Edmond Marie Cassandre, Fang Anna Potter, Poola Nivedita, Normil Manouchka, Payant Sherley Jean Michel, Luc Pierre Ricot, Rimpel Linda, Checkett Keegan, Strokes Natalie, Calixte Manise, Marsh Regan H, Rouhani Shada A
Department of Emergency Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.
Zanmi Lasante, Port-au-Prince, Haiti.
Emerg Med J. 2025 Feb 21;42(3):171-178. doi: 10.1136/emermed-2024-214200.
Advanced cardiovascular life support (ACLS) for cardiac arrest is a cornerstone of emergency care and yet remains poorly studied in low- and middle-income countries. We characterised the clinical epidemiology and outcomes of cardiac arrest and ACLS in an ED in central Haiti, a lower middle-income country with a nascent emergency care system.
We conducted a prospective observational study of adult and paediatric patients who suffered cardiac arrest in an academic hospital ED in central Haiti from January 2019 to August 2020. Patients were identified prospectively at the time of clinical care. Data on demographics, comorbidities, clinical presentation, management with or without ACLS and outcomes were extracted from patient charts using a standardised form and analysed in SAS V.9.4. The primary outcome was survival to 24 hours after arrest.
We identified 161 patients who suffered cardiac arrest in the ED. The mean age was 45 years; 55.9% were female, and 82.6% were aged >18. Common presenting diagnoses were pneumonia (16.1%), sepsis (14.9%), congestive heart failure/cardiogenic shock (11.2%) and cerebrovascular accident (10.6%). Few patients were on cardiac or oxygen saturation monitors (23.1%; 63.5%) prior to arrest. 43 (27%) patients received ACLS (two patients missing data). Among these, 58.1% had initial rhythm assessed, and 2/25 (8%) patients had shockable rhythms. The median time to arrest was 23.6 hours. Sustained return of spontaneous circulation was achieved in two patients (4.7%). Among patients for whom ACLS was not initiated, the majority were due to poor prognosis (66.4%) or irreversible cause (22.4%) in the setting of available resources. One patient survived to 24 hours; none survived to hospital discharge.
In this lower middle-income setting, cardiac arrest in the ED was associated with poor survival despite ACLS. Survival may be impacted by limited resources for prearrest monitoring as well as for ongoing critical care.
心脏骤停的高级心血管生命支持（ACLS）是急诊护理的基石，但在低收入和中等收入国家仍缺乏充分研究。我们对海地中部一家急诊室的心脏骤停及ACLS的临床流行病学和结局进行了描述，海地是一个中低收入国家，其急诊护理系统尚处于起步阶段。
我们对2019年1月至2020年8月在海地中部一家学术医院急诊室发生心脏骤停的成年和儿科患者进行了一项前瞻性观察研究。在临床护理时对患者进行前瞻性识别。使用标准化表格从患者病历中提取有关人口统计学、合并症、临床表现、接受或未接受ACLS治疗及结局的数据，并在SAS V.9.4中进行分析。主要结局是心脏骤停后存活至24小时。
我们在急诊室识别出161例发生心脏骤停的患者。平均年龄为45岁；55.9%为女性，82.6%年龄大于18岁。常见的就诊诊断为肺炎（16.1%）、脓毒症（14.9%）、充血性心力衰竭/心源性休克（11.2%）和脑血管意外（10.6%）。很少有患者在心脏骤停前接受心脏或血氧饱和度监测（23.1%；63.5%）。43例（27%）患者接受了ACLS（2例患者数据缺失）。其中，58.1%进行了初始心律评估，2/25（8%）例患者有可电击心律。心脏骤停的中位时间为23.6小时。2例患者（4.7%）实现了自主循环持续恢复。在未启动ACLS的患者中，大多数是由于预后不良（66.4%）或在现有资源情况下存在不可逆病因（22.4%）。1例患者存活至24小时；无患者存活至出院。
在这个中低收入环境中，尽管进行了ACLS，但急诊室的心脏骤停患者存活率较低。心脏骤停前监测以及持续重症护理的资源有限可能会影响存活率。
