Abstract 18: Differential Effect of Analyze Early versus Analyze Late prior to Initial Rhythm Analysis in Out-of-Hospital Cardiac Arrest: the Role of EMS Agency
Bibliographic record
Abstract
Background: An effective resuscitation strategy in one community may not be effective in another community. We hypothesized that a strategy that prioritized initial Emergency Medical Services (EMS) rhythm analysis (Analyze Early) would provide a survival advantage among EMS systems with lower baseline ventricular fibrillation (VF) survival, while one prioritizing initial EMS CPR (Analyze Late) would provide a survival advantage among systems with higher baseline VF survival. Methods: We conducted an ancillary study of Analyze Early versus Analyze Late randomized trial of the Resuscitation Outcomes Consortium. Subjects were stratified according to pretrial EMS agency VF survival and their randomization arm. The primary outcome was survival to hospital discharge with favorable functional status. We used a binomial family mixed-effects model to determine whether outcomes from the trial intervention differed according to pretrial EMS agency VF survival. Results: Characteristics were similar among patients randomized to Analyze Early (n=4964) versus Analyze Late (n=4426). For EMS agencies with pretrial VF survival ≤20%, Analyze Early compared to Analyze Late was associated with a higher likelihood of favorable functional survival (5.5% versus 3.8%, OR=1.50 [1.11,2.0]). Conversely, among agencies with pretrial VF survival > 20%, Analyze Early compared to Analyze Late was associated with lower likelihood of favorable functional survival (6.1% versus 7.5%, OR=0.82 [0.66,1.02]). In the multivariable model, for every 10% improvement in pretrial VF survival, Analyze Late versus Analyze Early was associated with a 34% increase in the odds of favorable functional survival (OR=1.34 [1.07-1.66]). Conclusion: In this ancillary investigation of a clinical trial evaluating initial EMS CPR strategy, we observed a robust interaction indicating the Analyze Early strategy was associated with greater survival among EMS agencies with lower pretrial VF survival while the Analyze Late strategy was associated with greater survival among EMS agencies with a higher pretrial VF survival. The findings support distinct EMS CPR strategies based on a system’s baseline VF survival in order to achieve optimal outcomes following out-of-hospital cardiac arrest.
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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 | 0.006 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".