“Out-of-Hospital Cardiac Arrest (OHCA) Survival Rate for Individuals Aged 40 or Below” Research (2020-2023)
Press Release (For Immediate Release)
The highest incidence of OHCA is at home,
with 3 cases of young OHCA occurring at home every week.
Be a brave first responder and save your loved ones’ lives.
(Hong Kong, November 30, 2023) SADS HK Foundation (SADS HK) has commissioned the Department of Rehabilitation Sciences of The Hong Kong Polytechnic University (PolyU) to conduct research on the “Out-of-Hospital Cardiac Arrest (OHCA) Survival Rate for Individuals Aged 40 or Below”, in collaboration with the Hong Kong Fire Services Department. Based on nearly 30,000 OHCA cases from January 2020 to May 2023, the research team analyzed the incidence, locations, and public utilization of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) for individuals aged 40 or below. The aim is to comprehensively identify factors that can improve the survival rate of this specific group, contributing to the formulation of relevant public cardiac health strategies in Hong Kong.
3 cases of young OHCA occurring at home every week
The PolyU research team analyzed 29,985 OHCA cases in Hong Kong from January 2020 to May 2023 and found 1,395 cases of OHCA in individuals aged 40 or below. Dr. Richard Xu, Assistant Professor of the Department of Rehabilitation Sciences of PolyU, stated, “The study found that OHCA cases in individuals aged 40 or below accounted for 4.65% of the total, which reflected an increase in this group compared to similar studies conducted between 2017 and 2020.”
It was generally believed that OHCA cases mostly occurred in public places, such as sports grounds. However, Prof. Amy Fu, Peter Hung Professor in Pain Management, Associate Head and Professor of the Department of Rehabilitation Sciences of PolyU, stated, “The study found that nearly half of the young OHCA cases occur at home, with an average of 3 cases every week.” Prof. Amy Fu added, “Among these cases, the survival rate of those admitted to the hospital and aged 40 or below was only 9.3%, with less than 40% of them receiving CPR before admission, and less than 10% receiving AED.” There is only a short time window to save OHCA individuals, and the survival rate significantly decreases with time.
Improving AED availability and encouraging public participation in Cardiac Arrest First Aid
Performing CPR or delivering an AED shock to individuals experiencing OHCA can significantly increase the overall success rate of cardiac arrest resuscitation. However, according to a subsequent survey conducted by the research team, about 70% of respondents who had completed CPR and AED training were not necessarily inclined to perform AED first aid in emergency situations. The main reason cited was the perceived shortage of AED. Increasing the number of AED and enhancing public awareness and knowledge of AED locations would be able to encourage citizens to engage in AED first aid.
Three essential points to improve survival rates
Dr. Siu Yuet-chung, Axel, Specialist in Emergency Medicine and Advisory Member of SADS HK, expressed concern about the limited public awareness of CPR and AED in Hong Kong compared to other developed countries or regions. For example, in Shenzhen, the ratio of AED to the population is 1 : 405, while in Hong Kong, the ratio is only 1 : 1,498, which is significantly lower than that of Shenzhen. After an OHCA occurs, the golden window for saving a’s life is only five minutes. For every minute of delay in receiving treatment, the survival rate decreases by 7-10%. Immediate first aid is crucial for improving survival rates.
To enhance OHCA survival rates, Dr. Siu proposed three essential recommendations. First, he suggested popularizing and diversifying cardiac arrest first aid education, extending the training to primary schools to cultivate public awareness of first aid from an early age, and moving towards universal first aid proficiency. Second, he recommended increasing access to AED for those in need, emphasizing the acquisition of AED in residential areas. Third, he advocated for the integration of technology to enhance the chances of patient recovery, encouraging the use of innovative technologies and big data to assist the public in performing first aid.
Additionally, Dr. Siu encouraged institutions and residential complexes with installed AED to participate in the “AED Anywhere for Anyone” Programme initiated by the Hong Kong Fire Services Department. This programme ensures that citizens can easily find the locations of publicly accessible AED across Hong Kong.
SADS patient calls for early diagnosis to prevent OHCA
Yin, a Sudden Arrhythmia Death Syndromes (SADS) patient who has experienced OHCA, shared her story: “I was going to work as usual. While I was about to answer a phone call from my
colleague, I suddenly collapsed and lost consciousness.” At that time, Yin was unaware that she was a “Long QT Syndrome” patient, a particular type of SADS. Unaware of her SADS condition, she took medication that triggered the arrhythmia problem, leading to cardiac arrest. Now, she knows to avoid using drugs that prolong the QT interval and refers to the “drug to avoid list” provided on the SADS HK’s website.
During her hospital stay, Yin experienced numerous critical situations throughout the day, such as over 20 times of cardiac arrests. Fortunately, she was resuscitated with the use of AED shocks. She said, “I can't imagine if these 20 incidents had occurred at home without anyone using an AED on me. I might not be sitting here today sharing my story with everyone.” She hopes that the public will be aware of the locations of AED in residential areas and communities, and encourages CPR and AED training to provide an additional layer of protection for the people around them.
Since SADS is a genetic issue, Yin expressed concern about her family’s situation. “Some of my family members have been diagnosed with SADS condition, but luckily with low risk. It relieved my worries.” She hopes that the public will not hesitate to seek medical advice. If they discover that their family members have SADS, they should undergo early diagnosis and understand their own conditions to prevent OHCA from occurring.
SADS HK Foundation promotes understanding of cardiac warning signs
There are many causes of OHCA, and sudden cardiac death can occur in seemingly healthy young individuals who have not been diagnosed, with Sudden Arrhythmia Death Syndromes (SADS) as one possible cause. Prevention is better than cure. SADS HK has established the “SADS Clinical Subsidy” program and the “SADS Genetic Testing Subsidy” program to provide subsidies for immediate family members of patients who have suffered sudden cardiac death due to SADS or unknown causes. They can undergo their first specialized cardiology clinical examination and genetic testing related to SADS, encouraging early testing for family members to reduce cases of sudden death due to SADS. SADS HK urges the public to pay attention to cardiac warning signs and understand their family medical history. If they experience any cardiac warning signs, seeking prompt assistance from a specialized cardiologist can reduce the risk.
Press Release (For Immediate Release)
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 of 10 folds higher with timely in use of AED
-8 potential strategies to Increase Survival
(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.
Molecular autopsy in Chinese sudden cardiac death in the young
https://drive.google.com/file/d/1kfHRy3P63tGt1_tPINX6F4obSQ_pfzJP/view?usp=sharing
SADS Foundation
Brugada Foundation
Cardiogenetica-Amc Amsterdam