ABSTRACTS
RUSTIC: Factors Influencing the Initiation of Cardiac Arrest Resuscitation in Rural Versus Urban SettingsAuthor: Andrew Tischer, NRP | | Associate Authors: Kayla M. Riel, MPH, Trenton J. Husick, BS, NRP, Kevin P. McCarthy, MPA, NRP, Jackson J. Baker, NRP, David A. Wampler, PhD, LP, Antonio R. Fernandez, PhD, NRP
Introduction Disparities in out-of-hospital cardiac arrest (OHCA) outcomes between rural and urban settings have been documented with lower rates of return of spontaneous circulation (ROSC) and survival to hospital discharge and higher overall mortality in rural settings. However, there is a lack of research examining the initiation of resuscitation attempts between these settings. Methods: A retrospective analysis was conducted on all 9-1-1 responses for adult patients with bystander-witnessed OHCA of presumed cardiac etiology. Exclusion criteria included unwitnessed arrest, do not resuscitate (DNR or POLST), or etiology other than presumed cardiac. The data source was the national ESO Data Collaborative (Austin, TX) from 2022. Variables included unit level of care, demographic information, response times, and location type across urban, rural, and super-rural areas. Descriptive statistics, logistic regression, adjusted odds ratios (aOR), and 95% confidence intervals (95% CI) were calculated. Results In 2022, 29,345 OHCA cases were reported from 2,061 EMS agencies across the United States: 22,754 (78%) urban, 5,651 (19%) rural, and 933 (3%) super-rural. Resuscitation efforts were not initiated by EMS in 1% (322) of cases in the urban setting, 2% (139) in the rural setting, and 4% (39) in the super-rural population. When compared to urban settings, rural patients had decreased odds of having CPR initiated (aOR: 0.70, 95% CI: 0.56–0.88), super-rural (aOR: 0.47, 95% CI: 0.32–0.68). Adjustment accounted for unit level of care, demographics, response times, and location type. Bystander CPR was the stronger predictor of EMS initiation of resuscitation (aOR: 8.21, 95% CI: 6.10–11.07). Other predictors were male sex (aOR: 1.51, 95% CI: 1.25–1.83] and African American (aOR: 1.42, 95% CI: 1.06–1.90) compared to White/Non-Hispanic/Latino. Patients older than 85 years had decreased odds even if the OHCA was witnessed (aOR: 0.27, 95% CI: 0.17–0.43). Conclusion Rural and super-rural areas have higher rates of patients not receiving resuscitation efforts initiated by EMS compared to urban areas. Factors such as bystander CPR and patient sex, race, and age influence resuscitation initiation. Targeted interventions are needed to address these disparities and improve outcomes in rural settings.
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