title: Profile and outcome of sudden cardiac arrests in the emergency department of a tertiary care hospital in South India.
abstract: BACKGROUND
  Sudden cardiac arrest (SCA) requiring cardiopulmonary resuscitation (CPR) is one of the common emergencies encountered in the emergency department (ED) of any hospital. Although several studies have reported the predictors of CPR outcome in general, there are limited data from the EDs in India.
  
  
  METHODS
  This retrospective study included all patients above 18 years with SCA who were resuscitated in the ED of a tertiary care hospital with an annual census of 60,000 patients between August 2014 and July 2015. A modified Utstein template was used for data collection. Factors relating to a sustained return of spontaneous circulation and mortality were analyzed using descriptive analytic statistics and logistic regressions.
  
  
  RESULTS
  The study cohort contained 254 patients, with a male predominance (64.6%). Median age was 55 (interquartile range: 42-64) years. Majority were in-hospital cardiac arrests (73.6%). Only 7.4% (5/67) of the out-of-hospital cardiac arrests received bystander resuscitation before ED arrival. The initial documented rhythm was pulseless electrical activity (PEA)/asystole in the majority (76%) of cases while shockable rhythms pulseless ventricular tachycardia/ventricular fibrillation were noted in only 8% (21/254) of cases. Overall ED-SCA survival to hospital admission was 29.5% and survival to discharge was 9.9%. Multivariate logistic regression analysis showed age ≥65 years (odds ratio [OR]: 12.33; 95% confidence interval [CI]: 1.38-109.59;P= 0.02) and total duration of CPR >10 min (OR: 5.42; 95% CI: 1.15-25.5;P= 0.03) to be independent predictors of mortality.
  
  
  CONCLUSIONS
  SCA in the ED is being increasingly seen in younger age groups. Despite advances in resuscitation medicine, survival rates of both in-hospital and out-of-hospital SCA remain poor. There exists a great need for improving prehospital care as well as control of risk factors to decrease the incidence and improve the outcome of SCA.
authors.affiliation: Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Gautham Raja
authors.initials: GR
authors.lastname: Pandian
authors.affiliation: Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Suma Mary
authors.initials: SM
authors.lastname: Thampi
authors.affiliation: Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Nilanchal
authors.initials: N
authors.lastname: Chakraborty
authors.affiliation: Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Deepthi
authors.initials: D
authors.lastname: Kattula
authors.affiliation: Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Paul Prabhakar Abhilash
authors.initials: PP
authors.lastname: Kundavaram
keywords: Cardiopulmonary resuscitation; emergency department; sudden cardiac arrest; survival