Apparatus, software, and methods for cardiac pulse detection using accelerometer data

• US 20040039420A1
• Filed: 08/26/2002
• Published: 02/26/2004
• Est. Priority Date: 08/26/2002
• Status: Abandoned Application

• Current Assignee: Medtronic Physio-Control Manufacturing Corp.
• Original Assignee: Medtronic Physio-Control Manufacturing Corp.
• Inventors: Kelly, Patrick F., Nova, Richard C., Jayne, Cynthia P., Stickney, Ronald E., Joo, Tae H., Hampton, David R., Lank, Paula, Saltzstein, William E., OʼHearn, Patricia
• Application Number:
  US10/229,339
• Publication Number:
  US 20040039420A1
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61B 2562/0214 Capacitive electrodes
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/6823 Trunk, e.g., chest, back, abdomen, hip
• 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: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A pulse detection apparatus, software, and method that uses signal data obtained from an accelerometer placed on a patient'"'"'s body to detect the presence of a cardiac pulse. The accelerometer is adapted to sense movement due to a cardiac pulse and produce accelerometer signal data in response thereto. Processing circuitry analyzes the accelerometer signal data for a feature indicative of a cardiac pulse and determines whether a cardiac pulse is present in the patient based on the feature. In one aspect, the feature may be a temporal energy feature, such as a relative change in energy. In another aspect, the feature may be a spectral energy feature such as the energy or frequency of a peak in the energy spectrum of the signal. In yet another aspect, the feature may be obtained by comparing the accelerometer signal data with a previously-identified pattern known to predict the presence of a cardiac pulse. Multiple features may also be obtained and classified to determine the presence of a cardiac pulse.

Claims

1. A medical device for detecting the presence of a cardiac pulse, comprising:

(a) an accelerometer configured for placement on a patient'"'"'s body, the accelerometer being adapted to sense movement in the patient'"'"'s body due to a cardiac pulse and produce accelerometer signal data in response thereto; and

(b) processing circuitry configured to analyze the accelerometer signal data for a feature indicative of the presence of a cardiac pulse and determine whether a cardiac pulse is present based on the feature.

2. The medical device of claim 1, in which the processing circuitry is in communication with the accelerometer.

3. The medical device of claim 1, further comprising a display, in which the processing circuitry is configured to automatically report via the display whether a cardiac pulse is present in the patient.

4. The medical device of claim 1, further comprising a display, in which the processing circuitry is configured to automatically prompt via the display the application of chest compressions or cardiopulmonary resuscitation if the processing circuitry determines that a cardiac pulse is not present in the patient.

5. The medical device of claim 1, further comprising a defibrillation pulse generator in communication with the processing circuitry for delivering a defibrillation pulse to the patient if the processing circuitry determines that a cardiac pulse is not present in the patient.

6. The medical device of claim 5, in which the medical device is an automated external defibrillator.

7. The medical device of claim 6, in which the processing circuitry is configured to automatically obtain and analyze the accelerometer signal data to determine the presence of a cardiac pulse in the patient.

8. The medical device of claim 5, further comprising an input device that allows an operator of the medical device to initiate delivery of the defibrillation pulse if the processing circuitry determines that a cardiac pulse is not present in the patient.

9. The medical device of claim 1, in which the processing circuitry is configured to determine the feature indicative of a cardiac pulse from a temporal parameter in the accelerometer signal data.

10. The medical device of claim 9, in which the feature indicative of a cardiac pulse is an amplitude of the accelerometer signal data, the processing circuitry being configured to compare the amplitude to a threshold to determine whether a cardiac pulse is present.

11. The medical device of claim 9, in which the feature indicative of a cardiac pulse is an energy in the accelerometer signal data, the processing circuitry being configured to compare the energy to a threshold to determine whether a cardiac pulse is present.

12. The medical device of claim 9, in which the feature indicative of a cardiac pulse is a derivative of the accelerometer signal data, the processing circuitry being configured to compare the derivative to a threshold to determine whether a cardiac pulse is present.

13. The medical device of claim 9, in which the temporal parameter is an energy in the accelerometer signal data, the processing circuitry being configured to determine a relative change in energy between an estimated first energy in the accelerometer signal data and an estimated second energy in the accelerometer signal data, and use the relative change in energy as the feature indicative of a cardiac pulse.

14. The medical device of claim 13, in which the first energy is estimated using a first set of accelerometer signal data and the second energy is estimated using a second set of accelerometer signal data, and in which the second set of accelerometer signal data is obtained prior to the first set of accelerometer signal data.

15. The medical device of claim 1, in which the processing circuitry is configured to determine the feature indicative of a cardiac pulse from a spectral parameter in the accelerometer signal data.

16. The medical device of claim 15, in which the processing circuitry is configured to calculate an energy spectrum of the accelerometer signal data and locate a peak energy in the energy spectrum, and in which the processing circuitry uses the energy value of the located peak energy as the feature indicative of a cardiac pulse.

17. The medical device of claim 15, in which the processing circuitry is configured to calculate an energy spectrum of the accelerometer signal data and locate a peak energy in the energy spectrum, and in which the processing circuitry uses the frequency at which the located peak energy occurs as the feature indicative of a cardiac pulse.

18. The medical device of claim 1, in which the feature indicative of the presence of a cardiac pulse is first feature, and in which the processing circuitry is further configured to analyze the accelerometer signal data for a second feature indicative of the presence of a cardiac pulse, the processing circuitry being configured to determine the presence of a cardiac pulse by evaluating the first and second features.

19. The medical device of claim 18, in which the first feature and the second feature are a temporal feature or a spectral feature determined from the accelerometer signal data.

20. The medical device of claim 1, further comprising a display, the processing circuitry being further configured to provide a graph on the display showing a representation of the accelerometer signal data.

21. The medical device of claim 1, further comprising an electrode adapted to sense an electrocardiogram (ECG) signal in the patient and communicate ECG signal data to the processing circuitry, the processing circuitry being configured to analyze the ECG data in connection with the accelerometer signal data to determine the feature indicative of a cardiac pulse.

22. The medical device of claim 21, in which the processing circuitry is further configured to determine the presence of a ventricular complex in the ECG data and determine the presence of a cardiac pulse in the patient if a ventricular complex occurs in the ECG data within an expected time period in relation to a feature in the accelerometer signal data that indicates a cardiac pulse.

23. The medical device of claim 21, in which the processing circuitry is configured to analyze the ECG data and determine the presence of a ventricular complex in the ECG data, the processing circuitry being further configured to use the occurrence of a ventricular complex to identify the accelerometer signal data to be used in determining the presence of a cardiac pulse.

24. The medical device of claim 21, further comprising a display, in which the processing circuitry is configured to prompt a message via the display recommending application of chest compressions or cardiopulmonary resuscitation to the patient if the processing circuitry determines that a cardiac pulse is not present in the patient and the ECG data obtained from the patient does not indicate a cardiac rhythm appropriate for immediate treatment by defibrillation therapy.

25. The medical device of claim 21, further comprising a defibrillation pulse generator, in which the processing circuitry is configured to instruct the defibrillation pulse generator to generate a defibrillation pulse if the processing circuitry determines that a cardiac pulse is not present in the patient and that ECG data obtained from the patient indicates a cardiac rhythm appropriate for treatment by defibrillation therapy.

26. The medical device of claim 25, further comprising a display, in which the processing circuitry is configured to count the delivery of defibrillation pulses to the patient and prompt a message via the display recommending application of chest compressions or cardiopulmonary resuscitation to the patient if the number of defibrillation pulses delivered to the patient equals or exceeds a predetermined number.

27. The medical device of claim 21, further comprising a display, in which the processing circuitry is configured to prompt a message via the display reporting whether the patient is in a state of pulseless electrical activity (PEA).

28. The medical device of claim 27, in which the processing circuitry determines the patient to be in a state of PEA if a ventricular complex is found in the ECG data and a cardiac pulse is not detected in the accelerometer signal data.

29. The medical device of claim 27, in which the processing circuitry is further configured to analyze the patient'"'"'s ECG data for at least ventricular fibrillation (VF), ventricular tachycardia (VT), and asystole, and if the patient is determined to be pulseless and not in a VF, VT, or asystole condition, the processing circuitry then prompting the message reporting that the patient is in a state of PEA.

30. The medical device of claim 1, further comprising a display, in which the processing circuitry is configured to prompt a message via the display recommending application of rescue breathing therapy to the patient if a cardiac pulse is not present and the patient is not breathing.

31. The medical device of claim 1, in which the processing circuitry is configured to analyze the accelerometer signal data for a feature indicative of the presence of a cardiac pulse by comparing the accelerometer signal data to a previously-identified accelerometer signal data pattern known to predict the presence of a cardiac pulse.

32. The medical device of claim 31, in which the comparison produces a pattern match statistic that is the feature indicative of the presence of a cardiac pulse, the processing circuitry being further configured to compare the feature to a predetermined pattern match threshold to determine whether a cardiac pulse is present in the patient.

33. The medical device of claim 31, further comprising a display, in which the processing circuitry is further configured to automatically prompt a message via the display reporting whether a cardiac pulse is present in the patient.

34. The medical device of claim 31, further comprising an electrode adapted to sense an electrocardiogram (ECG) signal in the patient and communicate ECG signal data to the processing circuitry, the processing circuitry being configured to analyze the ECG data and select accelerometer signal data corresponding in time with a ventricular complex in the ECG data for the analysis of the accelerometer signal data.

35. The medical device of claim 1, in which the processing circuitry is further configured to report the return of spontaneous circulation in the patient if a cardiac pulse is determined present in the patient after delivery of defibrillation therapy to the patient.

36. An electrotherapy device, comprising:

(a) an accelerometer configured for placement on a patient'"'"'s body, the accelerometer being adapted to sense movement in the patient'"'"'s body due to a cardiac pulse and produce accelerometer signal data in response thereto;

(b) an electrotherapy generator adapted for delivering electrotherapy to the patient; and

(c) processing circuitry configured to analyze the accelerometer signal data for a feature indicative of the presence of a cardiac pulse in the patient and determine the presence of a cardiac pulse based on the feature, the processing circuitry being further configured to prompt the delivery of an electrotherapy to the patient based on the presence of a cardiac pulse.

37. The electrotherapy device of claim 36, in which the processing circuitry is in communication with the accelerometer and the electrotherapy generator.

38. The electrotherapy device of claim 36, further comprising an electrode adapted to sense an electrocardiogram (ECG) signal in the patient and communicate ECG signal data to the processing circuitry, the processing circuitry being further configured to analyze the patient'"'"'s ECG signal data for ventricular tachycardia and prompt the delivery of defibrillation therapy to the patient if the patient is determined to be pulseless and experiencing ventricular tachycardia.

39. The electrotherapy device of claim 38, in which the processing circuitry is configured to prompt the delivery of defibrillation therapy if the patient is determined to be pulseless and experiencing ventricular tachycardia with a rate exceeding 100 beats per minute.

40. The electrotherapy device of claim 36, further comprising an electrode adapted to sense an electrocardiogram (ECG) signal in the patient and communicate ECG signal data to the processing circuitry, the processing circuitry being further configured to analyze the patient'"'"'s ECG signal data for at least ventricular fibrillation (VF), ventricular tachycardia (VT), and asystole, and if the patient is determined to be pulseless and not in a VF, VT, or asystole condition, the processing circuitry then being configured to prompt delivery of electrotherapy designed specifically for pulseless electrical activity (PEA).

41. The electrotherapy device of claim 36, the processing circuitry being further configured to report the return of spontaneous circulation in the patient if a cardiac pulse is determined present in the patient after delivery of electrotherapy to the patient.

42. The electrotherapy device of claim 36, further comprising an electrode adapted to sense an electrocardiogram (ECG) signal in the patient and communicate ECG signal data to the processing circuitry, the processing circuitry being further configured to analyze the patient'"'"'s ECG signal data for one or more of ventricular fibrillation (VF), ventricular tachycardia (VT), asystole, and pulseless electrical activity (PEA), and prompt a report of VF, VT, asystole, or PEA, if detected and if the patient is determined to be pulseless.

43. The electrotherapy device of claim 42, in which the processing circuitry determines the patient to be in a state of PEA if a ventricular complex is found in the ECG signal data and the patient is determined to be pulseless.

44. The electrotherapy device of claim 36, in which the electrotherapy generator and the processing circuitry are implemented in an automated external defibrillator.

45. The electrotherapy device of claim 44, further comprising a display, in which the processing circuitry is configured to automatically prompt via the display the delivery of chest compressions or cardiopulmonary resuscitation to the patient if the patient is determined to be pulseless.

46. An electrotherapy device, comprising:

(a) an accelerometer configured for placement on a patient'"'"'s body, the accelerometer being adapted to sense movement in the patient'"'"'s body due to a cardiac pulse and produce accelerometer signal data in response thereto;

(b) an electrotherapy generator for delivering pacing stimuli to the patient; and

(c) processing circuitry configured to analyze the accelerometer signal data and determine whether a cardiac pulse occurred in the patient following the delivery of a pacing stimulus to the patient.

47. The electrotherapy device of claim 46, in which the processing circuitry is configured to increase the current of further pacing stimuli to be delivered to the patient if a cardiac pulse did not occur in the patient following the delivery of the pacing stimulus.

48. The electrotherapy device of claim 46, in which the electrotherapy generator is configured to deliver pacing stimuli to the patient two or more times and the processing circuitry is configured to analyze the accelerometer signal data to determine whether a cardiac pulse occurred after the delivery of each pacing stimulus, the current of further pacing stimuli to be delivered to the patient being increased if a cardiac pulse does not consistently occur in the patient after the delivery of each pacing stimulus.

49. The electrotherapy device of claim 48, in which prior to the current of the pacing stimuli being increased, the processing circuitry is configured to prompt a user of the device to increase the pacing stimuli current.

50. An article comprising a storage medium having device-executable instructions stored thereon, in which when the instructions are executed by at least one device, they result in:

(a) obtaining accelerometer signal data from an accelerometer placed on a patient'"'"'s body;

(b) analyzing the accelerometer signal data for a feature indicative of the presence of a cardiac pulse; and

(c) determining whether a cardiac pulse is present in the patient based on the feature in the accelerometer signal data.

51. The article of claim 50, in which analyzing the accelerometer signal data includes evaluating a temporal parameter in the accelerometer signal data.

52. The article of claim 51, in which evaluating a temporal parameter in the accelerometer signal data includes:

(a) estimating an instantaneous energy in the accelerometer signal data;

(b) estimating a background energy in the accelerometer signal data; and

(c) comparing the instantaneous energy with the background energy to produce the feature indicative of the presence of a cardiac pulse.

53. The article of claim 50, in which analyzing the accelerometer signal data includes evaluating a spectral parameter in the accelerometer signal data.

54. The article of claim 53, in which evaluating a spectral parameter in the accelerometer signal data includes calculating an energy spectrum of the accelerometer signal data and evaluating the energy spectrum to locate a peak energy value, the instructions when executed further resulting in using the located peak energy value as the feature indicative of the presence of a cardiac pulse and determining whether a cardiac pulse is present in the patient by comparing the located peak energy value with a threshold energy value.

55. The article of claim 53, in which evaluating a spectral parameter in the accelerometer signal data includes calculating an energy spectrum of the accelerometer signal data, evaluating the energy spectrum to locate a peak energy value, and determining the frequency at which the peak energy value occurs, the instructions when executed further resulting in using the frequency of the peak energy value as the feature indicative of the presence of a cardiac pulse and determining whether a cardiac pulse is present in the patient by comparing the frequency of the peak energy value with a threshold frequency.

56. The article of claim 50, in which executing the instructions further results in:

(a) repeating the steps of obtaining accelerometer signal data, analyzing the accelerometer signal data for a feature, and determining whether a cardiac pulse is present based on the feature, to produce two or more preliminary determinations of the presence of a cardiac pulse; and

(b) determining whether a cardiac pulse is present in the patient based on the number of preliminary determinations indicating the presence of a cardiac pulse.

57. The article of claim 50, in which analyzing the accelerometer signal data includes comparing the accelerometer signal data to a previously-identified accelerometer signal data pattern known to predict the presence of a cardiac pulse.

58. The article of claim 57, in which the comparison produces a pattern match statistic that is the feature indicative of the presence of a cardiac pulse, the instructions when executed further resulting in comparing the feature to a predetermined pattern match threshold to determine whether a cardiac pulse is present in the patient.

59. The article of claim 57, in which executing the instructions further results in analyzing the accelerometer signal data for two or more features indicative of the presence of a cardiac pulse, in which one of the features is determined from the comparison of the accelerometer signal data with a previously-identified accelerometer signal data pattern and in which one of the other features is determined from an evaluation of an amplitude of the accelerometer signal data or an energy in the accelerometer signal data.

60. The article of claim 57, in which executing the instructions further results in obtaining electrocardiogram (ECG) data from the patient, and in which analyzing the obtained accelerometer signal data for a feature indicative of the presence of a cardiac pulse further includes determining whether a ventricular complex occurred in the ECG data.

61. The article of claim 60, in which executing the instructions further results in locating a ventricular complex in the ECG data and selecting accelerometer signal data for the pattern match comparison based on the location of the ventricular complex.

62. The article of claim 60, in which executing the instructions further results in determining whether the patient is in a state of pulseless electrical activity (PEA).

63. The article of claim 62, in which the patient is determined to be in a state of PEA if a ventricular complex is found in the ECG data and the patient is determined to be pulseless.

64. The article of claim 62, in which executing the instructions further results in analyzing the patient'"'"'s ECG data for at least ventricular fibrillation (VF), ventricular tachycardia (VT), and asystole, and determining that the patient is in a state of PEA if the patient is determined to be pulseless and not in a VF, VT, or asystole condition.

65. An article comprising a storage medium having device-executable instructions stored thereon, in which when the instructions are executed by at least one device, they result in:

(a) obtaining accelerometer signal data from an accelerometer placed on a patient'"'"'s body;

(b) estimating a first energy in the accelerometer signal data;

(c) estimating a second energy in the accelerometer signal data;

(d) determining a relative change in energy between the first energy and the second energy; and

(e) determining the presence of a cardiac pulse in the patient based on the determined relative change in energy.

66. The article of claim 65, in which the first energy is estimated using a first set of accelerometer signal data and the second energy is estimated using a second set of accelerometer signal data, and in which the second set of accelerometer signal data is obtained prior to the first set of accelerometer signal data.

67. The article of claim 65, in which executing the instructions further results in:

(a) calculating an energy spectrum of the accelerometer signal data;

(b) evaluating the energy spectrum for a spectral energy feature indicative of the presence of a cardiac pulse; and

(c) determining the presence of a cardiac pulse in the patient based on the determined relative change in energy and the spectral energy feature.

68. An article comprising a storage medium having device-executable instructions stored thereon, in which when the instructions are executed by at least one device, they result in:

(a) obtaining accelerometer signal data from an accelerometer placed on a patient'"'"'s body;

(b) calculating an energy spectrum of the accelerometer signal data;

(c) evaluating the energy spectrum for a spectral energy feature indicative of the presence of a cardiac pulse; and

(d) determining the presence of a cardiac pulse in the patient based on the spectral energy feature.

69. The article of claim 68, in which the spectral energy feature is a peak energy value in the energy spectrum.

70. The article of claim 69, in which determining the presence of a cardiac pulse includes comparing the peak energy value with a threshold energy value.

71. The article of claim 69, in which determining the presence of a cardiac pulse includes evaluating the frequency at which the peak energy value occurs in the energy spectrum.

72. The article of claim 71, in which evaluating the frequency at which the peak energy value occurs includes comparing the frequency of the peak energy value with a threshold frequency.

73. The article of claim 68, in which executing the instructions further results in identifying a set of accelerometer signal data that has a higher likelihood of indicating the presence of a cardiac pulse, and using the set of accelerometer signal data to calculate the energy spectrum.

74. The article of claim 68, in which the spectral energy feature is a first spectral energy feature, the instructions when executed further resulting in evaluating the energy spectrum for a second spectral energy feature indicative of the presence of a cardiac pulse, in which determining the presence of a cardiac pulse in the patient is based on the first and second spectral energy features.

75. The article of claim 74, in which the first spectral energy feature is a peak energy value in the energy spectrum, and in which the second spectral energy feature is the frequency at which a peak energy value occurs in the energy spectrum.

76. The article of claim 75, in which determining the presence of a cardiac pulse in the patient includes comparing the first spectral energy feature with a threshold energy value, and comparing the second spectral energy feature with a threshold frequency.

77. The article of claim 68, in which executing the instructions further results in evaluating a temporal parameter in the accelerometer signal data for a temporal feature, in which determining the presence of a cardiac pulse in the patient is based on the spectral energy feature and the temporal feature.

78. The article of claim 77, in which the temporal parameter is energy and the temporal energy feature in determined by estimating a first energy in the accelerometer signal data, estimating a second energy in the accelerometer signal data, and determining a relative change in energy between the first energy and the second energy.

79. The article of claim 78, in which the first energy is estimated using a first set of accelerometer signal data and the second energy is estimated using a second set of accelerometer signal data, and in which the second set of accelerometer signal data is obtained prior to the first set of accelerometer signal data.

80. The article of claim 77, in which the temporal feature is based on an estimated energy in the accelerometer signal data, and in which the spectral energy feature is based on a peak energy value in the energy spectrum.

81. The article of claim 77, in which the temporal feature and spectral energy feature are jointly classified in a multi-dimensional classifier to determine whether a cardiac pulse is present in the patient.

82. An article comprising a storage medium having device-executable instructions stored thereon, in which when the instructions are executed by at least one device, they result in:

(a) delivering a pacing stimulus to the patient;

(b) obtaining accelerometer signal data from an accelerometer placed on the patient'"'"'s body;

(c) analyzing the accelerometer signal data to determine whether a cardiac pulse occurred in the patient after delivery of the pacing stimulus; and

(d) if a cardiac pulse did not occur in the patient after delivery of the pacing stimulus, increasing the current of further pacing stimuli to be delivered to the patient.

83. The article of claim 82, in which executing the instructions further results in repeating steps (a)-(d) until a cardiac pulse occurs after delivery of the pacing stimulus.

84. The article of claim 82, in which executing the instructions results in delivering pacing stimuli to the patient two or more times and analyzing the accelerometer signal data to determine whether a cardiac pulse occurred after the delivery of each pacing stimulus, the current of further pacing stimuli to be delivered to the patient being increased if a cardiac pulse does not consistently occur in the patient after the delivery of each pacing stimulus.

85. The article of claim 84, in which prior to the current of the pacing stimuli being increased, executing the instructions results in prompting a user of the device to increase the pacing stimuli current.

86. The article of claim 84, in which executing the instructions further results in repeating the delivery of pacing stimuli and increasing the current of the pacing stimuli until a cardiac pulse consistently occurs in the patient after the delivery of each pacing stimulus.

87. A method of determining the presence of a cardiac pulse, comprising:

(a) obtaining accelerometer signal data from an accelerometer placed on a patient'"'"'s body;

(b) analyzing the accelerometer signal data for a feature indicative of the presence of a cardiac pulse; and

(c) determining whether a cardiac pulse is present in the patient based on the feature in the accelerometer signal data.

88. The method of claim 87, in which analyzing the accelerometer signal data includes evaluating a temporal parameter in the accelerometer signal data.

89. The method of claim 88, in which evaluating a temporal parameter in the accelerometer signal data includes:

(a) estimating an instantaneous energy in the accelerometer signal data;

(b) estimating a background energy in the accelerometer signal data; and

(c) comparing the instantaneous energy with the background energy to produce the feature indicative of the presence of a cardiac pulse.

90. The method of claim 87, in which analyzing the accelerometer signal data includes evaluating a spectral parameter in the accelerometer signal data.

91. The method of claim 90, in which evaluating a spectral parameter in the accelerometer signal data includes calculating an energy spectrum of the accelerometer signal data and evaluating the energy spectrum to locate a peak energy value, in which the located peak energy value is used as the feature indicative of the presence of a cardiac pulse, and in which determining whether a cardiac pulse is present in the patient includes comparing the located peak energy value with a threshold energy value.

92. The method of claim 90, in which evaluating a spectral parameter in the accelerometer signal data includes calculating an energy spectrum of the accelerometer signal data, evaluating the energy spectrum to locate a peak energy value, and determining the frequency at which the peak energy value occurs, in which the frequency of the peak energy value is used as the feature indicative of the presence of a cardiac pulse, and in which determining whether a cardiac pulse is present in the patient includes comparing the frequency of the peak energy value with a threshold frequency.

93. The method of claim 87, further comprising:

(a) repeating the steps of obtaining accelerometer signal data, analyzing the accelerometer signal data for a feature, and determining whether a cardiac pulse is present based on the feature, to produce two or more preliminary determinations of the presence of a cardiac pulse; and

(b) determining whether a cardiac pulse is present in the patient based on the number of preliminary determinations indicating the presence of a cardiac pulse.

94. The method of claim 87, in which analyzing the accelerometer signal data includes comparing the accelerometer signal data to a previously-identified accelerometer signal data pattern known to predict the presence of a cardiac pulse.

95. The method of claim 94, in which the comparison produces a pattern match statistic that is the feature indicative of the presence of a cardiac pulse, the method further comprising comparing the feature to a predetermined pattern match threshold to determine whether a cardiac pulse is present in the patient.

96. The method of claim 94, further comprising analyzing the accelerometer signal data for two or more features indicative of the presence of a cardiac pulse, in which one of the features is determined from the comparison of the accelerometer signal data with a previously-identified accelerometer signal data pattern and in which one of the other features is determined from an evaluation of an amplitude of the accelerometer signal data or an energy in the accelerometer signal data.

97. The method of claim 94, further comprising obtaining electrocardiogram (ECG) data from the patient, in which analyzing the obtained accelerometer signal data for a feature indicative of the presence of a cardiac pulse further includes determining whether a ventricular complex occurred in the ECG data.

98. The method of claim 97, further comprising locating a ventricular complex in the ECG data and selecting accelerometer signal data for the pattern match comparison based on the location of the ventricular complex.

99. The method of claim 97, further comprising determining whether the patient is in a state of pulseless electrical activity.

100. The method of claim 99, in which the patient is determined to be in a state of PEA if a ventricular complex is found in the ECG data and the patient is determined to be pulseless.

101. The method of claim 99, further comprising analyzing the patient'"'"'s ECG data for at least ventricular fibrillation (VF), ventricular tachycardia (VT), and asystole, and determining that the patient is in a state of PEA if the patient is determined to be pulseless and not in a VF, VT, or asystole condition.

102. A method of determining the presence of a cardiac pulse, comprising:

(a) obtaining accelerometer signal data from an accelerometer placed on a patient'"'"'s body;

(b) estimating a first energy in the accelerometer signal data;

(c) estimating a second energy in the accelerometer signal data;

(d) determining a relative change in energy between the first energy and the second energy; and

(e) determining the presence of a cardiac pulse in the patient based on the determined relative change in energy.

103. The method of claim 102, in which the first energy is estimated using a first set of accelerometer signal data and the second energy is estimated using a second set of accelerometer signal data, and in which the second set of accelerometer signal data is obtained prior to the first set of accelerometer signal data.

104. The method of claim 102, further comprising:

(a) calculating an energy spectrum of the accelerometer signal data;

(b) evaluating the energy spectrum for a spectral energy feature indicative of the presence of a cardiac pulse; and

(c) determining the presence of a cardiac pulse in the patient based on the determined relative change in energy and the spectral energy feature.

105. A method of determining the presence of a cardiac pulse, comprising:

(a) obtaining accelerometer signal data from an accelerometer placed on a patient'"'"'s body;

(b) calculating an energy spectrum of the accelerometer signal data;

(c) evaluating the energy spectrum for a spectral energy feature indicative of the presence of a cardiac pulse; and

(d) determining the presence of a cardiac pulse in the patient based on the spectral energy feature.

106. The method of claim 105, in which the spectral energy feature is a peak energy value in the energy spectrum.

107. The method of claim 106, in which determining the presence of a cardiac pulse includes comparing the peak energy value with a threshold energy value.

108. The method of claim 106, in which determining the presence of a cardiac pulse includes evaluating the frequency at which the peak energy value occurs in the energy spectrum.

109. The method of claim 108, in which evaluating the frequency at which the peak energy value occurs includes comparing the frequency of the peak energy value with a threshold frequency.

110. The method of claim 105, further comprising identifying a set of accelerometer signal data that has a higher likelihood of indicating the presence of a cardiac pulse, and using the set of accelerometer signal data to calculate the energy spectrum.

111. The method of claim 105, in which the spectral energy feature is a first spectral energy feature, the method further comprising evaluating the energy spectrum for a second spectral energy feature indicative of the presence of a cardiac pulse, in which determining the presence of a cardiac pulse in the patient is based on the first and second spectral energy features.

112. The method of claim 111, in which the first spectral energy feature is a peak energy value in the energy spectrum, and in which the second spectral energy feature is the frequency at which a peak energy value occurs in the energy spectrum.

113. The method of claim 112, in which determining the presence of a cardiac pulse in the patient includes comparing the first spectral energy feature with a threshold energy value, and comparing the second spectral energy feature with a threshold frequency.

114. The method of claim 105, further comprising evaluating a temporal parameter in the accelerometer signal data for a temporal feature, in which determining the presence of a cardiac pulse in the patient is based on the spectral energy feature and the temporal feature.

115. The method of claim 114, in which the temporal parameter is energy and the temporal energy feature in determined by estimating a first energy in the accelerometer signal data, estimating a second energy in the accelerometer signal data, and determining a relative change in energy between the first energy and the second energy.

116. The method of claim 115, in which the first energy is estimated using a first set of accelerometer signal data and the second energy is estimated using a second set of accelerometer signal data, and in which the second set of accelerometer signal data is obtained prior to the first set of accelerometer signal data.

117. The method of claim 114, in which the temporal feature is based on an estimated energy in the accelerometer signal data, and in which the spectral energy feature is based on a peak energy value in the energy spectrum.

118. The method of claim 114, in which the temporal feature and spectral energy feature are jointly classified in a multi-dimensional classifier to determine whether a cardiac pulse is present in the patient.

119. A method for delivering electrotherapy that provides pacing stimuli and seeks capture of a cardiac pulse in a patient, the method comprising:

(a) delivering a pacing stimulus to the patient;

(b) obtaining accelerometer signal data from an accelerometer placed on the patient'"'"'s body;

(c) analyzing the accelerometer signal data to determine whether a cardiac pulse occurred in the patient after delivery of the pacing stimulus; and

(d) if a cardiac pulse did not occur in the patient after delivery of the pacing stimulus, increasing the current of further pacing stimuli to be delivered to the patient.

120. The method of claim 119, further comprising repeating steps (a)-(d) until a cardiac pulse occurs after delivery of the pacing stimulus.

121. The method of claim 119, in which pacing stimuli is delivered to the patient two or more times and the accelerometer signal data is analyzed to determine whether a cardiac pulse occurred after the delivery of each pacing stimulus, and in which the current of further pacing stimuli to be delivered to the patient is increased if a cardiac pulse does not consistently occur in the patient after the delivery of each pacing stimulus.

122. The method of claim 121, further comprising prompting a user of the device to increase the pacing stimuli current prior to the current of the pacing stimuli being increased.

123. The method of claim 121, further comprising repeating the delivery of pacing stimuli and increasing the current of the pacing stimuli until a cardiac pulse consistently occurs in the patient after the delivery of each pacing stimulus.