NON-INVASIVE DEVICE FOR SYNCHRONIZING CHEST COMPRESSION AND VENTILATION PARAMETERS TO RESIDUAL MYOCARDIAL ACTIVITY DURING CARDIOPULMONARY RESUSCITATION

• US 20120016179A1
• Filed: 07/14/2011
• Published: 01/19/2012
• Est. Priority Date: 10/25/2004
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Inventors: PARADIS, Norman, BARASH, David, HALPERIN, Henry R., FREEMAN, Gary
• Granted Patent: US 9,259,543 B2
• Time in Patent Office: Days
• US Class Current: 600/17
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/5097 wireless
• CPC Class Codes: A61H 2230/00 Measuring physical parameters of the user
• CPC Class Codes: A61H 2230/045 used as a control parameter for the apparatus
• CPC Class Codes: A61H 31/005 with feedback for the user
• CPC Class Codes: A61H 31/006 Power driven
• CPC Class Codes: A61H 9/0078 with intermittent or alternately inflated bladders or cuffs mattresses for preventing bed-sores with alternated pressurized chambers A61G7/05776
• CPC Class Codes: A61M 16/0057 Pumps therefor
• CPC Class Codes: A61M 16/0063 Compressors
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 2205/33 Controlling, regulating or measuring
• CPC Class Codes: A61M 2205/332 Force measuring means
• CPC Class Codes: A61M 2205/581 by audible feedback
• CPC Class Codes: A61M 2205/583 by visual feedback
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/202 partial carbon oxide pressure, e.g. partial dioxide pressure (P-CO2)
• CPC Class Codes: A61M 2230/30 Blood pressure A61M2230/04 takes precedence
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

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 including 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 to treat a patient in shock comprising:

sensing myocardial motion or pulsatile blood flow in the patient;

repeatedly applying a phasic therapy to the patient synchronized to the sensed actual myocardial motion or pulsatile blood flow, wherein the phasic therapy includes repeatedly applying a compressive force to the chest or an electrical shock to the heart of the patient, and

adjusting the compressive force or electrical shock depending on whether the force or shock coincides with a heart beat as indicated by sensed myocardial motion or pulsatile blood flow.

2. A method as in claim 1 wherein the repeated application of the phasic therapy augments cardiac ejection of blood and the cessation of the application of the compressive force and the electrical shock avoids interfering with filling of the heart.

3. A method as in claim 1 wherein the phasic therapy includes a second phasic therapy selected from a group consisting of active chest decompression, abdominal compression, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

4. A method as in claim 1 wherein the compressive force is applied to at least one of a sternal, a parasternal or an intercostal area of the chest.

5. A method as in claim 1 wherein the compressive force or electrical shock is applied during each ejection phase of the heart in which the phasic therapy is applied.

6. A method as in claim 1 wherein the compressive force or electrical shock is applied during less than all of the ejection phase of the heart during a period in which the phasic therapy is applied.

7. A method as in claim 1 wherein the compressive force or electrical shock is applied during a predetermined portion of the ejection phase and the cessation occurs during another portion of the ejection phase.

8. A method as in claim 1 wherein the phasic therapy comprises actively lifting or actively decompressing of the chest during the relaxation phase and during the cessation of the compressive force.

9. A method as in claim 8 wherein the lifting or decompression is applied during an entirety of the relaxation phase.

10. A method of claim 8 wherein the lifting or decompression is applied during a predetermined portion of the relaxation phase and is not applied during another portion of the relaxation phase.

11. A method as in claim 1 further comprising applying or altering ventilations, gas flow or airway pressure of the patient based on the sensed myocardial motion or pulsatile blood flow.

12. A method as in claim 1 wherein the compressive force is applied using equipment selected from a group consisting of mechanical compression devices;

inflatable vests, nerve or muscle stimulators; and

a suction based compression-decompression device.

13. A method as in claim 1 wherein a sensing system directly senses the actual myocardial motion or pulsatile blood flow.

14. A method as in claim 13 wherein the sensing system comprises one or more sensors in a group consisting sensors of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography.

15. A method as in claim 13 wherein the sensing system comprises an array of sensors applied to the patient.

16. A method as in claim 1 further comprising displaying or broadcasting information indicating the sensed actual myocardial motion or pulsatile blood flow.

17. A method as in claim 16 wherein the repeated application of the phasic therapy is applied manually in synchronization with the displayed or broadcasted information.

18. A method as in claim 1 further comprising delaying initial application to the heart of the phasic therapy until a sensed natural heartbeat has a rate below a predetermined threshold rate.

19. A method to treat a patient as in claim 18 further comprising applying the chest compressions or the electric shocks at a rate faster than the sensed natural heartbeat.

20. A method to treat a patient comprising:

sensing a natural rate of myocardial activity of the heart of the patient, and

repeatedly applying a phasic therapy to the patient synchronized to the sensed myocardial activity, wherein the phasic therapy includes repeated myocardial electrical stimulation applied at a rate faster than the sensed natural rate of myocardial activity.

21. A method as in claim 20 wherein the myocardial electrical stimulation is applied during at least a portion of an ejection phase of the heart.

22. A method as in claim 20 wherein the myocardial electrical stimulation is not applied during a relaxation phase of the heart.

23. A method to treat a patient as in claim 20 further comprising determining the patient is in shock before the repeated application of the phasic therapy.

24. A method to treat a patient as in claim 20 further comprising determining the patient is suffering pulseless electrical activity (PEA) before applying the phasic therapy.

25. A method to treat a patient as in claim 20 further comprising determining the patient is suffering cardiac arrest before the repeated application of the phasic therapy.

26. A method as in claim 20 wherein the repeated application of the phasic therapy augments cardiac ejection of blood and the cessation of the application of the compressive force avoids interfering with filling of the heart.

27. A method as in claim 20 wherein the phasic therapy includes a second phasic therapy selected from a group consisting of active chest decompression, abdominal compression, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

28. A method as in claim 20 wherein the compressive force is applied to at least one of a sternal, a parasternal or an intercostal area of the chest.

29. A method as in claim 20 wherein the compressive force is applied during each ejection phase of the heart in which the phasic therapy is applied.

30. A method as in claim 20 wherein the compressive force is applied during less than all of the ejection phase of the heart during a period in which the phasic therapy is applied.

31. A method as in claim 20 wherein the compressive force is applied during a predetermined portion of the ejection phase and the cessation occurs during another portion of the ejection phase.

32. A method as in claim 20 wherein the phasic therapy comprises actively lifting or actively decompressing of the chest during the relaxation phase and during the cessation of the compressive force.

33. A method as in claim 20 wherein the lifting or decompression is applied during an entirety of the relaxation phase.

34. A method of claim 20 wherein the lifting or decompression is applied during a predetermined portion of the relaxation phase and is not applied during another portion of the relaxation phase.

35. A method as in claim 20 further comprising applying or altering ventilations, gas flow or airway pressure of the patient based on the sensed actual myocardial motion or pulsatile blood flow.

36. A method as in claim 20 wherein the compressive force is applied using equipment selected from a group consisting of mechanical compression devices;

inflatable vests, nerve or muscle stimulators; and

a suction based compression-decompression device.

37. A method as in claim 20 wherein a sensing system senses the actual myocardial motion or pulsatile blood flow.

38. A method as in claim 37 wherein the sensing system comprises one or more sensors in a group consisting sensors of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography.

39. A method as in claim 20 further comprising displaying or broadcasting information indicating the sensed actual myocardial motion or pulsatile blood flow.

40. A method as in claim 39 wherein the repeated application of the phasic therapy is applied manually in synchronization with the displayed or broadcasted information.

41. A system to treat a patient having a heart and a chest, the system comprising:

a least one sensor monitoring cardiac activity in the patient by detecting at least one of myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion;

a logic controller receiving signals from the at least one sensor and generating control commands for controlling one or more phasic therapies and synchronizing the one or more phasic therapies with the monitored cardiac activity in the patient; and

wherein the logic controller executes an algorithm stored in memory associated with the logic controller, wherein the algorithm causes the logic controller to generate commands to vary patterns of the application of the one or more phasic therapies, and thereafter detect changes in at least one of the sensed myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion due to variations in the patterns, and determine one of the patterns of phasic therapies corresponding to a desired level of at least one of sensed myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion hemodynamics and organ perfusion.

42. The system of claim 41 further comprising a sensing system comparing at least one of the sensed myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion hemodynamics and organ perfusion with and without application of the phasic therapies to determine which of the phasic therapies optimally augments hemodynamics or perfusion.

43. A method to treat a patient having a heart and a chest, the system comprising:

monitoring cardiac activity in the patient by detecting with at least one sensor at least one of myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion;

receiving the signals from the at least one sensor and, based on the signals, synchronizing one or more phasic therapies applied to the patient to the monitored cardiac activity in the patient;

varying the one or more phasic therapies;

detect changes in at least one of the sensed myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion due to the variations in the one or more phasic therapies;

determining at least one of the variations of the phasic therapies corresponding to a desired level of at least one of sensed myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion hemodynamics and organ perfusion.

44. The method of claim 43 further comprise comparing at least one of the sensed myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion hemodynamics and organ perfusion with and without application of the phasic therapies to determine which of the phasic therapies optimally augments hemodynamics or perfusion.

45. A method to treat a patient comprising:

sensing a natural rate of myocardial activity of the heart of the patient;

repeatedly applying a phasic therapy to the patient synchronized to the sensed myocardial activity, wherein the repeated phasic therapy is applied at a higher frequency than the frequency of the natural rate;

determining an error period between an event in the myocardial activity and the phasic therapy applied at time proximate to the myocardial activity, and

advancing or delaying one of the applications of the phasic therapy by a period determined using the error period.

46. The method to treat a patient as in claim 45 wherein the higher frequency of the phasic therapy is a harmonic of the frequency of the natural rate.

47. The method to treat a patient as in claim 45 wherein the myocardial activity is a QRS signal.

48. The method to treat a patient as in claim 45 further comprising terminating the phasic therapy before a vulnerable period in a T wave of the myocardial activity.

49. The method to treat a patient as in claim 45 further comprising terminating the phasic therapy a safety period before a T wave of the myocardial activity.