Abstract Body: Background: Out-of-hospital cardiac arrest (OHCA) is a significant public health issue with a <10% survival rate nationally. Golf courses represent the fifth most frequent location for OHCA in public settings. Bystander interventions, such as CPR and AED use, are crucial for improving survival rates. Despite the Professional Golfers' Association of America recommending AEDs at golfing facilities, their availability and use prior to EMS arrival is unknown.
Objective: This investigation sought to determine the frequency of OHCA on golf courses, the frequency of bystander CPR and AED utilization, and the outcome of golf course cardiac arrests.
Methods: This retrospective study utilized data from the Cardiac Arrest Registry to Enhance Survival 2020-2023. OHCA cases within 400 meters of a golf course address and classified as occurring in a recreational location were identified via ArcGIS. The primary outcome was bystander CPR or AED use; secondary outcomes included survival to hospital admission and discharge, and favorable neurological outcome (Cerebral Performance Category 1 or 2). Descriptive statistics and univariate analyses were employed to examine patient demographics, golf course characteristics, bystander interventions, and patient outcomes. Multivariable regression analysis was also used.
Results: A total of 476 OHCA cases occurred on golf courses during the study period. The patients were mostly male (91.4%, n=435), White (85.1%, n=330), with a mean age of 64.6 (SD 15.5). 61.8% had an initial shockable rhythm. Case distribution did not vary by region, course size, or public vs private status. Survival to discharge was 30.5% (n=145), with vast of majority survivors (97.2%, n=141) with good neurologic outcome. Among witnessed, shockable arrests with AED use, survival to discharge was 63.8%.
AED use was associated with significantly increased survival to hospital discharge (37.9% vs 18.7% aOR 1.9 (95% CI 1.1, 3.3 p<0.05), and more frequent on private courses (32.1% vs 19.7%, p=0.003).
Conclusion: Patients experiencing OHCA on golf courses frequently receive bystander interventions, and have high survival and excellent neurological outcomes. Despite empiric evidence, legislative mandates, and professional organization recommendations, AED use occurred in only 25% of cases. This study highlights the value of, and need for implementation strategies to optimize bystander CPR and AED response on golf courses.