U.S. patent application number 17/457521 was filed with the patent office on 2022-03-24 for long-term wear electrode.
The applicant listed for this patent is ZOLL Medical Corporation. Invention is credited to Gary A. Freeman.
Application Number | 20220088371 17/457521 |
Document ID | / |
Family ID | 1000006004330 |
Filed Date | 2022-03-24 |
United States Patent
Application |
20220088371 |
Kind Code |
A1 |
Freeman; Gary A. |
March 24, 2022 |
LONG-TERM WEAR ELECTRODE
Abstract
An electrode for long term wear can include a top layer. The top
layer includes a non-conductive, flexible, water vapor-permeable,
electrically-insulating material. The electrode also includes a
conductive adhesive material and at least one electrical connector
configured to connect the electrode to a wearable defibrillator
such that the electrode is configured to receive defibrillation
energy from the wearable defibrillator and provide a sensing
function for the wearable defibrillator. The conductive adhesive
material is configured to disperse current laterally along a plane
of a surface of the electrode prior to delivery of the
defibrillation energy.
Inventors: |
Freeman; Gary A.; (Waltham,
MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ZOLL Medical Corporation |
Chelmsford |
MA |
US |
|
|
Family ID: |
1000006004330 |
Appl. No.: |
17/457521 |
Filed: |
December 3, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16542355 |
Aug 16, 2019 |
11224739 |
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17457521 |
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15833124 |
Dec 6, 2017 |
10426944 |
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16542355 |
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15060694 |
Mar 4, 2016 |
9867976 |
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15833124 |
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62129204 |
Mar 6, 2015 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61N 1/0472 20130101;
A61N 1/0496 20130101; A61N 1/3625 20130101; A61N 1/39046 20170801;
A61N 1/046 20130101; A61N 1/36034 20170801; A61N 1/0456 20130101;
A61N 1/0492 20130101 |
International
Class: |
A61N 1/04 20060101
A61N001/04; A61N 1/362 20060101 A61N001/362; A61N 1/36 20060101
A61N001/36; A61N 1/39 20060101 A61N001/39 |
Claims
1-39. (canceled)
40. An electrode for long term wear, comprising: a top layer
comprising a non-conductive, flexible, water vapor-permeable,
electrically-insulating material; a conductive adhesive material;
and at least one electrical connector configured to connect the
electrode to a wearable defibrillator such that the electrode is
configured to receive defibrillation energy from the wearable
defibrillator and provide a sensing function for the wearable
defibrillator; wherein the conductive adhesive material is
configured to disperse current laterally along a plane of a surface
of the electrode prior to delivery of the defibrillation
energy.
41. The electrode of claim 40, wherein a water vapor permeability
of the electrode is between around 600 gm/m.sup.2/24 hours and
around 1400 gm/m.sup.2/24 hours.
42. The electrode of claim 40, wherein the defibrillation energy
comprises between around 150 Joules and around 360 Joules.
43. The electrode of claim 40, wherein the electrode is further
configured to deliver at least one pacing pulse.
44. The electrode of claim 43, wherein the at least one pacing
pulse comprises a current pulse having a duration in a range of
10-40 ms.
45. The electrode of claim 43, wherein the at least one pacing
pulse comprises a current pulse having an amplitude of at least 50
mAmps.
46. The electrode of claim 40, wherein the conductive adhesive
material comprises a flexible, water vapor-permeable, conductive
adhesive material.
47. The electrode of claim 46, wherein the flexible, water
vapor-permeable, conductive adhesive material comprises a material
selected from the group consisting of an electro-spun polyurethane
adhesive, a polymerized microemulsion pressure sensitive adhesive,
an organic conductive polymer, an organic semi-conductive
conductive polymer, an organic conductive compound and a
semi-conductive conductive compound, and combinations thereof.
48. The electrode of claim 46, wherein the flexible, water
vapor-permeable, conductive adhesive material comprises a material
selected from the group consisting of poly(3,4-ethylene
dioxythiophene), doped with poly(styrene sulfonate), (PEDOT:PSS)
poly(aniline) (PANI), poly(thiophene)s, and
poly(9,9-dioctylfluorene co-bithiophene) (F8T2), and combinations
thereof.
49. The electrode of claim 40, wherein a thickness of the
conductive adhesive material is between 0.25 and 50 mils.
50. The electrode of claim 40, wherein the conductive adhesive
material comprises conductive particles.
51. The electrode of claim 50, wherein the conductive particles
comprise at least one of microscopic or nano-scale particles.
52. The electrode of claim 50, wherein the conductive particles
comprise at least one of carbon black, silver, nickel, graphene,
graphite, carbon nanotubes, aluminum, copper, gold, or
platinum.
53. An electrode for long term wear, comprising: a top layer
comprising a non-conductive, flexible, water vapor-permeable,
electrically-insulating material; a conductive adhesive material;
at least one sensing element positioned between the non-conductive,
flexible, water vapor-permeable, electrically-insulating material
and the conductive adhesive material; and at least one electrical
connector configured to connect the electrode to a wearable
defibrillator, wherein the electrode is configured to receive
defibrillation energy from the wearable defibrillator via the at
least one electrical connector; wherein the conductive adhesive
material is configured to disperse current laterally along a plane
of a surface of the electrode prior to delivery of the
defibrillation energy.
54. The electrode of claim 53, wherein a water vapor permeability
of the electrode is between around 600 gm/m.sup.2/24 hours and
around 1400 gm/m.sup.2/24 hours.
55. The electrode of claim 53, wherein the electrode is further
configured to deliver at least one pacing pulse.
56. The electrode of claim 55, wherein the at least one pacing
pulse comprises a current pulse having a duration in a range of
10-40 ms.
57. The electrode of claim 53, wherein the conductive adhesive
material comprises conductive particles.
58. The electrode of claim 57, wherein the conductive particles
comprise at least one of carbon black, silver, nickel, graphene,
graphite, carbon nanotubes, aluminum, copper, gold, or
platinum.
59. The electrode of claim 55, further comprising a backing
attached to the conductive adhesive material.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 16/542,355, entitled "Long-Term Wear
Electrode," filed Aug. 16, 2019, which is a continuation of U.S.
patent application Ser. No. 15/833,124, entitled "Long-Term Wear
Electrode", filed Dec. 6, 2017, now U.S. Pat. No. 10,426,944, which
is a continuation of U.S. patent application Ser. No. 15/060,694,
entitled "Long-Term Wear Electrode", filed Mar. 4, 2016, now U.S.
Pat. No. 9,867,976, which claims priority to U.S. Provisional
Patent Application No. 62/129,204 entitled "Long-Term Wear
Electrode", filed Mar. 6, 2015. Each of the above foregoing
applications is hereby incorporated herein by reference in their
entirety.
BACKGROUND OF THE DISCLOSURE
Field of the Disclosure
[0002] The present disclosure is directed to a wearable electrode
for the delivery of therapeutic electrical current, using such an
electrode, where the electrode is both breathable and waterproof,
and with the conductive properties to be able to support the
efficacious delivery of high current electrical therapy.
Description of Related Art
[0003] Cardiac arrhythmias, such as ventricular fibrillation and
ventricular tachycardia, are electrical malfunctions of the heart,
in which regular electrical impulses in the heart are replaced by
irregular, rapid impulses. These irregular, rapid impulses can
cause the heart to stop normal contractions, thereby interrupting
blood flow therethrough. Such an interruption in blood flow can
cause organ damage or even death.
[0004] Normal heart contractions, and thus normal blood flow, can
be restored to a patient through application of electric shock.
This procedure, which is called defibrillation, has proven highly
effective at treating patients with cardiac arrhythmias, provided
that it is administered within minutes of the arrhythmia. Portable,
wearable defibrillator systems have been developed which monitor a
patient's cardiac activity, detect arrhythmias, and provide
defibrillation electric shocks to restore normal heart contractions
and blood flow.
[0005] Various other pathophysiological conditions may also be
treated by the delivery of therapeutic electrical current to
physiologic tissues such as the myocardium, nerves, or skeletal
muscles using such methods as transthoracic cardiac pacing
(TCP).
[0006] In the current state of the art, a so-called "dry"
therapeutic electrode may be employed where the conductive gel is
stored and then deployed via electronically-activated gas pressure,
much like an air-bag in a car, such as is manufactured by ZOLL
Medical Corporation, Pittsburgh Pa. In this case, separate
electrocardiogram (ECG) monitoring electrodes are used.
[0007] Alternatively, self-adhesive electrodes such as are used on
conventional, non-wearable defibrillators may be employed. In this
case, the electrodes are capable of performing both the functions
of ECG monitoring and defibrillation. The self-adhesive
defibrillator electrodes of these systems can be large, e.g., 2-8
inches in diameter, and use vapor impermeable materials such as
metal foils, hydrophilic, water saturated conductive hydrogels, and
electrically insulating layers that prevent the patient's expired
vapor from the skin surface from evaporating, eventually softening
the epidermis and resulting in degradation of the structural
integrity of the skin leading to sloughing and peeling of the skin
when the electrode is removed after extended wear. As a result, the
patient's skin may become irritated which can lead to the patient
being non-compliant with his/her treatment when he/she refuses to
or can no longer wear the electrodes.
[0008] Also, the materials from which these electrodes are made and
the adhesives that are used are not waterproof during bathing or
showering and do not conform well to the patient's body or
movement. This results in the electrodes having to be replaced
frequently, often on a daily basis.
[0009] Thus, there is a need for an electrode that is less
irritating to the patient's skin that remains adhered to the
patient's skin for a longer time period, for example, as long as
two weeks. A vapor permeable self-adhesive wearable electrical
therapy electrode would be desirable over the current art for
reducing thickness and weight while at the same time increasing
patient comfort and increasing the duration of continuous electrode
wear.
SUMMARY OF THE DISCLOSURE
[0010] An electrode for use with a therapeutic current delivery
system can comprise: a flexible, water vapor-permeable, conductive
adhesive material; a current dispersing element in contact with the
conductive adhesive material; and a non-conductive, flexible, water
vapor-permeable, electrically-insulating top layer provided in
contact with the current dispersing element. The current dispersing
element can be conductive at least laterally along a plane of the
electrode. The conductive adhesive material can be conductive in a
direction substantially orthogonal to the plane of the electrode
and semi-conductive in a direction substantially lateral to the
plane of the electrode.
[0011] In one example, the current dispersing element can be
conductive in a direction orthogonal to the plane of the electrode.
The water vapor permeability of the electrode can be greater than
100 gm/m.sup.2/24 hours. In one example, the therapeutic current
delivery system can be a defibrillation system or a pacing system.
In an example, the electrode can be configured to deliver a
defibrillation pulse. The defibrillation pulse can comprise a
therapeutic pulse having an energy of at least 200 joules. In
another example, the electrode can be configured to deliver at
least one pacing pulse. The pacing pulse can comprise a current
pulse having a duration in a range of 10-40 ms and an amplitude of
at least 50 mAmps. The electrode can be configured to uniformly
distribute current to a patient.
[0012] In one example, the flexible, water vapor-permeable,
conductive adhesive material can comprise a material selected from
the group consisting of an electro-spun polyurethane adhesive, a
polymerized microemulsion pressure sensitive adhesive, an organic
conductive polymer, an organic semi-conductive conductive polymer,
an organic conductive compound and a semi-conductive conductive
compound, and combinations thereof. In another example, the
flexible, water vapor-permeable, conductive adhesive layer can
comprise a material selected from the group consisting of
poly(3,4-ethylene dioxythiophene), doped with poly(styrene
sulfonate), (PEDOT:PSS) poly(aniline) (PANI), poly(thiophene)s, and
poly(9,9-dioctylfluorene co-bithiophene) (F8T2), and combinations
thereof. In an example, a thickness of the flexible, water
vapor-permeable, conductive adhesive material can be between 0.25
and 50 mils. In another example, the water vapor-permeable,
conductive adhesive material can comprise conductive particles.
[0013] In one example, the current dispersing element can comprise
a metallic wire mesh. The metallic wire mesh can comprise a metal
selected from the group consisting of copper, tin, nickel, silver,
gold, and combinations thereof. In another example, the conductive,
current dispersing element can comprise nickel-plated carbon-filled
fibers. In one example, the current dispersing element can be
segmented.
[0014] In an example, a backing can be attached to the flexible,
water vapor-permeable, conductive adhesive material. The backing
can extend beyond an outer surface of the electrode. In one
example, a frame can be provided on an outer surface of the
non-conductive, flexible, water vapor-permeable,
electrically-insulating top layer. The frame can be disposed around
the perimeter of the electrode.
[0015] In one example, a therapeutic current delivery system can
comprise: a therapeutic current delivery device; at least one cable
connector connected to the therapeutic current delivery device; and
at least one electrode connected to the at least one cable
connector. The at least one electrode can comprise: a flexible,
water vapor-permeable, conductive adhesive material; a current
dispersing element in contact with the conductive adhesive
material; and a non-conductive, flexible, water vapor-permeable,
electrically-insulating top layer provided in contact with the
current dispersing element. The current dispersing element can be
conductive at least laterally along a plane of the electrode. The
conductive adhesive material can be conductive in a direction
substantially orthogonal to the plane of the electrode and
semi-conductive in a direction substantially lateral to the plane
of the electrode. In one example, the cable connectors can be no
more than 10 inches long. In another example, the therapeutic
current delivery device can be a defibrillation device, a pacing
device, or a nerve stimulation device.
[0016] In another example, an electrode for use with a therapeutic
current delivery system can comprise: a flexible, water
vapor-permeable, conductive adhesive material; a current dispersing
element in contact with the conductive adhesive material to receive
a therapeutic current from a connector and distribute the
therapeutic current over a plane of the electrode; and a
non-conductive, flexible, water vapor-permeable,
electrically-insulating top layer in contact with the current
dispersing element. The conductive adhesive material is conductive
in a direction substantially orthogonal to a plane of the electrode
and semi-conductive in a direction substantially lateral to the
plane of the electrode. The water vapor permeability of the
electrode can be greater than 100 gm/m2/24 hours.
[0017] In one example, an electrode for use with a therapeutic
current delivery system can comprise a non-conductive, flexible,
water vapor-permeable, electrically-insulating top layer; and a
flexible, water vapor-permeable, conductive adhesive material
disposed on one side of the electrically-insulating top layer. The
conductive adhesive material can be configured to provide
conductive paths in both lateral and orthogonal directions to a
plane of the electrode. The top layer can be in contact with the
conductive adhesive material.
[0018] In one example, the electrode can be configured to deliver a
defibrillation pulse. The defibrillation pulse can comprise a
therapeutic pulse having an energy of at least 200 joules. In
another example, the electrode can be configured to deliver at
least one pacing pulse. The pacing pulse can comprise a current
pulse having a duration in a range of 10-40 ms and an amplitude of
at least 50 mAmps.
[0019] In an example, the conductive adhesive material can comprise
conductive particles distributed in a polymer material to provide
the conductive paths. The conductive adhesive material can be
configured to substantially distribute a therapeutic current over
the plane of the electrode prior to delivery to a subject. In one
example, the electrode can further comprise a current dispersing
element in contact with the conductive adhesive material. The
current dispersing element can be configured to be conductive at
least laterally along the plane of the electrode. The water vapor
permeability of the electrode can be greater than 100
gm/m.sup.2/24hours.
BRIEF DESCRIPTION OF THE DRAWINGS
[0020] These and other features and characteristics of the present
disclosure, as well as the methods of operation and functions of
the related elements of structures and the combination of parts and
economies of manufacture, will become more apparent upon
consideration of the following description and the appended claims
with reference to the accompanying drawings, all of which form a
part of this specification, wherein like reference numerals
designate corresponding parts in the various figures. It is to be
expressly understood, however, that the drawings are for the
purpose of illustration and description only and are not intended
as a definition of the limit of the invention.
[0021] FIG. 1 is a front elevational view of a defibrillation
system according to the present disclosure attached to a
patient;
[0022] FIG. 2 is a top elevational view of one example of an apex
electrode according to the present disclosure having a segmented
current dispersing element;
[0023] FIG. 3 is a top elevational view of one example of an
anterior electrode according to the present disclosure having a
segmented current dispersing element;
[0024] FIG. 4 is an expanded view of the electrode of FIG. 2;
[0025] FIG. 5 is an expanded view of the electrode of FIG. 3;
[0026] FIG. 6 is a top elevational view of one example of an apex
electrode according to the present disclosure having a
non-segmented current dispersing element;
[0027] FIG. 7 is a top elevational view of one example of an
anterior electrode according to the present disclosure having a
non-segmented current dispersing element;
[0028] FIG. 8 is a photograph of an electro-spun polyurethane
adhesive as used for the flexible, water vapor-permeable,
conductive adhesive layer of the present disclosure;
[0029] FIG. 9 is a schematic of the apparatus used to make the
electro-spun polyurethane adhesive of FIG. 8;
[0030] FIGS. 10A and 10B are schematic representations of the
equipment and set-up used to perform the two disclosed methods for
measuring Z-axis impedance;
[0031] FIG. 11 is a schematic cross-sectional view of an example of
an electrode according to the present disclosure;
[0032] FIG. 12 is an expanded view of an electrode according to the
present disclosure; and
[0033] FIG. 13 is a schematic cross-sectional view of the electrode
of FIG. 12.
DESCRIPTION OF THE DISCLOSURE
[0034] As used herein, spatial or directional terms, such as
"inner", "left", "right", "up", "down", "horizontal", "vertical"
and the like, relate to the invention as it is described herein.
However, it is to be understood that the invention can assume
various alternative orientations and, accordingly, such terms are
not to be considered as limiting. For the purposes of this
specification, unless otherwise indicated, all numbers expressing
quantities of ingredients, reaction conditions, dimensions,
physical characteristics, and so forth used in the specification
and claims are to be understood as being modified in all instances
by the term "about." Accordingly, unless indicated to the contrary,
the numerical parameters set forth in the following specification
and attached claims are approximations that may vary depending upon
the desired properties sought to be obtained by the present
invention. At the very least, and not as an attempt to limit the
application of the doctrine of equivalents to the scope of the
claims, each numerical parameter should at least be construed in
light of the number of reported significant digits and by applying
ordinary rounding techniques.
[0035] Notwithstanding that the numerical ranges and parameters
setting forth the broad scope of the invention are approximations,
the numerical values set forth in the specific examples are
reported as precisely as possible. Any numerical value, however,
inherently contain certain errors necessarily resulting from the
standard deviation found in their respective testing
measurements.
[0036] Also, it should be understood that any numerical range
recited herein is intended to include all sub-ranges subsumed
therein. For example, a range of "1 to 10" is intended to include
any and all sub-ranges between and including the recited minimum
value of 1 and the recited maximum value of 10, that is, all
subranges beginning with a minimum value equal to or greater than 1
and ending with a maximum value equal to or less than 10, and all
subranges in between, e.g., 1 to 6.3, or 5.5 to 10, or 2.7 to
6.1.
[0037] Biomedical electrodes (referred to herein as simply
"electrodes") may be used for defibrillating, pacing,
cardioversion, and/or monitoring the activity of a subject's heart.
The electrodes disclosed herein are suitable for use on human
subjects or patients, although use on non-human subjects is also
contemplated. Examples of electrodes as disclosed herein can be
coupled with power sources and control logic to deliver electrical
energy to a subject, to determine the timing, levels, and history
of applied energy, and to process monitored or detected data for
analysis by, for example, a health care provider. Examples of
electrodes as disclosed herein may be located proximate to the
subject, for example, attached, connected, or coupled to the
subject, at an anterior, posterior, lateral, or other location on
the subject. For example, examples of electrodes as disclosed
herein can be attached to the subject's chest, back, side, head,
abdomen, torso, thorax, or legs. In some examples, the electrodes
disclosed are configured to be attached to the subject proximate to
the subject's heart.
[0038] In various instances, it may be desirable to provide
non-invasive externally placed electrodes for an extended period of
time to allow for defibrillation, to pace the heart, and/or to
monitor the heart of a subject, for example, while the subject is
recovering from a heart attack, surgery, or other injury to the
heart, while awaiting a heart transplant, or to monitor and/or
protect a subject at risk of syncope. In some prior art
externally-attached biomedical electrodes, attachment of the
electrodes to the skin of a subject may result in skin irritation
at the point of attachment within a relatively short period of time
ranging, for example, from about a few hours to about a few days.
Extended-wear electrodes in accordance with examples of the present
disclosure are constructed of materials, for example, adhesive
films and electrically conducting materials, which can reduce the
occurrence of skin irritation and/or extend the time for which the
electrode may be comfortably attached to the skin of a subject.
[0039] In some examples, extended-wear electrodes in accordance
with the present disclosure may be worn continuously by a subj ect
for a time period in excess of, for example, three days, for a week
or more, or for up to about two weeks or more without the subject
experiencing significant skin irritation due to the attachment of
the electrode to the skin of the subject. As used herein
"significant skin irritation" is defined as corresponding to a skin
irritation grading of one (a weakly positive reaction usually
characterized by mild erythema and/or dryness across most of the
treatment site) or more as set forth in Table C.1 of Annex C of
AANI/AAMI/ISO standard 210993-10:2010 when electrodes are tested on
human subjects in accordance with the method set forth in this
standard. As used herein, the terms "long-term wear" or
"extended-wear" refer to continuous or substantially continuous
contact of an electrode with the skin of a subject for a time
period in excess of, for example, three days, for a week or more,
or for up to about two weeks or more. The extended-wear electrodes
disclosed herein can have the ability to apply a defibrillation
charge to, or perform cardioversion on, a subject wearing the
electrodes and may, in addition, monitor and/or pace the heart of a
subject. Examples of the electrodes disclosed herein may be
compliant with the ANSI/AAMI DF80:2003 medical electrical equipment
standard for the safety of cardiac defibrillators.
[0040] As discussed above, conventional electrodes using vapor
impermeable materials may trap vapor emanating from the surface of
a patient's skin. The water vapor emanating from intact skin can be
significant, on the order of 240-1,920 g/m.sup.2 per 24 hours
[Thomas S. Handbook of Wound Dressings. Macmillan: London, 1994].
In contrast, in some examples, the extended-wear electrodes in
accordance with the present disclosure may provide for the passage
of water vapor, for example, a patient's sweat, through the
electrode to facilitate reduction in skin irritation, for example
when the electrode is used for "long-term wear" or "extended-wear"
regimens. Extended-wear electrodes in accordance with the present
disclosure may exhibit a moisture vapor transmission rate (MVTR)
of, for example, between about 600 g/m.sup.2/day and about 1,400
g/m.sup.2/day when worn by a subject in an environment at room
temperature (e.g., about 25.degree. C.) and at a relative humidity
of, for example, about 70%.
[0041] In some systems, the defibrillator, TCP, or other device
capable of delivering therapeutic electrical current may be
incorporated into a wearable device in which case such a device can
continuously monitor the physiologic status of the patient over an
extended period of time of hours, days, and even months. In such
cases, the wearable therapeutic system can be configured to be
light and comfortable enough for a patient to be able to sleep,
walk, and engage in all the normal daily activities. In particular,
the current-carrying electrodes for delivery of the therapeutic
electrical current may be configured such that electrical contact
be made between the conductive element of the electrode and the
patient's skin at the time of delivery of the therapeutic current,
while at the same time be wearable for extended periods without
damage to the patient's skin.
[0042] Extended-wear electrodes in accordance with examples of the
present disclosure may provide one or more advantages over prior
art electrodes, for example the ability to wear the electrodes for
an extended period of time may reduce the number of electrodes
consumed over a given period of time, reducing the cost associated
with replacing electrodes which are not suitable for use in
extended-wear scenarios, for example, for time periods greater than
about a week.
[0043] Discomfort of a subject associated with wearing the
electrodes may be decreased due to a reduction in skin irritation
caused by the extended-wear electrodes as compared to conventional
electrodes. Discomfort of a subject associated with wearing the
electrodes may also be decreased due to a reduction in the number
of times which an extended-wear electrode may need to be removed
from the skin of the subject or repositioned, resulting in possible
damage to the underlying skin, as compared to conventional
electrodes. Further, accuracy of monitoring of the heart of a
subject may be facilitated by the use of extended-wear electrodes
by keeping the monitoring electrodes in the same position rather
than replacing them and mounting them in potentially different
positions as may occur with electrodes which should be replaced
frequently or repositioned due to the occurrence of skin
irritation.
[0044] Electrodes in accordance with some examples of the present
disclosure may be combined as part of a long-term wear device, for
example, as part of known non-invasive bodily-attached ambulatory
medical monitoring and treatment devices, such as the Life
Vest.RTM. Wearable Cardioverter Defibrillator available from ZOLL
Medical Corporation. Electrodes in accordance with some examples of
the present disclosure may be used in syncope monitoring and/or
treatment devices such as described in U.S. patent application Ser.
No. 13/907,406, titled SYSTEMS AND METHODS FOR DETECTING HEALTH
DISORDERS, now U.S. Pat. No. 9,814,894, the disclosure of which is
incorporated by reference herein in its entirety.
[0045] As shown in FIG. 1, two electrodes 12, 14 may be connected
to a wearable defibrillator/monitor 16 via a cable harness 18 and
cable connectors 20a, 20b. The defibrillator/monitor 16 may
communicate with the electrodes 12, 14 to monitor the patient,
provide pacing impulses to the patient, and to transmit
defibrillation energy to the patient. While a wearable
defibrillator/monitor 16 is described with reference to FIG. 1,
this is not to be construed as limiting the present disclosure, as
any suitable therapeutic current delivery system may be utilized
with the electrodes 12, 14 disclosed herein, such as a pacing
device or a transcutaneous electrical nerve stimulation device. If
a defibrillation system is used, an energy setting can be in a
range of 150-360 Joules. For example, the energy setting can be
about 200 Joules. In some examples, if a pacing device is used, an
initial energy setting may be configured to have the device deliver
through an electrode a 10-40 ms current pulse of energy at a
current of at least 50 mAmps.
[0046] In one example, two electrodes 12, 14 may be used. An apex
electrode 12 is placed on the patient's left abdomen and back and
an anterior electrode 14 is placed on the patient's upper right
chest as shown in FIG. 1. The electrodes 12, 14 may be provided,
for example, to apply electrical treatment or shock, or may further
comprise at least one sensing element 30 as shown in FIGS. 2-7. For
example, the apex electrode 12, shown in FIGS. 2, 4, and 6, can
include, e.g., two sensing elements 30, and the anterior electrode
14, shown in FIGS. 3, 5, and 7, can include, e.g., one sensing
element 30.
[0047] In one example, the electrodes 12, 14 can comprise a
conductive, water vapor-permeable adhesive material that is
configured to be positioned against the skin of a patient. The
conductive adhesive material provides the function of adhesion and
conduction of current primarily in the Z-axis direction (orthogonal
to the plane of the electrode). The electrodes 12, 14 can also
comprise a current dispersing element such as, but not limited to,
a conductive mesh. The current dispersing element provides the
function of current dispersal in the X-Y directions (laterally,
along the plane of the electrode) to ensure the current
distribution is more uniform, thus preventing burning of the
patient's skin as a result of therapeutic current delivery that is
uneven across the face of the electrode and causing electrical
current burns on the patient. The electrodes 12, 14 can also
comprise an outermost layer away from the patient's skin. This
layer provides the functions of electrical insulation, preventing
shocks to bystanders, and functions as a water-resistant or
water-proofing layer so that the electrodes 12, 14 may be worn in
the shower or while bathing.
[0048] Referring to FIGS. 2-7, prior to application to the skin of
the patient, each electrode 12, 14 comprises: at least one
non-conductive, flexible, water vapor-permeable, electrically
insulating top layer 22 that provides, e.g., protection from short
circuiting of the electrode against adjacent conductive objects in
the vicinity of the patient during a defibrillation shock; a
current dispersing element 24a, 24b, e.g., comprising or made from
a flexible, conductive, water vapor-permeable mesh providing
enhanced conductivity and mechanical support; a flexible, water
vapor-permeable, conductive adhesive material 26 for contact with
the patient's skin; and optionally a removable backing 28.
[0049] The flexible, water vapor-permeable, conductive adhesive
material 26 for contact with the patient's skin may comprise or be
made from materials including, but not limited to, a spun adhesive
polymer such as an electro-spun polyurethane adhesive, for example,
as described in Khil et al., "Electrospun Nanofibrous Polyurethane
Membrane as Wound Dressing", Journal of Biomedical Materials
Research Part B: Applied Biomaterials, 67(2), pp. 675-679, 2003,
the disclosure of which is incorporated by reference herein in its
entirety, and as shown in FIG. 8.
[0050] In one example, such electrospun polyurethane adhesive can
be produced using an electrospinning setup shown in FIG. 9. Polymer
solutions are injected through a syringe 60. A positive electrode
62 is inserted into the solution and a rotational collector 64 is
placed at an appropriate distance from the tip of the syringe 60 to
act as a grounded counter electrode. As an electrical potential is
applied, a polymer stream 66 is created. The polymer stream 66,
formed by electrical forces, follows a complicated stretching and
looping pattern as it solidifies. The resulting fibers 68 are
collected on the rotational collector 64 to produce a sheet of
membrane.
[0051] In order to achieve conductive qualities in the flexible,
water vapor-permeable, conductive adhesive material 26, conductive
particles may be injected into the housing containing the apparatus
of FIG. 9. The conductive particles may be microscopic or
nano-scale particles or fibers of materials, including but not
limited to, one or more of carbon black, silver, nickel, graphene,
graphite, carbon nanotubes, and/or other conductive biocompatible
metals such as aluminum, copper, gold, and/or platinum. The
conductive particles may be sprayed into the housing where the
electrospinning is occurring and are charged with the opposite
polarity as the polymer stream 66. The conductive particles are
attracted to and bonded to the polymer stream 66 resulting in a
conductive adhesive sheet.
[0052] Alternatively, the flexible, water vapor-permeable,
conductive adhesive material 26 may be fabricated via such known
means for creating polymerized microemulsion pressure sensitive
adhesives as described in U.S. Pat. No. 5,670,557, the disclosure
of which is incorporated by reference herein in its entirety.
During the mixing process of the microemulsion, the previously
described conductive particles are added and dispersed into the
microemulsion. The conductive particles may further be treated to
preferentially attract to one or the other of the two domains of
the microemulsion. Thus, if one domain is designed to evaporate,
leaving a microporous structure, the conductive particles will
reside in the evaporating layer, and then eventually coat the
inside walls of the porosities in the final film. Alternatively, an
electroplating process can be used to plate copper, silver
chloride, or other metal onto the inner walls of the microporous
structure.
[0053] Alternatively, an appropriate organic conductive or
semi-conductive polymer or other compound, such as
poly(3,4-ethylene dioxythiophene), doped with poly(styrene
sulfonate), (PEDOT:PSS) poly(aniline) (PAM), poly(thiophene)s like
poly(3-hexylthiophene) (P3HT) and poly(9,9-dioctylfluorene
co-bithiophene) (F8T2) can be used to prepare the conductive
adhesive. Such polymers can be printed as a flexible, water
vapor-permeable, conductive adhesive layer using such methods as
inkjet printing, screen printing, offset printing, flexo printing,
and gravure printing.
[0054] The flexible, water vapor-permeable, conductive adhesive
material 26 is designed to be sufficiently conductive in a
direction substantially orthogonal to a plane of the electrode
(i.e., in the Z-axis) by, e.g., controlling both its thickness and
a density and shape of the conductive particles that are dispersed
in the adhesive polymer matrix. Composite material properties,
which result when conductive particles are dispersed into a polymer
matrix, may be influenced by the particle volume fraction. The
conductive paths are formed by metal particles. At critical
concentration, a connected chain network of particles first appears
in the system. As the particle concentration is increased, the
fraction of particles in this network increases. Such a network can
contribute to the major conduction process. This is known as
Percolation Theory of conductive adhesives. Several factors are
known to affect the magnitude of the threshold volume fraction,
such as particle size distribution, particle shape, and
pre-treatment of the particle. For an adhesive that is
preferentially conductive in the Z-direction, the volume loading of
conductive particles can be on the order of 5-25% by volume. The
geometry of the conductive particles themselves may be
approximately spheroidal, flake, or needle-like. The size of the
conductive particles may be in the range of, though not limited to,
about 1 to about 100 .mu.m. While the conductive adhesive layer 26
may range in thickness from 0.25 to 50 thousandths of an inch or
more, in some implementations the thickness is about 1 to 10 mils.
The conductive particles may also be nano-sized particles. The
conductive particles may be pre-treated with an etchant such as
phosphoric acid, and/or coated with an interfacial coupling agent
such as a silane. The silane may be designed to provide some level
of semi-conductivity or conductivity. Alternative coupling agents
such as thiols, carboxylate, or others may also be used. Such
adhesives are discussed in detail in Sancaktar, E. et al.,
"Electrically Conductive Epoxy Adhesives", Polymers, vol. 3, pp.
427-466, 2011, the disclosure of which is incorporated by reference
herein in its entirety.
[0055] The current dispersing elements 24a, 24b may comprise a
flexible, conductive mesh that can provide enhanced conductivity
and mechanical support for the structure or any other suitable
flexible, conductive material. Without it, the flexible, water
vapor-permeable, conductive adhesive material 26 can be
insufficiently conductive in the lateral (X-Y) direction to carry
defibrillation current through the cable connectors 20a, 20b to the
patient without substantial current or voltage degradation. The
mesh may be a simple metallic mesh composed, for example, of
copper, tin, nickel, silver, gold, and/or other conductive,
biocompatible material as discussed in detail above. The gauge and
weave of the mesh are designed to be conformable to the body.
Generally, the gauge of the wire is higher than 22 AWG (smaller
diameter, less than 0.0253 inches). In some examples, the gauge is
around 60 AWG, with the mesh opening spaces making up at least 30%
of the mesh surface area. In some examples, the mesh occupies less
than 15% of the surface area of a plane defined by the mesh. In
other examples, the mesh may comprise nickel-plated carbon-filled
fibers. The current dispersing elements 24a, 24b may be formed into
the conductive adhesive material 26, during the polymerization of
the conductive pre-polymer solution, thereby creating a single
structure that incorporates the functionality of both the current
dispersal element 24a, 24b and the adhesive 26. In addition, the
conductive adhesive material 26 is not required to be a sheet or
continuous film interposed between the current dispersing elements
24a, 24b and the patient's skin. In one example, the conductive
adhesive material 26 can be sprayed or applied as a coating onto
the current dispersing elements 24a, 24b.
[0056] In one example, the current dispersing elements 24a, 24b can
be positioned between the flexible, water vapor-permeable,
conductive adhesive layer 26 and a non-conductive, flexible, water
vapor-permeable, electrically-insulating top layer 22 as discussed
in greater detail hereinafter.
[0057] In some examples, the current dispersing elements 24a, 24b
is adhered to the conductive adhesive layer 26 by positioning the
current dispersing elements 24a, 24b in contact with or facing
engagement with at least a portion of the adhesive portion, such
that at least the contacting portion of the current dispersing
elements 24a, 24b is adhered to the adhesive material 26. In some
examples, the optional removable backing 28 can be adjacent to the
adhesive material 26 prior to contact with the current dispersing
elements 24a, 24b, and heat and/or pressure can be applied to form
an adhesive bond between the current dispersing elements 24a, 24b
and the adhesive material 26. The adhesive material itself may be
designed to bond self-adhesively to the other layers in contact
with it. Additional current dispersing materials may be interposed
between the current dispersing elements 24a, 24b and the conductive
adhesive material 26. The additional current dispersing material
may take the form of sprayed conductive nano- or micro-particles
such as carbon black or nickel flake. For example, this can improve
current uniformity in the case when the current dispersing element
is made of a metallic wire mesh.
[0058] The top layer 22 is generally non-conductive, flexible,
water vapor-permeable, electrically-insulating, and optionally at
least substantially liquid-impermeable or waterproof. The
non-conductive flexible, water-vapor permeable,
electrically-insulating top layer 22 may comprise or consist of
polyurethane, such as Tegaderm.TM. polyurethane film (available
from 3M), Opsite.TM. polyurethane film (available from Smith &
Nephew), or Hydrofilm.TM. polyurethane film (available from Hartman
USA). The top layer 22 can provide some protection from
defibrillation current inadvertently shocking someone close to the
patient. In addition, where the top layer 22 is waterproof, the
extended-wear electrodes disclosed herein may be worn when the user
is showering.
[0059] With respect to the top layer 22, as used herein, the term
"non-conductive" means impedance in excess of 1000 ohms by the
Z-axis Impedance Measurement Method 1 discussed hereinafter. With
respect to the top layer 22, as used herein, the term
"electrically-insulating" means using the test set-up of Z-axis
Impedance Measurement Method 1 discussed hereinafter, then applying
120+/-10 VDC, 15 second duration, with leakage current not to
exceed 100 microamps. With respect to the top layer 22, as used
herein, the term "liquid-impermeable" means waterproof per AATCC
127-2014. In some embodiments, the top layer 22 may be composed of
Tegaderm, and the top layer 22 contains its own adhesive with which
the Tegaderm is affixed to the underlayers of the current
dispersing elements 24a, 24b, or alternatively may be a
GORE-TEX.RTM. PTFE film that is adhesively affixed to the
underlayers. The top layer 22 in some implementations has a larger
diameter than the other sublayers, thus providing an
adhesively-sealed perimeter that provides both waterproofing as
well as enhanced electrical insulation.
[0060] In an example, the electrodes 12, 14 are a laminate
structure with the adhesive material 26, the current dispersing
elements 24a, 24b, and the top layer 22 being laminated together.
In such an example, the flexural rigidity of the electrodes 12, 14
is, by necessity, is equal to or greater than the flexural rigidity
of each of the individual components. The overall flexural rigidity
of the electrodes 12, 14 can be less than 40 grams/cm.sup.2, as
measured using the ASTM D1388-14, "Standard Test Method for
Stiffness of Fabrics". This standard requires the electrode 12, 14
to be slid at a specified rate in a direction parallel to its long
dimension until its leading edge projects from the edge of a
horizontal surface. The length of the overhang is measured when the
tip of the specimen is depressed under its own mass to a point
where the line joining the top to the edge of the platform makes a
41.5.degree. angle with the horizontal. From this measured length,
the bending length and flexural rigidity are calculated using the
following equations.
c=O/2
where: [0061] c=bending length, mm; and [0062] O=length of
overhang.
[0062] G=1.421.times.10.sup.-5.times.W.times.c.sup.3
where: [0063] G=flexural rigidity; [0064] W=fabric mass per unit
area; and [0065] c=bending length.
[0066] In addition, in one example, the vapor permeability of the
electrodes 12, 14 is greater than 100 gram/meter.sup.2/24 hours, as
measured by such vapor transmission standards of ASTM E-96-80
(Version E96/E96M-13), using either the "in contact with water
vapor" ("dry") or "in contact with liquid" ("wet") methods
discussed in greater detail hereinafter.
[0067] The electrodes 12, 14 may be used to deliver other forms of
high-power therapeutic electrical current to the patient other than
defibrillation, for instance external TCP used to keep a
bradycardic heart beating at a normal rate or other cardiac
conditions. "High power" is here considered an electrical pulse in
excess of 1 Joule or 20 milliamps.
[0068] The present disclosure is not limited to any particular
shape for the electrode, or of the components thereof, and any one
or more components of an electrode in accordance with the present
disclosure may have different shapes than those illustrated. For
example, the current dispensing element 24a can be segmented with a
low surface area and high perimeter as compared to a circular or
square electrode and as shown in FIGS. 2-5 where the current
dispersing element 24a takes a clover shape having four circular
segments. The overall size and shape of the current dispersing
element 24a may differ from that of the adhesive material 26 and/or
the top layer 22. Overall area for the electrode when used in
pacing or defibrillation can be about 25-200 inches.sup.2.
[0069] Alternatively, the current dispersing element 24b may be
non-segmented and may be oval, triangular, square, pentagonal, or
any other shape desired. As shown in FIGS. 6 and 7 for example, the
current dispersing element 24b is a single, large circle.
[0070] A small area of the non-conductive, flexible, water
vapor-permeable, electrically-insulating top layer 22 is relieved
to expose a small area, of approximately 0.25 square inches
.+-.90%, of the current dispersing elements 24a, 24b. Wires 32, 34
(shown in FIG. 1) of the cable connectors 20a, 20b are attached to
the electrodes 12, 14 by a connector, such as a rivet or clamp
mechanism directly to the current dispersing elements 24a, 24b, and
an additional small piece(s) of adhesive material 26 may be used to
cover any small regions of exposed conductive surfaces in the area
of the attachment.
[0071] In some examples, backing 28 can be attached to the adhesive
material 26. The backing 28 extends beyond the outer surfaces of
the electrodes 12, 14 in order to provide an area for the user to
grasp the backing 28 when removing it from the electrodes 12, 14
for placement on the patient. The backing 28 may be made from
liners made of or coated with polyethylene, polypropylene, and
fluorocarbons and silicone coated release papers or polyester
films, for example.
[0072] If present, the sensing elements 30 can be positioned
between the flexible, water vapor-permeable, conductive adhesive
material 26 and the non-conductive, flexible, water
vapor-permeable, electrically-insulating top layer 22. The sensing
elements 30 may be made of a core plastic or metal substrate
element that is coated with a thick-film polymeric compound filled
with a conductive Ag/Ag/Cl metallic filler, as is currently used by
most ECG electrode manufacturers such as Biodetek (Pawtucket,
R.I.). Alternatively, the sensing function may be provided by the
electrodes 12, 14 themselves, and the separate sensing element is
eliminated.
[0073] Both the current dispersing elements 24a, 24b and the
sensing element 30 may include a portion which extends through the
top layer 22 to contact an electrical connector 38 (shown in FIG.
1). The electrical connector 38 may include a protrusion that acts
as a snap for connection of the wires 32, 34 of the cable
connectors 20a, 20b or may take any other suitable form including,
but not limited to a structure suitable for attaching an alligator
clip. Alternatively, the wires 32, 34 of the cable connectors 20a,
20b may be directly hard wired to the current dispersing elements
24a, 24b and/or the sensing element 30 as described above.
[0074] Alternatively, the current dispersing elements 24a, 24b
could be used both for defibrillation and sensing and the sensing
elements 30 could be eliminated.
[0075] As can be seen in FIGS. 2-7, the top layer 22 can be
configured to completely cover the current dispersing elements 24a,
24b and the sensing element 30. However, the surface area of the
top layer 22 is minimized as much as possible so that the amount of
the patient's skin that is subjected to possible irritation is
minimized. Along these lines, it can be seen when comparing FIGS.
2, 4, and 6 to FIGS. 3, 5, and 7, that when using the segmented
current dispersing element 24a, the sensing elements 30 can be
moved closer to the center of the electrodes 12, 14 than when using
the non-segmented current dispersing element 24b, thus reducing the
overall area of the electrodes 12, 14.
[0076] A frame 40 may be provided on the outer surface of the top
layer 22 to give some structural stability to the electrodes 12, 14
after being removed from the backing 28 and before being placed on
the patient's skin. The frame 40 may cover the entire surface of
the top layer 22 or, as shown in FIGS. 2-7, may be disposed only
around the perimeter of the electrodes 12, 14 extending a short
distance toward the center of the electrodes 12, 14. The frame 40
may include any number or shape of extensions or tabs 42 that
extend beyond the perimeter of the electrodes 12, 14 to assist in
removal of the electrodes 12, 14 from the backing 28 for placement
on the patient's skin, and the frame 40 from the electrodes 12, 14
after the electrodes 12, 14 have been placed on the patient's skin.
The frame 40 may also include one or more perforations or score
lines to assist in its removal.
[0077] In use, the backing 28 is peeled from the electrodes 12, 14.
The electrodes 12, 14 are placed on the patient's skin and pressed
into place. The frame 40 is then removed from the electrodes 12,
14.
[0078] The electrodes 12, 14 can be capable of undergoing, without
failure, at least one current pulse delivered by a current
generating device, such as a defibrillator or pacemaker, the pulse
being of at least 1 millisecond in duration and 200 volts peak and
at least 1 Ampere peak.
[0079] Vapor Permeability
[0080] As mentioned hereinabove, the electrodes 12, 14 are vapor
permeable to allow the electrodes 12, 14 to be worn continuously by
the patient for more than 24 hours. Vapor permeability of the
complete electrode assembly is greater than 100 gram/m.sup.2/24
hours, as measured by such vapor transmission standards of ASTM
E-96-80 (Version E96/E96M-13), using either the "in contact with
water vapor" ("dry") or "in contact with liquid" ("wet") methods.
Such test methods are described in U.S. Pat. No. 6,548,727, the
disclosure of which is incorporated by reference herein in its
entirety. These test methods are discussed in additional detail
below.
[0081] Moisture Vapor Transmission Rate (Standard "Dry" Method)
[0082] A sample (3.5-cm diameter) is placed between
adhesive-containing surfaces of two foil adhesive rings, each
having a 2.54-cm diameter hole. The holes of each ring are
carefully aligned. Finger pressure is used to form a foil/sample
assembly that is flat, wrinkle-free, and has no void areas in the
exposed sample.
[0083] A 120-mid glass jar is filled to the halfway level with
deionized water. The jar is fitted with a screw-on cap having a
3.8-cm diameter hole in the center and a 4.45-cm diameter rubber
washer having a 2.84-cm diameter hole in its center. The rubber
washer is placed on the lip of the jar and the foil/sample assembly
is placed on the rubber washer. The lid is then screwed loosely on
the jar.
[0084] The assembly is placed in a chamber at 38.degree. C. and 20%
relative humidity for four hours. At the end of four hours, the cap
is tightened inside the chamber so that the sample is level with
the cap (no bulging) and the rubber washer is in the proper seating
position.
[0085] The foil/sample assembly is then removed from the chamber
and weighed immediately to the nearest 0.01 gram (initial weight
W1). The assembly is then returned to the chamber for at least 18
hours, after which it is removed and weighed immediately to the
nearest 0.01 gram (final weight W2). The moisture vapor
transmission (MVTR) in grams of water vapor transmitted per square
meter of sample area in 24 hours is calculated according to the
following formula (where "T1" refers to exposure time in
hours):
"Dry" MVTR=(W1-W2)(4.74.times.104).+-.T1
[0086] Three measurements are taken and averaged, and the "dry"
MVTR value is reported as grams/m.sup.2/24 hrs.
[0087] Moisture Vapor Transmission Rate (Inverted "Wet" Method)
[0088] The inverted "Wet" Moisture Vapor Transmission Rate
(Standard "Dry" Method) (MVTR) is measured using the following test
procedure. After obtaining the final "dry" weight (W2) as described
for the "dry" MVTR procedure, the assembly is returned to the
chamber (38.degree. C. and 20% relative humidity) for at least 18
additional hours with the sample jars inverted so that the
deionized water is in direct contact with the test sample. The
sample is then removed from the chamber and weighed to the nearest
0.01 gram (final "Wet" weight, W3). The inverted "Wet" MVTR in
grams of water vapor transmitted per square meter of sample area in
24 hours is calculated according to the following formula (where
"T2" refers to exposure time in hours):
Inverted "Wet" MVTR=(W2-W3)(4.74.times.104).+-.T2
[0089] Three measurements are taken and averaged, and the "wet"
MVTR value is reported as g/m.sup.2/24 hrs.
[0090] Peel Adhesion
[0091] The electrode 12, 14 also meets the peel adhesion test
established by the Pressure Sensitive Adhesive Tape Council of
Chicago, Ill. ("PSTC"): namely, PSTC-1 (11/75) entitled "Peel
Adhesion for Single Coated Tapes 180.degree. Angle", ("PSTC-1
Test"), the disclosure of which is incorporated by reference herein
in its entirety. This test is described in U.S. Pat. Nos.
5,670,557, 4,952,650, and 4,833,179, the disclosures of which are
incorporated by reference herein in their entireties. The PSTC-1
Test determines peel adhesion as the force required to remove a
pressure sensitive adhesive tape from a panel or its own backing at
a specified angle and speed. The electrode 12, 14 has a peel
adhesion of at least 3 N/100 mm as determined by the PSTC-1 Test.
This test method is discussed in additional detail below.
[0092] Peel Adhesion Test
[0093] Peel adhesion is the force required to remove a coated
flexible sheet material from a test panel measured at a specific
angle and rate of removal. This force is expressed in Newtons per
100 mm (N/100 mm) width of coated sheet. A 12.5 mm width of the
coated sheet is applied to the horizontal surface of a clean glass
test plate with at least 12.7 lineal cm in firm contact. A hard
rubber roller is used to apply the strip. The free end of the strip
is doubled back nearly touching itself, so the angle of removal
will be 180.degree.. The free end is attached to the adhesion
tester scale. The glass test plate is clamped in the jaws of a
tensile testing machine which is capable of moving the plate away
from the scale at a constant rate of 2.3 meters per minute. The
scale reading in Newtons is recorded as the tape is peeled from the
glass surface. The data is recorded as the average value of the
range of numbers observed during the test.
[0094] Impedance
[0095] Impedance of the disclosed electrode may be measured in
three different ways as described in "3M.TM. Electrically
Conductive Cushioning Gasket Tape ECG-8035/ECG-8055/ECG-8075",
Technical Data, February, 2010, the disclosure of which is
incorporated by reference herein in its entirety.
[0096] Z-Axis Impedance Measurement Method 1
[0097] As shown in FIG. 10A, a 25.4 mm.times.25.4 mm sample is
placed between two 25.4 mm.times.25.4 mm gold plated brass probes,
and the sample assembly is placed under a 1 kg load. The impedance
is measured using a 60 second dwell time and reported in ohms
(.OMEGA.). Using this method, the Z-axis impedance of the
conductive adhesive material 26 is less than 25 ohms.
[0098] Z-Axis Impedance Measurement Method 2
[0099] As shown in FIG. 10B, a 10 mm.times.10 mm sample is placed
between two gold plated brass probes. The impedance is measured
using a 60 second dwell time without any load and reported in ohms
(.OMEGA.). Using this method, the Z-axis impedance of the
conductive adhesive material 26 is less than 50 ohms. Satisfying
these two test methods can constitute "conductive" in the Z-axis
direction.
[0100] Surface Impedance Measurement
[0101] The surface of a sample is contacted by a 25 mm.times.25 mm
Cu plate for 10 seconds and the impedance is measured and reported
in ohms sq. (.OMEGA./.quadrature.). Using this method, the surface
impedance of the conductive adhesive material 26 is less than 100
ohms/sq.
[0102] X-Y Axis Impedance Measurement
[0103] A 25.4 mm.times.75 mm wide strip of conductive adhesive
material is cut out. 25 mm of the length is adhered to one of the
25.4 mm wide gold plated brass probes of FIG. 10A, and then the
upper probe is placed on top as in the figure. At the other end of
the strip, a 25 mm is adhered in the same fashion to a second pair
of probes. Impedance is then measured along the length of the
strip. Using this method, the impedance shall exceed 5 ohms.
Satisfying this test condition constitutes "semi-conductive" in the
X-Y directions.
[0104] The same X-Y axis Impedance Measurement is performed for the
current dispersing element. Using this method, the impedance shall
be less than 5 ohms. Satisfying this test condition shall
constitute "conductive" in the X-Y directions. In some examples,
the current dispersing element is also conductive in the
Z-direction such that the current dispersed in the X-Y direction is
guided to the conductive adhesive 26 and to the patient.
[0105] For the case when the electrodes are to be used for
defibrillation, the impedance of the electrodes when measured using
the AAMI DF-2 large signal impedance test shall not exceed 10
ohms.
[0106] With reference to FIG. 11, for example, current from the
cable connector 20a is provided to the current dispersing elements
24a, 24b, which is conductive at least laterally along the plane of
the electrodes 12, 14 as denoted by arrows A.sub.1. Accordingly,
the current dispersing elements 24a, 24b are conductive at least in
the X-Y direction and distribute an electric current over a plane
of the electrode. Further, at a plurality of points along the
current dispersing elements 24a, 24b, the current can move downward
in the Z-axis direction. Accordingly, the current dispersing
elements 24a, 24b are conductive in a direction orthogonal to the
plane of the electrode or conductive in the Z-axis direction as
denoted by arrows A.sub.2 in FIG. 11. The conductive adhesive
material 26 of the electrodes 12, 14 is conductive in a direction
substantially orthogonal to the plane of the electrode 12 as
denoted by arrows A.sub.2. Accordingly, the conductive adhesive
material 26 is conductive in the Z-axis direction. In addition, the
conductive adhesive material 26 is also semi-conductive in a
direction substantially laterally along the plane of the electrodes
12, 14 as denoted by arrows A.sub.3. Accordingly, the conductive
adhesive material 26 is semi-conductive in the X-Y directions.
[0107] With reference to FIG. 12, another example of an electrode
112 comprises at least one non-conductive, flexible, water
vapor-permeable, electrically insulating top layer 122 that
provides, e.g., protection from short circuiting of the electrode
against adjacent conductive objects in the vicinity of the patient
during a defibrillation shock; a flexible, water vapor-permeable,
conductive adhesive material 126 for contact with the patient's
skin; and optionally a removable backing 128.
[0108] In this example, the conductive adhesive material 126 can
comprise conductive particles distributed in a polymer material to
provide conductive paths. Accordingly, the conductive adhesive
material 126 can be manufactured from any of the materials
described hereinabove with reference to conductive adhesive
material 26.
[0109] In addition, the top layer 122 can be generally
non-conductive, flexible, water vapor-permeable,
electrically-insulating, and optionally at least substantially
liquid-impermeable or waterproof. The non-conductive flexible,
water-vapor permeable, electrically-insulating top layer 122 may
comprise or consist of polyurethane, such as Tegaderm.TM.
polyurethane film (available from 3M), Opsite.TM. polyurethane film
(available from Smith & Nephew), or Hydrofilm.TM. polyurethane
film (available from Hartman USA). The top layer 122 can provide
some protection from defibrillation current inadvertently shocking
someone close to the patient. In addition, where the top layer 122
is waterproof, the extended-wear electrodes disclosed herein may be
worn when the user is showering.
[0110] With reference to FIG. 13, for example, the conductive
adhesive material 126 is configured to substantially distribute a
therapeutic current from a therapeutic current delivery device (not
shown) over the plane of the electrode 112 prior to delivery to a
subject. Current from a cable connector 120 connected between the
therapeutic current delivery device and the conductive adhesive
material 126 is provided, the conductive adhesive material 126 as
denoted by arrows B.sub.1. Since the conductive adhesive material
126 includes a plurality of conductive particles distributed in a
polymer material, the conductive adhesive material 126 is
conductive in both lateral (denoted by arrows B.sub.2 and B.sub.4)
and orthogonal directions (denoted by arrows B.sub.3) to a plane of
the electrode. For example, the conductive adhesive material 126
can be configured by, e.g., controlling both its thickness and a
density and shape of the conductive particles that are dispersed in
the adhesive polymer matrix, to provide conductive paths in both
the lateral and orthogonal directions relative to the plane of the
electrode. In some examples, the conductive adhesive layer can be
applied as a coating to the electrically-insulating top layer.
Accordingly, the current distribution is uniform, thus preventing
burning of the patient's skin as a result of therapeutic current
delivery that is uneven across the face of the electrode and
causing electrical current burns on the patient. In some
implementations, a current dispersing element disposed in a similar
manner as described in connection with FIG. 11 can also be included
to improve current dispersing qualities of the electrode.
[0111] Electrodes in accordance with the present disclosure may
include additional features not illustrated, for example, adhesive
layers bonding the various components of the electrode together,
labeling, a mechanism for holding the electrical conductor in place
and in electrical contact with the conductive element, and/or
packaging. Exemplary additional features are disclosed in U.S.
patent application Ser. No. 13/079,336, titled BIOMEDICAL
ELECTRODE, now U.S. Pat. No. 9,162,045, the disclosure of which is
incorporated by reference herein in its entirety. Components of
electrodes in accordance with examples of the present disclosure
may be formed from materials having certain desirable properties.
For example, an electrode may be formed of materials that render it
radiolucent or radiotransparent, as disclosed in co-pending U.S.
patent application Ser. No. 13/079,336. Further, electrodes in
accordance with the present disclosure may communicate wirelessly
with other circuitry.
[0112] Electrodes in accordance with the present disclosure may be
substantially flat. For example, the electrodes may have a flat
profile that is not noticeable or is minimally noticeable when
attached to the subject, under the subject's clothes. The
electrodes may also be substantially flexible. For example, the
electrodes may conform to the contours of the subject's body during
initial attachment to the subject, and may conform to body
positioning changes when the subject is in motion. The electrodes
can also be substantially devoid of rigid components, such as hard
snaps, connectors, and rigid plates. For example, the electrodes
may be devoid of hard rigid substances that may cause uncomfortable
pressure points when a subject with the electrodes attached to
his/her body is in a prone, prostrate, supine, or lateral position
with the electrodes pressed against an object, such as a bed,
couch, medical examining table, clothes, or medical equipment.
[0113] As shown in FIG. 1, the cable harness 18, which is connected
to the defibrillator/monitor 16, includes three sensing element
wires, two current dispersing element wires, and two ground wires.
Two sensing element wires, one current dispersing element wire, and
one ground wire are contained in an apex composite cable 44 of the
cable harness 18 having an apex connector 46 for connecting the
apex composite cable 44 to the apex electrode cable connector 20a,
and one sensing element wire, one current dispersing element wire,
and one ground wire are contained in an anterior composite cable 48
of the cable harness 18 having an anterior connector 50 for
connecting the anterior composite cable 48 to the anterior
electrode cable connector 20b. The apex electrode cable connector
20a includes a connector 52 adapted for connection to the apex
connector 46 of the apex composite cable 44 and three individual
wires 32 each having a connector, such as a snap or an alligator
clip, for connecting to the electrical connectors 38 of the apex
electrode 12, and the anterior electrode cable connector 20b
includes a connector 56 for connection to the anterior connector 50
of the anterior composite cable 48 and two individual wires 34 each
having a connector for connecting to the electrical connectors 38
of the anterior electrode 14. The connectors 46, 50 of the cable
harness 18 and the connectors 52, 56 of the apex electrode cable
connector 20a and the anterior electrode cable connector 20b may
have structures, markings, colors, and the like so that it is clear
which connector 46, 50 of the cable harness 18 is to be connected
to the apex electrode cable connector 20a and which connector 46,
50 of the cable harness 18 is to be connected to the anterior
electrode cable connector 20b and may further include structure
that only allows the proper connection to be made.
[0114] The individual wires 32, 34 of the apex electrode cable
connector 20a and the anterior electrode cable connector 20b may
alternatively be hard wired to the electrical connectors 38 of the
electrodes 12, 14.
[0115] The length of the apex electrode cable connector 20a and the
anterior electrode cable connector 20b should be minimized,
especially when they are hardwired to the electrodes 12, 14, so
that they provide as little force on the thin flexible electrodes
12, 14 during placement on the patient's skin as possible. For
example, the apex electrode cable connector 20a and the anterior
electrode cable connector 20b should have a maximum length no
longer than 10 inches and preferably, no longer than 9 inches.
[0116] Although the disclosure has been described in detail for the
purpose of illustration based on what is currently considered to be
the most practical and preferred examples, it is to be understood
that such detail is solely for that purpose and that the disclosure
is not limited to the disclosed examples but, on the contrary, is
intended to cover modifications and equivalent arrangements that
are within the spirit and scope of the appended claims. For
example, it is to be understood that the present disclosure
contemplates that, to the extent possible, one or more features of
any example can be combined with one or more features of any other
example.
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