Discussion

This study demonstrated a low rate of survival among OHCA patients in Penang, Malaysia. Importantly, only 16.3% of all OHCA cases received an EMS resuscitation attempt. This is largely attributable to the overlap between OHCA and “confirm death” calls, as 999 is activated for both types of calls, and paramedics do not initiate resuscitation if obvious signs of death are present upon arrival as per treatment standards.2 Among EMS-treated cases, poor outcomes were likely driven by prolonged EMS response times and low rates of bystander CPR and AED use, each of which is known to affect survival.4, 5 These findings align with previous Malaysian and other low- and middle- income country (LMIC) studies reporting delayed response, low bystander intervention, and correspondingly poor outcomes.4, 6 Notably, Penang’s crude OHCA incidence during the study period (292 per 100,000 person-years) was more than four times Singapore’s (67 per 100,000 person-years),7 with a lower rate of bystander CPR (43.5% vs 59.4%). Given that most arrests occur at home (92.8%), interventions like mandatory school-based BLS training may be warranted. Furthermore, the median EMS response time of 22 min is suboptimal and particularly concerning. A study in the neighbouring country of Thailand found that response times under 6 min were associated with three-fold higher odds of survival to hospital discharge.4 These metrics represent clear, modifiable targets for quality improvement, and the registry provides a robust foundation for monitoring and refining interventions to improve OHCA outcomes in Penang.

The launch of the myOHCA2.0 platform enabled sustainable, systematic OHCA data collection in Penang. Previously, OHCA research relied on manual abstraction of data from existing care records1 into a Google Form, which was a labour-intensive process prone to inconsistencies and incomplete entries. The myOHCA2.0 platform overcame this via Utstein-aligned fields,3 automated electronic synchronisation and built-in validation rules to enhance accuracy. High-quality data are essential for evaluating interventions like dispatcher-assisted CPR, community CPR training, and evidence-driven ambulance deployment. Such registry infrastructure has proven value globally: the Pan-Asian Resuscitation Outcomes Study (PAROS) showed measurable survival gains in resource-limited settings through policy reform.8 Similarly, high-income registries such as CARES in the United States9 have used benchmarking and system gap analysis to implement evidence-based changes that substantially improved OHCA outcomes over time.

Finally, it is important to note that the functions of myOHCA2.0 can be easily programmed via open-source coding platforms. The system also leverages the Ministry of Health, Malaysia MyGovUC 3.0 platform, ensuring secure database access restricted to authorised personnel. Thus, costs for proprietary software, server infrastructure, and ongoing maintenance are significantly reduced, making the establishment of a sustainable OHCA registry plausible in resource-limited regions without sacrificing data quality. Prospects for international adoption of this universally integrable registry technology strongly align with the World Health Organisation (WHO) goals for LMIC, where OHCA underreporting exceeds 70%.5 Technological innovations such as myOHCA2.0 could bridge the gap between emergency care efficiency in LMICs and that of higher-income countries by supporting robust data collection, multilingual interfaces and even integration with mobile first-responder reporting tools. With more regions establishing OHCA registries, this could scale OHCA epidemiological surveillance globally and further cultivate collaborative research networks, strengthening global resuscitation developments beyond the traditional focus of high-income countries. Future research would need to evaluate long-term implementation and effectiveness in other settings.