• Resuscitation · Apr 2015

    INTERVENTIONAL STRATEGIES ASSOCIATED WITH IMPROVEMENTS IN SURVIVAL FOR OUT-OF-HOSPITAL CARDIAC ARRESTS IN SINGAPORE OVER 10 YEARS.

    • Hsuan Lai, Caroline V Choong, Stephanie Fook-Chong, Yih Yng Ng, Eric A Finkelstein, Benjamin Haaland, E Shaun Goh, Benjamin Sieu-Hon Leong, Han Nee Gan, David Foo, Lai Peng Tham, Rabind Charles, Ong Marcus Eng Hock ME Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Duke-NUS Graduate School of Medicine, , and PAROS study group.
    • Duke-NUS Graduate School of Medicine, Singapore.
    • Resuscitation. 2015 Apr 1; 89: 155-61.

    AimWe aim to study if there has been an improvement in survival for Out-of-Hospital Cardiac Arrest (OHCA) in Singapore, the effects of various interventional strategies over the past 10 years, and identify strategies that contributed to improved survival.MethodsRates of OHCA survival were compared between 2001-2004 and 2010-2012, using nationwide data for all OHCA presenting to EMS and public hospitals. A multivariate logistic regression model for survival to discharge was constructed to identify strategies with significant impact.ResultsA total of 5453 cases were included, 2428 cases from 2001 to 2004 and 3025 cases from 2010 to 2012. There was significant improvement in Utstein (witnessed, shockable) survival to discharge from 2001-2004 (2.5%) to 2010-2012 (11.0%), adjusted odds ratio (OR) 9.6 [95% CI: 2.2-41.9]). Overall survival to discharge increased from 1.6% to 3.2% (adjusted OR 2.2 [1.5-3.3]). Bystander CPR rates increased from 19.7% to 22.4% (p=0.02). The multivariate regression model (adjusted for important non-modifiable risk factors) showed that response time <8min (OR 1.5 [1.0-2.3]), bystander AED (OR 5.8 [2.0-16.2]), and post-resuscitation hypothermia (OR 30.0 [11.5-78.0]) were significantly associated with survival to hospital discharge. Conversely, pre-hospital epinephrine (OR 0.6 [0.4-0.9]) was associated negatively with survival.ConclusionsOHCA survival has improved in Singapore over the past 10 years. Improvement in response time, public AEDs and post-resuscitation hypothermia appear to have contributed to the increase in survival. Singapore's experience might suggest that developing EMS systems should focus on reducing times to basic life support, including bystander defibrillation and post-resuscitation care.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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