Abstract
Background and objective: Quantitative measures extracted from ventricular fibrillation (VF) waveform reflect the metabolic state of the myocardium and are associated with survival outcome. The quality of delivered chest compressions during cardiopulmonary resuscitation are also linked with survival. The aim of this research is to explore the viability and effectiveness of a thoracic impedance (TI) based chest compression (CC) guidance system to control CC depth within individual subjects and influence VF waveform properties.
Methods: This porcine investigation includes an analysis of two protocols. CC were delivered in 2-minute episodes at a constant rate of 110 CC min-1. Subject-specific CC depth was controlled using a TI-thresholding system where CC were performed according to the amplitude (ZRMS, 0.125 to 1.250 Ω) of a band-passed TI signal (ZCC). Protocol A was a retrospective analysis of a 12-porcine study to characterise the response of two VF waveform metrics: amplitude spectrum area (AMSA) and mean slope (MS), to varying CC quality. Protocol B was a prospective 12-porcine study to determine if changes in VF waveform metrics, due to CC quality, were associated with defibrillation outcome.
Results: Protocol A: A directly proportional relationship was observed between ZRMS and CC depth applied within each subject (r = 0.90; p <0.001). A positive relationship was observed between ZRMS and both AMSA (p <0.001) and MS (p <0.001), where greater TI thresholds were associated with greater waveform metrics. Protocol B: MS was associated with return of circulation following defibrillation (odds ratio = 2.657; p = 0.043).
Conclusion: TI-thresholding was an effective way to control CC depth within-subjects. Compressions applied according to higher TI thresholds evoked an increase in AMSA and MS. The response in MS due to deeper CC resulted in a greater incidence of ROSC compared to shallow chest compressions.
Methods: This porcine investigation includes an analysis of two protocols. CC were delivered in 2-minute episodes at a constant rate of 110 CC min-1. Subject-specific CC depth was controlled using a TI-thresholding system where CC were performed according to the amplitude (ZRMS, 0.125 to 1.250 Ω) of a band-passed TI signal (ZCC). Protocol A was a retrospective analysis of a 12-porcine study to characterise the response of two VF waveform metrics: amplitude spectrum area (AMSA) and mean slope (MS), to varying CC quality. Protocol B was a prospective 12-porcine study to determine if changes in VF waveform metrics, due to CC quality, were associated with defibrillation outcome.
Results: Protocol A: A directly proportional relationship was observed between ZRMS and CC depth applied within each subject (r = 0.90; p <0.001). A positive relationship was observed between ZRMS and both AMSA (p <0.001) and MS (p <0.001), where greater TI thresholds were associated with greater waveform metrics. Protocol B: MS was associated with return of circulation following defibrillation (odds ratio = 2.657; p = 0.043).
Conclusion: TI-thresholding was an effective way to control CC depth within-subjects. Compressions applied according to higher TI thresholds evoked an increase in AMSA and MS. The response in MS due to deeper CC resulted in a greater incidence of ROSC compared to shallow chest compressions.
| Original language | English |
|---|---|
| Article number | 107780 |
| Pages (from-to) | 107780 |
| Number of pages | 7 |
| Journal | Computer Methods and Programs in Biomedicine |
| Volume | 241 |
| Early online date | 25 Aug 2023 |
| DOIs | |
| Publication status | Published (in print/issue) - 30 Nov 2023 |
Bibliographical note
Funding Information:The authors of this paper would like to acknowledge the laboratory and veterinary staff at the Roslin Institute for their contribution and commitment to quality research. The present research was fully funded by HeartSine Technologies Ltd. within the scope of an industrially sponsored PhD program.
Publisher Copyright:
© 2023 The Author(s)
Keywords
- Automated External Defibrillator
- ventricular fibrillation
- impedance
- defibrillation
- cardiac arrest
- data analysis
- biomedical engineering
- Mean slope
- Quantitative waveform measures
- Ventricular fibrillation
- Chest compressions
- Thoracic impedance
- Amplitude spectrum area
- Prospective Studies
- Electric Impedance
- Amsacrine
- Animals
- Swine
- Ventricular Fibrillation - therapy
- Retrospective Studies
