Abstract
Objectives:To determine epidemiology of in-hospital cardiac arrest (IHCA) in a tertiary care hospital, pre- and during pandemic.Methods:This is a cross-sectional study of inpatients who experienced an in-hospital-cardiac arrest at a tertiary care hospital in Karachi between August 2019 and August 2020. Outcome variables were return of spontaneous circulation (ROSC) and survival to discharge (StD) and analysis was also done comparing pre- and during pandemic period.Results:A total of 77 patients experienced at least one IHCA event during the 1-year study period. Comparing pre- and during pandemic, ROSC for women was higher during the pandemic albeit not significant (43% vs 50%) in comparison to men (54% vs 10%, p<0.001). During the pandemic, women with IHCA were significantly younger than men (μ ± sd; 36.8 ± 15.3 vs 55.9 ± 12.7, p=0.001,) whereas pre-pandemic, there was no gender differences in mean age. Non-shockable rhythm was more common (92.2%) than shockable rhythm (6.5%). Pre- and during pandemic, there were significant differences in the cause of IHCA for 4H4T (87% vs 100%) and cardiac (36% vs 9%). The proportion of hypoxic patients increased from 50% during pre-pandemic to 91% during the pandemic period, whereas hypo/hyperkalemia decreased from 53% to 34%.Conclusion:Despite the limitation of a small sample size, our study has provided important information regarding the epidemiology and outcomes of IHCA pre- and during pandemic in a busy Pakistani tertiary care hospital. Our finding that gender differences exist in survival pre- and during pandemic needs to be explored further with more hospitals doing comparative studies.
Highlights
In-hospital cardiac arrest (IHCA) is a major cause of death worldwide yet, data on the epidemiology of IHCA is limited.[1]
With limited published literature from Pakistan on the epidemiology of IHCA in adults and evidence that the COVID-19 pandemic is associated with a higher incidence of arrests with worse survival rates, in the present study, we aimed to investigate the profile and outcomes of IHCA patients preand during the COVID-19 pandemic
An IHCA event was defined as a cardiac arrest that occurs in a hospital and for which resuscitation was attempted with chest compressions, defibrillation, or both
Summary
In-hospital cardiac arrest (IHCA) is a major cause of death worldwide yet, data on the epidemiology of IHCA is limited.[1] Cardiac-related causes such as heart failure, arrhythmia or myocardial infarction account for the majority of the cases (50%60%) followed by respiratory insufficiency as a leading cause.[2] Survival outcomes after an IHCA event vary between 0% to 42% globally.[3] Some major patient-related factors age, gender, initial presentation, underlying conditions; whereas major healthcare related factors include response time of emergency team, location of event, duration and method of resuscitation.[1,4,5,6,7] Studies have reported that patients with a shockable rhythm have upto 2 to 3 times higher survival to. In the first meta-analysis comparing outcomes in patients with IHCA before and during the COVID-19 pandemic, concluded that even though cardiac arrests in COVID-19 patients was higher, the return of spontaneous circulation (ROSC) was similar in the pre- and COVID-19 periods as was overall mortality.[11]
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