Characteristics and outcomes of out-of-hospital-cardiac-arrest in rural and suburban areas of Sindh, Pakistan: A cross-sectional study.

Background: Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs). Aim: To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan. Methods: Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh Results: Out of 139 OHCA patients, 75.5 % were males, and 24.5 % were females, with a mean age of 52.78 ± 13.1 years. Most cardiac arrests occurred at home (54.75 %). Only 0.7 % of patients were transported by emergency medical services (EMS), while 59 % arrived via private transport, such as cars or vans. An additional 4.3 % were brought by other ambulance services, including private and philanthropic organizations, and for 36 % of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2 % of cases. CPR (either in-hospital or pre-hospital) was performed on 59 % of patients, but only 6.1 % received pre-hospital CPR (Bystander: 1.22 %, Ambulance Staff: 2.44 %, Family Member: 2.44 %). Return of spontaneous circulation (ROSC) was achieved in 14.63 % of patients, while 4.88 % were alive at hospital admission. Conclusion: This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.