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Okada Y, Shahidah N, Ng YY, Chia MYC, Gan HN, Leong BSH, Mao DR, Ng WM, Edwin N, Kiguchi T, Nishioka N, Kitamura T, Iwami T, Ong MEH. Comparing outcomes of out-of-hospital cardiac arrest patients with initial shockable rhythm in Singapore and Osaka using population-based databases. Crit Care 2023; 27:479. [PMID: 38057881 PMCID: PMC10699037 DOI: 10.1186/s13054-023-04771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Previous research indicated outcomes among refractory out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm were different in Singapore and Osaka, Japan, possibly due to the differences in access to extracorporeal cardiopulmonary resuscitation. However, this previous study had a risk of selection bias. To address this concern, this study aimed to evaluate the outcomes between Singapore and Osaka for OHCA patients with initial shockable rhythm using only population-based databases. METHODS This was a secondary analysis of two OHCA population-based databases in Osaka and Singapore, including adult OHCA patients with initial shockable rhythm. A machine-learning-based prediction model was derived from the Osaka data (n = 3088) and applied to the PAROS-SG data (n = 2905). We calculated the observed-expected ratio (OE ratio) for good neurological outcomes observed in Singapore and the expected derived from the data in Osaka by dividing subgroups with or without prehospital ROSC. RESULTS The one-month good neurological outcomes in Osaka and Singapore among patients with prehospital ROSC were 70% (791/1,125) and 57% (440/773), and among patients without prehospital ROSC were 10% (196/1963) and 2.8% (60/2,132). After adjusting patient characteristics, the outcome in Singapore was slightly better than expected from Osaka in patients with ROSC (OE ratio, 1.067 [95%CI 1.012 to 1.125]), conversely, it was worse than expected in patients without prehospital ROSC (OE ratio, 0.238 [95%CI 0.173 to 0.294]). CONCLUSION This study showed the outcomes of OHCA patients without prehospital ROSC in Singapore were worse than expected derived from Osaka data even using population-based databases. (249/250 words).
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Affiliation(s)
- Yohei Okada
- Duke-NUS Medical School, Health Services and Systems Research, 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
| | - 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
| | - Michael Y C Chia
- Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore
| | - Han Nee Gan
- Accident and 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
| | - Nausheen Edwin
- Department of Emergency Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Takeyuki Kiguchi
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Okada Y, Shahidah N, Ng YY, Chia MYC, Gan HN, Leong BSH, Mao DR, Ng WM, Irisawa T, Yamada T, Nishimura T, Kiguchi T, Kishimoto M, Matsuyama T, Nishioka N, Kiyohara K, Kitamura T, Iwami T, Ong MEH. Outcome assessment for out-of-hospital cardiac arrest patients in Singapore and Japan with initial shockable rhythm. Crit Care 2023; 27:351. [PMID: 37700335 PMCID: PMC10496207 DOI: 10.1186/s13054-023-04636-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
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. 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). 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]). 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.
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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
| | - 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
| | - Michael Y C Chia
- Emergency Department, 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
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - 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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Lim SL, Lau YH, Chan MY, Chua T, Tan HC, Foo D, Lim ZY, Liew BW, Shahidah N, Mao DR, Cheah SO, Chia MYC, Gan HN, Leong BSH, Ng YY, Yeo KK, Ong MEH. Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest. J Clin Med 2021; 10:jcm10215191. [PMID: 34768711 PMCID: PMC8584598 DOI: 10.3390/jcm10215191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
We evaluated the association between early coronary angiography (CAG) and outcomes in resuscitated out-of-hospital cardiac arrest (OHCA) patients, by linking data from the Singapore Pan-Asian Resuscitation Outcomes Study, with a national registry of cardiac procedures. The 30-day survival and neurological outcome were compared between patients undergoing early CAG (within 1-calender day), versus patients not undergoing early CAG. Inverse probability weighted estimates (IPWE) adjusted for non-randomized CAG. Of 976 resuscitated OHCA patients of cardiac etiology between 2011–2015 (mean(SD) age 64(13) years, 73.7% males), 337 (34.5%) underwent early CAG, of whom, 230 (68.2%) underwent PCI. Those who underwent early CAG were significantly younger (60(12) vs. 66(14) years old), healthier (42% vs. 59% with heart disease; 29% vs. 44% with diabetes), more likely males (86% vs. 67%), and presented with shockable rhythms (69% vs. 36%), compared with those who did not. Early CAG with PCI was associated with better survival and neurological outcome (adjusted odds ratio 1.91 and 1.82 respectively), findings robust to IPWE adjustment. The rates of bleeding and stroke were similar. CAG with PCI within 24 h was associated with improved clinical outcomes after OHCA, without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore; (M.Y.C.); (H.C.T.)
- Correspondence: ; Tel.: +65-67-723-301
| | - Yee How Lau
- Department of Cardiology, National Heart Centre, Singapore 169609, Singapore; (Y.H.L.); (T.C.); (K.K.Y.)
| | - Mark Y. Chan
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore; (M.Y.C.); (H.C.T.)
| | - Terrance Chua
- Department of Cardiology, National Heart Centre, Singapore 169609, Singapore; (Y.H.L.); (T.C.); (K.K.Y.)
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore; (M.Y.C.); (H.C.T.)
| | - David Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Zhan Yun Lim
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore 768828, Singapore;
| | - Boon Wah Liew
- Department of Cardiology, Changi General Hospital, Singapore 529889, Singapore;
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore 168753, Singapore; (N.S.); (M.E.H.O.)
| | - Desmond R. Mao
- Department of Acute & Emergency Care, Khoo Teck Puat Hospital, Singapore 768828, Singapore;
| | - Si Oon Cheah
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore 609606, Singapore;
| | - Michael Y. C. Chia
- Emergency Department, Tan Tock Seng Hospital, Singapore 308433, Singapore; (M.Y.C.C.); (Y.Y.N.)
| | - Han Nee Gan
- Accident & Emergency, Changi General Hospital, Singapore 529889, Singapore;
| | - Benjamin S. H. Leong
- Emergency Medicine Department, National University Hospital, Singapore 119074, Singapore;
| | - Yih Yng Ng
- Emergency Department, Tan Tock Seng Hospital, Singapore 308433, Singapore; (M.Y.C.C.); (Y.Y.N.)
- Ministry of Home Affairs, Singapore 329560, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore 169609, Singapore; (Y.H.L.); (T.C.); (K.K.Y.)
| | - Marcus E. H. Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 168753, Singapore; (N.S.); (M.E.H.O.)
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
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Goh SSN, Chia MYC. Anxiety and Morale in Front-Line Healthcare Workers During the Coronavirus Disease 2019 (COVID-19) Outbreak at the National Screening Centre in Singapore. Ann Acad Med Singap 2020; 49:259-262. [PMID: 32419010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Serene S N Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Tiah L, Kajino K, Alsakaf O, Bautista DCT, Ong MEH, Lie D, Naroo GY, Doctor NE, Chia MYC, Gan HN. Does pre-hospital endotracheal intubation improve survival in adults with non-traumatic out-of-hospital cardiac arrest? A systematic review. West J Emerg Med 2014; 15:749-57. [PMID: 25493114 PMCID: PMC4251215 DOI: 10.5811/westjem.2014.9.20291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 09/04/2014] [Accepted: 07/31/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Endotracheal intubation (ETI) is currently considered superior to supraglottic airway devices (SGA) for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA). We aimed to determine if the research supports this conclusion by conducting a systematic review. METHODS We searched the MEDLINE, Scopus and CINAHL databases for studies published between January 1, 1980, and 30 April 30, 2013, which compared pre-hospital use of ETI with SGA for outcomes of return of spontaneous circulation (ROSC); survival to hospital admission; survival to hospital discharge; and favorable neurological or functional status. We selected studies using pre-specified criteria. Included studies were independently screened for quality using the Newcastle-Ottawa scale. We did not pool results because of study variability. Study outcomes were extracted and results presented as summed odds ratios with 95% CI. RESULTS We identified five eligible studies: one quasi-randomized controlled trial and four cohort studies, involving 303,348 patients in total. Only three of the five studies reported a higher proportion of ROSC with ETI versus SGA with no difference reported in the remaining two. None found significant differences between ETI and SGA for survival to hospital admission or discharge. One study reported better functional status at discharge for ETI versus SGA. Two studies reported no significant difference for favorable neurological status between ETI and SGA. CONCLUSION Current evidence does not conclusively support the superiority of ETI over SGA for multiple outcomes among adults with OHCA.
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Affiliation(s)
- Ling Tiah
- Changi General Hospital, Accident and Emergency Department, Singapore
| | - Kentaro Kajino
- Ministry of Health, Labour and Welfare, Government of Japan, Department of Acute Medicine & Critical Care Medical Center, Osaka National Hospital, Osaka, Japan
| | - Omer Alsakaf
- Dubai Corporate for Ambulance Services, Dubai, United Arab Emirates
| | | | - Marcus Eng Hock Ong
- Duke-NUS Graduate Medical School, Health Services and Systems Research, Singapore ; Singapore General Hospital, Department of Emergency Medicine, Singapore
| | - Desiree Lie
- Duke-NUS Graduate Medical School, Office of Clinical Sciences, Singapore
| | - Ghulam Yasin Naroo
- Rashid Hospital, Department of Health & Medical Services, ED-Trauma centre, Dubai, United Arab Emirates
| | | | | | - Han Nee Gan
- Changi General Hospital, Accident and Emergency Department, Singapore
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Doctor NE, Yap S, Gan HN, Leong BSH, Goh ES, Chia MYC, Tham LP, Ng YY, Lim SH, Ong MEH. Recognition and treatment of out-of-hospital cardiac arrests by non-emergency ambulance services in Singapore. Ann Acad Med Singap 2013; 42:445-450. [PMID: 24162319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Prompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore. MATERIALS AND METHODS This is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied. RESULTS Eighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%). CONCLUSION We found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use.
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Affiliation(s)
- Nausheen E Doctor
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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