Can thoracic impedance monitor the depth of chest compressions during out-of-hospital cardiopulmonary resuscitation?

Aim: To analyze the relationship between the depth of the chest compressions and the fluctuation caused in the thoracic impedance (TI) signal in out-of-hospital cardiac arrest (OHCA). The ultimate goal was to evaluate whether it is possible to identify compressions with inadequate depth using information of the TI waveform. Methods: 60 OHCA episodes were extracted, one per patient, containing both compression depth (CD) and TI signals. Every 5s the mean value of the maxima of the CD, D_max, and three features characterizing the fluctuations caused by the compressions in the TI waveform (peak-to-peak amplitude, area and curve length) were computed. The linear relationship between D_max and the TI features was tested using Pearson correlation coefficient (r) and univariate linear regression for the whole population, for each patient independently, and for series of compressions provided by a single rescuer. The power of the three TI features to classify each 5s-epoch as shallow/non-shallow was evaluated in terms of area under the curve, sensitivity and specificity. Results: The r was 0.34, 0.36 and 0.37 for peak-to-peak amplitude, area and curve length respectively when the whole population was analyzed. Within patients the median r was 0.40, 0.43 and 0.47, respectively. The analysis of the series of compressions yielded a median r of 0.81 between D_max and the peak-to-peak amplitude, but it decreased to 0.47 when all the series were considered jointly. The classifier based on the TI features showed 90.0%/37.1% and 86.2%/43.5% sensitivity/specificity values, and an area under the curve of 0.75 and 0.71 for the training and test set respectively. Conclusion: Low linearity between CD and TI was noted in OHCA episodes involving multiple rescuers. Our findings suggest that TI is unreliable as a predictor of D_max and inaccurate in detecting shallow compressions.