Pulse detection apparatus, software, and methods using patient physiological signals

• US 8,744,577 B2
• Filed: 08/07/2012
• Issued: 06/03/2014
• Est. Priority Date: 09/30/1999
• Status: Expired due to Fees

• Current Assignee: Physio-Control Incorporated (Stryker Corporation)
• Original Assignee: Physio-Control Incorporated (Stryker Corporation)
• Inventors: Joo, Tae H., Stickney, Ronald E., Jayne, Cynthia P., Lank, Paula, O'Hearn, Patricia, Hampton, David R., Taylor, James W., Crone, William E., Yerkovich, Daniel
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US13/569,147
• Publication Number:
  US 20120302896A1
• Time in Patent Office: 665 Days
• Field of Search: 607/9, 607/10, 607/18, 607/62
• US Class Current: 607/10
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/39044 in combination with cardiopulmonary resuscitation [CPR] therapy
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

The presence of a cardiac pulse in a patient is determined by evaluating physiological signals in the patient. In one embodiment, a medical device evaluates two or more different physiological signals, such as phonocardiogram (PCG) signals, electrocardiogram (ECG) signals, patient impedance signals, piezoelectric signals, and accelerometer signals for features indicative of the presence of a cardiac pulse. Using these features, the medical device determines whether a cardiac pulse is present in the patient. The medical device may also be configured to report whether the patient is in a VF, VT, asystole, or PEA condition, in addition to being in a pulseless condition, and prompt different therapies, such as chest compressions, rescue breathing, defibrillation, and PEA-specific electrotherapy, depending on the analysis of the physiological signals. Auto-capture of a cardiac pulse using pacing stimuli is further provided.

Claims

1. An electrotherapy device, comprising:

a first sensor, that is adapted to be external to and adapted to be placed on a patient, and configured to sense a photodetection signal in a patient that includes a pulse oximetry signal;

a second sensor, that is adapted to be external to and adapted to be placed on a patient, and configured to receive an impedance-sensing signal from the patient;

an electrotherapy generator, that is external to the patient, and is configured for delivering pacing stimuli to the patient through skin of the patient; and

processing circuitry, that is adapted to be external to the patient, and configured to analyze the photodetection signal for features indicative of a cardiac pulse and to analyze the impedance-sensing signal for a fluctuation due to a cardiac pulse, the processing circuitry also configured to average the analyzed photodetection signal and the analyzed the impedance-sensing signal, and determine, based on the averaged photodetection signal and the averaged impedance-sensing signal, whether the cardiac pulse occurred in the patient following the delivery of a pacing stimulus of the pacing stimuli of the patient, the processing circuitry increasing the current of further pacing stimuli to be delivered to the patient if a cardiac pulse did not occur in the patient following the delivery of the pacing stimulus.

2. The electrotherapy device of claim 1, in which the electrotherapy device is configured to deliver pacing stimuli to the patient two or more times and the processing circuitry is configured to analyze the photodetection signal and the impedance-sensing signal to determine whether a cardiac pulse occurred after the delivery of each pacing stimulus, the current of further pacing stimuli to be delivered to the patient being increased if a cardiac pulse does not consistently occur in the patient after the delivery of each pacing stimulus.

3. The electrotherapy device of claim 1, in which prior to the current of the pacing stimuli being increased, the processing circuitry is configured to prompt a user of the device to increase the pacing stimuli current.

4. The electrotherapy device of claim 1, wherein the electrotherapy device further includes one or more electrodes coupled to the electrotherapy generator and adapted to be coupled to the skin of the patient, and in which the electrotherapy generator delivers pacing stimuli to the patient via the one or more electrodes, and wherein the sensor is integrated with or attached to a back of at least one of the one or more electrodes.

5. The electrotherapy device of claim 1, wherein the electrotherapy device further includes one or more electrodes coupled to the electrotherapy generator and adapted to be coupled to the skin of the patient, and in which the electrotherapy generator delivers pacing stimuli to the patient via the one or more electrodes, and further including a flap that includes the first sensor, the flap adapted to be connected to at least one of the one or more electrodes.

6. The electrotherapy device of claim 1, wherein the electrotherapy device further includes one or more electrodes coupled to the electrotherapy generator and adapted to be coupled to the skin of the patient, and in which the electrotherapy generator delivers pacing stimuli to the patient via the one or more electrodes, and further including wires that couple the first sensor to the skin of the patient, the wires not adapted to be coupled to the one or more electrodes.

7. The electrotherapy device of claim 1, further comprising a third sensor that is adapted to be external to and adapted to be placed on the patient, and structured to sense at least one of a CO₂ waveform signal from a capnography system, a Doppler probe signal, and an electrocardiogram (ECG) signal,

in which the processing circuitry is further configured to analyze the third sensed signal and average the analyzed third sensed signal, the analyzed photodetection signal, and the analyzed impedance-sensing signal, and determine, based on the averaged analyzed third sensed signal, analyzed photodetection signal, and analyzed impedance-sensing signal, whether the cardiac pulse occurred in the patient following the delivery of the pacing stimulus of the pacing stimuli of the patient.

8. The electrotherapy device of claim 7, in which the processing circuitry is further configured to analyze at least one of a temporal parameter in the CO₂ waveform signal that reflects cardiogenic oscillations, a spectral parameter in the CO₂ waveform signal, a temporal or spectral parameter in the Doppler probe signal, and an energy in the impedance signal.

9. The electrotherapy device of claim 7, wherein the processing circuitry is further configured to determine a majority based on the analyzed photodetection signal, the analyzed impedance-sensing signal, and the analyzed third sensed signal, wherein if a majority is determined, indicating that the cardiac pulse occurred in the patient following delivery of the pacing stimulus of the pacing stimuli of the patient.

10. The electrotherapy device of claim 9, wherein the majority is a simple majority.

11. The electrotherapy device of claim 7, wherein the processing circuitry is further configured to determine that at least one of the analyzed photodetection signal, the analyzed impedance-sensing signal, and the analyzed third sensed signal indicates that the cardiac pulse occurred in the patient following delivery of the pacing stimulus of the pacing stimuli of the patient.

12. The electrotherapy device of claim 1, wherein the processing circuitry is further configured to determine that at least one of the analyzed photodetection signal and the analyzed impedance-sensing signal indicate that the cardiac pulse occurred in the patient following delivery of the pacing stimulus of the pacing stimuli of the patient.

13. The electrotherapy device of claim 1, wherein the processing circuitry is further configured to weight the analyzed photodetection signal and the analyzed impedance-sensing signal.