A review of in-hospital cardiopulmonary resuscitation in a Private Hospital Group (PHG) in South Africa

Abstract

Introduction: The incidence of Sudden Cardiac Arrest (SCA) amongst in-hospital admitted patients, besides the very few that occur in visitors, hospital staff and on-site contractors, is unknown. Likewise, the relevant statistics regarding cardiopulmonary resuscitation (CPR) training, clinical resuscitative performance and clinical success is also unknown. This study reviewed in-hospital sudden cardiac arrest in a PHG in South Africa. Methodology: This is a quantitative, retrospective, descriptive and analytical, cross sectional study regarding in hospital cardiac arrest (IHCA) over a defined period occurring in a PHG in South Africa. The data collected for this research study was obtained from the PHG medical data bank that is housed in the head office in Johannesburg. Results: The number of IHCA events during the period of study, from 1stJanuary 2007 until 31stMarch 2010 (First Period), indicates a very low volume of 825 IHCA events (Table 2) across the PHG. This volume is dramatically increased more than eight times to 6956 IHCA events (Table 3) during the study period from 1st January 2015 to 31st December 2018 (Second Period).The majority of IHCA patients 57.7% were within the geriatric age group, of 60 years old and older. Those patients between 18 to 39 years old comprised a smaller 11, 27% of all IHCA events, leaving the remaining 24% patients in the 40 to 59-year-old group. Fifty-eight IHCA events did not have any age included to the data. The sex classification of IHCA in the PHG for the First Period was obtained, from the Medical Data Bank, but no consistent entries were made for the Second Period. Although the updated post IHCA patient information data form in the Second Period. The male IHCA appears consistently higher than the female rate of IHCA during the First Period. The number of hospital beds influence the number of IHCA events that occur. A hospital bed capacity of less than 200 beds has a mean IHCA rate of 20,23events per annum, hospitals with a bed capacity of between 200 to 400 beds have a mean IHCA rate of 41,08 events per annum, hospitals with a bed capacity exceeding 400 beds have a mean IHCA rate of 114,38 events per annum. During the Second Period, the location of IHCA events listed only three locations, namely the Emergency Department (ED), ICU or General Wards. In the First Period, the majority of IHCA events occurred in the ICU (50.19%) and General Wards (33.94%), with no ED data being recorded at all. In the Second Period, the majority of IHCA events continue to be recorded in the ICU (51.12%) and in the General Wards (25.06%), with the ED, responsible for the remaining (23.82%) IHCA events. In the First Period, 31.39% of IHCA events and in the Second Period 34, 93% IHCA events, resulted in ROSC. This presented an overall increase of 3.54% from the First Period to the Second Period. In the First Period, 16.36% of patients and in the Second Period 16.86% patients were discharged home following IHCA and ROSC. This presented an overall increase of 0.5% from the First Period to the Second Period. 18.83% of IHCA events occurred between midnight and 06h00 within the hospital environments within the Second Period. There are no records of this data in the First Period. Conclusion: The standard of cardiopulmonary resuscitation practiced within the PHG in South Africa is well within international norms when the ROSC and STD rates of this company are compared to other hospitals internationally or to the GWTG registry in the USA