A Machine Learning Model for the Prognosis of Pulseless Electrical Activity during Out-of-Hospital Cardiac Arrest

Pulseless electrical activity (PEA) is characterized by the disassociation of the mechanical and electrical activity of the heart and appears as the initial rhythm in 20–30% of out-of-hospital cardiac arrest (OHCA) cases. Predicting whether a patient in PEA will convert to return of spontaneous circulation (ROSC) is important because different therapeutic strategies are needed depending on the type of PEA. The aim of this study was to develop a machine learning model to differentiate PEA with unfavorable (unPEA) and favorable (faPEA) evolution to ROSC. An OHCA dataset of 1921 5s PEA signal segments from defibrillator files was used, 703 faPEA segments from 107 patients with ROSC and 1218 unPEA segments from 153 patients with no ROSC. The solution consisted of a signal-processing stage of the ECG and the thoracic impedance (TI) and the extraction of the TI circulation component (ICC), which is associated with ventricular wall movement. Then, a set of 17 features was obtained from the ECG and ICC signals, and a random forest classifier was used to differentiate faPEA from unPEA. All models were trained and tested using patientwise and stratified 10-fold cross-validation partitions. The best model showed a median (interquartile range) area under the curve (AUC) of 85.7(9.8)% and a balance accuracy of 78.8(9.8)% , improving the previously available solutions at more than four points in the AUC and three points in balanced accuracy. It was demonstrated that the evolution of PEA can be predicted using the ECG and TI signals, opening the possibility of targeted PEA treatment in OHCA.This work was supported by the Spanish Ministerio de Ciencia, Innovacion y Universidades through Grant RTI2018-101475-BI00, jointly with the Fondo Europeo de Desarrollo Regional (FEDER), by the Basque Government through Grant IT1229-19 and Grant PRE2020_1_0177, and by the university of the Basque Country (UPV/EHU) under Grant COLAB20/01

Real-time human ambulation, activity, and physiological monitoring:taxonomy of issues, techniques, applications, challenges and limitations

Automated methods of real-time, unobtrusive, human ambulation, activity, and wellness monitoring and data analysis using various algorithmic techniques have been subjects of intense research. The general aim is to devise effective means of addressing the demands of assisted living, rehabilitation, and clinical observation and assessment through sensor-based monitoring. The research studies have resulted in a large amount of literature. This paper presents a holistic articulation of the research studies and offers comprehensive insights along four main axes: distribution of existing studies; monitoring device framework and sensor types; data collection, processing and analysis; and applications, limitations and challenges. The aim is to present a systematic and most complete study of literature in the area in order to identify research gaps and prioritize future research directions

Automated ECG Analysis for Localizing Thrombus in Culprit Artery Using Rule Based Information Fuzzy Network

Cardio-vascular diseases are one of the foremost causes of mortality in today’s world. The prognosis for cardiovascular diseases is usually done by ECG signal, which is a simple 12-lead Electrocardiogram (ECG) that gives complete information about the function of the heart including the amplitude and time interval of P-QRST-U segment. This article recommends a novel approach to identify the location of thrombus in culprit artery using the Information Fuzzy Network (IFN). Information Fuzzy Network, being a supervised machine learning technique, takes known evidences based on rules to create a predicted classification model with thrombus location obtained from the vast input ECG data. These rules are well-defined procedures for selecting hypothesis that best fits a set of observations. Results illustrate that the recommended approach yields an accurateness of 92.30%. This novel approach is shown to be a viable ECG analysis approach for identifying the culprit artery and thus localizing the thrombus

Feasibility of waveform capnography as a non-invasive monitoring tool during cardiopulmonary resuscitation

178 p.Sudden cardiac arrest (SCA) is one of the leading causes of death in the industrialized world and it includes the sudden cessation of circulation and consciousness, confirmed by the absence of pulse and breathing. Cardiopulmonary resuscitation (CPR) is one of the key interventions for patient survival after SCA, a life-saving procedure that combines chest compressions and ventilations to maintain a minimal oxygenated blood flow.To deliver oxygen, an adequate blood flow must be generated, by effective CPR, during the majority of the cardiac arrest time. Although monitoring the quality of CPR performed by rescuers during cardiac arrest has been a huge step forward in resuscitation science, in 2013, a consensus statement from the American Heart Association prioritized a new type of CPR quality monitoring focused on the physiological response of the patient instead of how the rescuer is doing.To that end, current resuscitation guidelines emphasize the use of waveform capnography during CPR for patient monitoring. Among several advantages such as ensure correct tube placement, one of its most important roles is to monitor ventilation rate, helping to avoid potentially harmful over-ventilation. In addition, waveform capnography would enable monitoring CPR quality, early detection of ROSC and determining patient prognosis. However, several studies have reported the appearance of fast oscillations superimposed on the capnogram, hereinafter CC-artifact, which may hinder a feasible use of waveform capnography during CPR. In addition to the possible lack of reliability, several factors need to be taken into account when interpreting ETCO2 measurements. Chest compressions and ventilation have opposing effects on ETCO2 levels. Chest compressions increase CO2 concentration, delivering CO2 from the tissues to the lungs, whilst ventilations remove CO2 from the lungs, decreasing ETCO2. Thus, ventilation rate acts as a significant confounding factor.This thesis analyzes the feasibility of waveform capnography as non-invasive monitoring tool of the physiological response of the patient to resuscitation efforts. A set of four intermediate goals was defined.First, we analyzed the incidence and morphology of the CC-artifact and assessed its negative influence in the detection of ventilations and in ventilation rate and ETCO2 measurement. Second, several artifact suppression techniques were used to improve ventilation detection and to enhance capnography waveform. Third, we applied a novel strategy to model the impact of ventilations and ventilation rate on the exhaled CO2 measured in out-of-hospital cardiac arrest capnograms, which could allow to measure the change in ETCO2 attributable to chest compressions by removing the influence of concurrent ventilations. Finally, we studied if the assessment of the ETCO2 trends during chest compressions pauses could allow to detect return of spontaneous circulation, a metric that could be useful as an adjunct to other decision tool

Neuro-critical multimodal Edge-AI monitoring algorithm and IoT system design and development

In recent years, with the continuous development of neurocritical medicine, the success rate of treatment of patients with traumatic brain injury (TBI) has continued to increase, and the prognosis has also improved. TBI patients' condition is usually very complicated, and after treatment, patients often need a more extended time to recover. The degree of recovery is also related to prognosis. However, as a young discipline, neurocritical medicine still has many shortcomings. Especially in most hospitals, the condition of Neuro-intensive Care Unit (NICU) is uneven, the equipment has limited functionality, and there is no unified data specification. Most of the instruments are cumbersome and expensive, and patients often need to pay high medical expenses. Recent years have seen a rapid development of big data and artificial intelligence (AI) technology, which are advancing the medical IoT field. However, further development and a wider range of applications of these technologies are needed to achieve widespread adoption. Based on the above premises, the main contributions of this thesis are the following. First, the design and development of a multi-modal brain monitoring system including 8-channel electroencephalography (EEG) signals, dual-channel NIRS signals, and intracranial pressure (ICP) signals acquisition. Furthermore, an integrated display platform for multi-modal physiological data to display and analysis signals in real-time was designed. This thesis also introduces the use of the Qt signal and slot event processing mechanism and multi-threaded to improve the real-time performance of data processing to a higher level. In addition, multi-modal electrophysiological data storage and processing was realized on cloud server. The system also includes a custom built Django cloud server which realizes real-time transmission between server and WeChat applet. Based on WebSocket protocol, the data transmission delay is less than 10ms. The analysis platform can be equipped with deep learning models to realize the monitoring of patients with epileptic seizures and assess the level of consciousness of Disorders of Consciousness (DOC) patients. This thesis combines the standard open-source data set CHB-MIT, a clinical data set provided by Huashan Hospital, and additional data collected by the system described in this thesis. These data sets are merged to build a deep learning network model and develop related applications for automatic disease diagnosis for smart medical IoT systems. It mainly includes the use of the clinical data to analyze the characteristics of the EEG signal of DOC patients and building a CNN model to evaluate the patient's level of consciousness automatically. Also, epilepsy is a common disease in neuro-intensive care. In this regard, this thesis also analyzes the differences of various deep learning model between the CHB-MIT data set and clinical data set for epilepsy monitoring, in order to select the most appropriate model for the system being designed and developed. Finally, this thesis also verifies the AI-assisted analysis model.. The results show that the accuracy of the CNN network model based on the evaluation of consciousness disorder on the clinical data set reaches 82%. The CNN+STFT network model based on epilepsy monitoring reaches 90% of the accuracy rate in clinical data. Also, the multi-modal brain monitoring system built is fully verified. The EEG signal collected by this system has a high signal-to-noise ratio, strong anti-interference ability, and is very stable. The built brain monitoring system performs well in real-time and stability. Keywords: TBI, Neurocritical care, Multi-modal, Consciousness Assessment, seizures detection, deep learning, CNN, IoT