Eng Hock Ong Marcus, Chan Yiong Huak, Anantharaman Venkataraman, Lau Siew Tiang, Lim Swee Han, Seldrup Jorgen
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
Prehosp Emerg Care. 2003 Oct-Dec;7(4):427-33. doi: 10.1080/312703002120.
To describe the epidemiology of out-of-hospital cardiac arrest (OHCA) in Singapore, the emergency medical services (EMS) response, and to identify possible areas for improvement.
This prospective observational study constitutes phase I of the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Included were all patients with nontraumatic OHCA conveyed by the national emergency ambulance service. Patient characteristics, cardiac arrest circumstances, EMS response, and outcomes were recorded according to the Utstein style.
From October 1, 2001, to April 30, 2002, 548 patients were enrolled into the study. Mean (standard deviation [SD]) age was 62.2 (17.9) years, with a male predominance (65.6%). A total of 59.8% of collapses occurred at home, 35.3% of arrests were not witnessed, and bystander cardiopulmonary resuscitation was present for 20.6%. Mean (SD) time from collapse to call received by EMS was 10.6 (13.1) minutes. Mean (SD) EMS response time was 10.2 (4.3) minutes. Mean (SD) time from call to defibrillation was 16.7 (7.2) minutes. Mean (SD) on-scene time was 9.9 (4.5) minutes. First presenting rhythm at the scene was asystole in 54.5%, pulseless electrical activity 22.9%, ventricular fibrillation 19.6%, and ventricular tachycardia 0.4%. Of all cardiac arrests, 351 had resuscitation attempted and were of cardiac origin. Among these patients, 17.9% had return of spontaneous circulation, 8.5% survived to hospital admission, and 2.0% survived to discharge.
CARE I establishes the baseline for the evaluation of incremental introduction of prehospital Advanced Cardiac Life Support interventions planned for future phases. Continuing efforts should be made to strengthen all chains of survival. This represents the most comprehensive OHCA study yet conducted in Singapore.
描述新加坡院外心脏骤停（OHCA）的流行病学情况、紧急医疗服务（EMS）的响应情况，并确定可能需要改进的领域。
这项前瞻性观察性研究是心脏骤停与复苏流行病学（CARE）项目的第一阶段。纳入的患者均为由国家紧急救护服务运送的非创伤性OHCA患者。根据Utstein模式记录患者特征、心脏骤停情况、EMS响应情况及结果。
2001年10月1日至2002年4月30日，共有548例患者纳入研究。平均（标准差[SD]）年龄为62.2（17.9）岁，男性占多数（65.6%）。共59.8%的心脏骤停发生在家中，35.3%的心脏骤停未被目击，旁观者进行心肺复苏的比例为20.6%。从心脏骤停至EMS接到呼叫的平均（SD）时间为10.6（13.1）分钟。平均（SD）EMS响应时间为10.2（4.3）分钟。从呼叫至除颤的平均（SD）时间为16.7（7.2）分钟。平均（SD）现场时间为9.9（4.5）分钟。现场首次出现的心律情况为：心脏停搏占54.5%，无脉电活动占22.9%，心室颤动占19.6%，室性心动过速占0.4%。在所有心脏骤停患者中，351例尝试进行了复苏且为心脏源性。在这些患者中，17.9%恢复自主循环，8.5%存活至入院，2.0%存活至出院。
CARE I为评估计划在未来阶段逐步引入的院前高级心脏生命支持干预措施奠定了基线。应持续努力加强生存链的各个环节。这是新加坡迄今开展的最全面的OHCA研究。
