Key result
Bathroom out-of-hospital cardiac arrests linked to markedly lower rates of shockable rhythms at ~1%.
Why the study?
The circumstances and locations where critical events resulting in out-of-hospital cardiopulmonary arrest occur were unclear.
Observational (n=1,546)
No
p-value: p=0.002
Bathroom OHCA linked to rare shockable rhythms and zero survival; hypothesis-generating for location-specific etiology and prevention studies.
BACKGROUND: The aim of this study is to clarify the circumstances including the locations where critical events resulting in out-of-hospital cardiopulmonary arrest (OHCPA) occur. MATERIALS AND METHODS: Subjects of this population-based observational case series study were the clinical records of patients with nontraumatic and nonneck-hanging OHCPA. RESULTS: Of all 1546 cases, 10.3% occurred in a public place (shop, restaurant, workplace, stations, public house, sports venue, and bus), 8.3% on the street, 73.4% in a private location (victim's home, the homes of the victims' relatives or friends or cheap bedrooms, where poor homeless people live), and 4.1% in residential institutions. In OHCPA occurring in private locations, the frequency of asystole was higher and the outcome was poorer than in other locations. A total of 181 OHCPA cases (11.7%) took place in the lavatory and 166 (10.7%) in the bathroom; of these, only 7 (3.9% of OHCPA in the lavatory) and none in the bath room achieved good outcomes. The frequencies of shockable initial rhythm occurring in the lavatory and in bath room were 3.7% and 1.1% (lower than in other locations, P = 0.011 and 0.002), and cardiac etiology in OHCPA occurring in these locations were 46.7% and 78.4% (the latter higher than in other locations, P < 0.001). CONCLUSIONS: An unignorable population suffered from OHCPA in private locations, particularly in the lavatory and bathroom; their initial rhythm was usually asystole and their outcomes were poor, despite the high frequency of cardiac etiology in the bathroom. We should try to treat OHCPA victims and to prevent occurrence of OHCPA in these risky spaces by considering their specific conditions.
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Moriwaki et al. (2014) conducted an observational in Out-of-hospital cardiopulmonary arrest (OHCPA) (n=1,546). Occurrence in bathroom or lavatory vs. Occurrence in other locations was evaluated on Shockable initial cardiac rhythm in the bathroom compared to other locations (p=0.002). Out-of-hospital cardiopulmonary arrests occurring in bathrooms had significantly lower rates of shockable initial rhythms (1.1%) compared to other locations, resulting in exceedingly poor outcomes.
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