Non-invasive device for synchronizing chest compression and ventilation parameters to residual myocardial activity during cardiopulmonary resuscitation

• US 8,870,797 B2
• Filed: 01/11/2010
• Issued: 10/28/2014
• Est. Priority Date: 10/25/2004
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Norman A. Paradis
• Inventors: Paradis, Norman A.
• Primary Examiner(s): YOUNG, RACHEL T
• Application Number:
  US12/685,289
• Publication Number:
  US 20100114220A1
• Time in Patent Office: 1,751 Days
• Field of Search: 601/1, 601/15, 601 41- 44, 601/107, 601/108, 601148-152, 601/DIG.9, 607/3, 607 5- 7
• US Class Current: 601/152
• CPC Class Codes: A61H 2031/001 fixed on the chest by suction
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/5048 Audio interfaces, e.g. voice or music controlled
• CPC Class Codes: A61H 2201/5058 Sensors or detectors
• CPC Class Codes: A61H 2230/04 Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
• CPC Class Codes: A61H 31/005 with feedback for the user
• CPC Class Codes: A61H 31/006 Power driven
• CPC Class Codes: A61H 31/007 Manual driven
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 2205/332 Force measuring means
• CPC Class Codes: Y10S 601/09 including biological sensors

Abstract

A method for improving the cardiac output of a patient who is suffering from pulseless electrical activity or shock and yet still displays some myocardial wall motion including sensing myocardial activity to determine the presence of residual left ventricular pump function having a contraction or ejection phase and a filling or relaxation phase. In such cases, a compressive force is repeatedly applied to the chest based on the sensed myocardial activity such that the compressive force is applied during at least some of the ejection phases and is ceased during at least some of the relaxation phases to permit residual cardiac filling, thereby enhancing cardiac output and organ perfusion. Also incorporated may be a logic circuit capable of utilizing multiple sensing modalities and optimizing the synchronization pattern between multiple phasic therapeutic modalities and myocardial residual mechanical function.

Claims

1. A method to treat a patient in shock comprising:

determining the patient is in a pulseless electrical activity (PEA) condition;

during the PEA condition, sensing actual residual myocardial motion or residual pulsatile blood flow in the patient using one or more sensors for any of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography,

determining whether actual myocardial motion or residual pulsatile blood flow is occurring in the patient during the PEA condition, and

in response to the determination that the actual myocardial motion or residual pulsatile blood flow is occurring, repeatedly applying a phasic therapy to the patient synchronized to the sensed actual myocardial motion or pulsatile blood flow, wherein the phasic therapy includes applying a compressive force to the chest of the patient during at least a portion of an ejection phase of the heart and ceasing the application of the compressive force during at least a portion of a relaxation phase of the heart.

2. A method as in claim 1 wherein the repeated application of the phasic therapy augments cardiac ejection of blood and the cessation of the application of the compressive force avoids interfering with filling of the heart.

3. A method as in claim 1 wherein the phasic therapy includes a second phasic therapy selected from a group consisting of active chest decompression, abdominal compression, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

4. A method as in claim 1 wherein the compressive force is applied to at least one of a sternal, a parasternal or an intercostal area of the chest.

5. A method as in claim 1 wherein the compressive force is applied during each ejection phase of the heart in which the phasic therapy is applied.

6. A method as in claim 1 wherein the compressive force is applied during less than all of the ejection phase of the heart during a period in which the phasic therapy is applied.

7. A method as in claim 1 wherein the compressive force is applied during a predetermined portion of the ejection phase and the cessation occurs during another portion of the ejection phase.

8. A method as in claim 1 wherein the phasic therapy comprises actively lifting or actively decompressing of the chest during the relaxation phase and during the cessation of the compressive force.

9. A method as in claim 8 wherein the lifting or decompression is applied during an entirety of the relaxation phase.

10. A method of claim 8 wherein the lifting or decompression is applied during a predetermined portion of the relaxation phase and is not applied during another portion of the relaxation phase.

11. A method as in claim 1 further comprising applying or altering ventilations, gas flow or airway pressure of the patient based on the sensed actual myocardial motion or pulsatile blood flow.

12. A method as in claim 1 wherein the compressive force is applied using equipment selected from a group consisting of mechanical compression devices;

inflatable vests, nerve or muscle stimulators; and

a suction based compression-decompression device.

13. A method as in claim 1 wherein a sensing system senses the actual myocardial motion or pulsatile blood flow.

14. A method as in claim 13 wherein the sensing system comprises an array of sensors applied to the patient.

15. A method as in claim 1 further comprising displaying or broadcasting information indicating the sensed actual myocardial motion or pulsatile blood flow.

16. A method as in claim 15 wherein the repeated application of the phasic therapy is applied manually in synchronization with the displayed or broadcasted information.

17. A method as in claim 1 further comprising a determination that the patient is suffering from shock before the repeated application of the phasic therapy.

18. A method to treat a patient as in claim 1 further comprising determining the patient is suffering pulseless electrical activity (PEA).

19. A method to treat a patient comprising:

determining the patient is in a pulseless electrical activity (PEA) condition;

during the PEA condition, sensing actual residual myocardial motion or residual pulsatile blood flow in the patient using one or more sensors for any of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography,

determining whether actual myocardial motion or residual pulsatile blood flow is occurring in the patient during the PEA condition, and

in response to the determination that the actual myocardial motion or residual pulsatile blood flow is occurring, repeatedly applying a phasic therapy to the patient synchronized to the sensed actual myocardial motion or pulsatile blood flow, wherein the phasic therapy includes applying a compressive force to the chest of the patient during an ejection phase of the heart of the patient and ceasing the application of the compressive force during a relaxation phase of the heart.

20. A method to treat a patient as in claim 19 further comprising determining the patient is in shock before the repeated application of the phasic therapy.

21. A method to treat a patient as in claim 19 further comprising determining the patient is suffering pulseless electrical activity (PEA) before applying the phasic therapy.

22. A method to treat a patient as in claim 19 further comprising determining the patient is suffering cardiac arrest before the repeated application of the phasic therapy.

23. A method as in claim 19 wherein the repeated application of the phasic therapy augments cardiac ejection of blood and the cessation of the application of the compressive force avoids interfering with filling of the heart.

24. A method as in claim 19 wherein the phasic therapy includes a second phasic therapy selected from a group consisting of active chest decompression, abdominal compression, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

25. A method as in claim 19 wherein the compressive force is applied to at least one of a sternal, a parasternal or an intercostal area of the chest.

26. A method as in claim 19 wherein the compressive force is applied during each ejection phase of the heart in which the phasic therapy is applied.

27. A method as in claim 19 wherein the compressive force is applied during less than all of the ejection phase of the heart during a period in which the phasic therapy is applied.

28. A method as in claim 19 wherein the compressive force is applied during a predetermined portion of the ejection phase and the cessation occurs during another portion of the ejection phase.

29. A method as in claim 19 wherein the phasic therapy comprises actively lifting or actively decompressing of the chest during the relaxation phase and during the cessation of the compressive force.

30. A method as in claim 29 wherein the lifting or decompression is applied during an entirety of the relaxation phase.

31. A method of claim 29 wherein the lifting or decompression is applied during a predetermined portion of the relaxation phase and is not applied during another portion of the relaxation phase.

32. A method as in claim 19 further comprising applying or altering ventilations, gas flow or airway pressure of the patient based on the sensed actual myocardial motion or pulsatile blood flow.

33. A method as in claim 19 wherein the compressive force is applied using equipment selected from a group consisting of mechanical compression devices;

inflatable vests, nerve or muscle stimulators; and

a suction based compression-decompression device.

34. A method as in claim 19 wherein a sensing system comprises an array of sensors applied to the patient and the sensing system performs the sensing of the actual residual myocardial motion or the residual pulsatile blood flow.

35. A method as in claim 19 further comprising displaying or broadcasting information indicating the sensed actual myocardial motion or pulsatile blood flow.

36. A method as in claim 35 wherein the repeated application of the phasic therapy is applied manually in synchronization with the displayed or broadcasted information.

37. A method to treat a patient who is suffering from pulseless electrical activity, shock or other ailment of the heart, the method comprising:

determining the patient is in a pulseless electrical activity (PEA) condition;

during the PEA condition, sensing residual myocardial activity to determine left ventricular pump function or blood filling or ejection using one or more sensors for any of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography;

determining whether actual myocardial motion or residual pulsatile blood flow is occurring in the patient during the PEA condition;

characterizing at least one of a pattern, a timing, a force and a vector of the sensed left ventricular pump function, or blood filling or ejection;

in response to the determination that the actual myocardial motion or residual pulsatile blood flow is occurring, repeatedly applying a phasic therapy to the patient, and

synchronizing the phasic therapy with the characterized at least one of the pattern, the timing, the force and the vector of the determined left ventricular pump function or blood filling or ejection.

38. A method as in claim 37 wherein the synchronization of the phasic therapy augments cardiac ejection and minimizes interfering with cardiac filling.

39. A method as in claim 37 wherein the phasic therapy is applied at a location on the patient based on at least one of the pattern, the timing, the force or the vector of the left ventricular pump function or blood filling or ejection.

40. A method as in claim 37 wherein the characterization of at least one of a pattern, timing, force and vector of the determined left ventricular pump function includes determining occurrences of ejection phases of the heart of the patient, and the phasic therapy comprises repeating chest compressions and the synchronization of the phasic therapy includes applying the chest compressions during at least some ejection phases.

41. A method as in claim 40 wherein the compressive force is applied during each determined ejection phase.

42. A method as in claim 40 wherein the compressive force is applied selectively during some but not all of the determined ejection phases.

43. A method of claim 37 wherein the characterization of at least one of the pattern, the timing, the force and the vector of the determined left ventricular pump function includes determining occurrences of relaxation phases of the heart of the patient, and the synchronization of the phasic therapy includes ceasing the chest compressions during the relaxation phases.

44. A method as in claim 37 wherein the phasic therapy includes a plurality of phasic therapies applied to the patient and the phasic therapies include two or more of a group consisting of chest compressions, abdominal counter-pulsation, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

45. A method as in claim 44 wherein the compressive force is applied to the sternal, parasternal or intercostal areas of the chest.

46. A method as in claim 44 further comprising sensing actual cardiac output and varying the application of the phasic therapies based on the sensed actual cardiac output.

47. A method as in claim 46 wherein the sensed actual cardiac output is represented by a surrogate of hemodynamics.

48. A method as in claim 47 wherein the hemodynamics is at least one of end-tidal carbon dioxide and sensed arterial flow.

49. A method as in claim 46 the variation of the application of the phasic therapies increases the sensed cardiac output.

50. A method as in claim 37 wherein the sensing includes data collected from an array of Doppler probes placed over the chest, neck or abdomen and from data determining a velocity or magnitude of residual myocardial motion or surrogate hemodynamics.

51. A method as in claim 50 wherein the data is collected from multiple probe locations on the chest, neck or abdomen, and the determination of the velocity or magnitude includes calculation of a vector of the residual myocardial motion or blood filling or ejection.

52. A method to treat a patient comprising:

determining the patient is in a pulseless electrical activity (PEA) condition;

during the PEA condition, sensing residual myocardial activity of a heart of the patient or residual pulsatile blood flow pumped by the heart using one or more sensors for any of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography;

determining that actual myocardial motion or residual pulsatile blood flow is occurring based on the sensing;

in response to the determination that there is actual myocardial motion or residual pulsatile blood flow, repeatedly applying a phasic therapy to the patient in synchronization with the sensed myocardial activity;

sensing actual cardiac output or a surrogate of actual cardiac output, and

varying the application of the phasic therapy based on the sensed actual cardiac output or the surrogate.

53. A method as in claim 52 wherein the sensing of the myocardial activity is applied to determine a left ventricular pump function, a mechanical activity of blood filling or ejection of the heart.

54. A method as in claim 52 wherein the repeated application of the phasic therapy augments cardiac ejection of blood.

55. A method as in claim 52 wherein the phasic therapy includes a second phasic therapy selected from a group consisting of active chest decompression, abdominal compression, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

56. A method as in claim 52 wherein the phasic therapy includes a compressive force applied to at least one of a sternal, a parasternal or an intercostal area of the chest.

57. A method as in claim 56 wherein the compressive force is applied during each ejection phase of the heart in which the phasic therapy is applied.

58. A method as in claim 56 wherein the compressive force is applied during less than all of the ejection phase of the heart during a period in which the phasic therapy is applied.

59. A method as in claim 56 wherein the compressive force is applied during a predetermined portion of the ejection phase and the cessation occurs during another portion of the ejection phase.

60. A method as in claim 52 wherein the phasic therapy comprises actively lifting or actively decompressing of the chest during the relaxation phase and during the cessation of the compressive force.

61. A method as in claim 60 wherein the lifting or decompression is applied during an entirety of the relaxation phase.

62. A method of claim 60 wherein the lifting or decompression is applied during a predetermined portion of the relaxation phase and is not applied during another portion of the relaxation phase.

63. A method as in claim 52 further comprising applying or altering ventilations, gas flow or airway pressure of the patient based on the sensed actual myocardial motion or pulsatile blood flow.

64. A method as in claim 56 wherein the compressive force is applied using equipment selected from a group consisting of mechanical compression devices;

inflatable vests, nerve or muscle stimulators; and

a suction based compression-decompression device.

65. A method as in claim 52 wherein the sensing comprises sensing with an array of the sensors applied to the patient.

66. A method as in claim 52 further comprising displaying or broadcasting information indicating the sensed actual myocardial motion or the sensed surrogate.

67. A method as in claim 66 wherein the repeated application of the phasic therapy is applied manually in synchronization with the displayed or broadcasted information.

68. A method as in claim 52 further comprising a determination that the patient is suffering from shock before the repeated application of the phasic therapy.

69. A method to treat a patient as in claim 52 further comprising determining the patient is suffering pulseless electrical activity (PEA).

70. A method as in claim 52 further comprising varying the application of the phasic therapy to cause an increase in the sensed indicator of cardiac output.

71. A method as in claim 70 wherein the variation in the application of the phasic therapy or phasic therapies includes varying at least one of a pattern, a timing, a force, and the vector, of a compressive force applied to the patient in synchronization with the sensed myocardial activity.

72. A method as in claim 56 wherein the compressive force is applied to the patient'"'"'s chest at the sternal or parasternal, or left intercostal areas, and the variation in the application includes changing the location on the chest where the compressive force is applied.

73. A method as in claim 70 wherein the variation in the application of the phasic therapy includes selecting another phasic therapy to be applied wherein the selected phasic therapy is selected from a group consisting of chest compressions, abdominal counter-pulsation, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.

74. A method as in claim 52 wherein the sensed indicator of actual cardiac output includes at least one of sensed end-tidal carbon dioxide or sensed arterial flow.

75. A method as in claim 70 further comprising generating audible or visual prompts to notify a health care provider when to apply the phasic therapy to the patient, and

the variation includes varying a timing of the prompts.

76. A method as in claim 52 further comprising repeatedly ventilating the patient and varying the ventilation, gas flow or airway pressure of the patient based on the sensed actual cardiac output.

77. A method as in claim 76 wherein the ventilation of the patient is synchronized with the application of the sensed myocardial movement.

78. A method to optimize vital heart organ blood flow in a patient having a chest and a heart comprising:

determining the patient is in a pulseless electrical activity (PEA) condition;

during the PEA condition, sensing at least one of actual residual blood flow, an indicator of the actual residual blood flow and a status of a vital organ of the patient and generating blood flow data from the sensing, wherein the sensing uses one or more sensors for any of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography;

based on the determination that the actual myocardial motion or residual pulsatile blood flow is occurring, repeatedly applying a compressive force to the chest of the patient in synchronization with the blood flow data, and

adjusting further application of the compressive force based on current values of the blood flow data sensed after the repeated application of the compressive force.

79. A method for improving the cardiac output of a patient, the method comprising:

determining the patient is in a pulseless electrical activity (PEA) condition;

during the PEA condition, detecting residual myocardial mechanical activity and residual pump function using one or more sensors for any of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography,

determining that actual myocardial motion or residual pulsatile blood flow is occurring based on the sensing;

in response to the determination that there is actual myocardial motion or residual pulsatile blood flow, repeatedly applying a compressive or a decompressive force to the chest at least during a portion of an ejection phase of the heart and ceasing application of the compressive force, or applying the decompressive force during a portion of the relaxation phase, and

adjusting at least one of a start of the application of the compression force, a termination of the compression force and an initiation or termination of the decompressive force.

80. A method as in claim 79 further comprising sensing actual cardiac output or sensing a surrogate indicator of cardiac output, and wherein the adjusting is based on the sensed actual cardiac output or the sensed surrogate indicator.

81. A method as in claim 80 wherein the compressive force is applied to the patient'"'"'s chest at the sternal or parasternal, or left intercostal areas.

82. A method as in claim 79 wherein the compressive force is applied during each sensed ejection phase.

83. A method as in claim 79 wherein the compressive force is applied only at certain ejection phases.

84. A method as in claim 79 wherein the compressive force is applied for only a certain duration of the ejection phase.

85. A method as in claim 79 wherein the phasic therapy includes actively lifting or active decompression of the patient'"'"'s chest.

86. A method as in claim 85 wherein the lifting or the active decompression is applied only at certain relaxation phases of the heart or for a certain duration of the relaxation phases.