Method and apparatus for sensing lead and transthoracic impedances

• US 4,919,145 A
• Filed: 07/13/1988
• Issued: 04/24/1990
• Est. Priority Date: 07/13/1988
• Status: Expired due to Term

• Current Assignee: Creditanstalt-Bankverein (Unicredit SPA)
• Original Assignee: Physio-Control Incorporated (Stryker Corporation)
• Inventors: Marriott, Arthur R.
• Primary Examiner(s): Smith, Ruth S.
• Assistant Examiner(s): Zele, John D.
• Application Number:
  US07/219,080
• Time in Patent Office: 650 Days
• Field of Search: 128/696, 128/671, 128/734, 128/782
• US Class Current: 600/536
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/276 Protection against electrode failure

Abstract

A method and apparatus for use with medical electrode systems that sense the integrity of lead connections and patient transthoracic impedance is provided. In an ECG electrode application, a carrier circuit (12) produces two carrier signals (S_C1 and S_C2) that are out of phase with each other. The S_C1 signal is applied to an RA lead through a terminating impedance (Z1). The S_C2 signal is applied to LA, LL and V leads through terminating impedances (Z2, Z3, and Z4). Each of the S_C1 and S_C2 carrier signals comprises a lead impedance frequency component (S_LI) and an impedance respiration frequency component (S_IR). First stage amplifiers (A1, A2, and A3) located in an ECG preamplifier (13) amplify the difference between a lead voltage on the RA lead (V_RA) and lead voltages on the LA, LL, and V leads (V_LA, V_LL and V_V). High pass filters (F1, F2 and F3) remove patient ECG signals from the outputs of A1, A2 and A3 to produce first stage output voltages (V₁, V₂ and V₅). The V₁, V₂ and V₅ voltages are demodulated by a demodulator circuit (18). Lead impedance demodulators (DM1, DM2 and DM3) are clocked by a lead impedance control signal (S_A) that has the same frequency as the S_LI component so that the outputs of DM1, DM2 and DM3 are lead impedance-related voltages (V_L1, V_L2 and V_L5). V₂ is also demodulated by an impedance respiration demodulator (DM4). DM4 is clocked by an impedance respiration control signal (S_B) that has the same frequency as the S_IR component so that the output of DM4 is a transthoracic impedance-related voltage V_T. V_T is amplified by an operational amplifier (OA10) to produce an impedance respiration-related voltage (V_R). The ECG preamplifier (13) and the demodulator circuit (18) include fast DC restoration circuits (66, 68, 70 and 71) that use switched capacitor integrators (76) to restore ECG outputs (V_E1, V_E2, and V_E5) and the V_R voltage to nominal values when a DC offset has occurred.

Claims

1. An apparatus for use with medical diagnostic and therapeutic apparatus employing electrodes attached to a patient'"'"'s skin for sensing the integrity of lead connections and patient transthoracic impedance comprising:

(a) a carrier signal source means coupled to a first lead having a first lead impedance and coupled to a plurality of second leads having a plurality of second lead impedances;

(i) for producing a first carrier signal having a lead impedance frequency component and an impedance respiration frequency component and for applying said first carrier signal to said first lead; and

,

(ii) for producing a second carrier signal having said lead impedance frequency component and said impedance respiration frequency component and for applying said second carrier signal to said plurality of second leads;

(b) a receiver means coupled to said first lead and said plurality of second leads for receiving;

(i) a first lead voltage produced by said first carrier signal and said first lead impedance; and

,

(ii) a plurality of second lead voltages produced by said second carrier signal and said plurality of second lead impedances;

(c) amplifying means, coupled to receive a plurality of combinations of said first lead voltage with one of said plurality of second lead voltages, for amplifying the difference between said first and second lead voltages in each of said combinations and producing;

(i) a plurality of first stage output voltages, one of said first stage output voltages being produced for each of said combinations of said first and second lead voltages; and

,

(ii) a plurality of second stage output voltages, one of said second stage output voltages being produced for each of said combinations of said first and second lead voltages; and

,

(d) a signal separator means coupled to said amplifying means for receiving said plurality of first stage output voltages and for producing;

(i) a plurality of lead impedance-related voltages related to said lead impedance frequency component of said first and second carrier signals; and

,

(ii) at least one impedance respiration-related voltages related to said impedance respiration frequency component of said first and second carrier signals.

2. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 1, wherein said first carrier signal is out of phase with said second carrier signal.

3. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 1, wherein said carrier signal source means comprises a terminating impedance network, said carrier signal source means applying said first and second carrier signals to said first lead and said plurality of second leads through said terminating impedance network.

4. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 3, wherein said terminating impedance network comprises:

(a) a first terminating impedance coupled to said first lead, wherein said carrier signal source means applies said first carrier signal to said lead through said first terminating impedance; and

,

(b) a plurality of second terminating impedances coupled to said plurality of second leads, wherein said carrier signal source means applies said second carrier signal to said plurality of second leads through said plurality of second terminating impedances.

5. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 4, wherein said first terminating impedance and said plurality of second terminating impedances have the same impedance values.

6. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 1, wherein said amplifying means includes one or more DC restoration circuits each coupled to receive one of said plurality of second stage output voltages, said DC restoration circuit producing an output that compensates for a DC offset in said one of said plurality of second stage output voltages.

7. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 6, wherein each said DC restoration circuit comprises a switched capacitor integrator.

8. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 1, wherein said signal separator means comprises:

(a) a plurality of lead impedance demodulators coupled to receive said plurality of first stage output voltages and produce said plurality of lead impedance-related voltages;

(b) at least one impedance respiration demodulator coupled to receive said plurality of said first stage output voltages and produce at least one transthoracic impedance-related voltage and,

(c) at least one DC restoration circuit coupled to receive said at least one transthoracic impedance-related voltage, each of said at least one DC restoration circuit producing an output that compensates for a DC offset in said at least one impedance respiration-related voltage.

9. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 8, wherein said at least one DC restoration circuit comprises a switched-capacitor integrator.

10. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 8, wherein said plurality of lead impedance demodulators are clocked by a first control signal having a frequency equal to the frequency of said lead impedance component of said first and second carrier signals, and said at least one impedance respiration demodulator is clocked by a control signal having a frequency equal to the frequency of said impedance respiration component of said first and second carrier signals.

11. The apparatus for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 1, wherein said lead impedance frequency component has a frequency of 1024 Hz and said impedance respiration frequency component has a frequency of 18.432 kHz.

12. A method for sensing the integrity of lead connections and patient transthoracic impedance comprising the steps of:

(a) producing a first carrier signal having a lead impedance frequency component and an impedance respiration frequency component, and producing a second carrier signal having said lead impedance frequency component and said impedance respiration frequency component, wherein said first carrier signal is out of phase with said second carrier signal;

(b) applying said first carrier signal to a first lead having a first lead impedance and applying said second carrier signal to a plurality of second leads having a plurality of second lead impedances;

(c) receiving a first lead voltage produced by said first carrier signal and said first lead impedance and receiving a plurality of second lead voltages produced by said second carrier signal and said plurality of second lead impedances;

(d) amplifying the difference of a plurality of combinations of said first lead voltage and one of said plurality of second lead voltages and producing a plurality of first stage output voltages and a plurality of second stage output voltages; and

,

(e) producing a plurality of lead impedance-related voltages and at least one impedance respiration-related voltage from said plurality of first stage output voltages.

13. The method for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 12, wherein said step of producing said first and second carrier signals include the step of inverting one of said carrier signals.

14. The method of sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 12, wherein said step of applying said first and second carrier signals to said first and said plurality of second leads comprises the step of passing said first and second carrier signals through a terminating impedance network.

15. The method for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 12, wherein said step of amplifying comprises the steps of:

(a) high pass filtering said plurality of first stage output voltages; and

,

(b) restoring said plurality of second stage output voltages to nominal values by compensating for a DC offset in said plurality of second stage output voltages.

16. The method for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 15, wherein said step of restoring said plurality of second stage output voltages to nominal values includes the step of using one or more switched-capacitor integrators.

17. The method of sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 12, wherein said step of producing a plurality of lead impedance-related voltages and at least one impedance respiration-related voltage comprises the steps of:

(a) demodulating said first stage output voltages at a frequency equal to the frequency of said lead impedance frequency component and producing said plurality of lead impedance-related voltages;

(b) demodulating at least one of said second stage output voltages at a frequency equal to said impedance respiration frequency component and producing said at least one impedance respiration-related voltage; and

,

(c) restoring said at least one impedance respiration-related voltage to a nominal value by compensating for a DC offset in said at least one impedance respiration-related voltages.

18. The method for sensing the integrity of lead connections and patient transthoracic impedance claimed in claim 17, wherein said step of restoring said at least one impedance respiration-related voltage to a nominal value includes the step of using one or more switched-capacitor integrators.