• Nehemiah T Liu, Andriy I Batchinsky, Leopoldo C Cancio, William L Baker, and Jose Salinas.
• US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315. Electronic address: nehemiah.liu@us.army.mil.
• J Crit Care. 2013 Oct 1;28(5):885.e9-18.

PurposePrevious studies have shown that heart rate complexity may be a useful indicator of patient status in the critical care environment but will require continuous, accurate, and automated R-wave detection (RWD) in the electrocardiogram (ECG). Although numerous RWD algorithms exist, accurate detection remains a challenge. The purpose of this study was to develop and validate a novel fusion algorithm (Automated Electrocardiogram Selection of Peaks, or AESOP) that combines the strengths of several well-known algorithms to provide a more reliable real-time solution to the RWD problem.Materials And MethodsThis study involved the ECGs of 108 prehospital patient records and 32 ECGs from a conscious sedated porcine model of hemorrhagic shock. The criterion standard for validation was manual verification of R waves.ResultsFor 108 human ECG records, the AESOP algorithm overall outperformed each of its component algorithms. In addition, for 32 swine ECG records, AESOP achieved an R-wave sensitivity of 97.9% and a positive predictive value of 97.5%, again outperforming its component algorithms.ConclusionBy fusing several best algorithms, AESOP uses the strengths of each algorithm to perform more robustly and reliably in real time. The AESOP algorithm will be integrated into a real-time heart rate complexity software program for decision support and triage in critically ill patients.Copyright © 2013 Elsevier Inc. All rights reserved.

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