Rural versus urban out-of-hospital cardiac arrest response, treatment and outcomes in the North East of England from 2018 to 2019.

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is a time-sensitive medical emergency. There is international evidence to suggest that rural regions experience worse OHCA outcomes, such as reduced survival rates. The aim of this study was to quantitatively review and compare the OHCA response, treatment and pre-hospital outcomes in a single-centre ambulance service over a 1-year period in urban and rural areas.

Methods: This study used retrospective OHCA audit data from the North East Ambulance Service NHS Foundation Trust, from April 2018 to April 2019, comparing OHCA response, treatment and return of spontaneous circulation (ROSC) data in relation to urban or rural classification status, using the UK government urban-rural classification tool.

Results: A total of 1295 urban cases and 319 rural cases were compared. Bystander public-access defibrillator (PAD) use was higher in rural areas in comparison to urban areas (20/319 (6.3%) vs 47/1295 (3.6%); p = 0.03). The mean ambulance response time was slower in rural areas (10:43 minutes (n = 319) (SD ± 8.2) vs 07:35 minutes (n = 1295) (SD ± 7.1); p = < 0.01). Despite this, overall ROSC rates at hospital were similar between the groups, with no statistically significant difference (rural: 87/319 (27.3%) vs urban: 409/1295 (31.6%); p = 0.14).A further sub-group analysis of initially shockable OHCA cases showed slower ambulance response times in rural areas (10:45 minutes (n = 68) (SD ± 12.3) vs 07:55 minutes (n = 245) (SD ± 5.5); p = < 0.01) and that rural cases experienced lower ROSC at hospital rates (31/68 (45.6%) vs 151/245 (61.6%); p = 0.02).

Conclusion: This report showed differences in OHCA response and outcomes between rural and urban settings. In the shockable OHCA sub-group analysis, rural areas had slower ambulance response times and lower ROSC rates. The longer ambulance response times in the rural shockable OHCA group could be a factor in the reduced ROSC rates. Linking hospital survival data should be used in future research to explore this area further.