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Abstract Details

Machine Learning-informed Subtyping of Generalized Periodic Discharges in Cardiac Arrest
Neuro Trauma and Critical Care
S23 - Neurocritical Care (2:00 PM-2:12 PM)
006
GPDs are near invariably associated with poor outcome after cardiac arrest, but a small number of patients may survive with good outcomes. 
Identify generalized periodic discharge (GPD) subtypes associated with potential for neurological recovery after cardiac arrest.
We screened EEG data from a cohort of 1,020 comatose patients with cardiac arrest using SParCNet, a neural network for ictal interictal continuum classification trained on EEG data from a general ICU population. Hours of EEG data classified as GPD for at least 15 minutes in the first 120h post-cardiac arrest were included for further analysis. We used 5-fold cross validation and a gradient boosted classifier for good outcome prediction with 27 quantitative EEG features (i.e., spike rate, background continuity index [BCI], and spectral features averaged hourly) acquired from segments with GPD. Good outcome was defined as a Cerebral Performance Category score of 1-2 at 6-months.
5,525 hours of EEG containing GPDs with an estimated 20 million spikes were analyzed for 300 patients (248 poor and 52 good outcomes). Spike rate in GPD segments was lower in patients with good (median: 0.5 Hz, IQR: 0.61 Hz) vs. poor (0.83 Hz, 1.08 Hz) outcomes. The mean AUC for good outcome prediction using GPD information was 0.8 (+/- 0.11), accuracy of 0.9 (+/-0.03), and specificity of 0.99 (+/-0.01). Following univariate analysis of the most important features in cross-validation, thirty-one percent (N=21/68) of patients with GPDs with BCI > 0.99 and beta to total bandpower ratio < 0.02 were found to have good outcomes.
GPDs with higher continuity and lower beta to total bandpower ratios were associated with a good outcome in cardiac arrest patients. Further subtyping of GPDs associated with potential for neurological recovery may guide decisions about withdrawal of life-sustaining therapies.
Authors/Disclosures

PRESENTER
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Jong Lee (Brigham and Women's Hospital) Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bigoen. Dr. Lee has received stock or an ownership interest from Soterya. The institution of Dr. Lee has received research support from NIH. The institution of Dr. Lee has received research support from Epilepsy Foundation. The institution of Dr. Lee has received research support from Engage Therapeutics. Dr. Lee has received personal compensation in the range of $5,000-$9,999 for serving as a Contract work with Bioserenity. Dr. Lee has received personal compensation in the range of $10,000-$49,999 for serving as a Contract work with Teladoc.
Susan Herman (Barrow Neurological Institute) The institution of Dr. Herman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioserenity. Dr. Herman has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for National Association of Epilepsy Centers. Dr. Herman has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Treatment Options in Neurology. Dr. Herman has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. The institution of Dr. Herman has received research support from Epilepsy Foundation; Epilepsy Learning Healthcare System. The institution of Dr. Herman has received research support from CREMedical. The institution of Dr. Herman has received research support from NIH/NINDS. The institution of Dr. Herman has received research support from Marinus. Dr. Herman has received personal compensation in the range of $500-$4,999 for serving as a Medical Director, Neurodiagnostics Program with Laboure College. Dr. Herman has a non-compensated relationship as a Professional Advisory Board member with Epilepsy Foundation that is relevant to AAN interests or activities.
Adithya Sivaraju (Yale New Haven Medical Center) Dr. Sivaraju has nothing to disclose.
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No disclosure on file
M. Westover (MGH) Dr. Westover has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Edilberto Amorim The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from Society of Critical Care Medicine. The institution of Dr. Amorim has received research support from Zoll Foundation. The institution of Dr. Amorim has received research support from Hellman Foundation. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from Citizens United Against Epilepsy. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from AHA. The institution of Dr. Amorim has received research support from NIH.