The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis
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 metr...
| Main Authors: | , , , |
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| Format: | Journal Article |
| Language: | English |
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2023
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1174838 http://hdl.handle.net/20.500.11937/93325 |
| _version_ | 1848765721099632640 |
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| author | Smith, Ashlea Masters, Stacey Ball, Stephen Finn, Judith |
| author_facet | Smith, Ashlea Masters, Stacey Ball, Stephen Finn, Judith |
| author_sort | Smith, Ashlea |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T11:39:45Z |
| format | Journal Article |
| id | curtin-20.500.11937-93325 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:39:45Z |
| publishDate | 2023 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-933252023-10-11T01:02:58Z The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis Smith, Ashlea Masters, Stacey Ball, Stephen Finn, Judith Emergency medical services Incidence Out of Hospital Cardiac arrest Rural Health Survival Humans Cardiopulmonary Resuscitation Out-of-Hospital Cardiac Arrest Incidence Emergency Medical Services Hospitals Humans Cardiopulmonary Resuscitation Incidence Hospitals Emergency Medical Services Out-of-Hospital Cardiac Arrest 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. 2023 Journal Article http://hdl.handle.net/20.500.11937/93325 10.1016/j.resuscitation.2022.11.021 eng http://purl.org/au-research/grants/nhmrc/1174838 http://purl.org/au-research/grants/nhmrc/1116453 http://creativecommons.org/licenses/by-nc-nd/4.0/ fulltext |
| spellingShingle | Emergency medical services Incidence Out of Hospital Cardiac arrest Rural Health Survival Humans Cardiopulmonary Resuscitation Out-of-Hospital Cardiac Arrest Incidence Emergency Medical Services Hospitals Humans Cardiopulmonary Resuscitation Incidence Hospitals Emergency Medical Services Out-of-Hospital Cardiac Arrest Smith, Ashlea Masters, Stacey Ball, Stephen Finn, Judith The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis |
| title | The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis |
| title_full | The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis |
| title_fullStr | The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis |
| title_full_unstemmed | The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis |
| title_short | The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis |
| title_sort | incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: a systematic review and meta-analysis |
| topic | Emergency medical services Incidence Out of Hospital Cardiac arrest Rural Health Survival Humans Cardiopulmonary Resuscitation Out-of-Hospital Cardiac Arrest Incidence Emergency Medical Services Hospitals Humans Cardiopulmonary Resuscitation Incidence Hospitals Emergency Medical Services Out-of-Hospital Cardiac Arrest |
| url | http://purl.org/au-research/grants/nhmrc/1174838 http://purl.org/au-research/grants/nhmrc/1174838 http://hdl.handle.net/20.500.11937/93325 |