Prospective, multicenter, Turkish out‑of‑hospital cardiac arrest study: TROHCA

Alp Şener1,2, Murat Pekdemir3, Mehmet Muzaffer İslam4, Ersin Aksay5, Sevilay Karahan6, Gokhan Aksel4, Nurettin Özgür Doğan3, Berkant Öztürk7, Muhammet Hacımustafaoğlu7, Çağrı Türkücü7, Serkan Emre Eroğlu4, Yusuf Yürümez8, Nuray Aslan8, Necip Gokhan Güner8, Neşe Nur User9, Hüseyin Aldemir9, Abdullah Sadik Girişgin10, Sedat Koçak10, Sami Ataman10, Ayhan Özhasenekler1,2, Gul Pamukçu Günaydın1,2, Mustafa Burak Sayhan11, Ömer Salt11, Satuk Bugra Han Bozatlı11, Engin Deniz Arslan12, Fevzi Yılmaz12, Ramazan Sivil12, Özlem Köksal13, Vahide Aslıhan Durak13, Fatma Özdemir13, Mahmut Taş14, Yenal Karakoç14, Öner Avınca14, Yunus Emre Arık15, Adem Melekoğlu15, Özgür Çevrim15, Özlem Yiğit16, Cem Oktay16, Süleyman İbze16, Salim Satar17, Muge Gülen17, Selen Acehan17, Erhan Altunbaş18, Melis Efeoğlu Saçak18, Emir Ünal18, Erdem Çevik19, Dilay Satılmış19, Hande Asan19, Yunus Karaca20, Melih İmamoğlu20, Vildan Özer20, Ahmet Demircan21, Ayfer Keleş21, Gültekin Kadı21, Orhan Delice22, Sibel Güçlü Utlu22, Senol Arslan22, Neslihan Yücel23, Şükrü Gürbüz23, Hüseyin Burak Ayhan23, Abdullah Şen24, Mahmut Yaman24, Müge Günalp25, Sinan Genç25, Ahmet Baydın26, Fatih Çalışkan26, Şeyma Arzu Temür26, Murat Ersel27, Sercan Yalçınlı27, Enver Özçete27, Bulent Erbil28, Elif Ozturk Ince28, Mehmet Ali Karaca28, Murat Çetin29, Mehmet Demirbağ30, Mustafa Sabak31, Mustafa Bozkurt31

1Department of Emergency Medicine, Ankara Bilkent City Hospital, Ankara, Türkiye
2Department of Emergency Medicine, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Türkiye
3Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Türkiye
4University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Türkiye
5Department of Emergency Medicine, İzmir Ekonomi University, Medical Point Hospital, Izmir, Türkiye
6Department of Biostatistics, Hacettepe University, Faculty of Medicine, Ankara, Türkiye
7Department of Emergency Medicine, Aksaray University, Aksaray Training and Research Hospital, Aksaray, Türkiye
8Department of Emergency Medicine, Sakarya University, Faculty of Medicine, Sakarya, Türkiye
9Department of Emergency Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
10Department of Emergency Medicine, Necmettin Erbakan University, Faculty of Medicine, Konya, Türkiye
11Department of Emergency Medicine, Trakya University, Faculty of Medicine, Edirne, Türkiye
12Department of Emergency Medicine, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
13Department of Emergency Medicine, Bursa Uludağ University, Faculty of Medicine, Bursa, Türkiye
14Department of Emergency Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
15Department of Emergency Medicine, University of Health Sciences, İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
16Department of Emergency Medicine, Akdeniz University, Faculty of Medicine, Antalya, Türkiye
17Department of Emergency Medicine, University of Health Sciences, Adana City Training and Research Hospital, Adana, Türkiye
18Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
19Department of Emergency Medicine, University of Health Sciences, Sultan 2.Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
20Department of Emergency Medicine, Karadeniz Technical University, Faculty of Medicine, Trabzon, Türkiye
21Department of Emergency Medicine, Gazi University, Faculty of Medicine, Ankara, Türkiye
22Department of Emergency Medicine, Erzurum City Hospital, Erzurum, Türkiye
23Department of Emergency Medicine, İnönü University, Turgut Özal Medical Center, Malatya, Türkiye
24Department of Emergency Medicine, Dicle University, Faculty of Medicine, Diyarbakır, Türkiye
25Department of Emergency Medicine, Ankara University, Faculty of Medicine, Ankara, Türkiye
26Department of Emergency Medicine, Ondokuz Mayis University, Faculty of Medicine, Samsun, Türkiye
27Department of Emergency Medicine, Ege University, Faculty of Medicine, İzmir, Türkiye
28Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, Ankara, Türkiye
29Dr.Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
30Department of Emergency Medicine, Manisa Merkezefendi State Hospital, Manisa, Türkiye
31Department of Emergency Medicine, Gaziantep University, Şahinbey Research and Practice Hospital, Gaziantep, Türk

Keywords: Bystander cardiopulmonary resuscitation, cardiopulmonary resuscitation, cardiopulmonary resuscitation, out-of-hospital cardiac arrest, registry, return of spontaneous circulation, survival, survived event, Turkey, Türkiye

Abstract

OBJECTIVES: There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes.

MATERIALS AND METHODS: The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes.

RESULTS: One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge.

CONCLUSION: Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.

How to cite this article: Şener A, Pekdemir M, İslam MM, Aksay E, Karahan S, Aksel G, et al. Prospective, multicenter, Turkish out-of-hospital cardiac arrest study: TROHCA. Turk J Emerg Med 2024;24:133-44.

Ethics Committee Approval

This multicenter study was carried out in 28 health centers in Türkiye within the scope of the Emergency Medicine Association of Türkiye (EMAT) Resuscitation Study Group, and approval was obtained from the Kocaeli University Non-Interventional Clinical Research Ethics Committee (KÜ GOKAEK‑2022/18.24; November 10, 2022).

Author Contributions

All authors conducted the study concept and design and acquisition of the data. AŞ and SK conducted the statistical analysis and interpretation of the data. AŞ and MMİ conducted the drafting of the manuscript. All authors conducted critical revision of the manuscript for important intellectual content.

Conflict of Interest

None declared.

Financial Disclosure

None.

Acknowledgments

The researchers would like to thank the Emergency Medicine Association of Türkiye Resuscitation Study Group Members for their valuable contribution to the study.