• Yohei Okada, Nur Shahidah, Yih Yng Ng, ChiaMichael Y CMYCEmergency Department, Tan Tock Seng Hospital, Singapore, Singapore., Han Nee Gan, LeongBenjamin S HBSHEmergency Medicine Department, National University Hospital, Singapore, Singapore., 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, and OngMarcus Eng HockMEHHealth Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore..
• Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. yokada-kyf@umin.ac.jp.
• Crit Care. 2023 Sep 12; 27 (1): 351351.

BackgroundSingapore 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.MethodsThis 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).ResultsFrom 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]).ConclusionThis 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.© 2023. BioMed Central Ltd., part of Springer Nature.

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