ASSOCIATION OF INITIAL RHYTHM WITH RESUSCITATION OUTCOMES IN PATIENTS DEVELOPING CARDIAC ARREST IN EMERGENCY DEPARTMENT AND INTENSIVE CARE UNIT

Abstract

Background: Cardiac arrest is one of the major causes of death in the world despite the current developments in cardiopulmonary resuscitation and post-resuscitation. The first heartbeat has been thought of as one of the most powerful predictors of successful resuscitation and survival, but there is a lack of local data about the connection of the first heartbeat with the resuscitation outcomes in Pakistan. Aim: To determine the relationship between the initial cardiac rhythm and the success of resuscitation in patients who develop cardiac arrest. Methods: The study was a descriptive cross-sectional study that was carried out in Emergency Department of POF Hospital, Wah Cantt. A total of 300 eligible patients who were aged between 20-65 years and had developed cardiac arrest during their Emergency Department or Intensive Care Unit stay were enrolled using non-probability consecutive sampling. A structured proforma was used to document demographic features, clinical variables, initial cardiac rhythm, resuscitation, and return of spontaneous circulation (ROSC) and hospital outcomes. The SPSS version 25.0 was used to analyze the data. A p-value less than 0.05 was taken to be statistically significant. Results: The participants had a mean age of 60.8 ± 18.9 years and 53.3% were male. The majority of the cardiac arrests were in the hospital (95.7%). The predominant initial rhythm was asystole (47.7%), then pulseless electrical activity (38.0%), ventricular tachycardia/ ventricular fibrillation (5.3%), and unknown rhythm (9.0%). The proportion of patients that obtained ROSC was 29.3% and 70.7% that did not. Patients with VT/VF demonstrated the highest ROSC rate (56.3%; OR = 3.42, 95% CI: 1.28–9.10; p = 0.011), followed by PEA (41.2%; OR = 2.39, 95% CI: 1.48 3.87; p < 0.001), while asystole had the lowest ROSC rate (16.8%; OR = 0.34, 95% CI: 0.19–0.59; p < 0.001). The total hospital mortality stood at 89.3 and only 4.7% of the patients survived to get to the hospital discharge. Conclusion: There were significant relationships between initial cardiac rhythm and resuscitation outcomes in cardiac arrest patients. There was a significant improvement in ROSC with shockable compared to non-shockable rhythms, although overall survival was low. Recognition of rhythm early, prompt resuscitation, and management of post-cardiac arrest optimally can lead to better clinical outcomes in this high-risk group.