Out-of-hospital cardiac arrests occurring in primary health care facilities in Singapore.
OBJECTIVE
To study out-of-hospital cardiac arrests (OHCA) occurring in primary healthcare facilities (HCF) in Singapore and to compare these with arrests occurring in the community.


METHODS
This prospective observational study was part of the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Included were all patients with OHCA occurring in HCF. Patient characteristics, cardiac arrest circumstances, EMS response and outcomes were recorded according to the Utstein style.


RESULTS
From 1 October 2001 to 14 October 2004, the data from 2428 subjects were received of which 138 patients were OHCA occurring in HCF. This is an incidence of 1.12/100,000 population per year and constituted 6.0% of all OHCA. Arrest occurring in HCF were more likely to be witnessed (p<0.01), or have bystander CPR (p<0.01). The HCF group was also more likely to receive CPR with both compression and ventilation (p<0.01) and have a non-trauma cause of arrest (p=0.03). HCF arrests also had a shorter collapse to call (EMS number) than the non-HCF group (HCF 1.54min versus non-HCF 5.36min, p=0.01). However, no HCF patient received defibrillation prior to EMS arrival. HCF patients were more likely to have return of spontaneous circulation at any time (p=0.05), survival to hospital admission (p<0.01) and survival to discharge (p<0.01) compared to non-HCF patients.


CONCLUSIONS
This study suggests that primary health care providers do have an important role locally in managing out-of-hospital cardiac arrest. We propose an initiative to encourage early defibrillation by primary health care providers.
Ong
Marcus Eng Hock
ME
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. marcus.omg.e.h@sgh.com.sg
Yan
Xiuyuan
X
Lau
Gilbert
G
Tan
Eng Hoe
EH
Panchalingham
Anushia
A
Leong
Benjamin Sieu-Hon
BS
Ong
Victor Yeok Kein
VY
Tiah
Ling
L
Yap
Susan
S
Lim
Swee Han
SH
Venkataraman
Anantharaman
A
D000552:Ambulances; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology