Applications of the Transthoracic Impedance Signal during Resuscitation

Defibrillators acquire both the ECG and the transthoracic impedance (TI) signal through defibrillation pads. TI represents the resistance of the thorax to current flow, and is mea sured by defibrillators to check that defibrillation pads are correctly attached to the chest of the patient. Additionally, some defibrillators use the TI measurement to adjust the energy of the defibrillation pulse. Changes in tissue composition due to redistribution and movement of fluids induce fluctuations in the TI. Blood flow during the cardiac cycle generates small fluctuations synchronized to each heartbeat. Respiration (or assisted ventilation) also causes changes in the TI. Additionally, during cardiopulmonary resus citation (CPR), chest compressions cause a disturbance in the electrode-skin interface, inducing artifacts in the TI signal. These fluctuations may provide useful information regarding CPR quality, length of pauses in chest compressions (no flow time), presence of circulation, etc. This chapter explores the new applications of the transthoracic imped ance signal acquired through defibrillation pads during resuscitative attempts.