Unique Geographical Features of Out-of-Hospital Cardiac Arrest Patients within urban area: A Bayesian Spatial Analysis

Abstract

AbstractBackgroundThe advantages of urban areas for patients with out-of-hospital cardiac arrest (OHCA), attributable to their extensive medical resources, are well recognized. However, whether a greater abundance of these resources directly improves patient outcomes is unclear. Moreover, it is important to clarify this because of the ongoing global trend of urbanization. Therefore, this study aimed to investigate this issue and shed light on the potential challenges specific to urban environments.MethodsThis retrospective observational study was conducted to evaluate the correlation between the geographical features of patients with shockable OHCA and neurological outcomes. Data of patients who were transported to Tokyo Medical and Dental University Hospital between June 1, 2016, and May 30, 2022, were extracted from electronic review board records. The Glasgow-Pittsburgh Cerebral Performance Category Scale was utilized to evaluate the neurological results. The study employed Bayesian spatial modeling and analyzed the results using the Integrated Nested Laplace Approximation and Stochastic Partial Differential Equation methods.ResultsParadoxically, a region with the highest concentration of advanced medical facilities exhibited the poorest neurological outcomes. This area was characterized by an extended duration of on-site emergency medical service activity, which strongly correlated with a negative impact on patients’ neurological outcomes.ConclusionsThe abundance of healthcare resources in urban areas does not necessarily correlate with improved outcomes for patients with OHCA. A strategic approach to medical control that considers these factors can potentially enhance the outcomes of patients with OHCA in urban areas.Clinical PerspectivesWhat is new?In a retrospective geographical analysis of patients with shockable Out-of-Hospital Cardiac Arrest (OHCA), it was found that the region with the highest concentration of advanced medical facilities paradoxically exhibited the poorest neurological outcomes. Additionally, there was a noticeable extension in the duration of on-site emergency medical service activity in this area.What are the clinical implications?The abundance of healthcare resources in urban areas does not necessarily equate to improved outcomes for patients with OHCA. Therefore, a strategic approach to medical resource management should be considered to effectively utilize these resources and enhance the outcomes of patients in urban areas.