title: Reliable extraction of the circulation component in the thoracic impedance measured by defibrillation pads.
abstract: OBJECTIVE
  To analyze the feasibility of extracting the circulation component from the thoracic impedance acquired by defibrillation pads. The impedance circulation component (ICC) would permit detection of pulse-generating rhythms (PRs) during the analysis intervals of an automated external defibrillator when a non-shockable rhythm with QRS complexes is detected.
  
  
  METHODS
  A dataset of 399 segments, 165 associated with PR and 234 with pulseless electrical activity (PEA) rhythms, was extracted from out-of-hospital cardiac arrest episodes by applying a conservative criterion. Records consisted of the electrocardiogram and the thoracic impedance signals free of artifacts due to thoracic compressions and ventilations. The impedance was processed using an adaptive scheme based on a least mean square algorithm to extract the ICC. Waveform features of the ICC signal and its first derivative were used to discriminate PR from PEA rhythms.
  
  
  RESULTS
  The segments were split into development (83 PR and 117 PEA rhythms) and testing (82 PR and 117 PEA rhythms) subsets with a mean duration of 10.6s. Three waveform features, peak-to-peak amplitude, mean power, and mean area were defined for the ICC signal and its first derivative. The discriminative power in terms of area under the curve with the testing dataset was 0.968, 0.971, and 0.969, respectively, when applied to the ICC signal, and 0.974, 0.988 and 0.988, respectively, with its first derivative.
  
  
  CONCLUSIONS
  A reliable method to extract the ICC of the thoracic impedance is feasible. Waveform features of the ICC or its first derivative show a high discriminative power to differentiate PR from PEA rhythms (area under the curve higher than 0.96 for any feature).
authors.affiliation: Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ruiz
authors.forename: E
authors.initials: E
authors.lastname: Alonso
authors.forename: E
authors.initials: E
authors.lastname: Aramendi
authors.forename: J
authors.initials: J
authors.lastname: Kramer-Johansen
authors.forename: T
authors.initials: T
authors.lastname: Eftestøl
authors.forename: U
authors.initials: U
authors.lastname: Ayala
authors.forename: D
authors.initials: D
authors.lastname: González-Otero
mesh_terms: D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D047548:Defibrillators; D017097:Electric Impedance; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Automated external defibrillator (AED); Circulation detection; Pulse-generating rhythm (PR); Pulseless electrical activity (PEA); Thoracic impedance