Method and apparatus for scoring the reliability of shock advisory during cardiopulmonary resuscitation
A cardiopulmonary resuscitation, reliability technology, applied in the direction of electrotherapy, application, cardiac defibrillator, etc., can solve the problems of potential rhythm error determination, wrong call, imperfection, etc., and achieve the effect of improving quality
Active Publication Date: 2015-10-28
KONINKLJIJKE PHILIPS NV
5 Cites 7 Cited by
AI-Extracted Technical Summary
Problems solved by technology
Another limitation is that no known filtering technique is perfect
No matter how good the filtering is, there is almost always at least some residual error left on the ECG that could potentially lead to a wrong determination of the underlying rhythm by the AED shock advice algorithm
During non-shockable rhythms, especially during asystole, this imperfect filtering of CC artifacts may cause the shock advice algorithm to incorrectly call a shockable rh...
 A preferred second input indicative of CPR is shown in FIG. 6 through the chest impedance sensing channel 606. Many devices that monitor the ECG also develop impedance measurements across electrodes 602 in order to evaluate noise on the ECG signal, to detect patient motion or to optimize electrotherapy parameters. Here, impedance measurements are taken on impedance channel 606 to provide a CPR input. This source of CPR input can be advantageous because typically no additional hardware is required, saving rescue time and expense.
 It will be appreciated by those of ordinary skill in the art that, in view of the teachings presented herein, variations on the apparatus described herein with reference to the accompanying drawings ...
A method, system and device to detect and use clean ECG segments, which do not need filtering to remove artifact or CPR-induced noise, is described to provide a reliability score for the decision made by shock advisory algorithms. The method can be implemented in a system and/or device that is provided with a display for indicating to a user the relative quality of the determination of an electrotherapy analysis circuit.
Heart defibrillatorsDiagnostic recording/measuring +1
LungData mining +4
- Experimental program(1)
 With further reference to the attached drawings, figure 2 Illustrated is an exemplary 23 second ECG band from a subject patient whose underlying heart rhythm is VF. The first half of the waveform (left-hand side 50) is recorded during CPR, and the second half (right-hand side 60) is recorded after CRP has been paused (for example, there are no chest compression artifacts on the ECG data). It can be seen that during CPR on the left hand side 50, chest compression artifacts induced on the ECG mask the underlying VF rhythm. The previous known shock recommendation algorithm when applied to the left hand side 50 may evaluate the CPR artifact as a regular ECG rhythm and incorrectly determine that no shock is recommended. This situation is contrary to the evaluation of the right-hand side 60 waveform without CPR artifacts. In the right hand, the shock suggestion algorithm can accurately detect the VF rhythm and advise the shock appropriately. therefore, figure 2 The illustration illustrates the problem of obtaining accurate ECG readings during CPR compressions that occurred during rescue. figure 2 It is also illustrated that the current shock suggestion algorithm may not be able to detect whether the ECG rhythm changes from VF to normal sinus rhythm or vice versa, ie, severe tremor.
 The basic solution to the identified problem is for example Figure 3a , Figure 3b , Figure 3c with Figure 3d Exemplary method flow chart covered is illustrated. The exemplary flow chart illustrates a detailed reliability score update procedure for a series of ECG segments in an ECG according to an embodiment of the present invention.
 In general, according to the exemplary embodiment of the present invention, the RS remains in an unreliable area until the core shock suggestion algorithm makes a "shock" or "no shock" suggestion. After that, the RS is updated in the corresponding direction: "Shock" is positive and negative for "no shock". Its purpose is that subsequent decisions of the same type move the reliability score to the reliability area in the same direction until it reaches the score limit of, for example, +/−6. Any sudden shock advice in the opposite direction, such as from shock to no shock, will temporarily move the score into the unreliable area until the subsequent suggestion group moves it out of the unreliable area in the other direction. As chest compressions begin, the reliability score moves towards zero and enters the unreliability zone. Any other type of artifacts can be treated like chest compressions and also move the score towards zero.
 The exemplary embodiment of the method illustrated in Figure 3 requires two types of data. For example, the first category is raw ECG data, which is digitized and arranged into a collection through segments of a predetermined duration. ECG data does not need to be filtered before input. Figure 4a A preferred arrangement of ECG data is illustrated, where the first ECG data set 202 is 4.5 seconds long, and the second unfiltered ECG data set 202' overlaps the first ECG data set 202 by 0.5 seconds. However, those skilled in the art should understand that, taking into account the teachings herein, the scope of the present invention includes data segments having, for example, different lengths, different overlaps, no overlaps at all, or separated in time. Figure 3a The input to the method 100 of the corresponding time series ECG data sets 202, 202' in the obtaining step 110 is illustrated.
 In addition, according to an exemplary embodiment of the present invention, the second type of data can include or include CPR reference signal data, which is also arranged into a set through a segment of a predetermined duration. Figure 4b A preferred arrangement of CPR data is illustrated, where the first CPR reference signal data set 204 is 4.5 seconds long, and the second CPR reference signal data set 204' overlaps the first CPR data set 204 by 0.5 seconds. Each CPR reference signal data set corresponds to each unfiltered ECG data set in time. Therefore, those skilled in the art should also understand that, considering the teachings herein, the scope of the present invention includes CPR data decomposition segments having, for example, different lengths, different overlaps, no overlaps at all, or separated in time. Figure 3a The input to the method 100 of the corresponding time series CPR data sets 204, 204' in the obtaining step 120 is illustrated.
 Further reference Figure 3a , An exemplary embodiment of the method according to the present invention is described. The exemplary method starts by setting RS to zero, where R n Indicates the RS assigned to the currently obtained ECG segment and the corresponding collected CPR reference signal data segment. The ECG segment is preferably obtained in step 110 from electrodes placed on the patient. CPR reference signal data can be collected in step 120 from multiple sources, including chest impedance signals obtained from electrodes, accelerometers of force sensor signals obtained from CPR guidance devices, or compression state signals obtained from automatic CPR machines.
 The data from step 120 and/or 110 is then processed in step 130 to detect the presence and level of CPR-related noise on the ECG data set. Several methods have been described in the prior art to calculate CPR artifacts. In fact, almost all methods can be suitable for use in this step 130. If chest compression (CC) is detected in step 130, the RS will either remain at zero or update one unit towards zero, and the algorithm will return to the beginning to process the next data segment. The RS processing when the CC exists is shown as the steps between the connectors "B" and "G" in the subsequent illustration of FIG. 3.
 If no CPR related noise is detected, then in step 140 the ECG data set is analyzed for the presence of a shockable heart rhythm. It is also possible to receive the electric shock suggestion rhythm from one of many known methods. The output of analysis step 140 is passed to Figure 3b The classification step 150, which classifies the ECG data set as a "shock" suggestion or a "no shock" suggestion. If the analysis indicates that there are noise-related artifacts that can be induced by other causes other than CPR, the output of step 150 can optionally be "artifacts."
 The first ECG data set classified by step 150 is allocated using RS. If a shock is recommended, RS is 3, if no shock is recommended, RS is -3, or if it is an artifact, RS is 0. The exemplary method then proceeds back to the beginning of the process to evaluate the next ECG data set.
 However, if the ECG data set is the second or later of the series of ECG data sets, step 150 passes the classification to the determination step 160 to determine the RS. in Figure 3c As can be seen in the determination step 160, the recommendation from the current ECG data segment, the recommendation from the previous ECG data segment, the CC status on the previous ECG data segment, and/or the RS from the previous ECG data segment can be used to determine And update the current RS. According to the rules of the present invention, and passed Figure 3c As can be seen in the description of the exemplary embodiment of the present invention, the logic flow check in, the switching in the "clean" ECG proposal without artifacts and CPR noise makes the RS score unreliable. Confirm that the "clean" ECG data segment will increase the RS by one unit up to the maximum value, which is +6 or ﹣6. The first "clean" proposal resulted in an RS of +3 or -3 depending on the nature of the proposal. After the RS is determined in step 160, the process automatically outputs the current shock advice and updated RS to the device in the automatic issuance step 170. Figure 3d show. Preferably, the automatic publishing step 170 includes the display of the current RS. The automatic release step 170 can also determine the final shock decision used by the device based on the output of the classification step 150 and the determination step 160. Those of ordinary skill in the art should understand that the final shock decision can be determined based on a single or two or more suggestions. Then, the process returns to the beginning via the connector "G" to process the next ECG data segment.
 In addition, according to an exemplary embodiment of the present invention, the display of the current RS in the automatic publishing step 170 can be in several different user-perceivable formats. For example, the RS can be displayed as a text message, where the RS number is displayed along with a statement describing the reliability area it falls into. As an example, any of the following statements can be shown on the display on the ECG data segment determination with or without RS numbers:
 Reliable electric shock advice
 Unreliable advice
 Reliable non-shock advice
 Preferably, although RS (also) is displayed as a graphical indication that can be quickly and easily interpreted by the user. The graphic display is preferably intuitive, so that even users without the training or knowledge of the equipment operating instructions or doctor's guide files can quickly ascertain whether the electric shock decision is reliable or unreliable. Figure 11a with Figure 11b Shown in are two exemplary embodiments of such graphical indicators according to the present invention.
 E.g, Figure 11a Illustrated is an exemplary graphic indicator 1100 that includes a pointer graphic 1110 that points to a position on the bar graphic 1120 corresponding to the RS. The bar graph 1120 includes three segments. Segment 1130 indicates the area of reliable shock decision, in this case corresponding to RS scores of +4, +5, and +6. The segment 1130 preferably has a unique color, such as red. Segment 1132 indicates an unreliable decision, which in this case corresponds to an RS score in the range from +3 to -3. The unique color of the 1132 segment is preferably yellow. Finally, segment 1134 indicates areas of reliable no-shock decision making, in this case corresponding to RS scores of -4, -5, and -6. Segment 1134 should also have a unique color, such as green.
 Figure 11b An exemplary RS graphic display 1150 is shown, which is similar to the exemplary graphic 1100 except that the bar is a speedometer-shaped arc. For example, the exemplary graphic indicator 1150 includes a pointer graphic 1160 that points to a position on the bar graphic 1170 corresponding to the RS. The bar graph 1170 includes three segments. Segment 1180 indicates the area of reliable shock decision, in this case corresponding to RS scores of +4, +5, and +6. Segment 1180 preferably has a unique color, such as red. Segment 1182 indicates an unreliable decision, in this case corresponding to an RS score in the range from +3 to -3. The distinctive color of segment 1182 is preferably yellow. Finally, segment 1184 indicates areas of reliable non-shock decision making, in this case corresponding to RS scores of -4, -5, and -6. Segment 1184 should also have a unique color, such as green.
 in Figure 3a-Figure 3d The exemplary method shown in is preferably run continuously during potential cardiac rescue, whether on any equipment where it is installed. Optionally, according to an exemplary embodiment of the present invention, the exemplary method, in particular, the acquisition step 120, the detection step 130, the analysis step 140, the classification step 150, and the determination step 160 are performed only during the protocol CPR period, and during the protocol CPR period During this period, medical equipment is not operable to deliver defibrillation shocks. In this optional case, the automatic publishing step 170 occurs immediately after the end of the CPR protocol period. This optional situation can be desired by users who are comfortable with the existing shock recommendation protocol and user interface, for example, occurring during the electrotherapy cycle of the procedure.
 In addition, according to an exemplary embodiment of the present invention, in Figure 3a-3d The exemplary method illustrated in can include additional steps not shown, namely the step of adjusting the shock decision protocol used in the analysis step 140 and/or the issuance step 170 based on the output of the classification step 150 and the determination step 160. If the RS is always reliable, one goal of the adjustment protocol can be to shorten the duration of the shock decision analysis cycle required to issue a shock decision to a medical device. This can reduce the time to electric shock-a key parameter for patient survival. If RS is always unreliable, the corresponding goal can be to extend the duration of the shock decision analysis cycle. For example, the adjustment of duration can be facilitated by shortening each ECG data segment and/or by reducing the number of ECG data segments required to make a shock decision.
 Figure 5 Is a truth table 500 according to an exemplary embodiment of the present invention, which shows the update of RS on column 570 for each possible combination of current and previous ECG data segments and CPR reference signal data sets . For example, the parameters that affect RS update include the status of the CC on the current segment 510 and the previous segment 540, the status of the electric shock recommendations on the current ECG segment 520 and the previous ECG segment 550, and the status of the electric shock recommendations for the previous ECG data segment 530. RS and whether the current ECG data segment is the first segment of the ECG data stream 560.
 in Figure 5 It can be seen that the RS for each case is updated according to the previous and existing ECG and CPR data segmentation through the previously described exemplary method. For example, if no electric shock advice follows the electric shock advice, the RS is reduced by 7 units to ensure that the RS is displayed in an unreliable area. If the electric shock advice follows the no electric shock advice, a similar situation occurs. Then, if the new recommendations are confirmed, RS gradually becomes more reliable again. Each segment with artifacts or CC makes the RS more unreliable in one unit.
 Image 6 Illustrated is an exemplary embodiment of a medical device 600 for determining the reliability of heart rhythm analysis during the execution of CPR. In this example, the medical device 600 is a defibrillator. The basic functions of the device 600 follow Figure 3a-Figure 3d The exemplary method shown in. The ECG signal and the CPR reference signal (usually chest impedance), as described above, continuously reach the device 600. The chest compression detection module 608 checks for the presence of chest compressions (CC) in the ECG fixed length segment. The CPR reference signal can also be used for CC detection. The core shock suggestion algorithm module 620 recognizes the heart rhythm of the ECG segment and makes suggestions about the shockability of the heart rhythm, such as "shock", "no shock" or optional "artifact" suggestions. The reliability analyzer 630 receives the information about the presence of chest compressions from the detector 608 and the shockability of the latest ECG segment from the module 620 and updates the reliability score accordingly. The output of the reliability algorithm (reliability score RS) is displayed on the visual output and/or submitted to the decision making module 640 of the device 600 to participate in the final decision.
 According to the exemplary embodiment of the invention and shown in this example, the two required inputs to the medical device 600 are ECG and CPR chest compressions. The electrode 602 attached to the subject patient detects the patient's ECG signal. The detected ECG signal is passed to the ECG front end 604, where the ECG is processed and digitized into a time-varying data stream. The front end 604 further groups the ECG data streams into time series ECG data sets. In a preferred embodiment, the ECG data set is a 4.5 second segment that is sequentially overlapped by 0.5 seconds. Each original, ie unfiltered ECG data set is then output from the front end 604 to the electric shock recommendation algorithm module 620.
 In addition, according to an exemplary embodiment of the present invention, the input indicating the CPR pressing activity can be obtained from one of multiple sources. E.g, Image 6 Shown in is the CPR sensor 607, which is usually a disc-shaped device placed between the patient's chest and the CPR giver's hand. Sensors in the CPR sensor 607, such as a force sensor and an acceleration sensor, detect CPR pressing and provide input signals to the device 600. Alternatively, the CPR sensor 607 can be a pressing state signal obtained from an automatic CPR machine. For example, an automatic CPR machine may provide input indicating the start of CPR compressions.
 The preferred second input to indicate CPR is in Image 6 Shown by the chest impedance sensing channel 606. In order to evaluate the noise on the ECG signal to detect patient movement or optimize electrotherapy parameters, many devices for monitoring ECG have also developed impedance measurements on both sides of the electrode 602. Here, the impedance measurement is taken on the impedance channel 606 to provide CPR input. This source of CPR input can be advantageous because additional hardware is usually not required, saving rescue time and expense.
 But no matter how it is detected, according to an exemplary embodiment of the present invention, an input indicating a CPR compression is provided to the compression detector 608. In the compression detector, the input is initially digitized as a series of time changes indicating the frequency of chest compressions CPR reference signal. The compression detector 608 further groups the digitized CPR signals into time series CPR data sets. In a preferred embodiment, the CPR data set is a 4.5 second segment that overlaps in 0.5 second order. Each CPR data set corresponds in time to an ECG data set.
 The press detector 608 can use one of many known techniques to determine whether the corresponding ECG data set contains CPR-related noise. The detector 608 then outputs the determination as a preferred binary indicator, that is, chest compression is present (CC) or absent (clean). The determination is provided to the electric shock recommendation algorithm module 620 and the reliability analyzer 630.
 The shock suggestion algorithm module 620 applies the analysis algorithm to each ECG data set and classifies each data set as a "shock" or "no shock" rhythm, which is referred to herein as a recommendation. If the data set cannot be classified, the set can optionally be classified as an "artifact." The analysis algorithm is as described in the previous discussion of exemplary methods, and can be one of several known methods.
 The shock decision generator 640 uses the output from the shock recommendation algorithm module 620 to determine the final shock decision. A single recommendation is generally considered to be not robust enough to make a final decision in most cases. Some methods require two consecutive shock recommendations to make the final decision, or two of the three recommendations to do so.
 The reliability analyzer 630 utilizes the previously described exemplary method using input from the chest compression detector 608 and the shock recommendation algorithm module 620 to determine the reliability of the most recent recommendation. The output of the reliability analyzer 630 is the RS score, which can be provided to the user via the output generator 650. Optionally, the output of the reliability analyzer 630 can also be used by the shock decision generator 640 as a parameter to determine the final shock decision, for example by modifying the suggested quantity duration before making the decision.
 The output generator 650 converts the decision output command from the electric shock decision generator 650 into an actionable issuing command. For example, if the decision output command is “equipment”, the output generator 650 controls the device 600 to automatically start equipping the high-voltage electrotherapy circuit, such as the HV delivery circuit 680. The HV delivery circuit 680 can also deliver a defibrillation shock to the patient via the electrode 602.
 The output generator 650 preferably provides an indication of the reliability of the ECG shock recommendation via the display 660 and/or via an audible alarm. If displayed, the indication is preferably a graphical indicator, but can also include a text message. The output generator 650 can also generate user-perceivable indications of the shock decision, such as appropriate audible and visual indicators on the display 660. This alerts the rescuer in relation to the actionable order.
 According to an exemplary embodiment of the present invention, the exemplary device 600 can be provided as a stand-alone device, or can be integrated into another medical device and/or system. For example, the exemplary medical device 600 can be incorporated into a patient monitoring system for alerting medical personnel of changes in heart rhythm during CPR. The exemplary device 600 can also be integrated with a CPR auxiliary device that uses a CPR sensor 607. It can be conceived and considered within the scope of the present invention that the exemplary device 600 can also be used with an automatic CPR machine, where the input to the press detector 608 can also be a machine press state signal, and the output from the output generator 650 can be controlled Changes in machine operation. The preferred use/implementation for the exemplary device 600 is as a component in a defibrillator or AED, where the output generator 650 provides control of the equipment function for the high voltage delivery circuit 680 based on the need to deliver defibrillation shocks, The user interface is controlled to guide the user through cardiac rescue, and optionally automatically deliver electric shock through electrodes 602.
 The following three examples are provided to further illustrate the function of the method according to the exemplary embodiment of the present invention. In the following examples, the ECG signal is divided into continuous segments of fixed length. The output of the chest compression detector module and the core shock recommendation algorithm for each segment are shown as being calculated at the end of each segment. Segments on ECG signals with chest compression artifacts are marked by "CC", segments recommended for electric shock are marked as "Sh", segments recommended for no shock are marked by "NS", and have other types of artifacts The segment of is marked by "A". The reliability score RS is updated based on the data mentioned above.
 Figure 7 Illustrated is an example 700 according to an exemplary embodiment of the present invention, in which a potentially non-shockable heart rhythm is periodically contaminated by CPR CC noise. The state of chest compression in each ECG segment is shown in series 702. The shock recommendations for each ECG segment are shown in series 704. And the RS determined at the end of each ECG segment is shown in series 706. Such as Figure 7 As shown in, after a long series of chest compressions segmentation, the reliability score goes to zero. By stopping chest compressions during the quiet period 710 and accepting the "no shock" advice, the score moves towards a negative value until the RS is the lowest value of -6. When chest compressions restart, RS will return to zero, and the cycle repeats. As you can see, the segmentation just after the chest compressions are removed is still unreliable. Subsequent indexing becomes reliable until the second segment just after chest compressions restart.
 Figure 8 Another example 800 according to an exemplary embodiment of the present invention is illustrated, in which a potentially non-shockable heart rhythm is periodically contaminated by CPR CC noise. The chest compression state in each ECG segment is shown in series 802. The shock recommendations on each ECG segment are shown in series 804. And, the RS determined at the end of each ECG segment is shown in series 806. Figure 8 Shown in is a series of "no shock" recommendations during chest compressions, where the reliability score is zero. Once chest compressions are stopped during the quiet period 810, the RS biases to a negative value and enters a reliable shock-free zone after one ECG segment. But then, the underlying heart rhythm changes during cycle 820 to a shockable heart rhythm. After determining the first "shock" suggestion, the score starts to move towards a positive value and enters the reliable shock zone after three unreliable segments. The shock is applied to the patient at the end of cycle 820 (the "artifact" segment determined by the shock-advising algorithm), and the rhythm becomes non-shockable again during cycle 810 and enters a reliable non-shock zone.
 Picture 9 Illustrated is yet another example 900 according to an exemplary embodiment of the present invention, in which a potentially non-shockable heart rhythm is periodically contaminated by CPR CC noise. The chest compression state in each ECG segment is shown in series 902. The shock recommendations on each ECG segment are shown in series 904. And, the RS determined at the end of each ECG segment is shown in series 906. in Picture 9 What is seen in is a series of ECG segments, where chest compressions (CC), such as cycle 920, tends the reliability score towards zero. A single non-shockable let-off segment keeps the score in the unreliable area, while a series of upcoming non-shockable let-off segments during the quiet period 910 move the RS to the reliable non-shockable area. There are no "electric shock" recommendations during these let-off intervals.
 Now go to Picture 10 , Illustrates a defibrillator 1000 according to an exemplary embodiment of the present invention, which includes the reliability scoring function as described above. In this exemplary embodiment, the defibrillator 1000 is an automated external defibrillator (AED), which includes an electrode connector socket 1050 to which patient monitoring and defibrillation electrodes are connected. The socket 1050 is therefore the source of ECG data and CPR data. The status indicator 1040 continuously provides operating status.
 Defibrillator 1000 also includes many user interface elements. For example, an illuminated shock button 1060 is provided to enable the user to deliver a shock after the device equips itself. The speaker 1070 issues audible guidance and commands, such as suggesting or not suggesting electric shocks. A display 1020 is provided on which the RS graphics are provided to the user. Various user controls 1030 can be provided to manipulate other functions of the AED.
 According to an exemplary embodiment of the present invention, the internal circuit of the defibrillator 1000 is configured to Image 6 The main circuit 670 shown in, which operates in cooperation with the reliability analysis circuit 630. The reliability analysis algorithm resides on the circuit 630, while the core shock-recommendation algorithm module and the chest compression detector reside on the main circuit 670. Alternatively, these two modules can be implemented as part of the reliability algorithm circuit 630.
 As shown, the main circuit 670 operates to analyze the received ECG segment(s) and determine whether a defibrillation shock is necessary. The reliability analysis circuit 630 operates simultaneously to determine the reliability of the main circuit determination based on the current and previous analysis of the ECG segment. The RS is generated according to the reliability determination, which is then displayed on the display 1020. The nature of the graphic display is preferably similar to that described previously Figure 11a with Figure 11b The nature of the graphics shown in.
 A person of ordinary skill in the present invention should understand that, taking into account the teachings provided herein, modifications to the device described herein with reference to the accompanying drawings are encompassed within the scope of the present invention. E.g, Image 6 Several or all of the single circuits shown in can be integrated in a single controller or processor to reduce complexity and space. Specifically, each host computer function and reliability analyzer function can be implemented as a single software module. Alternatively, some of the described functions of a single circuit can be performed by other circuits. The independent analog-to-digital conversion circuit can, for example, be dedicated to providing all the preprocessing of ECG and CPR inputs. Changes in the nature and name of the output that substantially achieve the same user interface and device control goals also fall within the scope of the present invention.
 In addition, as a person of ordinary skill in the art will understand, considering the teachings provided herein, the features, elements, components, etc. described in the present disclosure/specification and/or depicted in the drawings can be implemented in hardware and software Are implemented in various combinations of and provide functions that can be combined in a single element or multiple elements. For example, the functions of the various features, elements, components, etc. shown/illustrated/drawn in the drawings can be provided by using dedicated hardware as well as hardware executing software that can be associated with appropriate software. When provided by a processor, the functions can be provided by a single dedicated processor, by a single shared processor, or by multiple individual processors, some of which can be shared and/or multiplexed. In addition, the explicit use of the term "processor" or "controller" should not be interpreted as specifically referring to hardware capable of executing software, which can implicitly include, without limitation, digital signal processor ("DSP") hardware, memory (For example, read-only memory ("ROM"), random access memory ("RAM"), non-volatile memory, etc. used to store software and capable of (and/or configured to) execute and/or control processes In fact, any unit and/or machine (including hardware, software, firmware and combinations thereof).
 In addition, all statements detailing the principles, various aspects, and embodiments of the present invention herein, as well as specific examples of the present invention, are intended to cover both the structure and its functional equivalents. Additionally, this means that such equivalents include both currently known equivalents and equivalents developed in the future (for example, any developed elements capable of performing the same or substantially similar functions, regardless of structure). Therefore, for example, those of ordinary skill in the art should understand that, taking into account the teachings provided herein, any block diagram presented herein can represent a conceptual view of illustrative system components and/or circuits embodying the principles of the present invention. Similarly, a person of ordinary skill in the art should understand that, taking into account the teachings provided herein, any flow chart, flowchart, etc. can represent different processes, and the processes can be substantially presented in a computer-readable storage medium and defined by It is executed by a computer, processor or other device with processing capabilities, regardless of whether such computer or processor is explicitly shown.
 In addition, the exemplary embodiments of the present invention can take the form of a computer program product that can be accessed from a computer-usable storage medium and/or a computer-readable storage medium, which is usable and/or The computer-readable storage medium provides program codes and/or instructions for use by, for example, a computer or any instruction execution system or in combination with, for example, a computer or any instruction execution system. According to the present disclosure, a computer-usable storage medium or a computer-readable storage medium can be, for example, capable of storing, communicating, propagating, or transmitting a program for use by an instruction execution system, apparatus, or equipment or in combination with an instruction execution system, apparatus, or equipment. Any device. This exemplary medium can be, for example, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system (or device or device) or a propagation medium. Examples of computer readable media include, for example, semiconductor or solid-state memory, magnetic tape, removable computer floppy disk, random access memory (RAM), read only memory (ROM), flash memory (drive), hard disk and optical disk. Current examples of optical discs include compact disc-read only memory (CD-ROM), compact disc read/write (CD-R–/W) and DVD. In addition, it should be understood that any new computer-readable media that can be developed thereafter should also be regarded as computer-readable media used or referenced in accordance with the present invention and the disclosed exemplary embodiments.
 The preferred embodiments and exemplary embodiments of the system, device and method for monitoring the heart rhythm of a subject during the application of cardiopulmonary resuscitation (CPR) have been described (the embodiments are intended to be illustrative and not limiting). It should be noted that, Those skilled in the art can make modifications and changes based on the teachings provided herein (including the drawings). Therefore, it should be understood that various modifications can be made in or to the preferred embodiments and exemplary embodiments of the present disclosure within the scope of the embodiments disclosed herein.
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