Incidence and Outcomes of Out‐of‐Hospital Cardiac Arrest in Singapore and Victoria: A Collaborative Study

Abstract

Background Incidence and outcomes of out‐of‐hospital cardiac arrest (OHCA) vary between communities. We aimed to examine differences in patient characteristics, prehospital care, and outcomes in Singapore and Victoria. Methods and Results Using the prospective Singapore Pan‐Asian Resuscitation Outcomes Study and Victorian Ambulance Cardiac Arrest Registry, we identified 11 061 and 32 003 emergency medical services‐attended adult OHCAs between 2011 and 2016 respectively. Incidence and survival rates were directly age adjusted using the World Health Organization population. Survival was analyzed with logistic regression, with model selection via backward elimination. Of the 11 061 and 14 834 emergency medical services‐treated OHCAs (overall mean age±SD 65.5±17.2; 67.4% males) in Singapore and Victoria respectively, 11 054 (99.9%) and 5595 (37.7%) were transported, and 440 (4.0%) and 2009 (13.6%) survived. Compared with Victoria, people with OHCA in Singapore were older (66.7±16.5 versus 64.6±17.7), had less shockable rhythms (17.7% versus 30.3%), and received less bystander cardiopulmonary resuscitation (45.7% versus 58.5%) and defibrillation (1.3% versus 2.5%) (all P <0.001). Age‐adjusted OHCA incidence and survival rates increased in Singapore between 2011 and 2016 ( P <0.01 for trend), but remained stable, though higher, in Victoria. Likelihood of survival increased significantly ( P <0.001) with arrest in public locations (adjusted odds ratio [aOR] 1.81), witnessed arrest (aOR 2.14), bystander cardiopulmonary resuscitation (aOR 1.72), initial shockable rhythm (aOR 9.82), and bystander defibrillation (aOR 2.04) but decreased with increasing age (aOR 0.98) and emergency medical services response time (aOR 0.91). Conclusions Singapore reported increasing OHCA incidence and survival rates between 2011 and 2016, compared with stable, albeit higher, rates in Victoria. Survival differences might be related to different emergency medical services practices including patient selection for resuscitation and transport.

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore

“…The increase in adult OHCA observed in 2020 was generally aligned with the secular trends in adult OHCA [ 21 ], contributed by ageing population and rising cardiovascular burden in Singapore [ 22 ]. Despite that, we could not discount the indirect contribution from the COVID-19 pandemic, due to changes in healthcare systems and health-seeking behaviour of the population.…”

“…It is noteworthy that the decrease in bystander CPR and AED application rates during the pandemic occurred against a backdrop of ongoing national efforts to improve community interventions for OHCA, through public education, community CPR+AED training programs, community first-responder schemes and initiatives to improve availability and accessibility to AEDs [ 28 , 29 ]. These efforts saw improvements in community interventions for OHCA over the years, contributing to better patient outcomes [ 21 , 29 ]. There may be a risk of the COVID-19 pandemic rolling back these improvements.…”

Influence of the COVID-19 Pandemic and Bystander-victim Relationship on the Willingness of Thai Healthcare Providers and Laypersons to Perform Cardiopulmonary Resuscitation: a Cross-sectional Online Survey

“…3,4 Bystander CPR plays a vital role in improving survival to hospital discharge in OHCA victims. 2,5 There are two currently accepted bystander CPR techniques: conventional CPR and chest compression-only CPR. 3,4 Conventional CPR requires the knowledge and skills to perform an initial assessment, chest compression, and ventilation and to use an automated de brillator (AED).…”

“…Out-of-hospital cardiac arrest (OHCA) is a signi cant health problem in many Asian countries. 1,2 Bystander CPR is a type of rst aid that aims to manage cardiac and respiratory arrest until the victim can be sent to a medical facility. 3,4 Bystander CPR plays a vital role in improving survival to hospital discharge in OHCA victims.…”

“…3 Although knowledge and skills are key factors in whether CPR is performed, the willingness of bystanders to initiate aid is also critical. Studies in various parts of Asia have found that anywhere from 10.5-79.0% of OHCA victims in the region receive bystander CPR, 1,2,6 and willingness to perform bystander CPR ranges 10.3-98.6%. [7][8][9][10][11][12] Willingness to perform CPR is affected by various complex factors having to do with the bystander (experience, training, age, fear, self-e cacy, physical tness), technique (ventilation or nonventilation), the victim (age, gender, relationship), and the environment (location, country, safety, infection risk).…”