title: Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival.
abstract: BACKGROUND
  The increasing number of people living in high-rise buildings presents unique challenges to care and may cause delays for 911-initiated first responders (including paramedics and fire department personnel) responding to calls for out-of-hospital cardiac arrest. We examined the relation between floor of patient contact and survival after cardiac arrest in residential buildings.
  
  
  METHODS
  We conducted a retrospective observational study using data from the Toronto Regional RescuNet Epistry database for the period January 2007 to December 2012. We included all adult patients (≥ 18 yr) with out-of-hospital cardiac arrest of no obvious cause who were treated in private residences. We excluded cardiac arrests witnessed by 911-initiated first responders and those with an obvious cause. We used multivariable logistic regression to determine the effect on survival of the floor of patient contact, with adjustment for standard Utstein variables.
  
  
  RESULTS
  During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria, of which 5998 (76.5%) occurred below the third floor and 1844 (23.5%) occurred on the third floor or higher. Survival was greater on the lower floors (4.2% v. 2.6%, p = 0.002). Lower adjusted survival to hospital discharge was independently associated with higher floor of patient contact, older age, male sex and longer 911 response time. In an analysis by floor, survival was 0.9% above floor 16 (i.e., below the 1% threshold for futility), and there were no survivors above the 25th floor.
  
  
  CONCLUSIONS
  In high-rise buildings, the survival rate after out-of-hospital cardiac arrest was lower for patients residing on higher floors. Interventions aimed at shortening response times to treatment of cardiac arrest in high-rise buildings may increase survival.
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont. drennani@smh.ca.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Drennan
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Strum
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Adam
authors.initials: A
authors.lastname: Byers
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Buick
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Steve
authors.initials: S
authors.lastname: Lin
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Cheskes
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hu
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute (Drennan, Strum, Byers, Buick, Lin, Cheskes, Hu, Morrison), St. Michael's Hospital, Toronto, Ont.; Institute of Medical Science, Faculty of Medicine (Drennan), Department of Family and Community Medicine (Cheskes) and Department of Medicine (Morrison), University of Toronto, Toronto, Ont.; Sunnybrook Centre for Prehospital Medicine (Drennan, Buick, Cheskes), Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult