Sky-high living lowers odds of surviving cardiac arrest: study
Just as Canadian cities grow staggeringly vertical comes a new study suggesting sky- high living in highrise buildings increases the chances of not surviving a cardiac arrest.
The study of nearly 8,000 adults shows the higher the floor, the lower the odds of surviving an “outof- hospital” cardiac arrest. People living above the third floor were about half as likely to survive than those living closer to the ground.
For those above the 16th floor, the survival rate was a “negligible” 0.9 per cent; by the 25th floor, it was zero. Locked front doors, missing concierges and agonizingly slow elevator times are contributing to some of the more obvious delays. But the odd elevator doesn’t even fit stretchers, said lead author Ian Drennan, a paramedic with York Region’s paramedic services and a researcher with Rescu, based at St. Michael’s Hospital in Toronto.
“So then you’re relegated to the stairs.”
For their study, Drennan’s team looked at 7,842 consecutive, out- of- hospital, adult cardiac arrests in the city of Toronto and neighbouring Peel Region between 2007 and 2012 that occurred in private residences — apartments, condos, townhouses and houses.
In total, 5,998 ( about 77 per cent) occurred below the third floor, the remainder on the third floor or higher.
Overall, 3.8 per cent survived to be discharged from hospital.
However, when t he y examined survival rates floor- by- floor, 4.2 per cent of the patients with a cardiac arrest below the third floor survived, compared with 2.6 per cent of those on the third floor or above.
Two out of the 216 people living above the 16th floor survived. Of the 30 patients above floor 25, none survived.
The study appears in the Canadian Medical Association Journal ( CMAJ).
Cardiac arrest isn’t the same as a heart attack. Cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, causing the heart to suddenly stop beating. A heart attack results when blood supply to a part of the heart is blocked, though it can lead to a lethal rhythm, and cardiac arrest.
According to the Heart and Stroke Foundation, on- ly five per cent of Canadians survive a cardiac arrest outside hospital.
Cardiac arrest can be reversed if CPR is performed and a defibrillator used to shock the heart into a normal rhythm. But the chance of surviving decreases by about 10 per cent for every one- minute delay.
In the Toronto study, it took paramedics a mean of 4.9 minutes to reach people on the third floor or higher, compared with three minutes for those below the third floor.
What’s more, a smaller proportion of people on the higher floors still had a shockable rhythm by the time paramedics arrived.
One of the biggest barri ers is elevator access. Drennan knows firsthand what it’s like to press the “up” arrow and have to watch the elevator come down from the 30th floor.
Other studies have shown that additional elevator stops occur in nearly 20 per cent of highrise residential calls, with every stop adding 54 seconds to the time paramedics arrive at the patient’s side.
Fire departments have a universal elevator key, giving them sole access to elevators. Paramedics almost never do.
Drennan said there should be emergency alerts to building staff to ensure elevators are waiting when paramedics arrive, and defibrillators could be placed in lobbies, elevators or on strategic floors. Residents, especially those with loved ones with heart disease, should also be trained in CPR, he said.
“It’s pretty well- shown throughout the literature that bystander CPR can almost double survival from cardiac arrest in some situations,” he said.
In Singapore, where most people live in high- rises, a public campaign is underway to enrol residents committees — a kind of cardiac Neighbourhood Watch — as first responders.
High- rises present probl ems f or al l emergency responders, not just paramedics, says Garrie Wright, deputy chief of Toronto Paramedic Services.
“I’ve been on calls with police and they’re pushing the superintendent buzzer or the apartment buzzer like we are, wanting to get into the building.”
A common key would help, he said. So, too, would defibrillators in every elevator. Residents “could push t he elevator button and grab the device, or have someone go out and grab it while you’re doing good CPR,” Wright said.
BYSTANDER CPR CAN ALMOST DOUBLE SURVIVAL.