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Abstract Details

Machine Learning Ensemble Models for Neurological Outcome Prediction Following Cardiac Arrest: A Multi-institutional Analysis
Epilepsy/Clinical Neurophysiology (EEG)
P2 - Poster Session 2 (11:45 AM-12:45 PM)
11-003
To develop automated prediction models that identify post-cardiac arrest patients at risk for poor neurological outcomes using early clinical and EEG features.
Accurately predicting neurological recovery following cardiac arrest is challenging. Integrating multiple data sources through computational models may improve early prognostication and inform family counseling.
We analyzed 716 consecutive post-cardiac arrest patients admitted to two tertiary centers (2015-2022) who underwent continuous EEG within 72 hours post-arrest. Neurological outcome at discharge was classified as good (modified Rankin Scale ≤4 AND Cerebral Performance Category ≤2) versus poor. We developed six prediction models using 18 features: demographics (age, sex, insurance, ethnicity), cardiac arrest characteristics (initial rhythm, time to return of spontaneous circulation), clinical features (seizures, myoclonus), and EEG findings (background suppression, stimulus reactivity, eight hyperexcitable patterns including periodic discharges and rhythmic delta activity). Models were validated using data splitting and cross-validation with comprehensive performance assessment.
Of 716 patients, 608 (84.9%) had poor outcomes. The best-performing ensemble model achieved an AUC-ROC of 0.878 (95% CI, 0.807–0.941). When predicting poor outcome, specificity was 95.6% and sensitivity was 50.0%. Feature importance indicated older age, suppressed EEG background, prolonged time to return of spontaneous circulation, and absent EEG reactivity as the strongest adverse predictors.
Automated models integrating early EEG and clinical data reliably identify cardiac arrest patients at highest and lowest risk for poor outcomes. Clinicians can use these tools alongside existing prognostic methods to counsel families about realistic recovery expectations and guide goal-concordant treatment decisions during the critical first 72 hours post-arrest.
Authors/Disclosures
Paul Karim
PRESENTER 		Mr. Karim has nothing to disclose.
Neha Madugala, BS Ms. Madugala has nothing to disclose.
Haoying Hsieh (Boston Medical Center) No disclosure on file
Carina Hou, BA Ms. Hou has nothing to disclose.
Rebecca Stafford (Boston Medical Center) Ms. Stafford has nothing to disclose.
Alexander T. Scott, Research coordinator Mr. Scott has nothing to disclose.
Isabelle Xu, BA Miss Xu has nothing to disclose.
Neil Dhruva, MD Mr. Dhruva has nothing to disclose.
Cathi Ann Thomas, RN, MS Ms. Thomas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avion.
Brian J. Coffey, MD Dr. Coffey has nothing to disclose.
Ali Daneshmand, MD (Boston University School of Medicine) Dr. Daneshmand has nothing to disclose.
Robert Araujo Contreras (Boston Medical Center) Mr. Araujo Contreras has nothing to disclose.
Prasad Patil The institution of Dr. Patil has received research support from NIH.
David M. Greer, MD, FAAN (Boston University School of Medicine) Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Ika Noviawaty, MD (Boston Medical Center) Dr. Noviawaty has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Jazz Pharmaceutical/CME Outfitter. The institution of Dr. Noviawaty has received research support from MARINUS. The institution of Dr. Noviawaty has received research support from UCB.