Method and apparatus for enhancement of chest compressions during CPR

• US 7,220,235 B2
• Filed: 11/06/2003
• Issued: 05/22/2007
• Est. Priority Date: 06/27/2003
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Inventors: Freeman, Gary A., Geheb, Frederick, Boucher, Donald R.
• Primary Examiner(s): Pezzuto; Robert E.
• Assistant Examiner(s): Gedeon; Brian T.
• Application Number:
  US10/704,366
• Publication Number:
  US 20040267325A1
• Time in Patent Office: 1,293 Days
• Field of Search: 607/3, 607/5, 601/41
• US Class Current: 601/41
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 2562/0247 Pressure sensors
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/11 Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb for measuring pulse A61B5/02 ;A61B5/1038 takes precedence; motion detection to correct for motion artifacts in physiological signals A61B5/721
• CPC Class Codes: A61B 5/1102 Ballistocardiography
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/6823 Trunk, e.g., chest, back, abdomen, hip
• CPC Class Codes: A61B 5/6833 Adhesive patches
• CPC Class Codes: A61B 5/7455 characterised by tactile indication, e.g. vibration or electrical stimulation
• CPC Class Codes: A61H 2031/002 fixed on the chest by adhesives
• CPC Class Codes: A61H 2201/5007 computer controlled
• 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 2201/5061 Force sensors
• CPC Class Codes: A61H 2201/5071 Pressure sensors
• CPC Class Codes: A61H 2201/5079 Velocity sensors
• CPC Class Codes: A61H 2201/5084 Acceleration sensors
• CPC Class Codes: A61H 2230/04 Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
• CPC Class Codes: A61H 2230/06 Heartbeat rate
• CPC Class Codes: A61H 2230/207 : partial O2-value
• CPC Class Codes: A61H 31/005 : with feedback for the user
• CPC Class Codes: A61H 31/007 : Manual driven
• CPC Class Codes: A61N 1/39044 : in combination with cardiopulmonary resuscitation [CPR] therapy
• CPC Class Codes: A61N 1/3925 : Monitoring; Protecting
• CPC Class Codes: G16H 15/00 : ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/63 : for local operation
• CPC Class Codes: H01H 2215/004 : Collapsible dome or bubble

Abstract

An apparatus for assisting a rescuer in performing chest compressions during CPR on a victim, the apparatus comprising a pad or other structure configured to be applied to the chest near or at the location at which the rescuer applies force to produce the chest compressions, at least one sensor connected to the pad, the sensor being configured to sense movement of the chest or force applied to the chest, processing circuitry for processing the output of the sensor to determine whether the rescuer is substantially releasing the chest following chest compressions, and at least one prompting element connected to the processing circuitry for providing the rescuer with information as to whether the chest is being substantially released following chest compressions.

Claims

1. Apparatus for assisting a rescuer in performing chest compressions during CPR on a victim, the apparatus comprising:

a pad or other structure configured to be applied to the chest near or at the location at which the rescuer applies force to produce the chest compressions;

at least one sensor connected to the pad, the sensor being configured to sense movement of the chest or force applied to the chest;

processing circuitry for processing the output of the sensor to determine whether the rescuer is substantially releasing the chest following chest compressions; and

at least one prompting element connected to the processing circuitry for providing the rescuer with information as to whether the chest is being substantially released following chest compressions.

2. The apparatus of claim 1 wherein the pad or other structure is a pad to which force is applied by rescuer.

3. The apparatus of claim 1 wherein the sensor includes an accelerometer.

4. The apparatus of claim 1 wherein the sensor includes a force sensor.

5. The apparatus of claim 1 wherein the sensor includes a velocity sensor.

6. The apparatus of claim 1 wherein the sensor includes both a force sensor and an accelerometer or velocity sensor.

7. The apparatus of claim 1 wherein the prompting device includes a speaker for delivering an audible message to the rescuer.

8. The apparatus of claim 1 wherein the prompting device includes a display for delivering a visual message to the rescuer.

9. The apparatus of claim 1 wherein the apparatus is part of an external defibrillator.

10. The apparatus of claim 9 wherein the external defibrillator is an AED.

11. The apparatus of claim 1 wherein the processing circuitry includes a digital processor executing software.

12. The apparatus of claim 1 wherein determining whether the rescuer is substantially releasing the chest comprises analyzing motion of the chest.

13. The apparatus of claim 12 wherein analyzing motion of the chest comprises analyzing features or the shape of a waveform representing chest motion.

14. The apparatus of claim 1 comprising both a sensor to sense movement of the chest and a sensor to sense force applied to the chest, and wherein the processing circuitry uses outputs of both sensors to provide information representative of chest compliance.

15. The apparatus of claim 14 wherein the information representative of chest compliance is used to determine a level of applied pressure/force that corresponds to a substantial release of the chest.

16. Apparatus for assisting a rescuer in performing chest compressions during CPR on a victim, the apparatus comprising:

a pad or other structure configured to be applied to the chest near or at the location at which the rescuer applies force to produce the chest compressions;

at least one motion sensor connected to the pad, the motion sensor being configured to sense movement of the chest;

processing circuitry for processing the output of the motion sensor to estimate the maximum velocity of compression of the chest; and

at least one prompting device connected to the processing circuitry for providing the rescuer with information representative of the maximum velocity of compression.

17. The apparatus of claim 16 wherein the motion sensor comprises a velocity sensor.

21. The apparatus of claim 18 or 17 wherein the velocity sensor is configured to be located approximately adjacent to the location at which the body is compressed.

22. The apparatus of claim 18 or 17 wherein the velocity sensor is configured to be positioned to sense the relative velocity between opposite surfaces of the chest.

23. The apparatus of claim 18 or 17 wherein the velocity sensor comprises a conductor and a magnet, and velocity is sensed by sensing the current induced in the conductor by relative motion between the conductor and the magnet.

24. The apparatus of claim 23 wherein the magnet comprises one of a permanent magnet and an electromagnet.

25. The apparatus of claim 23 wherein the conductor and magnet are positioned on opposite surfaces of the chest.

26. The apparatus of claim 23 wherein the conductor comprises a coil that is unitary with a defibrillation electrode pad.

27. The apparatus of claim 23 wherein the conductor and magnet each comprise a coil that is unitary with a defibrillation electrode pad.

28. The apparatus of claim 18 or 17 wherein the magnet comprises an electromagnet and the electromagnet produces a magnetic field that oscillates at a frequency greater than 1 KHz, and further comprising coil detection circuitry to which the coil is connected, wherein the coil detection circuitry is capable of synchronously demodulating the detected signal to reduce susceptibility to drift and noise.

29. The apparatus of claim 18 or 17 further comprising circuitry for acquiring ECG signals from the victim, and wherein the processing circuitry has the capability to process the output of the velocity sensor and the ECG signals to reduce ECG artifacts from chest compressions by use of velocity sensor output.

18. Apparatus for assisting a rescuer in performing chest compressions during CPR on a victim, the apparatus comprising:

a pad or other structure configured to be applied to the chest near or at the location at which the rescuer applies force to produce the chest compressions; and

at least one velocity sensor connected to the pad, the velocity sensor being configured to sense the linear velocity of upward and downward movement of the chest.

19. The apparatus of claim 18 further comprising processing circuitry for processing the output of the velocity sensor to estimate the displacement of the chest.

20. The apparatus of claim 19 wherein the processing circuitry has the capability to integrate an output of the velocity sensor.

30. A method of determining chest compression during CPR, the method comprising

applying a motion sensor to the chest of a patient at a location near or at the location at which a rescuer applies force to produce chest compressions;

determining chest displacement from analysis of features of the motion waveform produced by the motion sensor,

wherein determining chest displacement from analysis of features comprises determining onset and completion times for a compression cycle from the features of the waveforms.

31. The method of claim 30 wherein the motion sensor is a velocity sensor.

32. The method of claim 30 wherein the motion sensor is an accelerometer.

33. The method of claim 32 further comprising deciding from the analysis of features of the acceleration waveform whether or not a rescuer has sufficiently released the patient'"'"'s chest.

34. The method of claim 32 further comprising processing the output of the accelerometer to provide velocity and acceleration waveforms.

35. The method of claim 33 further comprising processing the output of the accelerometer to provide velocity and acceleration waveforms, and analyzing the velocity and acceleration waveforms to determine whether or not a rescuer has sufficiently released the patient'"'"'s chest.

36. The method of claim 34 wherein the analysis of velocity waveforms includes determining the maximal velocity of compression.

37. The method of claim 32 or 34 wherein determining chest displacement further comprises integrating the acceleration waveform over a time segment defined by the onset and completion times.

38. The method of claim 32 or 34 further comprising analyzing the features of the upstroke portion of the waveforms to determine whether there has been sufficient release of the chest.

39. The method of claim 32 or 34 further comprising prompting a rescuer based as to whether compressions are within desired limits on compression depth and compression release.

40. A method of determining chest compression during CPR, the method comprising

applying a motion sensor to the chest of a patient at a location near or at the location at which a rescuer applies force to produce chest compressions;

determining chest displacement from analysis of features of the motion waveform produced by the motion sensor,

wherein the motion sensor is an accelerometer, and

further comprising processing the output of the accelerometer to provide velocity and acceleration waveforms, and

further comprising prompting a rescuer based as to whether compressions are within desired limits on compression depth and compression release,

wherein the prompts to the rescuer are based on multi-cycle trends, so that they are not immediately influenced by the rescuer taking a brief break in the application of CPR.

41. A method of determining chest compression during CPR, the method comprising

applying a motion sensor to the chest of a patient at a location near or at the location at which a rescuer applies force to produce chest compressions;

determining chest displacement from analysis of features of the motion waveform produced by the motion sensor,

wherein the motion sensor is an accelerometer, and

further comprising processing the output of the accelerometer to provide velocity and acceleration waveforms, and

further comprising prompting a rescuer based as to whether compressions are within desired limits on compression depth and compression release, and

further comprising determining chest compliance, and using the determined chest compliance to adjust the level of pressure/force that the rescuer is permitted to apply at the end of a compression stroke without being prompted as to insufficiently releasing the chest.

42. A method of determining chest compression during CPR, the method comprising

applying a motion sensor to the chest of a patient at a location near or at the location at which a rescuer applies force to produce chest compressions;

determining chest displacement from analysis of features of the motion waveform produced by the motion sensor,

wherein the motion sensor is an accelerometer, and

further comprising processing the output of the accelerometer to provide velocity and acceleration waveforms, and

wherein the features determined from the waveforms include one or more of the following;

width, amplitude, area, center of mass, skewness, height/width ratio, TAR, TAMPR and TWR.

43. The method of claim 42 wherein the features are used to make a decision as to whether the chest of the victim has been sufficiently released.

44. The method of claim 43 wherein decisions are made using either standard decision logic, fuzzy-logic decision methodology, or statistical estimation.

45. A method of analyzing ECG signals during application of CPR, the method comprising:

detecting ECG signals during application of chest compressions;

detecting the output of a sensor from which information on the velocity of chest compressions can be determined; and

using the information on the velocity to reduce at least one signal artifact in the ECG signal resulting from the chest compressions.

46. The method of claim 45 wherein the sensor is a velocity sensor, and the information on the velocity is determined from the velocity sensor.

47. The method of claim 45 wherein the sensor is an accelerometer, and the information on the velocity is determined from integration of the output of the accelerometer.

48. The method of claim 45 wherein using the information on the velocity to reduce at least one signal artifact in the ECG signal comprises time aligning the ECG signals with the velocity.

49. The method of claim 45 wherein using the information on the velocity to reduce at least one signal artifact in the ECG signal comprises an adaptive filter that is adjusted to remove chest compression artifacts.

50. The method of claim 45 wherein using the information on the velocity to reduce at least one signal artifact in the ECG signal comprises feed forward active noise cancellation.

51. The method of claim 45 wherein using the information on the velocity to reduce at least one signal artifact in the ECG signal comprises determining a cutoff frequency for a filter that separates the ECG signal from chest compression artifacts.

52. Apparatus for assisting a rescuer in performing chest compressions during CPR on a victim, the apparatus comprising:

a pad or other structure configured to be applied to the chest near or at the location at which the rescuer applies force to produce the chest compressions;

at least one motion sensor connected to the pad, the motion sensor being configured to sense movement of the chest;

at least one force sensor connected to the pad, the force sensor being configured to sense force applied to the chest; and

processing circuitry for processing the output of the motion sensor and force sensor to estimate the compliance of the chest.

53. The apparatus of claim 52 wherein the estimated compliance and the output of the force sensor are used to determine the depth of compression of the chest.

54. The apparatus of claim 53 wherein the motion sensor is an accelerometer, and the output of the accelerometer is used primarily for estimating chest compliance, and compression depth during CPR is estimated by using the estimated compliance to convert the output of the force sensor into estimated compression depth.

55. The apparatus of claim 54 wherein the output of the accelerometer is used during limited time intervals for estimating chest compliance, and outside of those limited time intervals chest compression is determined from the estimated compliance and the output of the force sensor without substantial use of the output of the accelerometer.

56. The apparatus of claim 52 or 53 wherein the estimated compliance and the output of the force sensor are used to determine whether the chest has been substantially released.

57. Apparatus for assisting a rescuer in performing chest compressions during CPR on a victim, the apparatus comprising:

a pad or other structure configured to be applied to the chest near or at the location at which the rescuer applies force to produce the chest compressions;

at least one bistable mechanical element that when depressed provides tactile feedback to the hand of the rescuer upon the start of a compression and at the end of a compression.

58. The apparatus of claim 57 wherein the mechanical element comprises a dome that collapses under pressure and returns to a dome shape on release of pressure.

59. The apparatus of claim 57 wherein the bistable mechanical element further provides audible feedback at least at the end of a compression.

60. The apparatus of claim 57 wherein the tactile feedback at the end of a compression occurs at approximately an applied force corresponding to substantial release of the chest, so that the tactile feedback serves as feedback to the rescuer that the chest has been substantially released.