Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm
Year: 2023
Type: article
Abstract: BACKGROUND: Singapore and Osaka in Japan have comparable population sizes and prehospital management; however, the frequency of ECPR differs greatly for out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm. Given this disparity, we hypothesized that the outcomes among the OHCA patients with initial shockable rhythm in Singapore were different from those in Osaka. The aim of this study was to evaluate the outcomes of OHCA patients with initial shockable rhythm in Singapore compared to the expected outcomes derived from Osaka data using machine learning-based prediction models. METHODS: This was a secondary analysis of two OHCA databases: the Singapore PAROS database (SG-PAROS) and the Osaka-CRITICAL database from Osaka, Japan. This study included adult (18-74 years) OHCA patients with initial shockable rhythm. A machine learning-based prediction model was derived and validated using data from the Osaka-CRITICAL database (derivation data 2012-2017, validation data 2018-2019), and applied to the SG-PAROS database (2010-2016 data), to predict the risk-adjusted probability of favorable neurological outcomes. The observed and expected outcomes were compared using the observed-expected ratio (OE ratio) with 95% confidence intervals (CI). RESULTS: From the SG-PAROS database, 1,789 patients were included in the analysis. For OHCA patients who achieved return of spontaneous circulation (ROSC) on hospital arrival, the observed favorable neurological outcome was at the same level as expected (OE ratio: 0.905 [95%CI: 0.784-1.036]). On the other hand, for those who had continued cardiac arrest on hospital arrival, the outcomes were lower than expected (shockable rhythm on hospital arrival, OE ratio: 0.369 [95%CI: 0.258-0.499], and nonshockable rhythm, OE ratio: 0.137 [95%CI: 0.065-0.235]). CONCLUSION: This observational study found that the outcomes for patients with initial shockable rhythm but who did not obtain ROSC on hospital arrival in Singapore were lower than expected from Osaka. We hypothesize this is mainly due to differences in the use of ECPR.
Source: Critical Care
Authors: Yohei Okada, Nur Shahidah, Yih Yng Ng, Michael Y. C. Chia, Han Nee Gan, Benjamin S. H. Leong, Desmond R. Mao, Wei Ming Ng, Taro Irisawa, Tomoki Yamada, Tetsuro Nishimura, Takeyuki Kiguchi, Masafumi Kishimoto, Tasuku Matsuyama, Norihiro Nishioka, Kosuke Kiyohara, Tetsuhisa Kitamura, Taku Iwami, Marcus Eng Hock Ong
Institutions: National University of Singapore, Kyoto University, Duke-NUS Medical School, SingHealth, Singapore General Hospital, Nanyang Technological University, Tan Tock Seng Hospital, Changi General Hospital, National University Hospital, National University Health System, Khoo Teck Puat Hospital, Ng Teng Fong General Hospital, The University of Osaka, Osaka Police Hospital, Osaka Metropolitan University, Osaka Prefectural Medical Center, Kyoto Prefectural University of Medicine, Otsuma Women's University
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,790
Awards: Research on the development of a new firefighting communication command support system that applies artificial intelligence to 119 emergency calls, G264798222, G3937330793, Evidences for Improving Out-of-Hospital Cardiac Arrest Patient Outcomes for Personalized Medicine: A Registry Study, Development of machine-learning based resuscitation strategy, G7776307557, G858222188, 救命後の生活の質や患者・家族の意思を尊重した院外心停止治療戦略の構築に関わる研究
OpenAlex ID: W4386640683