More individuals are suffering from cardiac arrests in Singapore. However, with the concerted efforts of SingHealth and other agencies, the survival rates have improved from 2 to 25 per cent.

More than 3,000 cardiac arrests happen outside of hospitals in Singapore annually. Termed ‘out-of-hospital cardiac arrest’ (OHCA) cases, this figure is expected to rise, said Professor Marcus Ong (below), Senior Consultant, Department of Emergency Medicine, Singapore General Hospital (SGH). Prof Ong is concurrently the chairman of the Pan Asian Resuscitation Outcomes Study (PAROS) network, which conducts pre-hospital and emergency care (PEC) research and encourages collaboration within the industry to improve PEC.

“There are several possible factors driving the increase in OHCA locally. We have a rapidly ageing population.

The burden of chronic disease — such as hypertension, diabetes and heart disease that predisposes one to sudden cardiac death — is still increasing. We are also doing a better job of capturing data on such events,” Prof Ong explained. This trend is consistent with what is being seen in developing countries. However, in some advanced economies, the number of OHCA has been stable or even declining, in tandem with a decrease in risk factors for heart disease (smoking, hypertension, diabetes, etc).

When it comes to improving the survival rates of OHCA cases, every minute counts. If a bystander administers cardiopulmonary resuscitation (CPR) or uses an automated external defibrillator (AED) immediately, it can increase the patient’s chances of survival by 50 per cent. Prof Ong explained that help from the community in saving lives forms a crucial part of the PEC system, since 70 to 80 per cent of OHCA cases occur in the home or public places where there is often a bystander — a relative or a member of the public — nearby.

“The PEC system can be described using the ‘chain of survival’ concept. The chain of survival is a series of interconnected links that all need to be working well for someone to survive a cardiac arrest,” Prof Ong shared. There are three key elements to the chain of survival: community, dispatch and hospital. The community can help to recognise cardiac arrest early, provide CPR and use an AED to help the patient, while dispatch entails the early activation of the 995 system so that the Singapore Civil Defence Force (SCDF) can send the appropriate help for early advanced care and, lastly, the hospital that provides post-resuscitation care.

Prof Ong noted that, in the last 10 years, Singapore has made tremendous progress in the survival rates of OHCA cases. Community interventions increase bystander CPR and defibrillation before ambulance arrival that can increase survival rates several fold. “Initiatives such as CPR training in schools, during national service and through the DARE (Dispatcher-Assisted First Responder) programme, dispatcher-assisted CPR and the MyResponder application have allowed Singapore’s bystander CPR rates to increase from 20 per cent to more than 50 per cent today. We are also seeing a fivefold increase in the use of AEDs through the Save-A-Life (SAL) programme and mapping of public AEDs.”

Advanced treatments by firefighters and ambulance crews (high-performance CPR, devices to deliver drugs, open the airway, and mechanical CPR) and at the hospital (cooling to protect vital organs, opening blocked arteries, heart-lung bypass) mean that more than 70 per cent of survivors have good brain function on discharge.

To further increase the survival rates of OHCA patients, Prof Ong revealed that SingHealth has several ongoing research initiatives for the next five years. “We will introduce to our community volunteers on MyResponder new interventions like TCPRLINK, which will equip them with a credit card-sized CPR feedback device and a phone app that will enable video-coaching by a dispatcher,” he said.

Beyond that, there are also plans for a trial to equip volunteers with nextgeneration AEDs, which are lighter and more compact. Advanced treatments by firefighters and ambulance crews will also continue to evolve.

Pre-Hospital Emergency Care Programme in Southeast Asia (PEC)

In May 2022, SingHealth and Temasek Foundation launched the Pre-Hospital Emergency Care Programme in Southeast Asia (PEC) to improve survival and outcomes for patients with medical emergencies. The programme was developed in collaboration with the Asian Association for Emergency Medical Services (AAEMS) and the Pan Asian Resuscitation Outcomes Study (PAROS) network.

The three-year ground-up programme aims to train 250 participants from Indonesia, Malaysia, Vietnam, Thailand and the Philippines on emergency skills required to recognise, intervene and treat pre-hospital emergency cases. The participants include healthcare officials and workers, ambulance personnel, emergency first responders as well as leaders of community organisations. Of these participants, 30 will also be equipped to be Master Trainers; they will help to enhance the PEC systems in their respective countries and train other professionals and community partners.

The first run of the programme, with 30 participants, was completed in November 2022. A second run was held with the Master Trainers in February 2023.

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