Predicting neurological outcome in comatose patients after cardiac arrest with multiscale deep neural networks

Wei Long Zheng*, Edilberto Amorim, Jin Jing, Wendong Ge, Shenda Hong, Ona Wu, Mohammad Ghassemi, Jong Woo Lee, Adithya Sivaraju, Trudy Pang, Susan T. Herman, Nicolas Gaspard, Barry J. Ruijter, Jimeng Sun, Marleen C. Tjepkema-Cloostermans, Jeannette Hofmeijer, Michel J.A.M. van Putten, M. Brandon Westover

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: Electroencephalography (EEG) is an important tool for neurological outcome prediction after cardiac arrest. However, the complexity of continuous EEG data limits timely and accurate interpretation by clinicians. We develop a deep neural network (DNN) model to leverage complex EEG trends for early and accurate assessment of cardiac arrest coma recovery likelihood. Methods: We developed a multiscale DNN combining convolutional neural networks (CNN) and recurrent neural networks (long short-term memory [LSTM]) using EEG and demographic information (age, gender, shockable rhythm) from a multicenter cohort of 1,038 cardiac arrest patients. The CNN learns EEG feature representations while the multiscale LSTM captures short-term and long-term EEG dynamics on multiple time scales. Poor outcome is defined as a Cerebral Performance Category (CPC) score of 3-5 and good outcome as CPC score 1-2 at 3-6 months after cardiac arrest. Performance is evaluated using area under the receiver operating characteristic curve (AUC) and calibration error. Results: Model performance increased with EEG duration, with AUC increasing from 0.83 (95% Confidence Interval [CI] 0.79-0.87 at 12h to 0.91 (95%CI 0.88-0.93) at 66h. Sensitivity of good and poor outcome prediction was 77% and 75% at a specificity of 90%, respectively. Sensitivity of poor outcome was 50% at a specificity of 99%. Predicted probability was well matched to the observation frequency of poor outcomes, with a calibration error of 0.11 [0.09-0.14]. Conclusions: These results demonstrate that incorporating EEG evolution over time improves the accuracy of neurologic outcome prediction for patients with coma after cardiac arrest.

Original languageEnglish
Pages (from-to)86-94
Number of pages9
JournalResuscitation
Volume169
Early online date23 Oct 2021
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Cardiac arrest
  • Deep learning
  • EEG
  • Machine learning
  • Neurological outcome

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