Please use this identifier to cite or link to this item: https://doi.org/10.1161/JAHA.119.015368
Title: Implementation of a National 5-Year Plan for Prehospital Emergency Care in Singapore and Impact on Out-of-Hospital Cardiac Arrest Outcomes From 2011 to 2016
Authors: Ho, Andrew Fu Wah 
De Souza, Nurun Nisa Amatullah 
Blewer, Audrey L 
Wah, Win 
Shahidah, Nur 
White, Alexander Elgin 
Ng, Yih Yng 
Mao, Desmond Renhao 
Nausheen
Gan, Han Nee 
Chia, Michael Yih Chong 
Leong, Benjamin Sieu-Hon 
Cheah, Si Oon 
Tham, Lai Peng 
Ong, Marcus Eng Hock 
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
bystander CPR
emergency medical services
interventions
outcomes
out&#8208
of&#8208
hospital&#8208
cardiac arrest
prehospital
resuscitation
ASIAN RESUSCITATION OUTCOMES
MEDICAL-SERVICES SYSTEMS
HEALTH-PROFESSIONALS
SURVIVAL
ASSOCIATION
IMPROVEMENTS
COUNTRIES
INTERVENTION
STATEMENT
CHAIN
Issue Date: 3-Nov-2020
Publisher: WILEY
Citation: Ho, Andrew Fu Wah, De Souza, Nurun Nisa Amatullah, Blewer, Audrey L, Wah, Win, Shahidah, Nur, White, Alexander Elgin, Ng, Yih Yng, Mao, Desmond Renhao, Nausheen, Gan, Han Nee, Chia, Michael Yih Chong, Leong, Benjamin Sieu-Hon, Cheah, Si Oon, Tham, Lai Peng, Ong, Marcus Eng Hock (2020-11-03). Implementation of a National 5-Year Plan for Prehospital Emergency Care in Singapore and Impact on Out-of-Hospital Cardiac Arrest Outcomes From 2011 to 2016. JOURNAL OF THE AMERICAN HEART ASSOCIATION 9 (21). ScholarBank@NUS Repository. https://doi.org/10.1161/JAHA.119.015368
Abstract: BACKGROUND: Outcomes of patients from out-of-hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5-year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. METHODS AND RESULTS: Prospective, population-based data of OHCA brought to Emergency Departments were obtained from the Pan-Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival-to-discharge or 30-day postarrest. Mid-year population estimates were used to calculate age-standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival-to-discharge across time. A total of 11 465 cases qualified for analysis. Age-standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% (P=0.006). Overall survival rates improved from 3.6% to 6.5% (P<0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. CONCLUSIONS: Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.
Source Title: JOURNAL OF THE AMERICAN HEART ASSOCIATION
URI: https://scholarbank.nus.edu.sg/handle/10635/228732
ISSN: 20479980
DOI: 10.1161/JAHA.119.015368
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