The epidemiology and outcomes of adult in-hospital cardiac arrest in a high-income developing country.

Aim: In-Hospital Cardiac Arrest (IHCA) is a significant burden on healthcare worldwide. Outcomes of IHCA are worse in developing countries compared with developed ones. We aimed to study the epidemiology and factors determining outcomes in adult IHCA in a high income developing country. Methods: We abstracted prospectively collected data of adult patients admitted to our institution over a three-year period who suffered a cardiac arrest. We analysed patient demographics, arrest characteristics, including response time, initial rhythm and code duration. Pre-arrest vital signs, primary diagnoses, discharge and functional status, were obtained from the patients' electronic medical records. Results: A total of 447 patients were studied. The IHCA rate was 8.6/1000 hospital admissions. Forty percent (40%) achieved ROSC with an overall survival to discharge rate of 10.8%, of which 59% had a good functional outcome, with a cerebral performance category score of 1 or 2. Fifty-four percent (54%) of patients had IHCA attributed to causes other than cardiac or respiratory. Admission Glasgow Coma Scale (GCS), shockable rhythm and short code duration were significantly associated with survival (p < 0.001). Conclusion: A combination of patient and system-related factors, such as the underlying cause of cardiac arrest and a lack of DNAR policy, may explain the reduced survival rate in our setting compared with developed countries.

Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury.

BACKGROUND: Trauma is a leading cause of death in the United Arab Emirates (UAE). There have been major developments in the trauma system in Al-Ain City during the last two decades. We aimed to study the effects of these developments on the trauma pattern, severity, and clinical outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates. METHODS: This is a retrospective analysis of two separate sets of prospectively collected trauma registry data of Al-Ain Hospital. Data were collected over two periods: from March 2003 to March 2006 and from January 2014 to December 2017. Demography, injury mechanism, injury location, and clinical outcomes of 2573 trauma patients in the first period were compared with 3519 patients in the second period. RESULTS: Trauma incidence decreased by 38.2% in Al-Ain City over the last 10 years. Trauma to females, UAE nationals, and the geriatric population significantly increased over time (p < 0.0001, Fisher's exact test for each). Falls on the same level significantly increased over time, while road traffic collisions and falls from height significantly decreased over time (p < 0.0001, Fisher's exact test for each). Mortality significantly decreased over time (2.3% compared with 1%, p < 0.0001, Fisher's exact test). CONCLUSIONS: Developments in the trauma system of our city have reduced mortality in hospitalized trauma patients by 56% despite an increased severity of injury. Furthermore, the injury incidence in our city decreased by 38.2% over the last decade. This was mainly in road traffic collisions and work-related injuries. Nevertheless, falls on the same level in the geriatric population continue to be a significant problem that needs to be addressed.