U.S. patent application number 13/352055 was filed with the patent office on 2012-05-10 for cooperating defibrillators and external chest compression devices.
This patent application is currently assigned to PHYSIO-CONTROL, INC.. Invention is credited to D. Craig Edwards, David R. Hampton, Cynthia Jayne, Richard C. Nova, Stephen W. Radons, Steven E. Sjoquist, Ronald E. Stickney, Joseph L. Sullivan.
Application Number | 20120116272 13/352055 |
Document ID | / |
Family ID | 32853513 |
Filed Date | 2012-05-10 |
United States Patent
Application |
20120116272 |
Kind Code |
A1 |
Hampton; David R. ; et
al. |
May 10, 2012 |
COOPERATING DEFIBRILLATORS AND EXTERNAL CHEST COMPRESSION
DEVICES
Abstract
Devices, methods, and software implementing those methods for
providing communicating external chest compression (ECC) devices
and defibrillation (DF) devices, where the ECC and DF devices can
be physically separate from each other. Both ECC and DF devices are
able to operate autonomously, yet able to communicate with and
cooperate with another device when present. Some ECC and DF devices
are adapted to be physically and/or electrically coupled to each
other. One ECC device includes a backboard, a chest compression
member, a communication module, controller, and at least one
sensor, electrode lead or electrode. One DF device includes a
defibrillator module, a controller, and a communication module that
can communicate with the ECC communication module. The
communicating ECC and DF devices may deliver ECC, pacing,
defibrillation, ventilation, and cooling therapies, and may deliver
instructions to human assistants, in a coordinated and cooperative
fashion.
Inventors: |
Hampton; David R.;
(Woodinville, WA) ; Stickney; Ronald E.; (Edmonds,
WA) ; Nova; Richard C.; (Kirkland, WA) ;
Radons; Stephen W.; (Snohomish, WA) ; Edwards; D.
Craig; (Fall City, WA) ; Jayne; Cynthia;
(Redmond, WA) ; Sullivan; Joseph L.; (Kirkland,
WA) ; Sjoquist; Steven E.; (Lynnwood, WA) |
Assignee: |
PHYSIO-CONTROL, INC.
REDMOND
WA
|
Family ID: |
32853513 |
Appl. No.: |
13/352055 |
Filed: |
January 17, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
11953665 |
Dec 10, 2007 |
8121681 |
|
|
13352055 |
|
|
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|
10652148 |
Aug 29, 2003 |
7308304 |
|
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11953665 |
|
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|
60447587 |
Feb 14, 2003 |
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Current U.S.
Class: |
601/21 |
Current CPC
Class: |
A61H 2201/5048 20130101;
A61N 1/39044 20170801; A61M 16/00 20130101; A61H 2201/5007
20130101; A61H 2201/0214 20130101; A61M 2202/0208 20130101; G16H
40/63 20180101; A61H 2201/501 20130101; A61H 31/008 20130101; A61H
2201/5012 20130101; A61H 2201/5058 20130101; A61H 2230/04 20130101;
A61H 31/005 20130101; A61H 2201/5097 20130101; G06F 19/00 20130101;
A61H 31/006 20130101 |
Class at
Publication: |
601/21 |
International
Class: |
A61N 1/39 20060101
A61N001/39; A61H 31/00 20060101 A61H031/00 |
Claims
1. A system for performing external chest compression (ECC) and
defibrillation on a person, the system comprising: means for
compressing the person's chest; means for defibrillating the
person, in which the chest compression means and defibrillating
means can be physically apart from each other; and means for
communicating data between the chest compression means and the
defibrillating means.
2. A system as in claim 1, in which the chest compression means
includes means for supporting the person's back.
3. A system as in claim as in claim 1, further comprising means for
sensing at least one physiological attribute of the person, in
which the means for sensing is coupled to the communicating
means.
4. A system as in claim 3, in which the physiological attribute is
selected from the group consisting of pulse, heartbeat, breathing,
body temperature, externally applied chest pressure and thoracic
impedance.
5. A system as in claim 1, further comprising means for
coordinating the chest compression means and the defibrillating
means.
6. A system as in claim 1, further comprising means for
electrically coupling the chest compression means and the
defibrillating means.
7. A system as in claim 1, further comprising means for
electrically coupling the back support means and the defibrillating
means.
8. A system as in claim 1, further comprising means for delivering
defibrillation energy through the chest compression means.
9. A system as in claim 1, further comprising means for delivering
pacing through the chest compression means.
10. A system as in claim 9, further comprising means for
electrically coupling the defibrillating means to the chest
compression means.
11. A system as in claim 2, further comprising means for delivering
defibrillation energy through the back support means.
12. A system as in claim 11, further comprising means for
electrically coupling the defibrillation means to the chest
compression means.
13. A system as in claim 1, further comprising means for
ventilating the person.
14. A system as in claim 1, further comprising means for cooling
the person.
Description
RELATED APPLICATIONS
[0001] This application is a divisional of U.S. patent application
Ser. No. 11/953,665 titled COOPERATING DEFIBRILLATORS AND EXTERNAL
CHEST COMPRESSION DEVICES, filed Dec. 10, 2007, now allowed, which
is a continuation of U.S. patent application Ser. No. 10/652,148
titled "COOPERATING DEFIBRILLATORS AND EXTERNAL CHEST COMPRESSION
DEVICES", filed Aug. 29, 2003, which issued as U.S. Pat. No.
7,308,304, which application claims the benefit of U.S. Provisional
Patent Application Ser. No. 60/447,587 titled "COOPERATING
DEFIBRILLATORS AND CPR DEVICES", filed Feb. 14, 2003, all of which
are incorporated herein by reference in their entirety for all
intents and purposes.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention is related to the field of
resuscitation devices.
[0004] 2. Description of the Related Art
[0005] All over the world, people experience resuscitation events.
For example, both in and out of the hospital, there is a
significant incidence of cardiac and/or respiratory arrest among
at-risk patients. When an acute event occurs, a variety of
therapies may need to be administered to restore the patient's
normal function. The patient may require artificial respiration to
stimulate breathing, chest compressions to restore perfusion,
defibrillation to activate the heart, and/or pacing to promote
cardiac output.
[0006] Many devices exist which can separately administer these
therapies in these events and situations. For example, an automated
chest compression device is taught in patent U.S. Pat. No.
6,234,984 B1. Some of these devices even aggregate various
features, such as are described in U.S. Pat. No. 4,349,015, and
U.S. Pat. No. 4,424,806.
[0007] Many of the prior art devices, however, merely collect such
features into a single package, without synchronizing their
functions and making them work together. Therefore there exists a
need for devices that can combine, coordinate and integrate various
aspects of these diagnostics and therapies to better assess and
treat the patient. That is because many of these conditions occur
in combination, requiring that therapies blend constructively with
one another to be optimally effective.
SUMMARY OF THE INVENTION
[0008] Generally, the present invention provides devices, software,
and methods as described below. The invention offers devices that
can operate independently, or in a combined fashion, to monitor a
patient and administer diverse therapies, as they arise. Systems
provided by the present invention preferably include a device for
providing external chest compression and a defibrillator, where the
chest compression device and defibrillator can each operate
autonomously when necessary, yet can also each communicate with and
cooperate with each other when advantageous.
[0009] One system provided by the present invention includes an
external chest compression (ECC) device having a first
communication module, and a defibrillator having a second
communication module, in which the ECC device and the defibrillator
are capable of communicating via the first communication module and
the second communication module. The data communication modules can
utilize a communications medium selected from the group consisting
of wireless, radio frequency, infra-red light, light, hard-wired
electrical, and coupled optical fibers.
[0010] Some ECC devices include a backboard, and can also include
wheels and a handle. A chest compression member can be coupled to
the backboard, where the chest compression member can include a
rigid chest compression member and/or a retractable or contractible
belt or vest. Some chest compression members are driven by powered
actuators while others are manually operable. ECC devices can also
include cooling modules for cooling a person and ventilators for
ventilating.
[0011] ECC devices, on the backboard, on the chest compression
members, and/or on the defibrillation device, can include various
sensors, electrodes, and leads, which can include sensors for
measuring physiological attributes, one or more defibrillation
electrodes, and one or more EGG leads. Electrodes may include a
releasable electrolyte. Sensors can measure applied chest pressure,
temperature, respiration, pulse, ECG signals, EEG activity,
thoracic impedance, and other parameters. The sensors, electrodes,
and leads are preferably coupled to the communication module of the
respective ECC or defibrillation device. Some systems include a
communication module on either or both of the ECC device and
defibrillator that can communicate with a remote assistance center.
A camera can be coupled to the communication module.
[0012] Some ECC devices and defibrillators are adapted to be
physically and/or electrically coupled to each other. Some
defibrillators can be electrically coupled to defibrillation
electrodes on the ECC device.
[0013] The ECC device and/or the defibrillator preferably includes
a controller or processor that is coupled to the respective
bidirectional communication module. In systems having at least two
controllers, each controller may execute logic to designate a
master controller, and also slave controllers, as between the two
or more controllers. Various methods may be executed in the
controllers, including the master and/or slave controllers,
depending on the embodiment.
[0014] One method according to the present invention includes
placing a person on a first device, establishing data communication
between the first device and a second device that can be physically
apart from the first device, causing a chest compression member of
the first device to compress the chest of the person against the
backboard, and causing a defibrillator of the second device to
defibrillate the person responsive to the communication. Placing
the person on the first device can refer to placing the person on a
portion of the first device, for example on a backboard, or on a
vest or belt which encircles the person. Some embodiments utilize a
constrictive vest or belt and do not include a backboard or
backframe. The communication may be used either to synchronize the
delivery of the defibrillator shock with an optimal time in the
compression cycle, or to avoid applying the defibrillator shock at
a vulnerable period in the compression cycle. The communication
about defibrillator activity may, in turn, be used to initiate,
pause, or terminate chest compressions, or to change operating
parameters of the ECC device, such as rate and/or depth of chest
compression. In some methods, placing the person on a backboard of
the first device results in the person contacting a defibrillator
electrode of the first device.
[0015] Some methods include therapies, including pacing,
ventilating, cooling, and other modalities, and providing ECC
responsive to data communicated between or among the separate
devices. The therapies performed on the person can be automatic,
manual, or prompted manual mode, in response to voice instructions
from any of the devices.
[0016] Some systems include a controller executing logic for
generating an output to control a chest compression actuator in
combination with a defibrillator, responsive to sensor data
indicative of the presence of cardiac arrest and that indicate the
response of the patient to therapy. In one example, a sensor may
detect that a patient is in cardiac arrest (for example, some
combination of asystole or VF on the ECG, lack of a pulse, and no
respiratory and/or EEG signal) or pulseless electrical activity
(PEA) (for example, some combination of R- wave activity on the ECG
and lack of a pulse). Alternatively, the sensor may detect that the
patient has a perfusing rhythm, such as sinus activity (for
example, R-wave activity, a regular pulse, and adequate
respiration.)
[0017] Perfusion may be stimulated when controllers execute logic
in response to sensor inputs to implement methods to administer
automatic chest compressions, as in cardiac arrest or PEA. Further
sensor readings can establish whether adequate perfusion has been
stimulated, for example, by the return of pulse or EEG signals, and
the device may recommend or self-adjust based on sensor readings to
set an optimal rate and/or depth of chest compression. Some
indication of the adequacy of perfusion and the course of ECC
therapy can be indicated to the operator and stored to a
documentation log.
[0018] Similarly, it may be determined that defibrillation is
required in order to restore spontaneous cardiac contractions and
to restore cardiac output. Sensors may initiate defibrillation
responsive to physiological signals indicative of ventricular
fibrillation or ventricular tachycardia. A defibrillation shock can
be administered under manual or automatic control, synchronized to
the activity of the ECC device, and the response of the patient can
be determined by further reference to the sensors (e.g. pulse or
ECG).
[0019] Again, sensors may indicate that a patient is failing to
ventilate properly, or only with difficulty. Manual or automatic
ventilation may be initiated in conjunction with, and the
effectiveness determined by reference to sensors (e.g. CO2 or
oximetry). Optimal rate and depth, or possibly gas mixture, may be
determined and recommendations made to the operator. The
interaction between sensors and therapies may again be used to
establish a care record in a documentation log. Similarly, other
adjunct therapies (hypothermia and others) may be applied when the
sensors indicate that their effect is beneficial and safe for the
patient. ECC may be started, paused, or stopped in relation to
these adjunct therapies.
[0020] Each independent therapies may be applied alone or in
combination. But a patient in cardiac arrest may benefit most from
a synchronized combination of therapies, based on sensor readings.
This could occur when a patient has been placed on an ECC device
and instructions generated to establish communication between a
first data communication module operably coupled to the ECC device
and a second data communication module coupled to a defibrillator.
Sensors may determine that a patient is in cardiac arrest, and, for
example, may further indicate that the patient has been in a
nonperfusing state for a period longer than 5 minutes. The device
would recognize that a period of chest compressions should be
initiated, sufficient to perfuse the patient, for two minutes
before applying a defibrillation shock. The effectiveness of chest
compression could be monitored, and the duration of stimulated
perfusion measured. After two minutes, a defibrillation shock could
be automatically applied. it may be desirable to initiate the shock
during a chest compression, or between them, with such
synchronization being performed to enhance shock effectiveness.
Sensors detecting the re-appearance of a perfusing ECG rhythm may
initiate a 30-second period of pacing to further stimulate cardiac
function. Alternatively, failure to restore a perfusing rhythm may
cause a further period of CPR, followed by another defibrillation
shock, to be administered. In all cases, available therapies can be
synchronized and combined in ways responsive to the patient's
condition, and in ways that complement each other's
effectiveness.
DESCRIPTION OF THE DRAWINGS
[0021] FIG. 1 is a perspective view of a system including a
cooperating, communicating, and physically separate external chest
compression (ECC) device and defibrillation device;
[0022] FIG. 2 is a perspective view of the system of FIG. 1, having
a person disposed on the ECC device, and the ECC and defibrillation
devices directly coupled to each other;
[0023] FIG. 3 is a perspective view of a person disposed on another
system ECC device having a shorter backboard relative to the ECC
device of FIG. 1, and having the defibrillation electrodes on the
person; and
[0024] FIG. 4 is a transverse, cross-sectional view of an ECC
device in which the chest compression member includes a belt and a
piston;
[0025] FIG. 5 is a transverse, cross-sectional view of an ECC
device in which the chest compression member includes a retractable
belt;
[0026] FIG. 6 is a transverse, cross-sectional view of an ECC
device in which the chest compression member includes rigid members
pivotally coupled to the backboard;
[0027] FIG. 7 is a transverse, cross-sectional view of an ECC
device having a powered actuator coupled to a force multiplier for
delivering chest compression;
[0028] FIG. 8 is a perspective view of a system including a
cooperating external chest compression (ECC) device and a separate
defibrillation device, in which the ECC device includes a posterior
electrode in the backboard and an electrical connection coupled to
the defibrillation device;
[0029] FIG. 9 is a fragmentary, perspective view of a system
including a cooperating external chest compression (ECC) device and
a separate defibrillation device, in which the ECC device includes
electrodes for receiving defibrillator paddle electrodes for
electrically coupling to the defibrillation device;
[0030] FIG. 10 is a fragmentary, bottom view of a belt bearing a
defibrillator or electrode;
[0031] FIG. 11 is a fragmentary, bottom view of a belt hearing two
defibrillator electrodes;
[0032] FIG. 12 is a fragmentary, bottom view of a belt bearing
multiple ECG leads;
[0033] FIG. 13 is a fragmentary, bottom view of a belt bearing
multiple sensors and associated leads;
[0034] FIG. 14 is a fragmentary, transverse cross-sectional view of
a belt or vest bearing a spring biased defibrillator electrode, ECG
lead, or sensor;
[0035] FIG. 15 is a fragmentary, transverse cross-sectional view of
a belt or vest bearing an electrode, lead, or sensor having an
electrolyte gel;
[0036] FIG. 16 is a schematic view of an ECC device and
defibrillator similar to those FIG. 1, further including
communication modules in communication with a camera and
transmitter communicating with a remote assistance center;
[0037] FIG. 17 is a schematic view of the ECC device of FIG. 1,
further including a cooling module in the form of a cooling garment
disposed on the person;
[0038] FIG. 18 is a highly diagrammatic, cross-sectional view of
the person and cooling garment of FIG. 17;
[0039] FIG. 19 is a view of a sample screen of a defibrillator
according to the invention, when it requests cooperation with an
ECC device according to the invention;
[0040] FIG. 20 is a view of a sample screen of the ECC device of
FIG. 19, when the request is received;
[0041] FIG. 21 is a view of a sample screen of the defibrillator of
FIG. 19, as the handshake is being established;
[0042] FIG. 22 is a block diagram of the controller or computer
containing executable logic or software contained within an ECC
and/or defibrillation device;
[0043] FIG. 23 is a flow chart illustrating a method for performing
coordinated external chest compression and defibrillation
therapies;
[0044] FIG. 24 is a time diagram showing coordinated periodic chest
compressions and defibrillation and/or pacing pulses;
[0045] FIG. 25 is a flow chart segment illustrating an optional
pacing portion of the flow chart of FIGS. 18; and
[0046] FIG. 26 is a view of a display screen from an operation of
the invention.
DETAILED DESCRIPTION
[0047] According to the invention, an external chest compression
(ECC) device is provided, and also an external defibrillator. In
addition, each has an interface for communicating with the other,
and optionally also for cooperating for maximum effect. The
interfaces are made compatible with each other, as further
described below.
[0048] An important aspect of the invention is that the external
defibrillator is capable of functioning autonomously, independently
of the external chest compression device when they are not
communicating or cooperating. It is also highly preferable that the
external chest compression device be capable of functioning
autonomously, independently of the external defibrillator when they
are not communicating or cooperating.
[0049] FIG. 1 illustrates a system 60 for performing coordinated
ECC and defibrillation including an external chest compression
(ECC) device 30 and an external defibrillation device 68. ECC
device 30 includes a backboard or back frame 32, chest compression
members 40, a ventilator 42, an ECC human interface module or I/O
module 54, and a communication module 62 for communicating with
external defibrillation device 68.
[0050] Backboard 32 is shown as solid and having an upper surface
34. Backboard 32 need not be solid. Backboard 32 is preferably made
as lightweight as possible, allowing the integrated modules to be
included without adding unneeded weight. In some embodiments,
wheels 36 and a handle 38 are coupled to backboard 32. This permits
the device to be used as a gurney, making it easier to transport
the patient.
[0051] The chest compression portion may be implemented in a number
of ways, as described below. Two chest compression members 40 are
shown, in the form of two arms. Chest compression members 40 are
coupled to backboard 32. Even though only two arms are shown, the
chest compression members may be implemented as a belt, and/or as a
vest. either a full or partial vest. The belt or vest is intended
to generally wrap around the chest of the patient, for squeezing
it, or squeezing it against backboard 32. In this way, ECC or CPR
can be administered to the patient. The belt or vest may
incorporate other functionalities, as further described below. In
addition, it may be removable and/or reusable.
[0052] ECC device 30 can further include ventilator or ventilating
module 42. Ventilator 42 can include ventilator tubing 44.
Ventilator 42 can also be coupled to backboard 32 and can be used
for ventilating the patient. Ventilator 42 is shown schematically,
as ventilators are well known to those skilled in the art.
[0053] Human interface module 54 can be implemented in a number of
ways. Human interface module 54 can include an input portion and an
output portion. The input portion can include a keyboard and the
output portion can include a visual display or computer screen
and/or a voice output module for interacting with a human
assistant. Human interface module 54 can have input devices such as
keys, switches, knobs, levers, and a microphone for recording and
preferably also voice recognition. The human interface device can
also have output devices such as one or more display screens, a
speaker, a printer, and other output devices. All of these
functions may be aggregated at the human interface module, for
example, using a keypad.
[0054] In addition, the ECC device may include advanced features
for availing to a defibrillator, when one is coupled with it. This
may be useful when the defibrillator is a unit that lacks many
capabilities on its own. Having these features permits using a
defibrillator that itself lacks these features.
[0055] A battery 52 can be carried within backboard 32 for
supplying power for operating human interface device 54, ventilator
42, and chest compression members 40, in the various embodiments of
the invention. In some systems, battery 52 can also be used to
power the external defibrillator, where the defibrillator can be
electrically coupled to the ECC device. A controller or computer
can also be included within human interface device 54 or elsewhere
within ECC device 30 for coordinating the operation of external
chest compression, defibrillating, pacing, and ventilating.
depending on the embodiment of the invention present.
[0056] External defibrillation device 68 includes a defibrillation
human interface 70 including an input portion 72 and an output
portion 73. The input portion can include a keyboard and the output
portion can include a visual display or computer screen and/or a
voice output module for interacting with a human assistant.
Defibrillation device 68 also includes defibrillation electrodes 76
and a defibrillation communication module 64. Defibrillation
communication module 64 may be seen communicating with ECC device
communication module 62 through communication channel 66.
[0057] FIG. 2 illustrates system ECC device 30 having a person or
patient 100 disposed on backboard 32. Patient 100 has a chest
disposed under chest compression members 40 and a mouth for
receiving ventilator tubing 44. Defibrillator device 68 has been
moved toward ECC device 30. In some embodiments, ECC device and
defibrillator device 68 can be electrically and/or mechanically
coupled to each other through electrical connectors and/or cables,
allowing defibrillation pulses from the defibrillator to be
delivered through defibrillation electrodes of the ECC device.
[0058] FIG. 3 illustrates another system including an ECC device
120, for providing cooperating external chest compression and
defibrillation and/or pacing. ECC device 120 may be seen to include
chest compression members 40, human interface device 54 and battery
52, as previously described with respect to FIG. 1. ECC device 120
includes a short backboard or back frame 126. Shorter backboard 126
can decrease the weight and increase the portability of the ECC
device.
[0059] Compressing and releasing may be performed according to any
type of time profile. One such profile is seen in FIG. 24. Other
profiles may be sine wave, triangular shaped, or other shapes. In
an advantageous embodiment of the invention, a sine wave may be
used with a frequency outside the ECG range. The chest compression
profile shape and frequency may permit analyzing the ECG while
simultaneously performing chest compressions. This may also permit
the device to detect more quickly a rhythm that requires a
defibrillation shock, and to reduce the delay of its delivery from
the end of the chest compressions.
[0060] Other embodiments of the chest compression portion includes
devices performing active compression decompression, devices that
combine chest compressions with abdominal compressions, devices
where the belt is operated electronically (w/o gears), and devices
that use electricity to do chest compressions by electrically
inducing chest muscles to contract.
[0061] Referring again to FIGS. 1, 2, and 3, the invention external
defibrillation device is capable of performing defibrillation, and
optionally, also pacing. Pacing may be implemented by a separate
module than defibrillating, but it is highly advantageous to have
the same module perform both functions. The defibrillator may be of
any chosen automation level. That includes operation that is fully
automated to fully manual, and every option in between.
[0062] Moreover, the defibrillator may also advantageously provide
devices or modules that perform monitoring, and further provide
interpretation of the monitored signals. The monitoring results may
advantageously be displayed on the human interface device
previously described or on an I/O module as described below. In
other embodiments, there is a separate monitoring module.
Monitoring may be of any of the monitoring parameters or
physiological attributes common on defibrillator/monitors or
bedside monitors today, for example, NIBP, Sp0.sub.2, CO.sub.2, 12
lead ECG, etc. In other embodiments, monitoring is performed by the
ECC device, and may be transmitted to the defibrillator.
[0063] The defibrillator also can include an input/output (I/O) or
human interface module as previously described. In the embodiment
of FIG. 1, defibrillator human interface device 70 includes a
display screen and keyboard, as previously discussed, but that is
not limiting. The invention can also have input devices such as
keys, switches, knobs, levers, a microphone for voice recording,
and preferably also voice recognition, and output devices such as
one or more screens, a speaker, printer, or other output device.
All of these are preferably aggregated at the I/O module, but that
is not necessary for practicing the invention. They may be located
elsewhere in the devices, or received remotely, for example,
wirelessly.
[0064] The ECC device also optionally includes a ventilation
portion. A ventilation portion or ventilating module 42 was
previously described with respect to FIG. 1. The ventilation
portion may be implemented either automatically, or be intended for
use by a human operator. If by a human, the device may be made
giving prompts for instructing the rescuer. The prompts may be
timed. The rescuer may be either performing mouth-to-mouth
resuscitation or opening a bag valve mask device where the user
manually squeezes the bag. If the ventilator is to be automatic, a
tube can be inserted into the patient's mouth, and a pump can be
used. A mask may be placed on the face of the patient. The oxygen
can be delivered this way to the patient. Other devices, such as
valves that block the airway during chest decompression, for
example, a CPR-x valve, can be included in the ventilation portion
of the device of the invention.
[0065] The ECC device preferably also includes an electrical power
source for powering the various ECC portions. The power source may
be a battery, such as battery 52 discussed with respect to FIG. 1.
The battery may be either a rechargeable battery for maximum
portability, or a replaceable battery. The battery is preferably
integrated with the back frame, either permanently, or in such a
way that it can be removed and replaced. Some devices of the
invention have the benefits of being able to share a common power
source, CPU or controller, and I/O module for the interface with
the rescuer.
[0066] FIG. 4 illustrates an ECC device 150, in which the chest
compression is effected by a compressor or expandable member held
in place by a belt or vest 153, depending on what is provided in
the particular embodiment. The chest compressor includes a
mechanism for pushing downwards on the chest. In the ECC device
illustrated, the compressor is implemented as a base 151 and a
piston 152. Piston 152 is illustrated in a first, retracted
position 154 and a second, extended position 156. Belt or vest 153
can be coupled to a back frame 158, as previously discussed. A
posterior electrode 48 is embedded in the back frame 58.
[0067] FIG. 5 illustrates a belt or vest 172, having a buckle or
zipper 174 for fastening around the chest of the patient. Belt or
vest 172 can itself be contracted to effect chest compression. The
contraction can take place in many ways. In one way, the belt or
vest can be retracted into a back frame 176. In another way, belt
or vest 172 can be constricted about the patient. Belt or vest 172
may be seen having a first, expanded position 173 and a second,
constricted position 178. In yet another way, chest compression is
affected by electrically stimulating the chest muscles.
[0068] FIG. 6 illustrates still another ECC device 200 having a
patient 206 disposed on a backboard 210. In device 200, chest
compression is provided by rigid chest compression members or arms
202 having support prongs 208 that push down on the chest of
patient 206. Arms 202 can be pivotally coupled to backboard 210. In
the embodiment illustrated, arms 202 are operated by gears 204 that
are integrated with backboard 210. In some embodiments, arms 202
are driven by a powered chest compression actuator.
[0069] FIG. 7 illustrates another ECC device 220 including
backboard 210 carrying patient 206, as previously described. ECC
device 220 includes a force multiplier 224 using a lever
arrangement, so that a pressing member can exert a downward
pressure on the patient chest. ECC device 220 includes a gearbox or
a powered actuator 230 coupled through a shaft or rod 228 that may
be hollow in some embodiments. Shaft 228 can have first force
transmission member 236 slidably received within shaft 228 and
pivotally coupled to a second force transmission member 232 and a
third force transmission member 234. Force transmission members 232
and 234 can be further coupled to a chest compression pad 235 for
pressing against the chest of patient 206. Force multiplier device
224 can be held in place by a belt or vest 222. In some
embodiments, the lever arrangement may operate by having a rod
conduct a long rotation, such as in a corkscrew arrangement.
[0070] Other embodiments of the chest compression portion include
belts crossing the chest from over the shoulder down to the chest,
forming an "X" across the patient's chest. This is better than the
conventional way of having belts horizontally across the patient's
chest, in that it permits placement of sensors such as leads in
different places. Alternately, an "X"-belt configuration may be
combined with the conventional configuration. In yet other
embodiments, the chest compression portion includes devices
performing active compression-decompression, devices that combine
chest compressions with abdominal compressions, devices where the
belt is operated electronically without gears, and devices that use
electricity to do chest compressions by electrically inducing chest
muscles to contract. Various embodiments may use combinations of
these chest compression techniques.
[0071] FIG. 8 illustrates a system 250 including an external chest
compression (ECC) device 252 and an external defibrillation device
254. ECC device 252 can have backboard 32, human interface device
54, and ECC data communication module 62, as previously described.
ECC device 252 further includes chest compression members 256
having a built in electrode 264 on the underside, and a posterior
electrode 262 built into the backboard, for availing to a
defibrillator, when one is coupled with it. Electrodes 264 and 262
are placed on the patient by virtue of applying the ECC device. In
the example illustrated, one electrode can be integrated with the
chest compression portion, and the other on the back frame. In
another example, both electrodes may be integrated with the chest
compression portion. Instead of applying the external defibrillator
electrodes to the patient, special wires can be applied from the
external defibrillator to a defibrillator electrode interface or
connector 260 on the back frame. Those in turn can power the ECC
device built in electrodes. In the embodiment illustrated, an
electrical cable 266 may be seen extending from defibrillator 254
to ECC device 252.
[0072] Referring to FIG. 9, an optional embodiment is shown. An ECC
device 222 includes two electrodes 274 on the back frame for
placing thereon directly the defibrillator electrodes 258. This
way, no special wires are needed.
[0073] FIGS. 10 and 11 illustrate how defibrillator electrodes or
other electrodes might be attached to an underside of the vest or
belt of the chest compression portion of the devices of FIG. 1, 2,
or 3. For example, the electrodes can be part of a belt or vest of
FIG. 4 or 5. The electrodes can also be integrated with an arm or a
prong of a chest compression member, for example, prong 208 of FIG.
6 or chest contact pad 235 or FIG. 7.
[0074] FIG. 10 illustrates a belt or vest having a first portion
300 coupled through a buckle or zipper 304 to a second portion 302.
A first electrode 306 may be affixed to the underside of the belt
or vest and coupled to a wire or lead 308. In FIG. 10, one of the
electrodes is situated on the underside of the belt or vest, while
the other electrode may be expected to be in the backboard. At
least one wire can connect the electrode to the remainder of the
defibrillation/pacing portion. This is a preferred embodiment,
since it would minimize CPR artifact in the ECG signal. The
electrode preferably avoids the center of the chest. That is where
the buckle or zipper is shown (as wider than the open portion that
supports the electrode).
[0075] FIG. 11 illustrates the belt or vest of FIG. 10, having belt
or vest first portion 300, buckle or zipper 304, and second portion
302. First electrode 306 and wire 308 are as previously described
with respect to FIG. 10. In FIG. 11, a second electrode 310 is
coupled to a second wire or lead 312. In the embodiment illustrated
in FIG. 11, no electrode is needed in the backboard or back frame
for traditional defibrillation. At least one wire can connect each
electrode to the defibrillation/pacing portion.
[0076] FIG. 12 illustrates the underside of another belt or vest
having a first portion 320 coupled through a buckle or zipper 324
to a second portion 322. Belt or vest first portion 320 may be seen
carrying a first electrode 326 and a second electrode 327, coupled
to wires 332. Belt or vest second portion 322 may be seen carrying
third electrode 328, fourth electrode 329, and fifth electrode 330,
all coupled to wires 332. Wires 332, while having similar reference
numbers, are, of course, preferably electrically distinct. The ECG
leads of FIG. 12 are also preferably integrated with the underside
of the vest or belt of the chest compression portion of the devices
of FIG. 1, 2, or 3. The ECG leads may be placed so as to not
interfere with any defibrillation electrodes, for example, those of
FIGS. 10 and 11.
[0077] FIG. 13 illustrates yet another belt or vest having a first
portion 340 coupled through a buckle or zipper 344 to a second
portion 342. The underside of belt or vest first portion 340 may be
seen carrying a first sensor 346 coupled to a wire or other signal
transmission medium 349. The underside of belt or vest second
portion 342 may be seen carrying a second sensor 347, and a third
sensor 348, coupled to wires 349. The sensors are preferably also
integrated with the underside of the vest or belt of the chest
compression portion of the devices of FIGS. 1, 2 and 3. These
sensors can include pulse detection sensors, such as those made
from piezoelectric materials, temperature sensors, CO.sub.2,
sensors, and other sensors for measuring physiological attributes
or signals, well known to those skilled in the art.
[0078] The features integrated with the belt or vest are preferably
arranged so that they do not interfere with each other. The
electrode may be fully integrated, or detachable for servicing.
Alternately and equivalently, some electrodes, ECG leads, or
sensors may be hosted in the backboard.
[0079] FIGS. 14 and 15 illustrate how defibrillator electrodes, ECG
leads, or sensors may be integrated with an underside of the vest,
belt, or other chest compression members, for example those in FIG.
1, 2 or 3.
[0080] FIG. 14 illustrates a belt or vest 350 carrying an
electrode, lead, or sensor 352. Electrode, lead, or sensor 352 can
be coupled to a wire 356 and biased downward from the belt or vest
with a spring 354, so as to be pressed against the chest of the
patient. For use with a pulse sensor, some quieting time for the
spring is preferably allowed, so as to not provide interference
with the signal.
[0081] FIG. 15 illustrates a belt or vest 360 carrying an
electrode, lead, or sensor 362 on the underside of the vest or
belt. A gel or electrolyte 364 may be seen on the underside of the
electrode, lead, or sensor 362. For implementing an electrode, a
gel may be administered, or an electrolyte may be diffused. The gel
or electrolyte may be provided in a capsule that bursts at an
appropriate time to release it. The time may be prior to
defibrillation electrotherapy. Bursting may be caused by the mere
pressure against the chest, or by an appropriate electrical signal.
One advantage that can be provided by some embodiments is that
there is no need to disrobe the patient--the fluid may seep through
the clothes to establish electrical conduction.
[0082] FIG. 16 illustrates some other optional features of the
invention. ECC device 30, patient 100, and backboard 32 are shown,
as previously described. A camera 382 may be seen disposed on a
post secured to backboard 32. Camera 382 can be coupled to a
communication module 380 that can act as a transmitter or
transceiver. Communication module 380 can communicate with a remote
assistance center 396 coupled through a network 394 and a remote
antenna 392. A data/voice/video communications link 386 is shown as
existing between communication module 380 and remote assistance
center antenna 392, Communication link 386 can be bi-directional in
some embodiments.
[0083] A data/voice/video communications link 390 is shown as
existing between communication module 380 and defibrillation device
communication module 384. Yet another communication link 388 may be
seen between defibrillation device communication module 384 and
remote assistance center antenna 392. Communication links 390 and
388 are also preferably bi-directional. In a preferred embodiment,
communications modules 380 and/or 384 include the functionality of
a portable telephone and can establish wireless communication with
remote antenna 392, and network 394 is a network that can support
voice and/or data communications.
[0084] Camera 382 is preferably a digital camera, and may be either
a video camera or a still camera. A camera may be advantageously
attached to a post in the backboard and/or to the defibrillation
device. The camera is preferably attached to the ECC device. The
camera permits recording of the scene and the patient. The
recording may be used for record keeping, event analysis, and other
purposes. Alternately, the recording may be used for live
transmission to the remote assistance center 396, where more
trained medical personnel can in turn provide feedback.
[0085] The user may use the defibrillator of the invention and/or
the chest compression device of the invention to assist a victim.
In addition, the user can establish a communication link 386 and/or
388 with remote assistance center 396. Then the information can be
transmitted and can include images, if a camera is provided. The
patient's vital signs, encoded by the invention for communication,
along with the rescuer's comments, observations, and even questions
may be also transmitted to the remote assistance center.
[0086] If the defibrillator of the invention and the chest
compression device of the invention are interfaced, then only one
communication link need be established with the Remote Assistance
Center. The inputs from the other device can be passed via the
interface.
[0087] In some embodiments, the invention is operable from remote
assistance center 396. An operator at the remove assistance center
can transmit a command code through communication link 392 to ECC
device 30 and to the defibrillation device, and the devices
operated accordingly. Such operation may actually include
defibrillation and/or ECC.
[0088] Moreover, the monitored data, included also recorded data
such as events, wave forms, physiological signals or attributes,
and data indicative of the device operation itself, may be also
transmitted to a system for collecting or storing patient
information, and to a computer-aided dispatch system for
assistance. Furthermore, it may also be sent to a billing system
for determining patient billing.
[0089] FIGS. 17 and 18 illustrate additional optional cooling
figures of the invention. Cooling can be provided for performing
IMHT (Induction of Mild Hypo Thermia), which may slow down adverse
effects of the events being experienced by the patient.
[0090] ECC device 30 and patient 100 are as previously described.
FIG. 17 illustrates generally a cooling module aspect of the
present invention. In the example illustrated, the cooling module
includes a liquid gas storage container or tank 402 coupled to a
valve 404 coupled in turn to a tube 406 coupled to a cooling
garment 408. Liquid gas storage container 402 can be included
within the cooling module and is preferably carried under the
backboard. This is most advantageous in the event the backboard is
implemented with wheels.
[0091] The liquid in container 402 can be one that preferably turns
into gas upon being released into the atmosphere. A cooling
garment, similar to cooling garment 408, can be provided for each
part of the body that is of interest to cool. As used herein,
"cooling garments" include very loose, tent-type cooling garments
that allow cool air to be blown over the patient. As used herein,
"cooling garments" also include tightly adhering garments that may
contact the patient's skin or clothing and conduct heat away
through conductive cooling. Some tightly adhering cooling garments
are adhesively adhered to the patient's skin and conduct heat away
through a thermally conductive coupling agent. The cooling garment
can be shaped to be suitable for placing over the bodily part that
is to be cooled. Cooling garment 408 illustrated in FIG. 17 is
designed for placement on the patient's head. Cooling may also be
accomplished by evaporative cooling, for example, using a suitable
fluid delivery system and an absorber for alcohol, such as
cotton.
[0092] FIG. 18 illustrates a section of cooling garment 408.
Garment 408 has an inner shell 409 for contacting patient 100.
Garment 408 also has an outer garment or shell 411 that defines an
inner space 405 between outer shell 411 and inner shell 409.
Spacers may be used to maintain inner space 405 in an open
configuration. Alternately, small tubes may be used. Garment 408
can receive liquid gas from storage container 402 via tube 406 in
communication with inner space 405. The cooling gas or liquid can
also be received into the series of small tubes, previously
described. The gas can then be released into the atmosphere from
various places in the garment. As it is being released, the gas can
expand, cool, and thus draw heat away from the patient. Sensors,
for example for temperature, may also be included.
[0093] Referring again to FIG. 17, the gas can be directed from
storage container 402 to liquid controller or valve 404, and from
there to garment 408 via tube 406. Liquid controller 404 can in
turn be controlled by an IMHT controller, for controlling the rate
of cooling of the patient. The expanded cooled gas may be mixed
with air to control the final cooling gas/air temperature. The IMHT
controller may be implemented in combination with the liquid
controller, and optionally further communicates with the processor
or controller of the device of the invention.
[0094] In some embodiments (e.g. FIG. 2) the interface is physical,
and the devices are physically coupled to each other. In direct
coupling embodiments, the external defibrillator may slide into a
sheath of the back frame, and snap in place, making the required
contacts. In other embodiments, the external defibrillator is
coupled with the back frame via one or more wires. A physical
interface is necessary if a defibrillation shock is to be
transmitted, as in FIG. 8.
[0095] In other embodiments (e.g. FIG. 3) the interface is
wireless, and the devices communicate without contacting each
other. In that case, the defibrillator electrodes are applied
directly to the patient. Allowance must be made for not interfering
with the ECC device.
[0096] If the interface is wireless, it may use any one of many
known technologies and protocols for wireless communication.
Favored technologies are those that permit communication between
devices that are within 10 m (30 feet) from each other, such as
802.11 compatible devices, Bluetooth devices, etc.
[0097] The interface can be established in many different ways. In
the most advanced embodiments, both devices may exchange data with
each other, and either may exercise control of the other. In other
embodiments, either one of the devices of the invention may
communicate to the other, but be able to receive no commands. Or
they may be able to receive commands, but not communicate to the
other.
[0098] The exchanged data includes device data such as
identification, settings, status, time stamps, etc. The exchanged
data may also include user inputs, patient physiologic parameters,
electrotherapy, etc. The control data may include the ability of
one device to control the state of the other; to recognize and
interpret the inputs of the other for making decisions. In
addition, there can be "analog" connection to therapy electrodes,
ECG electrodes, or other sensors.
[0099] The handshake may be established with the one device as
"master" and the other as "slave", or both as peers. A peer
connection is not favored, since that might require a user to be
operating two I/O modules. In addition, prompts in at least one of
the devices might assist the user in connecting the device to the
other.
[0100] The determination of which one should be master is
preferably made by comparing their relative capability to
coordinate the devices. Such may start even wirelessly, as they are
brought close to each other. An example is described below.
[0101] FIG. 19 is a view of a sample screen 500 of a defibrillator
according to the invention, when it requests connection with an ECC
device according to the invention. The device ID may be seen at
502. Remarks can be displayed at 504. The detection of a
cooperating device is noted at 506. The coordination capability of
the coordinating device is displayed at 508. A master-slave
relationship is initiated at 510.
[0102] FIG. 20 is a view of a sample screen 520 of the ECC, when
the request is received. The device ID may be seen at 522. Remarks
are displayed at 524. The detection of a cooperating device is
noted at 526. Receipt of request for a master-slave relationship is
displayed at 528. The use is prompted for acceptance of the
master-slave relationship at 530.
[0103] The device that is in control preferably takes over all
input/output functionality. In addition, it takes control of
operations of both devices under a single operation.
[0104] As the connection is established, compatibility is
determined of the various functions, inputs, etc. An example is
seen below.
[0105] Referring to FIG. 21, a screen 550 is shown of when
compatibility is established at 558. The clocks are synchronized at
556. This may take place by coordinating the time stamps of the two
devices, either by using a common clock, or by communication of
events, or by denoting a difference between the times shown by the
clocks of the devices. Various inputs are checked at 558, to see if
they will be understood if received.
[0106] The present invention may be implemented by one or more
devices that include logic circuitry. The device performs functions
and/or methods as are described in this document. The logic
circuitry may include a processor that may be programmable for a
general purpose, or dedicated, such as microcontroller, a
microprocessor, a Digital Signal Processor (DSP), etc. For example,
the device may be a digital computer like device, such as a
general-purpose computer selectively activated or reconfigured by a
computer program stored in the computer. Alternately, the device
may be implemented as an Application Specific Integrated Circuit
(ASIC), etc. These features can be integrated with the invention,
or coupled with it.
[0107] Moreover, the invention additionally provides methods, which
are described below. The methods and algorithms presented herein
are not necessarily inherently associated with any particular
computer or other apparatus. Rather, various general-purpose
machines may be used with programs in accordance with the teachings
herein, or it may prove more convenient to construct more
specialized apparatus to perform the required method steps. The
required structure for a variety of these machines will become
apparent from this description.
[0108] In all cases there should be borne in mind the distinction
between the method of the invention itself and the method of
operating a computing machine. The present invention relates both
to methods in general, and also to steps for operating a computer
and for processing electrical or other physical signals to generate
other desired physical signals.
[0109] The invention additionally provides programs, and methods of
operation of the programs. A program is generally defined as a
group of steps leading to a desired result, due to their nature and
their sequence. A program made according to an embodiment of the
invention is most advantageously implemented as a program for a
computing machine, such as a general-purpose computer, a special
purpose computer, a microprocessor, etc.
[0110] The invention also provides storage media that, individually
or in combination with others, have stored thereon instructions of
a program made according to the invention. A storage medium
according to the invention is a computer-readable medium, such as a
memory, and is read by the computing machine mentioned above.
[0111] The steps or instructions of a program made according to an
embodiment of the invention requires physical manipulations of
physical quantities. Usually, though not necessarily, these
quantities may be transferred, combined, compared, and otherwise
manipulated or processed according to the instructions, and they
may also be stored in a computer-readable medium. These quantities
include, for example electrical, magnetic, and electromagnetic
signals, and also states of matter that can be queried by such
signals. It is convenient at times, principally for reasons of
common usage, to refer to these quantities as bits, data bits,
samples, values, symbols, characters, images, terms, numbers, or
the like. It should be borne in mind, however, that all of these
and similar terms are associated with the appropriate physical
quantities, and that these terms are merely convenient labels
applied to these physical quantities, individually or in
groups.
[0112] FIG. 22 illustrates a general computer, processor, or
controller 440 having a data storage device or computer readable
medium 446 interfaced with computer 440 to transfer data via link
448, or the data may define a program. Computer 440 of FIG. 22 may
be implemented by a CPU, and preferably interfaces with either one
of the 10 modules or human interface devices previously described.
Computer or controller 440 includes a memory 442 containing
executable logic or program 444.
[0113] This detailed description is presented largely in terms of
flowcharts, display images, algorithms, and symbolic
representations of operations of data bits within at least one
computer readable medium, such as a memory. An economy is achieved
in the present document in that a single set of flowcharts is used
to describe both methods of the invention, and programs according
to the invention. Indeed, such descriptions and representations are
the type of convenient labels used by those skilled in programming
and/or the data processing arts to effectively convey the substance
of their work to others skilled in the art. A person skilled in the
art of programming may use these descriptions to readily generate
specific instructions for implementing a program according to the
present invention.
[0114] Often, for the sake of convenience only, it is preferred to
implement and describe a program as various interconnected distinct
software modules or features, individually and collectively also
known as software and softwares. This is not necessary, however,
and there may be cases where modules are equivalently aggregated
into a single program with unclear boundaries. In any event, the
software modules or features of the present invention may be
implemented by themselves, or in combination with others. Even
though it is said that the program may be stored in a
computer-readable medium, it should be clear to a person skilled in
the art that it need not be a single memory, or even a single
machine. Various portions, modules or features of it may reside in
separate memories, or even separate machines. The separate machines
may be connected directly, or through a network, such as a local
access network (LAN), or a global network, such as the
Internet.
[0115] It will be appreciated that some of these methods may
include software steps which may be performed by different modules
of an overall parts of a software architecture. For example, data
forwarding in a router may be performed in a data plane, which
consults a local routing table. Collection of performance data may
also be performed in a data plane. The performance data may be
processed in a control plane, which accordingly may update the
local routing table, in addition to neighboring ones. A person
skilled in the art will discern which step is best performed in
which plane.
[0116] In the present case, methods of the invention are
implemented by machine operations, in other words, embodiments of
programs of the invention are made such that they perform methods
of the invention that are described in this document. These may be
optionally performed in conjunction with one or more human
operators performing some, but not all of them. As per the above,
the users need not be collocated with each other, but each only
with a machine that houses a portion of the program. Alternately,
some of these machines may operate automatically, without users
and/or independently from each other.
[0117] Methods of the invention are now described.
[0118] Referring now to FIG. 23, a flowchart 2000 is used to
illustrate a method according to an embodiment of the invention.
The method of flowchart 2000 may also be practiced by the devices
of the invention described in this document. Above and beyond the
method described herein, the responder (who is also a user) may be
instructed on how to apply a device, and or interactively give
feedback, and/or to perform steps of the method, etc.
[0119] According to a box 2010, signals are received about the
patient, and optionally are also monitored. Optionally, they are
also recorded, displayed, transmitted, etc.
[0120] The signals are received from the patient (such as ECG),
from special sensors (such as oximetry, impedance, force, pulse
detection sensors, etc.). Signals may also be received from other
components or devices (size of belt or vest around patient's chest,
GPS signals, control signals from a device of a responder attending
to the patient, etc.). Signals may further be received from the
responder interactively, e.g. by asking questions and receiving
answers.
[0121] The signals are then analyzed and treated as inputs, as is
also shown in the rest of flowchart 2000. Analysis may be
implemented also by taking advantage of the combined
functionalities and features. For example, knowledge of the time
profile of the chest compression is used to remove the chest
compression artifact from the ECG.
[0122] The process of box 2010 preferably takes place continuously,
even if execution moves also to other boxes of flowchart 2000.
Monitoring is for the conditions that are applicable for the below,
including, for example, for the effectiveness of chest
compressions. There can be different stages of monitoring, such as
main monitoring, at exact box 2010, and secondary monitoring
concurrent with other stages, e.g. at the same time as any one of
boxes 2030, 2040, 2080 below.
[0123] In addition, monitoring may be also for detecting Acute
Myocardial Infarction (AMI), via the ECG or other monitoring
parameters, and indicating this to the caregiver. If AMI is
detected, then monitoring may also be for cardiac arrest (which
commonly occurs during an AMI).
[0124] In addition to monitoring, preferably there is also
recording. The accumulated record may include records of events,
data monitored, and functionalities of the invention that are
operating, and time profiles of their operation.
[0125] A number of decision trees may then be implemented, in
determining what action to take next. The best embodiments known to
the inventors are described, but that is only by way of example,
and not of limitation. Further, the flowchart may be integrated
with other steps, such as administering medications (e.g. cardiac
drugs), etc. But simplistically, the ECG input is analyzed for a
shockable rhythm, and then either defibrillation takes place, or
pulse or other signs of circulation are checked, following the same
protocol as today's AEDs. Further, a user would be prompted to
start the chest compression device and ventilations if there was no
pulse (or no signs of circulation.) A more rigorous way is
described below.
[0126] According to a next box 2020, it is determined whether
Ventricular Fibrillation (VF) of the patient's heart is occurring.
If so, then according to a next box 2030, the patient is
defibrillated. This is accomplished by administering
electrotherapy, such as a defibrillation shock. If a child
("pediatric") patient is sensed, then the defibrillation energy
level may be adapted automatically (e.g. be set to 50 J). Such
sensing may be from responder inputs, the belt or vest size when
tightened around the patient, etc.
[0127] In some embodiments of the invention, at box 2030, instead
of delivering a defibrillation shock, the CPR portion is used to
deliver a precordial thump to deliver the patient. In particular,
when the device detects a shockable rhythm, rather than delivering
an electrical defibrillation pulse, the device first deliver a
precordial thump to the patient, via the chest compression device,
to attempt defibrillation. This is a great advantage of the
invention, in that it can revert from one form of therapy to
another.
[0128] In yet other embodiments, based on the patient's downtime
(which could be entered into the device by the caregiver), or by
analysis of parameter that indicates probability of shock success
(such as ECG), it may first he decided whether to deliver
electrotherapy, or to first perform CPR, and/or to first deliver
medications prior to defibrillating. That action could either be
started automatically by the system, or could be started with
manual action from the user.
[0129] Execution may then return to box 2010, where inputs are
received and analyzed. In a preferred optional embodiment, however,
according to a next box 2040, Cardiopulmonary Resuscitation (CPR)
is either performed automatically, or instructed for the responder
to perform, after defibrillating. Instruction may be by voice
commands, and/or may include sounds for the responder to
synchronize their action. In addition, depending on the monitored
inputs, the repetition rate of the CPR is adjusted. Further, if CPR
is performed automatically, the force and its time profile are also
adjusted. Execution returns to box 2010.
[0130] According to important alternate embodiments of the
invention, boxes 2030 and 2040 take place together. In other words,
defibrillation takes place while CPR is being performed
automatically.
[0131] Referring briefly to FIG. 24, a time profile of the chest
compressions is shown. More particularly, the changing
circumference of the patient chest is plotted, as squeezed and
released. In addition, the level of patient impedance is plotted in
dashed lines, following in pattern the time profile of the chest
circumference. (Other impedance variations may be superimposed on
the level of impedance). The profile of chest squeezing may be
known directly, or indirectly from a monitored parameter such as
the level of impedance.
[0132] Advantageously, defibrillation (the large lightning bolts in
FIG. 24) may take place any time in the CPR cycle. The exact timing
is chosen in synchronization to pursue various optimizations. For
example, if it is desired to exploit the smallest possible
impedance, defibrillation happens according to bolt (A). On the
other hand, if it is desired to exploit the moment that the heart
is filled with the most blood (and thus draw the most current
through the heart), then defibrillation happens according to bolt
(B).
[0133] CPR may continue after defibrillation, or even be halted
after it. An advantage of the invention is that the waiting time
from CPR to defibrillation is minimized. Pacing takes place as
described later in this document.
[0134] Returning to FIG. 23, if, at box 2020 it is determined that
the patient is not undergoing VF, then according to an optional
next box 2050, it is inquired whether a pulse is detected. If not,
then according to an optional next box 2060, it is inquired whether
the condition of Ventricular Tachycardia (VT) is detected. If so,
then execution reverts to box 2030, and the patient is
defibrillated. But if no VT is detected at box 2060, then execution
reverts to box 2040 for performing CPR.
[0135] If a pulse is detected at box 2050, then, according to an
optional next box 2070, it is inquired whether respiration is
detected. If so, then execution returns to box 2010. Respiration
may be detected automatically by respiration sensors, such as a CO2
(carbon dioxide) sensor, chest movement sensor, or an impedance
sensor.
[0136] If at box 2070 there is no respiration detected, then
according to an optional next box 2080, ventilation is performed
automatically by a ventilator, or rescue breathing is instructed
for the responder to perform. Execution returns to box 2010.
[0137] Since box 2010 is preferably executed continuously, the
method also includes discontinuing one type of therapy, and
optionally also starting another consistently with the above. Also,
if one of the signs changes, execution may return to box 2010 and
start over. For example, pulse may be lost while ventilating. Or
the onset of respiration may be detected, in which case other
activities (such as ventilation) stop.
[0138] Referring now to optional box 2090, optional pacing
according to the invention is also described. In the embodiment of
FIG. 23, the condition for enabling pacing is examined in two
circumstances, namely in transitioning from box 2050 to 2070, and
also in transitioning from box 2060 to 2040.
[0139] Referring now to FIG. 25, box 2090 is described in more
detail. In both cases, it is inquired whether severe bradycardia is
detected. In addition, if no pulse has been detected, it is
inquired whether ventricular asystole has been detected. If not,
then execution continues as before (from box 2050 to 2070, and from
box 2060 to 2040). If yes, then according to a box 2095, pacing is
performed.
[0140] Returning to FIG. 24, pacing (shown as a small lightning
bolt) may also be coordinated with the administration of CPR.
Pacing is preferably synchronized with the compression cycle. There
is some evidence that chest compressions may cause a QRS complex
(ventricular depolarization), if the heart is able to support it.
Accordingly, pacing during the compression cycle provides the
additional impetus to the ventricles. Also, pacing should be
avoided a few 100 msec after a QRS complex, during the ventricular
vulnerability period.
[0141] At any one time during the method of FIG. 23, inputs are
received (for monitoring) from the available sensors, from the user
through the I/O module, and from the interfaces during
communication. Outputs are communicated to the user through the I/O
module, sometimes through the interface during implementation.
[0142] Referring now to FIG. 26, a sample screen is shown for
communicating to the user the outputs. In the example of FIG. 21,
there is a count down for imminent defibrillation (at the 3 sec
point). The screen is preferably from the "master" device in the
relationship. Some of the inputs are generated on board, while
others are generated by the other device, and received by the
interface.
[0143] A person skilled in the art will be able to practice the
present invention in view of the description present in this
document, which is to be taken as a whole. Numerous details have
been set forth in order to provide a more thorough understanding of
the invention. In other instances, well-known features have not
been described in detail in order not to obscure unnecessarily the
invention.
[0144] While the invention has been disclosed in its preferred
form, the specific embodiments as disclosed and illustrated herein
are not to be considered in a limiting sense. Indeed, it should be
readily apparent to those skilled in the art in view of the present
description that the invention may be modified in numerous ways.
The inventors regard the subject matter of the invention to include
all combinations and sub combinations of the various elements,
features, functions and/or properties disclosed herein.
* * * * *