The inventions described below relate to the field of CPR.
Chest compression monitoring during the course of CPR is now possible with the Real CPR Help® and CPR-D-padz technology marketed by ZOLL Medical Corporation. This technology is described in U.S. Pat. No. 6,390,996, 7,108,665, and 7,429,250, and includes the use of an accelerometer to measure accelerations of the chest and calculating the depth of each compression from the acceleration signal. The technology is used in ZOLL's Real CPR Help® compression depth monitoring system to provide real-time rate and depth CPR feedback for manual CPR providers. Commercially, it is implemented in ZOLL's electrode pads, such as the CPR-D•padz® electrode pads. It is also implemented for training use in the PocketCPR® chest compression monitor and PocketCPR® iPhone app.
Halperin, et al., CPR Chest Compression Monitor, U.S. Pat. No. 6,390,996 (May 21, 2002), as well as Palazzolo, et al., Method of Determining Depth of Chest Compressions During CPR, U.S. Pat. No. 7,122,014 (Oct. 17, 2006), described chest compression monitors capable of determining chest compression depth accurately during repeated rapid chest compressions required by CPR. The devices of Halperin and Palazzolo were adapted to be placed between the CPR provider's hand and the patient's sternum during CPR. In both cases, the CPR chest compression monitor is held in fixed relationship to the chest during use, and the chest compression module is operable to determine the depth of each chest compression based on acceleration data from accelerometers in the chest compression module, without input from other sources, especially without input of data from other sensors fixed in space or remote from the compression module. The disclosures of U.S. Pat. Nos. 6,390,996, 7,108,665, and 7,429,250 to Halperin, and U.S. Pat. No. 7,122,014 to Palazzolo are hereby incorporated by reference.
Geheb, et al., Method and Apparatus for Enhancement of Compressions During CPR, U.S. Pat. No. 7,720,235 (May 22, 2007) provides an enhancement a CPR chest compression monitor. In addition to providing feedback regarding depth of compression, this system measures or computes the velocity of the chest compression module, and compare the upward velocity of the chest compression module with a predetermined desired velocity. The system advises, through a display or audio prompt, whether the CPR provider is substantially releasing the chest from compression, or failing to do so. The disclosure of U.S. Pat. No. 7,720,235 is hereby incorporated by reference. Complete release ensures that that the thorax of the CPR victim will expand without hindrance of the CPR provider's weight on the chest, and encourage (or at least avoid hindering) the creation of negative pressure in the chest which encourages venous return and filling of the heart.
The techniques of Halperin, Palazzolo and Geheb are accomplished by various ZOLL defibrillator systems which include and AED box and compression modules (the compression modules are combined with sensing and defibrillating electrodes in a convenient sheet which facilitates proper placement (see FIG. 2). In these systems, a compression monitor which includes accelerometers to sense movement is secured to the patients chest. The CPR provider pushes down on the patient's chest while the compression monitor is trapped between the CPR provider's hands and the patient's chest, so that it generates acceleration signals that correspond to the acceleration of the patient's chest. The AED box includes a control system, a display and speaker, and a defibrillator. The control system (a computer) is programmed to interpret the acceleration signals calculate compression depth and velocity (specifically, release velocity), and generate visual displays and/or audio prompts to be displayed or played to guide the CPR provider. (The control system also analyzes ECG signals obtained from the electrodes, to determine if defibrillating shock should be applied, and may prompt the user to apply shock or automatically operate the defibrillator to apply shock to the patient.) The control system comprises at least one processor and at least one memory including program code with the memory and computer program code configured with the processor to cause the system to perform the functions described throughout this specification.
As currently implemented, the system provides positive or negative feedback regarding release velocity based on a predetermined desirable release velocity of 300 inches (762 cm) per minute, which corresponds to an assumed compression depth of 1.5 inches (38.1 cm).
The threshold of release velocity used to determine whether actual release velocity achieved during CPR is determined through clinical experience, and the systems described above use a single set threshold, programmed into the control system. In some cases, it is desirable to provide greater release velocity, or acceptable to achieve lesser release velocity. For instance, where compression depth achieved is significantly greater than the desired 2 to 2.5 inches (5.08-6.35 cm), it is desirable to release the chest more quickly than is the case for compressions of standard depth, and for compressions of lesser depth, it may be acceptable to release the chest with a lower release velocity.
The devices and methods described below provide for feedback regarding release velocity of CPR chest compressions based on a user-entered compression depth target or the measured depth of compression. The system may be enhanced in that feedback based on release velocity is based on preconfigured release velocity values corresponding to assumed or desired depth targets, as determined by the CPR provider. For example, the CPR provider may enter a desired target depth of 1.5, 2.0 or 2.5 inches (3.81, 5.08 or 6.35 cm), and the control system will operate to provide feedback which varies according to the selected depth. The CPR compression depth monitoring system, and the method accomplished by the system, may also be enhanced in that feedback based on release velocity is based on the measured depth of compression. The control system is programmed to adaptively determine the depth of compression, or a moving average of depth of compression for a series of compressions, and determine the release velocity of a compression, or a moving average of release velocity for the series of compressions, and determine, based on the actual compression depth, the desired release velocity threshold, and advise the CPR provider with feedback as to whether or not the achieved release velocity meets the release velocity desired for particular depth of compression. The system is adaptive, in the sense that it is programmed to make adjustments in the threshold in response to changes in the actual performance of the chest compression depth and/or rate during the course of CPR on each cardiac arrest victim.
The system can be implemented with accelerometer-based compression monitors, or compression monitors based on other sensing and measuring devices, such a velocity sensors, optical sensors, magnetic sensors, or any other sensor or combination of sensors that provide signals corresponding to movement of the chest (the anterior surface of the thorax) of the CPR victim.
The chest compression monitor, as illustrated in
The accelerometer-based compression monitor is presented as the most convenient configuration for obtaining information regarding compression depth and release velocity. However, any device operable to sense compression depth and release velocity, or to sense signals or obtain data from which compression depth and release velocity may be derived or determined, may be used in place of the accelerometer based compression monitor. Thus, means for determining release velocity can include the accelerometers described above, velocity sensors which directly measure velocity, and distance sensors of proximity sensors which track the displacement of the compression module. For example, the proximity sensors, including and ultrasonic distance sensor arrangement, optical distance sensors, magnetic motion sensors, RFID sensors and emitter/detector arrangements, for example those described in Freeman and Herken, Chest Compression Belt with Belt Position Monitoring System, U.S. Provisional App. 61/654,642 filed Jun. 1, 2012, incorporated herein by reference in its entirety, can be used to measure the actual displacement of the chest, and the control system can readily determine the velocity as the derivative of the displacement curve. Velocity can be measured directly using an imposed magnetic field and inductive sensors, for example, as disclosed in Geheb, by placing a magnet on one side of the thorax (on or under the back of the patient) and an inductive coil on the opposite surface of the thorax (on the chest wall, or anterior surface of the chest) to detect voltage based on induction of current in the coil, which varies with the speed of coil through the magnetic field. A rheostat and mechanical linkage fixed to the puck may used to measure the displacement, as described in Gruben et al., Sternal Force Displacement Relationship During Cardiopulmonary Resuscitation, 115 Journal of Biomedical Engineering 195 (May 1993)(which describes the use of mechanical linkages incorporating position sensing transducers to measure chest displacement during CPR), and from displacement data the control system can calculate the release velocity.
Geheb, et al., Method and Apparatus for Enhancement of Compressions During CPR, U.S. Pat. No. 7,720,235 (May 22, 2007) and Centen, et al., Reference Sensor For CPR Feedback Device, U.S. Pub. 2012/0083720 (Apr. 5, 2012) disclose a system for measuring chest compression depth using a magnetic field generator under the patient and a inductive coil, which senses movement through the magnetic field, as a velocity sensing system. This system can be used as a velocity sensor in the system described above, from which compression depth can be determined. Centen, Optical Techniques For The Measurement Of Chest Compression Depth And Other Parameters During CPR, U.S. Pub. 2011/0040217 (Feb. 17, 2011) discloses a system for measuring chest compression depth using infrared optical illumination and detection of the reflected infrared light from the patient. This system can be used as a distance sensor in the system described above, from which velocity of the chest wall movement can be determined.
These and any other means for determining velocity may be used. Also, though a single sensor, and a single type of sensor, are sufficient to provide the necessary information to determine velocity and chest displacement, multiple sensors and sensor types can be used in any permutation. For example, a velocity sensor can be used to directly measure velocity, and an displacement sensor or measurement device (operable independently from the velocity sensor) can be used to directly measure displacement, such that the control system can determine velocity from the velocity sensor and determine displacement from the displacement sensor.
When compressions are accomplished at a more rapid rate, the average instantaneous velocity is greater. So, for example, 2 inch (5.08 cm) compressions at a rate of 120 compression per minute results in a average instantaneous velocity of 440 inches (1016 cm) per minute. Thus the table reflects the average instantaneous velocity of the compression module for compressions at various combinations of depth and rate. The indicated average instantaneous velocities can be taken as minimum upward or “release” velocities of the compression module during the upstroke needed to ensure substantial release of the chest that promotes refilling beneficial to CPR. Accounting for the rapidity of the downstroke, some delay at both the bottom of the compression stroke, and some delay between each complete compression cycle (up and down) and the downward stroke of the next compression, the average instantaneous velocity is a desirable goal for the instantaneous velocity of the upstroke of each compression. The threshold may be adjusted, as clinical experience dictates, to higher or lower velocities. Also, peak velocity during the upstroke may be used as the parameter to be compared to desirable release velocity goals, and velocity during specific period of time during the upstroke (such as the window of time immediately after release (that is, the start of the upstroke, ignoring a portions of the upstroke which is likely to be quite slow (the last few milliseconds, in which the chest wall is nearly fully rebounded, and likely to be moving slowly upwardly)). Where peak release velocity is used to determine the adequacy of release, peak velocities of about 15% to 25% above the average velocities shown in
In one mode of operation which implements the method insofar as desired release velocity is determined based on the depth of compression and/or the rate of compression, an input means such as a keyboard, selector dial , soft key , or other input can be provided so that the CPR provider or other user can indicate to the control system a desired depth and/or rate of compression for a particular CPR session, and the control system can be programmed to receive and interpret this input and provide release velocity feedback based on this predetermined depth and/or rate. Thus, the system is configurable in the field, at the point of use, by the CPR provider who decides and inputs the optimal configuration based on an individual assessment of the cardiac arrest victim. The desired depth and/or rate is predetermined in the sense that the CPR provider, just prior to the application of CPR compressions, assesses the patient and decides the appropriate depth of compression and/or rate of compression, and inputs this to the control system. In this manner, the release velocity feedback and the chest compression feedback can be provided based on the predetermined depth and rate targets, so that the system can be used to assist in CPR for a wider variety of patients including pediatric patients. For pediatric patients, the depth and rate may vary with the sized of the patient, so that a system that sets the desired release velocity to match the depth chosen by a CPR provider is beneficial. For example, for compression of small children, the chest compression goal is currently 2.5 cm (1 inch) of compression depth. Before providing CPR chest compressions to the child in cardiac arrest, a CPR provider may provide input the control system, indicating that the CPR provider has determined that compressions of 2.5 cm (1 inch), at 100 compressions per minute, are appropriate for this cardiac arrest victim. This is a user-determined chest compression depth and/or rate target. The control system then operates to determine the appropriate release velocity (either by calculation using a formula provided in the software which the control system operates under or by reference to a table of stored values) for the user determined chest compression depth and/or rate. In this mode, the control system is programmed to be user-configured in the field, at the point of use, and is programmed to accept user input regarding desired compression depth and/or rate goals, or accept user input regarding patient age and/or size, and select appropriate release velocity goals, against which it compares the measured release velocity, and provides corresponding output indicating that the CPR provider achieved, or failed to achieve, the desired release velocity. The threshold is chosen by the control system to match the average instantaneous velocity of the compression module necessary to achieve the user-entered compression depth and/or rate. Thus, according to the table, the control system would indicate that the CPR provider has fully released the compression if release velocity meets or exceeds 200 inches (508 cm) per minute, if the user has configured the system for a user-entered goal of 1 inch (2.54 cm) compression, 300 inches (762 cm) per minute for a user-entered goal 1.5 inch (3.8 cm) compression, 400 inches (1016 cm) per minute for a user entered goal of 2 inch (5.08) compression, 500 inches (1270 cm) per minute for a user-entered goal of 2.5 inch (6.35 cm) compression and 600 inches (1524 cm) per minute for a user-entered goal of 3 inch (7.62 cm) compression. The thresholds can be more or less finely granulated. 3 inch (7.62 cm) compression. The thresholds can be more or less finely granulated.
In other modes of operation, the control system is programmed to adaptively determine whether a compression, or a series of compressions, has been fully released based on the depth of the compression, or the series of compressions, rather than on the basis of a predetermined threshold value or a user-configured threshold value. The determined threshold varies with the measured compression depth, and the control system is programmed to choose the threshold, against which it compares the measured release velocity, depending on the measured compression depth, and provide corresponding output indicating that the CPR provider achieved, or failed to achieve, the desired release velocity. This may be accomplished without regard to compression rate. The threshold is chosen by the control system to match the average instantaneous velocity of the compression module necessary to achieve the measured compression depth at a presumed rate (for example, the recommended rate of 100 compressions per minute). Thus, according to the table, the control system would indicate that the CPR provider has fully released the compression if release velocity meets or exceeds 200 inches (508 cm) per minute for a inch (2.54 cm) compression, 300 inches (762 cm) per minute for a 1.5 inch (3.8 cm) compression, 400 inches (1016 cm) per minute for a 2 inch (5.08) compression, 500 inches (1270 cm) per minute for a 2.5 inch (6.35 cm) compression and 600 inches (1524 cm) per minute for a 3 inch (7.62 cm) compression. The thresholds can be more or less finely granulated.
In the user-configurable mode described above, the control system can be programmed to assess the release velocity based on average velocity on the upstroke or release, or the peak velocity detected on the upstroke.
The determined threshold may also vary with the measured compression rate, and the control system is programmed to choose the threshold, against which it compares the measured, depending on the measured compression rate, and provide corresponding output indicating that the CPR provider achieved, or failed to achieve, the desired release velocity. This may be accomplished without regard to compression depth. The threshold is chosen by the control system to match the average instantaneous velocity of the compression module necessary to achieve the measured compression depth at a presumed compression depth (2 inches (5.08 cm), for example). Thus, according to the table, the control system would indicate that the CPR provider has fully released the compression if release velocity meets or exceeds 320 inches (812 cm) per minute for a compression rate of 80 compression per minute, 360 inches (914 cm) per minute for a compression rate of 90 compression per minute, 400 inches (1016 cm) per minute for a compression rate of 100 compression per minute, 440 inches (1118 cm) per minute for a compression rate of 110 compression per minute and so on. The thresholds can be more or less finely granulated.
Both compression depth and compression rate can be taken into account to refine the system described in the preceding paragraphs. As illustrated in the chart of
In each of these three modes, the system is adaptive, in the sense that it is programmed to make adjustments in the threshold in response to changes in the actual performance of the chest compression depth and/or rate during the course of CPR on each cardiac arrest victim. The system adaptively determines the desired threshold for release velocity based on the determined compression depth, the determined compression rate, or a combination of the desired compression depth and compression rate, and applies that adaptively determined threshold to compare with the determined release velocity to determine if the release velocity meets the desired threshold.
In each of the three adaptive modes described above, the control system can be programmed to assess the release velocity based on average velocity on the upstroke or release, or the peak velocity detected on the upstroke.
Whether release velocity is satisfactory may be determined for each and every compression, or for a series of compressions, or as an average over a series of compressions. When determined on the basis of a series of compressions, the control system tracks a number of compressions, keeping track of those compressions which are fully releases and those compressions that are not fully released. The system designers pre-determine an acceptable compliance rate, and the control system is programmed to issue a prompt and generate the display accordingly. For example, the system may be programmed to track 10 compressions and their associated compression depths and release velocities, and issue a prompt indicated unacceptable release velocity if 2 of the 10 compressions are not fully released (these numbers are, of course, merely exemplary). When determined on the basis of an average over a series of compressions, the system designers pre-determine an acceptable average release velocity, weighted for compression depth, and the control system is programmed to issue a prompt and generate the display accordingly. The control system tracks a number of compressions, keeping track of those compressions and release velocities for each compression. If the average release velocity is less that an acceptable percentage of the desired release velocities, the control system will issue a prompt for more complete release. Alternatively, the control system can average the compression depth, and average the release velocity, and issue a prompt when the average release velocity fall below the threshold for the average compression depth. Thus, it is not necessary to issue a confirmation for every single compression with complete release or a prompt after every single compression with inadequate release.
The diamond-shaped icon 27 provides a quick, overall indicator of how well the rescuer's combined rate and depth of chest compressions match the AHA/ERC recommendations for adult CPR. The CPR Compression Indicator, also known as Perfusion Performance Indicator (PPI), is first displayed as an empty diamond. The control system operates to alter this icon, filling it as compressions begin, and gradually filling it as compressions continues, until consistent chest compression depth exceeding AHA/ERC 2010 guidelines of 2.0 inches (5.08 cm) and rate exceeding 90 compressions per minute (cpm) are achieved simultaneously, at which point the control system completely fills the diamond icon. Should the chest compression rate or depth begin to fall below the configured target levels, the indicator will only partially fill to indicate the need for more rigorous efforts. Following the cessation of compressions, the indicator's fill level gradually decreases until a hollow outline is displayed after a short period of time.
In addition to the visual display, the control system can also be programmed to operate a speaker which provides audio prompt to the CPR provider. For example, when release velocity for a compression or a series of compression is lower than the desired release velocity, the control system can generate a audio prompt such as “Release Fully,” and when release velocity is satisfactory, the control system can generate an audio prompts such as “Good Release” or “Good Compression.” The audio prompt may be either verbal or non-verbal.
In use, a CPR provider will place the chest compression monitor on the victim's chest, over the victim's sternum. If the chest compression monitor is embedded in an electrode assembly, this will be done by placing the electrode assembly on the chest so that the chest compression monitor is properly located over the sternum. If the chest compression monitor is incorporated into a stand-alone device, such as a puck or a smart phone, this may be done by trapping the device between the CPR provider's hands and the patient's chest. The CPR provider will then press down on the chest, keeping the chest compression monitor between his hands and the victim's chest (or otherwise in fixed relation to the victim's chest), so that the chest compression monitor moves up and down in fixed relation with the patient's chest. The CPR provider will operate an associated control system, and energize the sensors in the chest compression module, to analyze the sensor signals to determine chest compression depth, velocity of the compression monitor (including release velocity), and, optionally, the rate of compression, and determine the desired release velocity based on the determined chest compression depth (and, optionally, the chest compression rate), compare the determined release velocity to the desired release velocity, and operate an output device to provide prompts indicating whether the release velocity meets or fails meet the desired release velocity (and whether the chest compression depth meets the desired chest compression depth). If the system is used in a user-configurable mode, the CPR provider will operate an associated control system, and energize the sensors in the chest compression module, to analyze the sensor signals to determine chest compression depth, velocity of the compression monitor (including release velocity), and, optionally, the rate of compression, and determine the desired release velocity based on the user-entered chest compression depth target (and, optionally, the chest compression rate)(or the user-entered patient information), compare the determined release velocity to the desired release velocity, and operate an output device to provide prompts indicating whether the release velocity meets or fails meet the desired release velocity (and whether the chest compression depth meets the desired chest compression depth).
Thus, the system is used in a method for facilitating the effective administration of cardiopulmonary resuscitation (CPR). The method includes operating a sensor for generating a signal corresponding to motion of a cardiac arrest victim's chest to determine motion of the cardiac arrest victim's chest during CPR chest compressions, in tandem with operating a control system with an output device to provide prompts in response to the motion signals. The control system is operable to receive a signal corresponding to motion of the chest, and programmed to determine the depth of compressions from a signal corresponding to motion of the chest, and determine release velocity during a release portion of a CPR compression cycle from a signal corresponding to motion of the chest, and programed to determine whether the CPR provider is substantially releasing the chest following chest compressions, and further programmed to operate the output device to provide the CPR provider with information as to whether the chest is being substantially released following chest compressions. Specifically, the control system is programmed to determine whether the CPR provider has substantially released the chest based on a desired release velocity threshold, which it is programmed to determine based on (1) the CPR provider's target chest compression depth and/or compression rate, as entered by the operator or (2) the actual depth of compression and/or compression rate as measured by the sensors. The control system then provides, through the output device, a prompt to the CPR provider whether the chest is being substantially released following chest compressions. As the CPR provider performs CPR chest compressions on the patient, with the goal of meeting approved standards of depth, rate and release velocity, the CPR provider monitors the outputs, occasionally viewing the output displays and listening to audio prompts as the are provided by the system, and adjusts the effort of chest compression if the output indicates that depth, rate, or release velocity differs from the desired thresholds.
While the preferred embodiments of the devices and methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. The elements of the various embodiments may be incorporated into each of the other species to obtain the benefits of those elements in combination with such other species, and the various beneficial features may be employed in embodiments alone or in combination with each other. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.
This application is a continuation under 35 U.S.C. § 120 of U.S. patent application Ser. No. 13/874,372, filed on Apr. 30, 2013. All subject matter set forth in the above referenced applications is hereby incorporated by reference in its entirety into the present application as if fully set forth herein.
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Number | Date | Country | |
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20190053976 A1 | Feb 2019 | US |
Number | Date | Country | |
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Parent | 13874372 | Apr 2013 | US |
Child | 16167573 | US |