Enhancement of capnogram waveform in the presence of chest compression artefact during cardiopulmonary resuscitation. 2018

Sofía Ruiz de Gauna, and Mikel Leturiondo, and J Julio Gutiérrez, and Jesus M Ruiz, and Digna M González-Otero, and James K Russell, and Mohamud Daya
Department of Communications Engineering, University of the Basque Country, UPV/EHU, 48013 Bilbao, Spain. Electronic address: sofia.ruizdegauna@ehu.eus.

Current resuscitation guidelines emphasize the use of waveform capnography to help guide rescuers during cardiopulmonary resuscitation (CPR). However, chest compressions often cause oscillations in the capnogram, impeding its reliable interpretation, either visual or automated. The aim of the study was to design an algorithm to enhance waveform capnography by suppressing the chest compression artefact. Monitor-defibrillator recordings from 202 patients in out-of-hospital cardiac arrest were analysed. Capnograms were classified according to the morphology of the artefact. Ventilations were annotated using the transthoracic impedance signal acquired through defibrillation pads. The suppression algorithm is designed to operate in real-time, locating distorted intervals and restoring the envelope of the capnogram. We evaluated the improvement in automated ventilation detection, estimation of ventilation rate, and detection of excessive ventilation rates (over-ventilation) using the capnograms before and after artefact suppression. A total of 44 267 ventilations were annotated. After artefact suppression, sensitivity (Se) and positive predictive value (PPV) of the ventilation detector increased from 91.9/89.5% to 98.0/97.3% in the distorted episodes (83/202). Improvement was most noticeable for high-amplitude artefact, for which Se/PPV raised from 77.6/73.5% to 97.1/96.1%. Estimation of ventilation rate and detection of over-ventilation also upgraded. The suppression algorithm had minimal impact in non-distorted data. Ventilation detection based on waveform capnography improved after chest compression artefact suppression. Moreover, the algorithm enhances the capnogram tracing, potentially improving its clinical interpretation during CPR. Prospective research in clinical settings is needed to understand the feasibility and utility of the method.

UI MeSH Term Description Entries
D012042 Registries The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Parish Registers,Population Register,Parish Register,Population Registers,Register, Parish,Register, Population,Registers, Parish,Registers, Population,Registry
D006336 Heart Massage Rhythmic compression of the heart by pressure applied manually over the sternum (closed heart massage) or directly to the heart through an opening in the chest wall (open heart massage). It is done to reinstate and maintain circulation. (Dorland, 28th ed) Cardiac Massage,Cardiac Massages,Heart Massages,Massage, Cardiac,Massage, Heart,Massages, Cardiac,Massages, Heart
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000465 Algorithms A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. Algorithm
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D016477 Artifacts Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. Artefacts,Artefact,Artifact
D017063 Outcome Assessment, Health Care Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure). Assessment, Outcome,Outcome Assessment,Outcome Assessment (Health Care),Outcomes Research,Assessment, Outcomes,Outcome Measures,Outcome Studies,Outcomes Assessment,Assessment, Outcome (Health Care),Assessments, Outcome,Assessments, Outcome (Health Care),Assessments, Outcomes,Measure, Outcome,Measures, Outcome,Outcome Assessments,Outcome Assessments (Health Care),Outcome Measure,Outcome Study,Outcomes Assessments,Research, Outcomes,Studies, Outcome,Study, Outcome
D047548 Defibrillators Cardiac electrical stimulators that apply brief high-voltage electroshocks to the HEART. These stimulators are used to restore normal rhythm and contractile function in hearts of patients who are experiencing VENTRICULAR FIBRILLATION or ventricular tachycardia (TACHYCARDIA, VENTRICULAR) that is not accompanied by a palpable PULSE. Some defibrillators may also be used to correct certain noncritical dysrhythmias (called synchronized defibrillation or CARDIOVERSION), using relatively low-level discharges synchronized to the patient's ECG waveform. (UMDNS, 2003) Automated External Defibrillators,Defibrillators, External,Electric Shock Cardiac Stimulators,Stimulators, Electrical, Cardiac, Shock,Automated External Defibrillator,Defibrillator,Defibrillator, Automated External,Defibrillator, External,Defibrillators, Automated External,External Defibrillator,External Defibrillator, Automated,External Defibrillators,External Defibrillators, Automated
D056152 Respiratory Rate The number of times an organism breathes with the lungs (RESPIRATION) per unit time, usually per minute. Respiration Rate,Rate, Respiration,Rate, Respiratory,Rates, Respiration,Rates, Respiratory,Respiration Rates,Respiratory Rates
D058687 Out-of-Hospital Cardiac Arrest Occurrence of heart arrest in an individual when there is no immediate access to medical personnel or equipment. Out-of-Hospital Heart Arrest,Cardiac Arrest, Out-of-Hospital,Cardiac Arrests, Out-of-Hospital,Heart Arrest, Out-of-Hospital,Heart Arrests, Out-of-Hospital,Out of Hospital Cardiac Arrest,Out of Hospital Heart Arrest,Out-of-Hospital Cardiac Arrests,Out-of-Hospital Heart Arrests

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