Pulse detection using patient physiological signals

• US 8,992,432 B2
• Filed: 10/21/2011
• Issued: 03/31/2015
• Est. Priority Date: 08/26/2002
• Status: Expired due to Term

• Current Assignee: Physio-Control Incorporated (Stryker Corporation)
• Original Assignee: Physio-Control Incorporated (Stryker Corporation)
• Inventors: Owen, James M., Jayne, Cynthia P., Crone, William E.
• Primary Examiner(s): D'ANGELO, MICHAEL J
• Application Number:
  US13/279,030
• Publication Number:
  US 20120035485A1
• Time in Patent Office: 1,257 Days
• Field of Search: 600/479, 600/473, 600/310, 600/323, 600/324, 600/481, 600/500, 600/502, 600/504, 600/507
• US Class Current: 600/500
• CPC Class Codes: A61B 5/0059 using light, e.g. diagnosis by transillumination, diascopy, fluorescence A61B5/0093, A61B5/1455, A61B5/02416 and A61B5/0261 take precedence
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/02108 from analysis of pulse wave characteristics
• CPC Class Codes: A61B 5/02416 using photoplethysmograph signals, e.g. generated by infrared radiation A61B5/14552 takes precedence
• CPC Class Codes: A61B 5/02427 Details of sensor
• CPC Class Codes: A61B 5/082 Evaluation by breath analysis, e.g. determination of the chemical composition of exhaled breath A61B5/083, A61B5/091 take precedence
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• CPC Class Codes: A61B 8/06 Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: A61B 8/488 involving Doppler signals
• CPC Class Codes: A61N 1/3625 External stimulators
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• 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 1/3987 characterised by the timing or triggering of the shock

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 optical characteristics of light transmitted into a patient to ascertain physiological signals, such as pulsatile changes in general blood volume proximate a light detector module. 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. A method comprising:

transmitting light into a patient from a light source positioned external to the patient;

receiving the transmitted light at a sensor positioned external to the patient;

generating a light detection signal in response to the received light, the light detection signal having a first amplitude and a first shape at a first time;

monitoring, over a period of monitored time, the light detection signal for changes in at least one of the first amplitude and the first shape;

detecting, at a second time, at least one of a second amplitude and a second shape of the light detection signal;

comparing the at least one of the second amplitude and the second shape with a corresponding at least one of the first amplitude and the first shape;

analyzing, with a processor, the compared at least one of the second amplitude and the second shape to detect a trend that the patient'"'"'s pulse is detected and is becoming weaker over the period of monitored time;

determining that the patient'"'"'s pulse is weakening over the period of monitored time based on the detected trend; and

providing at least one of treatment and information concerning treatment based on the determined-weakening patient pulse.

2. The method of claim 1, further comprising:

detecting a temperature; and

adjusting the light detection signal based on the detected temperature.

3. The method of claim 1,

in which transmitting light comprises:

transmitting a first light into the patient at a first wavelength; and

transmitting a second light into the patient at a second wavelength, and

in which receiving the transmitted light comprises receiving the first light and the second light.

4. The method of claim 3, wherein the first wavelength is associated with a first level of optical transmission and the second wavelength is associated with a second level of optical transmission that is greater than the first level of optical transmission.

5. The method of claim 3, in which the first light is red light and the second light is near-infrared light.

6. The method of claim 1,

in which transmitting light comprises:

transmitting a first light into the patient at a first intensity; and

transmitting a second light into the patient at a second intensity, and

in which receiving light comprises receiving the first light and the second light.

7. The method of claim 1,

in which the at least one of the second amplitude and the second shape are less than the at least one of the first amplitude and the first shape.

8. The method of claim 1, further comprising monitoring, over the period of monitored time, the first light detection signal and the second light detection signal for an artifact, the artifact distinguishable from the change in the at least one of the amplitude and the shape of the at least one of the first light detection signal and the second light detection signal.

9. The method of claim 8, wherein the artifact is caused by an environment surrounding the patient.

10. The method of claim 8, further comprising adjusting the detected trend based on the artifact.

11. The method of claim 1, further comprising, in response to the determined-weakening patient pulse, at least one of:

prompting for CardioPulmonary Resuscitation;

indicating a spontaneous return to circulation;

indicating Pulseless Electrical Activity; and

delivering defibrillation therapy.

12. A method comprising:

transmitting light into a patient from a light source positioned external to the patient;

receiving the transmitted light at a sensor positioned external to the patient;

generating a light detection signal in response to the received light, the light detection signal having a first amplitude and a first shape at a first time;

monitoring, over a period of monitored time, the light detection signal for changes in at least one of the first amplitude and the first shape;

detecting, at a second time, at least one of a second amplitude and a second shape of the light detection signal;

comparing the at least one of the second amplitude and the second shape with a corresponding at least one of the first amplitude and the first shape;

analyzing, with a processor, the compared at least one of the second amplitude and the second shape to detect that the patient'"'"'s pulse is detected and is becoming weaker over the period of monitored time;

determining that the patient'"'"'s pulse is weakening over the period of monitored time based on the detection of the patient'"'"'s pulse and the detection that the patient'"'"'s pulse is become weaker over the period of monitored time; and

providing at least one of treatment and information concerning treatment based on the determined-weakening patient pulse.

13. The method of claim 12, further comprising, in response to the determined-weakening patient pulse, at least one of:

prompting for CardioPulmonary Resuscitation;

indicating a spontaneous return to circulation;

indicating Pulseless Electrical Activity; and

delivering defibrillation therapy.

14. A method, comprising:

generating light at a first wavelength corresponding to a first level of tissue and blood absorption;

generating light at a second wavelength corresponding to a second level of tissue and blood absorption;

transmitting the light at the first wavelength into a patient at a first time;

transmitting the light at the second wavelength into the patient at a second time;

receiving the transmitted first light and the transmitted second light;

generating a first light detection signal based on the received first light and a second light detection signal based on the received second light;

monitoring, over a period of monitored time, the first light detection signal and the second light detection signal for changes in at least one of an amplitude and a shape of at least one of the first light detection signal and the second light detection signal;

detecting a change in the at least one of the amplitude and the shape of the at least one of the first light detection signal and the second light detection signal, the detected change detected within the period of monitored time; and

analyzing, with a processor, the detected change for an indication of a trend that the patient'"'"'s pulse is detected and is becoming weaker over the period of monitored time; and

determining that the patient'"'"'s pulse is weakening over the period of monitored time based on the indication of the trend.

15. The method of claim 14, further comprising generating a prompt for a caregiver to administer treatment to the patient based on the determined-weakening pulse.

16. The method of claim 14, further comprising monitoring, over the period of monitored time, the first light detection signal and the second light detection signal for an artifact, the artifact distinguishable from the change in the at least one of the amplitude and shape of the at least one of the first light detection signal and the second light detection signal.

17. The method of claim 16, wherein the artifact is caused by an environment surrounding the patient.

18. The method of claim 16, further comprising adjusting the detected change based on the artifacts.

19. The method of claim 14, wherein the first wavelength is associated with a first level of optical transmission and the second wavelength is associated with a second level of optical transmission.