Cardiac Arrests and Outcomes at Accident and Emergency (A&E) Department in a Tertiary Care Hospital of Sri Lanka.

Background: Witnessed cardiac arrest is a common occurrence in an A&E department. The reported incidence of witnessed cardiac arrest is variable around the world. Overall unadjusted survival to hospital discharge rate was 18.4%. Objective: To assess the aetiology, factors associated in outcomes of witnessed cardiac arrests, and the rate of occurrence of cardiac arrest at the A&E of Provincial January1, 2016, to December 31, 2016 (one year) at the A&E department of PGHK. Survivors were followed up on for a one-year period. Results: There were 123 witnessed cardiac arrests (mean age 64 (+/- 15.9) years, 64% male), out of which 25 patients were successfully resuscitated {return of spontaneous circulation (ROSC)} and transferred to intensive care units for further care. However, only 6 (4.9%) patients were discharged from the hospital. The three-month and one-year survival numbers were 6 (4.9%) (males: 4, females: 2) and 4 (3.3%) (males: 3, female: 1) respectively. The age of the female survivor after one year was 43 years and the ages of the three male survivors were 46, 54, and 55 years respectively. The most common aetiology for cardiac arrest was myocardial infarction (43.1%) while the most common initial rhythm was non-shockable (82%). The initial rhythm was shockable in all 6 survivors. Conclusion: The overall ratio of survival to discharge was much lower in comparison to international figures. The poor survival rate in our study may be due a very high rate of cardiac arrests with initial non-shockable rhythms.