Strategies to improve survival outcomes of out-of-hospital cardiac arrest (OHCA) given a fixed budget: A simulation study.

Autor: Wei Y; Singapore Clinical Research Institute, Singapore, Singapore. Electronic address: yuan.wei.k@gmail.com., Pek PP; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore., Doble B; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore., Finkelstein EA; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore., Wah W; Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore, Singapore., Ng YY; Home Team, Ministry of Home Affairs, Singapore, Singapore; Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore., Cheah SO; Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore., Chia MYC; Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore., Leong BSH; Emergency Medicine Department, National University Hospital, Singapore, Singapore., Gan HN; Accident & Emergency, Changi General Hospital, Singapore, Singapore., Mao DRH; Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore., Tham LP; Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore., Fook-Chong S; Health Services Research Unit, Singapore General Hospital, Singapore, Singapore., Ong MEH; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2020 Apr; Vol. 149, pp. 39-46. Date of Electronic Publication: 2020 Feb 03.
DOI: 10.1016/j.resuscitation.2020.01.026
Abstrakt: Background: Our study aimed to identify a strategy that maximizes survival upon hospital discharge or 30-days post out-of-hospital cardiac arrest (OHCA) in Singapore for fixed investments of S$1, S$5, or S$10 million. Four strategies were compared: (1) no additional investment; (2) reducing response time via leasing of more ambulances; (3) increasing number of people trained in cardiopulmonary resuscitation (CPR); and (4) automated external defibrillators (AED).
Methods: We estimated the effect of ambulance response time, bystander CPR and AED on survival based on Singapore's 2010-2015 OHCA registry data. We simulated the changes in ambulance response times and likelihood of (1) CPR and (2) AED usage as a function of their increased availability, which was then combined with the effect of each factor to determine the increase in survival for each strategy.
Results: Survival given no additional investment was 4.03% (95% CI: 3.96%, 4.10%). The investments in ambulances, CPR training and AEDs for a given budget of S$1M changed survival to 4.03% (95% CI: 3.96%, 4.10%), 4.04% (95% CI: 3.98%, 4.11%), and 4.44% (95% CI: 4.35%, 4.54%), respectively. This generated 0, 2 and 102 additional life years saved respectively. Given a budget of S$5M or S$10M, 509 or 886 additional life years could be saved, by investing in an additional 10,000 or 20,000 AEDs respectively. The strategies reached a saturation effect whereby improvement in survival was marginal when the budget was increased to ≥S$5M for investment in ambulances and CPR training.
Conclusions: Investing in AEDs had the most gain in survival.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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