Abstract
Survival from out-of-hospital cardiac arrest depends largely on two factors: early cardiopulmonary resuscitation (CPR) and early defibrillation. CPR must be interrupted for a reliable automated rhythm analysis because chest compressions induce artifacts in the ECG. Unfortunately, interrupting CPR adversely affects survival. In the last twenty years, research has been focused on designing methods for analysis of ECG during chest compressions. Most approaches are based either on adaptive filters to remove the CPR artifact or on robust algorithms which directly diagnose the corrupted ECG. In general, all the methods report low specificity values when tested on short ECG segments, but how to evaluate the real impact on CPR delivery of continuous rhythm analysis during CPR is still unknown. Recently, researchers have proposed a new methodology to measure this impact. Moreover, new strategies for fast rhythm analysis during ventilation pauses or high-specificity algorithms have been reported. Our objective is to present a thorough review of the field as the starting point for these late developments and to underline the open questions and future lines of research to be explored in the following years.
Highlights
In the early 1990s, the American Heart Association (AHA) established the chain of survival [1] to describe the sequence of actions for a successful resuscitation in the event of an out-of-hospital cardiac arrest (OHCA)
As stated by the CoSTR, studies must demonstrate that rhythm analysis during cardiopulmonary resuscitation (CPR) optimizes the time of appropriate chest compressions
The classical sensitivity/specificity goals would change to new goals for uninterrupted CPR time
Summary
In the early 1990s, the American Heart Association (AHA) established the chain of survival [1] to describe the sequence of actions for a successful resuscitation in the event of an out-of-hospital cardiac arrest (OHCA). The chain of survival involves four links: early recognition, early bystander cardiopulmonary resuscitation (CPR), early defibrillation, and early advanced care. Evidence has accumulated suggesting that minimizing the interruptions in chest compressions during CPR is determinant for survival from OHCA [8,9,10,11]. Current resuscitation guidelines emphasize the importance of high-quality CPR with minimal interruptions in chest compressions [12, 13]. CPR must be interrupted for a reliable AED rhythm analysis. Interruptions for rhythm analysis alone take between 5.2 s and 28.4 s in commercial AEDs [16]. Reliable rhythm analysis methods during chest compressions would be of great value
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have