Extracting physiologic and clinical data from defibrillators for research purposes to improve treatment for patients in cardiac arrest

Background

A defibrillator should be connected to all patients receiving cardiopulmonary resuscitation (CPR) to allow early defibrillation. The defibrillator will collect signal data such as the electrocardiogram (ECG), thoracic impedance and end-tidal CO2, which allows for research on how patients demonstrate different responses to CPR. The aim of this review was to give an overview of methodological challenges and opportunities in using defibrillator data for research.

Methods

The successful collection of defibrillator files has several challenges. There is no scientific standard on how to store such data, which have resulted in several proprietary industrial solutions. The data needs to be exported to a software environment where signal filtering and classifications of ECG rhythms can be performed. This may be automated using different algorithms and artificial intelligence (AI). The patient can be classified being in ventricular fibrillation or -tachycardia, asystole, pulseless electrical activity or having obtained return of spontaneous circulation. How this dynamic response is time-dependent and related to covariates can be handled in several ways. These include Aalen’s linear model, Weibull regression and joint models.

Conclusions

The vast amount of signal data from defibrillator represents promising opportunities for the use of AI and statistical analysis to assess patient response to CPR. This may provide an epidemiologic basis to improve resuscitation guidelines and give more individualized care. We suggest that an international working party is initiated to facilitate a discussion on how open formats for defibrillator data can be accomplished, that obligates industrial partners to further develop their current technological solutions.

Full article below;

Extracting physiologic and clinical data from defibrillators for research purposes to improve treatment for patients in cardiac arrest – ScienceDirect

Optimising outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation

An interesting Article in the Resuscitation Journal

Abstract

Out-of-hospital cardiac arrest is a global public health issue experienced by approximately 3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into
the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives:

1. Identify known barriers to public-access defibrillator use and early defibrillation

2. Discuss established and novel strategies to address those barriers, and

3.  Identify high-priority knowledge gaps for future research to address.

The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behaviour change approaches, optimisation of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors.

The study provides evidence- and consensus based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Full article information below;

 

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation – PubMed (nih.gov)

Modeling optimal AED placement to improve cardiac arrest survival: The challenge is implementation – Resuscitation (resuscitationjournal.com)

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study

Abstract

Intervention by members of the public during an out of hospital cardiac arrest (OHAC) including resuscitation attempts and accessible automated external defibrillator (AED) has been shown to improve survival. This study aimed to investigate the OHCA and AED knowledge and confidence, and barriers to intervention, of the public of North East England, UK. This study used a face-to-face cross-sectional survey on a public high street in Newcastle, UK. Participants were asked unprompted to explain what they would do when faced with an OHCA collapse. Chi-Square analysis was used to test the association of the independent variables sex and first aid trained on the participants’ responses. Of the 421 participants recruited in the study, 82.9% (n = 349) reported that they would know what to do during an OHCA collapse. The most frequent OHCA action mentioned was call 999 (64.1%, n = 270/421) and 58.2% (n = 245/421) of participants reported that they would commence CPR. However, only 14.3% (n = 60/421) of participants spontaneously mentioned that they would locate an AED, while only 4.5% (n = 19/421) recounted that they would apply the AED. Just over half of participants (50.8%, n = 214/421) were first aid trained, with statistically more females (57.3%, n = 126/220) than males (43.9%, n = 87/198) being first aiders (p = 0.01 χ2 = 7.41). Most participants (80.3%, n = 338/421) knew what an AED was, and 34.7% (n = 326/421) reported that they knew how to use one, however, only 11.9% (n = 50/421) mentioned that they would actually shock a patient. Being first aid trained increased the likelihood of freely recounting actions for OHCA and AED intervention. The most common barrier to helping during an OHCA was lack of knowledge (29.9%, n = 126/421).

Although most participants reported they would know what to do during an OHCA and had knowledge of an AED, low numbers of participants spontaneously mentioned specific OHCA and AED actions.

Improving public knowledge would help improve the public’s confidence of intervening during an OHCA and may improve OHCA survival.

Full article;

 

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study – PubMed (nih.gov)

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study | Internal and Emergency Medicine (springer.com)

Development and testing of acoustically-matched hydrogel-based electrodes for simultaneous EMG-ultrasound detection

This study explores the development and testing of a bipolar electrode for the simultaneous acquisition of ultrasound (US) images and surface electromyograms (EMGs) from the same muscle region. The developed electrode (bEMG-US) consisted of two circular sensing regions (20 mm diameter) with fixed inter-electrode distance (3.5 cm, center-to-center). Both the sensing regions and the external structure of the electrode are made of hydrogel layers separated by insulating materials. The electrical properties (i.e., impedance and noise of the electrode-skin interface) and the quality of EMGs detected with the developed electrodes during electrically elicited contractions were assessed and compared with those provided by commercially available EMG electrodes. The effect of the bEMG-US electrode on US images was evaluated by comparing images detected from the same muscle region with and without the electrode interposed between the US probe and the skin. Tests on five subjects showed that the electrode-skin impedance of bEMG-US electrodes was higher than that of conventional EMG electrodes (mean (range): 15.6 (8.5-21.1) kΩ vs. 8.2 (4.9-16.5) kΩ).

Despite higher impedance values, both electrode systems provided comparable, electrode-skin noise levels (1.4 (1.1-1.7) µV vs. 1.3 (1.0-1.5) µV) and M waves (normalized mean square error: 2.6 (0.6-6.8)%). The quality of US images detected with and without the bEMG-US electrode between the US probe and the skin was comparable, as demonstrated by the low errors in the estimation of anatomical variables in the two experimental conditions (range: (0.37-2.35) deg for pennation angle and (-0.31-0.1) cm for muscle thickness).

Results demonstrate that bEMG-US can be used to acquire concurrently EMGs and US images from the same muscle region with a negligible effect on the quality of the two detected signals, thus allowing for a simultaneous, multimodal evaluation of muscle activation.

 

Full article linked below;

Development and testing of acoustically-matched hydrogel-based electrodes for simultaneous EMG-ultrasound detection – PubMed (nih.gov)

Cardiopulmonary Resuscitation and Defibrillator Use in Sports

Abstract:

Sudden cardiac arrest (SCA) in young athletes is rare, with an estimated incidence ranging from 0.1 to 2 per 100,000 per athlete year. The creation of SCA registries can help provide accurate data regarding incidence, treatment, and outcomes and help implement primary or secondary prevention strategies that could change the course of these events. Early cardiopulmonary resuscitation (CPR) and defibrillation are the most important determinants of survival and neurological prognosis in individuals who suffer from SCA. Compared with the general population, individuals with clinically silent cardiac disease who practice regular physical exercise are at increased risk of SCA events. While the implementation of national preparticipation screening has been largely debated, with no current consensus, the number of athletes who will be diagnosed with cardiac disease and have an indication for implantable defibrillator cardioverter defibrillator (ICD) is unknown. Many victims of SCA do not have a previous cardiac diagnosis. Therefore, the appropriate use and availability of automated external defibrillators (AEDs) in public spaces is the crucial part of the integrated response to prevent these fatalities both for participating athletes and for spectators. Governments and sports institutions should invest and educate members of the public, security, and healthcare professionals in immediate initiation of CPR and early AED use. Smartphone apps could play an integral part to allow bystanders to alert the emergency services and CPR trained responders and locate and utilize the nearest AED to positively influence the outcomes by strengthening the chain of survival.

This review aimed to summarize the available evidence on sudden cardiac death prevention among young athletes and to provide some guidance on strategies that can be implemented by governments and on the novel tools that can help save these lives.

Full article below;

Cardiopulmonary Resuscitation and Defibrillator Use in Sports – PubMed (nih.gov)

Wearable Sensors for the Monitoring of Maternal Health – A Systematic Review

Abstract

Maternal health includes health during pregnancy and childbirth. Each stage during pregnancy should be a positive experience, ensuring that women and their babies reach their full potential in health and well-being. However, this cannot always be achieved. According to UNFPA (United Nations Population Fund), approximately 800 women die every day from avoidable causes related to pregnancy and childbirth, so it is important to monitor mother and fetal health throughout the pregnancy. Many wearable sensors and devices have been developed to monitor both fetal and the mother’s health and physical activities and reduce risk during pregnancy. Some wearables monitor fetal ECG or heart rate and movement, while others focus on the mother’s health and physical activities.

This study presents a systematic review of these analyses. Twelve scientific articles were reviewed to address three research questions oriented to (1) sensors and method of data acquisition; (2) processing methods of the acquired data; and (3) detection of the activities or movements of the fetus or the mother.

According to the research results, this study explores the potential of sensors in efficiently overseeing the health of both mother and fetus throughout pregnancy. Enhancing the precision, conducting trials in real-world scenarios, improving the user comfort of wearable sensors, and ensuring continual, long-term monitoring all necessitate further advancements in wearable sensor technology. Overcoming these obstacles could significantly aid in decreasing mortality rates associated with pregnancy complications and maternal health concerns.

The researchers noted that the majority of wearable sensors were utilized within controlled settings. They suggest that more extensive testing in real-life conditions and continuous monitoring are imperative before advocating for widespread adoption of these sensors.

Link to article below;

Wearable Sensors for the Monitoring of Maternal Health-A Systematic Review – PubMed (nih.gov)

 

Sudden cardiac arrest in athletes and strategies to optimize preparedness

Sudden cardiac arrest (SCA) is the leading cause of death in young athletes. Despite efforts to improve preparedness for cardiac emergencies, the incidence of out-of-hospital cardiac arrests in athletes remains high, and bystander awareness and readiness for SCA support are inadequate. Initiatives such as designing an emergency action plan (EAP) and mandating training in cardiopulmonary resuscitation (CPR) and automated external defibrillator use (AED) for team members and personnel can contribute to improved survival rates in SCA cases. This review provides an overview of SCA in athletes, focusing on identifying populations at the highest risk and evaluating the effectiveness of different screening practices in detecting conditions that may lead to SCA. This study summarizes current practices and recommendations for improving the response to SCA events, and highlights the need for ongoing efforts to optimize preparedness through the implementation of EAPs and the training of individuals in CPR and AED use. Additionally, it proposes a call to action to increase awareness and training in EAP development, CPR, and AED use for team members and personnel. To improve outcomes of SCA cases in athletes, it is crucial to enhance bystander awareness and preparedness for cardiac emergencies. Implementing EAPs and providing training in CPR and AED use for team members and personnel are essential steps toward improving survival rates in SCA cases.

Full Article;

Sudden cardiac arrest in athletes and strategies to optimize preparedness – PMC (nih.gov)

Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review.

Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognizable or are obstructed. Therefore, AEDs should be used on-site, use clear signaling, have certified trained personnel, and be incorporated into stadiums’ medical plans.

 

For full study click below;

 

Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators) – PMC (nih.gov)

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

 

Full article linked below;

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces | Circulation (ahajournals.org)

Prehospital and Hospital Care on Clinical Outcomes in Out-of-Hospital Cardiac Arrest

In recent years, several actions have been made to shorten the chain of survival in out-of-hospital cardiac arrest (OHCA). These include placing defibrillators in public places, training first responders, and providing dispatcher-assisted CPR (DA-CPR). In this study, they aimed to evaluate the impact of these changes on patients’ outcomes, including achieving return of spontaneous circulation (ROSC), survival to discharge, and survival with favorable neurological function.

Full article link below;

The Impact of Prehospital and Hospital Care on Clinical Outcomes in Out-of-Hospital Cardiac Arrest – PubMed (nih.gov)