A pioneering study on out-of-hospital cardiac arrests by the Department of Emergency Medicine of Manila Doctors Hospital (The POHCA-MDH study)

ABSTRACT

Sudden cardiac arrest is the leading cause of death in the world and early cardiopulmonary resuscitation (CPR) is the key to saving lives. The survival rate of all out-of-hospital cardiac arrest (OHCA) patients is poor and is estimated to be below 5% worldwide. The actual efficacy of out-of-hospital CPR in the Philippines is still unknown. In this pioneering OHCA CPR reporting, we hope to identify gaps in our emergency medical service (EMS) system as well as to modify and optimize management strategies. Methods: A descriptive study in Manila during the year 2010-2011 by the EMS of Manila Doctors Hospital was done on adult patients who experienced a sudden OHCA. Patient variables, cardiac arrest variables, such as etiology, initial rhythm, and outcome variables, such as immediate return of spontaneous circulation (ROSC) and short-term survival rate after the out-of-hospital CPR were studied. End-points of the study were death or survival to discharge from the hospital. Results: Cardiac etiology was seen in 78.94% of the cases. The initial rhythm upon cardiac arrest was classified as ventricular fibrillation (VF) in 15.79%, pulseless ventricular tachycardia (VT) in 10.53%, pulseless electrical activity (PEA) in 26.31%, or asystole in 47.37% of cases. Return of spontaneous circulation was achieved at 36.84%. The male gender correlated with a higher survival rate of 66.67%. A lethal outcome following OHCA was observed on the field in 63.16% of patients and during the hospital stay in 57.14%. Discussion: Results rendered were not significantly different from neighboring countries. The factors influencing the outcome of out-of-hospital CPR are cardiac etiology of arrest, VT/VF as the initial rhythm of arrest and male sex. The establishment of national OHCA database would significantly improve the quality of medical management.