• Priscilla Zi Yin Ting, HoAndrew Fu WahAFWSingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; Cardiovascular & Metabolic Disorders Programme, Duke-National University of Sin, Xinyi Lin, Nur Shahidah, Audrey Blewer, Yih Yng Ng, Benjamin Sieu-Hon Leong, Han Nee Gan, Desmond Renhao Mao, ChiaMichael Yih ChongMYCEmergency Department, Tan Tock Seng Hospital, Singapore., Si Oon Cheah, and OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore..
• Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: e0005147@u.nus.edu.
• Resuscitation. 2020 Jun 1; 151: 103-110.

AimsSingapore is highly-urbanized, with >90% of the population living in high-rise apartments. She has implemented several city-wide interventions such as dispatcher-assisted CPR, community CPR training and smartphone activation of volunteers to increase bystander CPR (BCPR) rates for out-of-hospital cardiac arrest (OHCA). These may have different impact on residential and non-residential OHCA. We aimed to evaluate the characteristics, processes-of-care and outcome differences between residential and non-residential OHCA and study the differences in temporal trends of BCPR rates.MethodsThis was a national, observational study in Singapore from 2010 to 2016, using data from the prospective Pan-Asian Resuscitation Outcomes Study. The primary outcome was survival (to-discharge or to-30-days). Multivariate logistic regression was performed to determine the effect of location-type on survival and a test of statistical interaction was performed to assess the difference in the temporal relationship of BCPR rates between location-type.Results8397 cases qualified for analysis, of which 5990 (71.3%) were residential. BCPR and bystander automated external defibrillator (AED) rates were significantly lower in residential as compared to non-residential arrests (41.0% vs 53.6%, p < 0.01; 0.4% vs 10.8%, p < 0.01 respectively). Residential BCPR increased from 15.8% (2010) to 57.1% (2016). Residential cardiac arrests had lower survival-to-discharge (2.9% vs 10.1%, p < 0.01). Multivariate logistic regression analysis showed that location-type had an independent effect on survival, with residential arrests having poorer survival compared to non-residential cardiac arrests (adjusted OR 0.547 [0.435-0.688]). A test of statistical interaction showed a significant interaction effect between year and location-type for bystander CPR, with a narrowing of differences in bystander CPR between residential and non-residential cardiac arrests over the years.ConclusionResidential cardiac arrests had poorer bystander intervention and survival from 2010 to 2016 in Singapore. BCPR had improved more in residential arrests compared to non-residential arrests over a period of city-wide interventions to improve BCPR.Copyright © 2020 Elsevier B.V. All rights reserved.

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