title: Detection of a spontaneous pulse in photoplethysmograms during automated cardiopulmonary resuscitation in a porcine model.
abstract: BACKGROUND
  Reliable, non-invasive detection of return of spontaneous circulation (ROSC) with minimal interruptions to chest compressions would be valuable for high-quality cardiopulmonary resuscitation (CPR). We investigated the potential of photoplethysmography (PPG) to detect the presence of a spontaneous pulse during automated CPR in an animal study.
  
  
  METHODS
  Twelve anesthetized pigs were instrumented to monitor circulatory and respiratory parameters. Here we present the simultaneously recorded PPG and arterial blood pressure (ABP) signals. Ventricular fibrillation was induced, followed by 20 min of automated CPR and subsequent defibrillation. After defibrillation, pediatric-guidelines-style life support was given in cycles of 2 min. PPG and ABP waveforms were recorded during all stages of the protocol. Raw PPG waveforms were acquired with a custom-built photoplethysmograph controlling a commercial reflectance pulse oximetry probe attached to the nose. ABP was measured in the aorta.
  
  
  RESULTS
  In nine animals ROSC was achieved. Throughout the protocol, PPG and ABP frequency content showed strong resemblance. We demonstrate that (1) the PPG waveform allows for the detection of a spontaneous pulse during ventilation pauses, and that (2) frequency analysis of the PPG waveform allows for the detection of a spontaneous pulse and the determination of the pulse rate, even during ongoing chest compressions, if the pulse and compression rates are sufficiently distinct.
  
  
  CONCLUSIONS
  These results demonstrate the potential of PPG as a non-invasive means to detect pulse presence or absence, as well as pulse rate during CPR.
authors.affiliation: Signal Processing Systems, Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands. Electronic address: ralph.wijshoff@philips.com.
authors.forename: Ralph W C G R
authors.initials: RW
authors.lastname: Wijshoff
authors.forename: Toeno
authors.initials: T
authors.lastname: van der Sar
authors.forename: Wouter H
authors.initials: WH
authors.lastname: Peeters
authors.forename: Rick
authors.initials: R
authors.lastname: Bezemer
authors.forename: Paul
authors.initials: P
authors.lastname: Aelen
authors.forename: Igor W F
authors.initials: IW
authors.lastname: Paulussen
authors.forename: Simone C M A
authors.initials: SC
authors.lastname: Ordelman
authors.forename: Alyssa
authors.initials: A
authors.lastname: Venema
authors.forename: Paul F J
authors.initials: PF
authors.lastname: van Berkom
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Aarts
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Woerlee
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Scheffer
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Noordergraaf
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods*; D004195:Disease Models, Animal; D005260:Female; D017156:Photoplethysmography; D011674:Pulse; D013552:Swine; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*
keywords: Cardiopulmonary resuscitation; Chest compressions; Photoplethysmography; Pulse detection; Return of spontaneous circulation