Identification of return of spontaneous circulation during cardiopulmonary resuscitation via pulse oximetry in a porcine animal cardiac arrest model

  • Chen Li
  • Jun XuEmail author
  • Fei Han
  • Joseph Walline
  • Liangliang Zheng
  • Yangyang Fu
  • Huadong Zhu
  • Yanfen Chai
  • Xuezhong Yu
Original Research


In this prospective study we investigated whether the pulse oximetry plethysmographic waveform (POP) could be used to identify return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR). Tweleve pigs (28 ± 2 kg) were randomly assigned to two groups: Group I (non-arrested with compressions) (n = 6); Group II (arrested with CPR and defibrillation) (n = 6). Hemodynamic parameters and POP were collected and analyzed. POP was analyzed using both a time domain method and a frequency domain method. In Group I, when compressions were carried out on subjects with a spontaneous circulation, a hybrid fluctuation or “envelope” phenomenon appeared in the time domain method and a “double” or “fusion” peak appeared in the frequency domain method. In Group II, after the period of ventricular fibrillation was induced, the POP waveform disappeared. With compressions, POP showed a regular compression wave. After defibrillation, ROSC, and continued compressions, a hybrid fluctuation or “envelope” phenomenon appeared in the time domain method and a “double” or “fusion” peak appeared in the frequency domain method, similar to Group I. Analysis of POP using the time and frequency domain methods could be used to identify ROSC during CPR.


Cardiac arrest Cardiopulmonary resuscitation Pulse oximetry plethysmographic waveform Identification Return of spontaneous circulation 



Chest compressions


Cardiopulmonary resuscitation


The pulse oximetry plethysmographic waveform


Return of spontaneous circulation


Cardiac arrest


Partial pressure of end-tidal carbon dioxide


Ventricular fibrillation


Heart rate


Diastolic arterial pressure


The time domain method


The frequency domain method


Author contributions

CL conceived and designed the experiments, performed the experiments, analyzed the data and drafted the manuscript. JX conceived and designed the experiments, performed the experiments and finally approved the manuscript. FH analyzed the data. JW helped to draft the manuscript. LZ performed the experiments. YF performed the experiments. HZ, YC and XY helped to finally approve the manuscript. All authors read and approved the final manuscript.


The study was funded by the National Health and Family Planning Commission of the People’s Republic of China Special Research Fund (201502019) URL: : Xuezhong Yu received this funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. This experimental protocol was approved by the Animal Care and Use Committee at Peking Union Medical College Hospital (2013S-512).

Supplementary material (8.3 mb)
Supplementary material 1. Video 1. Wave transformation in the frequency domain method at the compression stage in non-arrested animals (MOV 8459 KB) (9.3 mb)
Supplementary material 2. Video 2. Wave transformation in the frequency domain method at the compression stage in cardiac arrested animals with CPR (MOV 9551 KB)


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Emergency DepartmentTianjin Medical University General HospitalTianjinChina
  2. 2.Emergency Department, Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijingChina
  3. 3.Institute of Life MonitoringMindray CorporationShenzhenChina
  4. 4.Division of Emergency Medicine, Department of SurgerySaint Louis University HospitalSaint LouisUSA

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