Adult out-of-hospital cardiac arrest in philadelphia from 2008-2012: An epidemiological study.
Wide variation in out-of-hospital cardiac arrest (OHCA) survival has been reported, with low survival in urban settings. We sought to describe the epidemiology of OHCA in Philadelphia, Pennsylvania, the fifth largest U.S. city, and identify potential areas for targeted interventions to improve survival.



Retrospective chart review of adult, non-traumatic, OHCA occurring in Philadelphia between 2008 and 2012. We determined incidence and epidemiological factors including: demographics, initial cardiac rhythm, bystander cardiopulmonary resuscitation, automated external defibrillator use, return of spontaneous circulation and 30-day survival. 5198 cases of adult, non-traumatic OHCA were identified. The incidence was 81.5/100,000. The majority of cases occurred in a residence (76.2%); 30.4% were witnessed events; the initial cardiac rhythm was pulseless ventricular tachycardia or ventricular fibrillation in 6.2% of cases, pulseless electrical activity in 21.0%, asystole in 38.3% and was unknown or undocumented in the remaining 34.5%. Multivariate logistic regression analysis demonstrated increased 30-day survival with younger age, shockable cardiac rhythms, and daytime arrest. 30-day survival was 8.1% for EMS-assessed patients and 8.6% for EMS-transported patients.



Philadelphia's reported incidence is consistent with urban settings although the survival rate is higher than other urban centers.
Thomas Jefferson University, Department of Emergency Medicine, United States. Electronic address: David.Gaieski@jefferson.edu.
David F
DF
Gaieski
University of Pennsylvania, Department of Emergency Medicine, United States.
Anish K
AK
Agarwal
University of Pennsylvania, Department of Emergency Medicine, United States.
Benjamin S
BS
Abella
University of Michigan School of Medicine, Department of Emergency Medicine, United States.
Robert W
RW
Neumar
University of Pennsylvania, Department of Emergency Medicine, United States; Philadelphia Fire Department, United States.
Crawford
C
Mechem
Johns Hopkins University School of Medicine, United States.
Sarah Wallace
SW
Cater
University of Pennsylvania, Department of Emergency Medicine, United States.
Frances S
FS
Shofer
University of Pennsylvania, Department of Emergency Medicine, United States.
Marion
M
Leary
University of Pennsylvania, Department of Healthcare Management, United States.
William P
WP
Pajerowski
University of Pennsylvania, Department of Emergency Medicine, United States.
Lance B
LB
Becker
Thomas Jefferson University, Department of Emergency Medicine, United States.
Brendan
B
Carr
University of Pennsylvania, Department of Emergency Medicine, United States.
Raina
R
Merchant
Thomas Jefferson University, Department of Emergency Medicine, United States.
Roger A
RA
Band
D000367:Age Factors; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000706:statistics & numerical data*; D047548:Defibrillators / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014505:Urban Population
Cardiac arrest; Cardio-pulmonary resuscitation; Epidemiology