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Ong CA, Nadarajan GD, Fook-Chong S, Shahidah N, Arulanandam S, Ng YY, Chia MYC, Tiah L, Mao DR, Ng WM, Leong BSH, Doctor N, Ong MEH, Siddiqui FJ. Increasing neurologically intact survival after out-of-hospital cardiac arrest among elderly: Singapore Experience. Resusc Plus 2024; 17:100573. [PMID: 38370311 PMCID: PMC10869923 DOI: 10.1016/j.resplu.2024.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives With more elderly presenting with Out-of-Hospital Cardiac Arrests (OHCAs) globally, neurologically intact survival (NIS) should be the aim of resuscitation. We aimed to study the trend of OHCA amongst elderly in a large Asian registry to identify if age is independently associated with NIS and factors associated with NIS. Methods All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18-64, 65-79, 80-89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS. Results 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18-64, 65-79- and 80-89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR. Conclusions Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.
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Affiliation(s)
- Chloe Alexis Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore
| | | | | | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Shalini Arulanandam
- Military Medicine Institute, Singapore Armed Forces Medical Corps, Singapore
| | - Yih Yng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation, Tan Tock Seng Hospital, Singapore
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Ling Tiah
- Accident & Emergency, Changi General Hospital, Singapore
| | - Desmond R Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Nausheen Doctor
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Fahad J Siddiqui
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
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Lim SL, Chan SP, Shahidah N, Ng QX, Ho AFW, Arulanandam S, Leong BSH, Ong MEH. Temporal trends in out-of-hospital cardiac arrest with an initial non-shockable rhythm in Singapore. Resusc Plus 2023; 16:100473. [PMID: 37727148 PMCID: PMC10506095 DOI: 10.1016/j.resplu.2023.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Aim Out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm is the predominant form of OHCA in adults. We evaluated its 10-year trends in epidemiology and management in Singapore. Methods Using the national OHCA registry we studied the trends of 20,844 Emergency Medical Services-attended adult OHCA from April 2010 to December 2019. Survival to hospital discharge was the primary outcome. Trends and outcomes were analyzed using linear and logistic regression, respectively. Results Incidence rates of adult OHCAs increased during the study period, driven by non-shockable OHCA. Compared to shockable OHCA, non-shockable OHCAs were significantly older, had more co-morbidities, unwitnessed and residential arrests, longer no-flow time, and received less bystander cardiopulmonary resuscitation (CPR) and in-hospital interventions (p < 0.001). Amongst non-shockable OHCA, age, co-morbidities, residential arrests, no-flow time, time to patient, bystander CPR and epinephrine administration increased during the study period, while presumed cardiac etiology decreased (p < 0.05). Unlike shockable OHCA, survival for non-shockable OHCA did not improve (p < 0.001 for trend difference). The likelihood of survival for non-shockable OHCA significantly increased with witnessed arrest (adjusted odds ratio (aOR) 2.02) and bystander CPR (aOR 3.25), but decreased with presumed cardiac etiology (aOR 0.65), epinephrine administration (aOR 0.66), time to patient (aOR 0.93) and age (aOR 0.98). Significant two-way interactions were observed for no-flow time and residential arrest with bystander CPR (aOR 0.96 and 0.40 respectively). Conclusion The incidence of non-shockable OHCA increased between 2010 and 2019. Despite increased interventions, survival did not improve for non-shockable OHCA, in contrast to the improved survival for shockable OHCA.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular Research Institute, National University Heart Centre, Singapore
| | - Nur Shahidah
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Andrew Fu Wah Ho
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Shalini Arulanandam
- Military Medicine Institute, Singapore Armed Forces Medical Corps, Singapore
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Goh JL, Pek PP, Fook-Chong SMC, Ho AFW, Siddiqui FJ, Leong BSH, Mao DRH, Ng W, Tiah L, Chia MYC, Tham LP, Shahidah N, Arulanandam S, Ong MEH. Impact of time-to-compression on out-of-hospital cardiac arrest survival outcomes: A national registry study. Resuscitation 2023; 190:109917. [PMID: 37506813 DOI: 10.1016/j.resuscitation.2023.109917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We aimed to quantify the association of no-flow interval in out-of-hospital cardiac arrests (OHCA) with the odds of neurologically favorable survival and survival to hospital discharge/ 30th day. Our secondary aim was to explore futility thresholds to guide clinical decisions, such as prehospital termination of resuscitation. METHODS All OHCAs from 2012 to 2017 in Singapore were extracted. We examined the association between no-flow interval (continuous variable) and survival outcomes using univariate and multivariable logistic regressions. The primary outcome was survival with favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1/2), the secondary outcome was survival to hospital discharge/ 30th day if not discharged. To determine futility thresholds, we plotted the adjusted probability of good neurological outcomes to no-flow interval. RESULTS 12,771 OHCAs were analyzed. The per-minute adjusted OR when no-flow interval was incorporated as a continuous variable in the multivariable model was: good neurological function- aOR 0.98 (95%CI: 0.97-0.98); survival to discharge- aOR 0.98 (95%CI: 0.98-0.99). Taking the 1% futility of survival line gave a no-flow interval cutoff of 12 mins (NPV 99%, sensitivity 85% and specificity 42%) overall and 7.5 mins for witnessed arrests. CONCLUSION We demonstrated that prolonged no-flow interval had a significant effect on lower odds of favorable neurological outcomes, with medical futility occurring when no-flow interval was >12 mins (>7.5 mins for witnessed arrest). Our study adds to the literature of the importance of early CPR and EMS response and provided a threshold beyond traditional 'down-times', which could aid clinical decisions in TOR or OHCA management.
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Affiliation(s)
- Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Pin Pin Pek
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Andrew F W Ho
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Fahad Javaid Siddiqui
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore
| | | | | | - Weiming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Ling Tiah
- Accident & Emergency, Changi General Hospital, Singapore
| | | | - Lai Peng Tham
- Children's Emergency, KK Women's and Children's Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
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Wang H, Ng QX, Arulanandam S, Tan C, Ong MEH, Feng M. Building a Machine Learning-based Ambulance Dispatch Triage Model for Emergency Medical Services. Health Data Sci 2023; 3:0008. [PMID: 38487206 PMCID: PMC10880163 DOI: 10.34133/hds.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/05/2023] [Indexed: 03/17/2024]
Abstract
Background In charge of dispatching the ambulances, Emergency Medical Services (EMS) call center specialists often have difficulty deciding the acuity of a case given the information they can gather within a limited time. Although there are protocols to guide their decision-making, observed performance can still lack sensitivity and specificity. Machine learning models have been known to capture complex relationships that are subtle, and well-trained data models can yield accurate predictions in a split of a second. Methods In this study, we proposed a proof-of-concept approach to construct a machine learning model to better predict the acuity of emergency cases. We used more than 360,000 structured emergency call center records of cases received by the national emergency call center in Singapore from 2018 to 2020. Features were created using call records, and multiple machine learning models were trained. Results A Random Forest model achieved the best performance, reducing the over-triage rate by an absolute margin of 15% compared to the call center specialists while maintaining a similar level of under-triage rate. Conclusions The model has the potential to be deployed as a decision support tool for dispatchers alongside current protocols to optimize ambulance dispatch triage and the utilization of emergency ambulance resources.
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Affiliation(s)
- Han Wang
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | | | | | - Colin Tan
- Singapore Civil Defence Force, Singapore
| | - Marcus E. H. Ong
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore
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Lim SL, Toh C, Fook-Chong S, Yazid M, Shahidah N, Ng QX, Ho AFW, Arulanandam S, Leong BSH, White AE, Ong MEH. Impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation in adult out-of-hospital cardiac arrests in Singapore. Resuscitation 2022; 181:40-47. [PMID: 36280214 PMCID: PMC9596179 DOI: 10.1016/j.resuscitation.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Fewer out-of-hospital cardiac arrest (OHCA) patients received bystander cardiopulmonary resuscitation during the COVID-19 pandemic in Singapore. We investigated the impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation (DA-CPR). METHODS We reviewed audio recordings of all calls to our national ambulance service call centre during the pandemic (January-June 2020) and pre-pandemic (January-June 2019) periods. Our primary outcome was the presence of barriers to DA-CPR. Multivariable logistic regression was used to assess the effect of COVID-19 on the likelihood of barriers to and performance of DA-CPR, adjusting for patient and event characteristics. RESULTS There were 1241 and 1118 OHCA who were eligible for DA-CPR during the pandemic (median age 74 years, 61.6 % males) and pre-pandemic (median age 73 years, 61.1 % males) periods, respectively. Compared to pre-pandemic, there were more residential and witnessed OHCA during the pandemic (87 % vs 84.9 % and 54 % vs 38.1 %, respectively); rates of DA-CPR were unchanged (57.3 % vs 61.1 %). COVID-19 increased the likelihood of barriers to DA-CPR (aOR 1.47, 95 % CI: 1.25-1.74) but not performance of DA-CPR (aOR 0.86, 95 % CI: 0.73 - 1.02). Barriers such as 'patient status changed' and 'caller not with patient' increased during COVID-19 pandemic. 'Afraid to do CPR' markedly decreased during the pandemic; fear of COVID-19 transmission made up 0.5 % of the barriers. CONCLUSION Barriers to DA-CPR were encountered more frequently during the COVID-19 pandemic but did not affect callers' willingness to perform DA-CPR. Distancing measures led to more residential arrests with increases in certain barriers, highlighting opportunities for public education and intervention.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore,Department of Medicine, National University of Singapore, Singapore,Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore,Corresponding author at: Department of Cardiology, National University Heart Centre 1E, Kent Ridge Road, NUHS Tower Block, Singapore 119228, Singapore
| | - Cherylyn Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Muhammad Yazid
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Andrew FW Ho
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore,Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Alexander E White
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore,Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Guerrero A, Blewer AL, Joiner AP, Leong BSH, Shahidah N, Pek PP, Ng YY, Arulanandam S, Østbye T, Gordee A, Kuchibhatla M, Ong MEH. Evaluation of telephone-assisted cardiopulmonary resuscitation recommendations for out-of-hospital cardiac arrest. Resuscitation 2022; 178:87-95. [PMID: 35870555 PMCID: PMC10013180 DOI: 10.1016/j.resuscitation.2022.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 10/17/2022]
Abstract
AIM OF THE STUDY While out-of-hospital cardiac arrest (OHCA) is associated with poor survival, early bystander CPR (B-CPR) and telephone CPR (T-CPR) improves survival from OHCA. American Heart Association (AHA) Scientific Statements outline recommendations for T-CPR. We assessed these recommendations and hypothesized that meeting performance standards is associated with increased likelihood of survival. Additional variables were analyzed to identify future performance measurements. METHODS We conducted a retrospective cohort study of non-traumatic, adult, OHCA using the Singapore Pan-Asian Resuscitation Outcomes Study. The primary outcome was likelihood of survival; secondary outcomes were pre-hospital Return of Spontaneous Circulation (ROSC) and B-CPR. RESULTS From 2012 to 2016, 2,574 arrests met inclusion criteria. Mean age was 68 ± 15; of 2,574, 1,125 (44%) received T-CPR with 5% (135/2574) survival. T-CPR cases that met the Lerner et al. performance metrics analyzed, demonstrated no statistically significant association with survival. Cases which met the Kurz et al. criteria, "Time for Dispatch to Recognize Need for CPR" and "Time to First Compression," had adjusted odds ratios of survival of 1.01 (95% CI:1.00, 1.02; p = <0.01) and 0.99 (95% CI:0.99, 0.99; p = <0.01), respectively. Identified barriers to CPR decreased the odds of T-CPR and B-CPR being performed. Patients with prehospital ROSC had higher odds of B-CPR being performed. EMS response time < 8 minutes was associated with increased survival among patients receiving T-CPR. CONCLUSION AHA scientific statements on T-CPR programs serve as ideal starting points for increasing the quality of T-CPR systems and patient outcomes. More work is needed to identify other system performance measures.
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Affiliation(s)
- Angel Guerrero
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Anjni P Joiner
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Benjamin S H Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Yih Yng Ng
- Emergency Department, Tan Tock Seng Hospital, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Alexander Gordee
- BERD Methods Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Maragatha Kuchibhatla
- BERD Methods Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Marcus E H Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Jaffar JLY, Fook-Chong S, Shahidah N, Ho AFW, Ng YY, Arulanandam S, White A, Liew LX, Asyikin N, Leong BSH, Gan HN, Mao D, Chia MYC, Cheah SO, Ong MEH. Inter-hospital trends of post-resuscitation interventions and outcomes of out-of-hospital cardiac arrest in Singapore. Ann Acad Med Singap 2022; 51:341-350. [PMID: 35786754 DOI: 10.47102/annals-acadmedsg.2021498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Hospital-based resuscitation interventions, such as therapeutic temperature management (TTM), emergency percutaneous coronary intervention (PCI) and extracorporeal membrane oxygenation (ECMO) can improve outcomes in out-of-hospital cardiac arrest (OHCA). We investigated post-resuscitation interventions and hospital characteristics on OHCA outcomes across public hospitals in Singapore over a 9-year period. METHODS This was a prospective cohort study of all OHCA cases that presented to 6 hospitals in Singapore from 2010 to 2018. Data were extracted from the Pan-Asian Resuscitation Outcomes Study Clinical Research Network (PAROS CRN) registry. We excluded patients younger than 18 years or were dead on arrival at the emergency department. The outcomes were 30-day survival post-arrest, survival to admission, and neurological outcome. RESULTS The study analysed 17,735 cases. There was an increasing rate of provision of TTM, emergency PCI and ECMO (P<0.001) in hospitals, and a positive trend of survival outcomes (P<0.001). Relative to hospital F, hospitals B and C had lower provision rates of TTM (≤5.2%). ECMO rate was consistently <1% in all hospitals except hospital F. Hospitals A, B, C, E had <6.5% rates of provision of emergency PCI. Relative to hospital F, OHCA cases from hospitals A, B and C had lower odds of 30-day survival (adjusted odds ratio [aOR]<1; P<0.05 for hospitals A-C) and lower odds of good neurological outcomes (aOR<1; P<0.05 for hospitals A-C). OHCA cases from academic hospitals had higher odds ratio (OR) of 30-day survival (OR 1.3, 95% CI 1.1-1.5) than cases from hospitals without an academic status. CONCLUSION Post-resuscitation interventions for OHCA increased across all hospitals in Singapore from 2010 to 2018, correlating with survival rates. The academic status of hospitals was associated with improved survival.
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Han MX, Yeo ANWT, Ong MEH, Smith K, Lim YL, Lin NH, Tan B, Arulanandam S, Ho AFW, Ng QX. Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review. J Clin Med 2021; 10:jcm10204684. [PMID: 34682806 PMCID: PMC8539960 DOI: 10.3390/jcm10204684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge (n = 3) and neurologically favourable survival (n = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients.
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Affiliation(s)
- Ming Xuan Han
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
| | - Amelia Natasha Wen Ting Yeo
- Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore 487372, Singapore;
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; (M.E.H.O.); (A.F.W.H.)
- SingHealth Emergency Medicine Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Clayton, VIC 3800, Australia;
| | - Yu Liang Lim
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
- MOH Holdings Pte Ltd., Singapore 099253, Singapore;
| | | | - Bobo Tan
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; (M.E.H.O.); (A.F.W.H.)
- SingHealth Emergency Medicine Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (M.X.H.); (Y.L.L.); (B.T.); (S.A.)
- MOH Holdings Pte Ltd., Singapore 099253, Singapore;
- Correspondence: ; Tel.: +65-6794-5502
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Ng JYX, Sim ZJ, Siddiqui FJ, Shahidah N, Leong BSH, Tiah L, Ng YY, Blewer A, Arulanandam S, Lim SL, Ong MEH, Ho AFW. Incidence, characteristics and complications of dispatcher-assisted cardiopulmonary resuscitation initiated in patients not in cardiac arrest. Resuscitation 2021; 170:266-273. [PMID: 34626729 DOI: 10.1016/j.resuscitation.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
AIM Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) can increase bystander CPR rates and improve outcomes in out-of-hospital cardiac arrest (OHCA). Despite the use of protocols, dispatchers may falsely recognise some cases to be in cardiac arrest. Hence, this study aimed to find the incidence of DA-CPR initiated for non-OHCA cases, its characteristics and clinical outcomes in the Singapore population. METHODS This was a multi-centre, observational study of all dispatcher-recognised cardiac arrests cases between January to December 2017 involving three tertiary hospitals in Singapore. Data was obtained from the Pan-Asian Resuscitation Outcomes Study cohort. Audio review of dispatch calls from the national emergency ambulance service were conducted and information about patients' clinical outcomes were prospectively collected from health records. Univariate analysis was performed to determine factors associated with in-hospital mortality among non-OHCA patients who received DA-CPR. RESULTS Of the 821 patients recognised as having OHCA 328 (40.0%) were not in cardiac arrest and 173 (52.7%) of these received DA-CPR. No complications from chest compressions were found from hospital records. The top diagnoses of non-OHCA patients were cerebrovascular accidents (CVA), syncope and infection. Only final diagnoses of CVA (aOR 20.68), infection (aOR 17.34) and myocardial infarction (aOR 32.19) were significantly associated with in-hospital mortality. CONCLUSION In this study, chest compressions initiated on patients not in cardiac arrest by dispatchers did not result in any reported complications and was not associated with in-hospital mortality. This provides reassurance for the continued implementation of DA-CPR.
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Affiliation(s)
- Julia Yu Xin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zariel Jiaying Sim
- Accident & Emergency, Changi General Hospital, Singapore; SingHealth Emergency Medicine Residency Programme, Singapore
| | - Fahad Javaid Siddiqui
- Pre-hospital & Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Ling Tiah
- Accident & Emergency, Changi General Hospital, Singapore
| | - Yih Yng Ng
- Home Team Medical Services Division, Ministry of Home Affairs, Singapore; Emergency Department, Tan Tock Seng Hospital, Singapore
| | - Audrey Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, USA
| | | | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Pre-hospital & Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.
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10
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White AE, Ho AFW, Shahidah N, Asyikin N, Liew LX, Pek PP, Kua JPH, Chia MYC, Ng YY, Arulanandam S, Leong SHB, Ong MEH. An essential review of Singapore's response to out-of-hospital cardiac arrests: improvements over a ten-year period. Singapore Med J 2021; 62:438-443. [PMID: 35001113 PMCID: PMC8804483 DOI: 10.11622/smedj.2021114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Care for patients who experience out-of-hospital cardiac arrest (OHCA) has rapidly evolved in the past decade. Increased sophistication of care in the community, emergency medical services (EMS) and hospital setting is associated with improved patient-centred outcomes. Notably, Utstein survival doubled from 11.6% to 23.1% between 2011 and 2016. These achievements involved collaboration between policymakers, clinicians and researchers, and were made possible by a strategic interplay of policy, research and implementation. We review the development and current state of OHCA in Singapore using primary population-based data from the Pan-Asian Resuscitation Outcomes Study and an unstructured search of research databases. We discuss the roles of important milestones in policy, community, dispatch, EMS and hospital interventions. Finally, we relate these interventions to relevant processes and outcomes, such as the relationship between the strategic implementation of bystander cardiopulmonary resuscitation and placement of automated external defibrillator with return of spontaneous circulation, survival to discharge and survival with favourable neurological outcomes.
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Affiliation(s)
- Alexander E White
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew FW Ho
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nurul Asyikin
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Le Xuan Liew
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Pin Pin Pek
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Jade PH Kua
- Emergency Department, Woodlands Health Campus, Singapore
| | | | - Yih Yng Ng
- Emergency Department, Tan Tock Seng Hospital, Singapore
- Home Team Medical Services Division, Ministry of Home Affairs, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | | | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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11
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Wang H, Yeung WLK, Ng QX, Tung A, Tay JAM, Ryanputra D, Ong MEH, Feng M, Arulanandam S. A Weakly-Supervised Named Entity Recognition Machine Learning Approach for Emergency Medical Services Clinical Audit. Int J Environ Res Public Health 2021; 18:ijerph18157776. [PMID: 34360065 PMCID: PMC8345494 DOI: 10.3390/ijerph18157776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
Clinical performance audits are routinely performed in Emergency Medical Services (EMS) to ensure adherence to treatment protocols, to identify individual areas of weakness for remediation, and to discover systemic deficiencies to guide the development of the training syllabus. At present, these audits are performed by manual chart review, which is time-consuming and laborious. In this paper, we report a weakly-supervised machine learning approach to train a named entity recognition model that can be used for automatic EMS clinical audits. The dataset used in this study contained 58,898 unlabeled ambulance incidents encountered by the Singapore Civil Defence Force from 1st April 2019 to 30th June 2019. With only 5% labeled data, we successfully trained three different models to perform the NER task, achieving F1 scores of around 0.981 under entity type matching evaluation and around 0.976 under strict evaluation. The BiLSTM-CRF model was 1~2 orders of magnitude lighter and faster than our BERT-based models. Our proposed proof-of-concept approach may improve the efficiency of clinical audits and can also help with EMS database research. Further external validation of this approach is needed.
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Affiliation(s)
- Han Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore;
| | - Wesley Lok Kin Yeung
- Singapore Civil Defence Force, Singapore 408827, Singapore; (W.L.K.Y.); (Q.X.N.); (A.T.); (J.A.M.T.); (D.R.); (S.A.)
- National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Qin Xiang Ng
- Singapore Civil Defence Force, Singapore 408827, Singapore; (W.L.K.Y.); (Q.X.N.); (A.T.); (J.A.M.T.); (D.R.); (S.A.)
| | - Angeline Tung
- Singapore Civil Defence Force, Singapore 408827, Singapore; (W.L.K.Y.); (Q.X.N.); (A.T.); (J.A.M.T.); (D.R.); (S.A.)
- Home Team Science & Technology Agency, Singapore 329560, Singapore
| | - Joey Ai Meng Tay
- Singapore Civil Defence Force, Singapore 408827, Singapore; (W.L.K.Y.); (Q.X.N.); (A.T.); (J.A.M.T.); (D.R.); (S.A.)
| | - Davin Ryanputra
- Singapore Civil Defence Force, Singapore 408827, Singapore; (W.L.K.Y.); (Q.X.N.); (A.T.); (J.A.M.T.); (D.R.); (S.A.)
- National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Marcus Eng Hock Ong
- Health Services Research Centre, Singapore Health Services, Singapore 169856, Singapore;
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore;
- Institute of Data Science, National University of Singapore, Singapore 117602, Singapore
- Correspondence: ; Tel.: +65-985-038-11
| | - Shalini Arulanandam
- Singapore Civil Defence Force, Singapore 408827, Singapore; (W.L.K.Y.); (Q.X.N.); (A.T.); (J.A.M.T.); (D.R.); (S.A.)
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12
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Ng QX, Yeung WLK, Tay JAM, Arulanandam S. Use of Technology to Aid Clinical Audit in an Asian Emergency Medical Services Department. Healthcare (Basel) 2021; 9:healthcare9050491. [PMID: 33921997 PMCID: PMC8143507 DOI: 10.3390/healthcare9050491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/25/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Although clinical audit is generally accepted to be an essential part of quality review and continuous quality improvement, there are limited reports on and several barriers to the implementation of effective clinical audit in an emergency medicine services (EMS) organization. The barriers include the significant amount of time, resources, and effort often required to conduct the audit. In this paper, we present a technology-enabled clinical audit tool, termed Medical Service Transformation and Innovation Compass (MYSTIC), which has transformed the way the clinical audit is performed in our EMS department. MYSTIC is a Python program we developed in-house, that extracts data from data fields found in routine ambulance case records maintained by our paramedics, and automatically assigns "pass" or "fail" flags based on pre-defined audit criteria. Compared to previous manual auditing, implementation of the MYSTIC computerized audit system increased the coverage of cases undergoing audit from 10% to 100% of all EMS-attended cases, and we were able to promptly identify and address some deficits in training and knowledge amongst our paramedics.
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Affiliation(s)
- Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore; (J.A.M.T.); (S.A.)
- Correspondence: ; Tel.: +65-(67)-945502
| | - Wesley Lok Kin Yeung
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore;
| | - Joey Ai Meng Tay
- Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore; (J.A.M.T.); (S.A.)
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore; (J.A.M.T.); (S.A.)
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13
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Lim SL, Shahidah N, Saffari SE, Ng QX, Ho AFW, Leong BSH, Arulanandam S, Siddiqui FJ, Ong MEH. Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore. Int J Environ Res Public Health 2021; 18:ijerph18073646. [PMID: 33807454 PMCID: PMC8036681 DOI: 10.3390/ijerph18073646] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
This study aimed to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) in Singapore. We used data from the Singapore Civil Defence Force to compare the incidence, characteristics and outcomes of all Emergency Medical Services (EMS)-attended adult OHCA during the pandemic (January-May 2020) and pre-pandemic (January-May 2018 and 2019) periods. Pre-hospital return of spontaneous circulation (ROSC) was the primary outcome. Binary logistic regression was used to calculate the adjusted odds ratios (aOR) for the characteristics of OHCA. Of the 3893 OHCA patients (median age 72 years, 63.7% males), 1400 occurred during the pandemic period and 2493 during the pre-pandemic period. Compared with the pre-pandemic period, OHCAs during the pandemic period more likely occurred at home (aOR: 1.48; 95% CI: 1.24-1.75) and were witnessed (aOR: 1.71; 95% CI: 1.49-1.97). They received less bystander CPR (aOR: 0.70; 95% CI: 0.61-0.81) despite 65% of witnessed arrests by a family member, and waited longer for EMS (OR ≥ 10 min: 1.71, 95% CI 1.46-2.00). Pre-hospital ROSC was less likely during the pandemic period (aOR: 0.67; 95% CI: 0.53-0.84). The pandemic saw increased OHCA incidence and worse outcomes in Singapore, likely indirect effects of COVID-19.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore 119228, Singapore
- Correspondence: ; Tel.: +65-6772-3301
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; (N.S.); (A.F.W.H.); (M.E.H.O.)
| | - Seyed Ehsan Saffari
- Center for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
| | - Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (Q.X.N.); (S.A.)
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; (N.S.); (A.F.W.H.); (M.E.H.O.)
- SingHealth Emergency Medicine Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- Pre-Hospital and Emergency Research Center, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
| | | | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore; (Q.X.N.); (S.A.)
| | - Fahad Javaid Siddiqui
- Pre-Hospital and Emergency Research Center, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; (N.S.); (A.F.W.H.); (M.E.H.O.)
- Pre-Hospital and Emergency Research Center, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
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14
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Wong XY, Fan Q, Shahidah N, De Souza CR, Arulanandam S, Ng YY, Ng WM, Leong BSH, Chia MYC, Ong MEH. Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation. Ann Acad Med Singap 2021; 50:212-221. [PMID: 33855317 DOI: 10.47102/annals-acadmedsg.2020458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Bystander cardiopulmonary resuscitation (B-CPR) is associated with improved out-of hospital cardiac arrest survival. Community-level interventions including dispatcher-assisted CPR (DA-CPR) and myResponder were implemented to increase B-CPR. We sought to assess whether these interventions increased B-CPR. METHODS The Singapore out-of-hospital cardiac arrest registry captured cases that occurred between 2010 and 2017. Outcomes occurring in 3 time periods (Baseline, DA-CPR, and DA-CPR plus myResponder) were compared. Segmented regression of time-series data was conducted to investigate our intervention impact on the temporal changes in B-CPR. RESULTS A total of 13,829 out-of-hospital cardiac arrest cases were included from April 2010 to December 2017. Higher B-CPR rates (24.8% versus 50.8% vs 64.4%) were observed across the 3 time periods. B-CPR rates showed an increasing but plateauing trend. DA-CPR implementation was significantly associated with an increased B-CPR (level odds ratio [OR] 2.26, 95% confidence interval [CI] 1.79-2.88; trend OR 1.03, 95% CI 1.01-1.04), while no positive change was detected with myResponder (level OR 0.95, 95% CI 0.82-1.11; trend OR 0.99, 95% CI 0.98-1.00). CONCLUSION B-CPR rates in Singapore have been increasing alongside the implementation of community-level interventions such as DA-CPR and myResponder. DA-CPR was associated with improved odds of receiving B-CPR over time while the impact of myResponder was less clear.
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15
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Bang C, Mao DRH, Cheng RCY, Pek JH, Gandhi M, Arulanandam S, Ong MEH, Quah S. Improving Psychological Comfort of Paramedics for Field Termination of Resuscitation through Structured Training. Int J Environ Res Public Health 2021; 18:ijerph18031050. [PMID: 33503964 PMCID: PMC7908355 DOI: 10.3390/ijerph18031050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
This study examines the impact of a newly developed structured training on Singapore paramedics’ psychological comfort before the implementation of a prehospital termination of resuscitation (TOR) protocol. Following a before and after study design, the paramedics underwent a self-administered questionnaire to assess their psychological comfort level applying the TOR protocol, 22 months before and one month after a 3-h structured training session. The questionnaire addressed five domains: sociocultural attitudes on resuscitation and TOR, multi-tasking, feelings towards resuscitation and TOR, interactions with colleagues and bystanders and informing survivors. Overall psychological comfort total (PCT) scores and domain-specific scores were compared using the paired t-test with higher scores representing greater comfort. Ninety-six of the 345 eligible paramedics responded. There was no statistically significant change in the mean PCT scores at baseline and post-training; however, the “feelings towards resuscitation and TOR” domain improved by 4.77% (95% CI 1.42 to 8.13 and p = 0.006) and the multi-tasking domain worsened by 4.11% (95% CI −7.82 to −0.41 and p = 0.030). While the structured training did not impact on the overall psychological comfort levels, it led to improvements in the feelings of paramedics towards resuscitation and TOR. Challenges remain in improving paramedics’ psychological comfort levels towards TOR.
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Affiliation(s)
- Chungli Bang
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (D.R.H.M.); (R.C.Y.C.)
- Correspondence: ; Tel.: +65-6555-8000
| | - Desmond Ren Hao Mao
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (D.R.H.M.); (R.C.Y.C.)
| | - Rebacca Chew Ying Cheng
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; (D.R.H.M.); (R.C.Y.C.)
| | - Jen Heng Pek
- Emergency Department, Sengkang General Hospital, Singapore 544886, Singapore;
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore 138669, Singapore;
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore;
| | - Marcus Eng Hock Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore; (M.E.H.O.); (S.Q.)
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Stella Quah
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore; (M.E.H.O.); (S.Q.)
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16
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Pek PP, Lim JYY, Leong BSH, Mao DRH, Chia MYC, Cheah SO, Gan HN, Ng YY, Tham LP, Arulanandam S, Shahidah N, Lin X, Ho AFW, Ong MEH. Improved Out-of-Hospital Cardiac Arrest Survival with a Comprehensive Dispatcher-Assisted CPR Program in a Developing Emergency Care System. PREHOSP EMERG CARE 2020; 25:802-811. [DOI: 10.1080/10903127.2020.1846824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Ng QX, Lee EZ, Tay JA, Arulanandam S. Impact of COVID-19 'circuit-breaker' measures on emergency medical services utilisation and out-of-hospital cardiac arrest outcomes in Singapore. Emerg Med Australas 2020; 33:149-151. [PMID: 33074594 DOI: 10.1111/1742-6723.13668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To understand the impact of COVID-19 restrictions on emergency medical services (EMSs) utilisation and out-of-hospital cardiac arrest outcomes in Singapore. METHODS This was a retrospective observational study comparing data collected by the Singapore Civil Defence Force on EMS utilisation in Singapore from 1 April to 31 May 2020 to previous figures. RESULTS Overall, EMS call volume and total out-of-hospital cardiac arrests remained comparable to past years. There was an appreciable decline in prehospital return of spontaneous circulation rates, albeit not statistically lower than pre-COVID periods (P = 0.078). CONCLUSION The findings contribute to a growing body of literature internationally on the potential impact of the COVID-19 pandemic on EMS utilisation and outcomes.
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Affiliation(s)
- Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force Headquarters, Singapore
| | - Ebenezer Zh Lee
- Emergency Medical Services Department, Singapore Civil Defence Force Headquarters, Singapore
| | - Joey Am Tay
- Emergency Medical Services Department, Singapore Civil Defence Force Headquarters, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force Headquarters, Singapore
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18
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Lim SL, Smith K, Dyson K, Chan SP, Earnest A, Nair R, Bernard S, Leong BSH, Arulanandam S, Ng YY, Ong MEH. Incidence and Outcomes of Out-of-Hospital Cardiac Arrest in Singapore and Victoria: A Collaborative Study. J Am Heart Assoc 2020; 9:e015981. [PMID: 33094661 PMCID: PMC7763419 DOI: 10.1161/jaha.119.015981] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Incidence and outcomes of out‐of‐hospital cardiac arrest (OHCA) vary between communities. We aimed to examine differences in patient characteristics, prehospital care, and outcomes in Singapore and Victoria. Methods and Results Using the prospective Singapore Pan‐Asian Resuscitation Outcomes Study and Victorian Ambulance Cardiac Arrest Registry, we identified 11 061 and 32 003 emergency medical services‐attended adult OHCAs between 2011 and 2016 respectively. Incidence and survival rates were directly age adjusted using the World Health Organization population. Survival was analyzed with logistic regression, with model selection via backward elimination. Of the 11 061 and 14 834 emergency medical services‐treated OHCAs (overall mean age±SD 65.5±17.2; 67.4% males) in Singapore and Victoria respectively, 11 054 (99.9%) and 5595 (37.7%) were transported, and 440 (4.0%) and 2009 (13.6%) survived. Compared with Victoria, people with OHCA in Singapore were older (66.7±16.5 versus 64.6±17.7), had less shockable rhythms (17.7% versus 30.3%), and received less bystander cardiopulmonary resuscitation (45.7% versus 58.5%) and defibrillation (1.3% versus 2.5%) (all P<0.001). Age‐adjusted OHCA incidence and survival rates increased in Singapore between 2011 and 2016 (P<0.01 for trend), but remained stable, though higher, in Victoria. Likelihood of survival increased significantly (P<0.001) with arrest in public locations (adjusted odds ratio [aOR] 1.81), witnessed arrest (aOR 2.14), bystander cardiopulmonary resuscitation (aOR 1.72), initial shockable rhythm (aOR 9.82), and bystander defibrillation (aOR 2.04) but decreased with increasing age (aOR 0.98) and emergency medical services response time (aOR 0.91). Conclusions Singapore reported increasing OHCA incidence and survival rates between 2011 and 2016, compared with stable, albeit higher, rates in Victoria. Survival differences might be related to different emergency medical services practices including patient selection for resuscitation and transport.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology National University Heart Centre Singapore
| | - Karen Smith
- Center for Research and Evaluation Ambulance Victoria Doncaster Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Victoria Australia
| | - Kylie Dyson
- Center for Research and Evaluation Ambulance Victoria Doncaster Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Victoria Australia
| | - Siew Pang Chan
- Department of Medicine Yong Loo Lin School of Medicine Singapore.,Cardiovascular Research Institute National University Heart Centre Singapore
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine Monash University Victoria Australia
| | - Resmi Nair
- Center for Research and Evaluation Ambulance Victoria Doncaster Victoria Australia
| | - Stephen Bernard
- Center for Research and Evaluation Ambulance Victoria Doncaster Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Victoria Australia.,Intensive Care Department The Alfred Hospital Melbourne Victoria Australia
| | | | | | - Yih Yng Ng
- Home Team Medical Service Division Ministry of Home Affairs Singapore.,Lee Kong Chian School of Medicine Nanyang Technological University Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine Singapore General Hospital Singapore.,Health Services and Systems Research Duke-NUS Medical School Singapore
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19
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Blewer AL, Ho AFW, Shahidah N, White AE, Pek PP, Ng YY, Mao DR, Tiah L, Chia MYC, Leong BSH, Cheah SO, Tham LP, Kua JPH, Arulanandam S, Østbye T, Bosworth HB, Ong MEH. Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study. The Lancet Public Health 2020; 5:e428-e436. [DOI: 10.1016/s2468-2667(20)30140-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/27/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022]
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20
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Ming Ng W, De Souza CR, Pek PP, Shahidah N, Ng YY, Arulanandam S, White AE, Leong BSH, Ong MEH. myResponder Smartphone Application to Crowdsource Basic Life Support for Out-of-Hospital Cardiac Arrest: The Singapore Experience. PREHOSP EMERG CARE 2020; 25:388-396. [PMID: 32497484 DOI: 10.1080/10903127.2020.1777233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Singapore myResponder is a novel smartphone application developed by the Singapore Civil Defence Force (SCDF) that notifies volunteer first responders of a suspected out-of-hospital cardiac arrest (OHCA) case and locations of Automated External Defibrillators (AED) in the vicinity so that they can assist with resuscitation. We aimed to examine the performance of this application, challenges encountered, and future directions. Methods: We analyzed data from the myResponder app since its launch from April 2015 to July 2019. The number of installations, registered community first responders, suspected OHCA cases, notifications sent by the app, percentage of responders who accepted activation and arrived at scene were reviewed. A subgroup of taxi driving responders (within a 1.5-kilometer response radius) carrying an AED under a subsequent pilot program was also analyzed. Results: By July 2019, 46,689 responders were registered in the myResponder app. There were a total of 19,189 cases created for suspected OHCA, with a median of 358 cases per month (IQR 330-430), in which 10,073 responders accepted activation from myResponder and 4,955 arrived on-scene. A total of 135,599 notifications were sent for these cases, with a median of 7.1 notifications per case (IQR 4.3-8.7). In 2019, the percentages of responders who accepted notification and arrived on scene were 45.8% and 24.1%, respectively. 43% (1110/2581) of responders arrived before EMS crew. Conclusion: The myResponder mobile application is a feasible smart technology solution to improve community response to OHCA, and to increase bystander CPR and AED use. Future directions include increasing the number of active responders, improving response rates, app performance, and better data capture for quality improvement.
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Leong PWK, Leong BSH, Arulanandam S, Ng MXR, Ng YY, Ong MEH, Mao DRH. Simplified instructional phrasing in dispatcher-assisted cardiopulmonary resuscitation - when 'less is more'. Singapore Med J 2020; 62:647-652. [PMID: 32460451 DOI: 10.11622/smedj.2020080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction "push 100 times a minute 5 cm deep". As part of quality improvement, the instruction was simplified to "push hard and fast". METHODS We analysed all dispatcher-diagnosed OHCAs over four months in 2018: January to February ("push 100 times a minute 5 cm deep") and August to September ("push hard and fast"). We also performed secondary per-protocol analysis based on the protocol used: (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231). RESULTS 506 cases were included, 282 in the 'before' group and 224 in the 'after' group. Adherence to the protocol was 15.2% in the 'before' phase and 72.8% in the 'after' phase (p < 0.001). The mean time between instruction and first compression for the 'before' and 'after' groups was 34.36 seconds and 26.83 seconds, respectively (p < 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the 'before' and 'after' groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and 'own words' groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p < 0.001). CONCLUSION Simplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.
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Affiliation(s)
| | | | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Marie Xin Ru Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Home Team Medical Services, Ministry of Home Affairs, Singapore.,Emergency Department, Tan Tock Seng Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Service and Systems Research, Duke-NUS Medical School, Singapore
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Sia CH, Dalakoti M, Tan BYQ, Lee ECY, Shen X, Wang K, Lee JS, Arulanandam S, Chow W, Yeo TJ, Yeo KK, Chua TSJ, Tan RS, Lam CSP, Chong DTT. A Population-wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males-results from the Singapore Armed Forces ECG (SAFE) study. Ann Noninvasive Electrocardiol 2019; 24:e12634. [PMID: 30707472 DOI: 10.1111/anec.12634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Routine use of pre-participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges specific to a young male multiethnic Southeast Asian cohort. METHODS AND RESULTS Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre-participation screening that included a 12-lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7 ± 19.7 vs. 145.21 ± 19.2 in Malays vs. 141.2 ± 18.8 ms in Indians), QRS duration (94.5 ± 9.8 vs. 92.6 ± 9.7 in Malays vs. 92.5 ± 9.4 ms in Indians) and QTcB interval (408.3 ± 21.3 vs. 403.5 ± 21.6 in Malays vs. 401.2 ± 21.4 ms in Indians) (all p < 0.001). Body mass index (BMI) >25 kg/m2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140 mmHg or diastolic blood pressure of >90 mmHg independently increased the prevalence of increased QRS voltage on ECG. CONCLUSIONS Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.
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Affiliation(s)
- Ching-Hui Sia
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Mayank Dalakoti
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Benjamin Y Q Tan
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Edward C Y Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Xiayan Shen
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Kangjie Wang
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Joshua S Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Shalini Arulanandam
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Weien Chow
- HQ Medical Corps, Singapore Armed Forces, Singapore, Singapore
| | - Tee Joo Yeo
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance S J Chua
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Daniel T T Chong
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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23
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Thong BYH, Arulanandam S, Tan SC, Tan TC, Chan GYL, Tan JWL, Yeow MCW, Tang CY, Hou J, Leong KP. Shellfish/crustacean oral allergy syndrome among national service pre-enlistees in Singapore. Asia Pac Allergy 2018; 8:e18. [PMID: 29732294 PMCID: PMC5931925 DOI: 10.5415/apallergy.2018.8.e18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/08/2018] [Indexed: 02/04/2023] Open
Abstract
Background All Singaporean males undergo medical screening prior to compulsory military service. A history of possible food allergy may require referral to a specialist Allergy clinic to ensure that special dietary needs can be taken into account during field training and deployment. Objective To study the pattern of food allergy among pre-enlistees who were referred to a specialist allergy clinic to work up suspected food allergy. Methods Retrospective study of all pre-enlistees registered in the Clinical Immunology/Allergy New Case Registry referred to the Allergy Clinic from 1 August 2015 to 31 May 2016 for suspected food allergy. Results One hundred twenty pre-enlistees reporting food allergy symptoms other than rash alone were referred to the Allergy Clinic during the study period. Of these, 77 (64.2%) had food allergy. Among those with food allergy, mean age was 19.1 ± 1.5 years. They comprised predominantly Chinese (66.2%) and Malays (20.8%). The most commonly reported foods were shellfish/crustaceans (78%), peanut (15.6%), and egg (6.5%). Self-limiting oral allergy syndrome, OAS (itchy lips and throat with/without lip angioedema) was the most common manifestation (n = 33, 42.9%) followed by anaphylaxis (n = 23, 29.9%). Majority of OAS was from shellfish/crustacean (90.6%); of which shrimp (30.3%), crab (15.2%), and lobster (3.0%) were the most common. Mild childhood asthma (69.7%), allergic rhinitis (6.3%), and eczema (6.1%) were the most common atopic conditions among individuals with shellfish/crustacean OAS. This pattern was similar for shellfish/crustacean anaphylaxis. Skin prick tests were most commonly positive for shrimp (OAS 87.1% vs. anaphylaxis 100%), crab (OAS 95.8% vs. 90.9%), and lobster (OAS 91.7% vs. 63.6%). Conclusion OAS to shellfish/crustaceans was more common than anaphylaxis among this study population of young males referred for food allergy symptoms other than rash alone.
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Affiliation(s)
- Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
| | | | - Sze-Chin Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
| | - Teck-Choon Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
| | - Grace Yin-Lai Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
| | - Justina Wei-Lyn Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
| | | | - Chwee-Ying Tang
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
| | - Jinfeng Hou
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
| | - Khai-Pang Leong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433
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Arulanandam S, Das De S, Kanagalingam J. A prospective study of epidemiological risk factors for ingestion of fish bones in Singapore. Singapore Med J 2016; 56:329-32; quiz 333. [PMID: 26106240 DOI: 10.11622/smedj.2015091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Ingestion of fish bones is a common clinical complaint among adult patients. The aim of this study was to evaluate the epidemiological and behavioural risk factors for fish bone ingestion. METHODS Between 2009 and 2010, a physician-administered questionnaire was administered to 112 consecutive patients who presented to the emergency department of an adult tertiary hospital with the complaint of fish bone ingestion. RESULTS The wearing of dentures, the use of utensils to eat fish and the practice of deboning fish in one's mouth were found to be associated with an increased risk of fish bone ingestion. CONCLUSION To prevent the occurrence of fish bone ingestion and its possible complications, at-risk populations should be advised on the precautions to take when eating boned fish.
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Affiliation(s)
| | - Soumen Das De
- Department of Orthopaedics, National University Hospital, Singapore
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25
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Arulanandam S, Hakim AJ, Aziz Q, Sandhu G, Birchall MA. Laryngological presentations of Ehlers-Danlos syndrome: case series of nine patients from two London tertiary referral centres. Clin Otolaryngol 2016; 42:860-863. [PMID: 27434416 DOI: 10.1111/coa.12708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S Arulanandam
- Department of Otolaryngology, Singapore General Hospital, Singapore
| | - A J Hakim
- The Hospital of St John and St Elizabeth, London, UK
| | - Q Aziz
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - G Sandhu
- Charing Cross Hospital, London, UK
| | - M A Birchall
- Royal National Throat Nose and Ear Hospital, London, UK
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26
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Lippmann J, Fock A, Arulanandam S. Cerebral arterial gas embolism with delayed treatment and a fatal outcome in a 14-year-old diver. Diving Hyperb Med 2011; 41:31-34. [PMID: 21560983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In today's recreational diving climate, diving fitness examinations are not mandatory, and even divers who go for these examinations may not have routine chest X-rays (CXR) done in the absence of respiratory symptoms or a past history of respiratory problems. We present a case of an ultimately fatal cerebral arterial gas embolism in a 14-year-old boy with an undiagnosed lung cyst, the contribution of which to his death is uncertain. Various factors such as lack of oxygen first aid at the remote dive site; poor communication; lack of diving medicine expertise, poor oxygen administration and management in a local hospital and long delay to recompression therapy contributed to the poor outcome. It is imperative that dive operators and physicians working in close proximity to popular dive sites be educated on how to recognise and treat diving emergencies and be well-acquainted, as should divers, with the contact numbers of diving medical hotlines that offer timely and appropriate advice in case of emergency.
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Arulanandam S, Tsing GCC. Comparison of alertness levels in ship crew. An experiment on rotating versus fixed watch schedules. Int Marit Health 2009; 60:6-9. [PMID: 20205120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
A short pilot study was conducted during a shipboard training deployment to compare alertness levels in the same crew members while working a fixed watch schedule, and then a rotating watch schedule. Alertness levels were assessed before and after each duty watch using measurements of oculomotor function (Fitness Impairment Tester). Saccadic velocity was shown to have the greatest correlation with duration of sleep deprivation and was significantly slower (indicating decreased alertness) in the crew working the rotating watch schedule than the crew working the fixed watch schedule. This pilot study corroborates previous studies' recommendations that fixed watch schedules allow better acclimatization of sleep patterns, thus minimizing fatigue and increasing operational alertness.
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Abstract
Carpal tunnel syndrome (CTS) is a nerve entrapment disorder, involving the median nerve when it passes the carpal tunnel at the wrist. Using a case-control methodology, 312 electrophysiologically confirmed CTS patients with mean age of 51.3+/-9.4 (27-74) years (81.7% women) and 100 controls with mean age of 50.4+/-9.2 (21-88) years (75% women) were examined utilising a questionnaire similar to the clinical diagnostic criteria of restless legs syndrome (RLS). Forty-four (14.1%) of the CTS patients have symptoms compatible with restless hand syndrome compared with none (0%) in the control group (p < 0.0001). The severity of CTS was not significantly associated with the motor restlessness. Our observations suggest that entrapment syndromes such as CTS can be associated with a form of restlessness in the hands, analogous to RLS.
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Affiliation(s)
- E K Tan
- Department of Neurology, Singapore General Hospital, Singapore.
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Tan AS, Arulanandam S, Chng CY, Vaithinathan R. Overview of legislation and tobacco control in Singapore. Int J Tuberc Lung Dis 2000; 4:1002-8. [PMID: 11092711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Legislative measures against smoking in Singapore began in the early 1970s, and can be said to have been the start of a comprehensive smoking control programme. With the launch of the National Smoking Control Programme (NSCP) in 1986, a National Smoking Control Coordinating Committee was set up to look into legislation and fiscal measures. To further increase the dimension and impact of the programme, a Civic Committee on Smoking Control was formed in 1996. This committee also looks into and recommends legislative measures. The NSCP is an ongoing programme that aims to reduce smoking rates through a combination of strategies, including education, establishment of no-smoking areas and increasing taxation and legislative measures. Existing legislation is regularly and systematically reviewed and revised, and new laws are recommended to strengthen our smoking control efforts. Concurrently, penalties and ways to improve enforcement of the legislation are also updated. The legislative measures that have been implemented in Singapore over the years include prohibition of tobacco advertising and promotion, restrictions on the sale of tobacco products, licensing of sales outlets, use of health warnings on cigarette packets, controlling and labelling of tar and nicotine contents, restriction of smoking in public places and prohibition of smoking in public by the under-eighteens. Several factors have helped make legislative measures work in Singapore. These include political will and support, starting legislation early, comprehensive legislative measures, enforcement measures and continuous review. To sustain these efforts, Singapore needs to continue to stay abreast of world-wide measures on smoking control.
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Affiliation(s)
- A S Tan
- Health Education Services, National Health Education Department, Ministry of Health, Singapore
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30
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Goh SY, Arulanandam S, Ho CL, Zhang L, Goh DY, Chew FT, Lee BW. Awareness of environmental issues and the acceptance of CFC-free inhalers. Ann Trop Paediatr 1998; 18:225-30. [PMID: 9924560 DOI: 10.1080/02724936.1998.11747951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With the recent availability of a chlorofluorocarbon (CFC)-free metered dose inhaler (MDI) (Airomir), a patient survey was carried out to evaluate awareness of the role of CFCs in our environment and acceptance of this new inhaler. A questionnaire survey was conducted on parents and guardians of 201 children. Depending on respondents' preference, the interview was conducted in English (71%), Chinese (23%), Malay (5%) or Tamil (1%). A 'taste' test was also conducted on 103 of these children. Only 13% (26/201) of parents/guardians were aware that MDIs contained CFCs. Although 70% of children were in favour of the new taste of the CFC-free inhaler, the cost of the new inhaler was an important consideration for parents and guardians in their decision to switch to the new inhaler. The majority (93%) were willing to switch if its cost were equivalent to their current inhaler. This study has provided pertinent information with regard to acceptance of CFC-free inhalers which should be considered when making the inevitable switch to environmentally friendly inhalers.
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Affiliation(s)
- S Y Goh
- Department of Paediatrics, National University of Singapore, Singapore
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