A machine learning approach for modeling decisions in the out of hospital cardiac arrest care workflow

• Published in: BMC medical informatics and decision making Vol. 22; no. 1; pp. 21 - 9
• Main Authors: Harford, Samuel, Del Rios, Marina, Heinert, Sara, Weber, Joseph, Markul, Eddie, Tataris, Katie, Campbell, Teri, Vanden Hoek, Terry, Darabi, Houshang
• Format: Journal Article
• Language: English
• Published: London BioMed Central 25.01.2022; BioMed Central Ltd; Springer Nature B.V; BMC
• Subjects: Adult; Algorithms; Ambulance services; Angiography; Artificial intelligence; Big Data; Cardiac arrest; Cardiopulmonary Resuscitation; Care and treatment; Classification; Cohort analysis; CPR; Decision analysis; Decision Making; Decision modeling; Decision trees; Deep learning; Emergency Medical Services; Fires; Health Informatics; Heart; Heart attacks; Hospitals; Humans; Information Systems and Communication Service; Learning algorithms; Machine Learning; Management of Computing and Information Systems; Medical care; Medical imaging; Medicine; Medicine & Public Health; Methods; Modelling; Models, Theoretical; Neural networks; Neurological outcome; Out of hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - etiology; Out-of-Hospital Cardiac Arrest - therapy; Patients; Performance evaluation; Quality control; Quality management; Survival; Workflow; United States; United States > US; Chicago Illinois; Deep learning; Decision modeling; Neurological outcome; Out of hospital cardiac arrest; Machine learning
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-021-01730-4

Background A growing body of research has shown that machine learning (ML) can be a useful tool to predict how different variable combinations affect out-of-hospital cardiac arrest (OHCA) survival outcomes. However, there remain significant research gaps on the utilization of ML models for decision-making and their impact on survival outcomes. The purpose of this study was to develop ML models that effectively predict hospital’s practice to perform coronary angiography (CA) in adult patients after OHCA and subsequent neurologic outcomes. Methods We utilized all (N = 2398) patients treated by the Chicago Fire Department Emergency Medical Services included in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2018 who survived to hospital admission to develop, test, and analyze ML models for decisions after return of spontaneous circulation (ROSC) and patient survival. ML classification models, including the Embedded Fully Convolutional Network (EFCN) model, were compared based on their ability to predict post-ROSC decisions and survival. Results The EFCN classification model achieved the best results across tested ML algorithms. The area under the receiver operating characteristic curve (AUROC) for CA and Survival were 0.908 and 0.896 respectively. Through cohort analyses, our model predicts that 18.3% (CI 16.4–20.2) of patients should receive a CA that did not originally, and 30.1% (CI 28.5–31.7) of these would experience improved survival outcomes. Conclusion ML modeling effectively predicted hospital decisions and neurologic outcomes. ML modeling may serve as a quality improvement tool to inform system level OHCA policies and treatment protocols.