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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.

Publication ,  Journal Article
Ho, AFW; De Souza, NNA; Blewer, AL; Wah, W; Shahidah, N; White, AE; Ng, YY; Mao, DR; Doctor, N; Gan, HN; Chia, MYC; Leong, BS-H; Cheah, SO ...
Published in: J Am Heart Assoc
November 3, 2020

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.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

November 3, 2020

Volume

9

Issue

21

Start / End Page

e015368

Location

England

Related Subject Headings

  • Survival Rate
  • Singapore
  • Registries
  • Outcome Assessment, Health Care
  • Out-of-Hospital Cardiac Arrest
  • Middle Aged
  • Male
  • Humans
  • Health Policy
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Ho, A. F. W., De Souza, N. N. A., Blewer, A. L., Wah, W., Shahidah, N., White, A. E., … Singapore Pan‐Asian Resuscitation Outcomes Study (PAROS) investigators *, . (2020). 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. J Am Heart Assoc, 9(21), e015368. https://doi.org/10.1161/JAHA.119.015368
Ho, Andrew Fu Wah, Nurun Nisa Amatullah De Souza, Audrey L. Blewer, Win Wah, Nur Shahidah, Alexander Elgin White, Yih Yng Ng, et al. “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.J Am Heart Assoc 9, no. 21 (November 3, 2020): e015368. https://doi.org/10.1161/JAHA.119.015368.
Ho AFW, De Souza NNA, Blewer AL, Wah W, Shahidah N, White AE, et al. 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. J Am Heart Assoc. 2020 Nov 3;9(21):e015368.
Ho, Andrew Fu Wah, et al. “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.J Am Heart Assoc, vol. 9, no. 21, Nov. 2020, p. e015368. Pubmed, doi:10.1161/JAHA.119.015368.
Ho AFW, De Souza NNA, Blewer AL, Wah W, Shahidah N, White AE, Ng YY, Mao DR, Doctor N, Gan HN, Chia MYC, Leong BS-H, Cheah SO, Tham LP, Ong MEH, Singapore Pan‐Asian Resuscitation Outcomes Study (PAROS) investigators *. 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. J Am Heart Assoc. 2020 Nov 3;9(21):e015368.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

November 3, 2020

Volume

9

Issue

21

Start / End Page

e015368

Location

England

Related Subject Headings

  • Survival Rate
  • Singapore
  • Registries
  • Outcome Assessment, Health Care
  • Out-of-Hospital Cardiac Arrest
  • Middle Aged
  • Male
  • Humans
  • Health Policy
  • Female