Non-invasive device for synchronizing chest compression and ventilation parameters to residual myocardial activity during cardiopulmonary resuscitation

• US 20060089574A1
• Filed: 10/25/2004
• Published: 04/27/2006
• Est. Priority Date: 10/25/2004
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: University of Colorado
• Inventors: Paradis, Norman A.
• Granted Patent: US 7,645,247 B2
• Time in Patent Office: Days
• US Class Current: 601/41
• CPC Class Codes: A61H 2031/001 fixed on the chest by suction
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/5048 Audio interfaces, e.g. voice or music controlled
• CPC Class Codes: A61H 2201/5058 Sensors or detectors
• CPC Class Codes: A61H 2230/04 Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
• CPC Class Codes: A61H 31/005 with feedback for the user
• CPC Class Codes: A61H 31/006 Power driven
• CPC Class Codes: A61H 31/007 Manual driven
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 2205/332 Force measuring means
• CPC Class Codes: Y10S 601/09 including biological sensors

Abstract

In one embodiment, a method for improving the cardiac output of a patient who is suffering from pulseless electrical activity or shock and yet still displays some myocardial wall motion comprises sensing myocardial activity to determine the presence of residual left ventricular pump function having a contraction or ejection phase and a filling or relaxation phase. In such cases, a compressive force is repeatedly applied to the chest based on the sensed myocardial activity such that the compressive force is applied during at least some of the ejection phases and is ceased during at least some of the relaxation phases to permit residual cardiac filling, thereby enhancing cardiac output and organ perfusion. Also incorporated may be a logic circuit capable of utilizing multiple sensing modalities and optimizing the synchronization pattern between multiple phasic therapeutic modalities and myocardial residual mechanical function.

Claims

1. A method for improving the cardiac output of a patient who is suffering from pulseless electrical activity or shock and yet still displays some myocardial wall motion, the method comprising:

sensing myocardial activity with a sensing system to determine the presence of residual left ventricular pump function, characterizing a pattern, timing, force and vector of the sensed pump function;

repeatedly applying at least one phasic therapy based on the sensed myocardial activity such that the phasic therapies are synchronized with the residual myocardial activity so as to augment cardiac ejection and avoid interfering with cardiac filling.

2. A method as in claim 1, wherein the phasic therapy comprises a repeating chest compression such that the compressive force is applied during at least some ejection phases and is ceased during at least some relaxation phases to permit residual cardiac filling, thereby enhancing cardiac output and organ perfusion.

3. A method as in claim 1, wherein the phasic therapies that may be synchronized with residual myocardial activity are selected from a group consisting of abdominal counter-pulsation, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

4. A method as in claim 2, wherein the compressive force is applied to the patient'"'"'s chest at the sternal or parasternal, or left intercostal areas.

5. A method as in claim 2, wherein the compressive force is applied during each sensed ejection phase.

6. A method as in claim 2, wherein the compressive force is applied only at certain ejection phases.

7. A method as in claim 2, wherein the compressive force is applied for only a certain duration of the ejection phase.

8. A method as in claim 1, wherein the phasic therapy comprises actively lifting the patient'"'"'s chest.

9. A method as in claim 8, wherein the lifting is applied only at certain relaxation phases of the heart or for a certain duration of the relaxation phases.

10. A method as in claim 1, further comprising applying ventilations based on the sensed myocardial activity.

11. A method as in claim 2, wherein the compressive force is applied using equipment selected from a group consisting of mechanical compression devices, inflatable vests, nerve stimulators, and suction based compression-decompression devices.

12. A method as in claim 1, wherein the myocardial activity is sensed used sensing systems selected from a group consisting of electrocardiography, Doppler ultrasonography, plethysmography, phonocardiography and echocardiography.

13. A method as in claim 1, further comprising displaying the presence of myocardial activity.

14. A method as in claim 1, wherein the myocardial activity is sensed using a sensing system that comprises an array of sensors.

15. A method for optimizing vital organ blood flow, comprising:

using at least one sensor to sense blood flow or vital organ status;

using control logic to vary a pattern or character of at lease one synchronized therapy so as to optimize vital organ blood flow.

16. A system for improving the cardiac output of a patient who is suffering from pulseless electrical activity or shock and yet still displays some myocardial wall motion, the system comprising:

at least one myocardial activity sensor that is adapted to sense movement of the myocardial wall to determine the presence of residual left ventricular pump function or blood flow;

a compression device that is configured to repeatedly apply a compressive force to the chest; and

a controller that is configured to receive signals from the myocardial activity sensor and to control operation of the compression device such that the compression device repeatedly applies synchronized compressive forces to the heart augmenting cardiac ejection and to permit residual cardiac filling, thereby enhancing cardiac output and organ perfusion.

17. A system as in claim 16, wherein the myocardial activity sensor is selected from a group of sensors consisting of electrocardiography sensors, Doppler ultrasonography sensors, plethysmography sensors, phonocardiography sensors and echocardiography sensors.

18. A system as in claim 16, wherein the controller is configured to apply the compressive force during each sensed ejection phase of the heart.

19. A system as in claim 16, wherein the controller is configured to apply the compressive force only at certain ejection phases of the heart.

20. A system as in claim 16, wherein the controller is configured to apply the compressive force for only a certain duration of each ejection phase of the heart.

21. A system as in claim 16, further comprising a ventilator device that is configured to provide ventilation to the patient based on the sensed myocardial activity.

22. A system as in claim 16, wherein the compression device is selected from a group of devices consisting of mechanical compression devices, inflatable vests, nerve stimulators, and suction based compression-decompression devices.

23. A system as in claim 16, further comprising a lifting device that is configured to actively decompressing the chest during relaxation phases of the heart.

24. A system for improving the cardiac output of a patient who is suffering from pulseless electrical activity or shock and yet still displays some myocardial wall motion, the system comprising:

at least one myocardial activity sensor that is adapted to sense movement of the myocardial wall to determine the presence of residual left ventricular pump function having an ejection phase and a relaxation phase;

a cadence device that is configured to produce audio and/or visual signals indicative of when compressive forces to the heart are to be applied and ceased; and

a controller that is configured to receive signals from the myocardial activity sensor and to control operation of the cadence device such that the cadence device repeatedly produces an audio and/or visual signal to indicate when compressive forces are to be applied during the ejection phases and when the compressive force is to be cased during the relaxation phases to permit residual cardiac filling, thereby enhancing cardiac output and organ perfusion.

25. A system as in claim 24, wherein the controller is further configured to produce an audio and/or visual signal to indicate when the patient'"'"'s chest is to be actively decompressed.

26. A system comprising:

at least one therapeutic device that is configured to treat a person who is suffering from pulseless electrical activity or shock;

a logic circuit that is configured to vary operation of the therapeutic device to optimize an applied pattern and combination of synchronization, force and vector produced by the therapeutic device, wherein synchronization relates to when a treatment is applied relative to heart function, wherein force relates to an amount of force applied to the person'"'"'s chest, and wherein vector relates to left ventricular ejection.

27. A system as in claim 26, wherein the logic circuit is configured to receive information on certain physiological parameters of the person and to vary operation of the therapeutic device over time based on the physiological parameters.

28. A system comprising:

a vector sensor or sensor array configured to sense the trajectory of cardiac ejection and logic circuitry capable of synchronizing a force of chest compression spatially based on information from the vector sensor.

29. A system comprising:

a plurality of sensors, wherein at least two of the sensors are configured to detect different physiological parameters; and

circuitry that is configured to receive information from the sensors and to determine an indicator of cardiac output based on the information.

30. A system as in claim 29, wherein the indicator of cardiac output is selected from a group consisting of end-tidal carbon dioxide or aortic flow.

31. A system as in claim 29, wherein the circuitry is further configured to control operation of one or more synchronization therapies designed to increase cardiac output based on the indicator of cardiac output in order to determine which synchronization therapy or pattern of therapies is effective.