Trends of the incidence and clinical outcomes of suicide-related out-of-hospital cardiac arrest in Korea: A 10-year nationwide observational study

The purpose of this study was to evaluate the characteristics and temporal trends of the incidence and survival outcomes of suicide-related out-of-hospital cardiac arrest (OHCA) according to the suicide attempt method during the past decade.A population-based observational study between 2009 and 2018 was conducted. EMS-treated suicide-related OHCAs were classified according to the suicide method into hanging, jumping, poisoning, asphyxia and drowning, and other trauma. The study outcomes were survival to discharge and good neurological outcome. The temporal trends of crude and age- and sex-standardized incidence per 100,000 person-years and standardized rates for outcomes were calculated using direct standardization methods. Predictors of survival to discharge were investigated using multivariable logistic regression.From 2009 to 2018, the age- and sex-standardized incidence rate of suicide-related OHCA increased from 3.5 to 4.0 cases per 100,000 person-years. Of 21,720 eligible OHCAs, hanging (59.2%) was the most common suicide method, followed by jumping (21.3%), poisoning (14.9%), and asphyxia and drowning (3.5%). Although the standardized rates of survival to hospital discharge improved from 2.9% to 5.1% during the study period, good neurological outcome was not improved (from 0.7% to 1.0%). By suicide method, survival to discharge for the hanging group was increased, and good neurological outcome for the poisoning group showed improvement (both p-for-trend0.05). Compared with hanging, other suicide methods were negatively associated with survival outcome.The incidence of suicide-related OHCA has increased over the past decade in Korea, and survival outcomes are still very low. New interventions are needed to decrease the incidence and burden of suicide-related OHCAs.