Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm
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...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Critical Care |
| Online Access: | https://doi.org/10.1186/s13054-023-04636-x |
| _version_ | 1827815600373628928 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Yohei Okada |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T00:01:51Z |
| format | Article |
| id | doaj.art-2ab874188e9d4724830051aae468d7e0 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-12T00:01:51Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-2ab874188e9d4724830051aae468d7e02023-09-17T11:17:09ZengBMCCritical Care1364-85352023-09-0127111210.1186/s13054-023-04636-xOutcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythmYohei Okada0Nur Shahidah1Yih Yng Ng2Michael Y. C. Chia3Han Nee Gan4Benjamin S. H. Leong5Desmond R. Mao6Wei Ming Ng7Taro Irisawa8Tomoki Yamada9Tetsuro Nishimura10Takeyuki Kiguchi11Masafumi Kishimoto12Tasuku Matsuyama13Norihiro Nishioka14Kosuke Kiyohara15Tetsuhisa Kitamura16Taku Iwami17Marcus Eng Hock Ong18Health Services and Systems Research, Duke-NUS Medical SchoolDepartment of Emergency Medicine, Singapore General HospitalLee Kong Chian School of Medicine, Nanyang Technological UniversityEmergency Department, Tan Tock Seng HospitalAccident & Emergency, Changi General HospitalEmergency Medicine Department, National University HospitalDepartment of Acute and Emergency Care, Khoo Teck Puat HospitalEmergency Medicine Department, Ng Teng Fong General HospitalDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of MedicineEmergency and Critical Care Medical Center, Osaka Police HospitalDepartment of Critical Care Medicine, Osaka Metropolitan UniversityCritical Care and Trauma Center, Osaka General Medical CenterOsaka Prefectural Nakakawachi Medical Center of Acute MedicineDepartment of Emergency Medicine, Kyoto Prefectural University of MedicineDepartment of Preventive Services, Graduate School of Medicine, Kyoto UniversityDepartment of Food Science Faculty of Home Economics, Otsuma Women’s UniversityDivision of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka UniversityDepartment of Preventive Services, Graduate School of Medicine, Kyoto UniversityHealth Services and Systems Research, Duke-NUS Medical SchoolAbstract 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.https://doi.org/10.1186/s13054-023-04636-x |
| spellingShingle | 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 Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm Critical Care |
| title | Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm |
| title_full | Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm |
| title_fullStr | Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm |
| title_full_unstemmed | Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm |
| title_short | Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm |
| title_sort | outcome assessment for out of hospital cardiac arrest patients in singapore and japan with initial shockable rhythm |
| url | https://doi.org/10.1186/s13054-023-04636-x |
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