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Location of out-of-hospital cardiac arrest and the awareness time interval: a nationwide observational study
  1. Seo Young Kim1,
  2. Sun Young Lee2,
  3. Tae Han Kim3,
  4. Sang Do Shin1,
  5. Kyoung Jun Song3,
  6. Jeong Ho Park1
  1. 1 Department of Emergency Medicine, Seoul National University Hospital, Seoul, The Republic of Korea
  2. 2 Public Healthcare Center, Seoul National University Hospital, Seoul, The Republic of Korea
  3. 3 Department of Emergency Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, The Republic of Korea
  1. Correspondence to Dr Sun Young Lee, Public Healthcare Center, Seoul National University Hospital, Jongno-gu 101, Seoul, The Republic of Korea; sy2376{at}


Aims A short awareness time interval (ATI, time from witnessing the arrest to calling for help) and bystander cardiopulmonary resuscitation (CPR) are important factors affecting neurological recovery after out-of-hospital cardiac arrest (OHCA). This study investigated the association of the location of OHCA with the length of ATI and bystander CPR.

Methods This population-based observational study used the nationwide Korea OHCA database and included all adults with layperson-witnessed OHCA with presumed cardiac aetiology between 2013 and 2017. The exposure was the location of OHCA (public places, private housing and nursing facilities). The primary outcome was short ATI, defined as <4 min from witnessing to calling for emergency medical service (EMS). The secondary outcome was the frequency of provision of bystander CPR. Multivariable logistic regression analysis was performed to evaluate the association of location of OHCA with study outcomes.

Results Of 30 373 eligible OHCAs, 66.6% occurred in private housing, 24.0% occurred in public places and 9.4% occurred in nursing facilities. In 67.3% of the cases, EMS was activated within 4 min of collapse, most frequently in public places (public places 77.0%, private housing 64.2% and nursing facilities 64.8%; p<0.01). The overall rate of bystander CPR was 65.5% with highest in nursing facilities (77.0%), followed by public places (70.1%) and private housing 62.3%; p<0.01). Compared with public places, the adjusted ORs (AORs) (95% CIs) for a short ATI were 0.58 (0.54 to 0.62) in private housing and 0.62 (0.56 to 0.69) in nursing facilities. The AORs (95% CIs) for bystander CPR were 0.75 (0.71 to 0.80) in private housing and 1.57 (1.41 to 1.75) in nursing facilities.

Conclusion OHCAs in private housing and nursing facilities were less likely to have immediate EMS activation after collapse than in public places. A public education is needed to increase the awareness of necessity of prompt EMS activation.

  • cardiac care
  • care systems
  • chain of survival
  • emergency ambulance systems
  • education
  • cardiac arrest
  • emergency care systems

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • Handling editor Ellen J Weber

  • Contributors SYK—writing (original draft) and formal analysis. SYL—conceptualisation, data curation, formal analysis, data interpretation, writing (review and editing) and supervision. THK—data curation, review and editing. SDS—project administration, data interpretation and supervision. KJS—project administration, concept and design, and supervision. JHP—data curation, review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.