Epidemiology and outcomes of out of hospital cardiac arrest in Karachi, Pakistan - A longitudinal study

Authors

Uzma Rahim Khan, Aga Khan UniversityFollow
Mirza Noor Ali Baig, Aga Khan UniversityFollow
Kamlesh M. Bhojwani, Aga Khan UniversityFollow
Ahmed Raheem Buksh, Aga Khan UniversityFollow
Rubaba Khan, Aga Khan University
Ayaz Ilyas, Aga Khan UniversityFollow
Munawar Khursheed, Aga Khan UniversityFollow
Mohammad Ahraz Hussain, Aga Khan University
Junaid Razzak, Aga Khan UniversityFollow
Fareed Ahmed, Aga Khan UniversityFollow
Salima Kerai, Aga Khan UniversityFollow
Syeda Kanza, Aga Khan UniversityFollow
Saadia Sajid, Aga Khan University
Nadeem Ullah Khan, Aga khan UniversityFollow

Document Type

Article

Department

Emergency Medicine; Center of Excellence for Trauma and Emergencies

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality globally, with survival outcomes remaining poor particularly in many low- and middle-income countries. We aimed to establish a pilot OHCA registry in Karachi, Pakistan to provide insights into OHCA patient demographics, pre-hospital and in-hospital care, and outcomes.
Methods: A multicenter longitudinal study was conducted from August 2015-October 2019 across 11 Karachi hospitals, using a standardized Utstein-based survey form. Data was retrospectively obtained from medical records, patients, and next-of-kin interviews at hospitals with accessible medical records, while hospitals without medical records system used on-site data collectors. Demographics, arrest characteristics, prehospital events, and survival outcomes were collected. Survivors underwent follow-up at 1 month, 6 months, 1 year, and 5 years.
Results: In total, 1068 OHCA patients were included. Mean age was 55 years, 61.1 % (n = 653) male. Witnessed arrests accounted for 94.9 % of the cases (n = 1013), whereas 89.4 % of the cases (n = 955) were transported via non-EMS. Bystander CPR was performed in 10.3 % (n = 110) cases whereas pre-hospital defibrillation performed in 0.4 % (n = 4). In-hospital defibrillation was performed in 9.9 % (n = 106) cases despite < 5 % shockable rhythms. Overall survival to discharge was 0.75 % (n = 8). Of these 8 patients, 7 patients survived to 1-year and 2 to 5-years. Neurological outcomes correlated with long-term survival.
Conclusion: OHCA survival rates are extremely low, necessitating public awareness interventions like CPR training, developing robust pre-hospital systems, and improving in-hospital emergency care through standardized training programs. This pilot registry lays the foundation for implementing interventions to improve survival and emergency medical infrastructure.

Comments

Issue and pagination are not provided by the author/publisher.

Publication (Name of Journal)

Resuscitation Plus

DOI

10.1016/j.resplu.2024.100773

Recommended Citation

Khan, U. R., Baig, M. N., Bhojwani, K. M., Buksh, A. R., Khan, R., Ilyas, A., Khursheed, M., Hussain, M. A., Razzak, J., Ahmed, F., Kerai, S., Kanza, S., Sajid, S., Khan, N. (2024). Epidemiology and outcomes of out of hospital cardiac arrest in Karachi, Pakistan - A longitudinal study. Resuscitation Plus, 20.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_emerg_med/367