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Out-of-hospital cardiac arrest in Hong Kong
L P Leung1, T W Wong, H K Tong
1Accident & Emergency Department, Queen Mary Hospital, Pokfulam, Hong Kong. lpleung@yahoo.co.uk
Insights
Out-of-hospital cardiac arrest survival in Hong Kong is poor, with a 1.25% discharge survival rate. Improvements are needed across all stages of emergency medical services response and resuscitation.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- Out-of-hospital cardiac arrest (OHCA) presents a significant public health challenge.
- Effective emergency medical services (EMS) are crucial for improving survival rates.
- Evaluating local EMS system performance is vital for identifying areas of improvement.
Purpose of the Study:
- To assess the effectiveness of the Hong Kong EMS system in resuscitating OHCA patients.
- To pinpoint specific areas within the EMS chain of survival requiring enhancement.
Main Methods:
- A prospective descriptive study was conducted on adult non-traumatic OHCA patients.
- Data collection followed the Utstein style, encompassing patient demographics, arrest circumstances, outcomes, and EMS response times.
- The study period spanned from March 15, 1999, to October 15, 1999, across three Hong Kong Island A&E departments.
Main Results:
- 320 patients were analyzed, with a male predominance and a mean age of 71.5 years.
- The bystander cardiopulmonary resuscitation (CPR) rate was 15.6%, and asystole was the most common initial ECG rhythm (57.5% unwitnessed arrests).
- Average prehospital interval was 27.55 minutes, leading to an immediate survival rate of 14.1% and a hospital discharge survival rate of only 1.25%.
Conclusions:
- The overall prognosis for OHCA in Hong Kong during the study period was extremely poor.
- Significant improvements are required at every step of the chain of survival for OHCA patients.
- Systemic enhancements in EMS response and resuscitation protocols are urgently needed.
Objectives:
To evaluate the effectiveness of the local emergency medical services system in resuscitation of out-of-hospital cardiac arrest and identify areas for improvement.
Methods:
This was a prospective descriptive study of adults with nontraumatic out-of-hospital cardiac arrest treated in the three accident & emergency departments that serve the whole of Hong Kong Island from March 15, 1999, to October 15, 1999. Patient characteristics, circumstances of cardiac arrest, final outcomes, and response times of the ambulance service were recorded according to the Utstein style.
Results:
Three hundred twenty patients were included. There was male predominance, and the mean age was 71.5 years. The majority of cardiac arrests occurred at patients' homes. In 57.5% of cases the arrest was not witnessed. The bystander cardiopulmonary resuscitation (CPR) rate was 15.6%. The most common electrocardiographic (ECG) rhythm at scene was asystole. Ventricular fibrillation or pulseless ventricular tachycardia constituted 14.1%. The average call to dispatch interval was 1.04 minutes. The average call to CPR interval was 9.82 minutes. The average total prehospital interval was 27.55 minutes. The overall immediate survival rate was 14.1% and the rate of survival to hospital discharge was 1.25%.
Conclusion:
The prognosis of out-of-hospital cardiac arrest in Hong Kong was dismal. Every link in the chain of survival has to be improved.
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