Sonification enables continuous surveillance of the ST segment in the electrocardiogram
Andrea Lorena Aldana Blanco1, Thomas Hermann1, Jens Tiesmeier2
1CITEC, Bielefeld University, Inspiration 1, 33619 Bielefeld, Germany.
Insights
This study shows that sonification of ST segments can help medical teams detect changes in ST elevation myocardial infarction. This new audio method aids in timely diagnosis and treatment adjustments for cardiac arrest patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Informatics
Background:
- ST segment elevation myocardial infarction is a frequent cause of out-of-hospital cardiac arrest in adults.
- Current ST segment surveillance relies on visual electrocardiogram interpretation, which has limitations in detecting dynamic changes during treatment.
- Prompt detection of ST elevation is critical for immediate coronary revascularization and improved patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of auditory ST segment sonification as a novel tool for real-time detection of ST elevation changes.
- To compare the performance and user experience of two distinct sonification designs (Water Ambience and Polarity) among medical and computer science students.
- To assess the utility of sonification in a simulated myocardial infarction scenario for guiding clinical decisions.
Main Methods:
- Two sonification designs were tested with 21 medical and computer science students to evaluate ST segment classification (none, low, medium, extreme elevation).
- A second study involved 25 medical students using sonification during a simulated transient ST elevation myocardial infarction case.
- Participants assessed sonification for ST elevation detection, aesthetics, usability, and impact on treatment decisions.
Main Results:
- Both student groups successfully classified ST segment elevation via sonification, with higher elevations yielding better detection rates.
- The Water Ambience sonification was rated higher than Polarity for pleasantness, informativeness, and long-term listening.
- In the simulated scenario, 96% of participants detected ST elevation, with 60% indicating sonification aided their detection.
Conclusions:
- ST segment sonification shows significant potential as an assistive tool for monitoring patients with suspected myocardial infarction, especially for transient ST elevation.
- This auditory approach can help differentiate ST elevation myocardial infarction from non-ST elevation myocardial infarction.
- Sonification is perceived positively by users and may help mitigate alarm fatigue in clinical settings.
Introduction:
ST segment elevation myocardial infarction is a common reason for out-of-hospital cardiac arrest in adult patients. The surveillance of the ST segment in the electrocardiogram is limited to visual presentation. However, the ST segment can change during the course of treatment. If ST elevation is present immediate coronary revascularization is needed, therefore detecting ST elevation changes the treatment fundamentally. Sonification of the ST segment is a new method which enables the emergency team to detect intermediate changes of the ST segment.
Material And Methods:
We have chosen two sonification designs which were introduced to two groups, medical students and computer science students. Twenty-one participants took part in the study. The sonification was designed for evaluation of the ST segment. The user was supposed to become empowered to distinguish between no, medium-low, medium-high or extreme ST elevation by listening to the sonification. The two groups were asked to evaluate the sounds for possible ST elevation as well as for aesthetics and usability. In a second study twenty-five medical students were taking part in a medical scenario in which sonification was played during a simulated case. The patient was suffering from a myocardial infarction, ST elevation was transient and sonification sounds were changing appropriately. The students were supposed to detect these changes and act accordingly by modifying the treatment.
Results:
Both groups were able to classify ST segment elevation by listening to the sonification samples. The higher the ST segment, the better was the detection rate overall. In all of the three categories (pleasantness, informativeness and long-term listening) the Water Ambience sonification was rated higher compared to the Polarity sonification. Moreover, in the two groups that took part in the study, we found a significant difference when comparing classification performance using both sonification designs. For the group of medical students as t(20) = 4.31, p = 3.44 × 10-4, p < 0.01 and for the computer science students as t(19) = 3.40, p = 9.39 × 10-6, p < 0.01. In the simulated medical scenario participants indicated that 96% detected the ST elevation. 60% stated that sonification played a role whereas for 32% it did not play a role for the detection of ST elevation.
Conclusions:
Sonification has the potential to play an important role as a new supporting tool for the surveillance of the ST segment during the care of patients with suspicion of myocardial infarction. It can be helpful to differentiate between ST segment elevation myocardial infarction and non-ST segment myocardial infarction especially if ST elevation is transient. Furthermore, sonification is viewed as pleasant to listen to and might not contribute to alarm fatigue.
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