The ability of machine learning algorithms to predict defibrillation success during cardiac arrest: A systematic review

Objective To evaluate the existing knowledge on the effectiveness of machine learning (ML) algorithms in predicting defibrillation success during in- and out-of-hospital cardiac arrest. Methods MEDLINE, Embase, CINAHL and Scopus were searched from inception to August 30, 2022. Studies were included that utilized ML algorithms for prediction of successful defibrillation, observed as return of spontaneous circulation (ROSC), survival to hospital or discharge, or neurological status at discharge. Studies were excluded if involving a trauma, an unknown underlying rhythm, an implanted cardiac defibrillator or if focused on the prediction or onset of cardiac arrest. Risk of bias was assessed using the PROBAST tool. Results There were 2399 studies identified, of which 107 full text articles were reviewed and 15 observational studies (n = 5680) were included for final analysis. 29 ECG waveform features were fed into 15 different ML combinations. The best performing ML model had an accuracy of 98.6 (98.5 – 98.7)%, with 4 second ECG intervals. An algorithm incorporating end-tidal CO2 reported an accuracy of 83.3% (no CI reported). Meta-analysis was not performed due to heterogeneity in study design, ROSC definitions, and characteristics. Conclusion Machine learning algorithms, specifically Neural Networks, have been shown to have potential to predict defibrillation success for cardiac arrest with high sensitivity and specificity. Due to heterogeneity, inconsistent reporting, and high risk of bias, it is difficult to conclude which, if any, algorithm is optimal. Further clinical studies with standardized reporting of patient characteristics, outcomes, and appropriate algorithm validation are still required to elucidate this. PROSPERO 2020 CRD42020148912.