Resuscitation termination suggestion during CPR

Abstract

A defibrillator employs an ECG monitor and a defibrillation controller for supporting a viewer to make a resuscitation termination (TOR) decision during cardiopulmonary resuscitation (CPR) of a patient's heart by the viewer. In an operation during CPR of a patient's heart by a viewer, an ECG monitor monitors an ECG waveform of the patient's heart, and a defibrillation controller monitors the CPR and TOR parameters of the ECG waveform, derives a TOR suggestion from the monitoring of the TOR parameters, and communicates the TOR suggestion to the viewer based on at least one of a request by the viewer or an occurrence of a TOR event.

Description

Technical Field

[0001] The present disclosure relates generally to cardiac arrest management involving bystander cardiopulmonary resuscitation ("CPR") of a patient's heart, and more particularly to supporting termination of resuscitation ("TOR") decisions during bystander CPR of a patient's heart. Background Art

[0002] FIG1 shows a CPR monitor 30 placed on the sternum of a patient 10 while a witness 20 applies chest compressions in a conventional manner using both hands (one hand placed on the other). However, rather than placing hands directly on the patient 10, the witness 20 places his hands on the CPR monitor 30 and applies chest compressions to the patient 10 via the CPR monitor 30. The witness 20 performs chest compressions on the heart of the patient 10 as specified in a conventional CPR protocol. As is well known in the art of this disclosure, the CPR monitor 30 monitors the quality of the CPR performed by the witness 20 on the heart of the patient 10, for example, whether the CPR is effective or ineffective in terms of compression depth and rate, chest release and recoil, and the placement of the witness's hands on the chest of the patient 10. A cable 31 is attached to a defibrillator 40 to couple the monitoring of the CPR quality to the defibrillator 40 and to issue audible CPR instructions via the speaker of the defibrillator 40.

[0003] FIG1 also shows a defibrillator 40 attached to the patient 10 via electrodes 41a and 41b. As is well known in the art of the present disclosure, the defibrillator 40 is used to deliver a defibrillation shock to the patient 10 as needed during CPR. More specifically, the defibrillator 40 is operable to deliver high-voltage pulses to the heart of the patient 10 in order to restore normal heart rhythm and contractile function in patients with arrhythmias (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)) who are not experiencing spontaneous circulation. In operation, the defibrillator 20 automatically analyzes the electrocardiogram (ECG) rhythm of the patient's 10 heart to determine whether defibrillation is needed. If so, when the defibrillator 40 recommends a shock, the defibrillator 40 prompts the witness 20 to terminate CPR and press the shock button to deliver a defibrillation shock to the patient.

[0004] As exemplarily shown in FIG1 , the field of resuscitation primarily focuses on improving the quality of care by identifying and providing optimal CPR / shock treatment for patients experiencing cardiac arrest. Summary of the Invention

[0005] The present disclosure is directed to improving existing defibrillators (eg, automated external defibrillators and advanced life support defibrillators) by providing a termination of resuscitation (TOR) recommendation during bystander cardiopulmonary resuscitation (CPR) of a patient's heart to support the bystander in making a TOR decision.

[0006] For purposes of describing and claiming the present disclosure, the term "termination of resuscitation" broadly includes criteria for objectively terminating bystander CPR on a patient's heart based on TOR parameters of the patient's CPR and ECG waveform, and optionally, criteria for subjectively terminating bystander CPR on a patient's heart based on the patient's CPR and ECG waveform.

[0007] Examples of objective criteria for TOR during CPR include, but are not limited to, (1) an initial or continued non-shockable rhythm (e.g., asystole) on the ECG waveform, (2) no shock delivery on the ECG waveform, and (3) no return of spontaneous circulation (ROSC) on the ECG waveform.

[0008] If objective criteria do not exist, examples of subjective criteria for TOR during CPR include, but are not limited to: (1) the duration of CPR; (2) the detection or absence of refractory ventricular fibrillation in the ECG waveform, which can indicate whether the patient may have an acute coronary artery occlusion; (3) the patient's gasping or absence of gasping, which can be determined based on the impedance signal as a marker of the potential effectiveness of CPR; (4) the heart rate at various times during CPR as an indication of perfusion level, particularly whether bradycardia is present or whether some blood flow may be present if the patient is in an organized rhythm for any length of time; and (5) the detection or absence of asystole in the ECG waveform after shock delivery.

[0009] The present disclosure may be embodied as (1) a defibrillator, (2) a defibrillation controller, and (3) a defibrillation method.

[0010] Various exemplary embodiments of a defibrillator of the present disclosure include an ECG monitor and a defibrillation controller for supporting a bystander in making a TOR determination during bystander CPR of a patient's heart. The ECG monitor is configured to monitor an ECG waveform of a patient's heart during bystander CPR of the patient's heart. The defibrillation controller is configured to monitor TOR parameters of the CPR and ECG waveforms during bystander CPR of the patient's heart, derive a TOR recommendation from the monitoring of the TOR parameters, and communicate the TOR recommendation to the bystander based on a bystander request or the occurrence of a TOR event.

[0011] Various exemplary embodiments of a defibrillator controller disclosed herein encompass a non-transitory machine-readable storage medium encoded with instructions for execution by one or more processors to support a bystander in making a TOR decision during bystander CPR of a patient's heart, a defibrillator, and a non-transitory machine-readable storage medium comprising instructions for performing the following operations during bystander CPR of a patient's heart: (1) monitoring TOR parameters of the patient's CPR and ECG waveforms, (2) deriving a TOR recommendation from the monitoring of the TOR parameters, and (3) communicating the TOR recommendation to the bystander based on a bystander request or the occurrence of a TOR event.

[0012] Various exemplary embodiments of a defibrillation method according to the present disclosure include supporting a bystander in making a TOR decision during bystander CPR of a patient's heart. The defibrillation method involves a defibrillator monitoring an ECG waveform of a patient's heart during bystander CPR of the patient's heart. The defibrillation method involves a defibrillator, during bystander CPR of the patient's heart, (1) monitoring TOR parameters and an ECG waveform of CPR, (2) deriving a TOR recommendation from the monitoring of the TOR parameters, and (3) communicating the TOR recommendation to a witness based on a request by the witness or the occurrence of a TOR event.

[0013] The foregoing exemplary embodiments and other embodiments of the present disclosure, as well as the various structures and advantages of the present disclosure, will become more apparent to those skilled in the art by reading the following detailed description of various embodiments of the present disclosure in conjunction with the accompanying drawings. The detailed description and drawings are merely illustrative of the present disclosure and are not limiting. The scope of the present disclosure is defined by the claims and their equivalents. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] The present disclosure will present the following description of exemplary embodiments in detail with reference to the following drawings, in which:

[0015] FIG1 illustrates cardiopulmonary resuscitation performed on a patient's heart by a bystander as is known in the art of the present disclosure;

[0016] Figure 2 An exemplary embodiment of a cardiac arrest treatment system according to the present disclosure is shown;

[0017] Figure 3 An exemplary embodiment of a defibrillator according to the present disclosure is shown;

[0018] Figure 4 shows a flow chart representing an exemplary embodiment of a defibrillation method according to the present disclosure; and

[0019] Figure 5 An exemplary embodiment of a defibrillation controller according to the present disclosure is shown. DETAILED DESCRIPTION

[0020] The present disclosure is directed to improving existing defibrillators (eg, automated external defibrillators and advanced life support defibrillators) by providing a termination of resuscitation (TOR) recommendation during bystander cardiopulmonary resuscitation (CPR) of a patient's heart to support the bystander in making a TOR decision.

[0021] For purposes of describing and claiming the present disclosure, the term "termination of resuscitation" broadly includes criteria for objectively terminating bystander CPR on a patient's heart based on TOR parameters of the patient's CPR and ECG waveform, and optionally, criteria for subjectively terminating bystander CPR on a patient's heart based on the patient's CPR and ECG waveform.

[0022] Examples of objective criteria for TOR during CPR include, but are not limited to, (1) an initial or continued non-shockable rhythm (e.g., asystole) on the ECG waveform, (2) no shock delivery on the ECG waveform, and (3) no return of spontaneous circulation (ROSC) on the ECG waveform.

[0023] If objective criteria do not exist, examples of subjective criteria for TOR during the administration of CPR include, but are not limited to: (1) the duration of the administration of CPR; (2) the detection or absence of refractory ventricular fibrillation in the ECG waveform, which can indicate whether the patient may have an acute coronary artery occlusion; the patient's (3) gasping or absence of gasping, which can be determined based on the impedance signal as a marker of the potential effectiveness of CPR; (4) heart rate at various times during CPR as an indication of perfusion level, particularly whether bradycardia is present or whether some blood flow may be present if the patient is in an organized rhythm for any length of time; and (5) the detection or absence of asystole in the ECG waveform after shock delivery.

[0024] As one of ordinary skill in the art will appreciate in light of this disclosure, exemplary embodiments of the present invention may be used to provide information to answer TOR questions commonly asked by witnesses, such as, "Is the rhythm shockable at any time?" and provide relevant information in accordance with this disclosure.

[0025] To facilitate understanding of this disclosure, Figure 2 The following description teaches exemplary embodiments of a cardiac arrest treatment system according to the present disclosure. Figure 2 With this description, one of ordinary skill in the art will understand how to apply the present disclosure to make and use additional embodiments of cardiac arrest treatment systems according to the present disclosure.

[0026] refer to Figure 2, an exemplary cardiac arrest treatment system of the present disclosure employs a CPR monitor 20a and a defibrillator 40a.

[0027] In practice, CPR monitor 20a is any device as known in the art of the present disclosure or hereinafter contemplated for analyzing the quality of CPR performed on heart 11 of patient 10a by a witness (not shown).

[0028] In a first exemplary embodiment, the CPR monitor 20a is configured as a CPR coaching device in accordance with US Pat. No. 8,532,765 B2 to Ochs et al., entitled "CPR Coaching Device with Reduced Motion Sensitivity," the entire contents of which are incorporated herein by reference.

[0029] In a second exemplary embodiment, monitor 20a is a mechanical CPR device that incorporates the CPR analysis principles described by Ochs et al.

[0030] Still refer to Figure 2 In practice, the defibrillator 40a is any type of defibrillator as known in the art of the present disclosure or contemplated hereinafter that incorporates the inventive principles of the present disclosure for supporting a bystander in making TOR decisions during cardiopulmonary resuscitation (CPR) of a patient's heart by the bystander.

[0031] In operation, defibrillator 40a inputs CPR feedback 22 from CPR monitor 20a as a basis for monitoring CPR being performed on the patient's heart by a bystander.

[0032] Further in operation, defibrillator 40a monitors the ECG waveform of heart 11 of patient 10a via electrodes 41a and 41b applied to patient 10a as known in the art of the present disclosure, and monitors the ECG waveform to detect any shockable rhythm of heart 11 of patient 10a as known in the art of the present disclosure.

[0033] If defibrillator 40a detects a shockable rhythm in heart 11 of patient 10a, defibrillator 40a may communicate a shock indicator to a bystander as is known in the art of this disclosure, whereby the bystander may initiate shock delivery to the patient's heart.

[0034] In practice, the defibrillator 40a further monitors the TOR parameter in the ECG waveform as a basis for determining whether the TOR parameter indicates the TOR objective criterion or the TOR subjective criterion to support the eyewitness in making a TOR decision.

[0035] For purposes of describing and claiming the present disclosure, the term "TOR parameter" broadly includes any parameter as known in the art of the present disclosure or hereafter contemplated that measures whether cardiac arrest treatment, including CPR and shock delivery, is likely to be successful.

[0036] Examples of TOR parameters include, but are not limited to, heart rhythm and heartbeats in the ECG waveform, shock indications in the ECG waveform, respiratory status of the patient, and duration of CPR.

[0037] Still refer to Figure 2 , the defibrillator 40a includes a user interface including a display 42, a TOR recommendation button 43, a shock button 44 and a speaker 45 as means for conveying the TOR recommendation to the witness to support the witness in making a TOR decision.

[0038] For example, if the defibrillator 40a determines that the TOR parameters are indicative of objective TOR criteria, the defibrillator 40a will communicate to the witness via the display 42 and / or speaker 45 that “TOR is desirable.”

[0039] Alternatively, for example, if the defibrillator 40a determines that the TOR parameters do not indicate objective TOR criteria and the witness activates the TOR suggestion button 43, the defibrillator 40a will transmit to the witness via the display 42 and / or speaker 45 subjective TOR criteria indicating that TOR is desirable and subjective TOR criteria indicating that TOR is undesirable.

[0040] To further facilitate understanding of this disclosure, Figure 3 The following description teaches exemplary embodiments of a defibrillator according to the present disclosure. Figure 3 With this description, one of ordinary skill in the art will understand how to apply the present disclosure to make and use additional embodiments of defibrillators according to the present disclosure.

[0041] refer to Figure 3 , the defibrillator 40b of the present disclosure employs a pair of electrode pads / paddles 41a and 41b, optional ECG leads 46, an ECG monitor 50 (internal or external), a shock source 60, and a defibrillation controller 70. Also shown is a CPR coaching device 20a communicatively coupled to the defibrillation controller 70.

[0042] As is known in the art of the present disclosure, electrode pads / plates 41a and 41b are structurally configured to be conductively applied to patient 10a in an anterior-apex arrangement as shown in FIG1 or alternatively in an anterior-posterior arrangement (not shown). Electrode pads / plates 41a and 41b conduct a defibrillation shock from a shock source 60 to the heart 11 of patient 10a, as controlled by a defibrillation controller 70 as is known in the art of the present disclosure, and conduct the electrical activity of the heart 11 of patient 10a to an ECG monitor 50 as is known in the art of the present disclosure. Alternatively or simultaneously, an ECG lead 46 as is known in the art of the present disclosure may be connected to patient 10a to conduct the electrical activity of the heart 11 of patient 10a to the ECG monitor 50.

[0043] ECG monitor 50 is structurally configured as is known in the art to generate an ECG waveform of heart 11 of patient 10a when patient 10a is experiencing an indication of an organized heartbeat condition or a disorganized heartbeat condition. An example of an ECG waveform indicative of an organized heartbeat condition is Figure 3 The ECG waveform 51a shown in FIG. 5 is representative of the organized contraction of the ventricles of the heart 11 capable of pumping blood. An example of an ECG waveform indicating that the patient 10a is experiencing a disorganized heartbeat condition is as shown in FIG. Figure 3 A random ECG waveform 51b is shown having zero (0) discernible waves indicating the absence of organized heartbeat activity in the heart 11 of the patient 10a.

[0044] In one exemplary embodiment, the ECG monitor 50 employs a digital signal processor (not shown) to stream the ECG waveform data 52 to the defibrillation controller 70 .

[0045] As is known in the art of the present disclosure, the shock source 60 is structurally configured to store electrical energy for delivering a defibrillation shock to the heart 11 of the patient 10a via the electrode pads / plates 41a and 41b under the control of the defibrillation controller 70. In practice, the defibrillation shock may have any waveform as is known in the art of the present disclosure. Examples of such waveforms include, but are not limited to, Figure 3 Shown are a single-phase sinusoidal waveform (positive sine wave) 61a and a two-phase truncated waveform 61b.

[0046] In one exemplary embodiment, shock source 60 employs a high-voltage capacitor bank (not shown) for storing high voltage via a high-voltage charger and power supply when a charge button is pressed. Shock source 60 also employs a switching / isolating circuit (not shown) for selectively applying a specific waveform of electrical energy charge from the high-voltage capacitor bank to electrode pads / plates 41 a and 41 b controlled by defibrillation controller 70.

[0047] The defibrillation controller 60 includes an ECG analyzer 80 , as is known in the art of the present disclosure and contemplated hereinafter, for analyzing and interpreting the ECG waveform data 52 from the ECG monitor 50 .

[0048] The defibrillation controller 60 also includes a TOR recommender 90 for deriving a TOR recommendation 91 from the ECG feedback data 82 and the CPR feedback data 22 .

[0049] In practice, TOR Recommendation 91 informs bystanders whether bystander CPR should be terminated based on one or more objective criteria, particularly as articulated by the American Heart Association.

[0050] Examples of criteria for objectively terminating CPR include (1) an initial or continued non-shockable rhythm (e.g., asystole) on the ECG waveform, (2) no shock delivery on the ECG waveform, and (3) no return of spontaneous circulation (ROSC) on the ECG waveform.

[0051] If objective criteria do not exist, examples of subjective criteria for TOR during CPR include, but are not limited to: (1) the duration of CPR; (2) the detection or absence of refractory ventricular fibrillation in the ECG waveform, which can indicate whether the patient may have an acute coronary artery occlusion; (3) the patient's gasping or absence of gasping, which can be determined based on the impedance signal as a marker of the potential effectiveness of CPR; (4) the heart rate at various times during CPR as an indication of perfusion level, particularly whether bradycardia is present or whether some blood flow may be present if the patient is in an organized rhythm for any length of time; and (5) the detection or absence of asystole in the ECG waveform after shock delivery.

[0052] In one embodiment, Figure 4 The illustrated flow chart 100 is executed by the TOR advisor 90 when a bystander initiates CPR.

[0053] refer to Figure 4 , stage S102 of flowchart 100 includes the TOR advisor 90 monitoring TOR parameters of the ECG waveform during CPR.

[0054] After the specified time has elapsed, the TOR adviser 90 enters stage S104 of the flowchart to determine whether a TOR event has occurred.For the purposes of describing and claiming the present disclosure, the term "TOR event" broadly includes satisfying all objective TOR criteria for terminating CPR.

[0055] If the TOR recommender 90 determines that a TOR event has occurred, the TOR recommender enters stage S110 of the flowchart 100 to derive a TOR recommendation for the TOR event and communicate it to the witness, and then enters the termination flowchart 100 if it is determined by the TOR recommender 90 during stage S110 of the flowchart 100 that the CPR has been terminated.

[0056] Otherwise, if the TOR suggester 90 ascertains that a TOR event has not occurred, the TOR suggester proceeds to stage S116 of the flowchart 100 to ascertain whether the witness is requesting TOR advice.

[0057] If the TOR recommender 90 determines that the witness is requesting a TOR recommendation, the TOR recommender enters stage S108 of the flowchart 100 to derive a TOR recommendation for the subjective TPC criterion and communicate it to the witness, and then enters the termination flowchart 100 if it is determined by the TOR recommender 90 during stage S110 of the flowchart 100 that the CPR has been terminated.

[0058] Otherwise, if the TOR recommender 90 determines that the witness has not requested a TOR recommendation, then the TOR recommender enters a termination flowchart 100 if it is determined by the TOR recommender 90 during stage S110 of the flowchart 100 that the CPR has terminated.

[0059] In practice, a witness may or may not follow the TOR recommendation for a TOR event (i.e., whether TOR is advisable). Nevertheless, this disclosure will support the witness in making this determination in any manner during CPR when the ECG waveform shows that CPR is continuing and shock delivery will likely not be successful.

[0060] Also in practice, the TOR suggestion of the subjective TOR criteria (i.e., TOR may be desirable) helps the eyewitness decide whether TOR is needed. Nevertheless, the present disclosure will support the eyewitness in making this decision during CPR, when the ECG waveform shows that CPR is still continuing and the shock delivery may or may not be successful.

[0061] In order to facilitate further understanding of this disclosure, Figure 5 The following description teaches exemplary embodiments of a defibrillation controller according to the present disclosure. Figure 5 With this description, one of ordinary skill in the art will understand how to apply the present disclosure to make and use additional embodiments of defibrillation controllers according to the present disclosure.

[0062] refer to Figure 5 , shows an exemplary embodiment of a defibrillator controller 170 that includes one or more processors 171 , a memory 172 , a user interface 173 , a network interface 174 , and a storage device 175 interconnected via one or more system buses 176 .

[0063] Each processor 171 may be any hardware device capable of executing instructions stored in the memory 162 or storage device or otherwise processing data as known in the art of the present disclosure or contemplated herein. In non-limiting examples, the processor 161 may include a microprocessor, a field programmable gate array (FPGA), an application specific integrated circuit (ASIC), or other similar device.

[0064] Memory 172 may include various memories as known in the art of the present disclosure or as contemplated below, including but not limited to L1, L2, or L3 cache or system memory. In non-limiting examples, memory 172 may include static random access memory (SRAM), dynamic RAM (DRAM), flash memory, read-only memory (ROM), or other similar memory devices.

[0065] The user interface 173 may include one or more devices for enabling communication with a user such as an administrator as known in the art of the present disclosure or as contemplated hereinafter. In a non-limiting example, the user interface may include a command line interface or a graphical user interface that may be presented to a remote terminal via the network interface 174.

[0066] The network interface 174 may include one or more devices as known in the art of the present disclosure or contemplated below for enabling communication with other components of the medical device. In a non-limiting example, the network interface 174 may include a network interface card (NIC) configured to communicate according to the Ethernet protocol. Additionally, the network interface 174 may implement a TCP / IP stack for communicating according to the TCP / IP protocol. Various alternative or additional hardware or configurations of the network interface 164 will be readily apparent.

[0067] The storage device 175 may include one or more machine-readable storage media as known in the art of the present disclosure or as contemplated below, including but not limited to read-only memory (ROM), random access memory (RAM), magnetic disk storage media, optical storage media, flash memory devices, or similar storage media. In various non-limiting embodiments, the storage device 175 may store instructions for execution by the processor(s) 171 or data that the processor(s) 171 may operate on. For example, the storage device 175 may store a basic operating system for controlling various basic operations of the hardware.

[0068] The storage device 175 may also store application modules in the form of executable software / firmware for implementing the previously described aspects of this disclosure. Figure 4 and various functions of the method of FIG. 6 .

[0069] In one exemplary embodiment shown, the storage device 175 stores an application module 177 comprising an ECG analyzer 178 for monitoring ECG waveforms as known in the art of the present disclosure and a TOR recommender 189 for deriving TOR recommendations as previously described in the present disclosure, in particular according to Figure 4 Flowchart 100.

[0070] Based on the description of Figures 1-5 herein, one of ordinary skill in the art will appreciate the numerous benefits of the present disclosure, including but not limited to supporting bystander termination of resuscitation (TOR) decisions during bystander cardiopulmonary resuscitation (CPR) of a patient's heart.

[0071] The present disclosure has been described with reference to preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the foregoing detailed description. The present disclosure is intended to be construed as including all such modifications and alterations as long as they fall within the scope of the claims or their equivalents.

[0072] Furthermore, as will be understood by those skilled in the art based on the teachings provided herein, the features, elements, components, etc. disclosed and described in this disclosure / specification and / or depicted in the accompanying drawings and / or referenced in the claims may be implemented in various combinations of hardware and software, and provide functionality that may be combined in a single element or multiple elements. For example, the functionality of the various features, elements, components, etc. shown / illustrated / depicted in the accompanying drawings and / or recited in the claims may be provided using dedicated hardware as well as hardware capable of executing software associated with appropriate software. When provided by a processor, these functions may be provided by a single dedicated processor, a single shared processor, or multiple separate processors, some of which may be shared and / or reused. Furthermore, the explicit use of the term “processor” or “controller” should not be construed to exclusively refer to hardware capable of executing software, and may implicitly include, but not be limited to, digital signal processor (“DSP”) hardware, memory (e.g., read-only memory (“ROM”) for storing software, random access memory (“RAM”), non-volatile storage devices, etc.), and virtually any device and / or machine (including hardware, software, firmware, combinations thereof, etc.) capable (and / or configurable) of executing and / or controlling a process.

[0073] In addition, all statements herein of the principles, aspects and exemplary embodiments of the present disclosure, and specific examples thereof, are intended to cover their structural and functional equivalents. In addition, such equivalents are intended to include currently known equivalents as well as equivalents developed in the future (e.g., any element developed that can perform the same or substantially similar function, regardless of the structure). Thus, for example, in view of the teachings provided herein, it will be understood by those of ordinary skill in the art that any block diagram presented herein can represent a conceptual diagram of an illustrative system component and / or circuit embodying the principles of the present invention. Similarly, in view of the teachings provided herein, it will be understood by those of ordinary skill in the art that any flow chart, flow diagram, etc. can represent various processes that can be substantially represented in a computer-readable storage medium and therefore performed by a computer, a processor, or other device having processing capabilities, whether or not such a computer or processor is explicitly shown.

[0074] Having described preferred and exemplary embodiments of the present disclosure, these embodiments are intended to be illustrative, not restrictive, and it should be noted that modifications and variations can be made by one of ordinary skill in the art based on the teachings provided herein (including the drawings and claims). Therefore, it should be understood that changes can be made to the preferred and exemplary embodiments of the present disclosure, and these changes are within the scope of the present disclosure and the exemplary embodiments disclosed, described, and taught herein.

[0075] Furthermore, corresponding and / or related systems that are contemplated to be incorporated into and / or implemented in devices or that can be used / implemented in devices according to the present invention are also contemplated and considered to be within the scope of the present invention. Furthermore, corresponding and / or related methods for making and / or using devices and / or systems according to the present disclosure are also contemplated and considered to be within the scope of the present disclosure.

Claims

1. A defibrillator for supporting a bystander in making a termination of resuscitation (TOR) decision during cardiopulmonary resuscitation (CPR) performed on a patient's heart by the bystander, the defibrillator comprising: an ECG monitor configured to monitor an ECG waveform of the patient's heart during CPR performed on the patient's heart by the bystander; as well as a defibrillation controller, wherein, during CPR performed on the patient's heart by the bystander, the defibrillation controller is configured to: monitoring TOR parameters of the CPR and the ECG waveform; deriving a TOR recommendation from monitoring said TOR parameters; and The TOR suggestion is communicated to the witness based on at least one of a request by the witness or an occurrence of a TOR event.

2. The defibrillator according to claim 1, wherein The defibrillation controller is configured to derive the TOR recommendation based on the TOR parameter being indicative of an objective TOR criterion of the ECG waveform.

3. The defibrillator according to claim 2, wherein: The TOR objective criteria include: an initial or continued non-shockable rhythm on the ECG waveform; No shock delivery occurred during the ECG waveform; and No return of spontaneous circulation occurred in the ECG waveform.

4. The defibrillator according to claim 1, wherein: The defibrillation controller is configured to derive the TOR recommendation based on the TOR parameter being indicative of a TOR subjective criterion for at least one of the ECG waveform and the CPR.

5. The defibrillator according to claim 4, wherein: The TOR subjective criteria include at least one of the following: the duration of performing the CPR; Refractory ventricular fibrillation is detected or not detected in the ECG waveform; wheezing or lack of wheezing of the patient as indicated by an impedance signal; the patient's heart rate in the ECG waveform at various times during the CPR as an indication of perfusion level; as well as Asystole may or may not be detected in the ECG waveform following shock delivery.

6. A defibrillator controller comprising: a non-transitory machine-readable storage medium encoded with instructions for execution by at least one processor to support a bystander's termination of resuscitation (TOR) decision during cardiopulmonary resuscitation (CPR) performed by the bystander on a patient's heart, Wherein, during the CPR performed on the heart of the patient by the witness, the non-transitory machine-readable storage medium includes instructions for performing the following operations: analyzing an ECG waveform and deriving a TOR recommendation from the analysis of the ECG waveform that is relevant to the TOR decision; and The TOR suggestion is communicated to the witness based on at least one of a request by the witness or an occurrence of a TOR event.

7. The defibrillation controller according to claim 6, wherein: The TOR recommendation indicates an objective TOR standard of the ECG waveform based on the TOR parameter.

8. The defibrillation controller according to claim 7, wherein: The TOR objective criteria include: an initial or continued non-shockable rhythm on the ECG waveform; No shock delivery occurred during the ECG waveform; and No return of spontaneous circulation occurred in the ECG waveform.

9. The defibrillation controller according to claim 6, wherein: The TOR recommendation indicates a TOR subjective standard for at least one of the ECG waveform and the CPR based on the TOR parameter.

10. The defibrillation controller according to claim 9, wherein: The TOR subjective criteria include at least one of the following: the duration of performing the CPR; Refractory ventricular fibrillation is detected or not detected in the ECG waveform; wheezing or lack of wheezing of the patient as indicated by an impedance signal; the patient's heart rate in the ECG waveform at various times during the CPR as an indication of perfusion level; as well as Asystole may or may not be detected in the ECG waveform following shock delivery.

11. A defibrillation method for supporting a bystander in making a termination of resuscitation (TOR) decision during cardiopulmonary resuscitation (CPR) performed on a patient's heart by the bystander, the defibrillator method comprising: monitoring an ECG waveform of the patient's heart by a defibrillator during the CPR performed on the patient's heart by the witness; and During the CPR performed on the patient's heart by the bystander: analyzing the ECG waveform by the defibrillator; deriving, by the defibrillator, a TOR recommendation from analysis of the ECG waveform associated with the TOR decision, and The TOR recommendation is communicated by the defibrillator to the witness based on at least one of a request by the witness or the occurrence of a TOR event.

12. The defibrillation method according to claim 11, wherein: The TOR recommendation indicates an objective TOR standard of the ECG waveform based on the TOR parameter.

13. The defibrillation method according to claim 12, wherein: The TOR objective criteria include: an initial or continued non-shockable rhythm on the ECG waveform; No shock delivery occurred during the ECG waveform; and No return of spontaneous circulation occurred in the ECG waveform.

14. The defibrillation method according to claim 11, wherein: The TOR recommendation indicates a TOR subjective standard for at least one of the ECG waveform and the CPR based on the TOR parameter.

15. The defibrillation method according to claim 14, wherein: The TOR subjective criteria include at least one of the following: the duration of performing the CPR; Refractory ventricular fibrillation is detected or not detected in the ECG waveform; wheezing or lack of wheezing of the patient as indicated by an impedance signal; the patient's heart rate in the ECG waveform at various times during the CPR as an indication of perfusion level; as well as Asystole may or may not be detected in the ECG waveform following shock delivery.

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