Abstract

Deep neural networks (DNN) are state-of-the-art machine learning algorithms that can be learned to self-extract significant features of the electrocardiogram (ECG) and can generally provide high-output diagnostic accuracy if subjected to robust training and optimization on large datasets at high computational cost. So far, limited research and optimization of DNNs in shock advisory systems is found on large ECG arrhythmia databases from out-of-hospital cardiac arrests (OHCA). The objective of this study is to optimize the hyperparameters (HPs) of deep convolutional neural networks (CNN) for detection of shockable (Sh) and nonshockable (NSh) rhythms, and to validate the best HP settings for short and long analysis durations (2–10 s). Large numbers of (Sh + NSh) ECG samples were used for training (720 + 3170) and validation (739 + 5921) from Holters and defibrillators in OHCA. An end-to-end deep CNN architecture was implemented with one-lead raw ECG input layer (5 s, 125 Hz, 2.5 uV/LSB), configurable number of 5 to 23 hidden layers and output layer with diagnostic probability p ∈ [0: Sh,1: NSh]. The hidden layers contain N convolutional blocks × 3 layers (Conv1D (filters = Fi, kernel size = Ki), max-pooling (pool size = 2), dropout (rate = 0.3)), one global max-pooling and one dense layer. Random search optimization of HPs = {N, Fi, Ki}, i = 1, … N in a large grid of N = [1, 2, … 7], Fi = [5;50], Ki = [5;100] was performed. During training, the model with maximal balanced accuracy BAC = (Sensitivity + Specificity)/2 over 400 epochs was stored. The optimization principle is based on finding the common HPs space of a few top-ranked models and prediction of a robust HP setting by their median value. The optimal models for 1–7 CNN layers were trained with different learning rates LR = [10−5; 10−2] and the best model was finally validated on 2–10 s analysis durations. A number of 4216 random search models were trained. The optimal models with more than three convolutional layers did not exhibit substantial differences in performance BAC = (99.31–99.5%). Among them, the best model was found with {N = 5, Fi = {20, 15, 15, 10, 5}, Ki = {10, 10, 10, 10, 10}, 7521 trainable parameters} with maximal validation performance for 5-s analysis (BAC = 99.5%, Se = 99.6%, Sp = 99.4%) and tolerable drop in performance (<2% points) for very short 2-s analysis (BAC = 98.2%, Se = 97.6%, Sp = 98.7%). DNN application in future-generation shock advisory systems can improve the detection performance of Sh and NSh rhythms and can considerably shorten the analysis duration complying with resuscitation guidelines for minimal hands-off pauses.

Highlights

  • Cardiac arrest describes the loss of mechanical cardiac function and the absence of systemic circulation, presenting electrocardiographically (ECG) recorded rhythms of ventricular fibrillation (VF), rapid ventricular tachycardia (VT), asystole (ASYS), or pulseless electrical activity

  • The hands-off pauses in chest compressions required for artifact-free ECG analysis in automatic external defibrillators (AEDs) should be shortened, considering that 5 s to 10 s delay of the shock after stopping chest compressions reduces the probability of the defibrillation success and survival [5,6]

  • of-hospital cardiac arrests (OHCA) databases are, proprietary, and we find only two deep neural network (DNN) models trained on OHCA ECGs, i.e., Picon et al (2019) [60] with two convolutional neural networks (CNN) layers and one long short-term memory (LSTM) layer; Irusta et al (2019) [59] with two or three CNN layers and two dense layers

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Summary

Introduction

Cardiac arrest describes the loss of mechanical cardiac function and the absence of systemic circulation, presenting electrocardiographically (ECG) recorded rhythms of ventricular fibrillation (VF), rapid ventricular tachycardia (VT), asystole (ASYS), or pulseless electrical activity. Guidelines for resuscitation recommend prompt and effective bystander basic life support, uninterrupted, high-quality chest compressions, and early defibrillation for improved survival after cardiac arrest [1]. The reliable and prompt detection of cardiac rhythms as shockable (Sh) or nonshockable (NSh) is the primary requirement to the shock advisory algorithms in automatic external defibrillators (AEDs). The AED performance goals on artifact-free ECGs are demanding (>90% for VFs, >75% for VTs, >95% for NSh, and >99% for normal sinus rhythms (NSR)), as set by the American Heart Association (AHA) in the early 1997 [4]. The hands-off pauses in chest compressions required for artifact-free ECG analysis in AEDs should be shortened, considering that 5 s to 10 s delay of the shock after stopping chest compressions reduces the probability of the defibrillation success and survival [5,6]. Effective strategies for early shock decision have been reported within the AED setting, such as early starting of the ECG analysis at the end of chest compressions [7] or during ventilation pauses [8]; as well as short ECG analysis durations, varying across studies from 2 s to 10 s [3,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]

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