Characteristics of out of hospital cardiac arrest in the United Arab Emirates

Abstract

Background: Out of hospital cardiac arrest is one of the leading causes of death globally. This study aimed to identify the characteristics of out of hospital cardiac arrest patients who were attended and treated by the National Ambulance crew. A lot of studies reported the importance of implementing chain of survival to increase survival rates from cardiac arrest. To be implemented in United Arab Emirates (UAE), it required a detailed study of the community engagement. The study aimed to explore the demography of the incidences, location, age, gender epidemiology of the patients who had their cardiac arrest witnessed along with their Bystander cardiopulmonary resuscitation (CPR) performed prior to the arrival of National Ambulance and public access to an automated external defibrillator. The return of spontaneous circulation was also explored prior to their arrival to the emergency department. Methods: The research is a prospective descriptive cohort study of out of hospital cardiac arrest patients attended by National Ambulance between July 2017 and June 2018. The National Ambulance provides emergency medical services for public and private hospitals in the Emirates of Sharjah, Ajman, Ras-al-Khaimah, Fujairah, and Umm Al-Quwain and its clients in Abu Dhabi in UAE. Data for the study were collected by the National Ambulance crew attending the OHCA patients, using a structured questionnaire. Results: In this 1-year period, a total of 715 out of hospital cardiac arrest cases were attended by the National Ambulance with higher percentage (77%) of male patients. Resuscitation and transportation were attempted for 95% whereas 5% were pronounced dead on the spot. In this study, the median age of the patients was 50 years. Majority of the patients were Asians 55% (n = 395) followed by Arabs non-UAE citizens 19.4% (n = 139) and UAE citizens 16% (n = 113). Patients facing sudden cardiac arrest in their homes or residences represented 69.9% (n = 500), street and public places 22.5% (n = 161), and workplace 6.8% (n = 49). The percentage of patients who had witnessed cardiac arrest was 51.7% (n = 370) only 197 had CPR performed on them prior to the arrival of National Ambulance. Low public access to AED was found in this population that is 1.8% (n = 13). A majority of the participants in this study had nonshockable rhythms 84.3% (n = 603) whereas shockable rhythms presented on 11% (n = 80). The percentage of patients who had ROSC at the scene or en route to the hospitals was found 9.2% (n = 66). Conclusion: In this 1-year study, the result showed that cardiac arrest was recognized and witnessed in about half of the cases, but low bystander CPR was performed. Low public access and use of AED were found. Data on hospitalized and discharged OHCA patients were not available and required further linkage and corporation between ambulance services and hospitals to ensure data continuity of OHCA cases. This study is essential for the implementation of proper chain of survival and reduction in mortality rates in UAE.

Keywords

• emergency medical services
• out of hospital cardiac arrest
• witnessed cardiac arrest