A Machine Learning Model to Predict Treatment Effect Associated with Targeted Temperature Management After Cardiac Arrest.

Background: Targeted temperature management (TTM) has been associated with neurological recovery among comatose survivors of cardiac arrest. The aim of this study is to determine whether models leveraging acute phase multimodal data after intensive care unit admission (hyperacute phase) can predict short-term outcome after TTM.

Methods: Clinical, physiologic, and laboratory data in the hyperacute phase were analyzed from adult patients receiving TTM after cardiac arrest. Primary end points were survival and favorable neurological outcome. Three machine learning algorithms were trained: generalized linear models, random forest, and gradient boosting. Models with optimal features from forward selection were tenfold cross-validated and resampled 10 times.

Results: The generalized linear model performed best, with an area under the receiver operating characteristic curve ± standard deviation of 0.86 ± 0.04 for the prediction of survival and 0.85 ± 0.03 for the prediction of favorable neurological outcome. Features most predictive of both end points included lower serum chloride concentration, higher serum pH, and greater neutrophil counts.

Conclusions: We found that in patients receiving TTM after cardiac arrest, short-term outcomes can be accurately determined using machine learning applied to data routinely collected in the first 12 h after intensive care unit admission. With validation, hyperacute prediction could enable personalized decision-making in the postcardiac arrest setting.