In this issue of the HKSEMS Newsletter, we feature two articles on out-of-hospital cardiac arrest (OHCA). Our President draws a vision for a comprehensive cardiac arrest centre, while Dr Irene Lo from NLTH introduces the advanced procedure of transesophageal echocardiography for diagnosis and management.

These insights aim to drive the conversation forward, but the reality remains stark: OHCA survival-to-discharge rate in Hong Kong has plateaued between 2% to 3% for years. We know that our dedicated ambulance crew perform resuscitation for every OHCA case, so this figure will include unwitnessed, non-shockable cases and patients with DNACPR orders. As emergency physicians, we recognize OHCA as the emergency of emergencies, a benchmark for the effectiveness of our emergency systems. While other regions have seen their survival rates double or even triple over the last decade, Hong Kong remains stuck.

We had done a lot. In ambulance services, we have introduced mechanical compression devices, intraosseous access and supraglottic airways. In hospitals, we have pursued faster emergency PCI. Yet, despite these efforts, the results we've hoped for remain elusive.

During my recent visit to Ambulance Victoria (AV) in Melbourne, I witnessed their advanced prehospital practices, including the use of ECMO at the arrest scene. But to me what is equally impressive is how they handle the fundamentals. Every paramedic uses a feedback device during resuscitation, which records the entire sequence and provides a detailed performance report afterward. This focus on continuous improvement through feedback exemplifies a commitment to excellence that we can learn from.

As we strive for new advancements, we must not forget the basics. Can our witnesses and first responders reliably and quickly identify cardiac arrest? Are AEDs within reach of bystanders when needed? Have we ensured that high-quality CPR is consistently delivered? These are fundamental questions, and many of the answers can be quantified and addressed as a foundation for improvement.

Hong Kong’s dense urban environment should in theory make it a leader in time-sensitive emergencies like OHCA. With the right systems in place, we can elevate our standards and close the gap. It’s time for us to blend advanced practices with a focus on the essentials, ensuring that every second counts when it matters most.