Yohei Okada1,2, Sho Komukai3, Tetsuhisa Kitamura4, Takeyuki Kiguchi5, Taro Irisawa6, Tomoki Yamada7, Kazuhisa Yoshiya8, Changhwi Park9, Tetsuro Nishimura10, Takuya Ishibe11, Yoshiki Yagi12, Masafumi Kishimoto13, Toshiya Inoue14, Yasuyuki Hayashi15, Taku Sogabe16, Takaya Morooka17, Haruko Sakamoto18, Keitaro Suzuki19, Fumiko Nakamura20, Tasuku Matsuyama21, Norihiro Nishioka1, Daisuke Kobayashi1, Satoshi Matsui4, Atsushi Hirayama22, Satoshi Yoshimura1, Shunsuke Kimata1, Takeshi Shimazu6, Shigeru Ohtsuru2, Taku Iwami1. 1. Department of Preventive Services, School of Public Health, Kyoto University. 2. Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University. 3. Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University. 4. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University. 5. Critical Care and Trauma Center, Osaka General Medical Center. 6. Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University. 7. Emergency and Critical Care Medical Center, Osaka Police Hospital. 8. Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital. 9. Department of Emergency Medicine, Tane General Hospital. 10. Department of Critical Care Medicine, Osaka City University. 11. Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine. 12. Osaka Mishima Emergency Critical Care Center. 13. Osaka Prefectural Nakakawachi Medical Center of Acute Medicine. 14. Senshu Trauma and Critical Care Center. 15. Senri Critical Care Medical Center, Saiseikai Senri Hospital. 16. Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital. 17. Emergency and Critical Care Medical Center, Osaka City General Hospital. 18. Department of Pediatrics, Osaka Red Cross Hospital. 19. Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital. 20. Department of Emergency and Critical Care Medicine, Kansai Medical University. 21. Department of Emergency Medicine, Kyoto Prefectural University of Medicine. 22. Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University.
Abstract
BACKGROUND: The hypothesis of this study is that latent class analysis could identify the subphenotypes of out-of-hospital cardiac arrest (OHCA) patients associated with the outcomes and allow us to explore heterogeneity in the effects of extracorporeal cardiopulmonary resuscitation (ECPR).Methods and Results: This study was a retrospective analysis of a multicenter prospective observational study (CRITICAL study) of OHCA patients. It included adult OHCA patients with initial shockable rhythm. Patients from 2012 to 2016 (development dataset) were included in the latent class analysis, and those from 2017 (validation dataset) were included for evaluation. The association between subphenotypes and outcomes was investigated. Further, the heterogeneity of the association between ECPR implementation and outcomes was explored. In the study results, a total of 920 patients were included for latent class analysis. Three subphenotypes (Groups 1, 2, and 3) were identified, mainly characterized by the distribution of partial pressure of O2(PO2), partial pressure of CO2(PCO2) value of blood gas assessment, cardiac rhythm on hospital arrival, and estimated glomerular filtration rate. The 30-day survival outcomes were varied across the groups: 15.7% in Group 1; 30.7% in Group 2; and 85.9% in Group 3. Further, the association between ECPR and 30-day survival outcomes by subphenotype groups in the development dataset was as varied. These results were validated using the validation dataset. CONCLUSIONS: The latent class analysis identified 3 subphenotypes with different survival outcomes and potential heterogeneity in the effects of ECPR.
BACKGROUND: The hypothesis of this study is that latent class analysis could identify the subphenotypes of out-of-hospital cardiac arrest (OHCA) patients associated with the outcomes and allow us to explore heterogeneity in the effects of extracorporeal cardiopulmonary resuscitation (ECPR).Methods and Results: This study was a retrospective analysis of a multicenter prospective observational study (CRITICAL study) of OHCA patients. It included adult OHCA patients with initial shockable rhythm. Patients from 2012 to 2016 (development dataset) were included in the latent class analysis, and those from 2017 (validation dataset) were included for evaluation. The association between subphenotypes and outcomes was investigated. Further, the heterogeneity of the association between ECPR implementation and outcomes was explored. In the study results, a total of 920 patients were included for latent class analysis. Three subphenotypes (Groups 1, 2, and 3) were identified, mainly characterized by the distribution of partial pressure of O2(PO2), partial pressure of CO2(PCO2) value of blood gas assessment, cardiac rhythm on hospital arrival, and estimated glomerular filtration rate. The 30-day survival outcomes were varied across the groups: 15.7% in Group 1; 30.7% in Group 2; and 85.9% in Group 3. Further, the association between ECPR and 30-day survival outcomes by subphenotype groups in the development dataset was as varied. These results were validated using the validation dataset. CONCLUSIONS: The latent class analysis identified 3 subphenotypes with different survival outcomes and potential heterogeneity in the effects of ECPR.
Entities:
Keywords:
Cardiac arrest; Clustering; Latent class analysis; Subphenotype; Ventricular fibrillation