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Bijman LAE, Wild SH, Clegg G, Halbesma N. Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011-2020. Int J Emerg Med 2024; 17:143. [PMID: 39375588 PMCID: PMC11459714 DOI: 10.1186/s12245-024-00731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/28/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Differences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland. METHODS A retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban-rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home). RESULTS The cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12-1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home). CONCLUSION Males had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA.
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Affiliation(s)
- Laura A E Bijman
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
- Scottish Ambulance Service, Edinburgh, United Kingdom.
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gareth Clegg
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Ambulance Service, Edinburgh, United Kingdom
| | - Nynke Halbesma
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Ambulance Service, Edinburgh, United Kingdom
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Nazeha N, Mao DR, Hong D, Shahidah N, Chua ISY, Ng YY, Leong BSH, Tiah L, Chia MYC, Ng WM, Doctor NE, Ong MEH, Graves N. Cost-effectiveness analysis of a 'Termination of Resuscitation' protocol for the management of out-of-hospital cardiac arrest. Resuscitation 2024; 202:110323. [PMID: 39029582 DOI: 10.1016/j.resuscitation.2024.110323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Historically in Singapore, all out-of-hospital cardiac arrests (OHCA) were transported to hospital for pronouncement of death. A 'Termination of Resuscitation' (TOR) protocol, implemented from 2019 onwards, enables emergency responders to pronounce death at-scene in Singapore. This study aims to evaluate the cost-effectiveness of the TOR protocol for OHCA management. METHODS Adopting a healthcare provider's perspective, a Markov model was developed to evaluate three competing options: No TOR, Observed TOR reflecting existing practice, and Full TOR if TOR is exercised fully. The model had a cycle duration of 30 days after the initial state of having a cardiac arrest, and was evaluated over a 10-year time horizon. Probabilistic sensitivity analysis was performed to account for uncertainties. The costs per quality adjusted life years (QALY) was calculated. RESULTS A total of 3,695 OHCA cases eligible for the TOR protocol were analysed; mean age of 73.0 ± 15.5 years. For every 10,000 hypothetical patients, Observed TOR and Full TOR had more deaths by approximately 19 and 31 patients, respectively, compared to No TOR. Full TOR had the least costs and QALYs at $19,633,369 (95% Uncertainty Interval (UI) 19,469,973 to 19,796,764) and 0 QALYs. If TOR is exercised for every eligible case, it could expect to save approximately $400,440 per QALY loss compared to No TOR, and $821,151 per QALY loss compared to Observed TOR. CONCLUSION The application of the TOR protocol for the management of OHCA was found to be cost-effective within acceptable willingness-to-pay thresholds, providing some justification for sustainable adoption.
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Affiliation(s)
- Nuraini Nazeha
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Desmond Renhao Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Dehan Hong
- Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Ivan Si Yong Chua
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Yih Yng Ng
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore 308207, Singapore
| | - Benjamin S H Leong
- Emergency Medicine Department, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Ling Tiah
- Accident and Emergency, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore
| | - Michael Y C Chia
- Emergency Department, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606, Singapore
| | - Nausheen E Doctor
- Department of Emergency Medicine, Sengkang General Hospital, 110 Sengkang E Wy, Singapore 544886, Singapore
| | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore; Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
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Sakamoto M, Ogawa T, Hasumi J. Evaluation of Confidence and Knowledge Regarding Chest Compression Training Among Children at a Health Promotion Event. Cureus 2024; 16:e68412. [PMID: 39360066 PMCID: PMC11445375 DOI: 10.7759/cureus.68412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Bystander cardiopulmonary resuscitation (CPR) significantly increases out-of-hospital cardiac arrest survival rates. Early CPR implementation and public education are essential for everyone, including children. Despite challenges such as ensuring proper chest compression depth in children, early CPR training at school is beneficial and supported by various studies. However, few studies demonstrate the effectiveness of CPR training for children in environments outside of school, such as health festivals. We conducted chest compression training for children under 15 years who attended a hospital festival and evaluated the changes in their confidence and knowledge of the training. Methods This study evaluated chest compression training in children under 15 years old at a hospital festival. Participants included preschoolers to junior high school students. Training effectiveness was assessed using pre- and post-training questionnaires to measure confidence in and knowledge of chest compressions. Data were analyzed using the χ² test to compare responses before and after training, with a p-value < 0.05 considered statistically significant. The training involved a 10-minute hands-only session using CPR mannequins conducted by paramedics, doctors, and nursing students. Results The study included 180 children (51% male, 49% female). Only 14% had prior CPR training. After CPR training, significant improvements in confidence and knowledge regarding chest compressions were observed among preschool and elementary school students. The overall correct response rate increased from 51% to 97% for the location and from 59% to 92% for the depth of chest compressions. Discussion This study evaluated CPR training for children at a hospital festival and showed that few children have experience with CPR training. Our CPR training improved children's confidence and knowledge of chest compressions. Despite concerns about the strength of younger children in effective chest compressions, preschool, and elementary school children showed high motivation and capability. This study highlights the importance of early CPR education supported by both school and health festival initiatives. The limitations include the short training duration and lack of automated external defibrillator instructions. Conclusion We confirmed that CPR training at a hospital festival improves children's knowledge and confidence. Future large-scale studies are needed to evaluate long-term retention and broader age ranges.
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Affiliation(s)
| | - Takahisa Ogawa
- Orthopedics, Saku Central Hospital Advanced Care Center, Saku, JPN
| | - Junpei Hasumi
- Pediatrics, Saku Central Hospital Advanced Care Center, Saku, JPN
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Julian GS, Shau WY, Chou HW, Setia S. Bridging Real-World Data Gaps: Connecting Dots Across 10 Asian Countries. JMIR Med Inform 2024; 12:e58548. [PMID: 39026427 PMCID: PMC11362708 DOI: 10.2196/58548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/17/2024] [Accepted: 07/19/2024] [Indexed: 07/20/2024] Open
Abstract
The economic trend and the health care landscape are rapidly evolving across Asia. Effective real-world data (RWD) for regulatory and clinical decision-making is a crucial milestone associated with this evolution. This necessitates a critical evaluation of RWD generation within distinct nations for the use of various RWD warehouses in the generation of real-world evidence (RWE). In this article, we outline the RWD generation trends for 2 contrasting nation archetypes: "Solo Scholars"-nations with relatively self-sufficient RWD research systems-and "Global Collaborators"-countries largely reliant on international infrastructures for RWD generation. The key trends and patterns in RWD generation, country-specific insights into the predominant databases used in each country to produce RWE, and insights into the broader landscape of RWD database use across these countries are discussed. Conclusively, the data point out the heterogeneous nature of RWD generation practices across 10 different Asian nations and advocate for strategic enhancements in data harmonization. The evidence highlights the imperative for improved database integration and the establishment of standardized protocols and infrastructure for leveraging electronic medical records (EMR) in streamlining RWD acquisition. The clinical data analysis and reporting system of Hong Kong is an excellent example of a successful EMR system that showcases the capacity of integrated robust EMR platforms to consolidate and produce diverse RWE. This, in turn, can potentially reduce the necessity for reliance on numerous condition-specific local and global registries or limited and largely unavailable medical insurance or claims databases in most Asian nations. Linking health technology assessment processes with open data initiatives such as the Observational Medical Outcomes Partnership Common Data Model and the Observational Health Data Sciences and Informatics could enable the leveraging of global data resources to inform local decision-making. Advancing such initiatives is crucial for reinforcing health care frameworks in resource-limited settings and advancing toward cohesive, evidence-driven health care policy and improved patient outcomes in the region.
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Affiliation(s)
| | - Wen-Yi Shau
- Pfizer Corporation Hong Kong Limited, Hong Kong, China (Hong Kong)
| | | | - Sajita Setia
- Executive Office, Transform Medical Communications Limited, Wanganui, New Zealand
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Lee DYX, Yau CE, Pek MPP, Xu H, Lim DYZ, Earnest A, Ong MEH, Ho AFW. Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study. Resusc Plus 2024; 18:100610. [PMID: 38524148 PMCID: PMC10960127 DOI: 10.1016/j.resplu.2024.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Background Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. Methods We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category. Results We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. Conclusions We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.
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Affiliation(s)
- Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Maeve Pin Pin Pek
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, North Carolina, USA
| | - Daniel Yan Zheng Lim
- Data Science and Artificial Intelligence Lab, Singapore General Hospital, Singapore, Singapore
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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Rahadian RE, Okada Y, Shahidah N, Hong D, Ng YY, Chia MY, Gan HN, Leong BS, Mao DR, Ng WM, Doctor NE, Ong MEH. Machine learning prediction of refractory ventricular fibrillation in out-of-hospital cardiac arrest using features available to EMS. Resusc Plus 2024; 18:100606. [PMID: 38533482 PMCID: PMC10963854 DOI: 10.1016/j.resplu.2024.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
Background Shock-refractory ventricular fibrillation (VF) or ventricular tachycardia (VT) is a treatment challenge in out-of-hospital cardiac arrest (OHCA). This study aimed to develop and validate machine learning models that could be implemented by emergency medical services (EMS) to predict refractory VF/VT in OHCA patients. Methods This was a retrospective study examining adult non-traumatic OHCA patients brought into the emergency department by Singapore EMS from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Data from April 2010 to March 2020 were extracted for this study. Refractory VF/VT was defined as VF/VT persisting or recurring after at least one shock. Features were selected based on expert clinical opinion and availability to dispatch prior to arrival at scene. Multivariable logistic regression (MVR), LASSO and random forest (RF) models were investigated. Model performance was evaluated using receiver operator characteristic (ROC) area under curve (AUC) analysis and calibration plots. Results 20,713 patients were included in this study, of which 860 (4.1%) fulfilled the criteria for refractory VF/VT. All models performed comparably and were moderately well-calibrated. ROC-AUC were 0.732 (95% CI, 0.695 - 0.769) for MVR, 0.738 (95% CI, 0.701 - 0.774) for LASSO, and 0.731 (95% CI, 0.690 - 0.773) for RF. The shared important predictors across all models included male gender and public location. Conclusion The machine learning models developed have potential clinical utility to improve outcomes in cases of refractory VF/VT OHCA. Prediction of refractory VF/VT prior to arrival at patient's side may allow for increased options for intervention both by EMS and tertiary care centres.
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Affiliation(s)
| | - Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Dehan Hong
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Han Nee Gan
- Accident & Emergency, Changi General Hospital, Singapore, Singapore
| | - Benjamin S.H. Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Desmond R. Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Ho AFW, Zheng H, Ng ZHC, Pek PP, Ng BJH, Chin YH, Lam TJR, Østbye T, Tromp J, Ong MEH, Yeo JW. Incidence and Long-Term Outcomes of Acute Myocardial Infarction Among Survivors of Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2024; 13:e031716. [PMID: 38156500 PMCID: PMC10863809 DOI: 10.1161/jaha.123.031716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/31/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Despite the increasing long-term survival after out-of-hospital cardiac arrest (OHCA), the risk of subsequent acute myocardial infarction (AMI) remains poorly understood. We aimed to determine the incidence, predictors, and long-term outcomes of AMI among survivors of OHCA. METHODS AND RESULTS We assembled a retrospective cohort of 882 patients with OHCA who survived to 30 days or discharge from the hospital between 2010 and 2019. Survivors of OHCA had an increased risk of subsequent AMI, defined as AMI occurring 30 days after index OHCA or following discharge from the hospital after OHCA, compared with the general population when matched for age and sex (standardized incidence ratio, 4.64 [95% CI, 3.52-6.01]). Age-specific risks of subsequent AMI for men (standardized incidence ratio, 3.29 [95% CI, 2.39-4.42]) and women (standardized incidence ratio, 6.15 [95% CI, 3.27-10.52]) were significantly increased. A total of 7.2%, 8.3%, and 14.3% of survivors of OHCA had a subsequent AMI at 3 years, 5 years, and end of follow-up, respectively. Age at OHCA (hazard ratio [HR], 1.04 [95% CI, 1.02-1.06]) and past medical history of prior AMI, defined as any AMI preceding or during the index OHCA event (HR, 1.84 [95% CI, 1.05-3.22]), were associated with subsequent AMI, while an initial shockable rhythm was not (HR, 1.00 [95% CI, 0.52-1.94]). Survivors of OHCA with subsequent AMI had a higher risk of death (HR, 1.58 [95% CI, 1.12-2.22]) than those without. CONCLUSIONS Survivors of OHCA are at an increased risk of subsequent AMI compared with the general population. Prior AMI, but not an initial shockable rhythm, increases this risk, while subsequent AMI predicts death. Preventive measures for AMI including cardiovascular risk factor control and revascularization may thus improve outcomes in selected patients with cardiac pathogenesis.
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Affiliation(s)
- Andrew Fu Wah Ho
- Pre‐Hospital and Emergency Research Centre, Health Services & Systems Research, Duke‐NUS Medical SchoolSingapore
- Department of Emergency MedicineSingapore General HospitalSingapore
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion BoardSingapore
| | - Zi Hui Celeste Ng
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Pin Pin Pek
- Pre‐Hospital and Emergency Research Centre, Health Services & Systems Research, Duke‐NUS Medical SchoolSingapore
| | - Benny Jun Heng Ng
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Yip Han Chin
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - Truls Østbye
- Programme in Health Services & Systems Research, Duke NUS Medical SchoolSingapore
| | - Jasper Tromp
- Saw Swee Hock School of Public HealthNational University of Singapore & the National University Health SystemSingapore
- Duke‐NUS Medical SchoolSingapore
| | - Marcus Eng Hock Ong
- Pre‐Hospital and Emergency Research Centre, Health Services & Systems Research, Duke‐NUS Medical SchoolSingapore
- Department of Emergency MedicineSingapore General HospitalSingapore
| | - Jun Wei Yeo
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
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Ho I, Kuo M, Hsu P, Lee I, Hsu T, Lin Y, Huang C. The impacts of anemia burden on clinical outcomes in patients with out-of-hospital cardiac arrest. Clin Cardiol 2024; 47:e24175. [PMID: 37872851 PMCID: PMC10777437 DOI: 10.1002/clc.24175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) has low survival rates, and few patients achieve a desirable neurological outcome. Anemia is common among OHCA patients and has been linked to worse outcomes, but its impact following the return of spontaneous circulation (ROSC) is unclear. This study examines the relationship between anemia burden and clinical outcomes in OHCA patients. HYPOTHESIS Higher anemia burden after ROSC may be related to higher mortality and worse neurologic outcomes. METHODS Patients who experienced OHCA and had ROSC were enrolled retrospectively. Anemia burden was defined as the area under curve from the target hemoglobin level over a 72-h period after OHCA. Hemoglobin level was measured at 12-h intervals. The clinical outcomes of the study included mortality and neurological outcomes at Day 30. RESULTS The study enrolled 258 nontraumatic OHCA patients who achieved ROSC between January 2017 and December 2021. Among the 162 patients who survived more than 72 h, a higher anemia burden, specifically target hemoglobin levels below 7 (hazard ratio [HR]: 1.129, 95% confidence interval [CI]: 1.013-1.259, p = .029), 8 (HR: 1.099, 95% CI: 1.014-1.191, p = .021), and 9 g/dL (HR: 1.066, 95% CI: 1.001-1.134, p = .046) was associated with higher 30-day mortality. Additionally, anemia burden with target hemoglobin levels below 7 (HR: 1.129, 95% CI: 1.016-1.248; p = .024) and 8 g/dL (HR: 1.088; 95% CI: 1.008-1.174, p = .031) was linked to worse neurological outcomes. CONCLUSIONS Anemia burden predicts 30-day mortality and neurological outcomes in OHCA patients who survive more than 72 h. Maintaining higher hemoglobin levels within the first 72 h after ROSC may improve short-term outcomes.
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Affiliation(s)
- I‐Wei Ho
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Ming‐Jen Kuo
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Pai‐Feng Hsu
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Healthcare and Services CenterTaipei Veterans General HospitalTaipeiTaiwan
| | - I‐Hsin Lee
- Department of EmergencyTaipei Veterans General HospitalTaipeiTaiwan
| | - Teh‐Fu Hsu
- Department of EmergencyTaipei Veterans General HospitalTaipeiTaiwan
| | - Yenn‐Jiang Lin
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Heart Rhythm CenterTaipei Veterans General HospitalTaipeiTaiwan
| | - Chin‐Chou Huang
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of Pharmacology, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Gräsner JT, Dicker B, Ho AFW. The value of resuscitation registries. Resusc Plus 2023; 15:100444. [PMID: 37583511 PMCID: PMC10423697 DOI: 10.1016/j.resplu.2023.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Affiliation(s)
- Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel and Lübeck, Germany
- Department for Anaesthesiology and Intensive Care, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Bridget Dicker
- Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore
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10
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Pin Pek P, Cheng Fan K, Eng Hock Ong M, Luo N, Østbye T, Lynn Lim S, Fuwah Ho A. Determinants of health-related quality of life after out-of-hospital cardiac arrest (OHCA): A systematic review. Resuscitation 2023; 188:109794. [PMID: 37059353 DOI: 10.1016/j.resuscitation.2023.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE With a growing number of out-of-hospital cardiac arrest (OHCA) survivors globally, the focus of OHCA management has now broadened to survivorship. An outcome central to survivorship is health-related quality of life (HRQoL). This systematic review aimed to synthesise evidence related to the determinants of HRQoL of OHCA survivors. METHODS We systematically searched MEDLINE, Embase, and Scopus from inception to 15 August 2022 to identify studies investigating the association of at least one determinant and HRQoL in adult OHCA survivors. All articles were independently reviewed by two investigators. We abstracted data pertaining to determinants and classified them using a well-established HRQoL theoretical framework - the Wilson and Cleary (revised) model. RESULTS 31 articles assessing a total of 35 determinants were included. Determinants were classified into the five domains in the HRQoL model. 26 studies assessed determinants related to individual characteristics (n=3), 12 studied biological function (n=7), nine studied symptoms (n=3), 16 studied functioning (n=5), and 35 studied characteristics of the environment (n=17). In studies that included multivariable analyses, most reported that individual characteristics (older age, female sex), symptoms (anxiety, depression), and functioning (impaired neurocognitive function) were significantly associated with poorer HRQoL. CONCLUSIONS Individual characteristics, symptoms, and functioning played significant roles in explaining the variability in HRQoL. Significant non-modifiable determinants such as age and sex could be used to identify populations at risk of poorer HRQoL, while significant modifiable determinants such as psychological health and neurocognitive functioning could serve as targets for post-discharge screening and rehabilitation plans. PROSPERO registration number: CRD42022359303.
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Affiliation(s)
- Pin Pin Pek
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai Cheng Fan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Marcus Eng Hock Ong
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Truls Østbye
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Andrew Fuwah Ho
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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