• HoAndrew Fu WahAFWSingHealth Duke-NUS Emergency Medicine Academic Clinical Programme Singapore.Pre-Hospital & Emergency Research Centre Duke-NUS Medical School Singapore., De SouzaNurun Nisa AmatullahNNASingapore Clinical Research Institute Singapore., Audrey L Blewer, Win Wah, Nur Shahidah, Alexander Elgin White, Yih Yng Ng, Desmond Renhao Mao, Nausheen Doctor, Han Nee Gan, ChiaMichael Yih ChongMYCEmergency Department Tan Tock Seng Hospital Singapore., Benjamin Sieu-Hon Leong, Si Oon Cheah, Lai Peng Tham, OngMarcus Eng HockMEHDepartment of Emergency Medicine Singapore General Hospital Singapore.Health Services & Systems Research Duke-NUS Medical School Singapore., and Singapore Pan‐Asian Resuscitation Outcomes Study (PAROS) investigators *.
• SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme Singapore.
• J Am Heart Assoc. 2020 Nov 3; 9 (21): e015368.

AbstractBackground 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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