A Robust Machine Learning Architecture for a Reliable ECG Rhythm Analysis during CPR.

Chest compressions delivered during cardiopulmonary resuscitation (CPR) induce artifacts in the ECG that may make the shock advice algorithms (SAA) of defibrillators inaccurate. There is evidence that methods consisting of adaptive filters that remove the CPR artifact followed by machine learning (ML) based algorithms are able to make reliable shock/no-shock decisions during compressions. However, there is room for improvement in the performance of these methods. The objective was to design a robust ML framework for a reliable shock/no-shock decision during CPR. The study dataset contained 596 shockable and 1697 nonshockable ECG segments obtained from 273 cases of out-of-hospital cardiac arrest. Shock/no-shock labels were adjudicated by expert reviewers using ECG intervals without artifacts. First, CPR artifacts were removed from the ECG using a Least Mean Squares (LMS) filter. Then, 38 shock/no-shock decision features based on the Stationary Wavelet Transform (SWT) were extracted from the filtered ECG. A wapper-based feature selection method was applied to select the 6 best features for classification. Finally, 4 state-of-the-art ML classifiers were tested to make the shock/no-shock decision. These diagnoses were compared with the rhythm annotations to compute the Sensitivity (Se) and Specificity (Sp). All classifiers achieved an Se above 94.5%, Sp above 95.5% and an accuracy around 96.0%. They all exceeded the 90% Se and 95% Sp minimum values recommended by the American Heart Association.