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Out-of-hospital cardiac arrest in the United Arab Emirates: results from the PAROS study

Authors:

Abstract

Background The Emergency Cardiovascular Care (ECC) chain of survival, requires five elements to be acted upon to improve a patient’s chance of survival from cardiac arrest: Immediate recognition of cardiac arrest & activation of the emergency response system; early cardiopulmonary resuscitation (CPR) with an emphasis on high-quality chest compressions; early defibrillation (ideally through public access defibrillators); early advanced life support and integrated post-cardiac arrest care. Methods National Ambulance introduced services to the Northern Emirates in February 2014 providing for each of these links in the chain of survival to be implemented. Results Over a one year period National Ambulance clinical staff in Northern Emirates attended 384 cardiac arrest incidents. Of these, 30% (n=115) had bystander CPR performed. An overall ROSC rate of 3.1% in the prehospital setting was observed (n=12) with a further 2.1% (n=9) ROSC gained on admission to Emergency Department. Utilisation of BLS measures was good among National Ambulance personnel with AED, LUCAS-2 and iGel applied in 100%, 71% and 84% application rates respectively. Conclusion The relatively low prehospital ROSC rate is attributable to low bystander CPR performance and the low availability of public access defibrillators. The rate of interventions performed by National Ambulance staff demonstrated overall good compliance.
Background
National Ambulance LLC began operations in the Emirates of Al-Sharjah, Ras-al-
Khaimah, Umm Al-Quwain, Al-Fujairah and Ajman in February 2014
These five Emirates are collectively known as the Northern Emirates.
Figure 1. National Ambulance Northern Emirates service area, UAE
The National Ambulance Northern Emirates service area is a single-tier Basic Life
Support (BLS) ambulance service staffed with Emergency Medical Technicians
(EMTs).
The service is provided across 12 stations and 25 standby points across the
Northern Emirates area.
The geographic area covers approximately 12,100 km2, and contains a population
of approximately 4.7 million persons.
PAROS
As part of its commitment to improving the health and well-being of both citizens
and residents in the UAE, National Ambulance is a contributing members to the
Pan-Asian Resuscitation Outcomes Study (PAROS), an international cardiac
arrest registry study.
PAROS is an Asia-Pacific collaborative research network that aims to inform
OHCA policies and practices within member states and in the Asia-Pacific region
in general.
Aim
This descriptive study aimed to identify patient characteristics and outcomes of
all OHCA cases presenting to National Ambulance crews in the Northern
Emirates.
Rationale
Anecdotally, survival rates for OHCA in the Middle East and Asia are low
compared to those in North America or Europe.
A recent study by Bin Salleeh et al (2015) confirmed unique demographic profile
and low survival rates cardiac arrests in one university hospital in Saudi Arabia.
Methods
A prospective cohort study design was applied to the study of all presenting
cases of OHCA between February 2014 and March 2015 in the National
Ambulance Northern Emirates service area of the United Arab Emirates.
All cases of out-of-hospital cardiac arrest treated by National Ambulance EMT
crews were included in this study.
EMTs who provided care for cardiac arrest patients completed PAROS data
collection forms specifically designed for this study.
Cardiac arrest was defined as cessation of cardiac mechanical activity that was
confirmed by the absence of a palpable pulse, unresponsiveness, and absence of
spontaneous respirations at the site of arrest.
Excluded from this study were all patients who were not treated by EMTs, due to
recognition of death at scene. Results from post-mortem examinations were not
utilised.
Ethical considerations
This study received ethical approval from the Office of the Chief Medical Advisor,
National Ambulance LLC.
Results
A total of 384 OHCA patients who presented to National Ambulance EMT crews
were enrolled in this study.
Patients ranged in age from less than one to 95 years old (median age 50.8 years;
SD ±21.1 years). (age data was missing for 12 cases)
Figure 2. Age distribution and gender frequency of OHCA cases in Northern Emirates, UAE from Feb 2014
to Mar 2015
Males comprised the majority of cases (76%, n=291) and there were 93 female
patients (24%).
Male patients tended on average to be significantly younger than female patients
(49 years vs. 55 years, p<0.05)
Figure 3. Location of OHCA cases in Northern Emirates, UAE from Feb 2014 to Mar 2015
Over half of OHCA cases occurred at a home residence (n=208; 54.2%). Other
locations can be seen above in Figure 3.
A total of 212 incidents were witnessed by a bystander and 30 events were
witnessed by National Ambulance EMTs.
Bystander CPR was attempted in 30% (n=115) of cases.
A bystander AED was applied in only two cases.
Almost all patients were transported to hospital (n=382;99.5%) by National
Ambulance crews.
An overall out-of-hospital (at scene or en-route) return-of-spontaneous-circulation
(ROSC) rate of 3.1% (n=12) was observed.
Conclusion
Data collected in this study displayed a low survival rate out-of-hospital cardiac
arrest patients.
The findings of this study are not a surprise given the low prevalence of early EMS
activation, bystander CPR and the poor availability of public-access defibrillators.
Further research is needed on the topic of out-of-hospital cardiac arrest in the
United Arab Emirates as the current literature on the topic is sparse.
References
1. Ong M.EH, Shin S.D, Tanaka H, Ma MH, et al.Pan-Asian Resuscitation Outcomes Study
(PAROS): Rationale, methodology, and implementation. Emergency Medicine. Aug
2011,18(8);890-897.
2. Bin Salleeh HM, Gabralla KA, Leggio WJ, Al Aseri ZA. Out-of-hospital adult cardiac arrests in a
university hospital in central Saudi Arabia. Saudi Medical Journal. 2015 Sep;36(9):1071-5
Out-of-hospital cardiac arrest in the United Arab Emirates:
results from the PAROS study
Batt A1,2, Al Hajeri A1, Haskins B1,4, Cummins F1,3,4
1Clinical Education & Research, National Ambulance LLC, Abu Dhabi, UAE.
2 Centre for Prehospital Research, University of Limerick, Ireland
3Graduate Entry Medical School, University of Limerick, Ireland. 4Charles Sturt University, NSW, Australia
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Objectives: To report the characteristics of adult out-of-hospital arrest patients and their outcomes in Riyadh, Saudi Arabia. Methods: This is a prospective descriptive study of out-of-hospital adult arrests incident transported to King Khalid University Hospital, Riyadh, Saudi Arabia between July 2012 and September 2013. Results: A total of 96 adult patients were enrolled in this study. Males represented 62.5% of the participants. The mean age of the study population was 58.9 years, and specifically 30.8 years for traumatic arrests, and 62.9 for non-traumatic. An over-all mortality rate of 95.8% was documented, as well as a low rate of bystander cardiopulmonary resuscitation being performed, and a family member transported most patients to the hospital. Conclusion: A low survival rate for non-traumatic out-of-hospital adult arrest patients and a 100% mortality rate in traumatic arrests were discovered.
Article
Disease-based registries can form the basis of comparative research to improve and inform policy for optimizing outcomes, for example, in out-of-hospital cardiac arrest (OHCA). Such registries are often lacking in resource-limited countries and settings. Anecdotally, survival rates for OHCA in Asia are low compared to those in North America or Europe, and a regional registry is needed. The Pan-Asian Resuscitation Outcomes Study (PAROS) network of hospitals was established in 2009 as an international, multicenter, prospective registry of OHCA across the Asia-Pacific region, to date representing a population base of 89 million in nine countries. The network's goal is to provide benchmarking against established registries and to generate best practice protocols for Asian emergency medical services (EMS) systems, to impact community awareness of prehospital emergency care, and ultimately to improve OHCA survival. Data are collected from emergency dispatch, ambulance providers, emergency departments, and in-hospital collaborators using standard protocols. To date (March 2011), there are a total of 9,302 patients in the database. The authors expect to achieve a sample size of 13,500 cases over the next 2 years of data collection. The PAROS network is an example of a low-cost, self-funded model of an Asia-Pacific collaborative research network with potential for international comparisons to inform OHCA policies and practices. The model can be applied across similar resource-limited settings.
Pan-Asian Resuscitation Outcomes Study (PAROS): Rationale, methodology, and implementation. Emergency Medicine
  • M Ong
  • Shin S D Eh
  • H Tanaka
  • Mh Ma
Ong M.EH, Shin S.D, Tanaka H, Ma MH, et al. Pan-Asian Resuscitation Outcomes Study (PAROS): Rationale, methodology, and implementation. Emergency Medicine. Aug 2011,18(8);890-897.
2 Centre for Prehospital Research
  • Clinical Education
  • Research
  • Llc Ambulance
  • Abu Dhabi
Clinical Education & Research, National Ambulance LLC, Abu Dhabi, UAE. 2 Centre for Prehospital Research, University of Limerick, Ireland 3 Graduate Entry Medical School, University of Limerick, Ireland. 4 Charles Sturt University, NSW, Australia