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Outcomes after in-hospital cardiac arrest in a LMIC hospital with a nurse led rescue team and availability of parameters for early warning scores.

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Outcomes after in-hospital cardiac arrest in a LMIC hospital with a nurse led rescue team and availability of parameters for early warning scores.

De Silva AP a,b,c  ,Sujeewa JA d, De Silva PN d, Rathnayake RMD d ,Vithanage AVDLAV d , Sigera PC a,b ,Munasinghe S a,b, Beane Aa,b,k, Stephens T a,e,f ,Athapattu PL  b,g ,Jayasinghe KSA h ,Dondorp A k Haniffa R a,b,h,k

a  Network for Improving Critical care Systems and Training, Colombo, Sri Lanka   

b National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka

c Intensive Care National Audit and Research Centre, London, United Kingdom

d District General Hospital, Monargala, Sri Lanka

e Critical Care Research Team, Royal London Hospital, London, United Kingdom

f William Harvey Institute, Queen Mary University of London, London, United Kingdom

g Office of Director Medical Services, Ministry of Health, Colombo, Sri Lanka

h  Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

i Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand


  • In LMIC countries, outcomes following and underlying reasons for in-hospital cardiac arrest are largely unknown. EWS and rapid response systems are not in use, resuscitation teams are uncommon, and formal resuscitation training for doctors and nurses is limited.

  • This study describes the cardiopulmonary resuscitation practices and outcomes in a District General Hospital (DGH) in rural South East Sri Lanka when a cardiac arrest nurse responder was activated.

  • The study also evaluates the availability of physiological variables used in existing EWS, to assess feasibility of future EWS implementation.


  • This retrospective study was carried out at District General Hospital (DGH) Monaragala, Sri Lanka.

  • All adult patients who had cardiac arrests and were reported to the nurse responder were included.

  • Availability of physiological parameters used in EWS (AVPU, age, heart rate, respiratory rate, SpO2, systolic blood pressure, temperature and urine output) was analysed at admission, at 24 and 48 hours prior to cardiac arrest.

Ethical approval obtained from the Ethics review committee of Faculty of Medicine, University of Colombo.



  • Immediate Return Of Spontaneous Circulation (ROSC): 49.3%

  • Survival to hospital discharge: 35.3 %

  • ROSC patients who did not receive post resuscitation care in ICU:48.6%

  • Overall availability of  physiological variables at admission was low and decreased for each measurement at 24 and 48 hours preceding cardiac arrest.


  • ROSC after nurse responder assisted cardiac arrests is nearly 50% in this LMIC DGH with 35% live discharge from hospital.

  • A high proportion of patients who had ROSC following CPR were cared for outside of the ICU setting; care that is considered essential in improving the chain of survival.

  • Prior to the validation and implementation of an EWS, training is needed to increase the availability and reporting of physiological variables.

  • Strategies such as those employed in HIC’s, including training for nurses and doctors in the importance of observations in recognising and detecting physiological deterioration may be of value.


  1. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: A report of cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation [Internet]. Elsevier; 2016 Feb 4;58(3):297–308. Available from: http://dx.doi.org/10.1016/S0300-9572(03)00215-6

  2. Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014;85(8):987–92.

  3. Kruisselbrink R, Kwizera A, Crowther M, Fox-Robichaud A, O’Shea T, Nakibuuka J, et al. Modified Early Warning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study. PLoS One [Internet]. 2016;11(3):e0151408. Available from: http://dx.plos.org/10.1371/journal.pone.0151408

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