Resuscitation for patients with out-of-hospital cardiac arrest: Singapore.
OBJECTIVE
To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients.


METHODS
All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation.


RESULTS
Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 +/- 3.36 minutes for the survivors and 11.8 +/- 4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 +/- 4.61 minutes for the survivors and 12.0 +/- 4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 +/- 8.32 minutes for the survivors and 37.2 +/- 9.00 minutes for the non-survivors.


CONCLUSIONS
The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is > or = 30 minutes coupled with no ROSC, and if continuous asystole has been documented for > 10 minutes.
Lim
Ghee Hian
GH
Emergency Department, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore. ghee_hian_lim@ttsh.com.sg
Seow
Eillyne
E
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D013996:Time and Motion Studies