title: Treatment and outcome of out-of-hospital cardiac arrest in outpatient health care facilities.
abstract: OBJECTIVE
  We evaluated the frequency and effectiveness of basic and advanced life support (ALS) interventions by medical professionals when out-of-hospital cardiac arrest (OHCA) occurred in ambulatory healthcare clinics before emergency medical services (EMS) arrival.
  
  
  METHODS
  Non-traumatic OHCAs in adults were systematically characterized over a 15 year period by their occurrence in clinics, at home, or in non-medical public locations, and outcomes compared between matched cohorts from each group.
  
  
  RESULTS
  Among 7784 patients, 6098 OHCA occurred at home, 1612 in non-medical public locations and 74 in clinics. Compared to non-medical public locations, clinic patients with OHCA were older, more often women and more frequently shocked; clinic arrests were more often witnessed, less likely to be of cardiac cause and to occur before EMS arrival. Compared to home, more clinic arrests were witnessed, occurred after EMS arrival, had bystander CPR, shockable rhythms and were defibrillated. When OHCA occurred before EMS arrival, 51 of 56 clinic patients (91%) received CPR, a defibrillator applied to 23 (41%), 17 (30%) were shocked, 4 (7%) intubated, and 7 (13%) received intravenous medications from facility personnel. Of these, only pre-EMS defibrillator use was associated with improved outcome. Among matched patients, OHCA survival was higher in clinics than at home (42% vs 26%, p=0.029), but comparable to other public locations.
  
  
  CONCLUSIONS
  Survival from OHCA in clinics was comparable to non-medical public locations, and higher than at home. Alongside CPR, use of defibrillators was associated with improved survival and worth prioritizing over other interventions before EMS arrival regardless of OHCA location.
authors.affiliation: University of Washington Department of Medicine, Seattle, WA, United States; King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States. Electronic address: kudenchu@u.washington.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kudenchuk
authors.affiliation: University of Virginia Health System, Department of Anesthesiology, Charlottesville, VA 22903, United States.
authors.forename: Russell
authors.initials: R
authors.lastname: Stuart
authors.affiliation: King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States.
authors.forename: Sofia
authors.initials: S
authors.lastname: Husain
authors.affiliation: King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States.
authors.forename: Carol
authors.initials: C
authors.lastname: Fahrenbruch
authors.affiliation: University of Washington Department of Medicine, Seattle, WA, United States; King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States.
authors.forename: Mickey
authors.initials: M
authors.lastname: Eisenberg
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Advanced life support; Cardiac arrest; Defibrillation; Resuscitation