Hong Kong’s first 3-year case-based study on  “The Survival Rate of Out-of-hospital Cardiac Arrest ”

-The survival rate of young patient is almost 10 folds higher with timely in use of AED-

 - 8 Potential Strategies to Increase Survival Rate - 

          

(Hong Kong, 15th Jun 2022) Out-of-hospital cardiac arrest (OHCA) is the major cause of unexpected and sudden death. If patients with sudden OHCA are delayed in Cardiopulmonary Resuscitation (CPR) or public-access defibrillation (PAD)1, their survival rate will drop by 7-10% for every minute of delay. To investigate the prevalence and survival rate of OHCA in Hong Kong, SADS HK Foundation (SADS HK) commissioned a research team at the Department of Rehabilitation Sciences of The Hong Kong Polytechnic University (PolyU) to conduct the first large scale study using three-year medical cases’ data of “The Survival Rate of Out-of-hospital Cardiac Arrest (OHCA)” in Hong Kong. The main objective of this study is to investigate the prevalence and survival rate of young patients <=age 40 with OHCA in Hong Kong, and to find out the factors that could increase the survival rate of this targeted group. 

Low OHCA Survival in Hong Kong

The team gathered 22,014 OHCA cases between December 2017 and December 2020, of which 21,617 individuals didn’t survive to discharge. For the OHCA patients <=age 40, a total of 829 cases were identified, only 35 (4.2%) cases survived to discharge. From these 829 patients, only 34% and 6.8% had ever received CPR and AED respectively.

1.5 OHCA cases found every 2 days in Hong Kong’s young individuals

Dr Richard XU, Co-Principal Investigator of the study and Research Assistant Professor of the Department of Rehabilitation Sciences at PolyU, explained, “Previous studies on OHCA focus on the overall prevalence and survival rate, which offer limited insights about young patients. This finding is the first of its kind that focuses on Hong Kong OHCA young patients of ages 40 or below.” The study found that between December 2017 and December 2020, there were on average 1.5 OHCA incidents every 2 days that involved young patients in Hong Kong.

 10 folds improvement in survival rate with timely use of AED

Prof. Amy FU, the other Co-Principal Investigator who is also Peter Hung Professor in Pain Management and Associate Head of the Department of Rehabilitation Sciences at PolyU, said, “Our study shows survival to hospital was largely improved from around 15% to 24.8% and 44.6% when cardiopulmonary resuscitation (CPR) or Automated External Defibrillator (AED) were applied respectively; the survival to discharge from hospital was largely improved from about 2% to 9.2 % and 25% when CPR or AED were delivered at the incident site respectively. Such findings suggested that the survival rate for OHCA young patients is enhanced by nearly 10 times if they can receive AED on-time.”

She added that overall, only 17.7 % of the young people who were attacked by cardiac arrest could survive to arrive at hospital and 4.2% could leave hospital. Meanwhile, the male to female young patients ratio was 2 to 1.

8 potential strategies to Increase Survival Rate

Dr Siu Yuet-chung, Axel, Specialist in Emergency Medicine and Advisory Member of SADS HK, revealed that “When compared to other developed Asian countries/regions, the survival rate of Hong Kong OHCA individual is extremely low (1.8%). And there is an acute shortage of Automated External Defibrillator (AED) in Hong Kong and the number of AED in Hong Kong is about 120 times fewer than Japan (5,000 vs.610,000). The study proved that the CPR and AED absolutely increased 10 times of the rate of survival in young patients. Otherwise, the survival rate drops by 7-10% in every minute based on overseas experience.” Dr. Siu emphasizes “The public need to understand the importance of first aid, publicize the use of CPR or AED is needed.”

To increase the rate of survival, Dr. Siu urges to have 8 strategies. Firstly, public education that enables a better understanding on the cardiac warning signs to reduce OHCA. Secondly, CPR and AED must be added as mandatory curriculum in school in order to enhance the knowledge of first aid in our young generation. Thirdly, the government must consider the enactment of Samaritan’s Law to alleviate public concerns about administering first aid. Fourthly, all public places and private/public properties should be equipped with AEDs and our government should consider to offer subsidy to enhance the AED allocation ratio per capita. Fifthly, unified the logo of AED to facilitate the easier identification of the AED installment site. Sixthly, enhance the “AED Anywhere for Anyone” by Fire Services Department as a blueprint to further develop an AED location mobile apps to browse the AED location for quick response. Seventhly, the government should promote the AED registration of all AED in anywhere that can be accessible by public.

Finally, the government should also establish an OHCA database to centralize the integration of all OHCA data including the cases, demographic, locations, rate of survival, etc..

Patient sharing - Experienced the importance of First Aid

Tommy Fung, a patient of OHCA, shared his experience, “When it happened in the early morning, I suddenly lost consciousness. My wife told me that I was stiff and stopped breathing for a while. I was so fortunate that paramedics kept talking with my wife when they were on the way to my home and instructed her how to perform CPR even she had no experience at all. When they arrived, AED was applied immediately. I had been without spontaneous breathing for more than 20 minutes by the time I arrived at the hospital.” He hopes that the public will not underestimate the importance of first aid. Timely implementation of first aid could save the lives of people at home or around them.

SADS HK urges pay more attention to the warning signs of cardiac

OHCA could have many causes, it could lead to sudden death of an apparently healthy undiagnosed young person. Sudden Arrhythmia Death Syndromes (SADS) is one of the many causes. Prevention is better than cure. To prevent cardiac arrest due to SADS, SADS launched the subsidy scheme to support the SADS victim’s or family member for their first clinical consultation. SADS HK urges the public to pay more attention to the warning signs of cardiac and to understand family medical history. If anyone experience any warning signs, please seek the cardiologist’s medical advice as soon as possible to avoid OHCA accidents.