The evaluation of urban vulnerability is of great significance to improve the quality of urbanization. An urban vulnerability index system was developed from four aspects of population vulnerability, economic vulnerability, social vulnerability and ecological vulnerability. The Spatial and temporal patterns of urban Vulnerability in Guangzhou were evaluated by a comprehensive index model and GIS analysis from three time sections (2005、2010、2014). The results indicated that: (1) economic density, population density, and per capita GDP are the main factors affecting the vulnerability of Guangzhou.(2) The population vulnerability is considerably higher for the central group cities than for the peripheral group cities. The economic vulnerability reflects a crisscross pattern, consisting of a central group and a peripheral group. The social and ecological vulnerabilities are higher for the peripheral group than for the central group. (3) The comprehensive vulnerability has a layered structure, with a high vulnerability in the inner ring layer, low vulnerability in the middle layer, and medium vulnerability in the outer layer.

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Introduction: Guidelines recommend epinephrine treatment after the first defibrillation in the resuscitation of patients with shockable rhythm cardiac arrest. Degrees to which routine practice adheres to clinical guidelines can be variable. Hypothesis: Epinephrine was administered prior to defibrillation in a non-trivial proportion of patients with shockable rhythm out-of-hospital cardiac arrest (OHCA). Such practice is associated with worse outcomes. Methods: We conducted a retrospective study in a North American OHCA epidemiologic registry between 2011 and 2015. We assessed the proportion of participants with shockable rhythm OHCA who received pre-defibrillation epinephrine and described their characteristics. In a propensity-matched cohort, we used logistic regression to evaluate associations between pre-defibrillation epinephrine and outcomes, i.e., pre-hospital return of spontaneous circulation (ROSC), survival to hospital discharge, and favorable neurological outcome (modified Rankin Scale score ≤3) at discharge. Results: Of 6938 individuals with shockable rhythm OHCA, 522 (7.5%) received epinephrine before defibrillation. Comparing these patients to those who did not receive pre-defibrillation epinephrine, mean time from emergency medical services activation to first defibrillation was longer (17.5 vs 10.5 min) and a greater proportion received epinephrine intra-osseously (24 vs 20%). In total, 392 (75%) and 5119 (80%) gained prehospital ROSC, 78 (15%) and 1237 (19%) survived to hospital discharge, and 48 (9%) and 996 (16%) had favorable functional outcome at discharge respectively. In propensity-matched analysis, epinephrine use prior to defibrillation was associated with statistically insignificant increases in odds of prehospital ROSC (OR=1.20, 95%CI 0.89-1.61; p=0.23), survival (OR=1.46, 95%CI 0.98-2.17; p=0.06), and favorable neurological outcome at hospital discharge (OR=1.21, 95%CI 0.76-1.93; p=0.43). Conclusions: Data from a North American OHCA registry found that epinephrine can be administered prior to defibrillation in up to 7.5% of patients with shockable rhythm cardiac arrest. Such approach was not associated with worse outcomes in propensity-matched analysis.

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Introduction: The optimal timing of epinephrine administration in shockable initial rhythm out-of-hospital cardiac arrest (OHCA) is unclear. Hypothesis: Early compared to late epinephrine following first electrical defibrillation attempt is associated with better outcomes in shockable initial rhythm OHCA. Methods: We conducted a retrospective study in adults with shockable initial rhythm OHCA from 2011-2015 in North America. We used multivariable logistic regression to assess associations between timing of epinephrine and prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and hospital discharge with favorable neurological outcome (modified Rankin Scale score≤3). We used propensity-score-matching and subgroup analyses to assess robustness of associations. Results: Of 6416 patients, median age was 64 (IQR: 54-74) years, 5136 (80%) were men, 2226 (35%) received epinephrine within four minutes after first defibrillation, 5119 (80%), 1237 (19%), and 996 (16%) had prehospital ROSC, survival to hospital discharge, and favorable neurological outcome at discharge respectively. Adjusted for confounders, we observed lower odds of prehospital ROSC (OR=0.95, 95%CI 0.94-0.96; p<0.001), survival to hospital discharge (OR=0.91, 95%CI 0.89-0.92; p<0.001), and favorable neurological outcomes at discharge (OR=0.92, 95%CI 0.90-0.93; p<0.001) per minute later epinephrine administration. Compared to epinephrine administration within four minutes following first defibrillation attempt, later epinephrine was associated with lower odds of prehospital ROSC (OR=0.58, 95%CI 0.51-0.68; p<0.001), survival to hospital discharge (OR=0.50, 95%CI 0.43-0.58; p<0.001), and favorable neurological outcome at discharge (OR=0.51, 95%CI 0.43-0.59; p<0.001). Associations remained significant in a well-balanced propensity score matched cohort and subgroup analyses by witness status, EMS response time, and total epinephrine dose. Conclusion: In shockable initial rhythm OHCA, early compared to late epinephrine administration following first defibrillation attempt was associated with better odds of prehospital ROSC, survival to hospital discharge, and hospital discharge with favorable neurological outcome.