential OHCAs, respectively. Individuals with OHCA in residential locations differed from public ones in that the patients were older (70.6 versus 60.6 years; P<0.0001), the ambulance response interval was longer (6.0 versus 5.0 minutes; P<0.0001), arrests occurred more often at night (21.2% versus 11.2%; P<0.0001), the patients had ventricular fibrillation less often (12.8% versus 38.1%; P<0.0001), and the patients had a worse 30-day survival rate (3.2% versus 13.9%; P<0.0001).


CONCLUSIONS
On the basis of simple demographic characteristics of a city center, we could identify residential areas suitable for automated external defibrillator placement. Individuals with OHCA in residential locations were more likely to have characteristics associated with poor outcome compared with public arrests.
Folke
Fredrik
F
Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. FF@heart.dk
Gislason
Gunnar H
GH
Lippert
Freddy K
FK
Nielsen
Søren L
SL
Weeke
Peter
P
Hansen
Morten L
ML
Fosbøl
Emil L
EL
Andersen
Søren S
SS
Rasmussen
Søren
S
Schramm
Tina K
TK
Køber
Lars
L
Torp-Pedersen
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000706:statistics & numerical data*; D047548:Defibrillators / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000639:trends*; D011159:Population Surveillance; D011633:Public Facilities; D012307:Risk Factors; D000078329:Workforce