Can thoracic impedance monitor the depth of chest compressions during out-of-hospital cardiopulmonary resuscitation?
OBJECTIVE
To analyze the relationship between the depth of the chest compressions and the fluctuation caused in the thoracic impedance (TI) signal in out-of-hospital cardiac arrest (OHCA). The ultimate goal was to evaluate whether it is possible to identify compressions with inadequate depth using information of the TI waveform.


METHODS
60 OHCA episodes were extracted, one per patient, containing both compression depth (CD) and TI signals. Every 5s the mean value of the maxima of the CD, Dmax, and three features characterizing the fluctuations caused by the compressions in the TI waveform (peak-to-peak amplitude, area and curve length) were computed. The linear relationship between Dmax and the TI features was tested using Pearson correlation coefficient (r) and univariate linear regression for the whole population, for each patient independently, and for series of compressions provided by a single rescuer. The power of the three TI features to classify each 5s-epoch as shallow/non-shallow was evaluated in terms of area under the curve, sensitivity and specificity.


RESULTS
The r was 0.34, 0.36 and 0.37 for peak-to-peak amplitude, area and curve length respectively when the whole population was analyzed. Within patients the median r was 0.40, 0.43 and 0.47, respectively. The analysis of the series of compressions yielded a median r of 0.81 between Dmax and the peak-to-peak amplitude, but it decreased to 0.47 when all the series were considered jointly. The classifier based on the TI features showed 90.0%/37.1% and 86.2%/43.5% sensitivity/specificity values, and an area under the curve of 0.75 and 0.71 for the training and test set respectively.


CONCLUSIONS
Low linearity between CD and TI was noted in OHCA episodes involving multiple rescuers. Our findings suggest that TI is unreliable as a predictor of Dmax and inaccurate in detecting shallow compressions.
Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain. Electronic address: erik_alonso@ehu.es.
Erik
E
Alonso
Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
Digna
D
González-Otero
Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
Elisabete
E
Aramendi
Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
Sofía
S
Ruiz de Gauna
Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
Jesús
J
Ruiz
Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
Unai
U
Ayala
Philips Healthcare, Bothell, WA 98021, United States.
James K
JK
Russell
Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239-3098, United States.
Mohamud
M
Daya
D017097:Electric Impedance; D004632:Emergency Medical Services; D005260:Female; D006336:Heart Massage / Q000592:standards*; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011312:Pressure; D012815:Signal Processing, Computer-Assisted
Automated external defibrillator (AED); Cardiac arrest; Cardiopulmonary resuscitation (CPR); Chest compression (CC); Compression depth (CD); Thoracic impedance (TI)