Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic

Abstract

Objectives: To determine epidemiology of in-hospital cardiac arrest (IHCA) in a tertiary care hospital, pre- and during pandemic.
 Methods: This is a cross-sectional study of inpatients who experienced an in-hospital-cardiac arrest at a tertiary care hospital in Karachi between August 2019 and August 2020. Outcome variables were return of spontaneous circulation (ROSC) and survival to discharge (StD) and analysis was also done comparing pre- and during pandemic period.
 Results: A total of 77 patients experienced at least one IHCA event during the 1-year study period. Comparing pre- and during pandemic, ROSC for women was higher during the pandemic albeit not significant (43% vs 50%) in comparison to men (54% vs 10%, p<0.001). During the pandemic, women with IHCA were significantly younger than men (μ ± sd; 36.8 ± 15.3 vs 55.9 ± 12.7, p=0.001,) whereas pre-pandemic, there was no gender differences in mean age. Non-shockable rhythm was more common (92.2%) than shockable rhythm (6.5%). Pre- and during pandemic, there were significant differences in the cause of IHCA for 4H4T (87% vs 100%) and cardiac (36% vs 9%). The proportion of hypoxic patients increased from 50% during pre-pandemic to 91% during the pandemic period, whereas hypo/hyperkalemia decreased from 53% to 34%.
 Conclusion: Despite the limitation of a small sample size, our study has provided important information regarding the epidemiology and outcomes of IHCA pre- and during pandemic in a busy Pakistani tertiary care hospital. Our finding that gender differences exist in survival pre- and during pandemic needs to be explored further with more hospitals doing comparative studies.
 doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776
 How to cite this:Ahmed F, Abbasi L, Ghouri N, Patel MJ. Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic. Pak J Med Sci. 2022;38(2):387-392. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Uncovering the effects of COVID-19 on in-hospital cardiac arrest – a living systematic review and meta-analysis

“…Of the remaining studies, another 23 were excluded because they were reviews, case reports, or not in English. Finally, the 11 included manuscripts [26][27][28][29][30][31][32][33][34][35][36] referring to 10 studies were included in the meta-analysis. Girotra et al [28] and Gupta et al [29] refer to the same population, however, Girotra et al [28] analyze the IHCA for positive and negative COVID-19 pandemic patients, while Gupta et al [29] compare the periods before and during the COVID-19 pandemic.…”

“…Studies included in the meta-analysis were published between 2020 -2022, and the countries included the USA, UK, Sweden, Singapore, Pakistan, Germany and China. Among those studies, eight reported IHCA outcomes between the prepandemic and COVID-19 pandemic periods (95,115 vs. 27,633 patients, respectively) [26,27,29,[32][33][34][35], and three studies during the COVID-19 period among SARS-CoV-2 positive vs. negative patients (6,225 vs. 20,401 patients, respectively) [28,30,34,36]. The baseline characteristics are described in Table 1.…”

Physicians' Competence in Terminating CPR in Cardiac Arrest Cases and Factors Influencing This Termination

“…Survival to discharge ranges from 18-28% in hospitals (de Visser et al, 2019;Schluep et al, 2018). In Pakistan, only 1 in 100 people survive cardiac arrest (Ahmed et al, 2022). Cardiac arrests without hospital admission have a survival to discharge of approximately 10% (Myat et al, 2018).…”