Synchronization of Repetitive Therapeutic Interventions

• US 20100160839A1
• Filed: 12/16/2009
• Published: 06/24/2010
• Est. Priority Date: 09/14/2005
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Inventors: Freeman, Gary A., Lisogurski, Daniel M.
• Granted Patent: US 9,283,140 B2
• Time in Patent Office: Days
• US Class Current: 601/41
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/501 connected to external computer devices or networks
• CPC Class Codes: A61H 2201/5043 Displays
• CPC Class Codes: A61H 2201/5048 Audio interfaces, e.g. voice or music controlled
• CPC Class Codes: A61H 2201/5084 Acceleration sensors
• CPC Class Codes: A61H 2201/5097 wireless
• CPC Class Codes: A61H 2230/04 Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
• CPC Class Codes: A61H 2230/205 partial CO2-value
• CPC Class Codes: A61H 2230/207 partial O2-value
• CPC Class Codes: A61H 2230/25 Blood flowrate, e.g. by Doppler effect
• CPC Class Codes: A61H 2230/42 Rate
• CPC Class Codes: A61H 31/00 Artificial respiration or heart stimulation, e.g. heart massage artificial respiration by treatment with gas or air, e.g. mouth-to-mouth respiration A61M16/00; applying electric currents by contact electrodes for stimulation, e.g. heart pace-makers A61N1/36 ; teaching or training models, demonstration models for medical purposes G09B23/288
• 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 5/142 Pressure infusion, e.g. using pumps
• CPC Class Codes: A61N 1/3625 External stimulators
• CPC Class Codes: A61N 1/3628 using sub-threshold or non-excitatory signals
• CPC Class Codes: A61N 1/39044 in combination with cardiopulmonary resuscitation [CPR] therapy
• CPC Class Codes: A61N 7/00 : Ultrasound therapy lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 ; using ultrasound for introducing media into the body A61M37/0092

Abstract

A medical device of the type used for assisting a user in manually delivering repetitive therapy to a patient (e.g., chest compressions or ventilations in cardiac resuscitation), the device comprising a feedback device configured to generate feedback cues to assist the user in timing the delivery of the repetitive therapy, at least one sensor or circuit element configured to detect actual delivery times, at which the user actually delivers the repetitive therapy, and a processor, memory, and associated circuitry configured to compare the actual delivery times to information representative of desired delivery times to determine cue times at which the feedback cues are generated by the feedback device.

Claims

1. A medical device for assisting a user in manually delivering chest compressions and ventilations to a patient as part of cardiac resuscitation, the device comprising

a feedback device configured to generate feedback cues to assist the user in timing the delivery of the chest compressions and ventilations;

a processor, memory, and associated circuitry configured to determine cue times at which the feedback cues are generated by the feedback device,

wherein the feedback cues are auditory, and the feedback cue for chest compressions is a different sound from the feedback cue for ventilations.

2. The device of claim 1 wherein the difference in sound between the compression and ventilation cues is a difference in tone.

3. The device of claim 2 wherein the feedback cue tone for compressions overlaps the feedback cue tone for ventilations on at least some occasions.

4. The device of claim 3 wherein the ventilation feedback cue is a gradually changing sound with a duration that overlaps a plurality of compression feedback cues, which are of substantially shorter duration.

5. A cardiac resuscitation device of the type used for assisting a user in manually delivering repetitive chest compressions to a patient, the device comprising

a feedback device configured to generate non-verbal feedback cues to provide the user with feedback to assist the user with respect to at least one compression parameter;

at least one sensor or circuit element configured to determine the user'"'"'s performance with respect to the compression parameter; and

a processor, memory, and associated circuitry configured to compare the user'"'"'s actual performance with respect to the compression parameter to a desired performance with respect to the compression parameter, and to determine non-verbal feedback cues to assist the user in achieving performance closer to the desired performance.

6. The device of claim 5 wherein the compression parameters are one or a combination of more than one of the following parameters:

compression depth;

compression velocity;

duty cycle;

velocity of chest release;

intrathoracic pressure during compressions;

pleural pressures during compressions;

sternal position, velocity, or accerlation;

chest wall or sternum strain or deformation.

7. The device of claim 5 wherein the processor is configured with a physiological model that relates delivery of the repetitive chest compressions to the at least one compression parameter.

8. A method of automatically delivering chest compressions in cardiac resuscitation, comprising

engaging the patient with a device for automatically delivering chest compressions at compression delivery times;

detecting the timing of electrical pacing stimuli being delivered to the patient; and

selecting the compression delivery times to be synchronized with a selected phase of electrical pacing stimuli.

9. The method of claim 8 wherein the device delivering compressions is separate from device delivering electrical pacing.

10. The method of claim 8 wherein the device detects the timing of electrical pacing stimuli from electrodes on the patient.

17. The medical device of claim 8 wherein the feedback cues are non-verbal cues.

11. A method of delivering a second repetitive therapy while repetitive chest compressions are being delivered, comprising

detecting the timing of the repetitive chest compressions;

and

delivering the second repetitive therapy at times that are synchronized to a selected phase of the repetitive chest compressions.

12. The method of claim 11 wherein the second repetitive therapy comprises electromagnetic pacing stimuli.

13. The method of claim 12 wherein the pacing stimuli are subthreshold and configured to improve tone of myocardium.

14. The method of claim 12 wherein the pacing stimuli are above threshold and configured to produce cardiac contractions.

15. The method of claim 11 wherein the chest compressions are being delivered manually.

16. The method of claim 11 wherein the chest compressions are being delivered by an automatic device.

18. A medical device for assisting a user in manually delivering repetitive therapy to a patient, the device comprising:

a visual display for generating a visual, non-verbal feedback graphic to provide the user with a graphical indication of how well the repetitive therapy is being delivered;

at least one sensor for sensing at least one parameter relating to how well the therapy is being delivered; and

a processor, memory, and associated circuitry configured to process at least one output from at least one sensor to control the appearance of the graphical indication on the visual display.

19. The medical device of claim 18 wherein the repetitive therapy comprises chest compressions as part of cardiac resuscitation.

20. The medical device of claim 18 wherein the repetitive therapy comprises ventilation as part of cardiac resuscitation.

21. The medical device of claim 19 wherein the graphical indication comprises at least a first graphical element that provides the user with feedback generally on a compression by compression basis as to approximately how well individual compressions are being delivered.

22. The medical device of claim 21 wherein the graphical indication further comprises at least a second graphical element that provides the user with feedback on an estimate of the cumulative impact of past compressions on coronary perfusion pressure.

23. The medical device of claim 22 wherein the first graphical element is the color or other graphical aspect of the boundary of a bar element, and the second graphical element is the percentage area within the bar element that bears a color or other graphical aspect.

24. The medical device of claim 18 wherein there are at least two sensors and at least two parameters, and the graphical indication comprises

a first graphical element comprising a first indicator that moves along a first axis to convey a value of a first parameter and

a second graphical element comprising a second indicator that moves along a second axis orthogonal to the first axis to convey a value of a second parameter.

25. The medical device of claim 24 wherein there are at least three parameters, and wherein the graphical indication further comprises a third graphical element positioned at the intersection of the first and second axes, wherein the third graphical element is configured to convey a value of a third parameter.

26. An ultrasonic sensor system for measuring blood flow, the sensor system comprising

an ultrasonic probe positioned at the end of a catheter, the probe and catheter being configured to be inserted into or at the opening of the esophagus,

wherein the probe is configured to deliver and measure ultrasonic sound energy posteriorly toward the spine at approximately the cervical vertebra C3-C6, measuring the reflected ultrasound energy from both the vertebrae and blood vessels;

and

a processor, memory, and associated circuitry configured to process the output of the probe to estimate blood flow in an artery or vein by ultrasonic Doppler flow measurement.

27. The system of claim 26 wherein the sensor is combined with a cardiac resuscitation device and the estimated blood flow determined from the sensor output is used in determining the timing of feedback cues delivered to the user.

28. The system of claim 26 wherein the sensor is configured to be inserted into the esophagus and to deliver ultrasonic energy toward the cervical vertebrae to estimate blood flow in the vertebral artery.

29. An ultrasonic sensor system for measuring blood flow, the sensor system comprising

an ultrasonic probe positioned at the end of a catheter, the probe and catheter being configured to be inserted into or at the opening of the esophagus,

wherein the probe is conically shaped such that it seats against the base of the pharynx at the superior end of the esophagus in the area of the esophageal muscle and the wide end of the probe just above that in the lower pharynx,

wherein the probe is configured to deliver and measure ultrasonic sound energy laterally, and

wherein the sensor is configured to deliver ultrasonic energy in a beam directed at an upward angle to intersect the common carotid artery and internal jugular vein;

and

a processor, memory, and associated circuitry configured to process the output of the probe to estimate blood flow in an artery or vein by ultrasonic Doppler flow measurement.

30. The system of claim 29 wherein the processor is configured to process the output of the ultrasonic probe to estimate blood flow velocity for both the carotid artery and jugular vein.

31. The system of claim 30 wherein the processor is configured to calculate a pulsatile index as the difference of the peak aortic velocity and minimum diastolic velocity divided by the average velocity over one cardiac cycle.

32. The system of claim 31 wherein the processor is configured to calculate a resistance index as the difference between the peak aortic velocity and minimum diastolic velocity divided by the peak aortic velocity.