An essential review of Singapore’s response to out-of-hospital cardiac arrests: improvements over a ten-year period

Abstract

Care for patients who experience out-of-hospital cardiac arrest (OHCA) has rapidly evolved in the past decade. Increased sophistication of care in the community, emergency medical services (EMS) and hospital setting is associated with improved patient-centred outcomes. Notably, Utstein survival doubled from 11.6% to 23.1% between 2011 and 2016. These achievements involved collaboration between policymakers, clinicians and researchers, and were made possible by a strategic interplay of policy, research and implementation. We review the development and current state of OHCA in Singapore using primary population-based data from the Pan-Asian Resuscitation Outcomes Study and an unstructured search of research databases. We discuss the roles of important milestones in policy, community, dispatch, EMS and hospital interventions. Finally, we relate these interventions to relevant processes and outcomes, such as the relationship between the strategic implementation of bystander cardiopulmonary resuscitation and placement of automated external defibrillator with return of spontaneous circulation, survival to discharge and survival with favourable neurological outcomes.

Incidence and Long‐Term Outcomes of Acute Myocardial Infarction Among Survivors of Out‐of‐Hospital Cardiac Arrest

“…PAROS is an international, multicenter, prospective registry for OHCA established in 2009 across the Asia‐Pacific region as part of a clinical research network for resuscitation involving up to 13 different countries. 12 This study uses only data on Singapore participants of PAROS 13 , 14 and captures all OHCAs conveyed by emergency medical services or presenting at emergency departments, confirmed by absence of pulse, unresponsiveness, and apnea. 12 The PAROS data were then linked with both the AMI registry and death registry to determine the survival status and duration of the survivors of OHCA after OHCA and after subsequent AMI.…”

Development of prehospital emergency care in Singapore

“…The community programs pushed by the NRC, introduction of annual National Life Saving Days, promotion of CPR + AED training programs for the public since 2005, and the piloting of AEDs in public housing estates with training in these skills provided near their places of residence in 2008 all helped to push the numbers of Singapore residents trained annually in these skills to about 180,000 persons per annum in 2017. These also resulted in an increase in the bystander CPR rate from 21% in 2002 to more than 60.9% in 2020 / [ 16 ] and contributed to an improvement in the rate of survival of out-of-hospital cardiac arrest patient at hospital discharge from 2.0% in 2002 [ 17 ] to 25.9% in 2018 [ 18 ].…”

“…In 2011, mechanical CPR was piloted in a limited number of SCDF ambulances. The pilot demonstrated doubling of rates of survival to hospital discharge for out-of-hospital cardiac arrest if the device was started at site [ 18 ]. Its use has since been extended to all emergency ambulances.…”

The Real Experience of Lay Responders Performing Cardiopulmonary Resuscitation: A Synthesis of Qualitative Evidence

“…However, it is of note that the percentage of OHCA patients receiving bystander CPR is significantly low worldwide, ranging between 35% and 45% [13], notwithstanding a myriad of CPRrelated training for lay responders [14]. Towards this end, extensive public education has been conducted to encourage lay responders to initiate CPR for unconscious victims who are not breathing [15], but this still cannot adequately prepare lay responders for OHCA patients.…”