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Resuscitation
. 2022 Jul 19;S0300-9572(22)00609-8.
doi: 10.1016/j.resuscitation.2022.07.018. Online ahead of print.
Predicting neurological outcomes after in-hospital cardiac arrests for patients with Coronavirus Disease 2019
Anoop Mayampurath 1 , Fereshteh Bashiri 2 , Raffi Hagopian 3 , Laura Venable 4 , Kyle Carey 4 , Dana Edelson 4 , Matthew Churpek 5 , American Heart Association's Get With The Guidelines®-Resuscitation Investigators
Affiliations
- PMID: 35868590
- PMCID: PMC9295318
- DOI: 10.1016/j.resuscitation.2022.07.018
Abstract
Background: Machine learning models are more accurate than standard tools for predicting neurological outcomes in patients resuscitated after cardiac arrest. However, their accuracy in patients with Coronavirus Disease 2019 (COVID-19) is unknown. Therefore, we compared their performance in a cohort of cardiac arrest patients with COVID-19.
Methods: We conducted a retrospective analysis of resuscitation survivors in the Get With The Guidelines®-Resuscitation (GWTG-R) COVID-19 registry between February 2020 and May 2021. The primary outcome was a favorable neurological outcome, indicated by a discharge Cerebral Performance Category score ≤ 2. Pre- and peri-arrest variables were used as predictors. We applied our published logistic regression, neural network, and gradient boosted machine models developed in patients without COVID-19 to the COVID-19 cohort. We also updated the neural network model using transfer learning. Performance was compared between models and the Cardiac Arrest Survival Post-Resuscitation In-Hospital (CASPRI) score.
Results: Among the 4,125 patients with COVID-19 included in the analysis, 484 (12%) patients survived with favorable neurological outcomes. The gradient boosted machine, trained on non-COVID-19 patients was the best performing model for predicting neurological outcomes in COVID-19 patients, significantly better than the CASPRI score (c-statistic: 0.75 vs. 0.67, P < 0.001). While calibration improved for the neural network with transfer learning, it did not surpass the gradient boosted machine in terms of discrimination.
Conclusion: Our gradient boosted machine model developed in non-COVID patients had high discrimination and adequate calibration in COVID-19 resuscitation survivors and may provide clinicians with important information for these patients.
Keywords: cardiac arrest; machine learning; neurological outcomes; prediction.