title: Detection of cardiac arrest using a simplified frequency analysis of the impedance cardiogram recorded from defibrillator pads.
abstract: An algorithm based only on the impedance cardiogram (ICG) recorded through two defibrillation pads, using the strongest frequency component and amplitude, incorporated into a defibrillator could determine circulatory arrest and reduce delays in starting cardiopulmonary resuscitation (CPR). Frequency analysis of the ICG signal is carried out by integer filters on a sample by sample basis. They are simpler, lighter and more versatile when compared to the FFT. This alternative approach, although less accurate, is preferred due to the limited processing capacity of devices that could compromise real time usability of the FFT. These two techniques were compared across a data set comprising 13 cases of cardiac arrest and 6 normal controls. The best filters were refined on this training set and an algorithm for the detection of cardiac arrest was trained on a wider data set. The algorithm was finally tested on a validation set. The ICG was recorded in 132 cardiac arrest patients (53 training, 79 validation) and 97 controls (47 training, 50 validation): the diagnostic algorithm indicated cardiac arrest with a sensitivity of 81.1% (77.6-84.3) and specificity of 97.1% (96.7-97.4) for the validation set (95% confidence intervals). Automated defibrillators with integrated ICG analysis have the potential to improve emergency care by lay persons enabling more rapid and appropriate initiation of CPR and when combined with ECG analysis they could improve on the detection of cardiac arrest.
authors.affiliation: Royal Victoria Hospital Belfast, Belfast, UK. cesar.navarro@ heartsine.co.uk
authors.forename: César O
authors.initials: CO
authors.lastname: Navarro
authors.forename: Nick A
authors.initials: NA
authors.lastname: Cromie
authors.forename: Colin
authors.initials: C
authors.lastname: Turner
authors.forename: Omar J
authors.initials: OJ
authors.lastname: Escalona
authors.forename: John McC
authors.initials: JM
authors.lastname: Anderson
mesh_terms: D000465:Algorithms; D002307:Cardiography, Impedance / Q000295:instrumentation / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D006323:Heart Arrest / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity