Incidence and Outcomes After Out-of-Hospital Cardiac Arrest at Train Stations in Denmark

Background

Following international guidelines, communities have deployed automated external defibrillators at train stations without substantive evidence. 

Methods and Results

We geocoded public out-of-hospital cardiac arrests (OHCAs) (2016-2020), automated external defibrillators, and train stations. The stations were divided into the following groups according to passenger flow: 1 (0-499), 2 (500-4999), 3 (5000-9999), and 4 (>10 000) passengers per day. Risk ratios (RRs) were calculated using Poisson regression of rates, and odds ratios (ORs) were analyzed through logistic regression. OHCAs at train stations accounted for 102 (2.3%) of 4467 public OHCAs. The incidence rate (IR) and RR for OHCAs were for group 1: IR, 0.02 OHCA per station per year, RR, 1.0 (reference); group 2: IR, 0.07, RR, 4.1 (95% CI, 2.3-7.3); group 3: IR, 0.25, RR, 12.7 (95% CI, 6.2-25.9); and group 4: IR, 0.34, RR, 16.3 (95% CI, 8.6-30.9). Compared with other public OHCAs, OHCAs at train stations were just as likely to receive bystander cardiopulmonary resuscitation (OR, 1.13 [95% CI, 0.60-2.12]). However, they had higher odds of bystander defibrillation (OR, 1.66 [95% CI, 1.06-2.58]), were more likely to achieve return of spontaneous circulation (OR, 1.88 [95% CI, 1.24-2.85]), and survive 30 days (OR, 2.37 [95% CI, 1.57-3.59]). 

Conclusions

The incidence of OHCAs at train stations was associated with passenger flow, with the busiest stations having a 16-fold higher risk of OHCAs than the lowest. OHCAs at train stations had better outcomes compared with other public OHCAs.