title: High-rise buildings and neurologically favorable outcome after out-of-hospital cardiac arrest.
abstract: BACKGROUND
  The number of people living in high-rise buildings has recently been increasing in Japan, and delayed transport time by emergency-medical-service (EMS) personnel from higher floors could lead to lower survival after out-of-hospital cardiac arrest (OHCA). However, there are no clinical studies assessing the association between the floor where patients reside and neurologically favorable outcome after OHCA.
  
  
  METHODS
  This was a prospective, population-based study conducted in Osaka City, Japan that enrolled adults aged >=18years suffering an OHCA of cardiac origin before EMS arrival between 2013 and 2014. The primary outcome measure was one-month survival with neurologically favorable outcome. We divided OHCA patients into the following groups: those residing on >=3 floors (the high floor group) and <3 floors (the low floor group). Multiple logistic regression analysis was used to assess factors associated with neurologically favorable outcome.
  
  
  RESULTS
  A total of 2979 patients were eligible for analysis. Of them, 1885 (62.3%) occurred below the third floor and 1094 (37.4%) occurred at or above the third floor. The proportion of neurologically favorable outcome after OHCA was significantly lower in the high floor group than in the low floor group (2.7% [30/1094] versus 4.8% [91/1885], P=0.005). In a multivariate analysis, neurologically favorable outcome after OHCA was significantly lower in the high floor group than in the low floor group (adjusted odds ratio, 0.59 [95% confidence interval, 0.37-0.96]).
  
  
  CONCLUSIONS
  In this population, one-month survival with neurologically favorable outcome from OHCA was lower in the high floor group than in the low floor group.
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. Electronic address: lucky_unatan@yahoo.co.jp.
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Public Health, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kiyohara
authors.affiliation: Department of Critical Care Nursing, Graduate School of Medicine and School of Health Sciences, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Nishiyama
authors.affiliation: Osaka Municipal Fire Department, 1-12-54 Kujo minami, Nishi-ku, Osaka 550-8566, Japan.
authors.forename: Sumito
authors.initials: S
authors.lastname: Hayashida
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Izawa
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Tomonari
authors.initials: T
authors.lastname: Shimamoto
authors.affiliation: Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-0841, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Matsuyama
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Hatakeyama
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Katayama
authors.affiliation: Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka 558-8558, Japan.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Kiguchi
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
mesh_terms: D000328:Adult; D000368:Aged; D001107:Architectural Accessibility / Q000592:standards*; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012111:Residence Characteristics; D016019:Survival Analysis; D013997:Time Factors
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Epidemiology; Resuscitation time course