Clinical profile, management, and outcome in patients with out of hospital cardiac arrest: insights from a 20-year registry

Abstract

BackgroundThere is limited information regarding the clinical characteristics and outcome of out of hospital cardiac arrest (OHCA) in Middle Eastern patients. The aim of this study was to evaluate clinical characteristics, treatment, and outcomes in patients admitted following OHCA at a single center in the Middle East over a 20-year period.MethodsThe data used for this hospital-based study were collected for patients hospitalized with OHCA in Doha, Qatar, between 1991 and 2010. Baseline clinical characteristics, in-hospital treatment, and outcomes were studied in comparison with the rest of the admissions.ResultsA total of 41,453 consecutive patients were admitted during the study period, of whom 987 (2.4%) had a diagnosis of OHCA. Their average age was 57±15 years, and 72.7% were males, 56.5% were Arabs, and 30.9% were South Asians. When compared with the rest of the admissions taken as a reference, patients with OHCA were more likely to have diabetes mellitus (42.8% versus 39.1%, respectively, P=0.02), prior myocardial infarction (21.8% versus 19.2%, P=0.04), and chronic renal failure (7.4% versus 3.9%, P=0.001), but were less likely to have dyslipidemia (16.9% versus 25.4%, P=0.001). Further, 52.6% of patients had preceding symptoms, the most common of which was chest pain (27.2%) followed by dyspnea (24.8%). An initially shockable rhythm (ventricular fibrillation or ventricular tachycardia) was present in 25.1% of OHCA patients, with ST segment elevation myocardial infarction documented in 30.0%. Severely reduced left ventricular systolic function (ejection fraction ≤35%) was present in 53.2% of OHCA patients; 42.9% had cardiogenic shock requiring use of inotropes at presentation. An intra-aortic balloon pump was inserted in 3.6% of cases. Antiarrhythmic medications were used in 27.4% and thrombolytic therapy in 13.9%, and 10.8% underwent a percutaneous coronary procedure (coronary angiography ± percutaneous coronary intervention). The in-hospital mortality rate was 59.8%.ConclusionOHCA was associated with higher incidences of diabetes, prior myocardial infarction, and chronic kidney disease as compared with the remaining admissions. Approximately half of the patients had no preceding symptoms. In-hospital mortality was high (59.8%), but similar to the internationally published data.

Results of Out-of-Hospital Cardiopulmonary Arrest Cases with Intervention by Lay Rescuers and Emergency Health Workers

“…We believe that this is because the population of elderly people is dense and that they do not receive adequate health care in these areas. The most frequently detected conditions preceding cardiac arrest, such as cerebrovascular events chest pain and breathing difficulty, were the same as those found in other studies (8)(9)(10). These results support the theory that cardiopulmonary and cerebrovascular events are one of the leading causes of sudden death in elderly patients.…”

“…A significant part of these interventions were performed by EMT (n=97, 47.3%) and by paramedics (n=75, 36.6%) ( Table 1). The mean experience of the EHP who performed the interventions was 5.72±3.81 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) years. The ratios of the last in-service training of the EMS personnel are given in Table 1.…”

“…The explanation for why 4/5 of our cases were witnessed by someone is that most of the OHCA cases occurred in the family environment. In related studies (8)(9)(10)(11)(12)(13), the ratio of witnessed OHCA cases varies from 33%-65%. Those studies have reported that people tend to live alone as the socio-cultural and economical levels rise; one indication of this is the decreasing rate of witnessed cardiac arrest cases at homes.…”

“…In various studies and meta-analyses (8,9,11,12,14), the rates of shockable (VF/PVT) and non-shockable (asystole and PEA) rhythms detected at the scene varied between 13%-38% and 25%-45%, respectively. In one meta-analysis that included seven studies conducted in Europe, North America, Asia, and Australia, the VF rates varied from 11%-40% (20).…”

Community involvement in out of hospital cardiac arrest

“…[ 2 6 7 ] OHCA admissions accounted for 2.4% of all hospital admissions in a study from Doha, Qatar with higher survival rates among patients with witnessed OHCA and bystander CPR [8] . Another study examined resuscitation practices from different Asian countries (Pan Asian Resuscitation Outcomes Study [PAROS] which included Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and UAE-Dubai) [9] ; the majority of arrests occurred at home with bystander CPR rates varying from 10.5% (UAE) to 40.2% (Japan) and overall survival rates ranging from 0.5% to 8.5% [9] .…”