System and method for using diagnostic pulses in connection with defibrillation therapy

• US 10,213,613 B2
• Filed: 06/20/2016
• Issued: 02/26/2019
• Est. Priority Date: 01/31/2005
• Status: Active Grant

• Current Assignee: Physio-Control Incorporated (Stryker Corporation)
• Original Assignee: Physio-Control Incorporated (Stryker Corporation)
• Inventors: Hampton, David R., Banville, Isabelle
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Morales, Jon Eric C
• Application Number:
  US15/187,684
• Publication Number:
  US 20160287890A1
• Time in Patent Office: 981 Days
• Field of Search: 607 5, 600509
• CPC Class Codes: A61H 2031/002 fixed on the chest by adhesives
• CPC Class Codes: A61H 31/005 with feedback for the user
• CPC Class Codes: A61M 2230/005 Parameter used as control input for the apparatus
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/025 Digital circuitry features of electrotherapy devices, e.g. memory, clocks, processors
• CPC Class Codes: A61N 1/385 Devices for inducing an abnormal cardiac function, e.g. fibrillation
• CPC Class Codes: A61N 1/39044 in combination with cardiopulmonary resuscitation [CPR] therapy
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

An external defibrillator system is disclosed that generates and applies a diagnostic signal to the patient in conjunction with defibrillation therapy. The diagnostic signal is designed to elicit a physiologic response from the patient'"'"'s heart, namely, mechanical cardiac response and electrical cardiac response, electrical cardiac response only, or no cardiac response. Depending upon the type of cardiac response detected, the system selects an appropriate resuscitation protocol that considers the likely responsiveness of the patient to defibrillation therapy. In one practical embodiment, a stimulus signal is applied to patients that show mechanical and electrical capture in response to the diagnostic signal. The stimulus signal maintains the mechanical capture (and, therefore, perfusion) for a period of time prior to the delivery of a defibrillation pulse.

Claims

1. A method of treating a patient, comprising:

outputting a diagnostic stimulus signal to elicit a physiologic response from the patient, wherein the physiologic response comprises at least one of mechanical cardiac response, electrical cardiac response in the absence of mechanical cardiac response, or absence of both mechanical cardiac response and electrical cardiac response;

detecting the elicited physiologic response;

selecting one of a plurality of resuscitation protocols based upon the detected physiologic response, wherein at least one of the plurality of resuscitation protocols includes application of a defibrillation therapy, the selection based at least in part on a likely patient response to the defibrillation therapy; and

initiating the selected resuscitation protocol,

wherein, if the physiologic response is one of electrical cardiac response in the absence of mechanical cardiac response, initiating the selected resuscitation protocol includes initiating a protocol recommending drug therapy and outputting a recommendation to administer cardio pulmonary resuscitation (CPR) with the drug therapy.

2. The method of claim 1 wherein the electrical cardiac response in the absence of mechanical cardiac response is pulseless electrical activity.

3. The method of claim 1 wherein initiating the selected resuscitation protocol includes initiating a protocol recommending drug therapy for the patient and farther includes outputting the recommendation to administer CPR both before and after the drug therapy.

4. One or more tangible, non-transitory machine-readable storage media configured to store machine-executable instructions that, when executed by a processor of a system capable of treating a patient, cause the system to perform operations comprising:

outputting a diagnostic stimulus signal to the patient to elicit a physiologic response from the patient, wherein the physiologic response includes at least one of mechanical cardiac response, electrical cardiac response in the absence of mechanical cardiac response, or absence of both mechanical cardiac response and electrical cardiac response;

detecting the elicited physiologic response;

selecting one of a plurality of resuscitation protocols based upon the detected physiologic response, wherein at least one of the plurality of resuscitation protocols includes application of a defibrillation therapy, the selection based at least in part on a likely patient response to the defibrillation therapy; and

initiating the selected resuscitation protocol,

wherein, if the physiologic response is one of electrical cardiac response in the absence of mechanical cardiac response, initiating the selected resuscitation protocol includes initiating a protocol recommending drug therapy for the patient and outputting a recommendation to administer cardio pulmonary resuscitation (CPR) in conjunction with the drug therapy.

5. The non-transient machine-readable storage media of claim 4 wherein the electrical cardiac response in the absence of mechanical cardiac response is pulseless electrical activity.

6. The non-transient machine-readable storage media of claim 4 wherein initiating the selected resuscitation protocol includes initiating a protocol recommending drug therapy for the patient and further includes outputting the recommendation to administer CPR both before and after the drug therapy.

7. An external defibrillator, comprising:

a connection port configured to receive a plurality of electrode leads for a patient;

a therapy circuit coupled to the connection port, the therapy circuit being configured to deliver defibrillation shocks and a diagnostic stimulus signal via the connection port; and

a processor configured to;

control the therapy circuit to generate and output the diagnostic stimulus signal to elicit a physiologic response from the patient, and in which the diagnostic stimulus signal is delivered to the patient via the connection port;

in response to the diagnostic stimulus signal, detect a physiological response from the patient that includes at least one of mechanical cardiac response, electrical cardiac response in the absence of mechanical cardiac response, or absence of both the mechanical cardiac response and the electrical cardiac response;

select one of a plurality of resuscitation protocols based upon the detected physiologic response, in which at least one of the plurality of resuscitation protocols includes application of a defibrillation therapy, the selection based at least in part on a likely response by the patient to the defibrillation therapy; and

initiate the selected resuscitation protocol, in which, if the physiologic response is electrical cardiac response in the absence of mechanical cardiac response, initiating the selected resuscitation protocol includes initiating a protocol recommending drug therapy for the patient and outputting a recommendation to administer cardio pulmonary resuscitation (CPR) with the drug therapy.

8. The external defibrillator of claim 7 wherein the electrical cardiac response in the absence of mechanical cardiac response is pulseless electrical activity.

9. The external defibrillator of claim 7 wherein initiating the selected resuscitation protocol includes initiating a protocol recommending drug therapy for the patient and further includes outputting the recommendation to administer CPR both before and after the drug therapy.

10. A method treating a patient, comprising:

applying a diagnostic stimulus signal to the patient to elicit a physiologic response from the patient, wherein the physiologic response comprises at least one of mechanical cardiac response, electrical cardiac response in the absence of mechanical cardiac response, or absence of both mechanical cardiac response and electrical cardiac response;

detecting the elicited physiologic response;

selecting one of a plurality of resuscitation protocols based upon the detected physiologic response, wherein at least one of the plurality of resuscitation protocols includes application of a defibrillation therapy, the selection based at least in part on a likely response by the patient to the defibrillation therapy; and

initiating the selected resuscitation protocol,

wherein, if the physiologic response is one of electrical cardiac response in the absence of mechanical cardiac response, initiating the selected resuscitation protocol includes initiating a protocol recommending initiating or continuing cardiopulmonary resuscitation (CPR) and administering drug therapy to the patient.

11. The method of claim 10 wherein the electrical cardiac response in the absence of mechanical cardiac response is pulseless electrical activity.

12. The method of claim 10 wherein initiating the selected resuscitation protocol further includes recommending an action related to the defibrillation therapy.

13. The method of claim 12 wherein recommending the action related to defibrillation therapy includes outputting a a recommendation to delay defibrillation therapy.

14. The method of claim 12 wherein recommending the action related to the defibrillation therapy outputting a recommendation to abort defibrillation therapy.

15. The method of claim 12 wherein recommending the action related to the defibrillation therapy includes outputting a recommendation to eliminate defibrillation therapy.

16. One or more tangible, non-transitory machine-readable storage media configured to store machine-executable instructions that, when executed by a processor of a system capable of treating a patient, cause the system to perform operations comprising:

applying a diagnostic stimulus signal to the patient to elicit a physiologic response from the patient, wherein the physiologic response includes at least one of mechanical cardiac response, electrical cardiac response in the absence of mechanical cardiac response, or absence of both mechanical cardiac response and electrical cardiac response;

detecting the elicited physiologic response;

selecting one of a plurality of resuscitation protocols based upon the detected physiologic response, wherein at least one of the plurality of resuscitation protocols includes application of a defibrillation therapy, the selection based at least in part on a likely response by the patient to the defibrillation therapy; and

initiating the selected resuscitation protocol,

wherein, if the physiologic response is one of electrical cardiac response in the absence of mechanical cardiac response, initiating the selected resuscitation protocol includes initiating a protocol recommending initiating or continuing cardiopulmonary resuscitation (CPR) and administering drug therapy to the patient.

17. The non-transient machine-readable storage media of claim 16 wherein the electrical cardiac response in the absence of mechanical cardiac response is pulseless electrical activity.

18. The non-transient machine-readable storage media of claim 16 wherein initiating the selected resuscitation protocol further includes recommending an action related to the defibrillation therapy.

19. The non-transient machine-readable storage media of claim 18 wherein recommending the action related to the defibrillation therapy includes outputting a recommendation to delay defibrillation therapy.

20. The non-transient machine-readable storage media of claim 18 wherein recommending the action related to the defibrillation therapy includes outputting a recommendation to abort defibrillation therapy.

21. The non-transient machine-readable storage media of claim 18 wherein recommending the action related to the defibrillation therapy includes outputting a recommendation to eliminate defibrillation therapy.

22. An external defibrillator, comprising:

a connection port configured to receive a plurality of electrode leads for a patient;

a therapy circuit coupled to the connection port, the therapy circuit configured to deliver defibrillation shocks and a diagnostic stimulus signal via the connection port; and

a processor configured to;

control the aid therapy circuit to generate the diagnostic stimulus signal to elicit a physiologic response from a heart of the patient, and in which the diagnostic stimulus signal is delivered to the patient via the connection port;

in response to the diagnostic stimulus signal, detect a physiological response that includes at least one of mechanical cardiac response, electrical cardiac response in the absence of mechanical cardiac response, and absence of both the mechanical cardiac response and the electrical cardiac response;

select one of a plurality of resuscitation protocols based upon the detected physiologic response, in which at least one of the plurality of resuscitation protocols includes application of a defibrillation therapy, the selection based at least in part on a likely response by the patient to the defibrillation therapy; and

initiate the selected resuscitation protocol, in which, if the physiologic response is electrical cardiac response in the absence of mechanical cardiac response, initiating the selected resuscitation protocol includes initiating a protocol recommending initiating or continuing cardiopulmonary resuscitation (CPR) and administering drug therapy to the patient.

23. The external defibrillator of claim 22 wherein the electrical cardiac response in the absence of mechanical cardiac response is pulseless electrical activity.

24. The external defibrillator of claim 22 wherein initiating the selected resuscitation protocol further includes recommending an action related to the defibrillation therapy.

25. The external defibrillator of claim 24 wherein recommending the action related to the defibrillation therapy includes outputting a recommendation to delay defibrillation therapy.

26. The external defibrillator of claim 24 wherein recommending the action related to the defibrillation therapy includes outputting a recommendation to abort defibrillation therapy.

27. The external defibrillator of claim 24 wherein recommending the action related to the defibrillation therapy includes outputting a recommendation to eliminate the defibrillation therapy.