Cardiac Arrest at Exercise Facilities: Implications for Placement of Automated External Defibrillators.
ABSTRACT We sought to characterize the relative frequency, care and survival of sudden cardiac arrest in traditional indoor exercise facilities, alternative indoor exercise sites and other indoor sites.
Little is known about the relative frequency of sudden cardiac arrest at traditional indoor exercise facilities versus other indoor locations where people engage in exercise, nor of the survival at these sites in comparison with other indoor locations.
We examined every public indoor sudden cardiac arrest in Seattle and King County from 1996 to 2008 and categorized each event as occurring at a traditional exercise center, an alternative exercise site or a public indoor location not used for exercise. Arrests were further defined by the classification of the site, activity performed, demographics and characteristics of treatment and survival. For some location types, annualized site incident rates of cardiac arrests were calculated.
We analyzed 849 arrests, with 52 at traditional, 84 at alternative exercise sites, and 713 at sites not associated with exercise. The site incident rates of arrests at indoor tennis facilities, indoor ice arenas, and bowling alleys were higher than at traditional fitness centers. Survival to hospital discharge was greater at exercise sites (56% at traditional and 45% at alternative) than at other public indoor locations (34%; p=0.001).
We observed a higher rate of cardiac arrests at some alternative exercise facilities than at traditional exercise sites. Survival was higher at exercise sites than at non-exercise indoor sites. These data have important implications for automated external defibrillator placement.
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ABSTRACT: To examine the independent relationship between effectiveness of bystander cardiopulmonary resuscitation (CPR) and survival following out-of-hospital cardiac arrest. Prospective observational cohort. New York City. A total of 2071 consecutive out-of-hospital cardiac arrests meeting Utstein criteria. Trained prehospital personnel assessed the quality of bystander CPR on arrival at the scene. Satisfactory execution of CPR required performance of both adequate compressions and ventilations in conformity with current American Heart Association guidelines. Adjusted association between CPR effectiveness and survival. Survival was defined as discharge from hospital to home. Outcome was determined on all members of the inception cohort--none were lost to follow-up. When the association between bystander CPR and survival was adjusted for effectiveness of CPR in the parent data set (N = 2071), only effective CPR was retained in the logistic model (adjusted odds ratio [OR] = 5.7; 95% confidence interval [CI], 2.7 to 12.2; P < .001). Of the subset of 662 individuals (32%) who received bystander CPR, 305 (46%) had it performed effectively. Of these, 4.6% (14/305) survived vs 1.4% (5/357) of those with ineffective CPR (OR = 3.4; 95% CI, 1.1 to 12.1; P < .02). After adjustment for witness status, initial rhythm, interval from collapse to CPR, and interval from collapse to advanced life support, effective CPR remained independently associated with improved survival (adjusted OR = 3.9; 95% CI, 1.1 to 14.0; P < .04). The association between bystander CPR and survival in out-of-hospital cardiac arrest appears to be confounded by CPR quality. Effective CPR is independently associated with a quantitatively and statistically significant improvement in survival.JAMA The Journal of the American Medical Association 12/1995; 274(24):1922-5. · 29.98 Impact Factor
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ABSTRACT: The purpose of this study was to describe the public locations of cardiac arrest and to estimate the annual incidence of cardiac arrest per site to determine optimal placement of automatic external defibrillators (AEDs). This was a retrospective cohort study. Locations of cardiac arrest were abstracted from data collected by emergency medical service programs in Seattle and King County, Washington, from January 1, 1990, through December 31, 1994. Types of commercial and civic establishments were tallied and grouped into 23 location categories consistent with Standard Industrial Codes, and the number of sites within each location category was determined. With the addition of "public outdoors" and "automobiles" as categories, there were 25 location categories. During the study period, 7185 arrests occurred, 1130 (16%) of which were in public locations. An annual incidence of cardiac arrest per site was calculated. Ten location categories with 172 sites were identified as having a higher incidence of cardiac arrest (> or = .03 per year per site). Thirteen location categories had a lower incidence of arrest (< or = .01 per year per site). There were approximately 71,000 sites within these categories. Placement of 276 AEDs in the 172 higher-incidence sites would have provided treatment for 134 cardiac arrest patients in a 5-year period, 60% of whom were in ventricular fibrillation. We estimate between 8 and 32 lives could be saved in 5 years. To cover the remaining 347 arrests occurring in public in a 5-year period, defibrillators would have to be placed in 71,000 sites, not including outdoors and automobiles. Placement of AEDs in public locations can be guided by the site-specific incidence of arrest.Circulation 07/1998; 97(21):2106-9. · 15.20 Impact Factor
- Circulation 04/2002; 105(9):1147-50. · 15.20 Impact Factor