Feasibility of biosignal-guided chest compression during cardiopulmonary resuscitation: A proof of concept

Abstract

Objectives Cardiac arrest is one of the leading causes of death in the United States and is treated by cardiopulmonary resuscitation (CPR). CPR involves both chest compressions and positive pressure ventilations when given by medical providers. Mechanical chest compression devices automate chest compressions and are beginning to be adopted by emergency medical services with the intent of providing high-quality, consistent chest compressions that are not limited by human providers who can become fatigued. Biosignals acquired from cardiac arrest patients have been characterized in their ability to track the effect of CPR on the patient. The authors investigated the feasibility and appropriate response of a biosignal-guided mechanical chest compression device in a swine model of cardiac arrest. Methods After a custom signal-guided chest compression device was engineered, its ability to respond to biosignal changes in a swine model of cardiac arrest was tested. In a preliminary series of six swine, two biosignals were used: mean arterial pressure (MAP) and a mathematical derivative of the electrocardiogram waveform, median slope (MS). How these biosignals changed was observed when chest compression rate and depth were adjusted by the signal-guided chest compression device, independent of the user. Chest compression rate and depth were adjusted by the signal-guided chest compression device according to a preset threshold algorithm until either of the biosignals improved to satisfy a set "threshold" or until the chest compression rate and depth achieved maximum values. Defibrillation was attempted at the end of each resuscitation in an effort to achieve return of spontaneous circulation (ROSC). Results The signal-guided chest compression device responded appropriately to biosignals by changing its rate and depth. All animals exhibited positive improvements in their biosignals. During the course of the resuscitation, three of the six animals improved their MS biosignal to reach the MS threshold, while two of the six animals improved their MAP biosignal to reach the MAP threshold. In the six experiments conducted, defibrillation was attempted on five animals, and two animals achieved ROSC. Conclusions In this proof-of-concept study, a signal-guided chest compression device was demonstrated to be capable of responding to biosignal input and delivering chest compressions with a broad range of rates and depths.