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A systematic review of air pollution and incidence of out-of-hospital cardiac arrest
  1. Tiew-Hwa Katherine Teng1,2,
  2. Teresa A Williams1,3,4,
  3. Alexandra Bremner5,
  4. Hideo Tohira3,
  5. Peter Franklin5,
  6. Andrew Tonkin6,
  7. Ian Jacobs1,3,4,
  8. Judith Finn1,3,4,6
  1. 1Discipline of Emergency Medicine, The University of Western Australia, Crawley, Western Australia, Australia
  2. 2Combined Universities Centre for Rural Health, The University of Western Australia, Crawley, Western Australia, Australia
  3. 3Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
  4. 4St John Ambulance (WA), Belmont, Western Australia, Australia
  5. 5School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
  6. 6School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Tiew-Hwa Katherine Teng, Discipline of Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; katherine.teng{at}


Introduction Studies have linked air pollution with the incidence of acute coronary artery events and cardiovascular mortality but the association with out-of-hospital cardiac arrest (OHCA) is less clear.

Aim To examine the association of air pollution with the occurrence of OHCA.

Methods Electronic bibliographic databases (until February 2013) were searched. Search terms included common air pollutants and OHCA. Studies of patients with implantable cardioverter defibrillators and OHCA not attended by paramedics were excluded. Two independent reviewers (THKT and TAW) identified potential studies. Methodological quality was assessed by the Newcastle-Ottawa Scale.

Results Of 849 studies, 8 met the selection criteria. Significant associations between particulate matter (PM) exposure (especially PM2.5) and OHCA were found in 5 studies. An increase of OHCA risk ranged from 2.4% to 7% per interquartile increase in average PM exposure on the same day and up to 4 days prior to the event. A large study found ozone increased the risk of OHCA within 3 h prior to the event. The strongest risk OR of 3.8–4.6% per 20 parts per billion ozone increase of the average level was within 2 h prior to the event. Similarly, another study found an increased risk of 18% within 2 days prior to the event.

Conclusions Larger studies have suggested an increased risk of OHCA with air pollution exposure from PM2.5 and ozone.

  • Air Pollution
  • Heart Disease
  • Mortality

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