Background: The chain of survival is a set of most important factors affecting survival after an out-of-hospital cardiac arrest (OHCA). Recognising the difficulties in applying the chain is the key to improving outcomes. Early return of spontaneous circulation (ROSC) after a cardiac arrest is a fundamental factor for patient survival.

Aim: To assess the degree to which the location of OHCA affects ROSC during resuscitation efforts.

Methods: Emergency medical service (EMS) teams filled cardiac arrest forms based on standard (Utstein) guidelines. The registry covered data from January 2013 to May 2014 collected over the area of 23,706 km2 with the population density of 90 persons/km2. This constitutes 7.6% of the area of Poland. The average population density in Poland is 123 persons/km2.

Results: Over the time period covered by the study, 5185 cases of OHCA were reported. Resuscitation was attempted in 2415 (46.6%) cases. ROSC was achieved in 736 (30.48%) cases, including 374 (32.13%) cases in urban areas and 362 (28.94%) cases in rural areas. This difference was not statistically significant. Compared to urban areas, event witnesses in rural areas were more likely to perform bystander resuscitation and receive instructions from the EMS dispatchers. In the whole study group, cardiac disorders were the most common underlying cause of cardiac arrest (70.35%). The median time of ambulance arrival to the scene was significantly shorter in urban areas compared to rural areas (median time 6 min and 12 min, respectively).

Conclusions: No significant relation was found between the location of OHCA and ROSC despite the fact that the time to ambulance arrival was significantly shorter in urban areas. In rural areas, resuscitation was more frequently initiated by the event witnesses. Both in urban and rural areas, OHCA was most commonly due to cardiac causes, and the initial recorded cardiac rhythm was a non-shockable one.