Han Nee Gan

Background: Organ donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study.Methods: Using Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered.Results: 12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario,n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario,n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year).Conclusions: In Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.

Objective There is often little consensus on the levels of trainees’ performances, given the varied expertise and experience of the assessors, different tasks to be assessed and dynamic circumstances. Consequently, assessors are considered to be a major source of measurement error in workplace assessment. The aim of this pilot study is to assess the inter-rater reliability and agreement of a hybrid framework for assessment of nonspecialist doctors in our Emergency Department. Methods A hybrid framework was used to evaluate two core competencies of medical knowledge and patient care of nonspecialist doctors in our Emergency Department. Pre and post scores of these doctors were obtained at the end of their posting. Results The inter-rater agreement and reliability was markedly higher for the group of nonspecialist doctors with previous Emergency Medicine experience, with fair-to-good reliability of the ratings among the assessors after application of the framework. Conclusion The use of our hybrid framework improved the inter-rater reliability and agreement in our Emergency Department for a specific group of learners who have had previous Emergency Medicine experience. To improve the reliability of ratings, faculty development has to address how observations and assessments should be synthesized into an overall rating.

The American Heart Association recommends automated external defibrillator placement in public areas with a high probability (>1) of out-of-hospital cardiac arrest (OHCA) occurring in 5 years. We aimed to determine the incidence rate of OHCA for different location categories in Singapore. Cardiac arrest incidence was obtained from a national registry. Denominators for the actual number of sites per location category were obtained from public accessible sources, government officers and purchased statistics. Analysis was performed and expressed in terms of the corresponding 95% confidence interval (CI). From 1 October 2001 to 14 October 2004, 2254 non-trauma OHCA cases were included. Mean age for arrests was 62.2 years, with 67.5% men. The location category with the highest incidence of cardiac arrests per site per 5 years was Port/Airport/Immigration Checkpoints (5.24 CI [3.66-7.20]). Top individual site with high average incidence of cardiac arrests per 5 years was Changi Airport (25.0 CI [16.18-36.90]). Seventy-one per cent of arrests occurred in residential areas. The postal sector with the highest average incidence per 100 000 population was Bedok Reservoir (54.89), whereas that with the highest population density was Bukit Merah/Alexandra with 348.14 population per 100 km(2) . In this study, we found the categories and individual sites that clearly fulfilled the American Heart Association criteria of at least 1 OHCA per site per 5 years. This study provides a model of how cardiac arrest registry data can be used to guide local health policy on automated external defibrillator deployment.