Intelligent engineering framework for managing hospital cardiac arrest resources

Abstract

In-hospital cardiac arrest in intensive care remains frequent (often cited incidence roughly 0.5%-7.8% of admissions), while causes differ in what staff and equipment must be ready. We ask whether vital-sign trajectories from a standard EHR can classify which of three cardiac-related mechanisms is most salient arrhythmia, acute myocardial infarction (AMI), or respiratory failure or hypoxia so ICU resources can be aligned with risk. Using MIMIC-IV, we extracted diagnoses and charted vitals in the 12 hours before the index event, applied cleaning, aggregation, label encoding, sequence padding, and class balancing (3,000 cases per class), then trained and compared eXtreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and logistic regression (LR) with 5-fold cross-validation on an 80/20 split. XGBoost performed best (about 93% accuracy; sensitivity 89.15%; specificity 90.43%; AUC-ROC 0.94). Feature importance highlighted heart rate, oxygen saturation, and blood pressure patterns consistent with bedside monitoring practice. The study supports mechanism-oriented triage labels derived from widely recorded vitals, as a complement to generic early warning scores, for prioritizing telemetry, respiratory support, and cardiology pathways. External validation and prospective evaluation are needed before deployment.