Risky locations for out-of-hospital cardiopulmonary arrest in a typical urban city.
BACKGROUND
The aim of this study is to clarify the circumstances including the locations where critical events resulting in out-of-hospital cardiopulmonary arrest (OHCPA) occur.


METHODS
Subjects of this population-based observational case series study were the clinical records of patients with nontraumatic and nonneck-hanging OHCPA.


RESULTS
Of all 1546 cases, 10.3% occurred in a public place (shop, restaurant, workplace, stations, public house, sports venue, and bus), 8.3% on the street, 73.4% in a private location (victim's home, the homes of the victims' relatives or friends or cheap bedrooms, where poor homeless people live), and 4.1% in residential institutions. In OHCPA occurring in private locations, the frequency of asystole was higher and the outcome was poorer than in other locations. A total of 181 OHCPA cases (11.7%) took place in the lavatory and 166 (10.7%) in the bathroom; of these, only 7 (3.9% of OHCPA in the lavatory) and none in the bath room achieved good outcomes. The frequencies of shockable initial rhythm occurring in the lavatory and in bath room were 3.7% and 1.1% (lower than in other locations, P = 0.011 and 0.002), and cardiac etiology in OHCPA occurring in these locations were 46.7% and 78.4% (the latter higher than in other locations, P < 0.001).


CONCLUSIONS
An unignorable population suffered from OHCPA in private locations, particularly in the lavatory and bathroom; their initial rhythm was usually asystole and their outcomes were poor, despite the high frequency of cardiac etiology in the bathroom. We should try to treat OHCPA victims and to prevent occurrence of OHCPA in these risky spaces by considering their specific conditions.
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
Yoshihiro
Y
Moriwaki
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
Yoshio
Y
Tahara
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
Masayuki
M
Iwashita
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
Takayuki
T
Kosuge
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
Noriyuki
N
Suzuki
Bathroom; OHCPA; lavatory; out-of-hospital cardiopulmonary arrest; the relation between outcome and location