Survival from Cardiac Arrest Worse on Higher Floors of Buildings

More on Heart Disease on Interview with:
Ian R Drennan ACP PhD(c)
Institute of Medical Science,
University of Toronto
Rescu, St. Michael’s Hospital

Medical Research: What is the background for this study?

Dr. Drennan : Over the last number of years there has been an increase in the number of people living in high-rise buildings in many major urban centres. Research has shown that there are increased 911-response times for medical calls that occur in high-rise buildings. After a patient collapses in cardiac arrest, the chance of survival decreases by about 7-10% per minute without intervention. However, the impact living in high-rise buildings has on cardiac arrest care and survival remains unknown. 

Medical Research: What are the main findings?

Dr. Drennan : In this study in Toronto and neighbouring Peel Region we found that there was a significant decrease in survival between cardiac arrests that occurred in private residences on or above 3 floors compared to those that occurred below 3 floors (4.2% vs. 2.6%). Only 0.9% of cardiac arrests that occurred above the 16th floor survived and there were no survivors above the 25th floor. We also found that there was nearly a 2 minute delay in 911-response from when an emergency vehicle arrived on scene to when the 911-first responders arrived at the patient’s side when they were required to respond to the higher floors.

Medical Research: What should clinicians and patients take away from your report?

Dr. Drennan : Bystander CPR and use of AEDs is associated with more than double the odds of survival from cardiac arrest. Based on the results of our study, it is important to develop initiatives to increase bystander interventions in this population. The use of bystander AEDs was very low in this study. One important initiative should be to examine the optimal placements of AEDs in high-rise buildings. AEDs need to be accessible and readily available in these buildings which may include AEDs placed on standardized floors throughout the building or have AEDs placed in the elevators that can rapidly be delivered to the floor of the cardiac arrest.

It is also important to ensure that 911-first responders have easy access to the patient. This may include a 911 response plan involving security staff notification, so they can ensure that the building is accessible and that the elevators are waiting for 911-first responders (both paramedics and fire department personnel) without public interference.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Drennan : Future research in this area should focus on identifying barriers to 911-first responders and implementing measures that can be taken to minimize delays to patient care.

Further, it is important that future cardiac arrest research continue to measure not only the 911-response time from the call received by 911-dispatch to emergency vehicle arrival on scene, but the extended time interval from vehicle arrival to patient contact. As more high-rises continue to be built, this extended time interval to patient contact may become a more important predictor of survival, as response times to the scene should remain relatively constant.

Medical Research: Is there anything else you would like to add?

Dr. Drennan : I hope this study will promote awareness on this issue. I think that many people may not realize that although they are living in the city, in close proximity to healthcare resources, that living on higher floors is associated with delays to care and worse survival after cardiac arrest. Awareness of the importance of bystander interventions and increasing the number of patients that receive bystander CPR is important to help improve patient outcomes. This study does not suggest that there is anyone to blame for the delays to patient contact that occurred, and is intended to promote awareness to this issue and to encourage others to look for possible solutions.


Ian R. Drennan, Ryan P. Strum, Adam Byers, Jason E. Buick, Steve Lin,Sheldon Cheskes, Samantha Hu, Laurie J. Morrison,and for the Rescu Investigators

Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survivalCMAJ cmaj.150544; published ahead of print January 18, 2016,doi:10.1503/cmaj.150544

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Ian R Drennan ACP PhD(c (2016). Survival from Cardiac Arrest Worse on Higher Floors of Buildings

Last Updated on January 19, 2016 by Marie Benz MD FAAD