ABSTRACT
BACKGROUND: Sudden cardiac arrest (SCA) requiring cardiopulmonary resuscitation (CPR) is one of the common emergencies encountered in the emergency department (ED) of any hospital. Although several studies have reported the predictors of CPR outcome in general, there are limited data from the EDs in India. MATERIALS AND METHODS: This retrospective study included all patients above 18 years with SCA who were resuscitated in the ED of a tertiary care hospital with an annual census of 60,000 patients between August 2014 and July 2015. A modified Utstein template was used for data collection. Factors relating to a sustained return of spontaneous circulation and mortality were analyzed using descriptive analytic statistics and logistic regressions. RESULTS: The study cohort contained 254 patients, with a male predominance (64.6%). Median age was 55 (interquartile range: 42-64) years. Majority were in-hospital cardiac arrests (73.6%). Only 7.4% (5/67) of the out-of-hospital cardiac arrests received bystander resuscitation before ED arrival. The initial documented rhythm was pulseless electrical activity (PEA)/asystole in the majority (76%) of cases while shockable rhythms pulseless ventricular tachycardia/ventricular fibrillation were noted in only 8% (21/254) of cases. Overall ED-SCA survival to hospital admission was 29.5% and survival to discharge was 9.9%. Multivariate logistic regression analysis showed age ≥65 years (odds ratio [OR]: 12.33; 95% confidence interval [CI]: 1.38-109.59; P = 0.02) and total duration of CPR >10 min (OR: 5.42; 95% CI: 1.15-25.5; P = 0.03) to be independent predictors of mortality. CONCLUSION: SCA in the ED is being increasingly seen in younger age groups. Despite advances in resuscitation medicine, survival rates of both in-hospital and out-of-hospital SCA remain poor. There exists a great need for improving prehospital care as well as control of risk factors to decrease the incidence and improve the outcome of SCA.
ABSTRACT
BACKGROUND: Trauma is an increasing cause of morbidity and mortality in India. This study was done to improve the understanding of the mode of trauma, severity of injuries, and outcome of trauma victims in our hospital. MATERIALS AND METHODS: This was a retrospective observational study of all adult trauma patients more than 18-year-old presenting to our emergency department (ED). Details of the incident, injuries, and outcome were noted. RESULTS: The ED attended to 16,169 patients during the 3-month study period with 10% (1624/16,169) being adult trauma incidents. The gender distribution was 73.6% males and 26.4% females. The mean age was 40.2 ± 16.7 years. The median duration from time of incident to time of arrival to the ED was 3 h (interquartile range [IQR]: 1.5-6.5) for priority one patients, 3 h (IQR: 1.5-7.7) for priority two patients, and 1.5 h (IQR: 1-7) for priority three patients. The average number of trauma incidents increased by 28% during the weekends. Road traffic accident (RTA) (65%) was the most common mode of injury, followed by fall on level ground (13.5%), fall from height (6.3%), work place injuries (6.3%), and others. Traumatic brain injury was seen in 17% of patients while 13.3% had polytrauma with two-wheeler accidents contributing to the majority. The ED team alone managed 23.4% of patients while the remaining 76.6% required evaluation and treatment by the trauma, surgical teams. The in-hospital mortality rate was 2.3%. Multivariate analysis showed low Glasgow coma score (odds ratio [OR]: 0.65, 95% confidence interval [CI]: 0.55-0.76, P < 0.001) and high respiratory rate (OR: 1.15, 95% CI: 1.07-1.24, P < 0.001) to be independent predictors of mortality among polytrauma victims. CONCLUSIONS: RTA and falls are the predominant causes of trauma. A simple physiological variable-based scoring system such as the revised trauma score may be used to prioritize patients with polytrauma.