In-hospital vs out-of-hospital cardiac arrest in the Arab Asian countries: A contemporary review of the literature

Abstract

BACKGROUND

Cardiac arrest is a critical condition characterized by abrupt cessation of cardiac function, resulting in reduced oxygen delivery to vital organs and rapid progression to death if not timely treated. Despite advances in medical science and resuscitation techniques, cardiac arrest remains a significant burden globally, with survival rates remaining low. Comprehensive research on cardiac arrest, particularly comparisons between in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA), is limited.

AIM

To compare the survival rates, return of spontaneous circulation (ROSC), survival to discharge, and neurological outcomes after IHCA and OHCA in Arab Asian countries.

METHODS

We systematically searched PubMed, Medline, EMBASE and Google Scholar (2000-2024) using keywords (“IHCA”, “OHCA”, “cardiac arrest”, “Middle East”, “Arab”, “Asian”) in titles/abstracts. The inclusion criterion was observational studies on adults (≥ 18 years) in Arab Asian countries reporting relevant outcomes. The exclusion criteria were narrative reviews, non-Arab Asian studies, non-English publications, inaccessible full texts, pediatric-only populations, and studies lacking outcome data.

RESULTS

In total, 44 observational studies from nine Arab Asian countries comprising 32535 participants were included. This review highlights the substantial variability in cardiac arrest outcomes in Asian countries. OHCA mortality rates were alarmingly high in several nations, with Kuwait (99%), Bahrain (98.8%), and Qatar (97.6%) reporting the highest figures. In contrast, the Kingdom of Saudi Arabia (KSA) had a markedly lower OHCA mortality rate (8.2%). The rates of ROSC also varied, with Qatar achieving the highest (34.4%) and Kuwait the lowest (3.3%). Survival to hospital discharge ranged from 1.2% in Bahrain to 18.7% in Kuwait, with Qatar also reporting favorable rates (17.5%). For IHCA, mortality was 73.6% in the United Arab Emirates (UAE) and 72.8% in KSA, whereas Lebanon and Iraq reported higher rates of 94.6% and 88%, respectively. ROSC rates were the highest in Lebanon (55.9%) and the UAE (51.3%). Neurological outcome reporting has been inconsistent, although Qatar reported a high rate (68.6%) for OHCA survivors. Comparative data showed generally better survival and neurological outcomes with IHCA than with OHCA.

CONCLUSION

This systematic review underscores the clear disparity in survival outcomes between IHCA and OHCA in Arab Asian countries, with IHCA demonstrating superior outcomes. Despite progress in some countries, outcomes remain suboptimal compared with international standards. Future multicenter studies with standardized methodologies are required to generate high-quality evidence and provide region-specific interventions for cardiac arrest management.

Keywords: In-hospital; Cardiac arrest; Out-of-hospital; Resuscitation; Cardiopulmonary resuscitation; Arab; Asian countries

Core Tip: Without prompt resuscitation after cardiac arrest, vital organs deteriorate rapidly, culminating in irreversible organ damage and death. Cardiopulmonary resuscitation (CPR) and management of the underlying causes are essential to achieve return of spontaneous circulation. A systematic review comparing in-hospital and out-of-hospital cardiac arrest outcomes across Arab Asian nations is lacking. The outcomes remain suboptimal in this region compared with international standards. Improving community preparedness through CPR and automated external defibrillators training, strengthening the emergency medical services infrastructure, and standardizing post-arrest care protocols are vital steps toward improving survival rates. Future high-quality multicenter studies with standardized methodologies are required.