Survival Factors Associated with Toilet-Related Out-of-Hospital Cardiac Arrest

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Abstract
Objective: To identify the factors associated with a neurologically favourable survival of out-of-hospital cardiac arrest (OHCA) occurring in toilets. Methods: We retrospectively compared neurologically favourable 1-month survival rates and survival-related factors for 330,849 non-emergency medical service-witnessed OHCAs that occurred in toilets with those that occurred elsewhere using a nationwide database. Results: Compared to outpatient or hospital admission, OHCA was more likely to be associated with toilets (crude odds ratio [cOR] [95% confidence interval [CI]]: 2.52 [2.48–2.57]). The neurologically favourable 1-month survival rate for OHCA occurring in toilets (1.8%) was significantly lower than that in other places (2.9%) (cOR [95% CI]: 0.60 [0.53–0.68]). Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use were minimal in toilets. Neither bystander CPR (adjusted OR [95% CI]: 1.19 [0.91–1.75]) nor AED use (adjusted OR [95% CI]: 2.05 [0.65–6.41]) was associated with improved neurologically favourable 1-month survival in toilets. Conclusions: Despite the poor neurologically favourable survival rate of OHCA in toilets, the provision of bystander CPR and AED was not associated with survival. Potential contributing factors include low rates of bystander intervention and delayed patient detection. To address this issue, focusing particular attention on unwell patients who use the toilets is crucial, and preventive approaches should be promoted.

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