CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 AFRICA 265 resuscitation and poor access to post-ROSC care, the chain of survival in Cape Town is relatively weak, despite it being one of the most resourced prehospital and emergency care systems in Africa.45 However, as many of these interventions are not cost effective,35-38,46 contextual interventions for managing OHCA for LMICs in sub-Saharan Africa should be developed, especially considering an expected increase in its incidence. Proposed interventions should maximise outcome and resource utility, but be acceptable to the community and their ethical framework. Limitations This study is firstly limited by its retrospective design, which meant that greater clinical information, other than reported elsewhere,24 could not be obtained. This meant that the exact time of cardiac arrest (affecting the temporal analyses) and the exact location of the emergency vehicle at the time of the call (affecting the analyses on response times) might have been affected. Furthermore, the most likely aetiology of the OHCA (sudden cardiac arrest or from other natural causes) could not be determined and therefore some of these victims might not have benefited from PCI, even if it were accessible. Of course, the generalisability of these results is affected by the sampling frame being one single urban metropole. However, state and private patients were included. Regarding the geospatial analyses, the drive-time analysis was based on typical (average) drive times and traffic conditions, and therefore exceptions are not accounted for. By reducing the location of the cardiac arrest to the suburb, some accuracy had to be sacrificed, however the effect of this is expected to be minimal. Conclusion Incidents of OHCA occurred predominantly at home during the mid-morning and early afternoon, with hotspots around the city centre and residential suburbs of the Cape Town metropole. These clusters may be used for targeted public interventions or training for the families of high-risk patients. While the incidents occurred relatively close to PCI-capable facilities, some areas remained underserved and true access to PCI for OHCA victims may be impossible due to their socio-economic and insurance status. With a likely increase in the incidence of OHCA expected, it is essential that contextual, cost-effective interventions for the management of OHCA be devised. Basing interventions on these results may assist in ensuring that resources are distributed equitably and concentrating interventions to areas that may yield the greatest benefit. This study was partially funded through a National Research Foundation of South Africa grant (Thuthuka grant no 121971), held by WS. 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