Incidence and immediate outcomes of in-hospital cardiac arrest in Healthcare institutions on the Mulago hill

Abstract

Background: In-hospital cardiac arrest (IHCA) is an acute event that can occur to any hospitalized patient. It is associated with high morbidity and mortality and constitutes a significant healthcare burden worldwide. Despite advances in the understanding of its causes and management, outcomes of IHCA remain poor. Traditionally, IHCA has been viewed as a condition with such poor outcomes that resuscitation may not even be warranted. Most of the literature on IHCA is from developed countries. Data on IHCA in Uganda dates back to nearly a decade ago. Method: This prospective observational study recruited 385 inpatients who suffered a cardiac arrest from any of the four tertiary healthcare institutions on the Mulago Hill over 3 months. Approval was sought from the School of Medicine Research & Ethics Committee (SOMREC) and hospital Research & Ethics Committees. Pretested questionnaires were used for data collection. An exit interview with study unit heads was used to assess hospital systems for the prevention and management of IHCA. Data analysis was done using Stata software. Data was reported as frequencies, means (±SD), and medians (±IQR) and presented in tables, figures, charts, and graphs. Results: The incidence of IHCA was 19.7 per 1000 admissions with most (N = 242, 62.9%) of the cardiac arrest occurring in the general patient admission wards. All the cardiac arrests in this study were witnessed. A significant majority (N = 315, 81.8%) of the participants received cardiopulmonary resuscitation (CPR) and there was a return of spontaneous circulation (ROSC) in 85 (27.0%) of the participants following the index cardiac arrest. Of the participants who got ROSC, 61 (71.8%) were alive at 24 hours post the index cardiac arrest. However, the overall 24-hour mortality from this study was 84.2%. Conclusion: There is a high incidence of IHCA in our setting. Many of the victims receive CPR but the 24-hour outcome is still poor.