Patent Application
20240157114
The invention relates to the field of medical engineering, and more particularly to micromechanics and medical measuring technology.
Modern medicine employs microinvasive techniques in a variety of ways and to an increasing degree, so as to achieve maximum supportive, therapeutic or diagnostic success with minimal impact on the patient.
Examples of such techniques include the insertion of stents in blood vessels, the use of thrombus filters, the removal of deposits in blood vessels by milling, and the support or temporary or partial replacement of a patient's cardiac function through micropumps/blood pumps that are introduced in blood vessels.
Many of these techniques require appropriate functional elements to be introduced via the bloodstream into the patient's body by means of a catheter and to be positioned within the bloodstream in the most expedient manner possible.
Precise position control to as great an extent as possible is not only desirable, initially or during acute use, for example on a milling head, as well as in the long term, but also decisive for the success of the invasive measure.
Positioning plays a critical role especially with blood pumps because these often remain in the patient's body for extended periods and must operate reliably without constant supervision by medical staff, wherein in the case of a catheter configuration, notably with access via a femoral artery, the risk of shifting exists due to active or passive body movements. The precision with which blood pumps are placed is also subject to stringent requirements, especially when these are located in the vicinity of a heart valve or cooperate with a heart valve.
Often times the positions of the corresponding functional elements are analyzed using radioscopy or by means of transesophageal echocardiography. However, these methods are tied to complex devices, which are not always available. This makes the position determination not only complex and expensive, but in many instances it is also not practical or useful given the extreme time pressure. While in emergencies, it is possible to place an intra-aortic pump blindly by measuring the distance between the puncture site in the groin and the jugular notch. However, this presupposes normal anatomic circumstances and carries with it the risk of misplacement in the contralateral femoral artery. This method is also imprecise because the individual anatomic features of the aorta are not predictable. If the functional element, in particular the pump, cannot be optimally placed, the supporting effect of such a pump is not optimal, and other functional elements can likewise not function optimally.
In addition to the pure transillumination method, other options are known from the prior art for determining the position of a component, and more particularly that of a cardiac catheter, substantially precisely.
U.S. Pat. No. 5,983,126, for example, discloses the application of three orthogonal external signals outside the patient body to the positioning area, wherein a probe is used to measure the influence of the three signals on the functional element and thus conclude the position. The corresponding external signals must be designed so that they do not interfere with the electrophysiological signals of the heart.
U.S. Pat. No. 6,226,546 B 1 describes a catheter localization method using a plurality of acoustic probes at the catheter head, wherein signals emitted by the probes are received via acoustic receivers and processed by a processing unit so as to determine the position and map the anatomic environment of the probes.
A catheter localization method having an accuracy of approximately 1 mm is known from U.S. Pat. No. 5,391,199, in which a transmitter outside the patient body emits signals by means of an antenna and receiving antennas are provided at the catheter tip, which are connected to a receiver for processing the signals. The signals are compared to corresponding reference signals from reference antennas in the patient's body.
Devices and methods for recording and mapping the electrophysiological activity inside a heart by means of a cardiac catheter are known from U.S. Pat. No. 6,892,091 B1. The corresponding catheter also comprises a position sensor, which is designed as an electromagnetic sensor. The exemplary embodiment regarding the use of such a position sensor described involves the application of magnetic fields which are generated outside the patient body and which act on the position sensor, so that both a position and an orientation of the sensor, and thus of the catheter, can be determined by means of the sensor. In addition, the comparison to reference signals of additionally introduced catheters is described.
The methods known from the prior art all have complex equipment in common, either in form of imaging devices or of additional signal sources outside the patient body. Such methods are not suitable for everyday use that is otherwise unproblematic, with a blood pump that is operated for cardiac support purposes for extended periods without the supervision of medical staff.
It is the object of the present invention to create a medical product which allows simple and reliable position determination during the invasive use of blood pumps, having particularly low complexity in terms of the apparatus.
The object is achieved according to the invention by way of the characteristics of claim 1, 9 or 14.
The invention makes it possible to control the position of a blood pump for days, weeks and months, even when it is operated automatically, and even with customary patient movements.
In the variant of claim 1, a medical product comprises a functional element in form of a blood pump for the invasive use in a patient's body, having a main sensor, which has a fixed spatial relationship relative to the blood pump. The main sensor in particular has a fixed, known distance from the blood pump. In addition, a processing unit is provided, which receives signals from the main sensor representing the signals or readings acquired by the main sensor and which determines at least one variable representing the position of the blood pump from signals from the main sensor, on the basis of electrophysiological signals of the heart.
It has long been known to measure electrophysiological signals on a beating heart. A typical application is the conventional electrocardiogram using electrodes, which are placed on a patient's skin in a suitable number, depending on the type of lead and complexity.
The time-variable signals are typically processed to form a vector which represents a fingerprint characterizing the respective individual heart. Because the respective recorded electrophysiological signals are heavily dependent on the site of the lead, a comparison between a measured signal and a typical electrocardiogram of the same person allows a conclusion of the position of the measurement/lead. It also optionally possible to conclude the positions of individual measuring electrodes.
To this end, the invention comprises a corresponding processing unit which is either directly connected to electrodes or which can be supplied with appropriately preprocessed data from ECG electrodes.
If the signals recorded by the main sensor are continually or periodically compared or linked to the electrophysiological data of the heart, it is possible to monitor the position of the main sensor, and thus that of the functional element/the blood pump having a fixed spatial relationship therewith, on an ongoing basis. In a particularly simple design, the main sensor is, for example, disposed on the blood pump itself or at a fixed distance therefrom, for example at one of the ends of the pump, if the blood pump is designed as substantially elongate body.
The method may similarly be applied using impedance measurements, or the analysis of a pulse curve detected by the main sensor as compared to the corresponding readings from a peripheral artery (for example arm or leg artery). Here, the time delay between the pressure increase maxima and minima is measured and indicates changes of the position or of the circulatory characteristics.
In a particular design of the invention, the processing unit can be directly connected to auxiliary sensors which record appropriate electrophysiological heart signals, and the processing unit can further process the signals from the main sensor with currently detected signals from the auxiliary sensors, or with data determined therefrom, for example if the data has been preprocessed to obtain an ECG. The advantage of this procedure is, for example, that the temporal rhythm of the signals detected by the main sensor can be directly synchronized with the rhythm of the signals from the auxiliary sensors.
The signal obtained by way of the main sensor and the vector of the limb leads can, for example in relation to a specific limb lead in accordance with the technique described by Goldberger, can then be utilized to define an optimal position vector. This vector can be continuously compared to the ECG vector obtained by way of the main sensor, whereby the actual position of the main sensor, and hence the position of the functional element, can be determined for every beat of the heart and compared to a desired position. Data about measured vectors and data from the main sensor detected in this respect can be recorded for calibration purposes with various known positions of the main sensor and/or of the functional element/of the blood pump (for example with simultaneous use of an imaging method), and a kind of “map” of the position can thus be stored based on exemplary data and can later be compared to currently detected data. For example, it is possible to determine the data record that is closest to the currently detected data record, and the position data which is stored for this closest data record can be used to draw a conclusion of the current position of the main sensor and/or of the functional element.
It is also possible for the processing unit to be connected to a memory unit in which the previously detected electrophysiological heart signals, and more particularly those of the patient's heart, are stored, and for the processing unit to link signals from the main sensor to stored heart signals and/or to other previously detected data, or data determined therefrom, so as to determine the variable representing the position of the functional element.
Temporal scaling of the data currently obtained by means of the main sensor is then necessary, or at least advantageous, for the purpose of a comparison to the stored ECG data, before the currently obtained vector or the currently obtained data can be compared to the stored data.
It is also conceivable to establish a relationship between the stored reference ECG data and the currently obtained ECG data from the auxiliary sensors and to obtain data on this basis, to which the signals from the main sensor are compared.
The main sensor typically comprises an electrode and/or antenna for recording electrophysiological signals. In the patient's body, such signals propagate electrodynamically as well as galvanically, so that they can be recorded well even at a distance from the heart. The coupling of a corresponding electrode to a measuring circuit plays a decisive role in the frequency response that is attained and whether it is a measuring electrode or an antenna.
Advantageously, it is also possible to provide more than one electrode or antenna on the main sensor. For example, two mutually spaced electrodes/antennas can produce a more precise determination of the position and orientation. However, it is also conceivable to use more than two electrodes. It is then possible to obtain a multidimensional vector from the data detected by the main sensor.
The invention can be implemented particularly advantageously with a blood pump which can be moved through a blood vessel by means of a catheter. Information about blood pumps, which are typically used outside, or also inside, the heart and in which the distance from the ventricle inlet or outlet or the position along the blood vessel is crucial for successful use, can be of particular interest.
Typical functional elements according to the invention can be blood pumps, and more particularly intra-aortic balloon pumps or rotary pumps.
The positioning relative to the ventricle is especially important with blood pumps. An intra-aortic balloon pump, for example, must be positioned outside in front of the ventricle at a defined distance, while a rotary pump should protrude partially into the ventricle.
In this respect, according to the invention the variable representing the position of the functional element can be the distance of the functional element from the mouth of a blood vessel in which the functional element is located into a chamber of the heart, notably along the course of the blood vessel.
According to a particular design of the invention, it is also possible for the main sensor to comprise a sensor for detecting a fluid mechanics variable, in particular a pressure sensor or a sensor for the flow velocity of the blood, or it is possible for the main sensor to be such a sensor, and it is possible for the processing unit to detect the temporal relationship between currently detected electrophysiological heart signals and a measurand characterizing the blood flow at the position of the main sensor and to determine on this basis a variable representative of the position of the functional element. In this case, essentially the delay of flow modulations generated by the cardiac activity, and more particularly of the changes in the flow velocity or pressure changes in the blood circulation system, is used to determine the location of the main sensor or of the functional element formed by a blood pump. Because the electrophysiological signals are recorded virtually without delay, yet the migration of a pressure wave takes place considerably more slowly, the time delay of a pressure wave maximum, for example, can be used to calculate the distance of the main sensor from the heart when the migration velocity is known. Instead of the pressure wave maximum, it is also possible to use other typical points of the pressure curve in the vascular system.
Another advantageous embodiment of the invention relates to a medical product in which the processing unit detects changes in the variable representing the position of the functional element and generates a signal, especially an alarm signal, when a threshold for the change is exceeded. (In the context of this patent application, “exceed” is to be understood as any interesting deviation from a threshold, i.e. a deviation below and/or above a certain threshold.) When an alarm signal is emitted, the patient can then seek the care of medical staff, or an adjustment can be carried out independently and automatically by means of actuators.
Another advantageous embodiment of the invention relates to a medical product in which the processing unit comprises a memory unit for a determined position of the functional element, and a comparison unit which compares continuously determined position values of the functional element to a value stored in the memory unit, determines a difference value between the stored value and a currently determined position value, and emits a signal if the difference value exceeds an established threshold.
According to a further embodiment of the invention, the processing unit is advantageously connected to a unit which generates a signal representing the current power, and more particularly the rotational speed of the blood pump if it is a rotary pump, and the processing unit comprises a correction unit for taking the power of the blood pump into consideration in the determination of the position of the functional element.
In particular the rotational speed of a rotary pump can influence the cardiac function and thus influence the signals which are used for the position determination. The influence of the rotational speed can thus be advantageously determined, stored in characteristic fields and taken into consideration in the evaluation.
The invention further relates to a medical product, as was already partially described above by way of example, and to a method for operating a blood pump in the body of a patient, in particular in a blood vessel, characterized in that a variable representing the position of the blood pump is determined by a main sensor, which has a fixed spatial relationship relative to the pump, locally detecting at least one parameter which is defined by the cardiac function of the patient and by converting the parameter into signals, and by linking identical or additional data or signals which characterize the cardiac function and which are detected, for example in the same blood vessel in which the blood pump is located, in a known position which is spaced from the pump, to the signals from the main sensor.
The invention advantageously also refers to a method for operating a blood pump in which first the blood pump is positioned in the patient's body at a desired location using an imaging method, characterized in that thereafter, in accordance with the method of claim 14, a variable representing the position of the blood pump is determined and stored as a calibration variable, at a later time the method in accordance with claim 14 is carried out, and the determined variable representing the position of the blood pump is compared to the calibration variable, and a signal is emitted if a threshold value of the variance from the calibration value is exceeded.
The signal can be an optical and/or acoustic warning signal which is directed to the patient or medical staff, or it can be directly conducted to a device for adjusting the pump.
In an advantageous embodiment of the invention, the processing unit may be designed to process signals from an impedance sensor and/or from a blood pressure sensor and/or from a respiratory activity sensor and/or from a sensor for the oxygen content in the blood, and/or the processing unit may be connected to one or more sensors of the aforementioned sensor types. By linking one or more of the aforementioned measurands to detected signals or measurement results of the main sensor, it is thus possible to determine the position of the main sensor, either directly or by way of a comparison to stored reference data. The main sensor can likewise be suitable for detecting the aforementioned measurands, these being impedance, blood pressure, respiratory activity or oxygen content.
According to one embodiment of the invention, an auxiliary sensor, which like the main sensor comprises a variable characterizing the blood flood, and more particularly the variable measured also by the main sensor, is disposed in a position, in particular in a known position, which is spaced from the unknown position of the main sensor.
The invention will be described hereafter in an exemplary embodiment and is shown in drawings.
In the drawings
The diastolic filling of the pump balloon, as shown in
The key in this connection is to position the functional element as optimally as possible in the aorta relative to the heart valve 4 or the mouth of the blood vessel into the left ventricle.
In this connection, as is shown in
In addition, auxiliary sensor 7, 8, 9, 10, 11 are provided, which can be formed by electrodes for ECG measurement applied externally to the patient's body. Alternately, differently placed sensors are also conceivable, for example sensors which, as part of implanted devices, are not disposed on the body surface but in the body interior, but are suitable for recording electrophysiological cardiac signals. Such sensors can, for example, be provided in cardiac pacemakers or implanted defibrillators.
It is also conceivable to provide a lower number of auxiliary sensors, for example one, two, three or four auxiliary sensors, wherein a higher number allows a complex ECG vector to be attained, which allows more precise localization of the main sensor, and thus of the functional element 5, by comparison and linking to the signals from the main sensor 6.
Both the main sensor 6 and the auxiliary sensors record a respective temporal curve of the electrophysiological cardiac signals or other measured variables, so that the position of the main sensor can be determined by comparing and linking the signals from the main sensor to the signals of the remaining auxiliary sensors having various positions.
In addition to the functional element 12, which can be a rotary pump, for example, the corresponding main sensor 6 at the tip of the functional element, and the auxiliary sensors 7, 8, 9, 10, 11,
In the case of ECG data, the signals from the auxiliary sensors are combined to form a
vector,
while the temporally variable signal from the main sensor 6 is present as a scalar f1(t). The vector of the signals from the auxiliary sensors is compared to the function f1(t) so as to perform the position determination of the main sensor 6 in the processing unit 13 using predetermined metrics and to display the result in the display device 14. To this end, either the absolute distance of the functional element 12 from the inlet into the left ventricle, or the spacing along the blood vessel 3 can be shown in the display device.
currently detected electrophysiological signals are detected by auxiliary sensors and instead stored data is used. This data is stored in a memory unit 15 of the processing unit 13′ and was, for example, measured when the treatment of the patient started and was archived, so as to later allow the position of the functional element to be determined by comparing the currently measured signals from the main sensor to typical signals of the patient's heart.
and stored ECG data
are linked to the signals from a main sensor. To this end, as in the example described based on
recorded via several main sensor elements which are spatially distributed on the functional element 5, so that the main sensor also allows a signal vector to be detected. It is then possible to first compare the currently detected electrophysiological heart signals
to the stored data
and the link result of this comparison to the data detected by the main sensor, so as to output position information in the display unit 14 using metrics. To this end, either an absolute distance or a traffic light-type indicator in form of a green light for an allowed distance range, a yellow light for a critical distance range and a red light for a prohibited distance range of the functional element from the ventricle may be provided. As an alternative or in addition, the position may also be graphically represented, for example by a representation relative to the position of the heart or of a reference point, for example of an auxiliary sensor, the position of which can in particular be exactly known. Moreover, the position can also be represented by means of an acoustic signal, for example an alarm signal, which indicates the departure from the intended position or a change in distance from a predetermined location.
Because the electrophysiological signals are recorded by the sensors 7′ virtually without delay, these convey a current picture of the cardiac activity, which can be compared to the pressure fluctuations arriving at the main sensor 61 with delay due to the slower migration velocity. It can be determined, or it is known, at what times with regard to a complete cardiac period certain maximal or minimal blood pressure values are generated in the heart, so that, having knowledge of the migration velocity of pressure waves, the distance of the main sensor 6′ from the ventricle can be concluded from the time difference of the recording by the sensors 6′, 7′. Using the configuration shown and a corresponding processing unit 13′″, it is thus possible to determine the position of the main sensor 6′, and thus that of the functional element 5′, relative to the vascular system in relation to the heart and the position can be displayed.
The measurement is typically carried out based on the pressure maximum that is achieved. The measurement by means of the processing unit 13′″ can be calibrated when introducing the functional element 5′, for example by slowly inserting the blood vessel while also determining the position of the functional element 5′ by means of imaging.
The various coupling intensities are linked in the processing unit 13″″. In this case, it is also possible for several sensor elements to be disposed on the main sensor, for example so as to render the position determination more precise or additionally allow the orientation of the functional element to be determined.
During operation, the pump takes in blood via the intake cage 38 and ejects the same into the blood vessel 40 via ejection openings 39. A flexible outflow hose 41 is provided, which in cooperation with the heart valve 42, which surrounds the outflow hose, periodically closes the ejection/outflow openings 39 and thus prevents the backflow of blood.
This demonstrates that the position of the pump relative to the heart valve must be precisely adhered to.
If the position of the main sensor 37 can be determined, it is also possible to correctly position the pump 30 in the ventricle.
In a modification, a further sensor 37a is attached to the distal end of the pump housing. In this case, it is possible to determine a corresponding signal, for example an ECG vector, directly between these two sensors and to draw a conclusion therefrom as to the position, or change in position, of the pump. Depending on the accuracy requirements in terms of the position determination, it may be possible in this instance to forego additional, notably external, auxiliary sensors.
An operating property of the blood pump may also be used to implement a main sensor which measures a fluid mechanics variable. for example the blood pressure or the flow velocity of the blood, for example in the case of a rotary pump the current rotational speed can be used if the driving power/torque is known, or a driving torque, driving power, or current/voltage/electrical power of a driving motor of the pump.
The current rotational speed and the electrical power required for driving purposes, which can be determined based on the drive current required by the driving motor. can be used to determine the flow velocity of the blood flow flowing through the pump in a time-resolved manner. When the heart is beating, this results in a periodic pattern, the phase angle of which can be compared to ECG data so as to determine the delay of the fluid mechanics changes from the heart to the main sensor, and thus the distance of the main sensor from the heart.
It is also possible to position two sensors in the same blood vessel, and using travel time measurements which are determined based on the measurement of fluid mechanics variables by each of the sensors, it is possible to determine the distance or a change in the distance of the two sensors. If the position of one of the sensors is fixed and/or known, it is also possible to determine and monitor the absolute position of the other sensor.
The medical product described in this patent application can be used for visualizing the signals of the main sensor 6, 6′, 6″ for optimal positioning during the implantation process, enabling easier and safer placement of the medical product in the circulation. The visualization may take place on a screen of a user's console which is configured to show the position of the medical product within the human or animal body. The screen may be a touch screen configured to display and control the medical product during use. The visualization is very advantageous with regard to control of the medical product's position in the blood circuit. For instance, the position of a rotary blood pump in relation to a heart valve {see, for example,
| Number | Date | Country | Kind |
|---|---|---|---|
| 11075206.0 | Sep 2011 | EP | regional |
This application is a continuation of U.S. application Ser. No. 16/718,431, filed Dec. 18, 2019, now allowed, which is a continuation of U.S. application Ser. No. 13/261,824, filed May 19, 2014, now U.S. Pat. No. 10,561,773, which is a national stage entry of PCT/EP2012/067218, filed Sep. 4, 2012, which claims the benefit of U.S. Provisional Patent Application No. 61/531,030, filed Sep. 5, 2011, and European Patent Application No. 11075206.0, filed Sep. 5, 2011. The disclosures of each of the foregoing applications are incorporated herein by reference in their entirety.
| Number | Date | Country | |
|---|---|---|---|
| 61531030 | Sep 2011 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16718431 | Dec 2019 | US |
| Child | 18140078 | US | |
| Parent | 13261824 | May 2014 | US |
| Child | 16718431 | US |
