Care and outcomes of urban and non -urban out -of -hospital cardiac arrest patients during the HeartRescue Project in Washington state and North Carolina

Aim: We examined overall and temporal differences in out -of -hospital cardiac arrest (OHCA) care and outcomes by urban versus non -urban setting separately for North Carolina (NC) and Washington State (WA) during HeartRescue initiatives and associations of urban/non-urban settings with outcome by state. Methods: OHCAs of presumed cardiac etiology from counties with complete registry enrollment in NC during 2010-2014 (catchment population = 3,143,809) and WA during 2011-2014 (catchment population = 3,653,506) were identified. Geospatial arrest location data and US Census classification were used to categorize urban areas with 50,000 versus non -urban <50,000 people. Results: Included were 7731 NC cases (78.9% urban) and 4472 WA cases (85.8% urban). Bystander cardiopulmonary resuscitation (CPR) increased from 36.9% (2010) to 50.3% (2014) in NC non -urban areas versus 58.2% (2011) to 69.2% (2014) in WA; and from 39.3% to 51.1% in NC urban areas versus 52.4% to 61.8% in WA. Crude discharge survival odds ratio (OR) was 2.49 (95%CI 1.96-3.16) for urban versus non -urban NC cases not declared dead in field ( N = 4241). Adjusted for age, sex, public location, bystander -witness status, time between emergency call and emergency medical service (EMS) arrival, calendar -year, bystander and first -responder CPR and defibrillation and direct PCI-center transport, OR was 1.30 (95%CI 0.98 -1.73). In WA, corresponding crude and adjusted ORs were 1.38 (95%CI 0.99-1.93) and 1.46 (95%CI 1.00-2.13). In both states, bystander and first - responder CPR and defibrillation and direct PCI-hospital transport were associated with increased survival. Conclusions: During HeartRescue initiatives, bystander CPR increased in urban and non-urban locations. Bystander and first-responder interventions and direct PCI-hospital transport were associated with improved outcomes, including in non-urban areas.