doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. ‫ا‬ ‫ر‬ ‫ا‬ ‫ت‬.is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. was not certified by peer review)

Background Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality worldwide. Recent studies demonstrated low survival rates in Middle Eastern countries. Anecdotally there are unique demographic, cultural and logistical challenges in this region. However, there remains a paucity of data published on OHCA in the Middle East. In order to address OHCA in a meaningful manner in the region, we first need to quantify the issue. Methods We conducted a scoping review of published and grey literature on OHCA in the Gulf Cooperative Council region that utilised Arksey and O'Malley's framework. Electronic databases and grey literature sources were identified and searched. Subject matter experts in the region were consulted. All types of studies in English and Arabic were included. Results A total of 24 studies were included from Saudi Arabia, the UAE, Oman, Kuwait, and Qatar. No literature was identified from the state of Bahrain. OHCA victims in the region are younger, predominantly male, and more co-morbid than those in Western studies. We observed low Emergency Medical Service utilisation, low bystander cardiopulmonary resuscitation, return of spontaneous circulation, and survival to discharge rates across the region. There are differences in characteristics of OHCA among ethnic groups. Discussion and conclusions We identified unique characteristics associated with OHCA in the region, variances in processes and outcomes when compared to Western studies, and a lack of coordinated effort to research and address OHCA. We recommend creating lead agencies responsible for coordinating and developing strategies such as community response, public education, and reporting databases.

His energy in making contacts for scientific purposes was unbounded and a sources of inspiration to others. This was shown typically when he became President of the Physiology Section of the Indian Science Congress held at Bangalore in January 1946. Amongst his friends and colleagues his death leaves a gap which will be difficult to filll.

Background School cardiopulmonary resuscitation (CPR) training has not been previously implemented nor studied in the Arabian Peninsula, and this is due to the challenges that this training imposes. This study aims to determine high school teacher perspectives, willingness, and barriers as related to CPR student training in high schools. Methods An anonymous, voluntary, cross-sectional electronic questionnaire, primarily based on the theory of planned behavior (TPB) was distributed to high school principals and teachers from 20 local (public and private) high schools between October and December 2021. The questionnaire was a 4-part (demographics, willingness, barriers, implementation approach), 23-variable tool. Results Eighty-four out of 88 participants were included in the analysis from 20 high schools. The overall willingness to teach CPR to students was 4.2 ± 0.9, and this willingness was significantly associated with being a female ( p = 0.019), being a teacher ( p = 0.036), having a family history of cardiovascular disease ( p = 0.007), previous school CPR campaigns ( p = 0.02), and all TPB factors: attitude ( p = 0.001), subjective norms ( p = 0.011), and perceived behaviour control ( p = 0.007). As for perceived barriers, there was moderate concern regarding the absence of the Good Samaritan law (3.8 ± 1.1) and CoVID-19 transmission (3.5 ± 1.3). High school teaching staff recommended formal legislation of CPR training from the Ministry of Education (MoE) and favoured CPR training delivery by healthcare professionals. However, they were willing to conduct CPR training themselves with regular training, material integration into the curriculum, and online teaching material access. Conclusion High school teachers are willing to teach students CPR. They need MoE legislation, appropriate training, online material, and a standardized database. Teaching staff also recommend specific training session settings. CoVID-19 and Good Samaritan law are moderate barriers. A number of factors influence teaching staff willingness to conduct CPR training. From this analysis, we recommend piloting CPR training in Kuwait high schools with consideration to the identified influential factors and barriers.

Background The objective of this study is to describe the characteristics of hypertensive emergencies in Kuwait aiming to provide a preliminary background to update the current guidelines and improve patients’ management. Methods This is a prospective analysis of hypertensive emergency cases retrieved from emergency medical services (EMS) archived data between 1 January – 30 June 2020. Collected variables included patient characteristics, clinical presentations, vital signs, interventions, and complications. Outcome variable collected was: en route complications. Results Hypertensive emergency prevalence in Kuwait is 4.75 per 100,000. Most were non-Kuwaiti (62%) males (59%) with a mean age of 57 ±14 years. Most hypertensive emergency cases occurred at home (62%). The hypertensive emergency BP threshold was; SBP 182 (SD=31) and diastolic BP (DBP) 108 (SD=18). 36% of hypertensive emergency cases had silent hypertension. 67% of hypertensive emergencies were verified using ambulance verification tools. Nitroglycerin was administered to only hypertensive emergencies suspected to have acute coronary syndrome or acute heart failure (50%). Complications were seen in 9.5% of hypertensive emergency cases. Conclusion Hypertensive emergency is rare in the ambulance but can progress into a serious situation. One in every 10 hypertensive emergency cases will require en route resuscitation. Hypertensive emergencies should be recognized and managed within their clinical context. The most common clinical presentation of hypertensive emergency is cardiac chest pain. Some pre-hospital verification tools confirm acute HMOD. Further research is required to establish hypertension emergency recognition and management guidelines in the prehospital setting.