Assessing the burden of Out-of-Hospital Cardiac Arrest (OHCA) in Timor-Leste: A Retrospective analysis from a single tertiary care center and implications for Emergency Car
Keywords:
Out-of-hospital cardiac arrest, pre-hospital and ED intervention, Bystander CPR, HNGV, Timor-LesteAbstract
Background: Out-of-hospital cardiac arrest (OHCA) is a major global health challenge with poor survival outcomes, particularly in low- and middle-income countries (LMICs). Timor-Leste faces unique barriers to emergency care, including limited infrastructure, shortages of trained personnel, and geographic constraints. Despite progress in healthcare development, OHCA remains under-researched, with no national registry to guide interventions.
Objective: This study aimed to assess the burden of OHCA in Timor-Leste by analyzing patient outcomes at the Guido Valadares National Hospital (HNGV) and identifying gaps in the emergency response system to inform evidence-based recommendations.
Methods: A retrospective single-center observational cohort study was conducted at HNGV’s emergency department between January 2022 and December 2024. Data from 340 OHCA patients were extracted from medical records, including sociodemographic characteristics, pre-hospital and in-hospital interventions, and survival outcomes. Descriptive statistics were applied using Microsoft Excel.
Results: Of 340 OHCA cases, 75.2% were transported by relatives and 24.8% by ambulance. The mean patient age was 37.9 ± 20.8 years, with 60% male. The median time to ED arrival was 0.45 hours (IQR 0.30–0.60). Pre-hospital care was minimal: 99.4% received no CPR, and no advanced interventions were documented. Resuscitation was attempted in 60.5% of cases, with shockable rhythms observed in only 0.29%. Return of spontaneous circulation (ROSC) was achieved in 1.18% of patients, with three (0.88%) surviving to hospital discharge. All survivors had favorable neurological outcomes (CPC 1–2).
Conclusion: Survival following OHCA in Timor-Leste is extremely poor, reflecting critical gaps in the chain of survival, including absence of pre-hospital notification, lack of CPR initiation, and limited advanced interventions. Despite these challenges, survivors demonstrated meaningful recovery, underscoring the potential impact of strengthening emergency response systems. Investments in EMS infrastructure, workforce training, public CPR education, and community-based first responder programs are urgently needed to reduce OHCA mortality and improve outcomes.
