Accelerometry-based classification of circulatory states during out-of-hospital cardiac arrest

TL;DR

This study presents a machine learning approach using accelerometry data to accurately detect spontaneous circulation during out-of-hospital cardiac arrest, improving over ECG-only methods and aiding clinical decision-making.

Contribution

Introduces the first accelerometry-based algorithm for circulatory state detection during cardiac arrest, achieving higher accuracy than ECG-only approaches.

Findings

Balanced accuracy of 81.2% in detection

Outperforms ECG-only methods in sensitivity and specificity

Potential to support clinical assessment during resuscitation

Abstract

Objective: Exploit accelerometry data for an automatic, reliable, and prompt detection of spontaneous circulation during cardiac arrest, as this is both vital for patient survival and practically challenging. Methods: We developed a machine learning algorithm to automatically predict the circulatory state during cardiopulmonary resuscitation from 4-second-long snippets of accelerometry and electrocardiogram (ECG) data from pauses of chest compressions of real-world defibrillator records. The algorithm was trained based on 422 cases from the German Resuscitation Registry, for which ground truth labels were created by a manual annotation of physicians. It uses a kernelized Support Vector Machine classifier based on 49 features, which partially reflect the correlation between accelerometry and electrocardiogram data. Results: Evaluating 50 different test-training data splits, the proposed algorithm exhibits a balanced accuracy of 81.2%, a sensitivity of 80.6%, and a specificity of 81.8%, whereas using only ECG leads to a balanced accuracy of 76.5%, a sensitivity of 80.2%, and a specificity of 72.8%. Conclusion: The first method employing accelerometry for pulse/no-pulse decision yields a significant increase in performance compared to single ECG-signal usage. Significance: This shows that accelerometry provides relevant information for pulse/no-pulse decisions. In application, such an algorithm may be used to simplify retrospective annotation for quality management and, moreover, to support clinicians to assess circulatory state during cardiac arrest treatment.