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Prior studies examining prehospital characteristics related to return of spontaneous circulation (ROSC) in pediatric out-of-hospital cardiac arrest (OHCA) are limited to structured data. Natural language processing (NLP) could identify new factors from unstructured data using free-text narratives. The purpose of this study was to use NLP to examine EMS clinician free-text narratives for characteristics associated with prehospital ROSC in pediatric OHCA. This was a retrospective analysis of patients ages 0–17 with OHCA in 2019 from the ESO Data Collaborative. We performed an exploratory analysis of EMS narratives using NLP with an  a priori  token library. We then constructed biostatistical and machine learning models and compared their performance in predicting ROSC. There were 1,726 included EMS encounters for pediatric OHCA; 60% were male patients, and the median age was 1 year (IQR 0–9). Most cardiac arrest events (61.3%) were unwitnessed, 87.3% were identified as having medical causes, and 5.9% had initial shockable rhythms. Prehospital ROSC was achieved in 23.1%. Words most positively correlated with ROSC were “ROSC” ( r  =  0.42), “pulse” ( r  = 0.29), “drowning” ( r  =  0.13), and “PEA” ( r  =  0.12). Words negatively correlated with ROSC included “asystole” ( r  =  −0.25), “lividity” ( r  =  −0.14), and “cold” ( r  =  −0.14). The terms “asystole,” “pulse,” “no breathing,” “PEA,” and “dry” had the greatest difference in frequency of appearance between encounters with and without ROSC ( p  &lt; 0.05). The best-performing model for predicting prehospital ROSC was logistic regression with random oversampling using free-text data only (area under the receiver operating characteristic curve 0.92). EMS clinician free-text narratives reveal additional characteristics associated with prehospital ROSC in pediatric OHCA. Incorporating those terms into machine learning models of prehospital ROSC improves predictive ability. Therefore, NLP holds promise as a tool for use in predictive models with the goal to increase evidence-based management of pediatric OHCA.

prehospital emergency care

Identification of Factors Associated with Return of Spontaneous Circulation after Pediatric Out-of-Hospital Cardiac Arrest Using Natural Language Processing