Initial Rhythm and Resuscitation Outcomes for Patients Developing Cardiac Arrest in Hospital: Data From Low-Middle Income Country.
Glob Heart
; 13(4): 255-260, 2018 12.
Article
in En
| MEDLINE
| ID: mdl-30131253
ABSTRACT
BACKGROUND:
Health care resource allocation remains challenging in lower middle income countries such as Kenya with meager resources being allocated to resuscitation and critical care. The causes and outcomes for in-hospital cardiac arrest and resuscitation have not been studied.OBJECTIVES:
This study sought to determine the initial rhythm and the survival for patients developing in-hospital cardiac arrest.METHODS:
This was a prospective study for in-hospital cardiac arrest in 6 Kenyan hospitals from July 2014 to April 2016. Resuscitation teams were utilized to collect data during resuscitation using a standardized protocol. Patients with do-not-resuscitate orders, trauma, postsurgical, and pregnancy-related complications were excluded. The Modified Early Warning Score (MEWS)- systolic blood pressure, heart rate, respiration rate, temperature, and responsiveness-was determined based on worst parameters at least 4 hours prior to the arrest.RESULTS:
A total of 353 patients with cardiac arrest were included over 19 months. The mean age was 61 years, 53.5% were male, and admission diagnoses included cardiovascular disease (15%), pneumonia 18.13%, and cancer 9%. The mean MEWS was 4.48 and low, intermediate, and high MEWS were found in 25.8%, 29.5%, and 44.8%, respectively. The mean time to cardiopulmonary resuscitation was 0.84 min. The initial rhythm was asystole in 47.6%, pulseless electrical activity in 38.2%, ventricular tachycardia/ventricular fibrillation in 5.4%, and unknown in 8.8%. Return of spontaneous circulation (ROSC) occurred in 29.2% of patients with the mean time to ROSC being 5.3 min. ROSC occurred in 17.3% of patients with asystole, 40.7% in pulseless electrical activity, 57.9% in ventricular tachycardia/ventricular fibrillation, and 25.8% in patients with an unknown rhythm. Of all patients, 16 (4.2%) were discharged alive.CONCLUSIONS:
Nonshockable rhythms account for the majority of the cardiac arrests in hospitals in a lower middle income country and are associated with unfavorable outcomes. Future work should be directed to training health care personnel in recognizing early warning signs and implementing appropriate measures in a resource-scarce environment.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Outcome Assessment, Health Care
/
Cardiopulmonary Resuscitation
/
Developing Countries
/
Heart Arrest
Type of study:
Clinical_trials
/
Guideline
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Aspects:
Determinantes_sociais_saude
Limits:
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Africa
Language:
En
Journal:
Glob Heart
Year:
2018
Document type:
Article