title: Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: a prospective observational study.
abstract: BACKGROUND
  Research on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known about the prevalence and management of in-hospital cardiac arrest in low-resource settings. We therefore sought to determine the prevalence, outcomes and associated factors of adult inpatients with cardiac arrest at a tertiary referral hospital in a low-income country.
  
  
  METHODS
  Upon obtaining institutional approval, we conducted a prospective observational period prevalence study over a 2-month period. We recruited adult inpatients with cardiac arrest in the intensive care unit and emergency wards of Mulago Hospital, Uganda during the study period. We reviewed all files and monitoring charts, and also any postmortem findings. Data were analyzed with Stata 12 and statistical significance was set at p < 0.05.
  
  
  RESULTS
  There was a cardiac arrest in 2.3% (190) of 8,131 hospital admissions; 34.5% occurred in the intensive care unit, 4.4% in emergency operating theaters, and 3.0% in emergency wards. A majority (63.2%) was unwitnessed, and only 35 patients (18.4%) received CPR. There was return of spontaneous circulation (ROSC) in 14 (7.4%) cardiac arrest patients. Survival to 24 h occurred in three ROSC patients, which was only 1.6% of all cardiac arrest patients during the study period. Trauma was the most common primary diagnosis and HIV infection was the most common co-morbidity.
  
  
  CONCLUSIONS
  Our hospital has a high prevalence of cardiac arrest, and low rates of CPR performance, ROSC, and 24-hour survival. Single provider CPR; abnormal temperatures as well as after hours/weekend CAs were associated with lower survival rates.
authors.affiliation: Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda. d4davidson@yahoo.co.uk.
authors.forename: Davidson
authors.initials: D
authors.lastname: Ocen
authors.affiliation: Department of Pathology, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda. skalungi@gmail.com.
authors.forename: Sam
authors.initials: S
authors.lastname: Kalungi
authors.affiliation: Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda. ejokuj@gmail.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ejoku
authors.affiliation: Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda. tluggya@gmail.com.
authors.forename: Tonny
authors.initials: T
authors.lastname: Luggya
authors.affiliation: Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda. aggiewabule2000@yahoo.co.uk.
authors.forename: Agnes
authors.initials: A
authors.lastname: Wabule
authors.affiliation: Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda. janattumukunde@gmail.com.
authors.forename: Janat
authors.initials: J
authors.lastname: Tumukunde
authors.affiliation: Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda. akwizera@chs.mak.ac.ug.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kwizera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D003906:Developing Countries; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult