Only one in a hundred people in Pakistan survive a cardiac arrest, one of the deadliest types of medical emergencies, according to the findings of a new registry run by researchers at Aga Khan University in partnership with 12 public and private hospitals in Karachi.
Rahat Hussain*, 38, is one of the rare
survivors of cardiac arrest: a malfunction in the electrophysiology, or
vital rhythms of the heart, that disrupts blood flow to critical organs
such as the brain and kidneys. Rahat survived because she was travelling in an ambulance service at
the time of her arrest that had defibrillators and trained paramedics.
They performed cardiopulmonary resuscitation, CPR, on Rahat without interruption as they rushed her to a
specialised hospital which greatly boosted her chances of recovering from cardiac arrest.
After two months in hospital and a long battle with kidney failure, Rahat is now leading a full and healthy life.
Studies show that an individual’s chance of surviving cardiac arrest falls by up to 10 per cent every minute that passes without CPR or the use of defibrillators. The Out of Hospital Cardiac Arrest registry gathered data from 1,064 cases in Karachi to understand how such delays in seeking or receiving treatment affected the chain of survival: the sequence of critical actions that can save the lives of people like Rahat who suffer a cardiac arrest.
Preliminary findings from the registry show that 7 out of 10 cardiac arrests happen at home, a statistic that points to the importance of family members and bystanders being trained to provide immediate CPR to their loved ones.
Steps in the chain of survival
- Early recognition of and call for help: to prevent cardiac arrest
- Early initiation of CPR: to buy time
- Early defibrillation: to restart the heart
- Early transport to hospital: to enable access to advanced care
- Post-resuscitation care at hospital: to restore quality of lif
The registry also found that immediate CPR by bystanders only took place in 1 in 10 cases: a statistic that greatly increases the likelihood of death. Karachi, which is estimated to need 200 fully-equipped ambulances, has just 60 ambulances that can prevent mortality from cardiac arrest with the researchers noting that 93 per cent of ambulance staff did not conduct CPR on the way to hospital.
“Pre-hospital care and emergency response services are still in their initial early stages in Karachi,” said Dr Nadeem Khan, an associate professor in emergency medicine at AKU. “Survival rates from cardiac arrests in the developing world are at least ten times higher than Pakistan which highlights the importance of initiatives to strengthen our chain of survival.”
Researchers noted that Norway, which has had CPR in its national curriculum since the 1960s, has achieved survival rates of 25 per cent from cardiac arrest. Every home across the country should have a person trained in conducting CPR as bystander CPR is a vital link in the chain of survival. Pakistan should also set up a single 911 type number that will help dispatch an ambulance with defibrillators and paramedics trained in CPR in cases of cardiac arrest, Dr Nadeem added. Studies in the West show that telephone-CRP initiatives, where helpline operators advised laymen on how to perform CPR, also helped boost the chances of survival.
The registry's objectives are in line with global efforts to achieve targets under goal 3 of the Sustainable Development Goals: ensure healthy lives and promote well-being for all at all ages. Target 3.4.1 of the goal calls for special efforts to reduce premature deaths caused by cardiovascular conditions by a third by 2030.
Partners on the project included The First Response Initiative of Pakistan, HOPE, Humanity Initiative, Aman Foundation, Jinnah Postgraduate Medical Center, Tabba Heart Institute, Karachi Institute of Heart Disease, Patel Hospital, National Institute of Cardiovascular Diseases, Memon Medical Institute, Indus Hospital, Darul Sehat Hospital, Chiniot General Hospital, Ziauddin Hospital and Abbasi Shaheed Hospital.
* The individual’s name has been changed to protect her identity.