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An essential review of Singapore’s response to out-of-hospital cardiac arrests: improvements over a ten-year period
Authors:Alexander E White  Andrew FW Ho  Nur Shahidah  Nurul Asyikin  Le Xuan Liew  Pin Pin Pek  Jade PH Kua  Michael YC Chia  Yih Yng Ng  Shalini Arulanandam  Sieu-Hon Benjamin Leong  Marcus EH Ong
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.
Keywords:CPR+AED  dispatchers  feedback  out-of-hospital cardiac arrest  smartphone applications
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