Search

Little is known about survival outcomes after traumatic cardiac arrest in Asia, or the association of Utstein factors with survival after traumatic cardiac arrests. This study aimed to describe the epidemiology and outcomes of traumatic cardiac arrests in Asia, and analyze Utstein factors associated with survival.Traumatic cardiac arrest patients from 13 countries in the Pan-Asian Resuscitation Outcomes Study registry from 2009 to 2018 were analyzed. Multilevel logistic regression was performed to identify factors associated with the primary outcomes of survival to hospital discharge and favorable neurological outcome (Cerebral Performance Category (CPC) 1-2), and the secondary outcome of return of spontaneous circulation (ROSC).There were 207,455 out-of-hospital cardiac arrest cases, of which 13,631 (6.6%) were trauma patients aged 18 years and above with resuscitation attempted and who had survival outcomes reported. The median age was 57 years (interquartile range 39-73), 23.0% received bystander cardiopulmonary resuscitation (CPR), 1750 (12.8%) had ROSC, 461 (3.4%) survived to discharge, and 131 (1.0%) had CPC 1-2. Factors associated with higher rates of survival to discharge and favorable neurological outcome were arrests witnessed by emergency medical services or private ambulances (survival to discharge adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI) = 1.99-4.38; CPC 1-2 aOR = 2.57, 95% CI = 1.25-5.27), bystander CPR (survival to discharge aOR = 2.16; 95% CI 1.71-2.72; CPC 1-2 aOR = 4.98, 95% CI = 3.27-7.57), and initial shockable rhythm (survival to discharge aOR = 12.00; 95% CI = 6.80-21.17; CPC 1-2 aOR = 33.28, 95% CI = 11.39-97.23) or initial pulseless electrical activity (survival to discharge aOR = 3.98; 95% CI = 2.99-5.30; CPC 1-2 aOR = 5.67, 95% CI = 3.05-10.53) relative to asystole.In traumatic cardiac arrest, early aggressive resuscitation may not be futile and bystander CPR may improve outcomes.

Survival with favorable neurological outcomes is an important indicator of successful resuscitation in out-of-hospital cardiac arrest (OHCA). We sought to validate the CaRdiac Arrest Survival Score (CRASS), derived using data from the German Resuscitation Registry, in predicting the likelihood of good neurological outcomes after OHCA in Singapore.We conducted a retrospective population-based validation study among EMS-attended OHCA patients (≥18 years) in Singapore, using data from the prospective Pan-Asian Resuscitation Outcomes Study registry. Good neurological outcome was defined as a cerebral performance category of 1 or 2. To evaluate the CRASS score in light of the difference in patient characteristics, we used the default constant coefficient (0.8) and the adjusted coefficient (0.2) to calculate the probability of good neurological outcomes.Out of 11,404 analyzed patients recruited between April 2010 and December 2018, 260 had good and 11,144 had poor neurological function. The CRASS score demonstrated good discrimination, with an area under the curve of 0.963 (95% confidence interval: 0.952-0.974). Using the default constant coefficient of 0.8, the CRASS score consistently overestimated the predicted probability of a good outcome. Following adjustment of the coefficient to 0.2, the CRASS score showed improved calibration.CRASS demonstrated good discrimination and moderate calibration in predicting favorable neurological outcomes in the validation Singapore cohort. Our study established a good foundation for future large-scale, cross-country validations of the CRASS score in diverse sociocultural, geographical, and clinical settings.

Introduction: Hospital-based resuscitation interventions, such as therapeutic temperature management (TTM), emergency percutaneous coronary intervention (PCI) and extracorporeal membrane oxygenation (ECMO) can improve outcomes in out-of-hospital cardiac arrest (OHCA). We investigated postresuscitation interventions and hospital characteristics on OHCA outcomes across public hospitals in Singapore over a 9-year period. Methods: This was a prospective cohort study of all OHCA cases that presented to 6 hospitals in Singapore from 2010 to 2018. Data were extracted from the Pan-Asian Resuscitation Outcomes Study Clinical Research Network (PAROS CRN) registry. We excluded patients younger than 18 years or were dead on arrival at the emergency department. The outcomes were 30-day survival post-arrest, survival to admission, and neurological outcome. Results: The study analysed 17,735 cases. There was an increasing rate of provision of TTM, emergency PCI and ECMO (P

Out-of-hospital cardiac arrest (OHCA) is associated with poor survival. Studies have demonstrated improved survival with early bystander cardiopulmonary resuscitation (BCPR). This study evaluated the impact of a dispatcher-assisted CPR (DA-CPR) program on BCPR rate and outcomes of OHCA in a developing emergency medical services (EMS) system setting.Data were extracted from the national cardiac arrest registry. A before-after analysis was performed between OHCA cases with cardiac etiology conveyed by EMS from April 2010-June 2012 (pre-intervention) and July 2012-December 2015 (post-intervention). Primary outcomes were survival-to-discharge/30 days post-arrest and favorable cerebral performance (Glasgow-Pittsburgh cerebral performance categories 1 and 2).6365 OHCA cases were analyzed with 2129 in the pre-intervention and 4236 in the post-intervention group. In the post-intervention group, there was an increase in BCPR rates from 24.8% to 53.8% (p 0.001), adjusted OR 3.67 (aOR; 95%CI: 3.26-4.13). OHCA outcomes also improved with survival-to-discharge rates increasing from 3.0%-4.5% (p 0.01), aOR 2.10 (95%CI: 1.40-3.17) and favorable cerebral performance increasing from 1.6% to 2.7% (p 0.05), aOR 2.82 (95%CI: 1.65-4.82). In patients with initial shockable rhythm, BCPR without dispatcher assistance was associated with significantly higher odds of survival-to-discharge (aOR 1.67, 95%CI: 1.06-2.64) and favorable cerebral performance (aOR 2.32, 95%CI: 1.26-4.27) compared to no BCPR.Our study showed that a simplified DA-CPR program can be successfully implemented in a developing EMS system and can contribute to higher BCPR rate and in turn, improve OHCA survival. Future studies can examine bystanders' characteristics and quality of the CPR performed to understand their impact on survival.

This is a case involving the development of a delayed chronic subdural hematoma 2 months after a minor head injury with normal clinical neurological findings and brain computed tomography at initial presentation. An 84‐year‐old man visited the emergency department (ED) after a minor head trauma. The patient complained of dizziness and vomiting 8 hours after an injury. He was not on an antiplatelet or anticoagulant. He did not have any abnormal findings during neurological examination, and brain computed tomography did not show any intracranial pathology or skull fractures. He was admitted to the ED short‐stay ward for observation and was discharged asymptomatic and stable 12 hours later. However, he presented 2 months later with dizziness and unsteady gait. He was asymptomatic within those 2 months. At the ED, his brain computed tomography showed a large right chronic subdural hematoma, compressing the right lateral and third ventricles, with a 1.2 cm midline shift, subfalcine and uncal herniations, and early hydrocephalus. An emergency burr‐hole evacuation was performed. He was discharged without neurological deficit 3 days later. Emergency physicians attending to patients with normal neurologic examination and initial brain computed tomography after suffering a mild traumatic brain injury should be vigilant for a chronic subdural hematoma should the patient re‐present for evaluation subsequently. The attending physician may be biased as patients could have symptoms attributed to postconcussion syndrome that may overlap with symptoms of chronic subdural hematoma. Unsteady gait and ataxia are uncommon clinical signs of postconcussion syndrome and should prompt the physician to consider a repeat brain computed tomography.

Aim Survival is the most consistently captured outcome across countries for out-of-hospital cardiac arrests (OHCA), with return of spontaneous circulation (ROSC) representing the earliest endpoint for ‘unbiased’ initial resuscitation success. The ROSC after cardiac arrest (RACA) score was developed to predict ROSC and has been validated in several European countries. In this study, we aimed to evaluate the performance of RACA in a Pan-Asian population. Methods We conducted a retrospective analysis of data collected in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. We included OHCA cases from seven communities (Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand, and United Arab Emirates) between January 2009 and December 2012. Paediatric cases, cases that were conveyed by non-emergency medical services (EMS), and cases with incomplete records were excluded from the study. Results The RACA score showed similar discrimination performance as the original German study and various European validation studies. However, it had poor calibration with the original constant regression coefficient, which was primarily due to the low ROSC rate (8.2%) in the PAROS cohort. The calibration performance of RACA significantly improved after the constant coefficient was modified to adjust for the disparity in ROSC rates between Asia and Europe. Conclusion This is the largest validation study of the RACA score. RACA consistently performs well in both Pan-Asian and European communities and can thus be a valuable tool for evaluating EMS systems. However, to implement it, the constant coefficient has to be modified in the RACA formula with local historical data.

Background Our 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). Methods We 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. Results Survival 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. Conclusions Investing in AEDs had the most gain in survival.

Background 70% of Out-of-hospital cardiac arrests (OHCA) in Singapore occur in residential areas, and are associated with poorer outcomes. We hypothesized that an interventional bundle consisting of Save-A-life (SAL) initiative (cardiopulmonary resuscitation (CPR)/automated external defibrillator (AED) training and public-housing AED installation), dispatcher-assisted CPR (DA-CPR) program and myResponder (mobile application) will improve OHCA survival. Methods This is pilot data from initial implementation of a stepped-wedge, before-after, real-world interventional bundle in six selected regions. Under the SAL initiative, 30,000 individuals were CPR/AED trained, with 360 AEDs installed. Data was obtained from Singapore’s national OHCA Registry. We included all adult patients who experienced OHCA in Singapore from 2011 to 2016 within study regions, excluding EMS-witnessed cases and cases due to trauma/drowning/ electrocution. Cases occurring before and after intervention were allocated as control and intervention groups respectively. Survival was assessed via multivariable logistic regression. Results 1241 patients were included for analysis (Intervention: 361; Control: 880). The intervention group had higher mean age (70 vs 67 years), survival (3.3% [12/361] vs. 2.2% [19/880]), pre-hospital return of spontaneous circulation (ROSC) (9.1% [33/361] vs 5.1% [45/880]), bystander CPR (63.7% [230/361] vs 44.8% [394/880]) and bystander AED application (2.8% [10/361] vs 1.1% [10/880]). After adjusting for age, gender, race and significant covariates, the intervention was associated with increased odds ratio (OR) for survival (OR 2.39 [1.02–5.62]), pre-hospital ROSC (OR 1.94 [1.15–3.25]) and bystander CPR (OR 2.29 [1.77–2.96]). Conclusion The OHCA interventional bundle (SAL initiative, DA-CPR, myResponder) significantly improved survival and is being scaled up as a national program.

BackgroundOrgan donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study.MethodsUsing Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered.Results12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario,n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario,n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year).ConclusionsIn Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.

Introduction: Bystander cardiopulmonary resuscitation (B-CPR) is associated with improved out-ofhospital cardiac arrest survival. Community-level interventions including dispatcher-assisted CPR (DA-CPR) and myResponder were implemented to increase B-CPR. We sought to assess whether these interventions increased B-CPR. Methods: The Singapore out-of-hospital cardiac arrest registry captured cases that occurred between 2010 and 2017. Outcomes occurring in 3 time periods (Baseline, DA-CPR, and DA-CPR plus myResponder) were compared. Segmented regression of time-series data was conducted to investigate our intervention impact on the temporal changes in B-CPR. Results: A total of 13,829 out-of-hospital cardiac arrest cases were included from April 2010 to December 2017. Higher B-CPR rates (24.8% versus 50.8% vs 64.4%) were observed across the 3 time periods. B-CPR rates showed an increasing but plateauing trend. DA-CPR implementation was significantly associated with an increased B-CPR (level odds ratio [OR] 2.26, 95% confidence interval [CI] 1.79–2.88; trend OR 1.03, 95% CI 1.01–1.04), while no positive change was detected with myResponder (level OR 0.95, 95% CI 0.82–1.11; trend OR 0.99, 95% CI 0.98–1.00). Conclusion: B-CPR rates in Singapore have been increasing alongside the implementation of community-level interventions such as DA-CPR and myResponder. DA-CPR was associated with improved odds of receiving B-CPR over time while the impact of myResponder was less clear.

Unilateral anterior shoulder dislocations are the most common major joint dislocation. However, bilateral shoulder dislocations are rare, and when present are mostly posterior. Given the rarity of this clinical entity, many emergency physicians would suspect central cord syndrome in a patient who presents with disproportionate weakness of the arms compared to the legs post trauma. This case report describes a 65-year-old woman presenting with inability to move both arms after she tripped. She displayed signs consistent with an initial diagnosis of central cord syndrome. Appropriate investigations led to the correct and timely diagnosis of bilateral anterior shoulder dislocations. Bilateral shoulder dislocations are uncommon. Central cord syndrome can mimic similar clinical presentations, and vice versa. It is important for emergency physicians to recognise these pitfalls in diagnosis, and to increase awareness of this clinical entity to avoid future late or missed diagnoses.

Background Aortic aneurysm ruptures are associated with high fatality. The timely diagnosis of a ruptured aortic aneurysm can be challenging for the emergency physician when hoarseness of voice is the only presenting symptom. Ortner's syndrome was first reported in 1897 as a case of left recurrent laryngeal nerve paralysis secondary to mitral stenosis and left atrial enlargement. In this case report, we describe a unique association of aortic aneurysm rupture with dysphonia presenting as Ortner's syndrome. Case Report An 81-year-old man presented to our emergency department (ED) with an acute hoarse voice. Physical examination of his cardiovascular and neurologic systems was normal. Further evaluation with a nasoendoscope revealed a left vocal cord palsy. Consideration of Ortner's syndrome prompted an early call for thoracic imaging. A computed tomogram of the aorta showed a contained aortic aneurysm rupture with an acute hyperdense periaortic hematoma at the aortic arch. As our patient was a poor surgical candidate in view of concurrent comorbidities, he was managed conservatively. Why Should an Emergency Physician Be Aware of This? We identified a unique presentation of a painless, ruptured aortic aneurysm. This is a fatal diagnosis that all emergency physicians struggle to make in a timely fashion. The imminent aortic aneurysm rupture, masked by the absence of pain in our patient, could have resulted in a potentially catastrophic event. In the evaluation of a patient with hoarse voice, early consideration of Ortner's syndrome could result in timely diagnosis of a ruptured aortic aneurysm.

Summary: Background: Bystander cardiopulmonary resuscitation (CPR) increases an individual's chance of survival from out-of-hospital cardiac arrest (OHCA), but the frequency of bystander CPR is low in many communities. We aimed to assess the cumulative effect of CPR-targeted public health interventions in Singapore, which were incrementally introduced between 2012 and 2016. Methods: We did a secondary analysis of a prospective cohort study of adult, non-traumatic OHCAs, through the Singapore registry. National interventions introduced during this time included emergency services interventions, as well as dispatch-assisted CPR (introduced on July 1, 2012), a training programme for CPR and automated external defibrillators (April 1, 2014), and a first responder mobile application (myResponder; April 17, 2015). Using multilevel mixed-effects logistic regression, we modelled the likelihood of receiving bystander CPR with the increasing number of interventions, accounting for year as a random effect. Findings: The Singapore registry contained 11 465 OHCA events between Jan 1, 2011, and Dec 31, 2016. Paediatric arrests, arrests witnessed by emergency medical services, and healthcare-facility arrests were excluded, and 6788 events were analysed. Bystander CPR was administered in 3248 (48%) of 6788 events. Compared with no intervention, likelihood of bystander CPR was not significantly altered by the addition of emergency medical services interventions (odds ratio [OR] 1·33 [95% CI 0·98–1·79]; p=0·065), but increased with implementation of dispatch-assisted CPR (3·72 [2·84–4·88]; p

Singapore is highly-urbanized, with90% 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.This 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.8397 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.Residential 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.

There is paucity of data examining the incidence and outcomes of young OHCA adults. The aim of this study is to determine the outcomes and characteristics of young adults who suffered an OHCA and identify factors that are associated with favourable neurologic outcomes.All EMS-attended OHCA adults between the ages of 16 and 35 years in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry were analysed. The primary outcome was favourable neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge or at 30th day post OHCA if not discharged. Regression analysis was performed to identify factors associated with favourable neurologic outcomes.66,780 OHCAs were collected between January 2009 and December 2013; 3244 young OHCAs had resuscitation attempted by emergency medical services (EMS). 56.8% of patients had unwitnessed arrest; 47.9% were of traumatic etiology. 17.2% of patients (95% CI: 15.9-18.5%) had return of spontaneous circulation; 7.8% (95% CI: 6.9-8.8%) survived to one month; 4.6% (95% CI: 4.0-5.4%) survived with favourable neurologic outcomes. Factors associated with favourable neurologic outcomes include witnessed arrest (adjusted RR=2.42, p-value0.0001), bystander CPR (adjusted RR=1.57, p-value=0.004), first arrest shockable rhythm (adjusted RR=27.24, p-value0.0001), and cardiac etiology (adjusted RR=3.99, p-value0.0001).OHCA among young adults are not uncommon. Traumatic OHCA, occurring most frequently in young adults had dismal prognosis. First arrest rhythms of VF/VT/unknown shockable rhythm, cardiac etiology, bystander-witnessed arrest, and bystander CPR were associated with favourable neurological outcomes. The results of the study would be useful for planning preventive and interventional strategies, improving EMS, and guiding future research.

Background In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA. Methodology This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models. Results 40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR = 6.10, 95% confidence interval/CI = 5.06–7.34) and subsequent conversion to shockable rhythm (OR = 2.00,95%CI = 1.10–3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses. Conclusion Initial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy.

Introduction: Bystander cardiopulmonary resuscitation (B-CPR) may increase a victim’s chance of survival from sudden cardiac arrest (SCA), but B-CPR rates are low in many communities. Few studies have examined the association of city-wide public health interventions on B-CPR. Objectives: We sought to assess whether there is variation in B-CPR by intervention and location of arrest. We hypothesized that implementation of dispatch-assisted CPR (DA-CPR), CPR/AED training, and a first responder mobile application (myResponder) would increase B-CPR by two-fold. Methods: We conducted a retrospective study of adult, non-traumatic SCAs from the Singapore registry (4/2010-12/2016). Interventions included DA-CPR (7/2012 - present), CPR/AED training (04/2014 - present), and myResponder (4/2015 - present). Using logistic regression, we modeled the likelihood of receiving B-CPR by increased number of interventions over time. We examined these effects together, in the home, and public accounting for patient-level confounding. Results: From 2010-2016, the Singapore registry contained 12,546 SCA events. Excluding pediatric, EMS witnessed, and healthcare facility arrests, 7,476 were analyzed. Of these, mean age was 66±15 and 68% were male. B-CPR was administered in 45% of the events and varied by location (home: 43% v public: 52%). With implementation of DA-CPR, likelihood of B-CPR increased (OR: 3.5 (2.9-4.2) p Conclusion: City-level public health interventions increased the likelihood of layperson B-CPR, while variation was seen in the home and public. Understanding the impact of public health interventions may shed light on strategies to increase B-CPR and inform targeted initiatives to improve survival from SCA.

Objectives: The objective was to compare the survival outcomes of emergency medical services (EMS)-witnessed to bystander-witnessed, and unwitnessed out-of-hospital cardiac arrests (OHCA) in Singap...

Objective: We aimed to examine the association of ethnicity and socioeconomic status (SES) with Out-of-Hospital Cardiac Arrest (OHCA) incidence and 30-day survival in Singapore. Methods: We...

Hypoglycemia was part of the "H's and T's" in the 2005 American Heart Association ACLS guidelines for reversible causes of cardiac arrest but was removed in subsequent editions. We present a case of return of spontaneous circulation in a patient with cardiac arrest after administration of dextrose for hypoglycemia. Routine administration of dextrose to patients in cardiac arrest has been shown to be associated with increased mortality and worse neurological outcomes. However, this case reminds the clinician to consider hypoglycemia in patients with cardiac arrest, and to attempt correcting a low blood glucose if noted.

The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai).This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community.Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival.In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.

Background: Variability in post-resuscitation care of out-of-hospital cardiac arrests (OHCA) contributes to differences in survival outcomes. Interventions of significance include targeted temperature management (TTM) and percutaneous coronary intervention (PCI). In this study, we sought to determine the magnitude and factors involved. Methods: From April 2010 to December 2014, all consecutive OHCAs presenting to hospitals across Singapore were considered for analysis. Primary outcome was survival to discharge or 30 days. Secondary outcomes included survival to admission, and neurological outcome (Glasgow-Pittsburgh Cognitive Performance Categories ≤2). The effects of hospital-based resuscitative interventions and admitting hospital on outcome were compared using Chi-squared tests and multivariate logistic regression models. Results: A total of 7,609 OHCA cases were included from six hospitals in Singapore. TTM and PCI usage varied significantly (P

To evaluate the effects of a comprehensive dispatcher-assisted CPR (DACPR) training program on bystander CPR (BCPR) rate and the outcomes of out-of-hospital cardiac arrest (OHCA) in Singapore.This is an initial program evaluation of a national DACPR intervention. A before-after analysis was conducted using OHCA cases retrieved from a local registry and DACPR information derived from audio recordings and ambulance notes. The primary outcomes were survival to admission, survival at 30 days post-arrest and good functional recovery.Data was collected before the intervention (April 2010 to December 2011), during the run-in period (January 2012 to June 2012) and after the intervention (July 2012 to February 2013). A total of 2968 cases were included in the study with a mean age of 65.6. Overall survival rate was 3.9% (116) with good functional recovery in 2.2% (66) of the patients. BCPR rate increased from 22.4% to 42.1% (p0.001) with odds ratio (OR) of 2.52 (95% confidence interval [CI]: 2.09-3.04) and ROSC increased significantly from 26.5% to 31.2% (p=0.02) with OR of 1.26 (95%CI: 1.04-1.53) after the intervention. Significantly higher survival at 30 days was observed for patients who received BCPR from a trained person as compared to no BCPR (p=0.001, OR=2.07 [95%CI: 1.41-3.02]) and DACPR (p=0.04, OR=0.30 [95%CI: 0.04-2.18]).A significant increase in BCPR and ROSC was observed after the intervention. There was a trend to suggest improved survival outcomes with the intervention pending further results from the trial.

Aim. To determine the level of knowledge of signs and symptoms of heart attack and stroke in Singapore resident population, in comparison to the global community.Methods. A population based, random sample of 7,840 household addresses was selected from a validated national sampling frame. Each participant was asked eight questions on signs and symptoms of heart attack and 10 questions on stroke.Results.The response rate was 65.2% with 4,192 respondents. The level of knowledge for preselected, common signs and symptoms of heart attack and stroke was 57.8% and 57.1%, respectively. The respondents scored a mean of 5.0 (SD 2.4) out of 8 for heart attack, while they scored a mean of 6.8 (SD 2.9) out of 10 for stroke. Respondents who were ≥50 years, with lower educational level, and unemployed/retired had the least knowledge about both conditions. The level of knowledge of signs and symptoms of heart attack and stroke in Singapore is comparable to USA and Canada.Conclusion. We found a comparable knowledge of stroke and heart attack signs and symptoms in the community to countries within the same economic, educational, and healthcare strata. However older persons, those with lower educational level and those who are unemployed/retired, require more public health education efforts.