Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: a prospective observational study

Abstract

BackgroundResearch on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known about the prevalence and management of in-hospital cardiac arrest in low-resource settings. We therefore sought to determine the prevalence, outcomes and associated factors of adult inpatients with cardiac arrest at a tertiary referral hospital in a low-income country.MethodsUpon obtaining institutional approval, we conducted a prospective observational period prevalence study over a 2-month period. We recruited adult inpatients with cardiac arrest in the intensive care unit and emergency wards of Mulago Hospital, Uganda during the study period. We reviewed all files and monitoring charts, and also any postmortem findings. Data were analyzed with Stata 12 and statistical significance was set at p < 0.05.ResultsThere was a cardiac arrest in 2.3 % (190) of 8,131 hospital admissions; 34.5 % occurred in the intensive care unit, 4.4 % in emergency operating theaters, and 3.0 % in emergency wards. A majority (63.2 %) was unwitnessed, and only 35 patients (18.4 %) received CPR. There was return of spontaneous circulation (ROSC) in 14 (7.4 %) cardiac arrest patients. Survival to 24 h occurred in three ROSC patients, which was only 1.6 % of all cardiac arrest patients during the study period. Trauma was the most common primary diagnosis and HIV infection was the most common co-morbidity.ConclusionOur hospital has a high prevalence of cardiac arrest, and low rates of CPR performance, ROSC, and 24-hour survival. Single provider CPR; abnormal temperatures as well as after hours/weekend CAs were associated with lower survival rates.

Epidemiology of in-hospital cardiac arrest in Abu Dhabi, United Arab Emirates, 2013–2015

“… 4 10 14 Despite these differences, the high incidence of IHCA reported in our study is a concern and warrants the need for further longitudinal research and the development of a national UAE Register of Cardiopulmonary Resuscitation. Overall, 38.3% of patients with IHCA achieved ROSC in this study, which was higher than a single-site tertiary hospital in Uganda (7.4% 5 ) and close to the value reported by Redeschi et al 10 (35.7%) in their cohort of patients in Italy. However, other studies conducted in Canada (46.9% 15 ), Italy (52.8% 10 ), Iran (42.9% in diabetic patients; 61.0% in non-diabetic patients 16 ), Israel (12.8%–14.2% 9 ), South Korea (54.1%–69.5% 17 ), Thailand (58.9% 18 ) and the UK (45.0% 11 ) have reported better ROSC.…”

Audit of defibrillators at an urban public sector hospital

“…In contrast, a Ugandan study reported an exceptionally high rate of 190 cardiac arrest episodes among 8131 hospital admissions (23.4 per 1000) 12. Although the incidence of in-hospital cardiac arrest is not known in South Africa, the incidence of out-of-hospital cardiac arrest has been reported as 6.4 per 100 000 population 13.…”

Abnormal Admission Chest X-Ray and MEWS as ICU Outcome Predictors in a Sub-Saharan Tertiary Hospital: A Prospective Observational Study

“…This study has found that males were the majority of admitted patients for mechanical ventilation at the ICU with most admissions between 16 and 45 years. Trauma was the commonest need for ICU admission which signifies its persistent burden to Mulago Hospital as other studies showed trauma associated with severe head injury was the most common comorbidity for cardiac arrests in Mulago Hospital [ 13 ]. This glaring burden will remain persistent due to lack of critical care prioritization and facilities yet prior studies have shown Uganda had the world's second highest accident burden of over 20,000 road accidents annually, with 2,334 fatalities [ 14 ].…”