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
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 aim...
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| Format: | Article |
| Language: | English |
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Wiley
2020-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.015368 |
| _version_ | 1818307388499820544 |
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| author | Andrew Fu Wah Ho Nurun Nisa Amatullah De Souza Audrey L. Blewer Win Wah Nur Shahidah Alexander Elgin White Yih Yng Ng Desmond Renhao Mao Nausheen Doctor Han Nee Gan Michael Yih Chong Chia Benjamin Sieu‐Hon Leong Si Oon Cheah Lai Peng Tham Marcus Eng Hock Ong |
| author_facet | Andrew Fu Wah Ho Nurun Nisa Amatullah De Souza Audrey L. Blewer Win Wah Nur Shahidah Alexander Elgin White Yih Yng Ng Desmond Renhao Mao Nausheen Doctor Han Nee Gan Michael Yih Chong Chia Benjamin Sieu‐Hon Leong Si Oon Cheah Lai Peng Tham Marcus Eng Hock Ong |
| author_sort | Andrew Fu Wah Ho |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T06:57:35Z |
| format | Article |
| id | doaj.art-17b8dabbe66b4f5595ef59a5a18011c0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T06:57:35Z |
| publishDate | 2020-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-17b8dabbe66b4f5595ef59a5a18011c02022-12-21T23:56:00ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-11-0192110.1161/JAHA.119.015368Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016Andrew Fu Wah Ho0Nurun Nisa Amatullah De Souza1Audrey L. Blewer2Win Wah3Nur Shahidah4Alexander Elgin White5Yih Yng Ng6Desmond Renhao Mao7Nausheen Doctor8Han Nee Gan9Michael Yih Chong Chia10Benjamin Sieu‐Hon Leong11Si Oon Cheah12Lai Peng Tham13Marcus Eng Hock Ong14SingHealth Duke‐NUS Emergency Medicine Academic Clinical Programme SingaporeSingapore Clinical Research Institute SingaporeDepartment of Family Medicine and Community Health and Department of Population Health Sciences Duke University School of Medicine Durham NCUnit for Prehospital Emergency Care Singapore General Hospital SingaporeDepartment of Emergency Medicine Singapore General Hospital SingaporeUnit for Prehospital Emergency Care Singapore General Hospital SingaporeMedical Department Singapore Civil Defence Force SingaporeDepartment of Acute and Emergency Care Khoo Teck Puat Hospital SingaporeDepartment of Emergency Medicine Sengkang General Hospital SingaporeAccident & Emergency Changi General Hospital SingaporeEmergency Department Tan Tock Seng Hospital SingaporeEmergency Medicine Department National University Hospital SingaporeEmergency Medicine Department Ng Teng Fong General Hospital SingaporeChildren’s Emergency KK Women’s and Children’s Hospital SingaporeDepartment of Emergency Medicine Singapore General Hospital SingaporeBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.119.015368bystander CPRemergency medical servicesinterventionsoutcomesout‐of‐hospital‐cardiac arrestprehospital |
| spellingShingle | Andrew Fu Wah Ho Nurun Nisa Amatullah De Souza Audrey L. Blewer Win Wah Nur Shahidah Alexander Elgin White Yih Yng Ng Desmond Renhao Mao Nausheen Doctor Han Nee Gan Michael Yih Chong Chia Benjamin Sieu‐Hon Leong Si Oon Cheah Lai Peng Tham Marcus Eng Hock Ong 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: Cardiovascular and Cerebrovascular Disease bystander CPR emergency medical services interventions outcomes out‐of‐hospital‐cardiac arrest prehospital |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | bystander CPR emergency medical services interventions outcomes out‐of‐hospital‐cardiac arrest prehospital |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.015368 |
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