title: Reliability and accuracy of the thoracic impedance signal for measuring cardiopulmonary resuscitation quality metrics.
abstract: OBJECTIVE
  To determine the accuracy and reliability of the thoracic impedance (TI) signal to assess cardiopulmonary resuscitation (CPR) quality metrics.
  
  
  METHODS
  A dataset of 63 out-of-hospital cardiac arrest episodes containing the compression depth (CD), capnography and TI signals was used. We developed a chest compression (CC) and ventilation detector based on the TI signal. TI shows fluctuations due to CCs and ventilations. A decision algorithm classified the local maxima as CCs or ventilations. Seven CPR quality metrics were computed: mean CC-rate, fraction of minutes with inadequate CC-rate, chest compression fraction, mean ventilation rate, fraction of minutes with hyperventilation, instantaneous CC-rate and instantaneous ventilation rate. The CD and capnography signals were accepted as the gold standard for CC and ventilation detection respectively. The accuracy of the detector was evaluated in terms of sensitivity and positive predictive value (PPV). Distributions for each metric computed from the TI and from the gold standard were calculated and tested for normality using one sample Kolmogorov-Smirnov test. For normal and not normal distributions, two sample t-test and Mann-Whitney U test respectively were applied to test for equal means and medians respectively. Bland-Altman plots were represented for each metric to analyze the level of agreement between values obtained from the TI and gold standard.
  
  
  RESULTS
  The CC/ventilation detector had a median sensitivity/PPV of 97.2%/97.7% for CCs and 92.2%/81.0% for ventilations respectively. Distributions for all the metrics showed equal means or medians, and agreements >95% between metrics and gold standard was achieved for most of the episodes in the test set, except for the instantaneous ventilation rate.
  
  
  CONCLUSIONS
  With our data, the TI can be reliably used to measure all the CPR quality metrics proposed in this study, except for the instantaneous ventilation rate.
authors.affiliation: Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain. Electronic address: erik_alonso@ehu.es.
authors.forename: Erik
authors.initials: E
authors.lastname: Alonso
authors.affiliation: Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Aramendi
authors.affiliation: Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
authors.forename: Digna
authors.initials: D
authors.lastname: González-Otero
authors.affiliation: Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
authors.forename: Sofía
authors.initials: S
authors.lastname: Ruiz de Gauna
authors.affiliation: Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
authors.forename: Unai
authors.initials: U
authors.lastname: Ayala
authors.affiliation: Philips Healthcare, Bothell, WA 98021, United States.
authors.forename: James K
authors.initials: JK
authors.lastname: Russell
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, 97239-3098 Portland, OR, United States.
authors.forename: Mohamud
authors.initials: M
authors.lastname: Daya
mesh_terms: D000465:Algorithms; D002307:Cardiography, Impedance / Q000379:methods*; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D017097:Electric Impedance; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy*; D015203:Reproducibility of Results
keywords: Automated external defibrillator; Cardiopulmonary resuscitation quality; Chest compression; Thoracic impedance; Ventilations