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Lu Washington 0250E 20182.Pdf (3.851Mb) © Copyright 2019 Tsung-Chien Lu Using Smart Watches to Facilitate High Quality Cardiopulmonary Resuscitation for Patients with Cardiac Arrest Tsung-Chien Lu A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington 2019 Reading Committee: Anne M. Turner, Chair George Demiris Hendrika W. Meischke Program Authorized to Offer Degree: Biomedical Informatics and Medical Education University of Washington Abstract Using Smart Watches to Facilitate High Quality Cardiopulmonary Resuscitation for Patients with Cardiac Arrest Tsung-Chien Lu Chair of the Supervisory Committee: Professor Anne M. Turner Biomedical Informatics and Medical Education Survival rates for victims of cardiac arrest remain poor worldwide despite medical advancement and technology development. Chest compression quality has been considered the key for patient survival during cardiopulmonary resuscitation (CPR). Past studies have shown that both healthcare professionals and laypersons often perform CPR at inadequate rates and depths. Prior studies also showed that with adequate feedback, CPR quality can be improved and more adherent to the guideline-recommended rate (100 to 120 per minute) and depth (5 to 6 cm). This dissertation sought to develop a wearable application (app) with real-time feedback mechanism by using a commercially available smartwatch (ASUS ZenWatch 2) to facilitate the delivery of high-quality CPR. First, a systematic review on healthcare applications of smartwatches was conducted by using the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” as the systematic review methodology. After screening 356 articles, 24 were selected for review. The results find that most of the identified smartwatch studies focused on applications involving health monitoring for the elderly (6; 25%), and there is potential for smartwatch use in clinical settings. The second step is to develop a smartwatch app that can accurately estimate the rate and depth of chest compression in real-time, while also providing a user-centered design interface as an assistive device to be used during CPR in clinical settings. By using the sensor data collected from a smartwatch-based accelerometer during chest compressions on a manikin, two novel algorithms capable of estimating chest compression rate and depth were introduced, respectively. The validation study indicates that the developed algorithm based on a smartwatch with a built-in accelerometer is promising. User- centered design was adopted during the user interface development of the prototype and usability testing was conducted for the final app. Finally, to evaluate whether the developed smartwatch app with real-time audiovisual feedback can improve the delivery of high-quality CPR, a total of 80 healthcare professionals were recruited and randomly allocated to either the intervention group wearing a smartwatch with feedback or the control group without a smartwatch. All participants were asked to perform CPR for two minutes, with chest compression and ventilation at a 30:2 ratio. The results show that without feedback chest compressions tend to be too fast and too shallow, and that CPR quality can be improved with the assistance of a smartwatch providing real-time feedback. This work is a great example of applying modern information technology to improve the quality of healthcare. Although it is a simulation study performed on a manikin, it has substantial potential to be utilized in the clinical settings. TABLE OF CONTENTS List of Figures ................................................................................................................................. v List of Tables ................................................................................................................................ vii Chapter 1. Introduction ................................................................................................................... 1 1.1 Motivation ....................................................................................................................... 1 1.2 Specific Aims and Contribution...................................................................................... 2 1.3 Significance..................................................................................................................... 3 1.4 Guides for the Reader ..................................................................................................... 4 1.5 References ....................................................................................................................... 6 Chapter 2. Review of Literature...................................................................................................... 7 2.1 CPR Standard and Outcome ........................................................................................... 7 2.2 Methods for Measuring CPR Quality ............................................................................. 8 2.2.1 Video-recording/Time-motion Analysis ..................................................................... 8 2.2.2 Retrospective Analysis Using External Pad with an Accelerometer ........................ 10 2.3 Improving CPR Quality by Feedback Devices ............................................................. 10 2.4 References ..................................................................................................................... 12 Chapter 3. Paper 1: Healthcare Applications of Smartwatches: A Systematic Review ............... 15 3.1 Prologue ........................................................................................................................ 15 3.2 Paper 1 Abstract ............................................................................................................ 15 3.3 Paper 1 Full Text ........................................................................................................... 16 i 3.3.1 Introduction ............................................................................................................... 16 3.3.2 Materials and Methods .............................................................................................. 18 3.3.3 Results ....................................................................................................................... 21 3.3.4 Discussion ................................................................................................................. 32 3.3.5 Limitations ................................................................................................................ 38 3.3.6 Conclusions ............................................................................................................... 39 3.4 Concluding Remarks ..................................................................................................... 39 3.5 References ..................................................................................................................... 40 Chapter 4. Development of a Smartwatch App for CPR .............................................................. 46 4.1 Introduction ................................................................................................................... 46 4.2 System Architecture ...................................................................................................... 47 4.2.1 The Mobile Application ............................................................................................ 48 4.2.2 The Wearable Application ........................................................................................ 49 4.3 User-Centered Design (UCD) of the Wearable (Smartwatch) App.............................. 50 4.3.1 The Design Process ................................................................................................... 51 4.3.2 The Usability Testing ................................................................................................ 53 4.3.3 The Results of the User Interface.............................................................................. 53 4.4 The Rate Estimation Algorithm of Chest Compression ............................................... 57 4.4.1 The Mathematical Model .......................................................................................... 57 4.4.2 The Rate Estimation Algorithm ................................................................................ 57 4.4.3 Evaluation of the Rate Estimation Model ................................................................. 60 4.5 References ..................................................................................................................... 61 ii Chapter 5. Paper 2: A Novel Depth Estimation Algorithm of Chest Compression for Feedback of High-Quality Cardiopulmonary Resuscitation Based on a Smartwatch ....................... 63 5.1 Prologue ........................................................................................................................ 63 5.2 Paper 2 Abstract ............................................................................................................ 63 5.3 Paper 2 Full Text ........................................................................................................... 65 5.3.1 Introduction ............................................................................................................... 65 5.3.2 Materials and Methods .............................................................................................
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