Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest.

Abstract

Objectives: The use of machine learning to identify patient 'clusters' using post-return of spontaneous circulation (ROSC) vital signs may facilitate the identification of patient subgroups at high risk of rearrest and mortality. Our objective was to use k-means clustering to identify post-ROSC vital sign clusters and determine whether these clusters were associated with rearrest and mortality.

Methods: The ESO Data Collaborative 2018-2022 datasets were used for this study. We included adult, non-traumatic OHCA patients with >2 post-ROSC vital sign sets. Patients were excluded if they had an EMS-witnessed OHCA or were encountered during an interfacility transfer. Unsupervised (k-means) clustering was performed using minimum, maximum, and delta (last minus first) systolic blood pressure (BP), heart rate, SpO₂, shock index, and pulse pressure. The assessed outcomes were mortality and rearrest. To explore the association between rearrest, mortality, and cluster, multivariable logistic regression modeling was used.

Results: Within our cohort of 12,320 patients, five clusters were identified. Patients in cluster 1 were hypertensive, patients in cluster 2 were normotensive, patients in cluster 3 were hypotensive and tachycardic (n = 2164; 17.6%), patients in cluster 4 were hypoxemic and exhibited increasing systolic BP, and patients in cluster 5 were severely hypoxemic and exhibited a declining systolic BP. The overall proportion of patients who experienced mortality stratified by cluster was 63.4% (c1), 68.1% (c2), 78.8% (c3), 84.8% (c4), and 86.6% (c5). In comparison to the cluster with the lowest mortality (c1), each other cluster was associated with greater odds of mortality and rearrest.

Conclusions: Unsupervised k-means clustering yielded 5 post-ROSC vital sign clusters that were associated with rearrest and mortality.