• Marcus Eng Hock Ong, Xiuyuan Yan, Gilbert Lau, Eng Hoe Tan, Anushia Panchalingham, Benjamin Sieu-Hon Leong, Victor Yeok Kein Ong, Ling Tiah, Susan Yap, Swee Han Lim, and Anantharaman Venkataraman.
• Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. marcus.omg.e.h@sgh.com.sg
• Resuscitation. 2007 Jul 1;74(1):38-43.

ObjectivesTo study out-of-hospital cardiac arrests (OHCA) occurring in primary healthcare facilities (HCF) in Singapore and to compare these with arrests occurring in the community.MethodsThis prospective observational study was part of the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Included were all patients with OHCA occurring in HCF. Patient characteristics, cardiac arrest circumstances, EMS response and outcomes were recorded according to the Utstein style.ResultsFrom 1 October 2001 to 14 October 2004, the data from 2428 subjects were received of which 138 patients were OHCA occurring in HCF. This is an incidence of 1.12/100,000 population per year and constituted 6.0% of all OHCA. Arrest occurring in HCF were more likely to be witnessed (p<0.01), or have bystander CPR (p<0.01). The HCF group was also more likely to receive CPR with both compression and ventilation (p<0.01) and have a non-trauma cause of arrest (p=0.03). HCF arrests also had a shorter collapse to call (EMS number) than the non-HCF group (HCF 1.54min versus non-HCF 5.36min, p=0.01). However, no HCF patient received defibrillation prior to EMS arrival. HCF patients were more likely to have return of spontaneous circulation at any time (p=0.05), survival to hospital admission (p<0.01) and survival to discharge (p<0.01) compared to non-HCF patients.ConclusionThis study suggests that primary health care providers do have an important role locally in managing out-of-hospital cardiac arrest. We propose an initiative to encourage early defibrillation by primary health care providers.

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