title: Electrocardiographic analysis during uninterrupted cardiopulmonary resuscitation.
abstract: OBJECTIVE
  Prior studies have shown that interruptions of chest compressions could result in high failure rates of resuscitation. Chest compression artifacts force the interruption of compressions before electrocardiographic rhythm analysis. It was the goal of this study to evaluate the accuracy of an automated electrocardiographic rhythm analysis algorithm designed to attenuate compression-induced artifact and minimize uninterrupted chest compressions.
  
  
  METHODS
  Retrospective diagnostic analysis.
  
  
  METHODS
  Out-of-hospital cardiopulmonary resuscitation.
  
  
  METHODS
  Eight hundred thirty-two patients.
  
  
  METHODS
  Patients were treated with defibrillation and cardiopulmonary resuscitation. Continuous data were recorded using automated external defibrillators with concurrent measurement of electrocardiographic and sternal motion during chest compressions.
  
  
  RESULTS
  Human electrocardiographics recorded by automated external defibrillators were annotated and randomly selected to build distinct training and testing databases. The artifact reduction and tolerant filter was applied to the electrocardiographic signal. The algorithm was optimized with the training database (sensitivity, 93.9%; specificity, 91.2%) and tested with the testing database (sensitivity, 92.1%; specificity, 90.5%). Average attenuation of compression-induced artifact was more than 35 dB.
  
  
  CONCLUSIONS
  Shockable ventricular arrhythmias can be differentiated from electrocardiographic rhythms not requiring defibrillation in the presence of chest compression-induced artifact with sensitivity and specificity above 90%. With the artifact reduction and tolerant filter, it is possible to effectively eliminate pre- and postshock compression pauses.
authors.affiliation: ZOLL Medical Corporation, Chelmsford, MA, USA. qtan@zoll.com
authors.forename: Qing
authors.initials: Q
authors.lastname: Tan
authors.forename: Gary A
authors.initials: GA
authors.lastname: Freeman
authors.forename: Fred
authors.initials: F
authors.lastname: Geheb
authors.forename: Joe
authors.initials: J
authors.lastname: Bisera
mesh_terms: D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015203:Reproducibility of Results; D012189:Retrospective Studies