Rationale and Design of the BECA Project: Smartwatch-based Activation of the Chain of Survival for Out-of-Hospital Cardiac Arrest

Abstract

ABSTRACTIntroductionOut-of-hospital cardiac arrest (OHCA) is a major health problem, and the overall survival rate is low (4.6%-16.4%). The initiation of the current chain of survival depends on the presence of a witness of the OHCA, which is not present in 29.7%-63.4% of the cases. Furthermore, a delay in starting this chain is common in witnessed OHCA. This project aims to reduce morbidity and mortality due to OHCA by developing a smartwatch-based solution to expedite the chain of survival in the case of (un)witnessed OHCA.Methods and analysisWithin the BECA (BEating Cardiac Arrest) project, we aim to develop a demonstrator product that can detect OHCA using photoplethysmography and accelerometer analysis, and autonomously alert emergency medical services. A target group study will be performed to determine who benefits the most from this product. Furthermore, several clinical studies will be conducted to capture or simulate data on OHCA cases, as to develop detection algorithms and validate their diagnostic performance. Volunteers will be asked to simulate OHCA by interrupting radial arterial and venous blood flow by blood pressure cuff inflation while lying still. Data will also be captured during cardiac electrophysiologic and implantable cardioverter defibrillator (ICD) testing procedures. In addition, patients at risk for OHCA are recruited to acquire measurements over a longer period. Moreover, studies on psychosocial and ethical acceptability will be conducted, consisting of surveys, focus groups, and interviews. These studies will focus on end-user preferences and needs, to ensure that important individual and societal values are respected in the design process.Ethics and disseminationEthical approval or waivers will be sought from the research ethics committees of the different institutions. Written informed consent will be obtained from the participants of all studies. Study findings will be submitted to international peer-reviewed journals and will be presented at international scientific conferences.STRENGTHS AND LIMITATIONSStrengths-This research project aims to develop unobtrusive technology that could save lives by autonomously alerting emergency medical services in case of out-of-hospital cardiac arrest.-The project includes a broad range of aspects to maximize the technology’s chance of adoption: clinical, technical, psychological, and ethical.-The project aims for the inclusion of a wide and diverse research sample and the involvement of different stakeholder groups to minimize bias and ensure accessibility for everyone in society.Limitations-Smartwatch-obtained data of OHCA cases is scarce and hard to acquire: the more realistic the data is, the more difficult its acquisition is.