Out of hospital cardiac arrests--the experience of one hospital in Singapore.

In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrillators and the crew is trained in their use. This is the first paper from Singapore reporting the survival rate in patients presenting to an urban public hospital with acute coronary syndrome (ACS) who developed out-of-hospital cardiac arrest (OHCA). All consecutive patients who presented to the ED of a public hospital with OHCA or ACS were surveyed from 1 April 1999 to 30 September 1999. There were 392 patients among whom 115 (28.5%) had OHCA. There was no significant difference in age and gender distribution between the OHCA and non-OHCA patients. More than 2/3 of the OHCA patients had no report of chest pain or breathlessness before they collapsed. Forty five (39.1%) of the 115 OHCA patients were noted to have initial rhythms of ventricular tachycardia (VT) or ventricular fibrillation (VF) and received pre-hospital defibrillation. The mean time from collapse to first DC shock was 12.07+/-7.2 min. Twenty (17.4%) of the OHCA patients had return of spontaneous circulation after resuscitation in the ED. Four patients (3.5%), all with an initial rhythm of VF were discharged alive from the hospital. Much remains to be done to reduce the time interval to first DC shock for the OHCA group.