Proportion of cardiac arrest survival and "Do Not Attempt Resuscitation" among patients admitted to the Intensive Care Unit at a regional referral hospital in Bhutan: a cross-sectional study.

Introduction: This study describes the proportions of Intensive Care Unit-Cardiac Arrest, Return of Spontaneous Circulation events, Do Not Attempt Resuscitation orders, outcome of hospital admission and the neurological performance at discharge from the hospital among patients admitted at the Adult Intensive Care Unit at a regional referral hospital in Bhutan. Methods: This was a cross-sectional study among patients admitted at the Adult Intensive Care Unit, Central Regional Referral Hospital, Bhutan between 2021 and 2023. The data were extracted from the hospital records into a structured pro forma. Results: Data from 287 patients were analysed; four (1.4 %) had out-of-hospital cardiac arrest and 29 (10.1 %) had prior in-hospital cardiac arrest. There were 155 patients (54.0 %) who suffered Intensive Care Unit-Cardiac Arrest. In the first event of Intensive Care Unit-Cardiac Arrest, the proportion of Return of Spontaneous Circulation was 23.9 %. The most common electrical rhythm recorded during Intensive Care Unit-Cardiac Arrest was asystole. The overall mortality was 51.2 % (147 deaths) which included all four patients with out-of-hospital cardiac arrest (mortality 100.0 %) and 22 of those with prior in-hospital cardiac arrest (mortality 75.9 %). Do Not Attempt Resuscitation was signed in 57 patients (19.9 %). The Good Outcome Following Attempted Resuscitation score provides an indication on good neurological status on discharge, c statistic 0.823 (95 % CI 0.706-0.940). Conclusions: Return of Spontaneous Circulation was achieved one out of four Intensive Care Unit-Cardiac Arrest events. One-fifth of patients in the Intensive Care Unit were under Do Not Attempt Resuscitation orders.