Restoration of the electrocardiogram during mechanical cardiopulmonary resuscitation

Objective: An artefact-free electrocardiogram (ECG) is essential during cardiac arrest to decide therapy such as defibrillation. Mechanical cardiopulmonary resuscitation (CPR) devices cause movement artefacts that alter the ECG. This study analyzes the effectiveness of mechanical CPR artefact suppression filters to restore clinically relevant ECG information. Approach: In total, 495 10 s ECGs were used, of which 165 were in ventricular fibrillation (VF), 165 in organized rhythms (OR) and 165 contained mechanical CPR artefacts recorded during asystole. CPR artefacts and rhythms were mixed at controlled signal-to-noise ratios (SNRs), ranging from –20 dB to 10 dB. Mechanical artefacts were removed using least mean squares (LMS), recursive least squares (RLS) and Kalman filters. Performance was evaluated by comparing the clean and the restored ECGs in terms of restored SNR, correlation-based similarity measures, and clinically relevant features: QRS detection performance for OR, and dominant frequency, mean amplitude and waveform irregularity for VF. For each filter, a shock/no-shock support vector machine algorithm based on multiresolution analysis of the restored ECG was designed, and evaluated in terms of sensitivity (Se) and specificity (Sp). Main results: The RLS filter produced the largest correlation coefficient (0.80), the largest average increase in SNR (9.5 dB), and the best QRS detection performance. The LMS filter best restored VF with errors of 10.3% in dominant frequency, 18.1% in amplitude and 11.8% in waveform irregularity. The Se/Sp of the diagnosis of the restored ECG were 95.1/94.5% using the RLS filter and 97.0/91.4% using the LMS filter. Significance: Suitable filter configurations to restore ECG waveforms during mechanical CPR have been determined, allowing reliable clinical decisions without interrupting mechanical CPR therapy.