The following is a summary of “Rural cardiac arrest care and outcomes in Texas,” published in the April 2024 issue of Emergency Medicine by Nikonowicz, et al.

Out-of-hospital cardiac arrest (OHCA) in rural communities often results in worse outcomes despite higher rates of bystander cardiopulmonary resuscitation (CPR) compared to urban areas. For a study, researchers sought to assess various aspects of the continuum of care, including post-arrest care, for rural OHCA victims and to explore factors contributing to the higher rates of bystander CPR in rural settings.

Data from the Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) spanning 2014–2020 were analyzed for adult OHCA cases. TX-CARES data were linked to census tract data, allowing the stratification of OHCAs into urban and rural events. A mixed-model logistic regression was employed to compare cardiac arrest characteristics, pre-hospital care, and post-arrest care between rural and urban settings, adjusting for confounders and modeling the census tract as a random intercept. Different regression models were compared to evaluate the association between response time and bystander CPR.

The study included 1,202 rural and 28,288 urban cardiac arrests. Bystander CPR rates were significantly higher in rural communities compared to urban areas (49.6% vs. 40.6%, adjusted odds ratio [aOR] 1.3, 95% confidence interval [CI] 1.1–1.5). However, rural areas had longer median response times (11.5 min vs. 7.3 min) and lower rates of ambulance response times of <10 min (aOR 0.2, 95% CI 0.2–0.2) compared to urban areas. Percutaneous coronary intervention (PCI) rates were higher in rural communities (aOR 1.7, 95% CI 1.01–2.8), but survival to hospital discharge was lower (aOR 0.6, 95% CI 0.4–0.7). Rates of automated external defibrillator (AED) use and targeted temperature management (TTM) were similar between rural and urban areas. Although not statistically significant, rural communities exhibited a lower survival rate with a cognitive performance score (CPC) of 1 or 2, with an adjusted odds ratio (aOR) of 0.7 and a 95% CI ranging from 0.6 to 1.003. No significant association was found between response time and bystander CPR rates.

Despite higher rates of bystander patients with CPR and PCI in rural Texas have lower survival rates after OHCA compared to urban areas. Response times did not correlate with bystander CPR rates. The findings highlighted the need for targeted interventions to improve post-arrest care and outcomes in rural communities.

Reference: sciencedirect.com/science/article/abs/pii/S073567572300712X