title: A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore.
abstract: OBJECTIVE
  To evaluate the effects of a comprehensive dispatcher-assisted CPR (DACPR) training program on bystander CPR (BCPR) rate and the outcomes of out-of-hospital cardiac arrest (OHCA) in Singapore.
  
  
  METHODS
  This is an initial program evaluation of a national DACPR intervention. A before-after analysis was conducted using OHCA cases retrieved from a local registry and DACPR information derived from audio recordings and ambulance notes. The primary outcomes were survival to admission, survival at 30 days post-arrest and good functional recovery.
  
  
  RESULTS
  Data was collected before the intervention (April 2010 to December 2011), during the run-in period (January 2012 to June 2012) and after the intervention (July 2012 to February 2013). A total of 2968 cases were included in the study with a mean age of 65.6. Overall survival rate was 3.9% (116) with good functional recovery in 2.2% (66) of the patients. BCPR rate increased from 22.4% to 42.1% (p<0.001) with odds ratio (OR) of 2.52 (95% confidence interval [CI]: 2.09-3.04) and ROSC increased significantly from 26.5% to 31.2% (p=0.02) with OR of 1.26 (95%CI: 1.04-1.53) after the intervention. Significantly higher survival at 30 days was observed for patients who received BCPR from a trained person as compared to no BCPR (p=0.001, OR=2.07 [95%CI: 1.41-3.02]) and DACPR (p=0.04, OR=0.30 [95%CI: 0.04-2.18]).
  
  
  CONCLUSIONS
  A significant increase in BCPR and ROSC was observed after the intervention. There was a trend to suggest improved survival outcomes with the intervention pending further results from the trial.
authors.affiliation: Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Sumitro
authors.initials: S
authors.lastname: Harjanto
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: May Xue Bi
authors.initials: MX
authors.lastname: Na
authors.affiliation: Division of Research, Singapore General Hospital, Singapore, Singapore.
authors.forename: Ying
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Medical Department, Singapore Civil Defence Force, Singapore, Singapore.
authors.forename: Yih Yng
authors.initials: YY
authors.lastname: Ng
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Nausheen
authors.initials: N
authors.lastname: Doctor
authors.affiliation: Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: E Shaun
authors.initials: ES
authors.lastname: Goh
authors.affiliation: Emergency Medicine Department, National University Hospital, Singapore, Singapore.
authors.forename: Benjamin Sieu-Hon
authors.initials: BS
authors.lastname: Leong
authors.affiliation: Accident & Emergency, Changi General Hospital, Singapore, Singapore.
authors.forename: Han Nee
authors.initials: HN
authors.lastname: Gan
authors.affiliation: Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Michael Yih Chong
authors.initials: MY
authors.lastname: Chia
authors.affiliation: Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore.
authors.forename: Lai Peng
authors.initials: LP
authors.lastname: Tham
authors.affiliation: Emergency Medicine Department, Alexandra Hospital, Singapore, Singapore.
authors.forename: Si Oon
authors.initials: SO
authors.lastname: Cheah
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Nur
authors.initials: N
authors.lastname: Shahidah
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore. Electronic address: marcus.ong.e.h@sgh.com.sg.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Dispatcher-assisted; Survival