Bystander Response and Out of Hospital Cardiac Arrest Outcomes (Bro. Study) in Three Gulf Countries, Protocol for an International Collaboration Study (Preprint)

Abstract

Globally, there is significant variation in the Out of Hospital Cardiac Arrest (OHCA) survival rate. Early links in the chain of survival, including bystander Cardiopulmonary Resuscitation (CPR) and the use of an Automated External Defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East is limited and reports variable rates of bystander cardiopulmonary resuscitation (CPR) and survival. It is crucial to get prospective reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes.

This international collaborative study is aimed at 1) To describe the characteristics, including bystander interventions and outcomes in out-of-hospital cardiac arrests brought to the hospitals enrolled in the study from Abu Dhabi (UAE), Doha (Qatar), and Muscat (Oman). 2) To describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rate.

This multicenter, prospective, noninterventional observational study will be conducted at the Emergency Departments of four participating tertiary care hospitals in three countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, co-morbidities), peri cardiac arrest variables (location, witnessed or not, bystander CPR, use of AED, time of EMS arrival, initial rhythm, number of shocks, time of prehospital CPR) and outcome variables (Return of Spontaneous Circulation (ROSC), survival to discharge and neurological outcome at discharge and at three months).

The trial is expected to record reliable prospective data about bystander response and OHCA outcomes. Descriptive statistics using means with standard deviation and modes with interquartile ranges will be presented in tables and graphs. Univariate and multivariate analysis with logistic regression models will be used to measure the strength of association of bystander interventions with outcomes using SPSS Version 22.

Bystander response to an OHCA is key to a favorable outcome. The reliable baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community.

Nil.