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. 2018 Oct 1;11(1):40.
doi: 10.1186/s12245-018-0200-0.

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

Umme Salama Moosajee  1 , Syed Ghazanfar Saleem  2 , Sundus Iftikhar  3 , Lubna Samad  4
Affiliations

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

Umme Salama Moosajee et al. Int J Emerg Med. .

Abstract

Background: Cardiopulmonary 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.

Methods: Patient 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.

Results: Four 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).

Conclusion: Our 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.

Keywords: Cardiopulmonary resuscitation; Return of spontaneous circulation; Survival to discharge.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by Interactive Research and Development’s Institutional Review Board. Anonymity and confidentiality of the participants data was maintained throughout the research. No unauthorized person had access to identifiable patient data.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests associated with this study and/or manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Outcome of cardiopulmonary resuscitation in cardiac arrest patients. This figure shows a breakdown of the study population, i.e., cardiac arrest patients that were presented to the emergency department of The Indus Hospital during the duration of the study period, based on the CPR outcomes
See this image and copyright information in PMC

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