Duke-NUS Graduate School of Medicine, Singapore.
Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.
Resuscitation. 2015 Apr;89:155-61. doi: 10.1016/j.resuscitation.2015.01.034. Epub 2015 Feb 11.
We aim to study if there has been an improvement in survival for Out-of-Hospital Cardiac Arrest (OHCA) in Singapore, the effects of various interventional strategies over the past 10 years, and identify strategies that contributed to improved survival.
Rates of OHCA survival were compared between 2001-2004 and 2010-2012, using nationwide data for all OHCA presenting to EMS and public hospitals. A multivariate logistic regression model for survival to discharge was constructed to identify strategies with significant impact.
A total of 5453 cases were included, 2428 cases from 2001 to 2004 and 3025 cases from 2010 to 2012. There was significant improvement in Utstein (witnessed, shockable) survival to discharge from 2001-2004 (2.5%) to 2010-2012 (11.0%), adjusted odds ratio (OR) 9.6 [95% CI: 2.2-41.9]). Overall survival to discharge increased from 1.6% to 3.2% (adjusted OR 2.2 [1.5-3.3]). Bystander CPR rates increased from 19.7% to 22.4% (p=0.02). The multivariate regression model (adjusted for important non-modifiable risk factors) showed that response time <8min (OR 1.5 [1.0-2.3]), bystander AED (OR 5.8 [2.0-16.2]), and post-resuscitation hypothermia (OR 30.0 [11.5-78.0]) were significantly associated with survival to hospital discharge. Conversely, pre-hospital epinephrine (OR 0.6 [0.4-0.9]) was associated negatively with survival.
OHCA survival has improved in Singapore over the past 10 years. Improvement in response time, public AEDs and post-resuscitation hypothermia appear to have contributed to the increase in survival. Singapore's experience might suggest that developing EMS systems should focus on reducing times to basic life support, including bystander defibrillation and post-resuscitation care.
本研究旨在探讨新加坡院外心脏骤停（OHCA）患者生存率的变化，以及过去 10 年中各种干预策略的效果，并确定提高生存率的策略。
利用全国范围内所有因 OHCA 被 EMS 和公立医院收治的患者数据，比较 2001-2004 年和 2010-2012 年 OHCA 患者的生存率。构建了一个用于出院生存率的多变量逻辑回归模型，以确定具有显著影响的策略。
共纳入 5453 例患者，其中 2001-2004 年 2428 例，2010-2012 年 3025 例。乌斯泰因（目击者、可电击）出院生存率从 2001-2004 年的 2.5%显著提高至 2010-2012 年的 11.0%，调整后的优势比（OR）为 9.6（95%CI：2.2-41.9）。总体出院生存率从 1.6%提高至 3.2%（调整后的 OR 为 2.2（1.5-3.3））。旁观者心肺复苏（CPR）率从 19.7%提高至 22.4%（p=0.02）。多变量回归模型（调整了重要的不可改变的风险因素）显示，反应时间<8min（OR 1.5[1.0-2.3]）、旁观者 AED（OR 5.8[2.0-16.2]）和复苏后低体温（OR 30.0[11.5-78.0]）与出院生存率显著相关。相反，院前肾上腺素（OR 0.6[0.4-0.9]）与生存率呈负相关。
在过去 10 年中，新加坡 OHCA 患者的生存率有所提高。反应时间、公众 AED 和复苏后低体温的改善似乎是生存率提高的原因。新加坡的经验表明，发展 EMS 系统应侧重于缩短基本生命支持的时间，包括旁观者除颤和复苏后护理。
