Out-of-Hospital Cardiac Arrest at the Workplace

A Retrospective Analysis of the German Resuscitation Registry

Out-of-hospital cardiac arrest (OHCA) is a common event. The event location affects the prognosis because of the probability for resuscitation given by bystanders, among others. International data show that 0.3–4.7% of OHCAs happen at the workplace and are associated with significantly better outcomes than in other locations (1). For Germany it is, however, not clear how an OHCA at the workplace differs from other locations, especially private residences. This study compares resuscitation at the workplace and private residence, especially with regard to the rates of resuscitation provided by bystanders, the use of automated external defibrillators (AEDs), and the likelihood of survival with good neurologic function.

Methods

We conducted a retrospective, descriptive, and comparative analysis of all cases of OHCA in private residences and at the workplace that had been documented in the German Resuscitation Registry from 2015 to 2024. We included adults (≥18 years of age) in whom resuscitation measures had actually been started. The registry is based on anonymously reported datasets from currently 198 emergency medical services (2). We considered for our analyses only sites submitting “good quality data,” because not all systems are able to document data pertaining to the in-hospital course: An OHCA incidence >30/100 000 inhabitants per year, a return-of-spontaneous-circulation (ROSC) rate <80%, a ROSC-after-cardiac-arrest score (RACA score) in >60% of cases, and—if applicable—documented in-hospital courses in >30% of cases. In addition to the deployment site we analyzed among others the primary ECG rhythm, the cause of the cardiac arrest, and pre-existing conditions (pre-emergency status PES 1–5, 1: no pre-existing conditions; PES 5: moribund patient unlikely to survive the following 24 hours). The primary endpoint was survival with a good neurologic outcome, defined as cerebral performance categories (CPC) 1 or 2 (good or moderate cerebral performance) at hospital discharge.

Numerical variables are shown as medians and interquartile ranges (IQR), categorical variables as frequencies and percentages. We used IBM SPSS Statistics 29 (Armonk, NY, USA) for our calculations.

The study was approved by the ethics committee at Christian Albrechts-University Kiel (ref: D 631/21) and the scientific advisory board of the German Resuscitation Registry (ref: 2021–13).

Results

We recorded a total of 1369 (1.9%) OHCAs at the workplace and 45 579 (64.4%) in private residences and included these in our analysis. Patients with OHCA at the workplace were younger (median 56.4 versus 73.2 years of age), more commonly male (87.6% versus 64.8%), and had fewer pre-existing conditions (PES 1+2 63.1% versus 31.9%).

The time to onset of resuscitation was shorter (median 5 minutes versus 7 minutes) and bystander resuscitation was more common (59.5% versus 36.0%). Automated external defibrillators (AEDs) were also more commonly attached (7.5% versus 0.7%). An initially shockable rhythm was present in more than half the cases at the workplace (51.5% versus 18.4%) and the pathogenesis was more commonly cardiac (73.6% versus 60.6%) or trauma-related (7.7% versus 1.0%) as the cause of the cardiac arrest (Table 1).

Table 1

Patient characteristics

Patients who were resuscitated at the workplace had a greater probability of survival to discharge or 30 days after the event (29.4% versus 9.4%) and of a good neurologic outcome at discharge (22.1% versus 6.3%) (Table 2).

Table 2

Outcome

Discussion

Patients with OHCA at the workplace were younger, had fewer pre-existing conditions, and in more than half of cases had a shockable initial rhythm. The rate of bystander resuscitation was higher, AED attachment more common, and—which is possibly explained by these differences—the probability of survival with a good neurologic outcome was higher.

These results are consistent with international data (1), but on comparison it is obvious that OHCA at the workplace in Germany results far less often in bystander resuscitation (59.5% versus 70.9%) and deployment of AEDs is rarer (7.5% versus 22.5%) than, for example, in a study from Sweden (3). This indicates unused potential since bystander resuscitation, especially in the setting of a cardiac pathogenesis of cardiac arrest, is associated with a notably better prognosis (4) and a study in Japan, where additionally an AED was attached, showed a further increased probability for a good neurologic outcome on day 30 (37.7% versus 22.6%) (5). Since more than half of patients with OHCA at the workplace initially presented with a shockable rhythm, providing (and utilizing) an AED at the workplace seem particularly promising—in addition to optimized training for staff and occupational first responders. The interpretation is limited by the retrospective design and possible selection and documentation bias. OHCA at the workplace affected mainly younger persons with fewer pre-existing conditions, which may have led to selection bias. Furthermore it is not known whether an AED was available at the site of the event and remained unused. In conclusion, despite better neurological outcomes for workplace OHCA, there remains high potential to increase bystander CPR rates and AED utilization, particularly since an initial shockable rhythm was present in more than one in two patients.

Christoph Hüser, Christine Eimer, Jan Wnent, Jan-Thorsten Gräsner, Stephan Seewald

Conflict of interest statement
JTG is the spokesman for the organizational committee of the German Resuscitation Registry in the German Society of Anaesthesiology [sic] and Intensive Care Medicine (DGAI) and chairs the Deutsches Zentrum für Reanimationsforschung

SS was reimbursed travel expenses by the German Resuscitation Registry and the DGAI, the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), HCCM Consulting Ltd, and AGNN. He is also a member of the organizational committee of the German Resuscitation Registry.

JW was reimbursed travel expenses by the DGAI, is a member in the data and safety monitoring board (DSMB) of the DoS-VF2 Study, spokesman for the section of emergency medicine in the DGAI, and a member of the organizational committee of the German Resuscitation Registry. He is a member of the inner circle of the executive committee of the DGAI.

The remaining authors declare that no conflict of interest exists.

Manuscript received on 4 February 2026, revised version accepted on 4 May 2026

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Hüser C, Eimer C, Wnent J, Gräsner JT, Seewald S: Out-of-hospital cardiac arrest at the workplace: A retrospective analysis of the German Resuscitation Registry. Dtsch Arztebl Int 2026; 123: 457–8; DOI: 10.3238/arztebl.m2026.0087

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