Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Crit Care. 2023 Sep 12;27(1):351. doi: 10.1186/s13054-023-04636-x.
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.
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).
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]).
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.
新加坡和日本大阪的人口规模相当，且在院外心脏骤停（OHCA）患者的院前管理方面也相似；然而，心搏骤停初始可电击节律的 OHCA 患者接受体外心肺复苏（ECPR）的频率却有很大差异。鉴于这种差异，我们假设新加坡心搏骤停初始可电击节律 OHCA 患者的结局与大阪的数据有所不同。本研究旨在使用基于机器学习的预测模型，评估新加坡心搏骤停初始可电击节律 OHCA 患者的结局，并与大阪数据得出的预期结局进行比较。
这是两项 OHCA 数据库的二次分析：新加坡 PAROS 数据库（SG-PAROS）和日本大阪的 Osaka-CRITICAL 数据库。本研究纳入了成人（18-74 岁）心搏骤停初始可电击节律 OHCA 患者。使用来自 Osaka-CRITICAL 数据库（2012-2017 年的推导数据，2018-2019 年的验证数据）的数据，建立并验证了基于机器学习的预测模型，并将其应用于 SG-PAROS 数据库（2010-2016 年的数据），以预测风险调整后良好神经结局的概率。使用观察到的-预期比值（OE 比值）及其 95%置信区间（CI）比较观察到的结局和预期结局。
从 SG-PAROS 数据库中纳入了 1789 例患者进行分析。对于在医院到达时实现自主循环恢复（ROSC）的 OHCA 患者，观察到的良好神经结局与预期水平相同（OE 比值：0.905[95%CI：0.784-1.036]）。另一方面，对于在医院到达时持续心脏骤停的患者，结局则低于预期（医院到达时可电击节律，OE 比值：0.369[95%CI：0.258-0.499]，非可电击节律，OE 比值：0.137[95%CI：0.065-0.235]）。
本观察性研究发现，新加坡心搏骤停初始可电击节律但在医院到达时未实现 ROSC 的患者结局低于大阪的预期。我们假设这主要是由于 ECPR 使用的差异所致。
