ABSTRACT
BACKGROUND: Our study aimed to identify a strategy that maximizes survival upon hospital discharge or 30-days post out-of-hospital cardiac arrest (OHCA) in Singapore for fixed investments of S$1, S$5, or S$10 million. Four strategies were compared: (1) no additional investment; (2) reducing response time via leasing of more ambulances; (3) increasing number of people trained in cardiopulmonary resuscitation (CPR); and (4) automated external defibrillators (AED). METHODS: We estimated the effect of ambulance response time, bystander CPR and AED on survival based on Singapore's 2010-2015 OHCA registry data. We simulated the changes in ambulance response times and likelihood of (1) CPR and (2) AED usage as a function of their increased availability, which was then combined with the effect of each factor to determine the increase in survival for each strategy. RESULTS: Survival given no additional investment was 4.03% (95% CI: 3.96%, 4.10%). The investments in ambulances, CPR training and AEDs for a given budget of S$1M changed survival to 4.03% (95% CI: 3.96%, 4.10%), 4.04% (95% CI: 3.98%, 4.11%), and 4.44% (95% CI: 4.35%, 4.54%), respectively. This generated 0, 2 and 102 additional life years saved respectively. Given a budget of S$5M or S$10M, 509 or 886 additional life years could be saved, by investing in an additional 10,000 or 20,000 AEDs respectively. The strategies reached a saturation effect whereby improvement in survival was marginal when the budget was increased to ≥S$5M for investment in ambulances and CPR training. CONCLUSIONS: Investing in AEDs had the most gain in survival.
Subject(s)
Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Defibrillators , Humans , Out-of-Hospital Cardiac Arrest/therapy , Singapore/epidemiologyABSTRACT
Despite years of medical advances, bystander cardiopulmonary resuscitation (CPR) remains the most important factor in the saving of out-of-hospital cardiac arrest victims. However, the prevalence of bystander CPR remains low. New international recommendations, which aim to increase bystander CPR prevalence, allow for hands-only CPR under certain circumstances. More should be done to increase the awareness and training of CPR in Singapore as well as encourage the public to perform bystander CPR.
Subject(s)
Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Out-of-Hospital Cardiac Arrest/therapy , Practice Guidelines as Topic , Animals , Cardiopulmonary Resuscitation/psychology , Emergency Medical Services , Health Knowledge, Attitudes, Practice , Humans , Singapore , SurvivalABSTRACT
There is relatively less literature available on in-hospital cardiac arrest (IHCA) as opposed to that of out-of-hospital cardiac arrest (OHCA). Although IHCA and OHCA patients may differ at baseline, they share similar factors that are associated with survival. Important variables need to be standardised for reporting. Principles such as the 'chain of survival' remain applicable in the response. Early escalation protocols and medical emergency teams, together with streamlined activation pathways and staff training, are crucial. Post-resuscitation care bundles should be implemented.
Subject(s)
Heart Arrest , Resuscitation , Clinical Competence , Comorbidity , Heart Arrest/complications , Heart Arrest/epidemiology , Heart Arrest/therapy , Humans , Prognosis , Quality of Health Care , Resuscitation/methods , Resuscitation/standards , Singapore/epidemiology , SurvivalABSTRACT
INTRODUCTION: There appears to be a circadian rhythm in the timing of cardiovascular and neurovascular events. The majority of studies have been conducted in western populations. This is the first study to look at the peaks and distribution of out-of-hospital cardiac arrest (OHCA) patients in Singapore. METHODS: The Cardiac Arrest and Resuscitation Epidemiology Studies I and II were prospective observation studies on OHCA in Singapore from October 1, 2001 to October 14, 2004. This study analysed data for patients older than 16 years. All data was collected and recorded as per the Utstein style template. Analysis was done for each of the quadrants of the 24-hour clock: 0001-0600, 0601-1200, 1201-1800 and 1801-2400 hours. RESULTS: Of the 2,428 cases, 2,167 OHCA patients qualified for the final analysis. Their mean ages were in the 60s for all the four quadrants, with a male predominance. The two peaks noted were at 0800 and 1900 hours for cardiac causes of death (n = 1,591), and at 0900 and 2000 hours for non-cardiac causes of death (n = 576). At all times of the day, the majority of OHCA occurred in residences and the bystander cardiopulmonary resuscitation rate ranged from 14.6 to 24.3 percent in the different quadrants of the day. CONCLUSION: OHCA has a bimodal distribution in our local cohort of patients. The information obtained will be utilised for fine-tuning emergency medical services strategies, as we strive to improve our current survival rates for OHCA.
