Survival and neurological outcomes among OHCA patients in middle- and high-income countries in the Asia-Pacific

Fang K 1 , Fook-Chong S 2 , Okada Y 3 , Siddiqui F 2 , Shahidah N 4 , Tanaka H 5 Show all authors , Shin SD 6 , Ma MH 7 , Kajino K 8 , Lin CH 9 , Kuo CW 10 , Karim S 11 , Jirapong S 12 , Chen C 13 , Hock Ong ME 14 , PAROS Clinical Research Network CRN

Affiliations 

  • 1 Duke-NUS Medical School, Singapore; Nanyang Technological University Singapore
  • 2 Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
  • 3 Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 4 Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
  • 5 Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
  • 6 Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
  • 7 Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
  • 8 Department of Emergency Medicine, Kansai Medical University, Osaka, Japan
  • 9 Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 10 Department of Emergency Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
  • 11 Department of Emergency Medicine, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
  • 12 Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand
  • 13 Prehospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
  • 14 Department of Emergency Medicine, Singapore General Hospital, Singapore; Prehospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Resuscitation, 2025 Mar 24.
PMID: 40139425 DOI: 10.1016/j.resuscitation.2025.110592

Abstract

BACKGROUND: Currently, there is a knowledge gap on how OHCA impacts lower-resourced areas, and how they fare compared to their higher-resourced counterparts. This study aims to explore the relationship between a country's income category and neurological outcomes after OHCA in the Asia-Pacific region.

METHODS: A multivariable logistic regression model was applied to the prospective Pan-Asian Resuscitation Outcomes Study (PAROS) dataset. The main exposure was country income status (defined by the World Bank), and the main outcome was neurological outcomes (measured by cerebral performance category score). Sensitivity analyses were run to evaluate the robustness of our findings.

RESULTS: Out of a total of 207,450 PAROS cases between 2009-2018, 168,967 OHCA cases were included in the study. 165,404 cases were from high-income countries and 3563 cases were from middle-income countries. All pediatric, pronounced dead at scene, unknown on-scene survival status, no resuscitation attempted, and traumatic cases were excluded from the analysis. A larger proportion of OHCA patients in high-income countries survived with favorable neurological outcomes (3.65%) compared to middle-income countries (0.75%). High-income countries were associated with better neurological outcomes (AOR 9.05; 95% CI 6.27 to 13.72). Results remained consistent throughout sensitivity analyses.

CONCLUSION: In the PAROS cohort, high-income countries outperform middle income countries in post-OHCA neurological outcomes. Further research is needed to obtain better quality data in middle-income countries and expand reach into low-income countries.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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