Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.
Department of Industrial Engineering and Business Information Systems, University of Twente, Enschede, The Netherlands.
Resuscitation. 2017 Sep;118:1-7. doi: 10.1016/j.resuscitation.2017.06.013. Epub 2017 Jun 24.
Cities worldwide have underground or above-ground enclosed walkway systems for pedestrian travel, representing unique environments for studying out-of-hospital cardiac arrests (OHCAs). The characteristics and outcomes of OHCAs that occur in such systems are unknown.
To determine whether OHCAs occurring in enclosed pedestrian walkway systems have differing demographics, prehospital intervention, and survival outcomes compared to the encompassing city, by examining the PATH walkway system in Toronto.
We identified all atraumatic, public-location OHCAs in Toronto from April 2006 to March 2016. Exclusion criteria were obvious death, existing DNR, and EMS-witnessed OHCAs. OHCAs were classified into mutually exclusive location groups: Toronto, Downtown, and PATH-accessible. PATH-accessible OHCAs were those that occurred within the PATH system between the first basement and third floor. We analyzed demographic, prehospital intervention, and survival data using t-tests and chi-squared tests.
We identified 2172 OHCAs: 1752 Toronto, 371 Downtown, and 49 PATH-accessible. Compared to Toronto, a significantly higher proportion of PATH-accessible OHCAs was bystander-witnessed (62.6% vs 83.7%, p=0.003), had bystander CPR (56.6% vs 73.5%, p=0.019), bystander AED use (11.0% vs 42.6%, p<0.001), shockable initial rhythm (45.5% vs 72.9%, p<0.001), and overall survival (18.5% vs 33.3%, p=0.009). Similar significant differences were observed when compared to Downtown.
This study suggests that OHCAs in enclosed pedestrian walkway systems are uniquely different from other public settings. Bystander resuscitation efforts are significantly more frequent and survival rates are significantly higher. Urban planners in similar infrastructure systems worldwide should consider these findings when determining AED placement and public engagement strategies.
全球许多城市都有地下或地上封闭的行人通道系统，为行人出行提供了独特的环境，这些系统也成为研究院外心脏骤停（OHCA）的理想场所。然而，目前对于此类系统中发生的 OHCA 的特征和结局尚不清楚。
通过研究多伦多的 PATH 行人通道系统，确定与包含该系统的城市相比，发生在封闭行人通道系统中的 OHCA 是否在人口统计学特征、院外干预措施和生存结局方面存在差异。
我们从 2006 年 4 月至 2016 年 3 月期间确定了多伦多所有非创伤性、公共区域发生的 OHCA。排除标准为明显死亡、已存在的 DNR 以及有急救人员见证的 OHCA。OHCA 分为互斥的位置组：多伦多、市中心和 PATH 可到达区。PATH 可到达区是指发生在 PATH 系统的第一层地下室到第三层之间的 OHCA。我们使用 t 检验和卡方检验分析人口统计学、院外干预措施和生存数据。
共确定了 2172 例 OHCA：1752 例发生在多伦多、371 例发生在市中心、49 例发生在 PATH 可到达区。与多伦多相比，PATH 可到达区 OHCA 明显有更高比例的目击者（62.6% 比 83.7%，p=0.003）、目击者心肺复苏（56.6% 比 73.5%，p=0.019）、目击者使用 AED（11.0% 比 42.6%，p<0.001）、初始可除颤节律（45.5% 比 72.9%，p<0.001）和整体存活率（18.5% 比 33.3%，p=0.009）。与市中心相比，也观察到类似的显著差异。
这项研究表明，封闭行人通道系统中的 OHCA 与其他公共场所明显不同。旁观者复苏努力的频率明显更高，存活率也明显更高。全球具有类似基础设施系统的城市规划者在确定 AED 放置和公众参与策略时应考虑这些发现。
