Fully automatic rhythm analysis during chest compression pauses

Aim: Chest compression artefacts impede a reliable rhythm analysis during cardiopulmonary resuscitation (CPR). These artefacts are not present during ventilations in 30:2 CPR. The aim of this study is to prove that a fully automatic method for rhythm analysis during ventilation pauses in 30:2 CPR is reliable an accurate.Methods: For this study 1414 min of 30:2 CPR from 135 out-of-hospital cardiac arrest cases were analysed. The data contained 1942 pauses in compressions longer than 3.5 s. An automatic pause detector identified the pauses using the transthoracic impedance, and a shock advice algorithm (SAA) diagnosed the rhythm during the detected pauses. The SAA analysed 3-s of the ECG during each pause for an accurate shock/no-shock decision.Results: The sensitivity and PPV of the pause detector were 93.5% and 97.3%, respectively. The sensitivity and specificity of the SAA in the detected pauses were 93.8% (90% low CI, 90.0%) and 95.9% (90% low CI, 94.7%), respectively. Using the method, shocks would have been advanced in 97% of occasions. For patients in nonshockable rhythms, rhythm reassessment pauses would be avoided in 95.2% (95% CI, 91.6-98.8) of occasions, thus increasing the overall chest compression fraction (CCF).Conclusion: An automatic method could be used to safely analyse the rhythm during ventilation pauses. This would contribute to an early detection of refibrillation, and to increase CCF in patients with nonshockable rhythms.