Key result
ED cardiac arrest is linked to ~39% lower odds of hypoxia compared to OHCA.
Why the study?
Advanced cardiovascular life support for cardiac arrest is a cornerstone of emergency care but remains poorly studied in low- and middle-income countries.
Does the location of cardiac arrest (emergency department vs out-of-hospital) alter the distribution of clinically identified reversible causes in adult patients?
Cohort (n=910)
No
Does the location of cardiac arrest (emergency department vs out-of-hospital) alter the distribution of clinically identified reversible causes in adult patients?
The differing distributions of suspected reversible causes between EDCA and OHCA indicate that clinicians should adjust their resuscitation priorities and situational awareness based on the arrest setting.
Arrest location may shape reversible cause identification; hypothesis-generating and should not alter practice without prospective validation.
BACKGROUND: Advanced cardiovascular life support (ACLS) for cardiac arrest is a cornerstone of emergency care and yet remains poorly studied in low- and middle-income countries. We characterised the clinical epidemiology and outcomes of cardiac arrest and ACLS in an ED in central Haiti, a lower middle-income country with a nascent emergency care system. METHODS: We conducted a prospective observational study of adult and paediatric patients who suffered cardiac arrest in an academic hospital ED in central Haiti from January 2019 to August 2020. Patients were identified prospectively at the time of clinical care. Data on demographics, comorbidities, clinical presentation, management with or without ACLS and outcomes were extracted from patient charts using a standardised form and analysed in SAS V.9.4. The primary outcome was survival to 24 hours after arrest. RESULTS: We identified 161 patients who suffered cardiac arrest in the ED. The mean age was 45 years; 55.9% were female, and 82.6% were aged >18. Common presenting diagnoses were pneumonia (16.1%), sepsis (14.9%), congestive heart failure/cardiogenic shock (11.2%) and cerebrovascular accident (10.6%). Few patients were on cardiac or oxygen saturation monitors (23.1%; 63.5%) prior to arrest. 43 (27%) patients received ACLS (two patients missing data). Among these, 58.1% had initial rhythm assessed, and 2/25 (8%) patients had shockable rhythms. The median time to arrest was 23.6 hours. Sustained return of spontaneous circulation was achieved in two patients (4.7%). Among patients for whom ACLS was not initiated, the majority were due to poor prognosis (66.4%) or irreversible cause (22.4%) in the setting of available resources. One patient survived to 24 hours; none survived to hospital discharge. CONCLUSION: In this lower middle-income setting, cardiac arrest in the ED was associated with poor survival despite ACLS. Survival may be impacted by limited resources for prearrest monitoring as well as for ongoing critical care.
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Edmond et al. (2025) conducted a cohort in Cardiac arrest (n=910). Emergency department cardiac arrest (EDCA) vs. Out-of-hospital cardiac arrest (OHCA) was evaluated on Clinically identified or suspected reversible cause during resuscitation: Hypoxia (aOR 0.61, 95% CI 0.45-0.83, p=0.002). Emergency department cardiac arrest was associated with a significantly lower likelihood of clinically identified hypoxia (aOR 0.61) compared to out-of-hospital cardiac arrest.
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