A Review of the Performance of Artifact Filtering Algorithms for Cardiopulmonary Resuscitation

Chongqing University, Ch’ung-ch’ing-shih, Chongqing Shi, China
Journal of Healthcare Engineering (Impact Factor: 0.75). 06/2013; 4(2):185-202. DOI: 10.1260/2040-2295.4.2.185
Source: PubMed


Various filtering strategies have been adopted and investigated to suppress the cardiopulmonary resuscitation (CPR) artifact. In this article, two types of artifact removal methods are reviewed: one is the method that removes CPR artifact using only ECG signals, and the other is the method with additional reference signals, such as acceleration, compression depth and transthoracic impedance. After filtering, the signal-to-noise ratio is improved from 0 dB to greater than 2.8 dB, the sensitivity is increased to > 90% as recommended by the American Heart Association, whereas the specificity was far from the recommended 95%, which is considered to be the major drawback of the available artifact removal methods. The overall performance of the adaptive filtering methods with additional reference signal outperforms the methods using only ECG signals. Further research should focus on the refinement of artifact filtering methods and the improvement of shock advice algorithms with the presence of CPR.

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Available from: Yongqin Li, May 13, 2014
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    • "Although the sensitivity for detecting a shockable rhythm was significantly improved with the application of these techniques, the specificity was still below the 95% limit recommended by the AHA task force on AEDs for accurately detecting nonshockable rhythms [22]. Further studies are, therefore, still required to analyze the interaction between the artifact and underlying rhythms and to improve the accuracy of nonshockable rhythm decision [23] [24]. "
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    ABSTRACT: Current automated external defibrillators mandate interruptions of chest compression to avoid the effect of artifacts produced by CPR for reliable rhythm analyses. But even seconds of interruption of chest compression during CPR adversely affects the rate of restoration of spontaneous circulation and survival. Numerous digital signal processing techniques have been developed to remove the artifacts or interpret the corrupted ECG with promising result, but the performance is still inadequate, especially for nonshockable rhythms. In the present study, we suppressed the CPR artifacts with an enhanced adaptive filtering method. The performance of the method was evaluated by comparing the sensitivity and specificity for shockable rhythm detection before and after filtering the CPR corrupted ECG signals. The dataset comprised 283 segments of shockable and 280 segments of nonshockable ECG signals during CPR recorded from 22 adult pigs that experienced prolonged cardiac arrest. For the unfiltered signals, the sensitivity and specificity were 99.3% and 46.8%, respectively. After filtering, a sensitivity of 93.3% and a specificity of 96.0% were achieved. This animal trial demonstrated that the enhanced adaptive filtering method could significantly improve the detection of nonshockable rhythms without compromising the ability to detect a shockable rhythm during uninterrupted CPR.
    Full-text · Article · Mar 2014
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    • "Over the last 15 years, many efforts have been made to reliably analyze the rhythm during CPR. Strategies have focused either on adaptive filters to suppress the CPR artifact [20] or, more recently, on approaches based on the direct analysis of the corrupted ECG. Most studies report sensitivities above 90%, the minimum value recommended by the AHA for AED performance [21]. "
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    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.
    Full-text · Article · Jan 2014