title: Return of spontaneous circulation and survival at hospital discharge in patients with out-of-hospital and emergency department cardiac arrests in a tertiary care centre.
abstract: OBJECTIVE
  To examine clinical variables and outcomes in patients with out-of-hospital (unwitnessed) and emergency department (ED; witnessed) cardiac arrests at a tertiary care hospital in Karachi.
  
  
  METHODS
  A prospective observational study was conducted to note that outcomes in patients with first attempted cardiopulmonary resuscitation in the Emergency Department of the Aga Khan University Hospital, Karachi, between Jan. 2000 and Dec. 2000. Cardiac arrest was defined as absence of a palpable central pulse and apnoea. Return of spontaneous circulation (ROSC) and survival at hospital discharge were primary outcomes. Logistic regression was applied to determine predictors for ROSC.
  
  
  RESULTS
  Of 106 patients with cardiac arrest, 59% (n = 62/106) patients had ROSC [52% (n = 29/56) of unwitnessed group; 64% (n = 32/50) of witnessed group]. Mean age was 48 years (range: 27-86); 68% (n = 72/106) were males; and 41% (n = 43/106) had ventricular fibrillation (VF) as initial rhythm. Male gender (OR 0.381; CI 0.156-0.928), PEA (OR 0.175; CI 0.063-0.489, reference VF) and asystole (OR 0.328; CI 0.114-0.944, reference VF) were negatively associated with ROSC. Less than ten minutes duration of CPR (OR 63.628; CI 8.221-429.457) and one co-morbidity status (OR 3.607; CI: 1.26-10.327, reference two or more co-morbidities) were positively associated with ROSC. Overall, 22% (n = 23/106) of enrolled patients left the hospital alive: 34% (n = 17/50) of the witnessed group and 12% (n = 6/56) of the unwitnessed group.
  
  
  CONCLUSIONS
  Out of hospital arrest was associated with dismal survival at hospital discharge, emphasizing the need for development of pre-hospital care services for our country.
authors.affiliation: Section of Emergency Medicine, The Aga Khan University Hospital, Karachi.
authors.forename: Rifat
authors.initials: R
authors.lastname: Rehmani
authors.forename: Muhammad
authors.initials: M
authors.lastname: Baqir
authors.forename: Siraj
authors.initials: S
authors.lastname: Amanullah
mesh_terms: D000328:Adult; D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D010351:Patient Discharge; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome