ArticleCritical care (London, England)2018
Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas.
Article in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
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Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it, 86 citations in OpenAlex.
- Systematic review of the relationship between comorbidity and out-of-hospital cardiac arrest outcomes.BMJ open · 2019Pooled it
- Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review.International journal of environmental research and public health · 2019Pooled it
- Obstetric Life Support Education for Maternal Cardiac Arrest: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Spatial heterogeneity in risk-adjusted return of spontaneous circulation after out-of-hospital cardiac arrest: the urbanization-adjusted RACA model.BMC emergency medicine · 2026Article
- No "Golden Hour" in Alaska: Characteristics and Implications of Medevac-centered Emergency Care.The western journal of emergency medicine · 2026Article
- Computed tomography assessment after out-of-hospital cardiac arrest resuscitation.Resuscitation plus · 2026Article
- The five-link theory for improving the integrated and balanced development of emergency medical care in urban and rural areas.Journal of global health · 2025Article
- Epidemiology and outcomes of out-of-hospital cardiac arrest in Zhejiang, China based on Electronic Medical Record Surveillance.Resuscitation plus · 2025Article
- Assessing the Association of Physician and Specialist Maldistribution with Out-of-hospital Cardiac Arrest Outcomes: Implications for Regulatory Policy.JMA journal · 2025Article
- PULSE survey: Population Survey on Knowledge, Gaps and Perception of Heart Rhythm disorders-an initiative of the Scientific Initiatives Committee of the European Heart Rhythm Association.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- An app to keep: smartphone-based dispatch of community first responder to cardiac arrest.BMC cardiovascular disorders · 2025Article
- Modelling emergency response times for Out-of-Hospital Cardiac Arrest (OHCA) patients in rural areas of the North of England using routinely collected data.BMC emergency medicine · 2025Observational
- Article
- Out-of-hospital cardiac arrest outcomes' determinants: an Italian retrospective cohort study based on Lombardia CARe.Internal and emergency medicine · 2024Article
- Article
- Review
- Pakistan's Emergency Medical Services (EMS) system & out-of-hospital-cardiac-arrest (OHCA): A narrative review of an EMS system of a low middle income country in context of OHCA.Resuscitation plus · 2024Review
- Trends of Pulmonary Embolism-Related Sudden Cardiac Death in the United States, 1999-2019.Journal of thrombosis and thrombolysis · 2024Article
- Article
- Ambulance nurses' experiences as the sole caregiver with critical patients during long ambulance transports: an interview study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA.
methodsWe analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots.
resultsWe found a significantly higher probability for survival to hospital admission (OR: 1.84, 95% CI 1.43-2.36, p < 0.001), to hospital discharge (OR: 1.51, 95% CI 1.08-2.11, p = 0.017), and at 1 year (OR: 1.58, 95% CI 1.11-2.26, p = 0.012) in the urban group versus the rural group. In patients receiving bystander CPR before EMS arrival, the odds of survival to hospital discharge increased more than threefold (OR: 3.05, 95% CI 2.00-4.65, p < 0.001). However, bystander CPR was associated with increased patient survival to discharge only in urban areas (survival probability 0.26 with CPR vs. 0.08 without CPR, p < 0.001). EMS response time ≥ 10 min was associated with decreased survival (OR: 0.61, 95% CI 0.45-0.83, p = 0.002), however, only in urban areas (survival probability 0.15 ≥ 10 min vs. 0.25 < 10 min, p < 0.001). In patients with prehospital EMS physician attendance, no significant differences were found in survival to hospital discharge (OR: 1.37, 95% CI 0.87-2.16, p = 0.17). In rural areas, patients with EMS physician attendance had an overall better survival to hospital discharge (survival probability 0.17 with EMS physician vs. 0.05 without EMS physician, p = 0.019). Adjusted for modifiable factors, the survival differences remained.
conclusionsOverall, OHCA survival was higher in urban compared to rural areas, and the effect of bystander CPR, EMS response time and EMS physician attendance on survival differ between urban and rural areas. The effect of modifiable factors on survival was highest in the prehospital stage of care. In patients surviving to hospital admission, there was no significant difference in in-hospital mortality or in 1 year mortality between OHCA in rural versus urban areas.
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