DEMO · REAL MOVER CASE

One intraoperative hypotension event
attributed to the cause underneath the number.

This demo runs against real physiological case data from MOVER (UC Irvine, 55,483 anesthesia cases). We pick a representative case with a sustained MAP <65 mmHg event, render the case timeline, and attribute the endotype using the same physiological-signature heuristic an anesthesiologist uses at the bedside — the wedge-product version of LINCR's audit. The eventual learned endotype head, trained on the cause-attributed data this audit produces, is the M3-M6 deliverable.

01 · CASE TIMELINE

Case # — 0 minutes of intraoperative physiology.

Each line is the actual recorded value from the MOVER dataset. Pink shaded windows are detected IOH events (sustained MAP <65 mmHg for ≥5 minutes). Drug administrations are stem markers along the bottom.

Mean Arterial Pressure (mmHg)
Threshold line at MAP = 65 mmHg. IOH event windows shaded.
Heart rate & ETCO2
Heart rate (teal) and end-tidal CO2 (amber) during the case. The HR × ETCO2 joint signature is what the endotype attribution reasons on.
Heart rate (bpm) ETCO2 (mmHg)
Drug administrations & fluid record
Vasopressors (phenylephrine, ephedrine, norepi, vasopressin) above zero; sedatives (propofol) and crystalloid below zero.
Phenylephrine Ephedrine Norepi/Vasopressin Propofol Crystalloid
02 · ENDOTYPE ATTRIBUTION

Each event gets a cause, a rationale, and a treatment recommendation.

The audit produces this for every IOH event in every case the customer uploads. At the group level, these become protocol-change reports. At the clinician level, outlier identification. For QI committees and malpractice carriers, defensible documentation that QI activity actually happened.

Full decision logic, signal definitions, and priority order are documented in section 02B below.

02B · ATTRIBUTION LOGIC

The same decision tree a CAA reasons through at the bedside, made reproducible in code.

For each detected IOH event (sustained MAP <65 mmHg for ≥5 minutes), the heuristic computes eight signals from the surrounding minutes of vitals + intervention record, then applies a priority-ordered decision tree. Bradycardia is checked first as a deterministic override. Hypovolemia and myocardial depression both score multiple weak signals — the distinguishing feature is whether HR rose (compensation) or fell (failure) in response to the MAP drop. Vasodilation is the default when HR is preserved. Unattributable is surfaced honestly when key data is missing rather than defaulting against insufficient evidence — in the audit it doubles as a data-quality flag for the customer.

Signals consumed per event

HR Δ
Percent change in median HR during the event vs the 10-min baseline before
ETCO2 Δ
Percent change in median end-tidal CO2 — proxy for pulmonary perfusion
SVV
Stroke volume variation during event — fluid responsiveness marker
EBL recent
Cumulative blood loss recorded in 15 min before event onset
Propofol load
Cumulative propofol in 10 min before event — IV anesthetic depth proxy
Agent Et
Median end-tidal volatile agent during event — inhaled anesthetic depth
HR absolute
Median HR during event — gates the bradycardia trigger
MAP
Median + minimum during event — gates IOH detection itself

Decision priority — first match wins

01 Bradycardia DETERMINISTIC — overrides all other rules
TriggerHR during event < 50 bpm with concurrent low MAP
ConfidenceAlways HIGH — single deterministic signal
TreatmentChronotrope (atropine, ephedrine, glycopyrrolate)
02 Hypovolemia SCORED — multiple weak signals stack to threshold
Score components
  • +2 HR Δ ≥ +12%  (+1 if 5–12%) — tachycardic compensation
  • +2 ETCO2 Δ ≤ −8% — pulmonary perfusion drop
  • +2 SVV ≥ 13% — volume responsiveness
  • +2 EBL recent ≥ 100 ml — recent blood loss
TriggerTotal score ≥ 2 — either one strong signal or two weak signals
ConfidenceHIGH if score ≥ 3, otherwise MEDIUM
TreatmentVolume resuscitation — crystalloid, colloid, or blood
03 Myocardial depression SCORED — checked only after hypovolemia fails to trigger
Score components
  • +1 HR Δ < 0 — failed compensation, HR did not rise
  • +2 ETCO2 Δ ≤ −10% — perfusion drop without compensation
  • +1 Propofol load > 100 in 10 min — IV anesthetic burden
  • +1 Agent Et ≥ 1.2% — high volatile agent
TriggerScore ≥ 2 and at least one of: ETCO2 drop present, propofol load > 100, or agent ≥ 1.2%
ConfidenceHIGH if score ≥ 3, otherwise MEDIUM
TreatmentInotrope (epinephrine, dobutamine) and/or reduce anesthetic depth
04 Vasodilation DEFAULT — for HR-preserved hypotension
TriggerHR Δ between −5% and +15% — HR approximately preserved, no compensatory pattern
RationaleThe most common cause of intraoperative hypotension under anesthesia. Drug evidence (propofol or volatile agent during event) is mentioned in the rationale but not gating — HR preservation is the discriminating signal.
ConfidenceAlways MEDIUM — default attribution, not a strong signal match
TreatmentVasopressor (phenylephrine, vasopressin, norepinephrine)
05 Unattributable DATA-QUALITY FLAG — honest output when signal is missing
TriggerHR data missing or NaN around the event window, or HR pattern outside all four endotype signatures
Why this existsRefusing to attribute when evidence is insufficient is a feature, not a bug. In the aggregate report, the percent unattributable is itself a metric — it tells the customer how complete their EHR data capture is, and which sites need monitoring upgrades.
ConfidenceAlways LOW — surfaced for data-quality review
ActionNo clinical recommendation issued. Event flagged for data audit.

Why this priority order

Bradycardia first because it has a deterministic single-signal trigger and missing it has high consequence (different drug class entirely). Hypovolemia before myocardial depression because their signatures overlap (both can show ETCO2 drop), and the distinguishing feature is whether HR rose (compensation) or fell (failure). Vasodilation as default because it is the most common cause of intraoperative hypotension under anesthesia and the safest assumption when HR is preserved. Unattributable last so the system never claims an endotype the underlying data cannot support — the same hesitation a CAA shows when key vitals are missing at the bedside.

03 · AGGREGATE ACROSS THE SAMPLE

Run the same audit across N cases. Site-level pattern emerges in one query.

This is the report a Premier Anesthesia medical director sees after a 90-day retrospective audit. The headline number is the endotype distribution — what's actually driving IOH at this facility, in this group's case mix. That's the protocol-change wedge: stop guessing, start changing the highest-leverage protocol first.