Characterization of in-hospital cardiac arrest in adult patients at a tertiary hospital in Kenya

Abstract

In-hospital cardiac arrest (IHCA) is defined as a cardiac arrest that occurs in a hospital and for which resuscitation is attempted. Despite the increased morbidity and mortality, IHCA incidence and outcomes remain largely unknown especially in sub-Saharan Africa. This study describes the baseline characteristics, pre-arrest physiological parameters and the rate of survival to hospital discharge of adult patients with an IHCA at a tertiary hospital in Kenya. Methods: This was a retrospective chart review. Data on patient characteristics, pre-arrest physiological parameters and discharge condition were collected on all patients 18 years of age or older with an IHCA at the Aga Khan University Hospital, Nairobi, from January 2013 to December 2013. Results: The main study population comprised 108 patients. The mean age was 59.3 ± 18.4 years and 63 (58.3%) patients were men. The initial rhythm post cardiac-arrest was pulseless electrical activity (41.7%) or asystole (35.2%) in the majority of cases. Hypertension (43.5%), septicaemia (40.7%), renal insufficiency (30.6%), diabetes mellitus (25.9%) and pneumonia (15.7%) were the leading pre-existing conditions in the patients. A Modified Early Warning Score (MEWS) of 5 or more was reached in 56 (67.5%, n = 83) patients before the cardiac arrest. The rate of survival to hospital discharge was 11.1%. All the patients who survived to hospital discharge had a good neurological outcome. Conclusions: Early identification of warning signs that precede many in-hospital arrests may enable institution of treatment to prevent patient deterioration. Local hospitals should be encouraged to provide patients with resuscitation services and equipment in line with evidence-based programmes.