Abstract 18393: Survival after Post-Arrest Therapeutic Hypothermia: Secondary Analysis of The Strategies for Post-Arrest Care (SPARC) Stepped-Wedge Trial
Bibliographic record
Abstract
Introduction: Current guidelines recommend early institution of therapeutic hypothermia (TH) in survivors of out of hospital cardiac arrest (OHCA) regardless of initial rhythm. This was based on trials employing concurrent or historical controls since the original randomized trials restricted the analysis to OHCA presenting with ventricular fibrillation (VF) or ventricular tachycardia (VT). We sought to measure the survival of patients after application of these recommended guidelines during a stepped-wedge randomized trial that compared KT strategies to improve TH in a network of 36 hospitals. Methods: After a baseline period of 12 months, 4 wedges of 8 to 10 hospitals were randomized to receive 12 months of passive KT followed by 4 months of active KT. We measured the secondary outcome of survival to hospital discharge in patients that had received therapeutic hypothermia. We used multilevel modeling to calculate odds ratios (OR) for survival after adjusting for time and the Utstein factors. Results: During the study, 4,742 OHCA patients were transported to hospital; 1,963 (39%) achieved ROSC and 1,104 (56%) of these were eligible for TH. 638 (58%) of the eligible patients had cooling initiated and 223 (35%) were cooled to 34 degrees within 6 hours. No survival advantage of cooling was observed for all eligible patients (cooling ever vs never, OR adjusted for time only 1.04, 95% CI 0.74-1.47; OR adjusted for prehospital variables (Utstein) 0.80, 95% CI 0.53-1.20). Similar findings were observed when the analyses were restricted to the 516 eligible patients that presented with VF/VT (OR adjusted for time only 0.74, 95% CI 0.44-1.24; OR adjusted for Utstein variables 0.84, 95% CI 0.52-1.37). Conclusions: During a stepped wedge knowledge translation randomized trial, we were unable to confirm the survival advantage associated with cooling after OHCA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".