Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

In developing countries, a lack of knowledge about basic life support and overcrowded emergency departments (EDs) may cause problems related to the quality of cardiopul-monary resuscitation and postresuscitation care. We aimed to investigate which factors affect the return of spontaneous circulation (ROSC) and survival rates among out-of-hospital and in-hospital arrest patients in an upper-middle income country. The study was prospectively conducted from January 2018 to April 2019. All patients resuscitated in the ED, except trauma patients, were included. The out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) groups were followed up for 30 days. The primary outcome was the 30-day-survival rate, while the secondary outcome was the ROSC rate. A total of 177 patients were included in the study (80 OHCA and 97 IHCA patients). Among the OHCA patients, ROSC was achieved at a rate of 58.8%, and a 30-day survival rate of 12.5% was observed. None of the OHCA patients underwent bystander CPR. One of the main factors affecting survival in this group was the time interval until the patient reached the ED. ROSC was achieved in 54.4% of IHCA patients, while 17.5% of them were alive at 30 days. Patients who survived 30 days were significantly younger than those who died within 30 days (56 (46–74) vs. 73 (64.2–83.7) years, respectively). In the IHCA group, patients with creatinine and potassium levels closer to normal survived for 30 days. Effective and rapid fluid-electrolyte treatments of patients with high lactate and potassium levels may improve the mortality rates of these patients. We think that a focus on improving the quality of the prehospital CPR practice in OHCA patients and increasing the rates of bystander CPR by educating the public can positively contribute to outcomes.

Cardiac arrest; Emergency department; Out-of-hospital arrest; In-hospital arrest

[1] 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 3: Adult Basic and Advanced Life Support. cpr.heart.org. Avaliable at: https: //cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-basic-and-advanced-life-support (Accessed: 6 January 2021).

[2] International Liaison Committee on Resuscitation. Avaliable at: https: //www.ilcor.org/about (Accessed: 8 January 2021).

[3] Schnaubelt S, Monsieurs KG, Semeraro F, Schlieber J, Cheng A, Bigham BL, et al. Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings — a scoping review. Resuscitation. 2020; 156: 137–145.

[4] Sá-Couto C, Nicolau A. General Public’s Knowledge Regarding Basic Life Support: A Pilot Study with a Portuguese Sample. Acta Médica Portuguesa. 2019; 32: 111–118.

[5] Pehlı̇ van M, Mercan NC, Çı̇ nar İ, Elmali F, Soyöz M. The evaluation of laypersons awareness of basic life support at the university in Izmir. Turkish Journal of Emergency Medicine. 2019; 19: 26–29.

[6] Mekonnen CK, Muhye AB. Basic Life Support Knowledge and Its Associated Factors Among a Non-Medical Population in Gondar Town, Ethiopia. Open Access Emergency Medicine. 2020; 12: 323–331.

[7] World Bank Country and Lending Groups – World Bank Data Help Desk. Avaliable at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups (Accessed: 7 January 2021).

[8] Salway R, Valenzuela R, Shoenberger J, Mallon W, Viccellio A. Emergency department (ed) overcrowding: evidence-based answers to frequently asked questions. Revista MéDica ClíNica Las Condes. 2017; 28: 213–219.

[9] Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernández-Frackelton M, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Academic Emergency Medicine. 2004; 11: 38–50.

[10] Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest. Circulation. 2015; 132: 1286–1300.

[11] Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: Adult Advanced Cardiovascular Life Support. Circulation. 2015; 132: S444–S464.

[12] White L, Melhuish T, Holyoak R, Ryan T, Kempton H, Vlok R. Advanced airway management in out of hospital cardiac arrest: a systematic review and meta-analysis. The American Journal of Emergency Medicine. 2018; 36: 2298–2306.

[13] Grunau B, Kime N, Leroux B, Rea T, Van Belle G, Menegazzi JJ, et al. Association of Intra-arrest Transport vs Continued on-Scene Resuscitation with Survival to Hospital Discharge among Patients with out-of-Hospital Cardiac Arrest. The Journal of the American Medical Association. 2020; 324: 1058.

[14] Gregers E, Kjærgaard J, Lippert F, Thomsen JH, Køber L, Wanscher M, et al. Refractory out-of-hospital cardiac arrest with ongoing car-diopulmonary resuscitation at hospital arrival - survival and neurological outcome without extracorporeal cardiopulmonary resuscitation. Critical Care. 2018; 22: 242.

[15] Porzer M, Mrazkova E, Homza M, Janout V. Out-of-hospital cardiac arrest. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2017; 161: 348–353.

[16] Rajan S, Folke F, Hansen SM, Hansen CM, Kragholm K, Gerds TA, et al. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology. Resuscitation. 2017; 114: 157–163.

[17] Moosajee US, Saleem SG, Iftikhar S, Samad L. Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country. International Journal of Emergency Medicine. 2018; 11: 40.

[18] Andersen LW, Holmberg MJ, Løfgren B, Kirkegaard H, Granfeldt A. Adult in-hospital cardiac arrest in Denmark. Resuscitation. 2019; 140: 31–36.

[19] Hessulf F, Karlsson T, Lundgren P, Aune S, Strömsöe A, Södersved Källestedt M, et al. Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - a population-based register study of more than 18,000 cases. International Journal of Cardiology. 2018; 255: 237–242.

[20] Issa MS, Grossestreuer AV, Patel H, Ntshinga L, Coker A, Yankama T, et al. Lactate and hypotension as predictors of mortality after in-hospital cardiac arrest. Resuscitation. 2021; 158: 208–214.