Evidence map›Paper›PMID 41371332›Full record

ArticleResuscitation2026

Large-scale automated phenotyping of cardiac arrest and withdrawal of life-sustaining therapy using electronic health record data.

Catherine Clive, Arjun Singh, Bram Overmeer, Spencer Boris, Lydia Peterson, Jaden Searle, Greg Hooke, Niels Turley, Marta Fernandes, Aditya Gupta and 7 more

Abstract readMulticenter Study
In one paragraph

Article in Resuscitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Catherine CliveDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Brigham Young University, Provo, UT 84602, USA. Electronic address: kittyclive@gmail.com.
Arjun SinghDepartment of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
Bram OvermeerDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Utrecht University, 3584 CS Utrecht, the Netherlands.
Spencer BorisDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Brigham Young University, Provo, UT 84602, USA.
Lydia PetersonDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Brigham Young University, Provo, UT 84602, USA.
Jaden SearleDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Brigham Young University, Provo, UT 84602, USA.
Greg HookeDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Brigham Young University, Provo, UT 84602, USA.
Niels TurleyDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Marta FernandesDepartment of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
Aditya GuptaDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Manohar GhantaDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Valdery Moura JuniorDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
S MukerijiDepartment of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
Sahar ZafarDepartment of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
Edilberto AmorimDepartment of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94110, USA.
M Brandon WestoverDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Haoqi SunDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

Funding

Late-onset Unexplained Epilepsy as a Risk Factor for DementiaR01NS130119 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI Alice D Lam · 2023 to 2026
$8.7M
Data-Driven Sleep Biomarkers of Brain Health, Heart Health, and MortalityR01HL161253 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI CLIFFORD, GARI DAVID, MIGNOT, EMMANUEL J · 2022 to 2025
$8.3M
Investigation of Sleep in the Intensive Care Unit (ICU-SLEEP)R01NS102190 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI WESTOVER, MICHAEL BRANDON · 2018 to 2022
$3.2M
Prospective Validation of Neurophysiologic Outcome Prediction in Acute Brain InjuryR01NS126282 · NINDS · BETH ISRAEL DEACONESS MEDICAL CENTER · PI Aaron F Struck, Michael Brandon Westover · 2023 to 2026
$2.9M
Big Data and Deep Learning for the Interictal-Ictal-Injury ContiuumR01NS107291 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI WESTOVER, MICHAEL BRANDON · 2018 to 2022
$2.8M
Establishing a Brain Health Index from the Sleep ElectroencephalogramRF1NS120947 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI CASH, SYDNEY S, THOMAS, ROBERT JOSEPH · 2021 to 2021
$2.4M
Establishing a Brain Health IndexR01NS120947 · NINDS · BETH ISRAEL DEACONESS MEDICAL CENTER · PI CASH, SYDNEY S, THOMAS, ROBERT JOSEPH · 2024 to 2025
$1.6M
NHLBI NIH HHS R01 HL161253NINDS NIH HHS R01 NS102190NINDS NIH HHS R01 NS107291NINDS NIH HHS R01 NS120947NINDS NIH HHS R01 NS126282NINDS NIH HHS R01 NS130119NINDS NIH HHS RF1 NS120947
6 · The paper itself

Abstract

aims of the studyAnoxic brain injury following cardiac arrest is a leading cause of death in the United States. Withdrawal of life-sustaining therapy (WLST) is a common end-of-life decision in these patients, but its contributing factors and outcomes remain poorly understood. We developed machine learning models to enable large-scale, automated phenotyping to identify patients who died following WLST.

methodsWe used structured and unstructured EHR (Electronic Health Record) data from two major hospitals to train models that identify (1) patients with cardiac arrest and coma, and (2) patients who died after WLST. Performance was evaluated using the area under the receiver operating characteristic (AUROC) and precision-recall (AUPRC) curves, as well as other precision metrics.

resultsOn holdout (internal) testing the models achieved AUROC/AUPRC values of 0.984/0.968 (cardiac arrest) and 0.992/0.991 (WLST). Cross-hospital evaluation showed strong performance for the cardiac arrest phenotype but variable generalizability for the WLST phenotype, with sensitivity depending on the training site. Population-level error rates were low (<0.5 %) for the cardiac arrest phenotype; estimates for WLST varied by hospital.

conclusionThese models establish a reproducible framework for automated cohort identification. Nearly half of comatose post-arrest patients died following WLST, with 42 % of these deaths occurring within 72 h, highlighting the impact of early prognostication decisions. The models enable rapid cohort identification for research on neuroprognostication, including how WLST decisions may perpetuate self-fulfilling prophecies. Broader validation across health systems and larger cohorts will improve generalizability and inform evidence-based end-of-life decision-making. Institutional review board approval: Mass General Brigham IRB BIDMC: 2022P000481; MGB: 2013P001024. All procedures complied with institutional and national ethical standards; informed consent was waived for use of de-identified data.

Indexed as

Electronic Health RecordsHeart ArrestHypoxia, BrainMachine LearningWithholding TreatmentAgedComaFemaleHumansMaleMiddle AgedPhenotypeUnited StatesBrain injuryCardiac arrestElectronic health recordsMachine learningNatural language processingPrognostication

Identifiers

PMID41371332
PMCPMC13233148

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.