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Predicting survival and neurological outcome in out-of-hospital cardiac arrest using machine learning: the SCARS model
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.ORCID iD: 0000-0003-2730-8710
Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, United States.
Karolinska Institutet, Department of Medicine, Karolinska University Hospital Danderyd, Stockholm, Sweden.
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. a Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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2023 (English)In: eBioMedicine, ISSN 2352-3964, Vol. 89, article id 104464Article in journal (Refereed) Published
Abstract [en]

Background: A prediction model that estimates survival and neurological outcome in out-of-hospital cardiac arrest patients has the potential to improve clinical management in emergency rooms.

Methods: We used the Swedish Registry for Cardiopulmonary Resuscitation to study all out-of-hospital cardiac arrest (OHCA) cases in Sweden from 2010 to 2020. We had 393 candidate predictors describing the circumstances at cardiac arrest, critical time intervals, patient demographics, initial presentation, spatiotemporal data, socioeconomic status, medications, and comorbidities before arrest. To develop, evaluate and test an array of prediction models, we created stratified (on the outcome measure) random samples of our study population. We created a training set (60% of data), evaluation set (20% of data), and test set (20% of data). We assessed the 30-day survival and cerebral performance category (CPC) score at discharge using several machine learning frameworks with hyperparameter tuning. Parsimonious models with the top 1 to 20 strongest predictors were tested. We calibrated the decision threshold to assess the cut-off yielding 95% sensitivity for survival. The final model was deployed as a web application.

Findings: We included 55,615 cases of OHCA. Initial presentation, prehospital interventions, and critical time intervals variables were the most important. At a sensitivity of 95%, specificity was 89%, positive predictive value 52%, and negative predictive value 99% in test data to predict 30-day survival. The area under the receiver characteristic curve was 0.97 in test data using all 393 predictors or only the ten most important predictors. The final model showed excellent calibration. The web application allowed for near-instantaneous survival calculations.

Interpretation: Thirty-day survival and neurological outcome in OHCA can rapidly and reliably be estimated during ongoing cardiopulmonary resuscitation in the emergency room using a machine learning model incorporating widely available variables.

Place, publisher, year, edition, pages
2023. Vol. 89, article id 104464
Keywords [en]
Machine learning, Out-of-hospital cardiac arrest, Prediction model, Web application
National Category
Cardiac and Cardiovascular Systems
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-29456DOI: 10.1016/j.ebiom.2023.104464Scopus ID: 2-s2.0-85147657303OAI: oai:DiVA.org:hb-29456DiVA, id: diva2:1738054
Funder
Swedish Research Council, 2019–02019
Note

Funding: Swedish Research Council (2019–02019); Swedish state under the agreement between the Swedish government, and the county councils (ALFGBG-971482); The Wallenberg Centre for Molecular and Translational Medicine

Available from: 2023-02-20 Created: 2023-02-20 Last updated: 2024-02-01Bibliographically approved

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Lundgren, PeterHerlitz, Johan

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