Assessment of the impedance cardiogram recorded by an automated external defibrillator during clinical cardiac arrest

OBJECTIVE: To assess the impedance cardiogram recorded by an automated external defibrillator during cardiac arrest to facilitate emergency care by lay persons. Lay persons are poor at emergency pulse checks (sensitivity 84%, specificity 36%); guidelines recommend they should not be performed. The impedance cardiogram (dZ/dt) is used to indicate stroke volume. Can an impedance cardiogram algorithm in a defibrillator determine rapidly circulatory arrest and facilitate prompt initiation of external cardiac massage?

DESIGN: Clinical study.

SETTING: University hospital.

PATIENTS: Phase 1 patients attended for myocardial perfusion imaging. Phase 2 patients were recruited during cardiac arrest. This group included nonarrest controls.

INTERVENTIONS: The impedance cardiogram was recorded through defibrillator/electrocardiographic pads oriented in the standard cardiac arrest position.

MEASUREMENTS AND MAIN RESULTS: Phase 1: Stroke volumes from gated myocardial perfusion imaging scans were correlated with parameters from the impedance cardiogram system (dZ/dt(max) and the peak amplitude of the Fast Fourier Transform of dZ/dt between 1.5 Hz and 4.5 Hz). Multivariate analysis was performed to fit stroke volumes from gated myocardial perfusion imaging scans with linear and quadratic terms for dZ/dt(max) and the Fast Fourier Transform to identify significant parameters for incorporation into a cardiac arrest diagnostic algorithm. The square of the peak amplitude of the Fast Fourier Transform of dZ/dt was the best predictor of reduction in stroke volumes from gated myocardial perfusion imaging scans (range = 33-85 mL; p = .016). Having established that the two pad impedance cardiogram system could detect differences in stroke volumes from gated myocardial perfusion imaging scans, we assessed its performance in diagnosing cardiac arrest. Phase 2: The impedance cardiogram was recorded in 132 "cardiac arrest" patients (53 training, 79 validation) and 97 controls (47 training, 50 validation): the diagnostic algorithm indicated cardiac arrest with sensitivities and specificities (+/- exact 95% confidence intervals) of 89.1% (85.4-92.1) and 99.6% (99.4-99.7; training) and 81.1% (77.6-84.3) and 97% (96.7-97.4; validation).

CONCLUSIONS: The impedance cardiogram algorithm is a significant marker of circulatory collapse. Automated defibrillators with an integrated impedance cardiogram could improve emergency care by lay persons, enabling rapid and appropriate initiation of external cardiac massage.

The impedance cardiogram recorded through two electrocardiogram/defibrillator pads as a determinant of cardiac arrest during experimental studies

OBJECTIVE: Laypersons are poor at emergency pulse checks (sensitivity 84%, specificity 36%). Guidelines indicate that pulse checks should not be performed. The impedance cardiogram (dZ/dt) is used to assess stroke volume. Can a novel defibrillator-based impedance cardiogram system be used to distinguish between circulatory arrest and other collapse states?

DESIGN: Animal study.

SETTING: University research laboratory.

SUBJECTS: Twenty anesthetized, mechanically ventilated pigs, weight 50-55 kg.

INTERVENTIONS: Stroke volume was altered by right ventricular pacing (160, 210, 260, and 305 beats/min). Cardiac arrest states were then induced: ventricular fibrillation (by rapid ventricular pacing) and, after successful defibrillation, pulseless electrical activity and asystole (by high-dose intravenous pentobarbitone).

MEASUREMENTS AND MAIN RESULTS: The impedance cardiogram was recorded through electrocardiogram/defibrillator pads in standard cardiac arrest positions. Simultaneously recorded electro- and impedance cardiogram (dZ/dt) along with arterial blood pressure tracings were digitized during each pacing and cardiac arrest protocol. Five-second epochs were analyzed for sinus rhythm (20 before ventricular fibrillation, 20 after successful defibrillation), ventricular fibrillation (40), pulseless electrical activity (20), and asystole (20), in two sets of ten pigs (ten training, ten validation). Standard impedance cardiogram variables were noncontributory in cardiac arrest, so the fast Fourier transform of dZ/dt was assessed. During ventricular pacing, the peak amplitude of fast Fourier transform of dZ/dt (between 1.5 and 4.5 Hz) correlated with stroke volume (r2 = .3, p < .001). In cardiac arrest, a peak amplitude of fast Fourier transform of dZ/dt of < or = 4 dB x ohm x rms indicated no output with high sensitivity (94% training set, 86% validation set) and specificity (98% training set, 90% validation set).

CONCLUSIONS: As a powerful clinical marker of circulatory collapse, the fast Fourier transformation of dZ/dt (impedance cardiogram) has the potential to improve emergency care by laypersons using automated defibrillators.

Use of the impedance cardiogram in public access defibrillators as an indicator of cardiopulmonary resuscitation effectiveness

An algorithm has been developed for a Public Access Defibrillator which utilizes distinctive features from the impedance cardiogram (ICG) recorded via defibrillator pads to advise both lay users and minimally trained bystanders to ensure CPR effectiveness. Following ethical approval, data were collected and marked. CPR was administered by trained personnel. 211 cases were gathered and the training set included 106 cases. A retrospective analysis was carried out of simultaneously recorded ECG and ICG. The speed of compressions was calculated by counting the outstanding waves in the ICG during CPR. Also if the base-to-peak amplitude of the ICG is greater than a minimum threshold, the corresponding compressions were classified as being applied with adequate force. For the validation set, adequate speed was detected with 91.45% sensitivity and 96.27% specificity (79826s) and adequate force with 99.94% sensitivity and 97.91% specificity (91973s). © 2011 CCAL.

Loading Artificial Magnetic Conductor and Artificial Magnetic Conductor Absorber with Negative Impedance Convertor Elements

The general properties of a frequency selective surface loaded with negative impedance converter (NIC)-based active loads are discussed from a theoretical perspective.The stability problem associated with NIC circuits embedded in artificial magnetic conductor (AMC) and AMC absorber applications is studied using pole-zero analysis. The requirements and constraints for achieving stable operation with enhanced bandwidth using negative capacitance as realized by a floating NIC network are derived. Furthermore, it is shown that it is nearly impossible to simultaneously implement a negative capacitor and a negative inductor to such structures. © 2012 Wiley Periodicals, Inc. Microwave Opt Technol Lett 54:2111–2114, 2012; View this article online at wileyonlinelibrary.com. DOI 10.1002/mop.27019

Selective High Impedance Surface Active Region Loading of Archimedean Spiral Antenna

We show that a significant increase in the gain and front-to-back ratio is obtained when different high impedance surface (HIS) sections are placed below the active regions of an Archimedean spiral antenna. The principle of operation is demonstrated at 3, 6, and 9 GHz for an antenna design that employs a ground plane composed of two dissimilar HISs. The unit cells of the HISs are collocated and resonant at the same frequency as the 3- and 6-GHz active regions of the wideband spiral. It is shown that the former HIS must also be designed to resonate at 9 GHz to avoid the generation of a boresight null that occurs because the structure is physically large enough to support higher-order modes. The improvement that is obtained at each of the three frequencies investigated is shown by comparing the predicted and measured radiation patterns for the free space and HIS-backed antenna.

Detection of cardiac arrest using a simplified frequency analysis of the impedance cardiogram recorded from defibrillator pads

An algorithm based only on the impedance cardiogram (ICG) recorded through two defibrillation pads, using the strongest frequency component and amplitude, incorporated into a defibrillator could determine circulatory arrest and reduce delays in starting cardiopulmonary resuscitation (CPR). Frequency analysis of the ICG signal is carried out by integer filters on a sample by sample basis. They are simpler, lighter and more versatile when compared to the FFT. This alternative approach, although less accurate, is preferred due to the limited processing capacity of devices that could compromise real time usability of the FFT. These two techniques were compared across a data set comprising 13 cases of cardiac arrest and 6 normal controls. The best filters were refined on this training set and an algorithm for the detection of cardiac arrest was trained on a wider data set. The algorithm was finally tested on a validation set. The ICG was recorded in 132 cardiac arrest patients (53 training, 79 validation) and 97 controls (47 training, 50 validation): the diagnostic algorithm indicated cardiac arrest with a sensitivity of 81.1% (77.6-84.3) and specificity of 97.1% (96.7-97.4) for the validation set (95% confidence intervals). Automated defibrillators with integrated ICG analysis have the potential to improve emergency care by lay persons enabling more rapid and appropriate initiation of CPR and when combined with ECG analysis they could improve on the detection of cardiac arrest.

High-impedance metasurfaces with interwoven conductor patterns

High impedance metasurfaces (HIMSs) formed by interwoven conductor arrays are proposed. Bandwidth comparable with that of the basic square patches is achieved at an order of magnitude smaller unit cells. The presented structures are apt for small mobile terminals and low frequency applications.

Interwoven spiral arrays on ferrite-dielectric substrates for high-impedance metasurfaces

A high impedance metasurface (HIMS) composed of the arrays of intertwined planar spirals on thin (~0.1λ) ferrite-dielectric substrate is proposed. The HIMS exhibits fractional bandwidth in excess of 10% and excellent angular and polarisation stability of the circular polarised waves at oblique incidence.

Dielecting-resonator-loaded microstrip antenna for enhanced impedance bandwidth and efficiency

A new method for enhancing the 2.1 VSWR impedance bandwidth of microstrip antennas is presented. Bandwidth enhancement is achieved by loading the microstrip antenna by a ceramic microwave dielectric resonator (DR). The validity of this technique has been established using rectangular and circular radiating geometries. This method improves the bandwidth of a rectangular microstrip antenna to more than 10% (= 5 times that of a conventional rectangular microstrip antenna) with an enhanced gain of I dB

High Selectivity Filter Employing Stepped Impedance Resonators, Series Capacitors and Defected Ground Structures for Ultra Wide Band Applications

The paper presents a compact planar Ultra Wide Band ¯lter employing folded stepped impedance resonators with series capacitors and dumb bell shaped defected ground structures. An interdigital quarter wavelength coupled line is used for achieving the band pass characteristics. The transmission zeros are produced by stepped impedance resonators. The ¯lter has steep roll o® rate and good attenuation in its lower and upper stop bands, contributed by the series capacitor and defected ground structures respectively.

Study of the variation of the input impedance of induction machines with frequency

The results of a study of the variation of three-phase induction machines' input impedance with frequency are proposed. A range of motors were analysed, both two-pole and four-pole, and the magnitude and phase of the input impedance were obtained over a wide frequency range of 20 Hz-1 MHz. For test results that would be useful in the prediction of the performance of induction machines during typical use, a test procedure was developed to represent closely typical three-phase stator coil connections when the induction machine is driven by a three-phase inverter. In addition, tests were performed with the motor's cases both grounded and not grounded. The results of the study show that all induction machines of the type considered exhibit a multiresonant impedance profile, where the input impedance reaches at least one maximum as the input frequency is increased. Furthermore, the test results show that the grounding of the motor's case has a significant effect on the impedance profile. Methods to exploit the input impedance profile of an induction machine to optimise machine and inverter systems are also discussed.

Impedance mismatch: some differences between the way humans and robots control interaction forces

In over forty years of research robots have made very little progress still largely confined to industrial manufacture and cute toys, yet in the same period computing has followed Moores Law where the capacity double roughly every two years. So why is there no Moores Law for robots? Two areas stand out as worthy of research to speedup progress. The first is to get a greater understanding of how human and animal brains control movement, the second to build a new generation of robots that have greater haptic sense, that is a better ability to adapt to the environment as it is encountered. A remarkable property of the cognitive-motor system in humans and animals is that it is slow. Recognising an object may take 250 mS, a reaction time of 150 mS is considered fast. Yet despite this slow system we are well designed to allow contact with the world in a variety of ways. We can anticipate an encounter, use the change of force as a means of communication and ignore sensory cues when they are not relevant. A better understanding of these process has allowed us to build haptic interfaces to mimic the interaction. Emerging from this understanding are new ways to control the contact between robots, the user and the environment. Rehabilitation robotics has all the elements in the subject to not only enable and change the lives of people with disabilities, but also to facilitate revolution change in classic robotics.

Impedance control of redundant drive joints with double actuation

This paper proposes impedance control of redundant drive joints with double actuation (RDJ-DA) to produce compliant motions with the future goal of higher bandwidth. First, to reduce joint inertia, a double-input-single-output mechanism with one internal degree of freedom (DOF) is presented as part of the basic structure of the RDJ-DA. Next, the basic structure of RDJ-DA is further explained and its dynamics and statics are derived. Then, the impedance control scheme of RDJ-DA to produce compliant motions is proposed and the validity of the proposed controller is investigated using numerical examples.