Outcomes of out-of-hospital cardiac arrest in relation to prehospital care services in Hospital Canselor Tuanku Muhriz: A prospective study

Abstract

Background: The role of prehospital care (PHC) services in out-of-hospital cardiac arrest (OHCA) is well established in developed countries. The American Heart Association has defined PHC as the ‘chain of survival’ between public and advanced medical care. For developing countries such as Malaysia, the importance of PHC services in OHCA is evolving; however, data are lacking. Objective: This study aimed to investigate OHCA outcomes in relation to PHC services in Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia. Method: This was a prospective study conducted on OHCA cases attended by the PHC staff of Hospital Canselor Tuanku Muhriz. Independent variables were patient background, OHCA nature, and PHC interventions, while dependent variables were patient outcomes. Results: A total of 82 OHCA cases were identified. The survival rate to admission was 12.2% (n = 10), while the survival rate to discharge was 1.2% (n = 1) with cerebral performance categories of 1 or 2. The mean ambulance response time was 14.91 min. Among the variables, only OHCA location and adrenaline administration show significant association with OHCA outcome. OHCA location was significant in both outcomes (admission χ2(4) = 16.354, p < 0.03, Cramer's V = 0.447, discharge χ2(4) = 19.741, p < 0.001, Cramer's V = 0.491). However, adrenaline administration was significant only for survival to admission (χ2(1) = 3.776, p < 0.052, Cramer's V = 0.215) but not for survival to discharge (χ2(1) = 0.964, p < 0.326). Conclusion: Improvement in ambulance response time, public availability of automated external defibrillator, and public awareness of early cardiac arrest and cardiopulmonary resuscitation are required to increase the survivability of OHCA in developing countries.