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

• US 9,833,378 B2
• Filed: 02/10/2016
• Issued: 12/05/2017
• Est. Priority Date: 10/25/2004
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Inventors: Paradis, Norman, Barash, David, Halperin, Henry R., Freeman, Gary A.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Piateski, Erin M
• Application Number:
  US15/040,682
• Publication Number:
  US 20160158098A1
• Time in Patent Office: 664 Days
• Field of Search: 607 6
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/5097 wireless
• CPC Class Codes: A61H 2230/00 Measuring physical parameters of the user
• CPC Class Codes: A61H 2230/045 used as a control parameter for the apparatus
• CPC Class Codes: A61H 31/005 with feedback for the user
• CPC Class Codes: A61H 31/006 Power driven
• CPC Class Codes: A61H 9/0078 with intermittent or alternately inflated bladders or cuffs mattresses for preventing bed-sores with alternated pressurized chambers A61G7/05776
• CPC Class Codes: A61M 16/0057 Pumps therefor
• CPC Class Codes: A61M 16/0063 Compressors
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 2205/33 Controlling, regulating or measuring
• CPC Class Codes: A61M 2205/332 Force measuring means
• CPC Class Codes: A61M 2205/581 by audible feedback
• CPC Class Codes: A61M 2205/583 by visual feedback
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/202 partial carbon oxide pressure, e.g. partial dioxide pressure (P-CO2)
• CPC Class Codes: A61M 2230/30 Blood pressure A61M2230/04 takes precedence
• CPC Class Codes: A61N 1/3987 characterised by the timing or triggering of the shock

Abstract

A system for improving cardiac output of a patient suffering from pulseless electrical activity or shock and yet displays myocardial wall motion including: a sensor to detect myocardial activity to determine the presence of residual left ventricular pump function having a contraction or ejection phase and a filling or relaxation phase, a device to prompt the application of or apply a compressive force 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.

Claims

1. A system to treat a patient having a heart and a chest, the system comprising:

a least one sensor monitoring cardiac activity in the patient by detecting at least one of myocardial pump activity, myocardial mechanical activity, hemodynamics and organ perfusion; and

a logic controller receiving signals and executing an algorithm stored in a non-transitory memory accessible by the logic controller, which causes the system to;

determine whether the patient is in a pulseless electrical activity (PEA) condition,

in response to the determination that the patient is in the PEA condition, determine a pattern of myocardial motion or residual pulsatile blood flow occurring in the patient during the PEA condition and based on the received signals, and

in response to the determined pattern and during the PEA condition, generating a command to repeatedly apply a phasic therapy to the patient, wherein the command causes or prompts the application of the phasic therapy repeatedly and in synchrony with the pattern of the actual myocardial motion or the pulsatile blood flow.

2. The system of claim 1 wherein the logic controller executes the algorithm to further cause the system to:

sense the actual myocardial motion or residual pulsatile blood during the application of the phasic therapy;

change the application of the phasic therapy, and

determine if the changed application of the phasic therapy improves the myocardial pump activity or residual pulsatile blood flow.

3. The system of claim 1 wherein the command to cause or prompt the application of the phasic therapy causes the phasic therapy to be applied during at least a portion of an ejection phase of the heart and ceasing the application of the phasic therapy during at least a portion of a relaxation phase of the heart.

4. The system of claim 1 further comprising a medical device configured to apply a compressive force to the chest in response to the command.

5. The system of claim 4 wherein the compressive force is applied to at least one of a sternal, a parasternal or an intercostal area of the chest.

6. The system of claim 4 wherein the compressive force is applied during each ejection phase of the heart in which the phasic therapy is applied.

7. The system of claim 4 wherein the compressive force or an electrical shock is applied during less than all of an ejection phase of the heart during a period in which the phasic therapy is applied.

8. The system of claim 4 wherein the command causes the compressive force to be applied during a predetermined portion of an ejection phase and the compressive force to cease during another portion of the ejection phase.

9. The system of claim 8 further comprising a medical device configured to actively lift or actively decompress the chest during the relaxation phase and during the cessation of the compressive force, and in response to the command.

10. The system of claim 1 further comprising a medical device configured to apply, in response to the command, at least one 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.

11. The system of claim 10 wherein the command causes the lifting or decompression to be applied during an entirety of the relaxation phase.

12. The system of claim 10 wherein the medical device is at least one of a mechanical compression device;

an inflatable vest, a nerve or muscle stimulator; and

a suction based compression-decompression device.

13. The system of claim 1 wherein the at least one sensor is a plurality of sensors each monitoring the cardiac activity and the algorithm causes the logic controller to:

analyze the signals from the sensors during the application of the phasic therapy to determine which of the sensors generate signals representative of the myocardial motion or the pulsatile blood flow;

select the signals from at least one of the sensors producing signals representative of the myocardial motion or the pulsatile blood flow to determine the pattern, and

use the selected signals to determine the pattern of myocardial motion or residual pulsatile blood flow.

14. The system of claim 13 wherein the signals from the sensors are analyzed and the selection of the signals are performed periodically while the patient is in the PEA condition.

15. The system of claim 1 further comprising a ventilator and the logic controller executing the algorithm causes the ventilator to apply ventilations, gas flow or airway pressure of the patient in the PEA condition.

16. The system of claim 1 wherein the at least one sensor comprises a sensor of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography.

17. The system of claim 1 wherein the at least one sensor is an array of sensors applied to the patient.