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The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis

  • Ashlea Smith
    Correspondence
    Corresponding author at: PRECRU, Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia.
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia

    St John Western Australia, Western Australia, Australia
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  • Stacey Masters
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
    Search for articles by this author
  • Stephen Ball
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia

    St John Western Australia, Western Australia, Australia
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  • Judith Finn
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia

    St John Western Australia, Western Australia, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia

    Emergency Medicine, Medical School, The University of Western Australia, Perth, Australia
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      Abstract

      Background/aims

      Rurality poses a unique challenge to the management of out-of-hospital cardiac arrest (OHCA) when compared to metropolitan (metro) locations. We conducted a systematic review of published literature to understand how OHCA incidence, management and survival outcomes vary between metro and rural areas.

      Methods

      We included studies comparing the incidence or survival of ambulance attended OHCA in metropolitan and rural areas, from a search of five databases from inception until 9th March 2022. The primary outcomes of interest were cumulative incidence and survival (return of spontaneous circulation, survival to hospital discharge (or survival to 30 days)). Meta-analyses of OHCA survival were undertaken.

      Results

      We identified 28 studies (30 papers- total of 823,253 patients) across 13 countries of origin. The definition of rurality varied markedly. There was no clear difference in OHCA incidence between metro and rural locations. Whilst there was considerable statistical heterogeneity between studies, the likelihood of return of spontaneous circulation on arrival at hospital was lower in rural than metro locations (OR = 0.53, 95% CI 0.40, 0.70; I2 = 89%; 5 studies; 90,934 participants), as was survival to hospital discharge/survival to 30 days (OR = 0.52, 95% CI 0.38, 0.71; I2 = 95%; 15 studies; 18,837 participants).

      Conclusions

      Overall, while incidence did not vary, the odds of OHCA survival to hospital discharge were approximately 50% lower in rural areas compared to metro areas. This suggests an opportunity for improvement in the prehospital management of OHCA within rural locations. This review also highlighted major challenges in standardising the definition of rurality in the context of cardiac arrest research.

      Keywords

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