학술논문
Inter-hospital trends of post-resuscitation interventions and outcomes of out-of-hospital cardiac arrest in Singapore.
Document Type
Academic Journal
Author
Jaffar JLY; Ministry of Health Holdings, Singapore.; Fook-Chong S; Shahidah N; Ho AFW; Ng YY; Arulanandam S; White A; Liew LX; Asyikin N; Leong BSH; Gan HN; Mao D; Chia MYC; Cheah SO; Ong MEH
Source
Publisher: Academy Of Medicine, Singapore Country of Publication: Singapore NLM ID: 7503289 Publication Model: Print Cited Medium: Internet ISSN: 2972-4066 (Electronic) Linking ISSN: 03044602 NLM ISO Abbreviation: Ann Acad Med Singap Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Hospital-based resuscitation interventions, such as therapeutic temperature management (TTM), emergency percutaneous coronary intervention (PCI) and extracorporeal membrane oxygenation (ECMO) can improve outcomes in out-of-hospital cardiac arrest (OHCA). We investigated post-resuscitation interventions and hospital characteristics on OHCA outcomes across public hospitals in Singapore over a 9-year period.
Methods: This was a prospective cohort study of all OHCA cases that presented to 6 hospitals in Singapore from 2010 to 2018. Data were extracted from the Pan-Asian Resuscitation Outcomes Study Clinical Research Network (PAROS CRN) registry. We excluded patients younger than 18 years or were dead on arrival at the emergency department. The outcomes were 30-day survival post-arrest, survival to admission, and neurological outcome.
Results: The study analysed 17,735 cases. There was an increasing rate of provision of TTM, emergency PCI and ECMO ( P <0.001) in hospitals, and a positive trend of survival outcomes ( P <0.001). Relative to hospital F, hospitals B and C had lower provision rates of TTM (≤5.2%). ECMO rate was consistently <1% in all hospitals except hospital F. Hospitals A, B, C, E had <6.5% rates of provision of emergency PCI. Relative to hospital F, OHCA cases from hospitals A, B and C had lower odds of 30-day survival (adjusted odds ratio [aOR]<1; P <0.05 for hospitals A-C) and lower odds of good neurological outcomes (aOR<1; P <0.05 for hospitals A-C). OHCA cases from academic hospitals had higher odds ratio (OR) of 30-day survival (OR 1.3, 95% CI 1.1-1.5) than cases from hospitals without an academic status.
Conclusion: Post-resuscitation interventions for OHCA increased across all hospitals in Singapore from 2010 to 2018, correlating with survival rates. The academic status of hospitals was associated with improved survival.
Methods: This was a prospective cohort study of all OHCA cases that presented to 6 hospitals in Singapore from 2010 to 2018. Data were extracted from the Pan-Asian Resuscitation Outcomes Study Clinical Research Network (PAROS CRN) registry. We excluded patients younger than 18 years or were dead on arrival at the emergency department. The outcomes were 30-day survival post-arrest, survival to admission, and neurological outcome.
Results: The study analysed 17,735 cases. There was an increasing rate of provision of TTM, emergency PCI and ECMO ( P <0.001) in hospitals, and a positive trend of survival outcomes ( P <0.001). Relative to hospital F, hospitals B and C had lower provision rates of TTM (≤5.2%). ECMO rate was consistently <1% in all hospitals except hospital F. Hospitals A, B, C, E had <6.5% rates of provision of emergency PCI. Relative to hospital F, OHCA cases from hospitals A, B and C had lower odds of 30-day survival (adjusted odds ratio [aOR]<1; P <0.05 for hospitals A-C) and lower odds of good neurological outcomes (aOR<1; P <0.05 for hospitals A-C). OHCA cases from academic hospitals had higher odds ratio (OR) of 30-day survival (OR 1.3, 95% CI 1.1-1.5) than cases from hospitals without an academic status.
Conclusion: Post-resuscitation interventions for OHCA increased across all hospitals in Singapore from 2010 to 2018, correlating with survival rates. The academic status of hospitals was associated with improved survival.