Emoto Ryo, Nishikimi Mitsuaki, Kikutani Kazuya, Ishii Junki, Ohshimo Shinichiro, Matsui Shigeyuki, Shime Nobuaki
Department of Biostatistics, Nagoya University Graduate School of Medicine, 466-8550 Nagoya, Japan.
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 739-0046 Hiroshima, Japan.
Rev Cardiovasc Med. 2024 Jul 22;25(7):268. doi: 10.31083/j.rcm2507268. eCollection 2024 Jul.
There are few reports of studies on the differential effects of amiodarone among out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm at hospital arrival. The present study aimed to investigate the clinical heterogeneity of OHCA patients with a shockable rhythm upon hospital arrival and to identify subgroups with differential responses to amiodarone, using a machine learning approach.
We used the Japanese nationwide OHCA registry of the Japanese Association for Acute Medicine for this study; data from OHCA patients with a shockable rhythm at hospital arrival were included in the analyses. The primary outcome was a favorable neurological outcome at 30 days. We developed a scoring system by the weighting method with logistic likelihood loss to identify patient subgroups showing differential effects of amiodarone from the point of view of the neurological outcome and survival at 30 days.
Among the 68,111 cases of OHCA in the registry, the data of 2333 OHCA patients with an initial shockable rhythm at hospital arrival were analyzed. The developed score identified higher age, longer interval between the call to the emergency medical service and hospital arrival, absence of a "witness", no defibrillation prior to hospital arrival, hypothermia at hospital arrival, and pre-hospital epinephrine administration as variables that were significantly associated with a beneficial effect of amiodarone. Based on the results of the developed scoring system, 47% (1107/2333) of the patients were considered to greatly benefit from amiodarone administration, whereas 53% (1226/2333) of patients were considered to not benefit from amiodarone administration. The effect of amiodarone on the neurological outcome at 30 days varied significantly among the subgroups identified by the developed score ( : 1.07 [95% confidence interval (CI): 0.99-1.13], = 0.005).
We successfully developed a model that could discriminate between OHCA patients with an initial shockable rhythm at hospital arrival who would benefit or not benefit from the administration of amiodarone in terms of the neurological outcome at 30 days. There was clinical heterogeneity among OHCA patients with a shockable rhythm in terms of their response to amiodarone.
关于胺碘酮对院外心脏骤停（OHCA）患者到达医院时可电击心律的不同影响的研究报道较少。本研究旨在利用机器学习方法，调查OHCA患者到达医院时可电击心律的临床异质性，并识别对胺碘酮有不同反应的亚组。
我们使用了日本急性医学协会的日本全国OHCA登记处的数据进行本研究；分析了到达医院时具有可电击心律的OHCA患者的数据。主要结局是30天时良好的神经功能结局。我们采用逻辑似然损失加权法开发了一个评分系统，从神经功能结局和30天生存率的角度识别显示胺碘酮不同效果的患者亚组。
在登记处的68111例OHCA病例中，分析了2333例到达医院时初始可电击心律的OHCA患者的数据。所开发的评分确定较高年龄、呼叫紧急医疗服务与到达医院之间的间隔较长、无“目击者”、到达医院前未进行除颤、到达医院时体温过低以及院前使用肾上腺素为与胺碘酮有益效果显著相关的变量。根据所开发评分系统的结果，47%（1107/2333）的患者被认为从胺碘酮给药中获益极大，而53%（1226/2333）的患者被认为未从胺碘酮给药中获益。在所开发评分确定的亚组中，胺碘酮对30天时神经功能结局的影响差异显著（：1.07[95%置信区间（CI）：0.99 - 1.13]， = 0.005）。
我们成功开发了一个模型，该模型可以区分到达医院时初始可电击心律的OHCA患者，这些患者在30天时的神经功能结局方面是否会从胺碘酮给药中获益。在对胺碘酮的反应方面，到达医院时可电击心律的OHCA患者存在临床异质性。
