CC：新加坡和日本初始可电击复律的院外心脏停搏患者的结局评估

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. 新加坡和日本大阪的人口规模和院前管理相当；然而，对于初始可电击复律的院外心脏停搏(OHCA)患者，ECPR的频率有很大差异。鉴于这一差异，我们假设在新加坡，初始可电击复律心律的OHCA患者的结局与大阪患者不同。本研究的目的是使用基于机器学习的预测模型，评估在新加坡有初始可电击复律心律的OHCA患者的结局，并与大阪数据得出的预期结局进行比较。

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).这是对两个OHCA数据库的二次分析:新加坡PAROS数据库(SG-PAROS)和来自日本大阪的Osaka- critical数据库。本研究纳入初始可电击复律的成人(18 ~ 74岁)OHCA患者。利用大阪关键数据库(Osaka-CRITICAL database)的数据推导并验证基于机器学习的预测模型(推导数据为2012 ~ 2017年，验证数据为2018 ~ 2019年)，并应用于SG-PAROS数据库(2010 ~ 2016年数据)，预测经风险调整后的良好神经系统结局概率。采用观察预期比(OE比)及其95%可信区间(CI)比较观察和预期结局。

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]).从SG-PAROS数据库中，1,789例患者被纳入分析。在OHCA患者院内获得自主循环恢复(return of spontaneous circulation, ROSC)后，观察到的良好神经功能预后与预期水平相同(OE比:0.905 [95%CI: 0.784 ~ 1.036])。另一方面，对于入院时持续心脏停搏的患者，其结局低于预期(入院时可电击心律，OE比:0.369 [95%CI: 0.258 ~ 0.499]，不可电击心律，OE比: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.这项观察性研究发现，在抵达新加坡医院时未获得ROSC的初始可电击复律患者的结果低于大阪的预期。我们假设这主要是由于ECPR使用的差异。