System for cardiac resuscitation

• US 8,180,457 B2
• Filed: 08/02/2010
• Issued: 05/15/2012
• Est. Priority Date: 06/11/2003
• Status: Expired due to Term

• Current Assignee: Jeffrey A. Matos
• Original Assignee: Jeffrey A. Matos
• Inventors: Matos, Jeffrey A.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): PORTER, JR, GARY A
• Application Number:
  US12/848,461
• Publication Number:
  US 20100324612A1
• Time in Patent Office: 652 Days
• Field of Search: 607/2, 607/4, 607/5, 607/7, 607/10, 607/27, 607/30, 607/31, 607/32, 607/59, 607/60
• US Class Current: 607/60
• CPC Class Codes: A61N 1/046 Specially adapted for shock therapy, e.g. defibrillation
• CPC Class Codes: A61N 1/0476 Array electrodes (including any electrode arrangement with more than one electrode for at least one of the polarities)
• CPC Class Codes: A61N 1/0492 Patch electrodes A61N1/0412, A61N1/0428 take precedence
• CPC Class Codes: A61N 1/3904 External heart defibrillators [EHD]
• CPC Class Codes: A61N 1/39044 in combination with cardiopulmonary resuscitation [CPR] therapy
• CPC Class Codes: A61N 1/3968 Constructional arrangements, e.g. casings A61N1/375 takes precedence
• CPC Class Codes: A61N 1/3993 User interfaces for automatic external defibrillators

Abstract

System and method for monitoring and controlling, defibrillation and pacing which allows a victim of a cardiac rhythm abnormality immediate access to a medical professional at a central station, who will remotely monitor, diagnose and treat the victim at one of a plurality of remote sites in accordance with the following steps:

• • (1) providing a plurality of contact electrodes for a victim at a remote site for the receipt of ECG signals and for the application of electrical pulses to the victim;
  • (2) transmitting the signals from the remote site to a central station and displaying them for review by the medical professional;
  • (3) the medical professional selecting from a menu of defibrillation and pacing pulses, if the application thereof is appropriate;
  • (4) transmitting the selection results to the remote site; and
  • (5) receiving the selection results at the remote site and applying the selected pulses to the victim.

Claims

1. A cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a first display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) a first input device, responsive to said medical professional, for producing control signals for controlling operation of emergency cardiac monitoring and external defibrillation apparatus at one of said remote sites and the application of a defibrillation pulse to said victim at said one site; and

(3) a first transmitting/receiving (T/R) device, coupled to said first display device and said first input device, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a master control unit, connected to said second T/R device, for controlling the operation of said cardiac monitoring and defibrillation apparatus, said control unit having a plurality of operating states selected from the group consisting of;

(i) enable remote control by medical professional;

(ii) enable automatic local control; and

(iii) enable local control by emergency medical personnel;

(3) a defibrillator circuit, having a control input coupled to said second T/R device and said master control unit, for generating a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillator circuit control input;

(4) a logic device for automatic local control of the portable unit, coupled to said second T/R device, to said master control unit and to the control input of said defibrillator circuit, for automatically producing a second defibrillation control signal for controlling the application of said defibrillation pulse to said victim in response to electrocardiogram (ECG) signals received from said victim;

(5) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device and to said logic device, and having an ECG electrode input;

(6) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for the receipt of ECG signals from said victim and for application of said defibrillation pulse to said victim;

(7) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input and (ii) said defibrillator output;

(8) a second display device, coupled to said ECG circuit output for display of said ECG signals; and

(9) a second input device, coupled to said control input of said defibrillator circuit, for locally activating defibrillation;

wherein

(1) said ECG signals are transmitted from selected ones of said contact electrodes via said ECG circuit to said central station and displayed on said first display unit for evaluation by said medical professional, (2) said first defibrillation control signal may be transmitted from said central station to said control input of said defibrillator circuit and (3), in response thereto, said defibrillator circuit generates said defibrillation pulse for application to at least one of said contact electrodes for resuscitation of said victim; and

wherein said master control unit selects the operating state of said portable unit at the remote site under control of said medical professional at said central station; and

wherein, if enabled by said medical professional, (4) said ECG signals are transmitted from selected ones of said contact electrodes via said ECG circuit and displayed on said second display unit for evaluation by said emergency medical personnel, (5) said first defibrillation control signal may be transmitted from said second input device said control input of said defibrillator circuit, and (6), in response thereto, said defibrillator circuit generates said defibrillation pulse for application to at least one of said contact electrodes for resuscitation of said victim.

2. A cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) a first input device, responsive to said medical professional, for producing a first defibrillation control signal for controlling the application of a defibrillation pulse to said victim;

(3) a second input device, responsive to a medical professional, for producing a defibrillation command signal, for initiating the automatic application of a defibrillation pulse to said victim; and

(4) a first transmitting/receiving (T/R) device, coupled to said display device and to said first and second input devices, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a logic device for automatic control of the portable unit, coupled to the second T/R device, for automatically producing a second defibrillation control signal for controlling the application of a defibrillation pulse to said victim, upon receipt of a defibrillation command signal from said central station, in response to electrocardiogram (ECG) signals received from said victim;

(3) a defibrillator circuit, having a control input coupled to said second T/R device and to said logic device, for generating a defibrillation pulse at a defibrillator circuit output in response to a either a first or a second defibrillation control signal received at said defibrillator circuit control input;

(4) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device and to said logic device, and having an ECG electrode input;

(5) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for the receipt of ECG signals from said victim and for application of said defibrillation pulse to said victim; and

(6) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input and (ii) said defibrillator output;

wherein (1) said ECG signals are transmitted from selected ones of said contact electrodes via said ECG circuit to said central station for evaluation by said medical professional, (2) said logic device includes means for analyzing said ECG signals and produces a signal representing the result of the analysis, said analysis signal being transmitted to said central station via said second and first T/R devices, respectively, for display by said display device for the consideration by said medical professional, whereby said medical professional is able compare the analysis of said logic device with his/her own medical judgment;

(3) said first defibrillation control signal may be transmitted from said central station to said control input of said defibrillator circuit and, in response thereto, said defibrillator circuit generates said defibrillation pulse for application to at least one of said contact electrodes for resuscitation of said victim; and

(4) said defibrillation command signal may be sent from said central station to said logic device at said remote site and, in response thereto, said defibrillator circuit is responsive to said second defibrillation control signal generated by said logic device to generate said defibrillation pulse for application to said at least one contact electrode for resuscitation of said victim, thereby allowing said medical professional to take advantage of the analysis by said logic device.

3. A cardiac monitoring and external defibrillation and cardiac pacing system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) at least one first input device, responsive to said medical professional, for producing a defibrillation control signal for controlling the application of a defibrillation pulse to said victim;

(3) at least one second input device, responsive to said medical professional, for producing a cardiac pacing control signal for controlling the application of one or more cardiac pacing pulses to said victim; and

(4) a first transmitting/receiving (T/R) device, coupled to said display device and to said first and said second input devices, for electronic communication with emergency cardiac monitoring, defibrillation and cardiac pacing apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation and cardiac pacing apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a defibrillator circuit, having a defibrillation control input coupled to said second T/R device, for producing a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillation control input;

(3) a cardiac pacing circuit, having a pacing control input coupled to said second T/R device, for producing said one or more cardiac pacing pulses at a pacing circuit output in response to a cardiac pacing control signal received at said pacing control input;

(4) a logic device, coupled to the second T/R device and to the control input of said defibrillator circuit and to the pacing control input of said cardiac pacing circuit, for automatically producing at least one of a second defibrillation control signal for controlling the application of said defibrillation pulse to said victim, and a second cardiac pacing control signal for controlling the application of said cardiac pacing pulses to said victim, in the absence of proper communication between said first T/R device and said second T/R device, in response to electrocardiogram (ECG) signals received from said victim;

(5) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device and to said logic device, and an ECG electrode input;

(6) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for (1) the receipt of ECG signals from said victim;

(2) for application of said defibrillation pulse to said victim and (3) for application of said one or more pacing pulses to said victim; and

(7) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input;

(ii) said defibrillator output and (iii) said cardiac pacing output;

whereby (1) said ECG signals may be transmitted from selected ones of said contact electrodes via said ECG circuit to said central station for evaluation by said medical professional;

(2) said defibrillation control signal and said cardiac pacing control signal may be transmitted from said central station to said defibrillation control input and said pacing control input, respectively; and

(3) in response thereto, said defibrillation pulse may be transmitted from said defibrillator output or said cardiac pacing pulses may be transmitted from said cardiac pacing output to selected ones of said contact electrodes for resuscitation of said victim.

4. A cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) at least one first input device, responsive to said medical professional, for producing a defibrillation control signal for controlling the application of a defibrillation pulse to said victim;

(3) at least one second input device, responsive to said medical professional, for transmitting instructional information to said enabler; and

(4) a first transmitting/receiving (T/R) device, coupled to said display device and to said first and said second input devices, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a defibrillator circuit, having a defibrillation control input coupled to said second T/R device, for producing a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillation control input;

(3) an instruction receiving device, coupled to said second T/R device, for receiving said instructional information for use by said enabler;

(4) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device, and having an ECG electrode input;

(5) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for (1) the receipt of ECG signals from said victim;

(2) for application of said defibrillation pulse to said victim; and

(6) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input; and

(ii) said defibrillator;

whereby (1) said ECG signals may be transmitted from selected ones of said contact electrodes via said ECG circuit to said central station for evaluation by said medical professional;

(2) said defibrillation control signal may be transmitted from said central station to said defibrillation control input and said pacing control input, respectively; and

(3) in response thereto, said defibrillation pulse may be transmitted from said defibrillator output to selected ones of said contact electrodes for resuscitation of said victim.

5. The system defined in claim 4, wherein said second input device includes a microphone and said instruction receiving device includes a speaker, for providing spoken audio instructions to said enabler.

6. The system defined in claim 4, wherein said instruction receiving device includes an instructional display device, for providing video instructions to said enabler.

7. The system defined in claim 6, wherein said instruction receiving device further includes means for storing instructional video information, connected to said instructional display device, for causing said instructional display device to display said video information, whereby said medical professional can activate the display of said video information by means of said second input device.

8. The system defined in claim 7, wherein said instructional video information includes at least one of:

(i) instructional information concerning the performance of cardiopulmonary resuscitation;

(ii) instructional information concerning the use of said portable unit; and

(iii) instructional information concerning the placement of said contact electrodes by said enabler.

9. The system defined in claim 6, wherein said central station further includes means for storing instructional video information, coupled to said second input device and said first T/R device, for causing said instructional display device to display said video information, whereby said medical professional can activate the display of said video information by means of said second input device.

10. The system defined in claim 9, wherein said instructional video information includes at least one of:

(i) instructional information concerning the performance of cardiopulmonary resuscitation;

(ii) instructional information concerning the use of said portable unit; and

(iii) instructional information concerning the placement of said contact electrodes by said enabler.

11. The system defined in claim 6, wherein said central station further includes means for generating instructional video information in substantially real-time, coupled to said second input device, said display device and said first T/R device, for causing said instructional display device to display said video information, said instructional information consisting of at least one of

(i) video file information with at least one real-time video annotations by said MP;

and

(ii) real-time diagrammatic information by said MP.

12. The system defined in claim 11, wherein said emergency cardiac monitoring and external defibrillation apparatus further comprises a video camera, coupled to said second T/R device for the transmission of video images of said victim to said medical professional, and wherein said instructional video information consists of at least one of:

(i) video images of said victim with at least one real-time video annotation by said MP; and

(ii) instructional information for said enabler, based on analysis of said victim video image by said MP.

13. A cardiac monitoring and internal defibrillation and pacing system which allows a patient with an implanted cardiac pacing-defibrillator device immediate access to a medical professional who can and will remotely monitor, diagnose and treat a medical emergency, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a patient for evaluation by said medical professional;

(2) a first input device, responsive to said medical professional, for producing a first defibrillation control signal for controlling the application of a defibrillation pulse to said patient; and

(3) a second input device, responsive to said medical professional, for producing a first pacing control signal for controlling the application of a pacing pulse to said patient;

(4) a first transmitting/receiving (T/R) device, coupled to said display device and said first and said second input devices, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and internal pacing-defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a unit implanted in a patient and including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a defibrillator circuit, having a control input coupled to said second T/R device, for generating a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillator circuit control input;

(3) a pacing circuit, having a control input coupled to said second T/R device, for generating at least one pacing pulse at a pacing circuit output in response to a pacing control signal received at said pacing circuit control input;

(4) a logic device for automatic control of the implanted unit, coupled to the second T/R device and to the control inputs of said defibrillator circuit and said pacing circuit, for

(i) automatically producing a second defibrillation control signal for controlling the application of said defibrillation pulse to said patient in the absence of proper and timely communication between said first T/R device and said second T/R device, in response to electrogram (EGM) signals received from said patient;

(ii) automatically producing a second pacing control signal for controlling the application of said at least one pacing pulse to said patient in the absence of proper and timely communication between said first T/R device and said second T/R device, in response to electrogram (EGM) signals received from said patient;

(5) an electrogram (EGM) circuit, having an EGM circuit output, coupled to said second T/R device and to said logic device, and having one or more EGM electrode inputs;

(6) a plurality of electrodes, adapted to be coupled at separate locations to internal tissue of said patient, for the receipt of EGM signals from said patient and for application of said defibrillation pulse to said patient; and

(7) a means for connecting each of said electrodes to at least one of (i) said EGM electrode inputs and (ii) said defibrillator output;

whereby (1) said EGM signals may be transmitted from selected ones of said electrodes via said EGM circuit to said central station for evaluation by said medical professional, (2) said first defibrillation control signal may be transmitted from said central station to said control input of said defibrillator circuit and in response thereto, said defibrillator circuit may generate said defibrillation pulse for application to at least one of said electrodes for resuscitation of said patient; and

wherein, in the absence of proper and timely communication between said first T/R device and said second T/R device, said defibrillator circuit is responsive to said second defibrillation control signal received from said logic device to generate said defibrillation pulse for application to said at least one electrode for resuscitation of said patient, and (3) said first pacing control signal may be transmitted from said central station to said control input of said pacing circuit and in response thereto, said pacing circuit may generate said at least one pacing pulse for application to at least one of said electrodes for resuscitation of said patient; and

wherein, in the absence of proper and timely communication between said first T/R device and said second T/R device, said pacing circuit is responsive to said second pacing control signal received from said logic device to generate said at least one pacing pulse for application to said at least one electrode for resuscitation of said patient.

14. The system defined in claim 13, further comprising a control unit, adapted for use at the remote site of each implanted unit, said control unit comprising:

(1) third transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station; and

(2) fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said second T/R device of said implanted unit;

whereby said implanted unit may communicate with said central station through said control unit.

15. The system defined in claim 14, wherein said first T/R device and said second T/R device include means for direct duplex communication between them, without transmission through said third T/R device and said fourth T/R device, said communication means being selected from the group consisting of:

(i) a wireless transmission link;

(ii) a transmission link with wired and wireless segments; and

(iii) a transmission link with the Internet and wireless segments.