Auditory stimulation and deep learning predict awakening from coma after cardiac arrest.

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Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_EDB2E82E42AA
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Auditory stimulation and deep learning predict awakening from coma after cardiac arrest.
Journal
Brain
Author(s)
Aellen F.M., Alnes S.L., Loosli F., Rossetti A.O., Zubler F., De Lucia M., Tzovara A.
ISSN
1460-2156 (Electronic)
ISSN-L
0006-8950
Publication state
Published
Issued date
13/02/2023
Peer-reviewed
Oui
Volume
146
Number
2
Pages
778-788
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Assessing the integrity of neural functions in coma after cardiac arrest remains an open challenge. Prognostication of coma outcome relies mainly on visual expert scoring of physiological signals, which is prone to subjectivity and leaves a considerable number of patients in a 'grey zone', with uncertain prognosis. Quantitative analysis of EEG responses to auditory stimuli can provide a window into neural functions in coma and information about patients' chances of awakening. However, responses to standardized auditory stimulation are far from being used in a clinical routine due to heterogeneous and cumbersome protocols. Here, we hypothesize that convolutional neural networks can assist in extracting interpretable patterns of EEG responses to auditory stimuli during the first day of coma that are predictive of patients' chances of awakening and survival at 3 months. We used convolutional neural networks (CNNs) to model single-trial EEG responses to auditory stimuli in the first day of coma, under standardized sedation and targeted temperature management, in a multicentre and multiprotocol patient cohort and predict outcome at 3 months. The use of CNNs resulted in a positive predictive power for predicting awakening of 0.83 ± 0.04 and 0.81 ± 0.06 and an area under the curve in predicting outcome of 0.69 ± 0.05 and 0.70 ± 0.05, for patients undergoing therapeutic hypothermia and normothermia, respectively. These results also persisted in a subset of patients that were in a clinical 'grey zone'. The network's confidence in predicting outcome was based on interpretable features: it strongly correlated to the neural synchrony and complexity of EEG responses and was modulated by independent clinical evaluations, such as the EEG reactivity, background burst-suppression or motor responses. Our results highlight the strong potential of interpretable deep learning algorithms in combination with auditory stimulation to improve prognostication of coma outcome.
Keywords
Humans, Coma/etiology, Coma/therapy, Acoustic Stimulation, Deep Learning, Electroencephalography/methods, Heart Arrest/complications, Heart Arrest/therapy, Prognosis, EEG, cardiac arrest, coma, deep learning, outcome prognosis, ‌auditory processing
Pubmed
Web of science
Open Access
Yes
Funding(s)
Swiss National Science Foundation
University of Lausanne
Create date
16/01/2023 12:51
Last modification date
25/01/2024 8:46
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