Impedance Based Automatic Detection of Ventilations During Mechanical Cardiopulmonary Resuscitation

Monitoring ventilation rate is key to improve the quality of cardiopulmonary resuscitation (CPR) and increase the probability of survival in the event of an out-of-hospital cardiac arrest (OHCA). Ventilations produce discernible fluctuations in the thoracic impedance signal recorded by defibrillators. Impedance-based detection of ventilations during CPR is challenging due to chest compression artifacts. This study presents a method for an accurate detection of ventilations when chest compressions are delivered using a piston-driven mechanical device. Data from 223 OHCA patients were analyzed and 399 analysis segments totaling 3101 minutes of mechanical CPR were extracted. A total of 18327 ventilations were annotated using concurrent capnogram recordings. An adaptive least mean squares filter was used to remove compression artifacts. Potential ventilations were detected using a greedy peak detector, and the ventilation waveform was characterized using 8 waveform features. These features were used in a logistic regression classifier to discriminate true ventilations from false positives produced by the greedy peak detector. The classifier was trained and tested using patient wise 10-fold cross validation (CV), and 100 random CV partitions were created to statistically characterize the performance metrics. The peak detector presented a sensitivity (Se) of 99.30%, but a positive predictive value (PPV) of 54.43%. The best classifier configuration used 6 features and improved the mean (sd) Se and PPV of the detector to 93.20% (0.06) and 94.43% (0.04), respectively. When used to measure per minute ventilation rates for feedback to the rescuer, the mean (sd) absolute error in ventilation rate was 0.61 (1.64) min^-1. The first impedance-based method to accurately detect ventilations and give feedback on ventilation rate during mechanical CPR has been demonstrated.