Sarah A K, Mohd Sidqi M S, Md Noor J, Wong K D, Umul K M, Low M Y, Chia B Y, Sharifah F S A, Mahathar A W
Hospital Kuala Lumpur, Emergency and Trauma Department, Wilayah Persekutuan Kuala Lumpur, Malaysia.
Hospital Sultanah Bahiyah, Emergency and Trauma Department, Alor Setar, Kedah, Malaysia.
Med J Malaysia. 2025 Mar;80(2):147-152.
IOut-of-hospital cardiac arrest (OHCA) is globally a critical, time-sensitive emergency with varying outcomes. In Asia, the Pan Asian Resuscitation Outcome Study reported survival rates between 0.5% to 8.5%. We aim to describe the characteristics and outcomes of OHCA cases responded to by Emergency Medical Services (EMS) across several cities in Sarawak, Penang and Klang Valley in Malaysia.
This retrospective observational study analysed EMS data from Sarawak, Penang and Klang Valley from 2010 to 2019. All OHCA cases where EMS performed cardiopulmonary resuscitation (CPR) were included, regardless of age or aetiology. The primary outcome was survival to hospital admission with the secondary outcome a return of spontaneous circulation (ROSC) prior to Emergency Department arrival.
A total of 2,435 OHCA cases were analysed. Median patient age was 58 years, 70% of them are male with 63% had underlying medical conditions, with hypertension being the most common. Out of all cases, 71% of arrests occurred at home, 60% witnessed. Median time from arrest to 999 call was 20 minutes, median time for ambulance arrival thereafter is 17 minutes. Bystander CPR rate was 38%, bystander Automated External Defibrillator (AED) use 1.5- 2.6%. Detection of shockable rhythm on first analysis by EMS was 3.9 to 7.7%. Overall survival to admission rate was 4.76%. ROSC rate before Emergency Department arrival was 2.8%. Survival to admission among bystander-witnessed arrests with shockable rhythm was 14.7%.
Survival to admission rates for OHCA patients in the studied Malaysian regions (1.3-6.7%) are lower compared to some Asian countries. Areas for improvement include reducing time from arrest to 999 calls, decreasing time to EMS arrival, and increasing bystander CPR and AED use rates. Implementing the Utstein ten-step implementation strategy, focusing on community-based interventions and improving EMS response, could potentially enhance survival rates in Malaysia.
院外心脏骤停（OHCA）在全球范围内都是一种危急且对时间敏感的紧急情况，其结果各不相同。在亚洲，泛亚复苏结局研究报告的生存率在0.5%至8.5%之间。我们旨在描述马来西亚砂拉越、槟城和巴生谷多个城市的紧急医疗服务（EMS）所应对的OHCA病例的特征和结局。
这项回顾性观察研究分析了2010年至2019年来自砂拉越、槟城和巴生谷的EMS数据。纳入所有EMS进行心肺复苏（CPR）的OHCA病例，无论年龄或病因如何。主要结局是存活至入院，次要结局是在急诊科到达之前恢复自主循环（ROSC）。
共分析了2435例OHCA病例。患者中位年龄为58岁，其中70%为男性，63%有基础疾病，高血压最为常见。在所有病例中，71%的心脏骤停发生在家中，60%为有目击者的情况。从心脏骤停到拨打999的中位时间为20分钟，此后救护车到达的中位时间为17分钟。旁观者心肺复苏率为38%，旁观者自动体外除颤器（AED）使用率为1.5%至2.6%。EMS首次分析时可电击心律的检测率为3.9%至7.7%。总体存活至入院率为4.76%。急诊科到达之前的ROSC率为2.8%。有目击者且为可电击心律的心脏骤停患者存活至入院的比例为14.7%。
与一些亚洲国家相比，所研究的马来西亚地区OHCA患者的存活至入院率（1.3%至6.7%）较低。需要改进的方面包括减少从心脏骤停到拨打999的时间、缩短EMS到达时间以及提高旁观者心肺复苏和AED使用率。实施乌斯坦十步实施策略，侧重于基于社区的干预措施并改善EMS反应，可能会提高马来西亚的生存率。
