Initial Rhythm and Outcomes for Inhospital Cardiac Arrest in Kenya
Document Type
Article
Department
Internal Medicine (East Africa); Emergency Medicine (East Africa)
Abstract
Background: Health care resource allocation remains challenging in lower middle income countries (LMIC) like Kenya with the co-existence of both communicable and non-communicable diseases in hospitals. In-hospital cardiac arrest and resuscitation remains poorly elucidated.
Methods: This was a prospective study of cardiac arrest in 6 hospitals in Kenya from 2014 to 2016. Existing resuscitation teams were utilized to collect data during resuscitation using a standardized protocol. Patients with do-not-resuscitate (DNR) orders, trauma, post-surgical and pregnancy related complications were excluded. The Modified Early Warning Score (MEWS - SBP, HR, respiration rate, temperature, responsiveness) was determined based on worst parameters at least 4 hours prior to the arrest and divided in to low (<3), intermediate (3-4) or high risk (>4).
Results: 353 patients with cardiac arrest were included over 19 months. The mean age was 58.6 years, 53.5% were male, and admission diagnoses included cardiovascular disease (26%), sepsis 28.9%, and cancer 14.5%. The median MEWS was 5 (IQR 3-7) and low, intermediate and high MEWS was found in 21.2%, 21.5% and 57.2% respectively. The mean time to CPR was 0.83 minutes (IQR 0-26 minutes). The initial rhythm was asystole in 47.6%, PEA in 38.2%, VT/VF in 5.4% and unknown in 8.8%. Return of spontaneous circulation (ROSC) occurred in 29.2% of patients with the median time to ROSC being 28 minutes (IQR 7.5-16.5). ROSC was 17.3% in asystole, 40.7% in PEA, 57.9% in VT/VF and 25.8% in patients with an unknown rhythm. Of all patients, 16 (4.2%) were discharged alive.
Conclusion: Non-shockable rhythms account for the majority of the cardiac arrests in hospitals in a LMIC, and are associated with unfavourable outcomes. Future work should be directed to training healthcare personnel in recognizing early warning signs and implementing appropriate measures in a resource-scare environment.
Publication (Name of Journal)
Circulation
Recommended Citation
Ngunga, M.,
Yonga, G.,
Wachira, B.,
Justin, E.
(2017). Initial Rhythm and Outcomes for Inhospital Cardiac Arrest in Kenya. Circulation, 136(1).
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_intern_med/94