TY - JOUR
T1 - Initial Rhythm and Resuscitation Outcomes for Patients Developing Cardiac Arrest in Hospital
T2 - Data From Low-Middle Income Country
AU - Ngunga, Leonard Mzee
AU - Yonga, Gerald
AU - Wachira, Benjamin
AU - Ezekowitz, Justin A.
N1 - Publisher Copyright:
© 2018 World Heart Federation (Geneva)
PY - 2018/12
Y1 - 2018/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85051671359&partnerID=8YFLogxK
U2 - 10.1016/j.gheart.2018.07.001
DO - 10.1016/j.gheart.2018.07.001
M3 - Article
C2 - 30131253
AN - SCOPUS:85051671359
SN - 2211-8160
VL - 13
SP - 255
EP - 260
JO - Global Heart
JF - Global Heart
IS - 4
ER -