Effectiveness of out-of-hospital cardiopulmonary resuscitation in Nigeria: an evaluation of key components in the chain of survival

BACKGROUND: The ''Chain of Survival'' (CoS), provides a structure to evaluate an emergency response system for out-of-hospital cardiac arrest (OHCA) in any community. This CoS has not been previously evaluated in an African population. The study aims to assess the effectiveness and efficiency of OHCA resuscitation by evaluating the components of the CoS following sudden cardiac arrest in Nigeria. METHODOLOGY: This was a prospective multicenter descriptive cross-sectional exploratory survey of epidemiology and outcome of OHCA in adult Nigerians. The survey was conducted in six university teaching hospitals in the 6 geopolitical zones of Nigeria. Data was analyzed using IBM-SPSS version 25.0 (SPSS Inc., Chicago, IL, USA, and presented using tables. Continuous variables were summarized using means and standard deviation, or median and interquartile range (IQR), depending on the normality of the data. Primary outcome measures were return of spontaneous circulation (ROSC), survival to hospital admission and discharge. RESULTS: A total of 387 OHCA patients aged between 18 and 115 years met the inclusion criteria. They consisted of 62.5% males and 37.5% females, giving a male/female ratio of approximately 1.7:1. Most (55.6%) of the arrests occurred at home. Ninety-one-point 7% (91.7%) of the arrests were witnessed. Calls were made to ambulance services but only in a third (34.6%) did an ambulance arrive. The time taken for the ambulance to arrive ranged between 10 min and 60 min, with a median of 15 min (IQR 12.5-45). Pre-hospital resuscitation was attempted in 15.2%. Pre-hospital ROSC was achieved in 3.6% of all the OHCA events, but only 1.8% survived to hospital admission and were eventually discharged. CONCLUSION: The emergency response service to OHCA in Nigeria is very poor due to weaknesses in the critical components of the CoS. The shortcomings observed call for well-organized, coordinated deliberate efforts to strengthen pre-hospital chain of care.