Geospatial mapping of disparities in out-of-hospital cardiac arrests in the Swiss canton of Fribourg, 2018-2022: A retrospective observational study.
Resuscitation Plus · 2025-08-23 · Registry study
Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) has a high mortality rate worldwide. A first responder (FR) and automated external defibrillator (AED) network was implemented to complement emergency medical services (EMS) in the Swiss canton of Fribourg. This study aims to assess geospatial disparities in FR deployment, AED usage and prehospital response efficiency relative to OHCA clusters. METHODS: This retrospective observational study analysed all OHCA cases recorded in the Swiss Registry of Cardiac Arrest between 2018 and 2022, which occurred in the canton of Fribourg. We used visual spatial mapping to illustrate clusters of OHCA survival and explore their relationship with FR presence and AED use, including outcome proportions in five predefined geographical zones. Multivariate exact logistic regression models were constructed to assess the impact of the five geographical zones in which OHCA occurred on survival to hospital discharge. RESULTS: Of 1127 OHCA included, 34 % had a FR on-site and an AED was used in 19 % of cases. All OHCA clusters corresponded to the most densely inhabited areas. Survival rates were highest in urban areas (8.5 %) but decreased to 3.6 % in sparsely populated zones. Cardiopulmonary resuscitation (CPR) performance and AED use by first responders or bystanders showed no statistically significant impact across geographic areas. Heatmaps of FR deployment showed a lower intensity in urban areas and a more even distribution across the territory. Despite a higher AED density in urban areas, usage remained low (12 %). By the end of 2022, 2050 FRs and 549 AEDs were registered in the canton, which remains below international recommendations. CONCLUSION: Geospatial disparities highlighted the need for optimized FR recruitment, improved AED distribution and refined EMS activation strategies to enhance OHCA survival rates. These findings provide actionable insights for targeted resource allocation of the existing system at the cantonal level.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Automated external defibrillator · Alerted volunteer responders · Bystanders · Equity & disparities · Mortality & survival · Rural & remote · Urban
Related articles
- Disparities in Pediatric Out-of-Hospital Cardiac Arrest Outcomes Relating to Race, Urbanicity, and Poverty: A Study of the NEMSIS Database. (Prehosp Emerg Care, 2026)
- Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS). (Eur Heart J, 2006)
- Smartphone-activated volunteer responders and survival to discharge after out-of-hospital cardiac arrests in Victoria, 2018-23: an observational cohort study. (Med J Aust, 2025)
- Impact of smartphone activated first responders on provision of bystander CPR, bystander AED and outcomes for out-of-hospital cardiac arrest (OHCA). (Resuscitation, 2025)
- Out-of-Hospital Cardiac Arrest in Ireland 2012 to 2020: Bystander CPR, bystander defibrillation and survival in the Utstein comparator group. (Resusc Plus, 2025)
- Measuring disparities in out of hospital cardiac arrest outcomes in Chicago community areas. (Resusc Plus, 2025)