In-hospital cardiac arrest in a resource-limited emergency department in Somalia: Outcomes and priorities for resuscitation system development.

BACKGROUND

In-hospital cardiac arrest (IHCA) is associated with high mortality, particularly in low- and middle-income countries where monitoring, emergency response systems, and post-resuscitation resources are limited. Evidence from Somalia remains scarce. This study aimed to describe the clinical characteristics, arrest circumstances, resuscitation-process documentation, short-term outcomes, and exploratory factors associated with return of spontaneous circulation (ROSC) among adult IHCA patients in a resource-limited emergency department in Mogadishu, Somalia.

METHODS

This prospective observational study was conducted in the emergency department of Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital between January 1, 2025 and April 30, 2026. Adult patients aged ≥18 years who experienced IHCA during the study period were consecutively enrolled. Data were collected prospectively using a standardized structured form. The primary outcome was ROSC, and the secondary outcome was survival beyond 24 h. Logistic regression was used only as an exploratory analysis because of the low number of ROSC events.

RESULTS

A total of 240 patients were included. The mean age was 46.3 ± 15.2 years, and 136 patients (56.7%) were male. Most arrests occurred in the emergency department (200, 83.3%). Trauma was the leading admission diagnosis (139, 58.0%), predominantly severe traumatic brain injury (107, 76.9% of trauma cases), followed by sepsis (32, 13.3%). Witness status was documented in 190 patients; among these, 120 arrests (63.2%) were unwitnessed. Emergency response activation was documented in 43 patients (22.6%), and CPR initiation was documented in 35 patients (14.6%). ROSC was achieved in 14 patients (5.8%), and 3 patients (1.3%) survived beyond 24 h. In exploratory analysis, trauma admission, sepsis admission, HIV comorbidity, emergency department arrest, and weekend arrest were associated with reduced odds of ROSC.

CONCLUSION

Adult IHCA outcomes were extremely poor in this resource-limited emergency department, with low ROSC and minimal 24-h survival. The findings highlight a high burden of trauma-related arrest, frequent unwitnessed events, incomplete physiological and resuscitation-process documentation, low documented emergency response activation, and low documented CPR initiation. Context-specific strategies focusing on monitoring, early recognition, standardized emergency response activation, CPR training, structured documentation, and post-arrest review are needed to improve resuscitation systems in Somalia.