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

Table 1 Out-of-hospital cardiac arrest outcomes in the Arab Asian studies, n (%)/mean ± SD/median (25^th-75^th percentiles)

Ref.	Type of study	Country	Population	Male:Female	Age	Cause of cardiac arrest	Type of initial rhythm	Type of CPR	Mortality	ROSC	STD 30 days or 1 year	Neurological outcome
Irfan et al[14], 2017	Retrospective	Qatar	n = 410	377:29	33 (27-46)	Motor vehicle collision 172 (42.0), pedestrian 119 (29.0), falls 57 (13.9), vulnerable road users 14 (3.4), others 48 (11.7)	Shockable: 12. Non-shockable: 17	Manual and mechanical chest compression device	400 (97.6)	61 (15.0)	10 (2.4)	NA
Irfan et al[15], 2016	Retrospective	Qatar	n = 447	360:87	51 (39-66)	Presumed cardiac etiology	Shockable: 88. Non-shockable: 350. Missing: 9	Manual and mechanical	411 (91.9)	103 (23.0)	36 (8.1)	Favorable cerebral performance: 24 (68.6)
Arabi et al[16], 2018	Retrospective	Qatar	n = 987	718:269	STEMI 53 ± 13. Without STEMI 58 ± 16	Presumed cardiac etiology	Shockable: 248	Not mentioned	590 (59.8)	NA	397 (40.2)	NA
Albizreh et al[17], 2021	Retrospective	Qatar	n = 1146	839:305	Group 1: ≤ 40 years. Group 2: > 40 years	Presumed cardiac etiology	≤ 40 years: Shockable 23/159. > 40 years: Shockable 183/985	Not mentioned	756 (65.9)	1146 (100.0)	≤ 40 years = 76 (47.8). > 40 years = 312 (31.7)	NA
Khazaal et al[18], 2022	Retrospective	Qatar	n = 987	718:269	Male: 55 ± 15. Female:61 ± 14	Presumed cardiac etiology	Not mentioned	Not mentioned	Females: 176 (65.4). Males: 414 (57.7)	NA	79 (8.0)	NA
Irfan et al[19], 2021	Retrospective	Qatar	n = 397	266:131	62.8 ± 17.5	Presumed cardiac etiology	Shockable: 49	Manual and mechanical chest compression device	371 (93.5)	40 (10.2)	26 (6.5)	NA
Awad et al[20], 2024	Retrospective	Qatar	n = 4306	3434:869	54.0 ± 17.9	Not mentioned	Shockable: 1110. Non-shockable: 3196	Manual	NA	1241 (28.8)	NA	NA
Awad et al[21], 2023	Retrospective	Qatar	n = 4283	3414:869	Males 52.7 ± 16.4. Females 62.2 ± 19.1	Not mentioned	Shockable: 1042. Non-shockable: 3241	Manual	NA	1256 (29.3)	NA	NA
Abuzeyad et al[22], 2024	Retrospective	Bahrain	n = 331	228:103	65 (49-78)	Presumed medical cause	Shockable: 28. Non-shockable: 303	Manual	327 (98.8)	60 (18.1)	4 (1.2)	0
Abou Dagher et al[23], 2021	Retrospective	Lebanon	n = 200	140:60	Bacteremia: 71.3 ± 16.9. Non-bacteremia: 70.1 ± 17.3	Not mentioned	Bacteremia: Shockable 12, non-shockable 77, missing 4. Non-bacteremia: Shockable 10, non-shockable 87, missing 10	Manual	Bacteremia: 80 (86.0). Non-bacteremia: 78 (72.9)	Bacteremia: 30 (32.3). Non-bacteremia: 50 (46.7)	Bacteremia: 0. Non-bacteremia: 3 (2.8)	Bacteremia: 93 bad outcome (100). Non-bacteremia: 105 bad outcome (98.1)
El Sayed et al[24], 2017	Retrospective	Lebanon	n = 271	179:92	69.93 ± 15.03	Not mentioned	Shockable: 28. Non-shockable: 243	Manual	258 (95.2)	NA	13 (4.8)	7 good neurological outcome (2.6)
Ong et al[25], 2022	Prospective	Lebanon	n = 225	152:73	75 (52.5-97.5)	Not mentioned	Shockable: 3. Non-shockable: 32	Manual	214 (95.1)	41 (18.2)	11 (4.9)	NA
El Sayed et al[26], 2014	Retrospective	Lebanon	n = 214	139:75	69 ± 15.4	Presumed cardiac etiology	Shockable: 23. Non-shockable: 190	Manual	203 (94.6)	39 (19.0)	11 (5.5)	5 good outcome (45.4)
Refaat et al[27], 2019	Retrospective	Lebanon	n = 54	40:15	17.9 ± 10.9	Cardiac 21, trauma 14, intoxication 5, congenital heart defect 7	Shockable: 12. Non-shockable: 42	Manual	41 (76)	NA	9 (16.7)	7 good outcomes (13)
Al Hasan et al[28], 2020	Retrospective	Kuwait	n = 286	192:94	61.1 ± 16	Presumed cardiac etiology	Shockable: 3. Non-shockable: 85	Manual	285 (99.7)	10 (3.5)	1 (0.3)	NA
Al Hasan et al[29], 2019	Pre and post intervention	Kuwait	n = 176	114:62	Pre-intervention 59 ± 17. Post-intervention 63 ± 16	Cardiovascular risk: Pre-intervention (22), post-intervention (21.9)	Not mentioned	Manual	175 (99.2)	Pre: 3 (6). Post: 2 (1.6)	Pre: 0 (0). Post: 1 (0.8)	7 good outcome (13)
Al Hasan et al[30], 2020	Retrospective	Kuwait	n = 140	122:18	39.9 ± 13.94	RTA 106, FFH 18, slip/fall 10, assault 6	Not mentioned	Not mentioned	40 (28)	4 (2.8)	100 (72)	NA
Hasan et al[31], 2019	Retrospective	Kuwait	n = 314	210:104	60.4	Presumed cardiac etiology	Shockable: 11. Non-shockable: 86	Manual	308 (98.09)	10 (3.18)	6 (1.91)	NA
Al-Habsi et al[32], 2024	Retrospective cross-sectional	Oman	n = 822	540:282	60.2 ± 17.6	Presumed medical etiology	Shockable: 41. Non-shockable: 781	Manual	773 (94)	178 (30.4)	49 (8.4)	NA
Nadar et al[33], 2018	Retrospective	Oman	n = 216	150:66	55 ± 17	Not mentioned	Shockable: 23. Non-shockable: 191. Heart blockage: 2	Manual	188 (87)	NA	28 (13)	NA
Maddali et al[34], 2023	Retrospective cross-sectional	Oman	n = 117	102:15	Median age 33	Presumed cardiac etiology	Shockable: 21. Non-shockable: 96	Manual	108 (92.3)	13 (11.11)	9 (7.69)	3 (2.5) neurological deficits
Alqahtani et al[35], 2019	Prospective	UAE	n = 715	548:167	50.6 (35-65)	Not mentioned	Shockable:79. Non-shockable: 604. Missing: 32	Manua and mechanical	NA	66 (9.2)	NA	NA
Alhmoudi et al[36], 2021	Prospective	UAE	n = 330	250:79	Not mentioned	Presumed cardiac etiology	Not mentioned	Mechanical	314 (95.1)	56 (17)	16 (5)	NA
Batt et al[37], 2016	Prospective	UAE	n = 384	291:93	50.9 ± 21.1	Presumed cardiac etiology	Shockable: 67. Non-shockable: 160. Unknown: 63	Manual and mechanical	NA	12 (3.1)	NA	NA
Ong et al[25], 2022	Prospective	UAE	n = 911	692:218	53 (37.5-68.5)	Not mentioned	Shockable: 128. Non-shockable: 725. Unknown: 56	Manual	NA	39 (4.3)	NA	NA
Alremeithi et al[38], 2022	Retrospective	UAE	n = 87	60:27	48 (range: 20-118)	Not mentioned	Shockable: 5. Non-shockable: 82	Not mentioned	84 (96.6)	13 (14.9)	3 (3.4)	1 (1.1) good outcome
Alsaeed et al[39], 2023	Retrospective	7 ACS registries in Gulf region (Bahrain, Kuwait, Oman, Qatar, KSA, UAE, Yemen)	n = 611	489:122	58 ± 14	Acute coronary syndrome	NA	Manual	265 (43.3)	NA	346 (56.6)	NA
Albinali et al[40], 2022	Quantitative cross-sectional	KSA	n = 257	184:73	48.4 ± 23.2	Presumed cardiac 144, Trauma 113	Not mentioned	Manual	21 (8.2)	NA	236 (91.8)	2 (22.2) good outcome

ROSC: Return of spontaneous circulation; STD: Survival to discharge; RTA: Road traffic accident; FFH: Fall from height; KSA: Kingdom of Saudi Arabia; UAE: United Arab Emirates; CRP: Cardiopulmonary resuscitation; NA: Not available.

Table 2 In-hospital cardiac arrest outcomes in the Arab Asian studies, n (%)/mean ± SD/median (25^th-75^th percentiles)

Ref.	Type of study	Country	Population	Male:Female	Age	Cause of cardiac arrest	Type of initial rhythm	Type of CPR	Mortality	ROSC	STD 30-days or 1 year	Neurological outcome
Eltarras et al[41], 2021	Retrospective	Lebanon	n = 680	466:214	68 ± 17	Not mentioned	Shockable: 63. Non-shockable: 617	Manual	643 (94.6)	380 (55.9)	37 (5.4)	NA
Alao et al[42], 2024	Retrospective	UAE	n = 366	244:122	70 (55-81)	Cardiac 89, respiratory 67, others 210	Shockable: 30. Non-shockable: 336	Not mentioned	335 (91.5)	159 (43.4)	31 (8.5)	20 (5.5) good neurological outcomes
Alao et al[43], 2022	Prospective	UAE	n = 447	279:147	Survived 62.5 (47.5-80.8). Died 70 (55-81)	Survived: Cardiac 15, respiratory 10, others 21. Died: Cardiac 90, respiratory 74, others 216	Shockable: Survived 15, died 18. Unshockable: Survived 31. Died 362	Not mentioned	399 (89.2)	171 (40)	48 (10.8)	264 (59) good neurological outcomes
Aziz et al[44], 2018	Retrospective	UAE	n = 685	454:231	57.3 ± 23.3	Not mentioned	Shockable: 61. Non-shockable: 624	Not mentioned	632 (92.3)	262 (38.2)	53 (7.7)	NA
Alhajri et al[45], 2021	Retrospective	UAE	n = 20	12:8	Median 60.5	Presumed cardiac etiology	Shockable: 1. Non-shockable: 19	Not mentioned	12 (60)	19 (95)	8 (40)	NA
Khdr et al[46], 2019	Prospective	Iraq	n = 100	47:53	63.65 ± 16.7	Unknown 58, thrombosis 15, electrolyte disturbances 5, hypoxia 8, hypovolemia 13, toxins 1	Shockable: 23. Non-shockable: 77	Manual	88 (88)	12 (12)	12 (12)	NA
Kaki et al[47], 2017	Retrospective	KSA	n = 4361	2414:1937	40 ± 31	Cardiac 1806, respiratory 906, both 1292	Shockable: 497. Non-shockable: 3864	Manual	3024 (70)	1766 (40.4)	1330 (30)	NA
Al Bshabshe et al[48], 2019	Retrospective	KSA	n = 700	414:286	59.1 ± 22.3	Respiratory 46, cardiac 654	Shockable: 26. Non-shockable: 674	Manual	442(63.1)	NA	258 (36.9)	NA
Rasheed et al[49], 2016	Retrospective	KSA	n = 1350	889:461	Adults 44.39 ± 0.46. Geriatrics 77.58 ± 0.41	Not mentioned	Shockable: 92. Non-shockable: 1225	Manual	Adults: 542 (69.5). Geriatrics: 396 (69.5)	NA	Adults 237 (30.5). Geriatrics 173 (30.5)	NA
Alhaj Zeen et al[50], 2023	Retrospective	KSA	n = 351	264:87	56.6 ± 14.7	Cardiac 212, non-cardiac 33, respiratory 45, trauma 17, unknown 44	Shockable 23. Non-shockable 328	Manual	311 (88.6)	106 (30.2)	40 (11.4)	NA

ROSC: Return of spontaneous circulation; STD: Survival to discharge; KSA: Kingdom of Saudi Arabia; UAE: United Arab Emirates; CRP: Cardiopulmonary resuscitation; NA: Not available.

Table 3 Outcomes in studies comparing out of hospital cardiac arrest and in-hospital cardiac arrest in the Arab Asian studies, n (%)/mean ± SD/median (25^th-75^th percentiles)

Ref.	Type of study	Country	Population	Male:Female	Age	Cause of cardiac arrest	Type of initial rhythm	Type of CPR	Mortality	ROSC	STD 30 days or 1 year	Neurological outcome
Irfan et al[9], 2022	Retrospective	Qatar	OHCA (n = 410), IHCA (n = 199)	557:46	OHCA 33.0 (27-46). IHCA 33.5 (25-48.3)	OHCA, IHCA: Head injury (271, 120), spinal (28, 40), chest (40, 44), abdominal (67, 70)	OHCA Shockable: 12. IHCA Shockable: 15	Not mentioned	OHCA (n = 400, 97.6). IHCA (n = 184, 92.5)	NA	OHCA (n = 10, 2.4). IHCA (n = 15, 7.5)	NA
Elmelliti et al[51], 2023	Retrospective	Qatar	OHCA (n = 37), IHCA (n = 11)	36:12	41.88 ± 11.5	IHD 21, PE 6, others 21	Shockable: 16	Manual and ECPR	OHCA (n = 28, 75.7). IHCA (n = 10, 90.9)	NA	OHCA (n = 9, 24.3). IHCA (n = 1, 9.1)	NA
Shehatta et al[52], 2024	Retrospective	Qatar	OHCA (n = 25), IHCA (n = 62)	75:12	45.4 ± 11.9	Acute MI 52, Post cardiotomy 2, arrhythmia 3, HF 1, PE 7	Shockable: 27. Non-shockable: 61	Manual, ECPR, VA-ECMO	OHCA (n = 22, 88). IHCA (n = 43, 69.4)	NA	OHCA (n = 3, 12). IHCA (n = 19, 30.6)	Good neurological outcome for OHCA (n = 3, 12). IHCA (n = 19, 30.6)
Ait Hssain et al[13], 2025	Prospective	Qatar	OHCA (n = 281), IHCA (n = 273)	399:155	53.79 ± 16.24	Cardiac 383, non-cardiac 142, others 29	Shockable: 151	Manual	OHCA (n = 185, 65.8). IHCA (n = 171, 62.6)	NA	OHCA (n = 96, 34.2). IHCA (n = 102, 37.4)	Good neurological outcomes for OHCA (n = 36, 12.8), and IHCA (n = 42, 15.4)
Raffee et al[12], 2017	Retrospective	Jordan	OHCA (n = 79), IHCA (n = 257)	OHCA 51:28. IHCA 145:112	OHCA 59.50 ± 19.02. IHCA 63.36 ± 18.63	OHCA: IHD 3, MI 1, arrhythmia 1. IHCA: IHD 10, CHF 7, CVD 4, cancers 12	OHCA: Not mentioned. IHCA: Non-shockable 257	Manual	OHCA (n = 77, 97.03). IHCA (n = 219, 85.12)	NA	OHCA (n = 2, 2.97). IHCA (n = 38, 14.9)	NA
Alzahrani et al[53], 2019	Retrospective	KSA	OHCA (n = 15), IHCA (n = 414)	263:161	58.43 ± 18.02	Cardiac 88, non-cardiac 188, respiratory 102, sepsis 46	Shockable: 29. Non-shockable: 400	Not mentioned	OHCA (n = 9, 60.0). IHCA (n = 179, 43.2)	OHCA 8 (56.2). IHCA 235 (56.8)	NA	NA
Shirah et al[54], 2018	Retrospective	KSA	OHCA (n = 252), IHCA (n = 174)	287:139	64.0 ± 12.0	Not mentioned	OHCA Shockable: 0. Non-shockable: 252. IHCA Shockable: 52. Non-shockable: 120	Not mentioned	NA	NA	OHCA (n = 14, 5). IHCA (n = 52, 30)	NA

ROSC: Return of spontaneous circulation; STD: Survival to discharge; IHD: Ischemic heart disease; PE: Pulmonary embolism; MI: Myocardial infarction; CHF: Congestive heart failure; CVD: Cerebral vascular disease; IHCA: In-hospital cardiac arrest; OHCA: Out-of-hospital cardiac arrest; NA: Not available.