Abstract 18150: Prediction of Imminent Deterioration of Children after Stage I Palliation Using Real-Time Processing of Physiological Data
Patients after stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS) and related lesions are at risk of life threatening deterioration resulting in shock, cardiac arrest, & hypoxemia. We hypothesize that these sudden deteriorations may be forecast by subtle, previously unidentified changes in cardiorespiratory dynamics. Identification of these precursors may provide an opportunity for early, life-saving intervention.
We created complete high-resolution physiological recordings for all patients who had a primary admission of S1P after Jan. 1, 2013. We used the SickbayTM system (Medical Informatics Corp, Houston, TX) to collect high frequency physiological waveforms including EKG, ABP, LAP, SpO2 and Chest Impedance (60Hz - 240Hz), as well as HR, RR, Temp. and ST segment vital signs (0.5 Hz) during the patient’s interstage hospitalization. A logistic regression model was constructed to discriminate between physiological characteristics observed in the hours prior to deterioration from the characteristics observed >24 hours prior to or >96 hours after a clinical deterioration. Model validation was done using a standard bagging approach with a REPtree classifier and 10 fold cross validation.
Twenty five patients were included in the study. Of these, 15 (60%) were found to have one or more deterioration events (arrest, CPR, unplanned intubation), with 24 total events observed during the interstage period. Characteristics associated with imminent deterioration were low SpO2 and depressed ST segment. Changes in physiological dynamics could be detected 1-2 hours before overt deterioration occurs (ROC area = 0.89) (Figure 1). This altered physiological state remains for ~96 hours after deterioration.
In conclusion, it is possible to identify clinical deterioration in HLHS patients during their interstage period ~1-2 hours before overt deterioration occurs, providing an opportunity for early, life-saving intervention to be administered.
Author Disclosures: C.G. Rusin: Ownership Interest; Significant; Medical Informatics Corp.. S.I. Acosta: None. E.L. Vu: None. R.B. Myers: None. K.M. Brady: None. D.J. Penny: None.
- © 2014 by American Heart Association, Inc.