The impedance cardiogram recorded through two electrocardiogram/defibrillator pads as a determinant of cardiac arrest during experimental studies*

Cromie, N; Allen, John D.; Turner, Colin; Anderson, John; Adgey, A. A. J.

doi:10.1097/ccm.0b013e318170a03b

Cited by 20 publications

(9 citation statements)

References 16 publications

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“…Studies by Losert et al 18 and Risdal et al 19 concluded that a combination of features extracted from ECG and TI allows a proper discrimination between pulse-generating rhythms (PR) and pulseless electrical activity (PEA). Cromie et al used a single feature computed from the spectrum of the processed TI as a clinical marker of circulatory collapse in animals 20 and humans. 21 In our previous work, we presented a reliable method to extract the impedance circulation component (ICC) using an adaptive processing scheme, and concluded that morphological features extracted from ICC showed great potential for PEA/PR discrimination.…”

Section: Introductionmentioning

confidence: 99%

Circulation detection using the electrocardiogram and the thoracic impedance acquired by defibrillation pads

et al. 2016

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Aim To develop and evaluate a method to detect circulation in the presence of organized rhythms (ORs) during resuscitation using signals acquired by defibrillation pads. Methods Segments containing electrocardiogram (ECG) and thoracic impedance (TI) signals free of artifacts were used. The ECG corresponded to ORs classified as pulseless electrical acitivity (PEA) or pulse-generating rhythm (PR). A first dataset containing 1091 segments was split into training and test sets to develop and validate the circulation detector. The method processed ECG and TI to obtain the impedance circulation component (ICC). Morphological features were extracted from ECG and ICC, and combined into a classifier to discriminate between PEA and PR. The performance of the method was evaluated in terms of sensitivity (PR) and specificity (PEA). A second dataset (86 segments from different patients) was used to assess two application of the method: confirmation of arrest by recognizing absence of circulation during ORs and detection of return of spontaneous circulation (ROSC) during resuscitation. In both cases, time to confirmation of arrest/ROSC was determined. Results The method showed a sensitivity/specificity of 92.1%/90.3% and 92.2%/91.9% for training and test sets respectively. The method confirmed cardiac arrest with a specificity of 93.3% with a median delay of 0 s after the first OR annotation. ROSC was detected with a sensitivity of 94.4% with a median delay of 57 s from ROSC onset. Conclusion The method showed good performance, and can be reliably used to distinguish perfusing from non-perfusing ORs.

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Section: Introductionmentioning

confidence: 99%

Circulation detection using the electrocardiogram and the thoracic impedance acquired by defibrillation pads

et al. 2016

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“…Several methods for the automated detection of circulation based on the ECG and the TTI signals can be found in the literature [28][29][30][31][32][33][34]. In general, they rely on the analysis of the signals during chest compression pauses, looking for an organized rhythm in the ECG and the circulation component of the TTI.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation

et al. 2021

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Background Measurement of end-tidal CO2 (ETCO2) can help to monitor circulation during cardiopulmonary resuscitation (CPR). However, early detection of restoration of spontaneous circulation (ROSC) during CPR using waveform capnography remains a challenge. The aim of the study was to investigate if the assessment of ETCO2 variation during chest compression pauses could allow for ROSC detection. We hypothesized that a decay in ETCO2 during a compression pause indicates no ROSC while a constant or increasing ETCO2 indicates ROSC. Methods We conducted a retrospective analysis of adult out-of-hospital cardiac arrest (OHCA) episodes treated by the advanced life support (ALS). Continuous chest compressions and ventilations were provided manually. Segments of capnography signal during pauses in chest compressions were selected, including at least three ventilations and with durations less than 20 s. Segments were classified as ROSC or non-ROSC according to case chart annotation and examination of the ECG and transthoracic impedance signals. The percentage variation of ETCO2 between consecutive ventilations was computed and its average value, ΔETavg, was used as a single feature to discriminate between ROSC and non-ROSC segments. Results A total of 384 segments (130 ROSC, 254 non-ROSC) from 205 OHCA patients (30.7% female, median age 66) were analyzed. Median (IQR) duration was 16.3 (12.9,18.1) s. ΔETavg was 0.0 (-0.7, 0.9)% for ROSC segments and -11.0 (-14.1, -8.0)% for non-ROSC segments (p < 0.0001). Best performance for ROSC detection yielded a sensitivity of 95.4% (95% CI: 90.1%, 98.1%) and a specificity of 94.9% (91.4%, 97.1%) for all ventilations in the segment. For the first 2 ventilations, duration was 7.7 (6.0, 10.2) s, and sensitivity and specificity were 90.0% (83.5%, 94.2%) and 89.4 (84.9%, 92.6%), respectively. Our method allowed for ROSC detection during the first compression pause in 95.4% of the patients. Conclusion Average percent variation of ETCO2 during pauses in chest compressions allowed for ROSC discrimination. This metric could help confirm ROSC during compression pauses in ALS settings.

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“…Studies have proved that cardiac contractions determine coincident modifications in TTI signal with high sensitivity and specificity [18,19,20], which permit differentiation of PEA from pulse-generating rhythms [20]. On this basis, all stages of CPR in which CodeStat displayed an interruption of chest compressions in the presence of an organized ECG activity were identified and analyzed.…”

Section: Methodsmentioning

confidence: 99%

Impact of Transitory ROSC Events on Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest

Antonaglia¹,

Pegani²,

Caggegi

et al. 2019

JCM

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In out-of-hospital cardiac arrest (OHCA), the occurrence of temporary periods of return to spontaneous circulation (t-ROSC) has been found to be predictive of survival to hospital discharge. The relationship between the duration of t-ROSCs and OHCA outcome has not been explored yet. The aim of this prospective observational study was to analyze the duration of t-ROSCs during OHCA and its impact on outcome. Defibrillator-recorded OHCA events were analyzed via dedicated software. The number of t-ROSC episodes and their overall durations were recorded. The study endpoint was the good neurologic outcome at hospital discharge. Among 285 patients included in the study, 45 (15.8%) had one or more t-ROSCs. The likelihood of t-ROSC occurrence was higher in patients with a shockable rhythm (p = 0.009). The cumulative length of t-ROSC episodes was significantly higher for patients who achieved sustained ROSC (p < 0.001). The adjusted cumulative t-ROSC length was an independent predictor for good neurological outcome at hospital discharge (OR 1.588, 95% CI 1.017 to 2.481; p = 0.042). According to our findings and data from previous studies, t-ROSC episodes during OHCA should be considered as a favorable prognostic factor, encouraging continuing resuscitative efforts.

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The impedance cardiogram recorded through two electrocardiogram/defibrillator pads as a determinant of cardiac arrest during experimental studies*

Abstract: As a powerful clinical marker of circulatory collapse, the fast Fourier transformation of dZ/dt (impedance cardiogram) has the potential to improve emergency care by laypersons using automated defibrillators.

Cited by 20 publications

References 16 publications

Circulation detection using the electrocardiogram and the thoracic impedance acquired by defibrillation pads

Circulation detection using the electrocardiogram and the thoracic impedance acquired by defibrillation pads

Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation

Impact of Transitory ROSC Events on Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest

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