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Cited by 55Cardiac Arrest and ResuscitationPalliative Care and End-of-Life IssuesMechanical Circulatory Support Devices

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Effectiveness of a community based out-of-hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study

Tay, Pamela Jia Min, Pek, Pin Pin, Fan, Qiao, Ng, Yih Yng, Leong, Benjamin Sieu-Hon, Gan, Han Nee, Mao, Desmond Renhao, Chia, Michael Yih Chong, Cheah, Si Oon, Doctor, Nausheen, Tham, Lai Peng, Ong, Marcus Eng Hock·2020·Resuscitation
DOI 10.1016/j.resuscitation.2019.10.015
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Abstract

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.

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Metadata

Authors
Tay, P. J. M., Pek, P. P., Fan, Q., Ng, Y. Y., Leong, B. S.-H., Gan, H. N., Mao, D. R., Chia, M. Y. C., Cheah, S. O., Doctor, N., Tham, L. P., & Ong, M. E. H.
Affiliations
  • Duke-NUS Medical School (SG)
  • Singapore General Hospital (SG)
  • Tan Tock Seng Hospital (SG)
  • National University Hospital (SG)
  • Changi General Hospital (SG)
  • Khoo Teck Puat Hospital (SG)
  • Ng Teng Fong General Hospital (SG)
  • Sengkang General Hospital (SG)
  • KK Women's and Children's Hospital (SG)
  • SingHealth (SG)
Corresponding author
Tay, Pamela Jia Min
ORCID
Venue
Resuscitation
Publisher
Elsevier BV
Published
2020-01
Volume
146
Pages
220-228
ISSN
0300-9572 (ISSN-L)
DOI
10.1016/j.resuscitation.2019.10.015
OpenAlex
W2989420895
Cited by
55
References
1
Citations by year
2026: 5 · 2025: 12 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 13 · 2020: 10
FWCI
8.22
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Resuscitation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Ministry of Health -Singapore (HSRG/ 0021/2012)
  • Ministry of Health
  • National Medical Research Council (NMRC/CSA/ 0049/2013, NMRC/CSA/ 024/2010)
  • Ministerio de Sanidad, Consumo y Bienestar Social
Topics
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
Keywords
out-of-hospital cardiac arrest, bystander CPR, dispatcher-assisted CPR, automated external defibrillators, public housing, mobile application, return of spontaneous circulation, survival, community-based intervention, Singapore, OHCA registry, prehospital care, public health policy evaluation, stepped wedge design
MeSH terms
Emergency Medical Dispatcher, Emergency Medical Services, Female, Humans, Male, Middle Aged, Pilot Projects, Singapore, Program Evaluation, Survival Analysis, Cardiopulmonary Resuscitation, Community Networks, Defibrillators, Out-of-Hospital Cardiac Arrest, Quality Improvement, Patient Care Bundles

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