Comparing outcomes of out-of-hospital cardiac arrest patients with initial shockable rhythm in Singapore and Osaka using population-based databases.

BACKGROUND: Previous research indicated outcomes among refractory out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm were different in Singapore and Osaka, Japan, possibly due to the differences in access to extracorporeal cardiopulmonary resuscitation. However, this previous study had a risk of selection bias. To address this concern, this study aimed to evaluate the outcomes between Singapore and Osaka for OHCA patients with initial shockable rhythm using only population-based databases. METHODS: This was a secondary analysis of two OHCA population-based databases in Osaka and Singapore, including adult OHCA patients with initial shockable rhythm. A machine-learning-based prediction model was derived from the Osaka data (n = 3088) and applied to the PAROS-SG data (n = 2905). We calculated the observed-expected ratio (OE ratio) for good neurological outcomes observed in Singapore and the expected derived from the data in Osaka by dividing subgroups with or without prehospital ROSC. RESULTS: The one-month good neurological outcomes in Osaka and Singapore among patients with prehospital ROSC were 70% (791/1,125) and 57% (440/773), and among patients without prehospital ROSC were 10% (196/1963) and 2.8% (60/2,132). After adjusting patient characteristics, the outcome in Singapore was slightly better than expected from Osaka in patients with ROSC (OE ratio, 1.067 [95%CI 1.012 to 1.125]), conversely, it was worse than expected in patients without prehospital ROSC (OE ratio, 0.238 [95%CI 0.173 to 0.294]). CONCLUSION: This study showed the outcomes of OHCA patients without prehospital ROSC in Singapore were worse than expected derived from Osaka data even using population-based databases. (249/250 words).

National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.

AIM: This study aimed to assess knowledge, attitudes and practices among Singapore residents towards life-saving skills and providing emergency assistance in the community using a population representative sample. METHODS: A population based, random sample of 7840 household addresses were selected from a validated national sampling frame. Respondents were interviewed using face-to-face interview method. One adult aged between 18 and 69 years within each household was randomly selected using the "next birthday" method. RESULTS: The response rate achieved was 65.2% with 4192 respondents. The distribution of age, gender and ethnic group were similar to the Singapore resident population for 2009. A high proportion of participants believed that adults should be trained in first aid (89.1%) and cardiopulmonary resuscitation (CPR) (82.6%) while a lower proportion (57.2%) believed this for automated external defibrillator (AED). Proportion who had ever been trained in first aid was 34.3%, CPR was 31.4% and AED was 10.7%. In an emergency, respondents were most willing to use life-saving skills on family members or relatives (87.6%), followed by friends and colleagues (80.7%) and complete strangers (61.3%). Common barriers to applying life-saving skills were lack of knowledge (36%), fear of doing harm (22.1%) and lack of confidence (15.3%). Respondents who were more likely to have current life-saving certification were younger employed Malay male (p<0.05). CONCLUSION: This study found that although a high proportion of respondents believed that adults should be trained in first aid, CPR and AED, the proportion who had ever been trained in these skills are much lower.