Next Article in Journal
Special Issue: “Genetic Counseling and Genetic Testing in Precision Medicine”
Previous Article in Journal
Longitudinal Analysis of Pulmonary Function Impairment One Year Post-COVID-19: A Single-Center Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JPM
Volume 13
Issue 8
10.3390/jpm13081191
jpm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study

by
Young Taeck Oh
1 and
Chiwon Ahn
2,*
1
Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
2
Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2023, 13(8), 1191; https://doi.org/10.3390/jpm13081191
Submission received: 14 July 2023 / Revised: 24 July 2023 / Accepted: 25 July 2023 / Published: 26 July 2023
(This article belongs to the Section Personalized Critical Care)
Browse Figures
Versions Notes

Abstract

:
Sudden cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is a global public health concern. However, limited research exists on the epidemiology of OHCAs occurring in public places, trends and impact of bystander intervention, and influence of extraordinary circumstances. This study investigated the epidemiological factors, bystander characteristics, and outcomes of OHCAs that occurred in public places in South Korea from 2016 to 2021 and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic. A retrospective analysis was conducted using an Out-of-Hospital Cardiac Arrest Surveillance database, including 33,206 cases of OHCA that occurred in public places. Cases with do-not-resuscitate orders or insufficient data were excluded. A steady increase in bystander-performed cardiopulmonary resuscitation over the years and a constant decrease in bystander automated external defibrillator (AED) use were observed. Survival-to-discharge rates for OHCAs remained relatively steady until a marginal decrease was observed during the pandemic (pandemic, 13.1%; pre-pandemic, 14.4%). Factors affecting survival included the presence of a shockable rhythm, witnessed arrest, cardiac arrest due to disease, use of bystander AED, and period relative to the COVID-19 pandemic. These findings emphasize the critical role of bystanders in outcomes of OHCAs and inform public health strategies on better management of OHCAs in public places.

1. Introduction

Sudden cardiac arrest is a major global public health concern [1]. More than 30,000 victims occur annually in out-of-hospital settings in South Korea; however, survival remains low [2]. Out-of-hospital cardiac arrests (OHCAs) occurring in public spaces constitute a distinct subset of cardiac emergencies, distinguished by unique epidemiological characteristics and challenges [3,4,5,6]. As dynamic social spaces, such as streets, parks, shopping centers, and transportation hubs, public places engage a diverse population in various activities at any given moment. OHCAs occurring in public places may manifest distinctive patterns regarding age groups, prevalence of certain risk factors, time of occurrence, and causative factors compared to those occurring in residential or healthcare settings [6,7]. A detailed understanding of these differences could be vital in shaping the management of OHCAs occurring in public places, including improving response time, identifying high-risk locations, and enhancing the accessibility and utilization of emergency medical services.
With increasing public awareness and intervention during cardiac emergencies, bystanders have become critical factors determining outcomes of OHCAs occurring in public spaces [7,8]. Bystanders can potentially transform the survival rates through immediate recognition, initiation of cardiopulmonary resuscitation (CPR), and application of automated external defibrillators (AEDs) [8,9,10]. However, the trend, extent, and efficacy of bystander interventions have been variable and are likely influenced by factors such as public education, availability of AEDs, and sociocultural dynamics [11]. Additionally, the coronavirus disease 2019 (COVID-19) pandemic added another layer of complexity to the equation [12,13,14]. Pandemic-induced changes in public behavior, restrictions, and fear of infection may have influenced bystander intervention rates and, subsequently, the outcomes of OHCAs [12].
Despite these crucial issues, there is a conspicuous gap in the existing literature regarding the epidemiology of OHCAs occurring in public places, the trends and impact of bystander intervention, and the influence of extraordinary circumstances, such as the COVID-19 pandemic. Therefore, this study aimed to investigate the pre-hospital and epidemiological factors and outcomes of OHCAs that occurred in public places in South Korea between 2016 and 2021. We noted the findings in light of the pandemic and conducted further investigations. Such an understanding is essential for shaping better public health strategies, policy planning, and improving overall survival outcomes of OHCAs.

2. Materials and Methods

2.1. Study Design, Setting, and Data Source

This retrospective observational study used the nationwide, population-based Out-of-Hospital Cardiac Arrest Surveillance (OHCAS) database (managed by the Korea Disease Control and Prevention Agency (KDCA) (https://www.kdca.go.kr/, accessed on 3 July 2023) to evaluate the characteristics of OHCAs occurring in public places and the prognostic factors associated with the survival and good neurological outcomes from January 2016 to December 2021. The database contains information on all patients presenting with acute cardiac arrest transported to medical facilities by the emergency medical service (EMS), amounting to approximately 30,000 patients each year. As the study data were anonymous, the KDCA has allowed research using this database to be conducted, and this work was exempt from assessment by the institutional review board.
In South Korea, government-owned public EMS is available 24 h a day, 365 days a year, and is administered by 19 fire station headquarters under the National Fire Agency [15]. An ambulance is dispatched to the location of the OHCA patient in response to a call, and the patient is transported to a hospital. Before arriving at a hospital, paramedics perform CPR using an AED. Under the supervision of a physician, CPR can be suspended, or advanced airway techniques can be administered; however, drugs for advanced cardiac life support cannot be administered [16]. Information is transmitted from paramedics to the hospital upon the transfer of the patient. Resuscitation treatments at the hospital and after return of spontaneous circulation (ROSC) are administered according to each hospital’s protocol.
The OHCAS database uses patient data extracted from the EMS data registry and hospital medical records. Medical record investigators from the KCDA visit medical facilities to investigate the medical records of OHCA patients in relation to treatments and outcomes and to verify compliance with the Utstein style [17] and the Resuscitation Outcomes Consortium Project [18]. The database uses a customized survey form to record the information of individuals and settings; emergency medical services; emergency department care; hospital procedures; and outcomes at discharge, including survival and neurological outcomes.

2.2. Study Population and Classification of Arrest Location

In this study, we included only OHCAs that occurred in public places. Patients with do-not-resuscitate orders, traumatic cardiac arrest, invalid pre-hospital data, and unknown final outcomes were excluded from the study.
The OHCAS database contains arrest location information, which is divided into seven subcategories under a broad classification of public places: (1) roads/highways, (2) public buildings, (3) leisure facilities, (4) industrial facilities, (5) commercial facilities, (6) terminals, and (7) other public places. Detailed locations corresponding to each domain of the subclass were predetermined, provided via the OHCAS database manual, and are shown in Supplementary Table S1.

2.3. Variables

Data on several variables were collected, including age, sex, place of arrest, witnessed arrest, bystander CPR performed, rhythms initially monitored during the pre-hospital interval (non-shockable vs. shockable), and pre-hospital and in-hospital ROSC. A shockable rhythm was defined as the initial rhythm of pulseless ventricular tachycardia or fibrillation.
The OHCAS data collection period included the COVID-19 pandemic period, during which policies, such as social distancing, self-isolation, and restrictions on outdoor activities, were implemented [19]. As these could affect variables in the pre-hospital and hospital stages of OHCAs that occur in public places, we included a variable encoding the period of occurrence of OHCAs relative to the COVID-19 pandemic, defined based on the date of the World Health Organization’s pandemic declaration, 11 March 2020.

2.4. Outcome Measures

The primary outcome of this study was survival to discharge, which was characterized by the normal discharge or transfer of the patient to another healthcare facility for ongoing care following acute treatment. A favorable neurological outcome was the secondary outcome. The Cerebral Performance Category (CPC) score was used to classify neurological results. CPC scores of 1 and 2 were indicative of good neurological outcomes.

2.5. Statistical Analyses

The data were analyzed using Excel 2019 (Microsoft, Redmond, WA, USA) and R (version 4.3.1, The R Foundation for Statistical Computing, Vienna, Austria). Descriptive statistics were used to describe the baseline characteristics. For continuous variables, values are presented as the means ± standard deviations. Normally distributed variables were analyzed using Student’s t-test between groups. Categorical variables are expressed as frequencies and percentages. The χ2 test or Fisher’s exact test was used to analyze categorical variables using contingency tables. To identify the outcome predictors, covariates, including the binary variable of the period relative to the COVID-19 pandemic (pandemic or pre-pandemic), were evaluated using multivariate analysis. Logistic regression using the “enter” method was independently performed, adjusting for sex, age, witnessed arrest, bystander CPR, AED use, shockable rhythm, cause of arrest, and the period relative to the COVID-19 pandemic. p < 0.05 was considered statistically significant.

3. Results

We identified 33,206 patients who suffered OHCAs in public places between January 2016 and December 2021. We excluded patients who had do-not-resuscitate orders (n = 34) and those with insufficient data (n = 1035). After the exclusion of 1069 patients, 32,134 patients who suffered OHCAs in public places were finally included in the study (Figure 1).
The proportion of males among the OHCA patients was 78.1% in 2016 and 79.6% in 2021. The rate of witnessed arrest rates were 58.3% and 57.7% in 2016 and 2021, respectively. The rate of bystander CPR implementation for OHCAs occurring in public places gradually increased (18.8, 22.2, 24.8, 26.7, 26.0, and 29.2% from 2016 to 2021). Meanwhile, the rate of bystander AED use remained similar from 2016 to 2021 (1.6, 2.0, 2.1, 3.9, 1.9, and 2.7% from 2016 to 2021). The rate of survival to discharge of patients with OHCA in public places was similar between 2016 and 2019, with a marginal decrease in 2020 and 2021 (14.0, 14.0, 14.5, 15.4, 13.0, and 13.1% from 2016 to 2021) (Table 1 and Figure 2).
Seven subcategories of public places were analyzed in detail. Roads or highways and commercial facilities were the most common places of occurrence of OHCAs (39.4% and 26.4%, respectively). The occurrence of OHCAs caused by disease was low on roads or highways and at industrial facilities (17.1% and 38.8%, respectively) and was >75% in other places. The rate of bystander AED use was 10.6% at terminals and only 0.3% on roads or highways. In addition, the rate of bystander AED use in commercial facilities was low (1.8%; Table 2).
We compared the COVID-19 pandemic and pre-pandemic periods for OHCAs that occurred in public places. The rate of implementation of bystander CPR during the pandemic was significantly higher than that during the pre-pandemic period (27.3% and 22.2%, respectively; p < 0.001). The rate of OHCAs caused by disease during the pandemic was higher than that during the pre-pandemic period (55.7% and 52.2%, respectively; p < 0.001). Survival to discharge and favorable neurological outcomes significantly decreased during the pandemic (13.1%, 14.4%, p = 0.002 and 7.7%, 8.2%, p < 0.001, respectively) (Table 3).
Regarding the factors that affected the survival to discharge of patients who suffered OHCAs in public places, shockable rhythm was the most influential variable after adjusting for variables (odds ratio (OR), 10.12; 95% confidence interval (CI), 8.85–11.59, p < 0.001), followed by cardiac arrest due to disease and use of bystander AED (OR, 2.00; 95% CI, 1.37–2.90, p < 0.001). The period to the COVID-19 pandemic was associated with low survival to discharge (OR, 0.78; 95% CI, 0.68–0.90, p < 0.001) (Table 4 and Figure 3).

4. Discussion

This study provided a comprehensive epidemiological assessment of OHCAs that occurred in public places in South Korea from 2016 to 2021, exploring the factors associated with outcomes and analyzing the impact of bystander interventions. The findings highlighted the crucial role of bystanders in OHCA management, with the rate of bystander-performed CPR steadily increasing from 18.8% in 2016 to 29.2% by 2021. These figures highlighted the growing public awareness and intervention in cardiac emergencies. However, bystander use of AED remained low during the study period, indicating it as an area that requires further public health interventions. Upon the examination of the survival-to-discharge rates of patients who suffered OHCAs in public places, our data presented a marginal dip during the last 2 years of the study, which coincided with the COVID-19 pandemic period.
Previous studies have shown that OHCAs occurring in public places are frequently witnessed and have a high chance of bystander intervention [7,8]. In contrast to OHCA occurrences in residences, those occurring in public places involve younger people with fewer comorbidities [6,20,21]. However, this is not the only manner of describing public places. For example, a study showed that individuals who suffer OHCAs in workplaces have higher survival rates [22]. Additional research revealed that cardiac arrests occurring at terminals are frequently witnessed and such individuals receive more bystander intervention [23]. Consequently, it is important to distinguish between differences based on specific categories, even among public places.
Compared to other public places in this study, OHCAs that occurred on roads and highways showed distinctive characteristics. Trauma and other non-disease-related causes of OHCAs were common, whereas bystander intervention was uncommon (CPR, 11.6%; AED, 0.3%); the survival-to-discharge rate was only 7.0%. In contrast, leisure facilities, public buildings, and terminals showed considerable levels of bystander intervention (CPR: 41.5%, 40.1%, and 39.4%; AED use: 6.2%, 7.1%, and 10.6%, respectively). There is an apparent association between effective basic life support training and the presence of competent bystanders in public buildings, which typically includes schools [9,24,25]. AEDs are appropriately positioned in these buildings, and their relative accessibility increases the likelihood of immediate use [26]. The presence of multiple AEDs in transport terminals or transit stations contributes to a high rate of bystander AED use [27,28,29]. Terminals where large groups of people gather have numerous AEDs installed, which increase the likelihood of bystanders use. This study demonstrated that the use of AEDs at terminals was relatively high (10.6%). Public buildings, leisure facilities, and major locations, such as terminals, are required by law to install and administer AEDs. South Korea regulates the installation and maintenance of AEDs according to these laws. The frequency of AED use demonstrated in this study conformed to observations regarding regulations on AED installation.
The overall low implementation and usage rate of AEDs in various public places are problems requiring improvement. The rate of AED use for OHCAs occurring in public places is between 1.0% and 12.8% in other countries; however, it remains extremely low worldwide [7,30,31,32,33,34]. Kitamura et al. reported that the continuous deployment of Public Access Defibrillation and the increase in AED purchases and placements led to a 9-year increase in the use of bystander AEDs from 1.1% to 16.5% in Japan [35]. Despite legislation mandating the installation and administration of AEDs in South Korea, the considerable disparities in AED utilization rates across public spaces may be attributed to limited AED accessibility or a lack of AED use awareness in certain areas. Kwon et al. noted that the placement of AEDs mandated by law can impede placement efficiency if accessibility is not considered. In addition, whereas training on AED use was included, it did not cover how to locate and retrieve an AED [36]. Even if individuals are technically capable of using an AED, it may be difficult to increase their usage if individuals are unaware of how to access the device. To increase bystander use of AEDs in public places for OHCAs, it is necessary to consider these points.
The pandemic substantially impacted OHCA characteristics. Kim et al. reported that the pandemic led to an increase in OHCAs at home, a decrease in AED use, and an increase in EMS response time compared to the pre-pandemic period [12]. This alteration in epidemiological characteristics is associated with a decline in survival rates and favorable neurological outcomes of OHCA patients [12,37]. Considerable changes in emergency medical systems that influence these outcomes include the concentration of medical resources for COVID-19 treatment, emergence of a relative gap in critically ill patients, effects of social distancing measures, self-isolation, and diminished social activities [37]. In this study, when comparing the characteristics of OHCAs that occurred in public places during the pandemic and pre-pandemic periods, differences were found. Notably, there were more instances of bystander CPR implementation during the pandemic. Ball et al. also reported an increase in bystander CPR implementation during the pandemic, which was attributed to an increase in occurrence of OHCAs in residential areas [38]. In addition, meta-analyses found no significant difference between the CPR administered by bystanders before and during the pandemic [12,37]. This study attributed the increase in bystander CPR implementation during the pandemic in public places in South Korea to continued training on remote cardiopulmonary resuscitation, increased public awareness of CPR, and the easing of COVID-19 fears after the initial phase of the pandemic, owing to the availability of medicines and vaccines. The 29.2% rate of bystander CPR conducted in 2021 reflects this finding. This trend needs to be compared to the rate of bystander CPR implementation in public places in the following year.
The clinical outcomes of OHCAs that occurred in public places was markedly affected by factors such as the use of a bystander AED and the period relative to the COVID-19 pandemic, with a shockable rhythm having a substantial impact on the survival rate, which is consistent with prior knowledge. Research suggests that cardiac arrests in public places may be more likely to arise from certain heart conditions that result in shockable rhythms, in contrast to those occurring at home, which may often be due to medical conditions leading to non-shockable rhythms [6,7]. As cardiac arrests in public places are more likely to be witnessed, interventions, such as immediate CPR or defibrillation, can commence sooner. Consequently, shockable rhythms tend to have a more significant influence on outcomes than non-shockable rhythms.
This study has some limitations. First, despite using a nationwide dataset, the study utilized data collected by healthcare providers in the field, which may have resulted in a high probability of missing data and bias. Second, combining distinct public places into one large category for analysis can reduce representative homogeneity. For example, convenience stores, which are commercial facilities interspersed with residential areas and operate 24 h a day, may exhibit characteristics distinct from those of other commercial facilities. However, interpreting them as a single category may not adequately reflect these distinctions. Third, the study did not accurately reflect hospital treatment processes for each individual. Owing to lack of access to this information, we were unable to analyze the effect of drug use and hospital events on treatment outcomes. Fourth, although the purpose of this research was to report the characteristics of South Korean data, it is difficult to generalize these findings. The application of South Korea’s emergency medical systems, the function and capabilities of paramedics, and urban characteristics in other countries can be complicated by differences in these aspects. Finally, because this was a retrospective study, there is a substantial possibility of selection bias and the occurrence of latent confounders, which could limit the findings.

5. Conclusions

This study investigated the recent occurrence of OHCAs in public places in South Korea, offering insights into OHCAs occurring in these locations. The findings revealed a rising rate of bystander CPR implementation; however, AED use by bystanders remained low. Therefore, enhancing AED accessibility, boosting awareness, and adapting emergency systems are essential measures that need to be taken for improving outcomes for individuals who suffer OHCAs in public spaces.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jpm13081191/s1, Table S1: Detailed classification of public places by category.

Author Contributions

Conceptualization, C.A.; methodology, Y.T.O. and C.A.; investigation, Y.T.O. and C.A.; data curation, Y.T.O. and C.A.; writing—original draft preparation, Y.T.O. and C.A.; writing—review and editing, Y.T.O. and C.A.; visualization, Y.T.O.; supervision, C.A.; funding acquisition, C.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research was supported by the National Research Foundation of Korea (NRF) grant that was funded by the Korean Government (MSIT; 2021R1G1A1091336).

Institutional Review Board Statement

This study was exempt from review by the institutional review board of Chung-Ang University Hospital because the study data were anonymous (2307-002-19478).

Informed Consent Statement

Not applicable.

Data Availability Statement

The datasets generated during the current study are available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Yan, S.; Gan, Y.; Jiang, N.; Wang, R.; Chen, Y.; Luo, Z.; Zong, Q.; Chen, S.; Lv, C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: A systematic review and meta-analysis. Crit. Care 2020, 24, 61. [Google Scholar] [CrossRef] [Green Version]
  2. Korea Centers for Disease Control and Prevention Sudden Cardiac Arrest Survey Statistics. Available online: https://www.kdca.go.kr/injury/biz/injury/recsroom/statsSmMain.do (accessed on 1 July 2023).
  3. Iwami, T.; Hiraide, A.; Nakanishi, N.; Hayashi, Y.; Nishiuchi, T.; Uejima, T.; Morita, H.; Shigemoto, T.; Ikeuchi, H.; Matsusaka, M.; et al. Outcome and characteristics of out-of-hospital cardiac arrest according to location of arrest: A report from a large-scale, population-based study in Osaka, Japan. Resuscitation 2006, 69, 221–228. [Google Scholar] [CrossRef] [PubMed]
  4. Muraoka, H.; Ohishi, Y.; Hazui, H.; Negoro, N.; Murai, M.; Kawakami, M.; Nishihara, I.; Fukumoto, H.; Morita, H.; Hanafusa, T. Location of out-of-hospital cardiac arrests in Takatsuki City: Where should automated external defibrillator be placed. Circ. J. 2006, 70, 827–831. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  5. Weisfeldt, M.L.; Everson-Stewart, S.; Sitlani, C.; Rea, T.; Aufderheide, T.P.; Atkins, D.L.; Bigham, B.; Brooks, S.C.; Foerster, C.; Gray, R.; et al. Ventricular tachyarrhythmias after cardiac arrest in public versus at home. N. Engl. J. Med. 2011, 364, 313–321. [Google Scholar] [CrossRef] [Green Version]
  6. Folke, F.; Gislason, G.H.; Lippert, F.K.; Nielsen, S.L.; Weeke, P.; Hansen, M.L.; Fosbøl, E.L.; Andersen, S.S.; Rasmussen, S.; Schramm, T.K.; et al. Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation. Circulation 2010, 122, 623–630. [Google Scholar] [CrossRef] [Green Version]
  7. Murakami, Y.; Iwami, T.; Kitamura, T.; Nishiyama, C.; Nishiuchi, T.; Hayashi, Y.; Kawamura, T. Outcomes of out-of-hospital cardiac arrest by public location in the public-access defibrillation era. J. Am. Heart Assoc. 2014, 3, e000533. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  8. Cournoyer, A.; Grunau, B.; Cheskes, S.; Vaillancourt, C.; Segal, E.; de Montigny, L.; de Champlain, F.; Cavayas, Y.A.; Albert, M.; Potter, B.; et al. Clinical outcomes following out-of-hospital cardiac arrest: The minute-by-minute impact of bystander cardiopulmonary resuscitation. Resuscitation 2023, 185, 109693. [Google Scholar] [CrossRef]
  9. Pollack, R.A.; Brown, S.P.; Rea, T.; Aufderheide, T.; Barbic, D.; Buick, J.E.; Christenson, J.; Idris, A.H.; Jasti, J.; Kampp, M.; et al. Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests. Circulation 2018, 137, 2104–2113. [Google Scholar] [CrossRef]
  10. Lee, J.H.; Lee, D.E.; Ryoo, H.W.; Moon, S.; Cho, J.W.; Kim, Y.J.; Kim, J.K.; Kim, J.H.; Lee, K.W.; Jin, S.C.; et al. Public awareness and willingness to use automated external defibrillators in a metropolitan city. Clin. Exp. Emerg. Med. 2021, 8, 1–8. [Google Scholar] [CrossRef]
  11. Lee, M.J.; Hwang, S.O.; Cha, K.C.; Cho, G.C.; Yang, H.J.; Rho, T.H. Influence of nationwide policy on citizens’ awareness and willingness to perform bystander cardiopulmonary resuscitation. Resuscitation 2013, 84, 889–894. [Google Scholar] [CrossRef]
  12. Kim, J.H.; Ahn, C.; Park, Y.; Won, M. Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: An updated systematic review and meta-analysis. Front. Public Health 2023, 11, 1180511. [Google Scholar] [CrossRef]
  13. Kim, J.H.; Ahn, C.; Namgung, M. Epidemiology and Outcome of Out-of-Hospital Cardiac Arrests during the COVID-19 Pandemic in South Korea: A Systematic Review and Meta-Analyses. Yonsei Med. J. 2022, 63, 1121–1129. [Google Scholar] [CrossRef]
  14. Ahn, J.Y.; Ryoo, H.W.; Cho, J.W.; Kim, J.H.; Lee, S.H.; Jang, T.C. Impact of the COVID-19 outbreak on adult out-of-hospital cardiac arrest outcomes in Daegu, South Korea: An observational study. Clin. Exp. Emerg. Med. 2021, 8, 137–144. [Google Scholar] [CrossRef] [PubMed]
  15. National Fire Agency. Organization of the National Fire Agency. Available online: https://www.nfa.go.kr/eng/agency/organization/organization/ (accessed on 1 July 2023).
  16. Choi, S.W.; Shin, S.D.; Ro, Y.S.; Song, K.J.; Lee, E.J.; Ahn, K.O. Effect of therapeutic hypothermia on the outcomes after out-of-hospital cardiac arrest according to initial ECG rhythm and witnessed status: A nationwide observational interaction analysis. Resuscitation 2016, 100, 51–59. [Google Scholar] [CrossRef] [PubMed]
  17. Jacobs, I.; Nadkarni, V.; Bahr, J.; Berg, R.A.; Billi, J.E.; Bossaert, L.; Cassan, P.; Coovadia, A.; D’Este, K.; Finn, J.; et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004, 63, 233–249. [Google Scholar] [CrossRef] [PubMed]
  18. Daya, M.R.; Schmicker, R.H.; Zive, D.M.; Rea, T.D.; Nichol, G.; Buick, J.E.; Brooks, S.; Christenson, J.; MacPhee, R.; Craig, A.; et al. Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC). Resuscitation 2015, 91, 108–115. [Google Scholar] [CrossRef] [Green Version]
  19. Kim, J.H.; Ahn, C.; Namgung, M. Comparative Evaluation of the Prognosis of Septic Shock Patients from Before to After the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis. J. Pers. Med. 2022, 12, 103. [Google Scholar] [CrossRef]
  20. Wissenberg, M.; Lippert, F.K.; Folke, F.; Weeke, P.; Hansen, C.M.; Christensen, E.F.; Jans, H.; Hansen, P.A.; Lang-Jensen, T.; Olesen, J.B.; et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA 2013, 310, 1377–1384. [Google Scholar] [CrossRef] [Green Version]
  21. Perkins, G.D.; Handley, A.J.; Koster, R.W.; Castrén, M.; Smyth, M.A.; Olasveengen, T.; Monsieurs, K.G.; Raffay, V.; Gräsner, J.T.; Wenzel, V.; et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015, 95, 81–99. [Google Scholar] [CrossRef] [Green Version]
  22. Bylow, H.; Rawshani, A.; Claesson, A.; Lepp, M.; Herlitz, J. Characteristics and outcome after out-of-hospital cardiac arrest with the emphasis on workplaces: An observational study from the Swedish Registry of Cardiopulmonary Resuscitation. Resusc. Plus 2021, 5, 100090. [Google Scholar] [CrossRef]
  23. Gantzel Nielsen, C.; Andelius, L.C.; Hansen, C.M.; Blomberg, S.N.F.; Christensen, H.C.; Kjølbye, J.S.; Tofte Gregers, M.C.; Ringgren, K.B.; Folke, F. Bystander interventions and survival following out-of-hospital cardiac arrest at Copenhagen International Airport. Resuscitation 2021, 162, 381–387. [Google Scholar] [CrossRef]
  24. Suwanpairoj, C.; Wongsombut, T.; Maisawat, K.; Torod, N.; Jaengkrajan, A.; Sritharo, N.; Atthapreyangkul, N.; Wittayachamnankul, B. Outcome of basic life support training among primary school students in Southeast Asia. Clin. Exp. Emerg. Med. 2020, 7, 245–249. [Google Scholar] [CrossRef] [PubMed]
  25. Beck, S.; Issleib, M.; Daubmann, A.; Zöllner, C. Peer education for BLS-training in schools? Results of a randomized-controlled, noninferiority trial. Resuscitation 2015, 94, 85–90. [Google Scholar] [CrossRef]
  26. Karlsson, L.; Malta Hansen, C.; Wissenberg, M.; Møller Hansen, S.; Lippert, F.K.; Rajan, S.; Kragholm, K.; Møller, S.G.; Bach Søndergaard, K.; Gislason, G.H.; et al. Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: A registry-based study. Resuscitation 2019, 136, 30–37. [Google Scholar] [CrossRef] [Green Version]
  27. Caffrey, S.L.; Willoughby, P.J.; Pepe, P.E.; Becker, L.B. Public use of automated external defibrillators. N. Engl. J. Med. 2002, 347, 1242–1247. [Google Scholar] [CrossRef]
  28. Leung, K.H.B.; Alam, R.; Brooks, S.C.; Chan, T.C.Y. Public defibrillator accessibility and mobility trends during the COVID-19 pandemic in Canada. Resuscitation 2021, 162, 329–333. [Google Scholar] [CrossRef]
  29. Sasaki, M.; Iwami, T.; Kitamura, T.; Nomoto, S.; Nishiyama, C.; Sakai, T.; Tanigawa, K.; Kajino, K.; Irisawa, T.; Nishiuchi, T.; et al. Incidence and outcome of out-of-hospital cardiac arrest with public-access defibrillation. A descriptive epidemiological study in a large urban community. Circ. J. 2011, 75, 2821–2826. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  30. Andersen, L.W.; Holmberg, M.J.; Granfeldt, A.; Løfgren, B.; Vellano, K.; McNally, B.F.; Siegerink, B.; Kurth, T.; Donnino, M.W. Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest. Resuscitation 2018, 126, 72–79. [Google Scholar] [CrossRef]
  31. Hawkes, C.; Booth, S.; Ji, C.; Brace-McDonnell, S.J.; Whittington, A.; Mapstone, J.; Cooke, M.W.; Deakin, C.D.; Gale, C.P.; Fothergill, R.; et al. Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation 2017, 110, 133–140. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  32. Kim, T.Y.; Jung, Y.-k.; Yoon, S.H.; Kim, S.J.; Cha, K.-c.; Jung, W.J.; Roh, Y.I.; Kim, S.; Kim, S.H.; Kang, D.R.; et al. Trends in maintenance status and usability of public automated external defibrillators during a 5-year on-site inspection. Sci. Rep. 2022, 12, 10738. [Google Scholar] [CrossRef]
  33. Hubert, H.; Tazarourte, K.; Wiel, E.; Zitouni, D.; Vilhelm, C.; Escutnaire, J.; Cassan, P.; Gueugniaud, P.Y. Rationale, methodology, implementation, and first results of the French out-of-hospital cardiac arrest registry. Prehosp. Emerg. Care 2014, 18, 511–519. [Google Scholar] [CrossRef] [PubMed]
  34. Karam, N.; Marijon, E.; Dumas, F.; Offredo, L.; Beganton, F.; Bougouin, W.; Jost, D.; Lamhaut, L.; Empana, J.P.; Cariou, A.; et al. Characteristics and outcomes of out-of-hospital sudden cardiac arrest according to the time of occurrence. Resuscitation 2017, 116, 16–21. [Google Scholar] [CrossRef] [PubMed]
  35. Kitamura, T.; Kiyohara, K.; Sakai, T.; Matsuyama, T.; Hatakeyama, T.; Shimamoto, T.; Izawa, J.; Fujii, T.; Nishiyama, C.; Kawamura, T.; et al. Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan. N. Engl. J. Med. 2016, 375, 1649–1659. [Google Scholar] [CrossRef] [Green Version]
  36. Kwon, P.; Lee, Y.; Yu, K.; Lee, W.H. A Study of optimal location and allocation to improve accessibility of automated external defibrillator. J. Korean Soc. Surv. Geod. Photogramm. Cartogr. 2016, 34, 263–271. [Google Scholar]
  37. Lim, Z.J.; Ponnapa Reddy, M.; Afroz, A.; Billah, B.; Shekar, K.; Subramaniam, A. Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis. Resuscitation 2020, 157, 248–258. [Google Scholar] [CrossRef] [PubMed]
  38. Ball, J.; Nehme, Z.; Bernard, S.; Stub, D.; Stephenson, M.; Smith, K. Collateral damage: Hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care. Resuscitation 2020, 156, 157–163. [Google Scholar] [CrossRef]
Jpm 13 01191 g001 550
Figure 1. Flow diagram depicting the enrollment of the study population. DNR, do-not-resuscitate; OHCA, out-of-hospital cardiac arrest.
Figure 1. Flow diagram depicting the enrollment of the study population. DNR, do-not-resuscitate; OHCA, out-of-hospital cardiac arrest.
Jpm 13 01191 g001
Jpm 13 01191 g002 550
Figure 2. Graph showing the trends of bystander intervention and clinical outcomes of out-of-hospital cardiac arrests that occurred in public places from 2016 to 2021.
Figure 2. Graph showing the trends of bystander intervention and clinical outcomes of out-of-hospital cardiac arrests that occurred in public places from 2016 to 2021.
Jpm 13 01191 g002
Jpm 13 01191 g003 550
Figure 3. Forest plot of adjusted odds ratios and 95% confidence intervals for survival to discharge of patients who suffered from out-of-hospital cardiac arrests in public places.
Figure 3. Forest plot of adjusted odds ratios and 95% confidence intervals for survival to discharge of patients who suffered from out-of-hospital cardiac arrests in public places.
Jpm 13 01191 g003
Table
Table 1. Baseline characteristics for out-of-hospital cardiac arrests that occurred in public places between 2016 and 2021.
Table 1. Baseline characteristics for out-of-hospital cardiac arrests that occurred in public places between 2016 and 2021.
Variable2016
(N = 5410)		2017
(N = 5539)		2018
(N = 5587)		2019
(N = 5379)		2020
(N = 5178)		2021
(N = 5044)		p Value
Sex, Male4225 (78.1%)4359 (78.7%)4321 (77.3%)4206 (78.2%)4117 (79.5%)4017 (79.6%)0.030
Age57.7 ± 17.758.8 ± 17.559.2 ± 17.560.2 ± 17.260.1 ± 17.260.1 ± 17.5<0.001
Witnessed arrest2654 (58.3%)3185 (63.8%)2769 (56.6%)2327 (53.2%)2605 (56.1%)2733 (57.7%)<0.001
Bystander CPR996 (18.8%)1189 (22.2%)1332 (24.8%)1358 (26.7%)1302 (26.0%)1431 (29.2%)<0.001
Bystander AED use16 (1.6%)24 (2.0%)28 (2.1%)53 (3.9%)25 (1.9%)39 (2.7%)0.002
Cause, disease2636 (48.7%)2818 (50.9%)2857 (51.1%)2984 (55.5%)2851 (55.1%)2812 (55.7%)<0.001
Cause, cardiac origin2498 (46.2%)2705 (48.8%)2686 (48.1%)2848 (52.9%)2741 (52.9%)2673 (53.0%)0.001
Shockable rhythm1065 (20.6%)1056 (19.7%)1079 (20.0%)1099 (20.8%)1025 (20.3%)949 (19.1%)0.260
Pre-hospital ROSC508 (9.4%)574 (10.4%)585 (10.5%)571 (10.6%)499 (9.6%)497 (9.9%)0.194
Underlying disease
Hypertension795 (14.7%)860 (15.5%)938 (16.8%)967 (18.0%)896 (17.3%)1002 (19.9%)<0.001
Diabetes mellitus493 (9.1%)564 (10.2%)575 (10.3%)599 (11.1%)582 (11.2%)639 (12.7%)<0.001
Heart disease423 (7.8%)488 (8.8%)521 (9.3%)564 (10.5%)489 (9.4%)512 (10.2%)<0.001
Renal disease85 (1.6%)86 (1.6%)77 (1.4%)110 (2.0%)113 (2.2%)134 (2.7%)<0.001
Respiratory disease88 (1.6%)109 (2.0%)112 (2.0%)125 (2.3%)108 (2.1%)138 (2.7%)0.003
Stroke117 (2.2%)145 (2.6%)156 (2.8%)176 (3.3%)159 (3.1%)169 (3.4%)0.003
Hyperlipidemia60 (1.1%)93 (1.7%)104 (1.9%)128 (2.4%)128 (2.5%)165 (3.3%)<0.001
PCI180 (3.3%)229 (4.1%)278 (5.0%)270 (5.0%)241 (4.7%)271 (5.4%)<0.001
TTM113 (2.1%)159 (2.9%)220 (3.9%)200 (3.7%)178 (3.4%)179 (3.5%)<0.001
Mechanical CPR163 (3.0%)250 (4.5%)411 (7.4%)429 (8.0%)734 (14.2%)920 (18.2%)<0.001
ECMO CPR36 (0.7%)76 (1.4%)81 (1.4%)73 (1.4%)71 (1.4%)76 (1.5%)0.001
ROSC1662 (30.7%)1754 (31.7%)1883 (33.7%)1821 (33.9%)1660 (32.1%)1653 (32.8%)0.003
Survival to discharge755 (14.0%)778 (14.0%)811 (14.5%)826 (15.4%)675 (13.0%)663 (13.1%)0.006
Favorable neurological outcome *365 (6.7%)482 (8.7%)473 (8.5%)483 (9.0%)382 (7.4%)401 (8.0%)<0.001
AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; ECMO, extracorporeal membrane oxygenation; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation; TTM, target temperature management. * Favorable neurological outcomes included cerebral performance categories 1 and 2.
Table
Table 2. Outcomes of out-of-hospital cardiac arrests that occurred in public places, according to the detailed classification of public places.
Table 2. Outcomes of out-of-hospital cardiac arrests that occurred in public places, according to the detailed classification of public places.
VariableRoads or Highways
(N = 12,673)		Public Buildings
(N = 741)		Leisure Facilities
(N = 1086)		Industrial Facilities
(N = 3544)		Commercial Facilities
(N = 8496)		Terminals
(N = 837)		Other Public Places
(N = 4760)		p Value
Sex, male9471 (74.7%)564 (76.1%)872 (80.3%)3420 (96.5%)6879 (81.0%)702 (83.9%)3337 (70.1%)<0.001
Age56.6 ± 18.857.3 ± 21.158.7 ± 17.253.9 ± 11.662.0 ± 16.563.5 ± 15.365.6 ± 16.2<0.001
Witnessed arrest6768 (70.7%)474 (65.7%)616 (57.9%)1979 (61.2%)3700 (45.0%)469 (58.6%)2267 (49.5%)<0.001
Bystander CPR1465 (11.6%)297 (40.1%)451 (41.5%)890 (25.1%)2892 (34.0%)330 (39.4%)1283 (27.0%)<0.001
Bystander AED use5 (0.3%)21 (7.1%)28 (6.2%)20 (2.2%)53 (1.8%)35 (10.6%)23 (1.8%)<0.001
Cause, disease2152 (17.0%)593 (80.0%)813 (74.9%)1362 (38.4%)7298 (85.9%)701 (83.8%)4039 (84.9%)<0.001
Cause, cardiac origin2053 (16.2%)562 (75.8%)787 (72.5%)1302 (36.7%)6912 (81.4%)671 (80.2%)3864 (81.2%)0.070
Shockable rhythm1073 (8.9%)298 (40.8%)450 (42.5%)793 (23.3%)1984 (23.6%)277 (33.5%)1398 (29.7%)<0.001
Pre-hospital ROCS490 (3.9%)183 (24.7%)299 (27.5%)362 (10.2%)1106 (13.0%)148 (17.7%)646 (13.6%)<0.001
ROSC2607 (20.6%)355 (47.9%)558 (51.4%)1005 (28.4%)3433 (40.4%)370 (44.2%)2105 (44.2%)<0.001
Survival to discharge890 (7.0%)225 (30.4%)356 (32.8%)506 (14.3%)1503 (17.7%)168 (20.1%)860 (18.1%)<0.001
Favorable neurological outcome *336 (1.6%)157 (13.9%)276 (16.9%)296 (5.5%)897 (6.7%)119 (9.2%)505 (6.5%)<0.001
AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation. * Favorable neurological outcomes included cerebral performance categories 1 and 2.
Table
Table 3. Outcomes of out-of-hospital cardiac arrests that occurred in public places in the pandemic and pre-pandemic periods.
Table 3. Outcomes of out-of-hospital cardiac arrests that occurred in public places in the pandemic and pre-pandemic periods.
VariablePre-Pandemic
(N = 22,897)		Pandemic
(N = 9240)		p Value
Sex, male5024 (21.9%)1868 (20.2%)0.001
Age59.1 ± 17.560.0 ± 17.3<0.001
Witnessed arrest11,410 (58.0%)4863 (57.1%)0.170
Bystander CPR5090 (22.2%)2518 (27.3%)<0.001
Bystander AED use124 (2.4%)61 (2.4%)1.000
Cause, disease11864 (51.8%)5094 (55.1%)<0.001
Cause, cardiac origin11287 (49.3%)4864 (52.6%)0.349
Shockable rhythm4493 (20.3%)1780 (19.6%)0.212
Prehospital ROCS2328 (10.2%)906 (9.8%)0.339
ROSC7442 (32.5%)2991 (32.4%)0.829
Survival to discharge3300 (14.4%)1208 (13.1%)0.002
Favorable neurological outcome1874 (8.2%)712 (7.7%)<0.001
AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation.
Table
Table 4. Univariate and multivariate logistic regression analysis of survival to discharge of patients who suffered from out-of-hospital cardiac arrests in public places.
Table 4. Univariate and multivariate logistic regression analysis of survival to discharge of patients who suffered from out-of-hospital cardiac arrests in public places.
FactorUnivariate OR (95% CI)p ValueAdjusted ORp Value
Sex, male0.84 (0.77–0.91)<0.001-
Age0.99 (0.99–0.99)<0.0010.98 (0.98–0.98) *<0.001
Witnessed arrest2.70 (2.50–2.91)<0.0012.62 (2.25–3.07) *<0.001
Bystander CPR1.05 (1.03–1.07)<0.001-
Bystander AED use2.24 (1.66–3.01)<0.0012.00 (1.37–2.90) *<0.001
Shockable rhythm10.79 (10.06–11.57)<0.00110.12 (8.85–11.59) *<0.001
Cause of arrest, disease4.76 (4.40–5.16)<0.0012.11 (1.87–2.38) *<0.001
Period relative to the pandemic0.89 (0.83–0.96)0.0020.78 (0.68–0.90) *<0.001
Adjusted for sex, age, witnessed arrest, bystander CPR, AED use, shockable rhythm, cause of arrest, and the period relative to the COVID-19 pandemic. * Factors included in the final logistic regression model for survival to discharge. AED, automated external defibrillator; CI, confidence interval; COVID-19, coronavirus disease 2019; CPR, cardiopulmonary resuscitation; OR, odds ratio.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Oh, Y.T.; Ahn, C. Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study. J. Pers. Med. 2023, 13, 1191. https://doi.org/10.3390/jpm13081191

AMA Style

Oh YT, Ahn C. Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study. Journal of Personalized Medicine. 2023; 13(8):1191. https://doi.org/10.3390/jpm13081191

Chicago/Turabian Style

Oh, Young Taeck, and Chiwon Ahn. 2023. "Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study" Journal of Personalized Medicine 13, no. 8: 1191. https://doi.org/10.3390/jpm13081191

APA Style

Oh, Y. T., & Ahn, C. (2023). Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study. Journal of Personalized Medicine, 13(8), 1191. https://doi.org/10.3390/jpm13081191

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop