Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: a prospective observational study

Davidson Ocen, Sam Kalungi, Joseph Ejoku, Tonny Luggya, Agnes Wabule, Janat Tumukunde, Arthur Kwizera

Research on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known about the prevalence and management of in-hospital cardiac arrest in low-resource settings. We therefore sought to determine the prevalence, outcomes and associated factors of adult inpatients with cardiac arrest at a tertiary referral hospital in a low-income country. Upon obtaining institutional approval, we conducted a prospective observational period prevalence study over a 2-month period. We recruited adult inpatients with cardiac arrest in the intensive care unit and emergency wards of Mulago Hospital, Uganda during the study period. We reviewed all files and monitoring charts, and also any postmortem findings. Data were analyzed with Stata 12 and statistical significance was set at p < 0.05. There was a cardiac arrest in 2.3 % (190) of 8,131 hospital admissions; 34.5 % occurred in the intensive care unit, 4.4 % in emergency operating theaters, and 3.0 % in emergency wards. A majority (63.2 %) was unwitnessed, and only 35 patients (18.4 %) received CPR. There was return of spontaneous circulation (ROSC) in 14 (7.4 %) cardiac arrest patients. Survival to 24 h occurred in three ROSC patients, which was only 1.6 % of all cardiac arrest patients during the study period. Trauma was the most common primary diagnosis and HIV infection was the most common co-morbidity. Our hospital has a high prevalence of cardiac arrest, and low rates of CPR performance, ROSC, and 24-hour survival. Single provider CPR; abnormal temperatures as well as after hours/weekend CAs were associated with lower survival rates.