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Moosajee US, Saleem SG, Iftikhar S, et al. Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country. Int J Emerg Med. 2018;11(1):40doi: 10.1186/s12245-018-0200-0.
Moosajee, U. S., Saleem, S. G., Iftikhar, S., & Samad, L. (2018). Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country. International journal of emergency medicine, 11(1), 40. https://doi.org/10.1186/s12245-018-0200-0
Moosajee, Umme Salama, et al. "Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country." International journal of emergency medicine vol. 11,1 (2018): 40. doi: https://doi.org/10.1186/s12245-018-0200-0
Moosajee US, Saleem SG, Iftikhar S, Samad L. Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country. Int J Emerg Med. 2018 Oct 01;11(1):40. doi: 10.1186/s12245-018-0200-0. PMID: 31179917; PMCID: PMC6326149.
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Int J Emerg Med. 2018 Oct 01;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.

International journal of emergency medicine

Umme Salama Moosajee, Syed Ghazanfar Saleem, Sundus Iftikhar, Lubna Samad

Affiliations

  1. Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, 5th Floor, Woodcraft Building, Sector 47, Korangi Creek Road, Karachi, 75300, Pakistan. [email protected].
  2. Emergency Department, The Indus Hospital, Karachi, Pakistan.
  3. Indus Hospital Research Center, The Indus Hospital, Karachi, Pakistan.
  4. Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, 5th Floor, Woodcraft Building, Sector 47, Korangi Creek Road, Karachi, 75300, Pakistan.

PMID: 31179917 PMCID: PMC6326149 DOI: 10.1186/s12245-018-0200-0

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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