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10. Predicting Cardiac Arrest in Children with Heart Disease: A Novel Machine Learning Algorithm.

Author

Yu, Priscilla, Skinner, Michael, Esangbedo, Ivie, Lasa, Javier J., Li, Xilong, Natarajan, Sriraam, and Raman, Lakshmi

Subjects
MACHINE learning, CARDIAC arrest, JUVENILE diseases, HEART diseases, CLINICAL decision support systems
Abstract

Background: Children with congenital and acquired heart disease are at a higher risk of cardiac arrest compared to those without heart disease. Although the monitoring of cardiopulmonary resuscitation quality and extracorporeal resuscitation technologies have advanced, survival after cardiac arrest in this population has not improved. Cardiac arrest prevention, using predictive algorithms with machine learning, has the potential to reduce cardiac arrest rates. However, few studies have evaluated the use of these algorithms in predicting cardiac arrest in children with heart disease. Methods: We collected demographic, laboratory, and vital sign information from the electronic health records (EHR) of all the patients that were admitted to a single-center pediatric cardiac intensive care unit (CICU), between 2010 and 2019, who had a cardiac arrest during their CICU admission, as well as a comparator group of randomly selected non-cardiac-arrest controls. We compared traditional logistic regression modeling against a novel adaptation of a machine learning algorithm (functional gradient boosting), using time series data to predict the risk of cardiac arrest. Results: A total of 160 unique cardiac arrest events were matched to non-cardiac-arrest time periods. Using 11 different variables (vital signs and laboratory values) from the EHR, our algorithm's peak performance for the prediction of cardiac arrest was at one hour prior to the cardiac arrest (AUROC of 0.85 [0.79,0.90]), a performance that was similar to our previously published multivariable logistic regression model. Conclusions: Our novel machine learning predictive algorithm, which was developed using retrospective data that were collected from the EHR and predicted cardiac arrest in the children that were admitted to a single-center pediatric cardiac intensive care unit, demonstrated a performance that was similar to that of a traditional logistic regression model. While these results are encouraging, future research, including prospective validations with multicenter data, is warranted prior to the implementation of this algorithm as a real-time clinical decision support tool. [ABSTRACT FROM AUTHOR]

Published
2023
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16. Altered metabolic and inflammatory transcriptomics after cardiac surgery in neonates with congenital heart disease.

Author

Jain, Parag N., Robertson, Matthew, Lasa, Javier J., Shekerdemian, Lara, Guffey, Danielle, Zhang, Yuhao, Lingappan, Krithika, Checchia, Paul, and Coarfa, Cristian

Subjects
TRANSCRIPTOMES, MESSENGER RNA, PALLIATIVE treatment, GENE expression, INFLAMMATION
Abstract

The study examines the whole blood transcriptome profile before and after cardiopulmonary bypass (CPB) in neonates with hypoplastic left heart syndrome (HLHS), a severe form of congenital heart disease, that can develop low cardiac output syndrome (LCOS). Whole blood mRNA transcriptome profiles of 13 neonates with HLHS before and after their first palliative surgery were analyzed to determine differentially expressed genes and pathways. The median age and weight at surgery were 4 days and 3.2 kg, respectively. Of the 13 patients, 8 developed LCOS. There was no significant difference between CPB, aortic cross clamp, deep hypothermic cardiac arrest times between patients that develop LCOS and those that do not. Upon comparing differential gene expression profiles between patients that develop LCOS and those that do not in pre-operative samples, 1 gene was up-regulated and 13 were down regulated. In the post-operative samples, 4 genes were up-regulated, and 4 genes were down regulated when patients that develop LCOS were compared to those that do not. When comparing post-operative samples to pre-operative samples in the patients that do not develop LCOS, 1484 genes were up-regulated, and 1388 genes were down regulated; while patients that developed LCOS had 2423 up-regulated genes, and 2414 down regulated genes for the same pre to post-operative comparison. Pathway analysis revealed differential regulation of inflammatory pathways (IL signaling, PDGF, NOTCH1, NGF, GPCR) and metabolic pathways (heme metabolism, oxidative phosphorylation, protein metabolism including amino acid and derivatives, fatty acid metabolism, TCA cycle and respiratory electron transport chain). By identifying altered transcriptome profiles related to inflammation and metabolism in neonates with HLHS who develop LCOS after CPB, this study opens for exploration novel pathways and potential therapeutic targets to improve outcomes in this high-risk population. [ABSTRACT FROM AUTHOR]

Published
2021
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25. 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Author

Duff, Jonathan P., Topjian, Alexis A., Berg, Marc D., Chan, Melissa, Haskell, Sarah E., Joyner, Benny L., Lasa, Javier J., Ley, S. Jill, Raymond, Tia T., Sutton, Robert Michael, Hazinski, Mary Fran, Atkins, Dianne L., and Joyner, Benny L Jr

Published
2019
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26. Cardiopulmonary Resuscitation in the Pediatric Cardiac Catheterization Laboratory: A Report From the American Heart Association's Get With the Guidelines-Resuscitation Registry.

Author

Lasa, Javier J., Alali, Alexander, Minard, Charles G., Parekh, Dhaval, Kutty, Shelby, Gaies, Michael, Raymond, Tia T., Guerguerian, Anne-Marie, Atkins, Dianne, Foglia, Elizabeth, Fink, Ericka, Roberts, Joan, Duval-Arnould, Jordan, Bembea, Melanie, Kleinman, Monica, Gupta, Punkaj, Sutton, Robert, Sawyer, Taylor, and American Heart Association’s Get With the Guidelines-Resuscitation Investigators

Published
2019
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29. Outcomes After Extracorporeal Cardiopulmonary Resuscitation of Pediatric In-Hospital Cardiac Arrest: A Report From the Get With the Guidelines-Resuscitation and the Extracorporeal Life Support Organization Registries.

Author

Bembea, Melania M., Ng, Derek K., Rizkalla, Nicole, Rycus, Peter, Lasa, Javier J., Dalton, Heidi, Topjian, Alexis A., Thiagarajan, Ravi R., Nadkarni, Vinay M., Hunt, Elizabeth A., and American Heart Association’s Get With The Guidelines – Resuscitation Investigators

Published
2019
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34. Extracorporeal Cardiopulmonary Resuscitation (E-CPR) During Pediatric In-Hospital Cardiopulmonary Arrest Is Associated With Improved Survival to Discharge: A Report from the American Heart Association's Get With The Guidelines-Resuscitation (GWTG-R) Registry.

Author

Lasa, Javier J., Rogers, Rachel S., Localio, Russell, Shults, Justine, Raymond, Tia, Gaies, Michael, Thiagarajan, Ravi, Laussen, Peter C., Kilbaugh, Todd, Berg, Robert A., Nadkarni, Vinay, and Topjian, Alexis

Published
2016
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35. The authors reply.

Author

Achuff, Barbara-Jo MD, Moffett, Brady S. PharmD, MPH, Acosta, Sebastian PhD, Lasa, Javier J. MD, Checchia, Paul A. MD, Rusin, Craig G. PhD, Achuff, Barbara-Jo, Moffett, Brady S, Acosta, Sebastian, Lasa, Javier J, Checchia, Paul A, and Rusin, Craig G

Published
2019
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36. Perinatal course of Ebstein's anomaly and tricuspid valve dysplasia in the fetus.

Author

Lasa, Javier J., Tian, Zhi-Yun, Guo, Rong, and Rychik, Jack

Abstract

ABSTRACT Objective We sought to better define echocardiographic predictors of perinatal mortality in fetuses with Ebstein's anomaly (EA) or tricuspid valve dysplasia (TVD). Method Parameters included measured chamber size, the presence of hydrops, and Doppler recordings of the left ventricular (LV) myocardial performance index (MPI). Results Between 1 January 2000 and 31 December 2008, 21 fetuses were diagnosed with either EA (17) or TVD (4). Five fetuses were lost to follow-up, and 12 of 16 fetuses were born live (75%). Survivors were found to have smaller right atrial area index scores when compared with non-survivors (1.025 ± 0312 vs 1.502 ± 0.105, respectively, p = 0.013) and were less likely to present with hydrops (0% survivors vs 75% of non-survivors, p < 0.01). LV MPI sub-analysis revealed a shorter combined isovolemic contraction and relaxation time for non-survivors compared wth survivors (46.5 ± 8.2 ms vs 82.3 ± 21.2 ms, respectively, p = 0.004) although no difference was observed for LV ejection times or overall LV MPI between survivors and non-survivors. Conclusion Physiologic analysis of left ventricular function via the LV Tei index and its component measurements demonstrates potentially novel insights into hemodynamic derangements and their association with outcomes in patients with EA/TVD. © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Published
2012
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