A Prospective Observational Study on Factors that Influence Survival or Non-survival for the Patient Suffering Out-of-hospital Cardiac Arrest within Abu Dhabi Emergency Medical Services

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is a global health concern and one of the leading causes of death. Each year, three thousand patients in Scotland suffer OHCA while only 6% survive to hospital discharge. Only one out of ten OHCA cases in England survive OHCA every year. In total, 37,054 OHCA were reported from 28 European countries in 2017, with only 8% surviving. Death and disabilities from OHCA can be avoided (Graham et al. 2015). Immediate comprehensive strategies to improve patient’s survival is critical to saving lives. In the United Arab Emirates, strategies to improve OHCA survival do not exist in the capital city of Abu Dhabi. The OHCA survival rate within pre-hospital care has yet to be investigated. Lack of OHCA status knowledge impacts examining the survival rate adversely and may prevent any potential improvement in Abu Dhabi. Factors such as unique demographics, cultural aspects, patient characteristics, and policies may influence patient survival; however, the apparent lack of research in the Abu Dhabi context is a significant concern. Thus, the purpose of this thesis is to identify the survival rate and factors that may influence survival or non-survival for an OHCA by Abu Dhabi emergency medical services (EMS). Method: A descriptive cross-sectional approach based on a quantitative prospective data set was undertaken. A cardiac-arrest registry was created to record OHCA data prospectively in 2019 and was utilised for this thesis project. Result: Three hundred and thirty patients with OHCA (79 females, 250 males, 1 unknown) were included in this research between January and December 2019. Most patients recorded for this study were witnessed (72%), male (75%), of younger age 56.93 ± 18.67 years. Most OHCAs happened at patients' homes (60%) to individuals who have a history of cardiovascular diseases (76%). The EMS arrival at the patient’s side was 10.15 ± 4.92 minutes and the average time from patient collapse to EMS arrival was 14.7 minutes. The majority of resuscitation was initiated by the EMS staff (82.4%). First ECG rhythm and pre-hospital return of spontaneous circulation (ROSC) were predictors of survival status, while no significant prediction was determined for age, response time, and bystander CPR (X2 (5) = 31.61, p< 0.000, Nagelkerke R2 = 0.58). The current study found that Abu Dhabi EMS interventions (epinephrine injection, advanced airway management, and mechanical CPR device) do not yet significantly affect patient survival (X2 (3) = 8.50, p= 0.04, Nagelkerke R2 = 0.18). This study defines one key factor that influences survival for OHCA treated by Abu Dhabi EMS, being that the patient was more likely to survive if basic life support is started within seven minutes or less from when the patient collapsed (p = 0.02). Pre-hospital ROSC was observed in only 56 individuals with OHCA (17%). Of 330 patients, only 16 with OHCA (5%) (6 females, 10 males) survived to discharge from the hospital. Conclusion: A critical factor to emerge from this study is that scientific research is now recognised by the Abu Dhabi EMS for the first time since its inception in 2001. The findings shed light on current Abu Dhabi EMS abilities concerning critical patients' care. My original contribution to knowledge is identifying opportunities for a patient's survival following OHCA and suggesting high-priority actions in Abu Dhabi pre-hospital care.