An automatic system for the comprehensive retrospective analysis of cardiac rhythms in resuscitation episodes

Ali Bahrami Rad*, Trygve Eftestøl, Unai Irusta, Jan Terje Kvaløy, Lars Wik, Jo Kramer-Johansen, Aggelos K. Katsaggelos, Kjersti Engan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Aim An automatic resuscitation rhythm annotator (ARA) would facilitate and enhance retrospective analysis of resuscitation data, contributing to a better understanding of the interplay between therapy and patient response. The objective of this study was to define, implement, and demonstrate an ARA architecture for complete resuscitation episodes, including chest compression pauses (CC-pauses) and chest compression intervals (CC-intervals). Methods We analyzed 126.5 h of ECG and accelerometer-based chest-compression depth data from 281 out-of-hospital cardiac arrest (OHCA) patients. Data were annotated by expert reviewers into asystole (AS), pulseless electrical activity (PEA), pulse-generating rhythm (PR), ventricular fibrillation (VF), and ventricular tachycardia (VT). Clinical pulse annotations were based on patient-charts and impedance measurements. An ARA was developed for CC-pauses, and was used in combination with a chest compression artefact removal filter during CC-intervals. The performance of the ARA was assessed in terms of the unweighted mean of sensitivities (UMS). Results The UMS of the ARA were 75.0% during CC-pauses and 52.5% during CC-intervals, 55-points and 32.5-points over a random guess (20% for five categories). Filtering increased the UMS during CC-intervals by 5.2-points. Sensitivities for AS, PEA, PR, VF, and VT were 66.8%, 55.8%, 86.5%, 82.1% and 83.8% during CC-pauses; and 51.1%, 34.1%, 58.7%, 86.4%, and 32.1% during CC-intervals. Conclusions A general ARA architecture was defined and demonstrated on a comprehensive OHCA dataset. Results showed that semi-automatic resuscitation rhythm annotation, which may involve further revision/correction by clinicians for quality assurance, is feasible. The performance (UMS) dropped significantly during CC-intervals and sensitivity was lowest for PEA.

Original languageEnglish (US)
Pages (from-to)6-12
Number of pages7
StatePublished - Jan 2018


  • Automatic resuscitation rhythm annotator
  • Cardiac arrest
  • Cardiac rhythm classification
  • Cardiopulmonary resuscitation

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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