Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country

Abstract

BackgroundCardiopulmonary resuscitation (CPR) is a key component of emergency care following cardiac arrest. A better understanding of factors that influence CPR outcomes and their prognostic implications would help guide care. A retrospective analysis of 800 adult patients that sustained an in- or out-of-hospital cardiac arrest and underwent CPR in the emergency department of a tertiary care facility in Karachi, Pakistan, between 2008 and 15 was conducted.MethodsPatient demographics, clinical history, and CPR characteristics data were collected. Logistic regression model was applied to assess predictors of return of spontaneous circulation and survival to discharge. Analysis was conducted using SPSS v.21.0.ResultsFour hundred sixty-eight patients met the study’s inclusion criteria, and overall return of spontaneous circulation and survival to discharge were achieved in 128 (27.4%) and 35 (7.5%) patients respectively. Mean age of patients sustaining return of spontaneous circulation was 52 years and that of survival to discharge was 49 years. The independent predictors of return of spontaneous circulation included age ≤ 49 years, witnessed arrest, ≤ 30 min interval between collapse-to-start, and 1–4 shocks given during CPR (aOR (95% CI) 2.2 (1.3–3.6), 1.9 (1.0–3.7), 14.6 (4.9–43.4), and 3.0 (1.4–6.4) respectively), whereas, age ≤ 52 years, bystander resuscitation, and initial rhythm documented (pulseless electrical activity and ventricular fibrillation) were independent predictors of survival to discharge (aOR (95% CI) 2.5 (0.9–6.5), 1.4 (0.5–3.8), 5.3 (1.5–18.4), and 3.1 (1.0–10.2) respectively).ConclusionOur study notes that while the majority of arrests occur out of the hospital, only a small proportion of those arrests receive on-site CPR, which is a key contributor to unfavorable outcomes in this group. It is recommended that effective pre-hospital emergency care systems be established in developing countries which could potentially improve post-arrest outcomes. Younger patients, CPR initiation soon after arrest, presenting rhythm of pulseless ventricular tachycardia and ventricular fibrillation, and those requiring up to four shocks to revive are more likely to achieve favorable outcomes.

Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings — A scoping review

“…nine studies from Asia, 28À36 and three from South America, 14À16 Table 1). There were no eligible studies from low-income countries, four studies were from lower-middle-income countries (one from India, 31 two from Pakistan, 21,22 one from China 32 ), all others were from upper-middle-income economies. 14À20,23À30,33À37…”

Correlation between Patient’s Age and Advanced Response Time with Outcome of Cardio Pulmonary Resuscitation in Cardiac Arrest Patient

“…9,10 This can occur because by increasing the patient's age, the risk of experiencing comorbid diseases or terminal diseases is also getting bigger. 1,11 Statistically, the patient's age did not show a significant difference towards outcome in cardiac arrest patients. This is in line with the previous studies which said that age is not one of the factors or variables which determine the outcomes in cardiac arrest patients.…”

“…It is similar with the previous study which said that 83.3% cardiac arrest patients who experienced ROSC had advanced response time < 4 minutes. 11,12 Statistically, the advanced response time shows a significant difference towards outcome in cardiac arrest patients. This is in line with the previous study which said that patient who has advanced response time ≤ 5 minutes had an outcome 2.53 times better than patient who had advanced response time > 5 minutes.…”

How much ambulance personnel know about basic life support (BLS)? A hospital-based study from Eastern India

“…[ 10 ] The incidence of out-of-hospital cardiac arrest (OHCA) is more in comparison to in-hospital cardiac arrest. [ 11 12 ] Patients with OHCA who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS and were less likely to experience poor neurological functioning. [ 13 ] In a retrospective observational study, 75 out of 787 patients received CPR before and during the transport of OHCA patients.…”