Responses to and outcomes of out-of-hospital cardiac arrest in farmlands compared with other out-of-office workplaces: an observational study using an extended nationwide database

To examine the characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in farmlands, compared with that in other out-of-office workplaces.

We analyzed data from a 2016–2021 nationwide OHCA registry, combined with information from an emergency medical service (EMS) database that included location and patient care details. We analyzed 13,469 non-EMS-witnessed OHCA cases in out-of-office workplaces, including 3423 cases in farmlands.

OHCA in farmlands had disadvantageous characteristics for OHCA outcomes compared with that in other out-of-office workplaces: a much higher proportion of older (≥ 75 years) victims and unwitnessed cases, lower rates of bystander CPR and public access defibrillation use, and a much lower incidence of shockable initial electrocardiogram rhythms. Furthermore, EMS response and transportation time intervals were longer in farmlands. The rate of neurologically favorable survival after 1 month was 2.0% in farmlands, much lower than in other out-of-office workplaces (11.5%); crude odds ratio (OR): 0.16; 95% confidence interval (CI), 0.13–0.21. The survival rate was lower in farmland (17.1%) than in other out-of-office workplaces (36.0%) even when analyzed for witnessed OHCA cases with shockable initial rhythms. In multivariate interaction tests, the association between prolonged response time intervals and worse outcomes was enhanced in farmlands.

Bystander responses to OHCA were worse in farmlands than in other workplaces. Farmlands have been slow to reform their responses to health crises. To improve the OHCA outcomes and sustain the growth of agriculture, we recommend a community-based approach to establish a tight chain of survival for OHCA in farmlands.