Weil Institute of Critical Care Medicine, Rancho Mirage, CA 92270, USA.
IEEE Trans Biomed Eng. 2012 Jan;59(1):78-86. doi: 10.1109/TBME.2011.2118755. Epub 2011 Feb 22.
Ventricular fibrillation (VF) is the primary arrhythmic event in the majority of patients suffering from sudden cardiac arrest. Attention has been focused on this particular rhythm since it is recognized that prompt therapy, especially electrical defibrillation, may lead to a successful outcome. However, current versions of automated external defibrillators (AEDs) mandate repetitive interruptions of chest compression for rhythm analyses since artifacts produced by chest compression during cardiopulmonary resuscitation (CPR) preclude reliable electrocardiographic (ECG) rhythm analysis. Yet, repetitive interruptions in chest compression are detrimental to the success of defibrillation. The capability for rhythm analysis without requiring "hands-off" intervals will allow for more effective resuscitation. In this paper, a novel continuous-wavelet-transformation-based morphology consistency evaluation algorithm was developed for the detection of disorganized VF from organized sinus rhythm (SR) without interrupting the ongoing chest compression. The performance of this method was evaluated on both uncorrupted and corrupted ECG signals recorded from AEDs obtained from out-of-hospital victims of cardiac arrest. A total of 232 patients and 31,092 episodes of either VF or SR were accessed, in which 8195 episodes were corrupted by artifacts produced by chest compressions. We also compared the performance of this method with three other established algorithms, including VF filter, spectrum analysis, and complexity measurement. Even though there was a modest decrease in specificity and accuracy when chest compression artifact was present, the performance of this method was still superior to other reported methods for VF detection during uninterrupted CPR.
心室颤动 (VF) 是大多数遭受心搏骤停的患者的主要心律失常事件。由于人们认识到及时治疗，特别是电除颤，可能会带来成功的结果，因此人们一直关注这种特定的节律。然而，当前版本的自动体外除颤器 (AED) 需要重复中断胸外按压以进行节律分析，因为心肺复苏 (CPR) 期间胸外按压产生的伪影会妨碍可靠的心电图 (ECG) 节律分析。然而，重复中断胸外按压会对除颤的成功产生不利影响。无需“脱手”间隔即可进行节律分析的能力将使复苏更加有效。在本文中，开发了一种新颖的基于连续小波变换的形态一致性评估算法，用于在不中断正在进行的胸外按压的情况下，从有组织的窦性节律 (SR) 中检测无组织的 VF。该方法的性能在从院外心搏骤停患者获得的 AED 记录的未损坏和损坏的 ECG 信号上进行了评估。共访问了 232 名患者和 31092 个 VF 或 SR 发作，其中 8195 个发作被胸外按压产生的伪影损坏。我们还将该方法的性能与其他三种已建立的算法进行了比较，包括 VF 滤波器、频谱分析和复杂度测量。尽管在存在胸外按压伪影时特异性和准确性略有下降，但该方法在不间断 CPR 期间进行 VF 检测的性能仍优于其他报告的方法。
