What floor you live on may determine cardiac arrest survival: Canadian study

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High-rise dwellers have lower survival rate of cardiac arrest: study
WATCH: A new study suggests the higher up in a building you live, the less likely you are to survive a cardiac arrest. Allison Vuchnich has the results of new research – Jan 18, 2016

Living on the upper floors of an apartment or condominium? New Canadian research is warning that the higher up you live in a high-rise building, the more your risk of death from cardiac arrest increases.

After combing more than five years of data, Toronto researchers found that survival rates are nearly twice as low if you live below the third floor. Cardiac arrest patients see another dip in survival rates if they’re above the 16th floor, according to the findings published Monday in the Canadian Medical Association Journal.

“The problem is when you live way high is that the time to the paramedics arriving can be longer, or the [wait for] firefighters, the first responders can be long,” warned Dr. Laurie Morrison, a senior investigator in the study conducted by St. Michael’s Hospital.
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Paramedics have to navigate the building to figure out the quickest route in with their equipment. They could be waiting for security personnel to let them in or for elevators to get to the ground floor before getting their bearings and finding the right unit once they reach the correct floor.

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“All these things are not there when you walk into someone’s home. So the time to arrival of the firefighters and paramedics to the patient’s bedside, or wherever they’ve had their cardiac arrest in a high-rise has got a whole bunch of barriers in between when they arrive at scene to when they actually touch the patient,” Morrison told Global News.

The study was led by Ian Drennan, a St. Michael’s Hospital researcher and York Region paramedic. He and his team looked at data from 8,216 Canadians who suffered out-of-hospital cardiac arrest and were treated by paramedics from Toronto and Peel Region between 2007 and 2012. York Region Paramedic Services was not involved in the study.

Of all the cardiac arrests, 3.8 per cent survived until they could be discharged from hospital. Survival sat at 4.2 per cent for those who lived on the first two floors of a building. Survival rates dipped to 2.6 per cent for patients on the third floor and above.

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The situation worsened as the researchers looked at the data for patients on higher floors. There were 216 cardiac arrests above the 16th floor – only two survived (0.9 per cent). There were no survivors for patients who lived on the 25th floor and above.

The average age of a cardiac arrest patient is 67.

Response times – the measure of time between when a call comes in and when emergency responders get to the address – rarely fluctuate in major cities. It’s typically about five minutes, Morrison said. The lag in time kicks in once paramedics go from arriving at the high-rise to the patient’s bedside. That can be an additional wait time of about one to four minutes, according to Morrison.

(Leo Kavanagh, Babak Najafi/Global News)

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Cardiac arrest is often confused with a heart attack. A heart attack is triggered when blood flow to the heart is blocked, while cardiac arrest occurs when the heart malfunctions and stops beating unexpectedly.

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When it stops, it isn’t pumping blood to the brain, which is why paramedics have such a tight window to help patients before there’s a lasting impact on the brain.

“It’s not minutes, it’s seconds. The cardiac arrest becomes irreversible as seconds tick away,” Morrison warned.

She said there are “simple fixes” municipalities and building managers can make to cut down on response time once paramedics get to a building.

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Firefighters, for example, have universal access keys into buildings but paramedics in Ontario don’t.

“It’s not going to cost a lot of money to coordinate a switch so that the elevator is ready, waiting for the first responders,” Morrison said.

AEDs – or automated external defibrillators – cost about $500 to $1,300. The researchers recommend easy accessibility of AEDs so that they’re placed on specific floors, in building lobbies or inside elevators the same way that fire extinguishers and fire hoses are within reach.

Dispatchers at 911 call centres can instruct people over the phone how to administer chest compressions, as well as how to use an AED, as paramedics arrive to the scene, Morrison said. Cardiac arrests are set off by arrthymia, or an irregular heartbeat, so bystanders need to provide chest compressions and run the AED to help revive patients.  The researchers also recommend better signs on the floors and that Canadians learn CPR.

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“It’s essential, especially if you live in a high-rise,” Morrison said.

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Policymakers need to consider ways to alert building security personnel when a 911 call is placed so that first responders en route have easy access and an elevator waiting on the main floor when they arrive, too.

The team is hopeful the rest of Canada will collect and count cardiac arrest data.

Read their full findings in the CMAJ here.

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