Pacing management during cardiopulmonary resuscitation

• US 7,720,535 B2
• Filed: 08/23/2005
• Issued: 05/18/2010
• Est. Priority Date: 08/23/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Dong, Yanting, Ni, Quan
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): PATEL, NATASHA
• Application Number:
  US11/209,975
• Publication Number:
  US 20070049976A1
• Time in Patent Office: 1,729 Days
• Field of Search: 607/3, 600/515
• US Class Current: 607/3
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/39622 Pacing therapy
• CPC Class Codes: G09B 23/288 for artificial respiration or heart massage

Abstract

Systems and methods provide for coordinated cardiac pacing with delivery of cardiopulmonary resuscitation (CPR) to a patient. Managing cardiac pacing in a patient during a cardiac arrhythmia involves detecting a cardiac arrhythmia using a patient implantable medical device, prompting a cardiopulmonary resuscitation compression, and delivering, using the patient implantable medical device, a pacing pulse to a heart chamber in coordination with the compression prompt.

Claims

1. A method of managing cardiac pacing in a patient during a cardiac arrhythmia using a patient implantable medical device, comprising:

detecting a cardiac arrhythmia using a patient implantable medical device;

detecting a plurality of cardiopulmonary resuscitation compressions using the patient implantable medical device, the plurality of cardiopulmonary resuscitation compressions human delivered, and

delivering, using the patient implantable medical device, a plurality of pacing pulses sufficient to capture tissue of a heart chamber to the patient'"'"'s heart in timed relation to detection of the cardiopulmonary resuscitation compressions, each pulse of the plurality delivered in response to detection of a respective cardiopulmonary resuscitation compression of the plurality.

2. The method of claim 1, farther comprising prompting each of the cardiopulmonary resuscitation compressions in response to detection of the cardiac arrhythmia.

3. The method of claim 1, wherein:

detecting the cardiopulmonary resuscitation compressions comprises detecting accelerations of the patient implantable medical device; and

delivering the pacing pulses to the heart chamber comprises delivering an individual pacing pulse in response to detection of each acceleration.

4. The method of claim 1, wherein:

detecting the cardiopulmonary resuscitation compressions comprises detecting onset of each of the cardiopulmonary resuscitation compressions; and

delivering the pacing pulses to the heart chamber comprises initiating an individual pacing pulse to the heart chamber in response to each detection of onset of compression.

5. The method of claim 1, wherein:

detecting the cardiopulmonary resuscitation compressions comprises detecting changes in the patient'"'"'s transthoracic impedance using the patient implantable medical device, wherein each pulse of the plurality is delivered in response to a respective detected change in the patient'"'"'s transthoracic impedance.

6. The method of claim 2, wherein prompting the cardiopulmonary resuscitation compressions comprises providing a patient-externally audible prompt for each compression.

7. The method of claim 2, wherein prompting the cardiopulmonary resuscitation compressions comprises providing a patient-externally audible prompt at a predetermined rate.

8. The method of claim 2, wherein prompting the cardiopulmonary resuscitation compressions further comprises prompting at least one cardiopulmonary resuscitation breath by provision of a patient-externally audible prompt distinct from that associated with prompting the cardiopulmonary resuscitations.

9. The method of claim 2, comprising adjusting or terminating the prompting in response to detecting cessation of the cardiac arrhythmia.

10. A patient-implantable medical device, comprising:

a housing configured for implantation;

a pacing circuit configured to deliver a plurality of pacing pulses sufficient to capture cardiac tissue to a heart chamber, the pacing circuit contained at least partially within the housing;

a sensing circuit configured to sense cardiac signals, the sensing circuit contained at least partially within the housing;

a cardiopulmonary resuscitation compression circuit configured to detect delivery of a plurality of human delivered cardiopulmonary resuscitation compressions, the cardiopulmonary resuscitation compression circuit contained at least partially within the housing; and

a processor coupled to the pacing circuit, the sensing circuit, and the cardiopulmonary resuscitation compression circuit, the processor configured to detect a cardiac arrhythmia using the sensing circuit, detect the plurality of cardiopulmonary resuscitation compressions, and coordinate delivery of the plurality of pacing pulses to the heart chamber such that each pulse of the plurality is delivered in response to detection of a respective cardiopulmonary resuscitation compression of the plurality.

11. The device of claim 10, wherein the cardiopulmonary resuscitation compression circuit comprises an impedance sensing circuit coupled to the processor and configured to sense an impedance signal indicative of the cardiopulmonary resuscitation compressions.

12. The device of claim 10, wherein the cardiopulmonary resuscitation compression circuit comprises an accelerometer coupled to the processor and configured to sense an acceleration signal indicative of each of the cardiopulmonary resuscitation compressions.

13. The device of claim 10, further comprising a prompting circuit configured to prompt delivery of the cardiopulmonary resuscitation compressions in response to detection of the cardiac arrhythmia.

14. The device of claim 13, wherein the processor is configured to prompt a cardiopulmonary resuscitation breath at a predetermined rate following a predetermined number of prompts for cardiopulmonary resuscitation compressions.

15. The device of claim 10, wherein the processor is configured to detect onset of each cardiopulmonary resuscitation compression and initiate delivery of a respective one of the pacing pulses in response to detection of onset of each cardiopulmonary resuscitation compression of the plurality.

16. A patient-implantable medical device for managing cardiac pacing in a patient during a cardiac arrhythmia, comprising:

means for implantably detecting a cardiac arrhythmia;

means for implantably detecting a plurality of cardiopulmonary resuscitation compressions, the plurality of cardiopulmonary resuscitation compressions human delivered; and

means for implantably delivering a plurality of pacing pulses sufficient to capture cardiac tissue to a heart chamber in timed relation to detection of the cardiopulmonary resuscitation compressions, each pulse of the plurality delivered in response to detection of a respective cardiopulmonary resuscitation compression of the plurality.

17. The device of claim 16, comprising means for detecting an onset of each of the cardiopulmonary resuscitation compressions, wherein the pacing pulse delivery means is configured to initiate delivery of the pacing pulses in response to detection of compression onset such that each pulse of the plurality is delivered in response to detection of onset of a respective cardiopulmonary resuscitation compression of the plurality.

18. The device of claim 16, comprising means for detecting an acceleration of the patient implantable medical device.

19. The device of claim 16, comprising means for detecting electro-mechanical association of the cardiac response to the pacing pulse.