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. 2018 Nov 22;11(1):50.
doi: 10.1186/s12245-018-0214-7.

Characteristics of traumatic out-of-hospital cardiac arrest patients presenting to major centers in Karachi, Pakistan-a longitudinal cohort study

Minaz Mawani  1 , Masood Kadir  2 , Iqbal Azam  2 , Junaid Abdul Razzak  3
Affiliations

Characteristics of traumatic out-of-hospital cardiac arrest patients presenting to major centers in Karachi, Pakistan-a longitudinal cohort study

Minaz Mawani et al. Int J Emerg Med. .

Abstract

Background: Trauma is the leading cause of death for adults under 44 years of age. Survival after traumatic out-of-hospital cardiac arrest (OHCA) has been reported to be poor, and its epidemiology is not well defined. A few studies have reported better survival in response to pre-hospital life-saving interventions. Currently, no published data on traumatic cardiac arrests in the field exist from low- and lower middle-income countries. We aimed to explore the epidemiology and outcomes of traumatic OHCA patients from Karachi, Pakistan. We conducted a longitudinal cohort study at emergency departments (ED) of five major public and private hospitals of the city from January to April 2013. Data was collected on all adult patients (age 18 years or more) presenting to the hospitals directly from field with cardiac arrest and history of trauma using a structured questionnaire. Patients with do-not-resuscitate status and those referred from other hospitals were excluded.

Results: During 3 months, a total of 187 patients were enrolled with mean age of 35.1 years. About 95% were men, and 68.4% had a penetrating injury. Even though half of the patients had a witnessed arrest, none received a bystander cardiopulmonary resuscitation (CPR). 83.4% were brought to the hospital in an ambulance, with median response and scene times of 3 and 2 min respectively; however, only 3 received any pre-hospital life-support interventions. One hundred eighty-one patients (96.7%) were pronounced dead on arrival to the ED, and of the remaining 6 patients, 4 received CPR in the EDs. Overall survival at the end of ED stay was 0%. Patients who received life-support interventions survived for longer time, though not clinically significant, as compared to those who did not (45 min vs. 35 min, p = 0.02).

Conclusion: There was no survival after a traumatic OHCA in Karachi, Pakistan. Even though ambulances reached the scene in a very short time, pre-hospital interventions were largely absent. There is a strong need to strengthen our pre-hospital care system but most importantly train the general public to deal with emergencies and be able to provide timely bystander CPR.

Keywords: Pre-hospital care; Survival; Traumatic out-of-hospital cardiac arrest.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by ethics review committee of Aga Khan University and Karachi Medical and Dental College. Informed consent was obtained from family members of all participants which also included component for publishing the aggregate results.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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

Figures

Fig. 1
Fig. 1
Flow diagram of a multicenter longitudinal cohort study. Outcomes of patients by mode of pre-hospital transportation presenting with out-of-hospital traumatic cardiac arrests to the emergency department of five major hospitals of the city
See this image and copyright information in PMC

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