Vector-based shock indication

• US 10,258,248 B2
• Filed: 01/11/2018
• Issued: 04/16/2019
• Est. Priority Date: 03/14/2014
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Inventors: Quan, Weilun, Freeman, Gary A.
• Primary Examiner(s): Lavert, Nicole F
• Application Number:
  US15/868,277
• Publication Number:
  US 20180220913A1
• Time in Patent Office: 460 Days
• Field of Search: 600508, 600510
• CPC Class Codes: A61B 5/0531 Measuring skin impedance
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/7221 Determining signal validity, reliability or quality A61B5/7207 and A61B5/7217 take precedence
• CPC Class Codes: A61B 5/7257 using Fourier transforms
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock
• CPC Class Codes: A61N 1/3993 User interfaces for automatic external defibrillators
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

A system for managing care of a person receiving emergency cardiac assistance includes one or more capacitors arranged to deliver a defibrillating shock to a person; one or more electronic ports for receiving a plurality of signals from sensors for obtaining indications of an electrocardiogram (ECG) for the person; and a patient treatment module executable on one or more computer processors using code stored in non-transitory media and to provide a determination of a likelihood of success from delivering a future defibrillating shock to the person with the one or more capacitors, using a mathematical computation applied to a vector value defined by signals from at least two of the plurality of signals.

Claims

1. A defibrillation system for managing care of a person, the defibrillation system comprising:

an external defibrillator having one or more capacitors arranged to deliver a defibrillating shock to the person receiving emergency cardiac assistance;

a plurality of electrodes configured to be coupled to the person and acquire a plurality of electrocardiogram (ECG) signals from the heart of the person; and

a patient treatment module executable on one or more computer processors using code stored in non-transitory media and configured to execute operations comprising;

receiving the plurality of ECG signals acquired by the plurality of electrodes,

determining an ECG vector representation of the plurality of ECG signals comprising at least two orthogonal or near orthogonal signals indicative of an ECG electrical vector of the person, wherein the ECG vector representation includes information of both magnitude and direction of the ECG electrical vector,

identifying an angle of the ECG vector representation to provide an indication of whether the defibrillating shock should be delivered to the person via the one or more capacitors, and

delivering the defibrillating shock to the person based on the identified angle of the ECG vector representation.

2. The system of claim 1, wherein the operations comprise performing on the plurality of ECG signals at least one of one or more Fast Fourier Transforms (FFTs) and one or more amplitude spectrum area calculations.

3. The system of claim 1, wherein the operations comprise applying a pre-transform to the plurality of ECG signals so as to decrease an error of determining a likelihood of success from delivering the defibrillating shock to less than about 10 percent.

4. The system of claim 3, wherein the pre-transform is applied in response to determining that the plurality of ECG signals were not previously orthogonal or near orthogonal.

5. The system of claim 3, wherein the patient treatment module is programmed to apply a mathematical computation to the vector representation by calculating FFT for each of the plurality of ECG signals to create processed values and then combining the processed values.

6. The system of claim 5, wherein combining the processed values comprises determining a root of a sum of the processed values.

7. The system of claim 1, wherein the operations comprise performing a mathematical transform on the plurality of ECG signals from a time domain to a frequency domain on a window of data.

8. The system of claim 7, wherein the window comprises a tapered window.

9. The system of claim 8, wherein the tapered window is between about one second and about 2 seconds in width.

10. The system of claim 8, wherein the tapered window is selected from a group consisting of Tukey, Hann, Blackman-Harris, and Flat Top.

11. The system of claim 1, wherein the indication comprises a likelihood of success from delivering the defibrillating shock with the one or more capacitors to the person.

12. The system of claim 1, wherein the system is programmed to display to a user one of multiple possible indications that each indicates a degree of likelihood of success from delivering the defibrillating shock.

13. The system of claim 12, where the patient treatment module is programmed to determine whether a prior defibrillation shock was at least partially successful, and based at least in part on the determination of whether the prior defibrillation was at least partially successful, modifying a calculation of the likelihood of success from delivering the defibrillating shock.

14. The system of claim 12, wherein the indication of the likelihood of success from delivering the defibrillating shock to the person depends on a determination of whether one or more prior shocks delivered to the person were successful in defibrillating the person.

15. The system of claim 1, wherein the operations comprise performing a mathematical computation on the plurality of ECG signals, the mathematical computation comprising a transform selected from a group consisting of Fourier, discrete Fourier, Hilbert, discrete Hilbert, wavelet, and discrete wavelet methods.

16. The system of claim 1, wherein the patient treatment module is programmed to determine a likelihood of success from delivering the defibrillating shock using at least one patient-dependent physical parameter separate from a patient ECG reading.

17. The system of claim 16, wherein the patient treatment module is programmed to determine the likelihood of success from delivering the defibrillating shock using a measure of trans-thoracic impedance of the person.

18. A method for managing care of a person, the method comprising:

monitoring, with an external defibrillator, electrocardiogram (ECG) data from the person receiving emergency cardiac assistance, the ECG data defining an ECG vector representation from a plurality of ECG signals;

performing a vectorized mathematical transform of the ECG data that defines the ECG vector representation from a time domain to a frequency domain using a window in the time domain;

identifying an angle of the ECG vector representation to provide an indication of whether a defibrillating shock should be delivered to the person via one or more capacitors; and

delivering the defibrillating shock to the person based on the identified angle of the ECG vector representation.

19. The method of claim 18, wherein the vectorized mathematical transform comprises at least one of one or more vectorized Fast Fourier Transforms (FFTs) and one or more amplitude spectrum area (AMSA) calculations.

20. The method of claim 18, further comprising applying a pre-transform to the plurality of ECG signals before applying the vectorized mathematical transform so as to make the plurality of ECG signals orthogonal or near orthogonal.

21. The method of claim 18, further comprising applying the mathematical transform to a vector value by calculating FFT for each of the plurality of ECG signals to create processed values, and then combining the processed values.

22. The method of claim 18, wherein the mathematical transform comprises a transform from the time domain to the frequency domain on a window of ECG data.

23. The method of claim 22, wherein the window comprises a tapered window.

24. The method of claim 23, wherein the tapered window is between about one second and about two seconds wide.

25. The method of claim 23, wherein the tapered window is selected from a group consisting of Tukey, Hann, Blackman-Harris, and Flat Top.

26. The method of claim 18, further comprising determining a likelihood of future defibrillation shock success based on the vectorized mathematical transform.

27. The method of claim 26, wherein determining the likelihood of future defibrillation shock success comprises at least one of determining an amplitude spectrum area (AMSA) value for the ECG data and determining a value that is a function of electrocardiogram amplitude at particular different frequencies or frequency ranges.

28. The method of claim 27, wherein determining the likelihood of future defibrillation shock success further comprises adjusting the determined AMSA value using information about a prior defibrillation shock, and performing a calculation by an operation selected form a group consisting of logistic regression, table look-up, neural network, and fuzzy logic.

29. The method of claim 28, further comprising determining whether the adjusted AMSA value exceeds a predetermined threshold value.

30. The method of claim 29, further comprising providing to a rescuer a visual, audible, or tactile alert that a shockable situation exists for the person receiving emergency cardiac assistance.

31. The method of claim 18, further comprising determining whether a prior defibrillation shock was at least partially successful, and based at least in part on the determination of whether the prior defibrillation was at least partially successful, modifying a calculation of a likelihood of success from delivering the defibrillating shock.

32. The method of claim 18, where the indication of whether the defibrillating shock should be delivered to the person is determined using at least one patient-dependent physical parameter separate from a patient ECG reading.

33. The method of claim 32, wherein the at least one patient-dependent physical parameter comprises an indication of trans-thoracic impedance of the person receiving emergency cardiac assistance.

34. The method of claim 33, wherein the indication of trans-thoracic impedance is determined from signals sensed by a plurality of electrocardiogram leads that also provide the ECG data.

35. The method of claim 18, further comprising identifying compression depth of chest compressions performed on the person receiving emergency cardiac assistance, using a device on the person'"'"'s sternum and in communication with the external defibrillator, and providing feedback to a rescuer performing the chest compressions, the feedback regarding rate of compression, depth of compression, or both.