Living in high-rise buildings associated with lower survival rates from cardiac arrest

January 18, 2016
heart
Human heart. Credit: copyright American Heart Association

The number of people living in high-rise buildings in rising, but along with the convenience and panoramic views of a downtown condo comes a risk: a new study found that survival rates from cardiac arrest decrease the higher up the building a person lives.

"Cardiac arrests that occur in high-rise buildings pose unique barriers for 911-initiated first responders," said Ian Drennan, lead author of the study published today in the Canadian Medical Association Journal.

"Building access issues, elevator delays and extended distance from the emergency vehicle to the patient can all contribute to longer times for 911-initiated first responders to reach the patient and start time-sensitive, potentially life-saving resuscitation," he said.

Drennan is a paramedic with York Region Paramedic Services and a researcher with Rescu, a group based at St. Michael's Hospital that studies emergency health care that begins outside of a hospital.

Looking at data from 8,216 adults who suffered an out-of-hospital cardiac arrest treated by 911-initiated first responders in the City of Toronto and nearby Peel Region from January 2007 to December 2012, they found 3.8 per cent survived until they could be discharged from a hospital. Survival was 4.2 per cent for people living below the third floor and 2.6 per cent for people living on or above the third floor.

But Drennan said when they went back and looked at the exact floor the patients lived on, they found decreased as the floors got higher. Survival above the 16th floor was 0.9 per cent (of 216 cases, only two survived). There were no survivors to hospital discharge of the 30 cardiac arrests above the 25th floor.

"Patients who survived tended to be younger, their cardiac arrest was more often witnessed by bystanders, and bystanders were more likely to perform CPR," Drennan said, noting the rate of bystander AED use was very low in this study. "They also had shorter times for 911-initiated first responders to get to the scene and to the patient."

While this study was intended to compare the rate of survival to hospital discharge for cardiac arrests that occur on higher versus lower floors of residential buildings, it also highlighted the fact that response times for 911-initiated first responders are traditionally measured from the time a call is received by the 911 dispatch centre to when the first emergency vehicle arrives on the scene. But Drennan said this measure does not take into account the time required for 911-initiated first responders to reach the patient after they arrive on the scene and can begin resuscitation.

"After collapse from , early bystander CPR and a shock from a publicly accessible automated external defibrillator can make the difference between life and death," Drennan said. "Effective CPR performed by a bystander immediately after cardiac arrest can more than double a person's chance of survival, but only 30 per cent of cardiac arrest victims get CPR from a bystander. With a rapidly deteriorating heart rhythm, in the absence of bystander CPR and defibrillation, cardiac arrests that occurred on higher floors may have a lower probability of survival due to the delay to patient contact by 911-initiated first responders. This early period is essential for bystander interventions by a family member, friend, or other willing person to improve survival."

He said another possible explanation for lower survival at higher floors is that it simply takes longer to get patients out of the building.

The study made several recommendations:

  • Improving the accessibility of AEDs by placing them on specific floors, in building lobbies, or inside elevators so that they
  • Give paramedics a universal elevator key similar to what firefighters have, giving them sole access to elevators without public interference
  • Find ways to alert building security to the fact 911-initiated first responders are en route so they can have easy access to the building and elevators waiting on the main floor

Overall, the study said there was a 20 per cent increase in the rate of cardiac arrests suffered in private residences over the years of the study. In roughly the same time, 2006 to 2011, the number of people living in high-rise building grew by 13 per cent in Toronto. Many of those people are older, with higher rates of serious medical issues and higher risk of .

Explore further: Efforts to improve AED usage increase bystander defibrillation in public but not at home

More information: Canadian Medical Association Journal, www.cmaj.ca/lookup/doi/10.1503/cmaj.150544

Commentary: Canadian Medical Association Journal, www.cmaj.ca/lookup/doi/10.1503/cmaj.151044

Related Stories

Efforts to improve AED usage increase bystander defibrillation in public but not at home

August 30, 2015
Efforts to improve automated external defibrillator (AED) usage increase bystander defibrillation in public places but not at home, reveals a study of more than 25 000 cardiac arrest patients presented at ESC Congress today ...

Study finds increase in survival following bystander CPR for out-of-hospital cardiac arrest

October 1, 2013
In Denmark between 2001 and 2010 there was an increase in bystander cardiopulmonary resuscitation (CPR) that was associated with an increase in survival following out-of-hospital cardiac arrest, according to a study in the ...

Bystander CPR on kids has increased, survival odds improve for some

November 10, 2015
Bystander CPR on kids is increasing and is improving survival from cardiac arrest outside the hospital, according to research presented at the American Heart Association's Scientific Sessions 2015.

How to improve cardiac arrest survival in three easy steps

January 4, 2016
Although survival rates for people who suffer cardiac arrest outside a hospital are extremely low in most places, emergency physicians propose three interventions to improve survival rates and functional outcomes in any community ...

Refractory cardiac arrest patients brought to hospital with ongoing CPR can recover

August 29, 2015
Refractory cardiac arrest patients brought to hospital with ongoing cardiopulmonary resuscitation (CPR) can survive with good brain function, according to research in nearly 4 000 patients presented at ESC Congress today ...

Bystander CPR linked to lower nursing home admission and brain damage after cardiac arrest

August 30, 2015
Bystander cardiopulmonary resuscitation (CPR) has been linked to a 30% lower risk of nursing home admission and brain damage in survivors of cardiac arrest outside hospital in research presented at ESC Congress today by Dr ...

Recommended for you

Five vascular diseases linked to one common genetic variant

July 27, 2017
Genome-wide association studies have implicated a common genetic variant in chromosome 6p24 in coronary artery disease, as well as four other vascular diseases: migraine headache, cervical artery dissection, fibromuscular ...

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.