Abstract
Aims
Singapore 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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: March 23, 2020
Accepted:
March 9,
2020
Received in revised form:
February 26,
2020
Received:
December 23,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
