BACK TO THE BEGINNING – AN INTERVIEW WITH SAKARI SYVÄOJA
It is seven years ago since Helena Jäntti, and Sakari Syväoja sat down and started to discuss if it would be possible to recognise lifelessness with the help of a smartphone. This discussion was the beginning of Heart2Save and Syväoja’s doctoral thesis about recognition of out-of-hospital cardiac arrests.
Syväoja and Jäntti have known each other since they studied at the University of Eastern Finland. Syväoja once moved from Helsinki to Kuopio in order to study medicine; later his summer job took him to Joensuu. To Savonia and Kuopio Sakari returned for his specialisation courses in 1991 and years after that to Joroinen for his Emergency Doctor training in a rescue helicopter.
ALIVE OR LIFELESS – THE ASSESSMENT OVER THE PHONE IS DIFFICULT
When a medical emergency occurs outside of the hospital, the emergency number is called. ”The most serious and urgent situation is cardiac arrest. You should get help within minutes and start cardiopulmonary resuscitation immediately. This would, however, mean that one would already during the emergency call need to recognise that it is a case of cardiac arrest and lifelessness.” Sakari tells us.
”Nowadays the recognition of cardiac arrest is based on if the person is unresponsive and on an evaluation of the breathing. If an unresponsive person doesn’t breathe or doesn’t breathe normally, the starting point is that he/she is lifeless. The evaluation of if someone is breathing or not is difficult for an expert, not to speak of a layman. Let alone for the emergency service dispatcher who needs to evaluate over the phone,” Sakari explains. ”Many times the emergency service dispatcher must draw between different dispatch codes when there is no clarity in if the patient is lifeless or alive. It is mentally a very stressful situation, and it depends much on the psychological state of the caller, what kind of information the dispatcher gets regarding the incident. If the cardiac arrest is recognised, the cardiopulmonary resuscitation starts earlier and chances for survival increases.”
”To recognise lifelessness during the emergency call is vital.”
Syväoja’s doctoral thesis researched an extensive amount of material (of more than 2000 patients), in order to understand what the recognition of lifelessness means. ”A bigger part of the patients are being discharged from the hospital if lifelessness has been recognised during the emergency call and the cardiopulmonary resuscitation has started in time,” Sakari explains. ”To recognise lifelessness during the emergency call is vital.”
Helena and Sakari started together to think about a new way to approach and solve this recognition problem.
THE TECHNOLOGICAL PIECES NEEDED WERE ALREADY AVAILABLE
The practical problem evoked a thought about how to modify an already existing technology to something new. ”In 2012 the use of smartphones grew rapidly. Even if smartphones didn’t have apps in the same way they have today, the device was already becoming popular among users. Automated defibrillators had already for years had algorithms detecting heart rates. Also, ECGs were sent via mobile phones”, Sakari shares with us, ”so the pieces for recognising lifelessness based on the heart rhythm were already there.”
The idea of an ECG that could be registered with a mobile phone had been born; the next step was the research. ”The area of a mobile phone is small, which posed a challenge for registering ECG. We had to investigate if the signal registered from such a small area was strong enough for reliable ECG interpretations” Sakari tells about the beginning of the research. The participants were both volunteers, with normal heart beats and persons having a risk for ventricular fibrillation.
”The conclusion was, that the signal was of high quality and the area the size of a mobile phone was suitable for registering an ECG that could be used.”
The patients got pacemakers put in. The pacemakers were then tested so, that the patients were anaesthetised and exposed to ventricular fibrillation, which then was restored to natural heart beat by the defibrillator. The ventricular fibrillation caused in these controlled situations was the source of arrhythmia causing lifelessness.
The idea was to find out if the signal from an area the size of a mobile phone was of high enough quality so that one could recognise ventricular fibrillation causing lifelessness from it. The impact muscle tension and spasms have on the ECG was also researched. The conclusion was that the signal was of high quality and an ECG registered from an area the size of a mobile phone is suitable for measuring lifelessness based on the heart rhythm.
Since then Heart2Save has focused on recognising atrial fibrillation, but Syväoja hopes that Heart2Save would get back to its roots and the device would also get a feature for recognising ventricular fibrillation.
SYVÄOJA’S DOCTORAL THESIS WAS SUBMITTED ON 12.4.2019
The importance of recognising a patient’s lifelessness with respect to the survival rates and the recognition of ventricular fibrillation from an area the size of a mobile phone were parts of Sakari’s doctoral theses: “Recognition of out-of-hospital cardiac arrest”. The doctoral theses was submitted on Friday 12.4 2019 at North Karelia Central Hospital in Joensuu. Veli-Pekka Harjola, opponent and professor Jouni Kurola thesis supervisor.
More articles from Syväoja can be read here.