Associated Factors and Outcomes of Cardiopulmonary Resuscitation of Intrahospital Cardiorespiratory Arrests in Adults of North-Kivu in a Resource-Limited Setting: A Cohort Study
- 1 Department of Anesthesiology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of Congo (DRC)
- 2 World Federation of Intensive and Critical Care Research Academy, Toronto, Canada
- 3 School of Public Health, University of Goma, Goma, DRC
- 4 Laboratory Department, HEAL Africa Hospital, Goma, DRC
- 5 Department of Surgery, Faculty of Medicine, University of Goma, Goma, DRC
- 6 Kyondo General Referral Hospital, Kyondo Health Zone, Nord-Kivu, DRC
- 7 Kyondo General Referral Hospital, Kyondo Health Zone, Nord-Kivu, DRC
- 8 Kyondo General Referral Hospital, Kyondo Health Zone, Nord-Kivu, DRC
- 9 Department of Anesthesiology-Resuscitation and Intensive Care, HEAL Africa Hospital, Goma, DRC
- 10 Department of Anesthesiology-Resuscitation and Intensive Care, HEAL Africa Hospital, Goma, DRC
- 11 Department of Anesthesiology and Physiology, Faculty of Medicine, Notre Dame University of Australia, Sydney, Australia
- 12 Department of Ophthalmology, Faculty of Medicine, Official University of Bukavu, Bukavu, DRC
- 13 Department of Anesthesiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- 14 Department of Anesthesiology, Northwestern University, Evanston, IL, USA
- 15 Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, DRC
Abstract
Introduction: Intrahospital Cardiopulmonary Arrest (IHCA) is a common critical event with high morbidity and mortality in resource-limited settings. This study examines the outcomes of Cardiopulmonary Resuscitation (CPR) for IHCA and their associated factors in North-Kivu in the Democratic Republic of Congo. Methods: This is an 18-month prospective cohort study conducted in two hospitals located in North-Kivu Province: HEAL Africa and Kyondo General Reference Hospital. Data were analyzed using Fisher’s exact test for categorical data and multinomial regression. A p-value < 0.05 was considered statistically significant. Results: We included 84 patients, 58.3% men, with a mean (SD) age of 57.7 years (±17.1). IHCA was due to a combination of causes in 39.3% and isolated hypoxia in 33.3%. Metabolic acidosis was observed in 50%. Hyponatremia and hyperkalemia were the most common electrolyte disturbances in patients with IHCA (52.8% and 44.4%, respectively). In 41.6% of cases, the alert was launched after CA, and 47.6% of CPR was initiated within 4 minutes of CA. Most resuscitations were led by residents. Asystole was noted in 83.3% of monitored patients. Advanced resuscitation with intubation was performed in 45.2% of patients. The rate of Return of Spontaneous Cardiac Activity (ROSC) after IHCA was 42.9%. The factors associated with ROSC were CPR initiated by doctors and nurses, and a history of cardiovascular diseases. The survival rate on the seventh and thirtieth day after ROSC was 8.3% and 6%, respectively. Three out of five patients had a complete recovery on the thirtieth day. Conclusion: IHCA in North-Kivu is due to multiple reversible causes and often occurs in patients with multiple combined illnesses and cardiovascular disease. Early detection and prevention measures for IHCA are still very limited. The ROSC rate for IHCA is high, contrasting with a very low survival rate at day 30 of IHCA.
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