Direct evaluation of the effect of filtering the chest compression artifacts on the uninterrupted cardiopulmonary resuscitation time

Ruiz, J.; Ayala, Unai; Gauna, Sofía Ruiz de; Irusta, Unai; González-Otero, Digna M.; Aramendi, Elisabete; Alonso, Erik; Eftestøl, Trygve

doi:10.1016/j.ajem.2013.02.044

Cited by 9 publications

(12 citation statements)

References 23 publications

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“…13 Furthermore, when used to continuously monitor the rhythm during CPR their performance degrades substantially. 26 This study demonstrates the reliability of a fully automatic method that avoids chest compression artefacts altogether by analysing the rhythm during the ventilation pauses in 30:2 CV-ratio CPR (a video in the supplementary material shows a real-time demonstration of the method). This method would eliminate the need to stop CPR for rhythm analysis, and could therefore serve to advance the shock when patients refibrillate and to prolong the CPR cycle in patients with nonshockable rhythms.…”

Section: Discussionmentioning

confidence: 96%

“…Kaplan-Meier survival curves were used to estimate the probability of prolonging CPR cycles as a function of their duration. 26 Segments of at least 2 min in which the rhythm was nonshockable were selected, and for each segment the time at which the stop-CPR condition occurred determined the duration of the CPR cycle.…”

Section: Potential Therapeutic Benefitsmentioning

confidence: 99%

“…when the method is used to continuously assess the rhythm during CPR. This latter type of testing allows the statistical evaluation of the impact of using the method on the delivery of CPR, 26 as suggested by the 2010 consensus on resuscitation science. 27 Basic Life Support (BLS) guidelines recommend 30:2 CV-ratio CPR.…”

Section: Introductionmentioning

confidence: 99%

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Fully automatic rhythm analysis during chest compression pauses

et al. 2015

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Section: Discussionmentioning

confidence: 96%

Section: Potential Therapeutic Benefitsmentioning

confidence: 99%

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Fully automatic rhythm analysis during chest compression pauses

et al. 2015

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“…This involves, among other things, a statistical evaluation of whether the method avoids unnecessary CPR interruptions in nonshockable rhythms and unnecessary CPR prolongations in shockable rhythms [36]. The methodology for such an evaluation has recently been developed [44]. …”

Section: Discussionmentioning

confidence: 99%

A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

Ayala

Irusta

Ruiz

et al. 2014

BioMed Research International

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Interruptions in cardiopulmonary resuscitation (CPR) compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA) designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

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“…13 A study by Ruiz et al found that AFT reduces pauses in chest compressions during shockable arrest 14 and that the use of this particular AFT filter has reportedly high sensitivity (91.0%) and specificity (96.6%) for rhythm analysis during CPR in both shockable and non-shockable rhythms. 15 Despite the encouraging numbers, most manufacturers recommend a confirmatory pause prior to shock delivery.…”

Section: Cjem Jcmumentioning

confidence: 99%

Hands-on defibrillation and electrocardiogram artefact filtering technology increases chest compression fraction and decreases peri-shock pause duration in a simulation model of cardiac arrest

Fernando

Cheskes

Howes

2015

CJEM

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Background: Reducing pauses during cardiopulmonary resuscitation (CPR) compressions result in better outcomes in cardiac arrest. Artefact filtering technology (AFT) gives rescuers the opportunity to visualize the underlying electrocardiogram (ECG) rhythm during chest compressions, and reduces the pauses that occur before and after delivering a shock. We conducted a simulation study to measure the reduction of peri-shock pause and impact on chest compression fraction (CCF) through AFT. Methods: In a simulator setting, participants were given a standardized cardiac arrest scenario and were randomly assigned to perform CPR/defibrillation using the protocol from one of three experimental arms: 1) Standard of Care (pauses for rhythm analysis and shock delivery); 2) AFT (no pauses for rhythm analysis, but a pause for defibrillation); or 3) AFT with hands-on defibrillation (no pauses for rhythm analysis or defibrillation). The primary outcomes were CCF and peri-shock pause duration, with secondary outcomes of pre-and post-shock pause duration. Results: AFT with hands-on defibrillation was found to have the highest CCF (86.4%), as compared to AFT alone (83.8%, p < 0.001), and both groups significantly improved CCF in comparison with the Standard of Care (76.7%, p < 0.001). AFT with hands-on defibrillation was associated with a reduced peri-shock pause (2.6 seconds) as compared to AFT alone (5.3 seconds, p < 0.001), and the Standard of Care (7.4 seconds, p < 0.001). Conclusions: In this cardiac arrest model, AFT results in a greater CCF by reducing peri-shock pause duration. There is also a small but detectable improvement in CCF with the addition of hands-on defibrillation.

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Direct evaluation of the effect of filtering the chest compression artifacts on the uninterrupted cardiopulmonary resuscitation time

Cited by 9 publications

References 23 publications

Fully automatic rhythm analysis during chest compression pauses

Fully automatic rhythm analysis during chest compression pauses

A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

Hands-on defibrillation and electrocardiogram artefact filtering technology increases chest compression fraction and decreases peri-shock pause duration in a simulation model of cardiac arrest

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