title: The increased mortality from witnessed out-of-hospital cardiac arrest in the home.
abstract: BACKGROUND
  Research in 2008 demonstrated that the majority of out-of-hospital cardiac arrests (OHCAs) occur in the home, and many important characteristics differ between private and public locations. However, the influence of the location of collapse on survival from OHCA is not well understood. Furthermore, most of the reports have been from Western countries; there is little research from Asia that differentiates the conditions of OHCA.
  
  
  OBJECTIVE
  To investigate the influence of the location of collapse on being discharged alive from OHCA and whether the location of collapse is also an independent predictor of survival from OHCA in Japan.
  
  
  METHODS
  We analyzed 463 consecutive cases of witnessed OHCA with cardiac etiology that occurred between October 2004 and September 2008 in Japan. We investigated the characteristics of OHCA patients who collapsed in private and public locations, and assessed the influence of the location of collapse on survival from OHCA.
  
  
  RESULTS
  Patients who collapsed outside the home were younger, more likely to be male, more likely to receive bystander cardiopulmonary resuscitation (CPR), and more likely to have ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) and had a shorter time interval between collapse and 9-1-1 call than patients who collapsed in the home. Mortality was significantly higher in the group who collapsed in the home. The independent influence of the location of collapse was eliminated by additional adjustment for time interval from collapse to 9-1-1 call, age, bystander CPR, and initial cardiac rhythm. Finally, VF/pulseless VT as the initial rhythm and bystander CPR were independently associated with the patient's being discharged alive; the location of collapse was not an independently associated variable.
  
  
  CONCLUSIONS
  The present analysis demonstrated that there were significant differences in survival between groups of patients who suffered from cardiac arrest inside and outside the home in Japan. The outside-the-home group had a higher rate of survival from OHCA; however, the location of collapse was not an independent predictor of survival from OHCA. Education of the families of high-risk patients in placing a rapid emergency call and performing effective CPR might be needed to improve survival from cardiac arrest in the home.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ward, Kyoto, Japan. naka-nao@koto.kpu-m.ac.jp
authors.forename: Naohiko
authors.initials: N
authors.lastname: Nakanishi
authors.forename: Shinya
authors.initials: S
authors.lastname: Nishizawa
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kitamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Matsumuro
authors.forename: Takahisa
authors.initials: T
authors.lastname: Sawada
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006699:Home Care Services; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000628:therapy; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy