• Y Wei, P P Pek, B Doble, E A Finkelstein, W Wah, Y Y Ng, S O Cheah, M Y C Chia, LeongB S HBSHEmergency Medicine Department, National University Hospital, Singapore, Singapore., H N Gan, D R H Mao, L P Tham, S Fook-Chong, and OngM E HMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore..
• Singapore Clinical Research Institute, Singapore, Singapore. Electronic address: yuan.wei.k@gmail.com.
• Resuscitation. 2020 Apr 1; 149: 39-46.

BackgroundOur study aimed to identify a strategy that maximizes survival upon hospital discharge or 30-days post out-of-hospital cardiac arrest (OHCA) in Singapore for fixed investments of S$1, S$5, or S$10 million. Four strategies were compared: (1) no additional investment; (2) reducing response time via leasing of more ambulances; (3) increasing number of people trained in cardiopulmonary resuscitation (CPR); and (4) automated external defibrillators (AED).MethodsWe estimated the effect of ambulance response time, bystander CPR and AED on survival based on Singapore's 2010-2015 OHCA registry data. We simulated the changes in ambulance response times and likelihood of (1) CPR and (2) AED usage as a function of their increased availability, which was then combined with the effect of each factor to determine the increase in survival for each strategy.ResultsSurvival given no additional investment was 4.03% (95% CI: 3.96%, 4.10%). The investments in ambulances, CPR training and AEDs for a given budget of S$1M changed survival to 4.03% (95% CI: 3.96%, 4.10%), 4.04% (95% CI: 3.98%, 4.11%), and 4.44% (95% CI: 4.35%, 4.54%), respectively. This generated 0, 2 and 102 additional life years saved respectively. Given a budget of S$5M or S$10M, 509 or 886 additional life years could be saved, by investing in an additional 10,000 or 20,000 AEDs respectively. The strategies reached a saturation effect whereby improvement in survival was marginal when the budget was increased to ≥S$5M for investment in ambulances and CPR training.ConclusionsInvesting in AEDs had the most gain in survival.Copyright © 2020 Elsevier B.V. All rights reserved.

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