A mixture model classifier and its application on the biomedical time series

This article presents a methodology based on the mixture model to classify the real biomedical time series. The mixture model is shown to be an efficient probabilistic density estimation scheme aimed at approximating the posterior probability distribution of a certain class of data. The approximation is conducted by employing a weighted mixture of a finite number of Gaussian kernels whose parameters and mixing coefficients are estimated iteratively through a maximum likelihood method. A database of the real electrocardiogram (ECG) time series of out-of-hospital cardiac arrest patients suffering ventricular fibrillation (VF) with known defibrillation outcomes was adopted to evaluate the performance of this model and confirm its efficiency compared with other classification methods

A probabilistic neural network as the predictive classifier of out-of-hospital defibrillation outcomes

Introduction: Although modern defibrillators are nearly always successful in terminating ventricular fibrillation (VF), multiple defibrillation attempts are usually required to achieve return of spontaneous circulation (ROSC). This is potentially deleterious as cardiopulmonary resuscitation (CPR) must be discontinued during each defibrillation attempt which causes deterioration in the heart muscle and reduces the chance of ROSC from later defibrillation attempts. In this work defibrillation outcomes are predicted prior to electrical shocks using a neural network model to analyse VF time series in an attempt to avoid defibrillation attempts that do not result in ROSC. Methods: The 198 pre-shock VF ECG episodes from 83 cardiac arrest patients with defibrillation conversions to different outcomes were selected from the Oslo ambulance service database. A probabilistic neural network model was designed for training and testing with a cross validation method being used for the better generalisation performance. Results: We achieved an accuracy of 75% in overall prediction with a sensitivity of 84% and a specificity of 65% using VF ECG time series of an order of 1s in length. Conclusion: Pre-shock VF ECG time series can be classified according to the defibrillation conversion to a return of spontaneous circulation (ROSC) or No-ROSC

Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study

<p>Abstract</p> <p>Background</p> <p>One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions.</p> <p>Methods</p> <p>From an electrocardiogram database we identified all intervals without chest compressions that followed an interval with compressions, and where the patients had ventricular fibrillation or tachycardia. By calculating the mean-slope (a predictor of the return of spontaneous circulation) of the electrocardiogram for each 2-second window, and using a linear mixed-effects statistical model, we quantified the decline of mean-slope with time. Further, a mapping from mean-slope to probability of return of spontaneous circulation was obtained from a second dataset and using this we were able to estimate the expected development of the probability of return of spontaneous circulation for cases at different levels.</p> <p>Results</p> <p>From 911 intervals without chest compressions, 5138 analysis windows were identified. The results show that cases with the probability of return of spontaneous circulation values 0.35, 0.1 and 0.05, 3 seconds into an interval in the mean will have probability of return of spontaneous circulation values 0.26 (0.24–0.29), 0.077 (0.070–0.085) and 0.040(0.036–0.045), respectively, 27 seconds into the interval (95% confidence intervals in parenthesis).</p> <p>Conclusion</p> <p>During pre-shock pauses in chest compressions mean probability of return of spontaneous circulation decreases in a steady manner for cases at all initial levels. Regardless of initial level there is a relative decrease in the probability of return of spontaneous circulation of about 23% from 3 to 27 seconds into such a pause.</p

Improved prediction of defibrillation success for out-of-hospital VF cardiac arrest using Wavelet Transform Methods.

We report an improved method for the estimation of shock outcome prediction based on novel wavelet transform-based time-frequency methods. Wavelet-based peak frequency, energy, mean frequency, spectral flatness and a new entropy measure were studied to predict shock outcome. Of these, the entropy measure provided optimal results with 60 ± 6% specificity at 91 ± 2% sensitivity achieved for the prediction of return of spontaneous circulation (ROSC). These results represent a major improvement in shock prediction in human ventricular fibrillation

A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

nterruptions in cardiopulmonary resuscitation (CPR) compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA) designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.This work received financial support from Spanish Ministerio de Economia y Competitividad (Projects TEC2012-31144 and TEC2012-31928), from the UPV/EHU (unit UFI11/16), and from the Basque government (Grants BFI-2010-174, BFI2010-235, and BFI-2011-166). The authors would like to thank Professor Rojo-A lvarez from the University Rey Juan Carlos (Madrid, Spain) for his assistance with SVM classifiers and for his thorough review of the paper