The ARX decision-support algorithm provided accurate 1-minute-ahead MAP forecasts with an RMSE of 3.71 mmHg and was associated with shorter hypotension duration (0.8 vs 3.0 minutes, P=0.005) but higher phenylephrine dose (1823 vs 974 µg, P=0.001) compared to matched controls.
Does a real-time ARX algorithm accurately forecast MAP and support vasopressor management in pregnant patients at term undergoing elective cesarean delivery under spinal anesthesia?
Real-time MAP forecasting using an ARX algorithm is feasible and may reduce the duration of hypotension during cesarean delivery under spinal anesthesia.
Effect estimate: RMSE 3.71 mmHg
Question: In pregnant patients at term undergoing elective cesarean delivery under spinal anesthesia, can a real-time ARX algorithm accurately forecast MAP and support vasopressor management? Findings: One-minute-ahead forecasts were accurate (RMSE 3.71 mmHg), and ARX-guided care was associated with a shorter duration of hypotension and a higher phenylephrine dose versus matched nonconcurrent controls Meaning: Real-time MAP forecasting is feasible and warrants randomized evaluation to confirm clinical benefit and characterize trade-offs.
Kovacheva et al. (2026) studied Pregnant adults (≥18 years) at term (≥37 weeks' gestation) undergoing elective cesarean delivery under spinal anesthesia with planned prophylactic phenylephrine administration (n=60). Autoregressive with exogenous input (ARX) decision-support algorithm for blood pressure forecasting vs. Matched nonconcurrent controls receiving standard care without ARX guidance was evaluated on Prospective prediction accuracy of 1-minute-ahead maternal mean arterial pressure (MAP) forecasts quantified by RMSE (RMSE 3.71 mmHg). The ARX decision-support algorithm provided accurate 1-minute-ahead MAP forecasts with an RMSE of 3.71 mmHg and was associated with shorter hypotension duration (0.8 vs 3.0 minutes, P=0.005) but higher phenylephrine dose (1823 vs 974 µg, P=0.001) compared to matched controls.