Assessment of Cardiopulmonary Resuscitation Quality and Outcome Using the Modified Utstein Style Form: A Registry of in Hospital Cardiac Arrest Patients Admitted to Cairo University Hospitals

Abstract Background: The quality of cardiopulmonary resuscitation (CPR) performed according to the international guidelines is associated with improved survival in cardiac arrest (CA) survivors. The Utstein template (UT) has been used to objec-tively evaluate different variables of CPR quality and outcome. Aim of Study: To evaluate adherence to CPR guidelines and investigate different variables affecting return of sponta-neous circulation (ROSC) and survival to hospital discharge after in-hospital cardiac arrest (IHCA). Patients and Methods: A Prospective observational study that included all patients admitted to three cardiac care units at Cardiovascular Departments Cairo University Hospitals who developed cardiac arrest and required cardiopulmonary resuscitation during the period from July 2018 to June 2019. Standard reporting of in-hospital CPR was done using a modified version of Utstein style form. Results: The study included 3926 patients admitted to three cardiac care units at Cardiovascular Department Cairo University Hospitals from July 2018 to June 2019. The mean age of the studied patients was 55.6±14.1 years. There were 2376 males (60.5%) and 1550 females (39.5%). Out of 3926, 213 patients (5.4%) had in hospital cardiac arrest. Coronary artery disease (CAD) was the leading cardiac cause of admission in 1449 patients (36.9%), followed by congestive heart failure (CHF)/cardiogenic shock in 966 patients (24.6%). Cerebrovascular accidents was the leading non-cardiac cause of admissionin 132 patients (3.4%), followed by infec-tious diseases (such as pneumonia, meningitis, etc.) in 89 patients (2.3%), shock (non cardiogenic) in 87 patients (2.2%), other medical diseases in 204 patients (5.2%) and surgical diseases in 41 patients (1%). The main cause of cardiac arrest was congestive heart failure/cardiogenic shock found in 103 patients (48.4%). Cardiopulmonary resuscitation (CPR) was attempted in 211 patients. The initial rhythm was shockable in 33 patients (15.5%) and non shockable in 180 patients (84.5%). ROSC was achieved in 110 patients (52.1%) and survival to hospital discharge was achieved in 27 patients (12.8%). Conclusion: Among the admitted patients 5.4% had cardiac arrest. Resuscitation was attempted in 99.1%. The mean duration of CPR in our study was 21±12.2 minutes. Initially shockable rhythm showed higher rates of return of spontaneous circulation (ROSC) and survival to hospital discharge (69.7% and 36.4% respectively) when compared to non shockable rhythms (48.3% and 8.3% respectively). Return of spontaneous circulation was achieved in 52.1% of patients and the overall survival to hospital discharge was achieved in 12.8% of resuscitated patients. None of them had neurological deficit upon discharge.