Chest compression rate feedback based on transthoracic impedance

González-Otero, Digna M.; Gauna, Sofía Ruiz de; Ruiz, J.; Daya, Mohamud; Russell, James K.; Kramer‐Johansen, Jo; Eftestøl, Trygve; Alonso, Erik; Ayala, Unai

doi:10.1016/j.resuscitation.2015.05.027

Cited by 16 publications

(13 citation statements)

References 27 publications

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“…This effect has been studied to detect pauses in chest compressions [ 20 ], and to identify individual chest compressions [ 21 , 22 ]. A recent study has demonstrated the ability of this signal to provide accurate real-time feedback on the chest compression rate [ 23 ]. Unfortunately, the analysis of the TI fluctuations does not provide accurate information on depth [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Feedback on the Rate and Depth of Chest Compressions during Cardiopulmonary Resuscitation Using Only Accelerometers

et al. 2016

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BackgroundQuality of cardiopulmonary resuscitation (CPR) is key to increase survival from cardiac arrest. Providing chest compressions with adequate rate and depth is difficult even for well-trained rescuers. The use of real-time feedback devices is intended to contribute to enhance chest compression quality. These devices are typically based on the double integration of the acceleration to obtain the chest displacement during compressions. The integration process is inherently unstable and leads to important errors unless boundary conditions are applied for each compression cycle. Commercial solutions use additional reference signals to establish these conditions, requiring additional sensors. Our aim was to study the accuracy of three methods based solely on the acceleration signal to provide feedback on the compression rate and depth.Materials and MethodsWe simulated a CPR scenario with several volunteers grouped in couples providing chest compressions on a resuscitation manikin. Different target rates (80, 100, 120, and 140 compressions per minute) and a target depth of at least 50 mm were indicated. The manikin was equipped with a displacement sensor. The accelerometer was placed between the rescuer’s hands and the manikin’s chest. We designed three alternatives to direct integration based on different principles (linear filtering, analysis of velocity, and spectral analysis of acceleration). We evaluated their accuracy by comparing the estimated depth and rate with the values obtained from the reference displacement sensor.ResultsThe median (IQR) percent error was 5.9% (2.8–10.3), 6.3% (2.9–11.3), and 2.5% (1.2–4.4) for depth and 1.7% (0.0–2.3), 0.0% (0.0–2.0), and 0.9% (0.4–1.6) for rate, respectively. Depth accuracy depended on the target rate (p < 0.001) and on the rescuer couple (p < 0.001) within each method.ConclusionsAccurate feedback on chest compression depth and rate during CPR is possible using exclusively the chest acceleration signal. The algorithm based on spectral analysis showed the best performance. Despite these encouraging results, further research should be conducted to asses the performance of these algorithms with clinical data.

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Section: Discussionmentioning

confidence: 99%

Feedback on the Rate and Depth of Chest Compressions during Cardiopulmonary Resuscitation Using Only Accelerometers

et al. 2016

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“…Analyzing these fluctuations could be a simple way to monitor chest compression rate without requiring additional devices. Several authors [32,[44][45][46][47] have suggested using the TI signal to compute chest compression rate either online, to provide feedback to the rescuer during a resuscitation attempt, or offline, for episode debriefing.…”

Section: Chest Compression Rate Estimationmentioning

confidence: 99%

“…Most of the methods to compute compression rate from the TI signal that have been published in the literature were optimized and tested with subsets obtained from a single monitor-defibrillator, and thus the variability introduced by the signal acquisition front-end was not taken into account. A later study [47] presented a general method to calculate chest compression rate, and evaluated its accuracy with three different databases of out-of-hospital cardiac arrest records. The authors concluded that it is possible to reliably estimate compression rate by processing the TI, although the performance of the method will vary with the characteristics of the TI fluctuations.…”

Section: Chest Compression Rate Estimationmentioning

confidence: 99%

Applications of the Transthoracic Impedance Signal during Resuscitation

González-Otero¹,

Gauna²,

Gutiérrez³

et al. 2018

Special Topics in Resuscitation

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Defibrillators acquire both the ECG and the transthoracic impedance (TI) signal through defibrillation pads. TI represents the resistance of the thorax to current flow, and is measured by defibrillators to check that defibrillation pads are correctly attached to the chest of the patient. Additionally, some defibrillators use the TI measurement to adjust the energy of the defibrillation pulse. Changes in tissue composition due to redistribution and movement of fluids induce fluctuations in the TI. Blood flow during the cardiac cycle generates small fluctuations synchronized to each heartbeat. Respiration (or assisted ventilation) also causes changes in the TI. Additionally, during cardiopulmonary resuscitation (CPR), chest compressions cause a disturbance in the electrode-skin interface, inducing artifacts in the TI signal. These fluctuations may provide useful information regarding CPR quality, length of pauses in chest compressions (no flow time), presence of circulation, etc. This chapter explores the new applications of the transthoracic impedance signal acquired through defibrillation pads during resuscitative attempts.

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“…A comprehensive study that aimed to determine the feasibility of a generic algorithm for feedback on chest compression rate using the TI signal recorded through the defibrillation pads was recently published [24]. Out-of-hospital cardiac arrest episodes were collected equally from three different emergency services and different defibrillator models.…”

Section: Chest Compression Ratementioning

confidence: 99%

Audiovisual Feedback Devices for Chest Compression Quality during CPR

González-Otero¹,

Gauna²,

Ruiz³

et al. 2017

Resuscitation Aspects

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During cardiopulmonary resuscitation (CPR), chest compression quality is the key for patient survival. However, several studies have shown that both professionals and laypeople often apply CPR at improper rates and depths. The use of real-time feedback devices increases adherence to CPR quality guidelines. This chapter explores new alternatives to provide feedback on the quality of chest compressions during CPR. First, we describe and evaluate three methods to compute chest compression depth and rate using exclusively the chest acceleration. To evaluate the accuracy of the methods, we used episodes of simulated cardiac arrest acquired in a manikin model. One of the methods, based on the spectral analysis of the acceleration, was particularly accurate in a wide range of conditions. Then, we assessed the feasibility of using the transthoracic impedance (TI) signal acquired through defibrillation pads to provide feedback on chest compression depth and rate. For that purpose, we retrospectively analyzed three databases of out-of-hospital cardiac arrest episodes. When a wide variety of patients and rescuers were included, TI could not be used to reliably estimate the compression depth. However, compression rate could be accurately estimated. Development of simpler methods to provide feedback on CPR quality could contribute to the widespread of these devices.

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Chest compression rate feedback based on transthoracic impedance

Cited by 16 publications

References 27 publications

Feedback on the Rate and Depth of Chest Compressions during Cardiopulmonary Resuscitation Using Only Accelerometers

Feedback on the Rate and Depth of Chest Compressions during Cardiopulmonary Resuscitation Using Only Accelerometers

Applications of the Transthoracic Impedance Signal during Resuscitation

Audiovisual Feedback Devices for Chest Compression Quality during CPR

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