Abstract

Trauma is the leading cause of death for adults under 44 years of age. Survival after traumatic out-of-hospital cardiac arrest (OHCA) has been reported to be between 0%–3.7% only. A few studies have reported better survival in response to pre-hospital lifesaving interventions. However, there has been no published data from low and lower-middle income countries.

We aimed to explore characteristics and survival outcomes of traumatic OHCA patients from Karachi, Pakistan.

We conducted a prospective cohort study at emergency departments (ED) of five major public and private hospitals of the city during 2013. Twenty-four hour data collection was performed using a structured questionnaire. All patients>18 year, presenting with traumatic OHCA, were included. Patients with Do-not-resuscitate status and those referred from other hospitals were excluded.

During 3 months, a total of 187 patients were enrolled with mean age of 35.1 years. About 95.2% were men and 68.4% had a penetrating injury. Even though half of the patients had a witnessed arrest, none received a bystander CPR. 83.4% were brought to the hospital in an ambulance, with median response and scene times of 3 and 2 mins respectively, however, only 3 received any pre-hospital life support interventions. About 181 patients were pronounced dead on arrival in ED and of the remaining 6 patients, 4 received CPR in ED. Overall survival at the end of ED stay was 0% with median (IQR) survival time being 35 mins (23, 51). Patients who received life support interventions survived for a longer time as compared to those who did not (p=0.01).

In our population survival after a traumatic OHCA is zero. Patients receiving life support interventions survived for a longer time. This provides some evidence that organized pre-hospital care systems would be beneficial in our setting.