title: Out-of-hospital cardiac arrest: incidence, process of care, and outcomes in an urban city, Korea.
abstract: OBJECTIVE
  We aimed to determine the incidence, processes of care, and outcomes in out-of-hospital cardiac arrests (OHCA) in Ansan, South Korea.
  
  
  METHODS
  From the Ansan Fire Department's (1-1-9 emergency call number) Emergency Medical Services (EMS) database, we obtained a list of adult cardiac arrest cases occurring between January 2008 and December 2011. We excluded cases with obvious non-cardiac causes, such as trauma, drowning, hanging, and asphyxia. We matched the EMS data with in-hospital care and outcome data. We analyzed basic demographic variables (age and gender), the time and place of incidence, witnesses, bystander cardiopulmonary resuscitation (CPR), major time variables, CPR instructions during transport, initial cardiac rhythm at the scene, and automated defibrillator use.
  
  
  RESULTS
  The overall incidence of OHCA in Ansan was 33.1/100,000 persons per year. Out of 778 adult OHCAs in our study population, bystander CPR was provided in 103 cases (13.2%). Of the 517 OHCAs whose initial rhythms were confirmed, 85 (16.4%) showed shockable rhythms, but only 23 (27.1%) received defibrillation at the scene or during transportation. Of the 106 patients whose spontaneous circulation returned at the hospital, only 6 (5.7%) received mild therapeutic hypothermia. During the study period, 31 patients (4%) survived to discharge from hospitals, and 6 of these discharged patients (19.4%) showed favorable neurologic outcomes.
  
  
  CONCLUSIONS
  While the survival rate from OHCA in Ansan is very low, this study provides basic information needed to create improvements. Our analysis suggests that multiple variables contribute to the low OHCA survival rate. Several of these variables are modifiable; addressing them is a clear first step toward strengthening the chain of survival from OCHA in Ansan.
authors.affiliation: Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Hanjin
authors.initials: H
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Sungwoo
authors.initials: S
authors.lastname: Moon
authors.affiliation: Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Gapsu
authors.initials: G
authors.lastname: Han
authors.affiliation: Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Jong-Hak
authors.initials: JH
authors.lastname: Park
authors.affiliation: Ansan Public Health Center, Ansan, Korea.
authors.forename: Hongjae
authors.initials: H
authors.lastname: Lee
authors.affiliation: Ansan Fire Department, Ansan, Korea.
authors.forename: Jungoh
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.
authors.forename: Seungsik
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ, USA; Arizona Department of Health Services, Bureau of EMS and Trauma Systems, Phoenix, AZ, USA.
authors.forename: Bentley J
authors.initials: BJ
authors.lastname: Bobrow
keywords: Incidence; Korea; Out-of-hospital cardiac arrest; Patient outcome assessment; Resuscitation; Urban health