Customizing cardiac arrest treatment during CPR

Abstract

A defibrillator for customizing a cardiac therapy treatment of a patient during cardio-pulmonary resuscitation (CPR) of the patient's heart by a viewer. In operation, the defibrillator monitors the ECG waveform of the patient's heart during cardiopulmonary resuscitation of the patient's heart by the eyeballer. When the ECG waveform monitored by the defibrillator indicates a shockable rhythm of the patient's heart during CPR performed by the eyeballer on the patient's heart, the defibrillator derives treatment suggestions as a function of the quality of CPR performed by the eyeballer on the patient's heart and the vitality of the shockable rhythm of the patient's heart, and optionally from other factors.

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 tailoring cardiac arrest management for a patient during CPR. 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 who are not experiencing arrhythmias (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)) that are 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 relates to customizing cardiac therapy treatment for a patient during bystander cardiopulmonary resuscitation (CPR) of the patient's heart by deriving and communicating treatment recommendations from the bystander's assessment of the quality of the CPR (e.g., in terms of compression depth and rate, chest release and recoil, and placement of the bystander's hands on the patient's chest) in combination with a determination of the viability of a detected shockable rhythm (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)) of the patient's heart.

[0006] The action recommendations may be provided by way of auditory, visual, textual, or graphical instructions to the bystander to continue, modify, or discontinue CPR being performed by the bystander on the victim's heart.

[0007] The disposition recommendation can be provided by auditory, visual, textual, or graphical means to direct the witness to deliver a shock to the patient's heart.

[0008] The present disclosure may be embodied as (1) a defibrillator, (2) a defibrillation controller, and (3) a defibrillation method.

[0009] Various exemplary embodiments of a defibrillator of the present disclosure include an ECG monitor and a defibrillation controller for customizing a cardiac therapy treatment for a patient during CPR performed on the patient's heart by a witness. The ECG monitor is configured to monitor an ECG waveform of the patient's heart during the CPR performed on the patient's heart by the witness. The defibrillation controller is configured to, when the ECG waveform monitored by the ECG monitor indicates a shockable rhythm of the patient's heart during the CPR performed on the patient's heart by the witness, derive a treatment recommendation based on at least the quality of the CPR performed on the patient's heart by the witness and the vitality of the shockable rhythm of the patient's heart. The defibrillation controller is further configured to customize the cardiac therapy treatment for the patient by communicating the treatment recommendation to the witness.

[0010] Various exemplary embodiments of the defibrillation controller of the present disclosure encompass a non-transitory machine-readable storage medium encoded with instructions that are executed by one or more processors to adjust a cardiac therapy treatment for a patient during CPR performed on the patient's heart. The exemplary non-transitory machine-readable storage medium includes instructions for: (1) when an ECG waveform indicates a shockable rhythm of the patient's heart during CPR performed on the patient's heart by an eyewitness, deriving a treatment recommendation based on at least a quality of the CPR applied to the patient and a vigor of the shockable rhythm of the patient's heart, and (2) customizing the cardiac therapy treatment for the patient by communicating the treatment recommendation to the eyewitness.

[0011] Various exemplary embodiments of a defibrillation method according to the present disclosure include adjusting a cardiac therapy treatment for a patient during CPR being performed on the patient's heart by: (1) monitoring, by a defibrillator, an ECG waveform of the patient's heart during cardiopulmonary resuscitation of the patient's heart; (2) deriving, by the defibrillator, a treatment recommendation based on at least the quality of the CPR being performed on the patient and the vigor of the shockable rhythm of the patient's heart when the ECG waveform monitored by the defibrillator indicates a shockable rhythm of the patient's heart during CPR being performed on the patient's heart by a witness; and (3) customizing the cardiac therapy treatment for the patient by communicating the treatment recommendation to the witness.

[0012] 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

[0013] The present disclosure will present the following description of exemplary embodiments in detail with reference to the following drawings, in which:

[0014] FIG1 illustrates cardiopulmonary resuscitation performed on a patient's heart by a bystander as is known in the art of the present disclosure;

[0015] Figure 2 An exemplary embodiment of a cardiac arrest treatment system according to the present disclosure is shown;

[0016] Figure 3 An exemplary embodiment of a defibrillator according to the present disclosure is shown;

[0017] Figure 4 A flow chart representing an exemplary embodiment of a pre-shock defibrillation method according to the present disclosure is shown;

[0018] Figures 5A-5D Shown according to the present disclosure Figure 4 An exemplary disposition recommendation communication;

[0019] Figure 6 A flow chart representing an exemplary embodiment of a post-shock defibrillation method according to the present disclosure is shown;

[0020] FIG. 7A shows an exemplary ECG waveform of refractory ventricular fibrillation as known in the art of the present disclosure.

[0021] FIG. 7B shows an exemplary ECG waveform of recurrent ventricular fibrillation as known in the art of the present disclosure.

[0022] Figure 8A and 8B show the Figure 6 An exemplary disposition recommendation communication of; and

[0023] Figure 9 An exemplary embodiment of a defibrillation controller according to the present disclosure is shown. DETAILED DESCRIPTION

[0024] The present disclosure relates to customizing cardiac therapy treatment for a patient during bystander cardiopulmonary resuscitation (CPR) of the patient's heart by deriving and communicating treatment recommendations from the bystander's assessment of the quality of the CPR (e.g., in terms of depth and rate of compressions, chest release and recoil, and placement of the bystander's hands on the patient's chest) in combination with a determination of the viability of a detected shockable rhythm (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)) of the patient's heart.

[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 customizing cardiac therapy treatment of the heart 11 of the patient 10a during CPR performed on the heart 11 of the patient 10a by a witness.

[0031] In operation, defibrillator 40a inputs CPR feedback 22 from CPR monitor 20a as a basis for evaluating the quality of CPR performed on heart 11 of patient 10a by a witness.

[0032] In one exemplary embodiment, the CPR feedback 22 is an indicator of whether the quality of the CPR is effective or ineffective.

[0033] In a second exemplary embodiment, CPR feedback 22 includes data quantifying various CPR parameters (e.g., depth and rate of compressions, chest release and recoil, and placement of the witness's hands on the patient's chest), whereby defibrillator 40a determines whether the data indicates effective or ineffective CPR quality.

[0034] 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 analyzes the ECG waveform to detect any shockable rhythm of heart 11 of patient 10a as known in the art of the present disclosure.

[0035] If defibrillator 40a detects a shockable rhythm of heart 11 of patient 10a, defibrillator 40a determines the viability of the detected shockable rhythm of heart 11 of patient 10a.

[0036] In one exemplary embodiment, as is known in the art of this disclosure, defibrillator 40a performs an estimate of the probability (0-100%) of restoration of rhythm (ROR) after delivering a shock to heart 11 of patient 10a.

[0037] Thereafter, defibrillator 40a derives a treatment recommendation from the combined analysis of CPR quality and shockable rhythm viability, thereby guiding the bystander in optimal CPR / shock treatment of heart 11 of patient 10a.

[0038] In one exemplary embodiment, the defibrillator 40a implements a decision matrix with CPR quality being either effective or ineffective and shockable rhythm activity being either a possible ROR or an impossible ROR.

[0039] For example, if the quality of CPR is deemed effective, and the vitality score indicates an unlikely ROR, the disposition recommendation will instruct the bystander to continue CPR on the heart 11 of the patient 10 .

[0040] As another example, if the quality of CPR is deemed ineffective and the vitality score indicates an unlikely ROR, the treatment recommendation will direct the bystander to modify the CPR being performed on the heart 11 of the patient 10 in a manner that increases the effectiveness of the CPR.

[0041] Also by way of example, if the vitality score indicates a possible ROR, the treatment recommendation would instruct the bystander to discontinue CPR being performed on the heart 11 of the patient 10a and immediately administer a shock protocol to the heart 11 of the patient 10a.

[0042] In practice, other combinations of CPR quality / shockable rhythm vigor and related information may be additional factor(s) in deriving a treatment recommendation, including, but not limited to, the length of time that the patient's 10a heart 11 has been in ventricular fibrillation (VF). For example, if the patient's 11 heart 10 has been in VF for at least three (3) minutes, the treatment recommendation may direct the bystander to interrupt CPR on the patient's 10a heart 11 and immediately administer a shock protocol to the patient's 10a heart 11.

[0043] Still referring to FIG. 1 , defibrillator 40 a includes a display 42 , CPR advice 43 , shock advice 44 , and speaker 45 as means for conveying treatment advice to a witness.

[0044] For example, defibrillator 40a may communicate treatment recommendations to the bystander via display 42, CPR recommendations 43, and / or speaker 45, thereby directing the bystander to continue, modify, or discontinue CPR being performed by the bystander on the patient's heart.

[0045] By further example, defibrillator 40a may communicate a treatment recommendation to a bystander via display 42, shock recommendation 44, and / or speaker 45, thereby guiding the bystander in executing a shock protocol.

[0046] 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.

[0047] 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.

[0048] 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.

[0049] 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.

[0050] 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 .

[0051] 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.

[0052] 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.

[0053] 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 .

[0054] The defibrillator controller 60 also includes a treatment advisor 90 for customizing treatment of the patient's heart during bystander cardiopulmonary resuscitation (CPR) of the patient's heart by deriving and communicating treatment recommendations from the bystander's assessment of the quality of the CPR (e.g., in terms of depth and rate of compressions, chest release and recoil, and placement of the bystander's hands on the patient's chest) in combination with a determination of the viability of a detected shockable rhythm of the patient's heart (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)).

[0055] In an exemplary embodiment, the defibrillator controller 70 encompasses all structural configurations of a main circuit board or integrated circuit as understood in the art of the present disclosure and contemplated hereinafter for controlling the application of the various inventive principles of the present disclosure as exemplarily described herein. The structural configuration of the defibrillator controller 70 may include, but is not limited to, processor(s), computer-usable / computer-readable storage medium(s), operating system(s), application module(s), peripheral device controller(s), slot(s), and port(s).

[0056] Also in the exemplary embodiment, the ECG analyzer 80 and the treatment recommender 90 broadly encompass application programs incorporated within or accessible by the defibrillator controller 70, which is comprised of electronic circuitry (e.g., electronic components and / or hardware) and / or executable programs (e.g., executable software stored on non-transitory computer-readable medium(s) and / or firmware) for performing specific applications.

[0057] In operation, the ECG analyzer 80 will detect a shockable rhythm in the ECG waveform (e.g., Figure 3 ventricular fibrillation 81 shown), transmits a shockable rhythm detection 82 to a treatment advisor 90. The ECG analyzer 80 will also transmit a segment 83 of the ECG waveform that indicates a shockable rhythm.

[0058] In response, the treatment advisor 90 will generate a vitality score for the shockable rhythm of the ECG waveform and will interpret the CPR feedback 22 from the CPR coaching device 20a to enable the treatment advisor 90 to implement a flowchart 100 ( Figure 4 ) and flowchart 120 ( Figure 6 ), for communicating the treatment recommendation 94 to the user of the defibrillator 70.

[0059] This article will describe VF detection in the context of ECG waveforms. Figure 4 and Figure 6 Nevertheless, a person skilled in the art will understand how to Figure 4 and Figure 6 The same principle applies to other shockable rhythms.

[0060] refer to Figure 4 , stage S102 of flowchart 100 comprises determining whether the vitality of ventricular fibrillation 81 indicates a possible resumption of rhythm (ROR) or an unlikely ROR of heart 11 of patient 10a.

[0061] If the treatment recommender 90 determines that the viability of the ventricular fibrillation 81 indicates a possible return of rhythm (ROR) of the heart 10 of the patient 11a (e.g., the viability score of the ventricular fibrillation 81 is 75% or greater), the treatment recommender 90 proceeds to stage S104 of the flowchart 100 to derive an "interrupt CPR / deliver shock" treatment recommendation 94a and communicate the treatment recommendation 94a to a witness, such as Figure 5A As shown in the example.

[0062] Otherwise, if the treatment advisor 90 determines that the vitality of ventricular fibrillation 81 indicates an unlikely rhythm recovery (ROR) of the heart 10 of the patient 11a (e.g., the vitality score of ventricular fibrillation 81 is less than 75%), the treatment advisor 90 enters stage S106 of the flowchart 100 to determine whether the CPR quality indicates that the CPR is effective or ineffective.

[0063] If the treatment advisor 90 determines that the CPR quality indicates that the CPR is effective (e.g., the depth and rate of compressions are within acceptable ranges, the chest release and recoil are within acceptable ranges, and the placement of the witness's hands on the chest of the patient 10 is in an acceptable position), the treatment advisor 90 proceeds to stage S108 of the flowchart 100 to derive a "Continue CPR" treatment recommendation 94b and communicate the treatment recommendation 94b to the witness, such as Figure 5B As shown in the example.

[0064] Otherwise, if the treatment advisor 90 determines that the CPR quality indicates that the CPR is ineffective (e.g., the depth and rate of compressions are not within acceptable ranges, the chest release and recoil are not within acceptable ranges, and / or the placement of the witness's hands on the chest of the patient 10 is not in an acceptable position), the treatment advisor 90 proceeds to stage S110 of the flowchart 100 to derive a "Modify CPR" treatment recommendation 94c and communicate the treatment recommendation 94c to the witness, such as Figure 5C The "Modify CPR" disposition recommendation 94c will include instructions on how to improve the effectiveness of the quality of CPR.

[0065] Upon completion of either stage S108 or stage S110 , treatment adviser 90 proceeds to stage S112 of flowchart 100 to determine whether the vitality of ventricular fibrillation 81 still indicates an unlikely rhythm resumption (ROR) of the rhythm or now indicates a possible ROR of heart 11 of patient 10a .

[0066] If the treatment advisor 90 determines that the viability of ventricular fibrillation 81 still indicates an unlikely rhythm recovery (ROR) of the heart 10 of the patient 11a (e.g., the viability score of ventricular fibrillation 81 is still less than 75%), the treatment advisor 90 proceeds to stage S114 of the flowchart 100 to derive a "Complete CPR / Deliver Shock" treatment recommendation 94d and communicate the treatment recommendation 94d to a witness, such as Figure 5D As shown in the example.

[0067] Otherwise, if the treatment recommender 90 determines that the viability of the ventricular fibrillation 81 now indicates a possible rhythm restoration (ROR) of the heart 10 of the patient 11a (e.g., the viability score of the ventricular fibrillation 81 is now 75% or greater), the treatment recommender 90 proceeds to stage S116 of the flowchart 100 to derive an "interrupt CPR / deliver shock" treatment recommendation 94a and communicate the treatment recommendation 94a to the witness, such as Figure 5A As shown in the example.

[0068] In practice, relevant information may be additional factors in deriving treatment recommendations, including but not limited to the length of time that the heart 11 of the patient 10a has been in ventricular fibrillation (VF).

[0069] For example, stage S102 may include determining that the vitality score must indicate a possible ROR immediately prior to stage S104 to communicate a "interrupt CPU / deliver shock" treatment recommendation.

[0070] By further example, stage S102 may include detecting a low vitality score for VF 81 , and if the score fails to improve even after high-quality CPR at stage S108 , then a shock should be delivered at stage S114 anyway.

[0071] Again by way of example, stage S102 may include determining that the vitality score must indicate a possible ROR within a specified time period (eg, three (3) minutes) before entering stage S104 to communicate the "interrupt CPU / deliver shock" treatment recommendation.

[0072] By further example, stage S102 may include detecting a non-shockable rhythm before detecting VF 81 and accordingly lowering the vitality score of VF 81 or immediately entering stage S106.

[0073] Flowchart 100 will terminate or return to stage S102 when stage S114 or stage S116 is completed.

[0074] Figure 6 A flow chart 120 representing an exemplary embodiment of the disclosed post-shock cardiac arrest treatment method is shown.

[0075] refer to Figure 6 During stage S122 of flowchart 120, when treatment advisor 90 determines to deliver a shock, stage S124 of flowchart 120 includes treatment advisor 90 determining whether refractory VF is present in the ECG waveform. A refractory shock is an "unsuccessful shock" (i.e., VF continues after the shock). FIG7A illustrates an exemplary refractory VF 140 in an ECG waveform as known in the art of the present disclosure.

[0076] Still refer to Figure 6 If the treatment advisor 90 determines that refractory VF is present in the ECG waveform, the treatment advisor 90 proceeds to derive a "perform refractory VF protocol" treatment recommendation 94e and communicates the treatment recommendation 94e to the witness, such as Figure 8A The treatment recommendation 94e may include instructions to: (1) change the defibrillation vector, (2) apply double sequence defibrillation, (3) increase the defibrillation energy, or (4) apply stacking reserve.

[0077] Otherwise, if the treatment advisor 90 determines that refractory VF is not present in the ECG waveform, the treatment advisor 90 proceeds to stage S128 of the flowchart 120 to determine whether recurrent VF is present in the ECG waveform. A recurrent shock is a "successful shock" that terminates VF within a specified time period (e.g., 5 seconds), but the heart 11 of the patient 10a fibrillates again. 7B illustrates an exemplary recurrent VF 141 in an ECG waveform as known in the art of the present disclosure.

[0078] If the treatment advisor 90 determines that recurrent VF is present in the ECG waveform, the treatment advisor 90 proceeds to derive an "Execute Recurrent VF Protocol" treatment recommendation 94f and communicates the treatment recommendation 94f to the witness, as exemplarily shown in FIG8B . The treatment recommendation 94f may include instructions to: (1) administer antiarrhythmic medication to the patient 10a, (2) perform CPR, and (3) deliver a shock at the conclusion of CPR.

[0079] Otherwise, if the treatment adviser 90 determines that recurrent VF is not present in the ECG waveform, the treatment adviser 90 enters the termination flowchart 120 or returns to stage S122.

[0080] In order to facilitate further understanding of this disclosure, Figure 9 The following description teaches exemplary embodiments of a defibrillation controller according to the present disclosure. Figure 9With 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.

[0081] refer to Figure 9 , shows an exemplary embodiment of a defibrillator controller 160 , which includes one or more processors 161 , a memory 162 , a user interface 163 , a network interface 164 , and a storage device 165 interconnected via one or more system buses 166 .

[0082] Each processor 161 may be any hardware device capable of executing instructions stored in memory 162 or storage 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.

[0083] Memory 162 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 162 may include static random access memory (SRAM), dynamic RAM (DRAM), flash memory, read-only memory (ROM), or other similar memory devices.

[0084] User interface 163 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 contemplated hereinafter. In a non-limiting example, the user interface may include a command line interface or a graphical user interface, which may be presented to a remote terminal via network interface 164.

[0085] The network interface 164 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 164 may include a network interface card (NIC) configured to communicate according to the Ethernet protocol. Additionally, the network interface 164 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 apparent.

[0086] The storage device 165 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 165 may store instructions for execution by the processor 161 or data that the processor 161 can operate on. For example, the storage device 165 may store a basic operating system for controlling various basic operations of the hardware.

[0087] The storage device 165 may also store application modules in the form of executable software / firmware for implementing the previously described aspects of this disclosure. Figure 4 and Figure 6 Various functions of the method.

[0088] In one exemplary embodiment shown, the storage device 165 stores an application module 167 that includes an ECG analyzer 168 as known in the art of the present disclosure for analyzing ECG waveforms to detect shockable rhythms, a CPR analyzer 169a as known in the art of the present disclosure for analyzing the quality of CPR performed on a patient's heart by a witness, and a vigorous ventricular fibrillation scorer 169b as known in the art of the present disclosure for scoring the probability of cardiac rhythm recovery in the patient's heart after a shock has been delivered to the patient's heart.

[0089] The application module 167 also includes a recommendation generator 169c for deriving a treatment recommendation in accordance with the present disclosure as previously described herein from the quality of CPR performed on the patient's heart by a witness as analyzed by the CPR analyzer 169a and from a probability score of cardiac rhythm recovery in the patient's heart after an electric shock has been delivered to the patient's heart as analyzed by the vitality ventricular fibrillation scorer 169b.

[0090] Based on the description of Figures 1-9 herein, one of ordinary skill in the art will appreciate the numerous benefits of the present disclosure, including, but not limited to, customizing a patient's cardiac arrest treatment to facilitate optimal CPR application and shock delivery to the patient.

[0091] 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.

[0092] 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.

[0093] 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.

[0094] 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.

[0095] 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 customizing cardiac therapy treatment of a patient during bystander cardiopulmonary resuscitation (CPR) of the patient's heart, 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 Defibrillator controller, wherein the defibrillation controller is configured to: when the ECG waveform monitored by the ECG monitor indicates a shockable rhythm of the patient's heart during the CPR performed on the patient's heart by the bystander, derive a treatment recommendation based at least on the quality of the CPR performed on the patient's heart by the bystander and the vigor of the shockable rhythm of the heart; and Wherein, the defibrillation controller is further configured to customize the cardiac therapy treatment for the patient by communicating the treatment recommendation to the witness.

2. The defibrillator according to claim 1, wherein In response to the viability of the shockable rhythm of the patient's heart indicating a likely rhythm recovery of the patient's heart after a shock to the patient's heart, the treatment recommendation directs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient.

3. The defibrillator according to claim 2, in, After the treatment recommendation instructs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient, in response to the ECG waveform monitored by the ECG monitor indicating that the patient's heart is in refractory ventricular fibrillation after the shock to the patient's heart, the treatment recommendation instructs the bystander to implement a refractory ventricular fibrillation protocol; and wherein the refractory ventricular fibrillation protocol includes at least one additional shock to the patient's heart.

4. The defibrillator according to claim 2, in, After the treatment recommendation instructs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient, in response to the ECG waveform monitored by the ECG monitor indicating recurrent ventricular fibrillation in the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the bystander to implement a recurrent ventricular fibrillation protocol; and wherein the recurrent ventricular fibrillation protocol includes continuing or modifying the CPR performed on the patient's heart by the bystander followed by an additional shock to the patient's heart.

5. The defibrillator according to claim 1, wherein In response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after a shock to the patient's heart and further in response to the quality of the CPR performed on the patient's heart by the witness indicating effective CPR was performed on the patient's heart by the witness, the treatment recommendation directs the witness to continue the CPR performed on the patient's heart by the witness.

6. The defibrillator according to claim 3, wherein: After the treatment recommendation instructs the witness to continue the CPR being performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating a possible rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to discontinue the CPR being performed by the witness on the patient's heart and to shock the patient.

7. The defibrillator according to claim 3, wherein: After the treatment recommendation instructs the witness to continue the CPR performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to complete the CPR performed by the witness on the patient's heart and to shock the patient.

8. The defibrillator according to claim 1, wherein: In response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after a shock to the patient's heart and further in response to the quality of the CPR performed on the patient's heart by the witness indicating ineffective CPR performed on the patient's heart by the witness, the treatment recommendation directs the witness to modify the CPR performed on the patient's heart by the witness.

9. The defibrillator according to claim 6, wherein: After the treatment recommendation instructs the witness to modify the CPR being performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating possible rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to discontinue the CPR being performed by the witness on the patient's heart and shock the patient.

10. The defibrillator according to claim 6, wherein: After the treatment recommendation instructs the witness to modify the CPR performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to complete the CPR performed by the witness on the patient's heart and to shock the patient.

11. A defibrillator controller, comprising: A non-transitory machine-readable storage medium encoded with instructions for execution by at least one processor to adjust cardiac therapy treatment of a patient during bystander cardiopulmonary resuscitation (CPR) of the patient's heart, the non-transitory machine-readable storage medium comprising instructions for: when an ECG waveform indicates a shockable rhythm of the patient's heart during the CPR performed on the patient's heart by the bystander, deriving a treatment recommendation based at least on a quality of the CPR performed on the patient's heart by the bystander and a vigor of the shockable rhythm of the patient's heart; and The cardiac therapy treatment is customized for the patient by communicating the treatment recommendation to the witness.

12. The defibrillation controller according to claim 11, wherein: In response to the viability of the shockable rhythm of the patient's heart indicating a likely rhythm recovery of the patient's heart after a shock to the patient's heart, the treatment recommendation directs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient.

13. The defibrillation controller according to claim 12, in, After the treatment recommendation instructs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient, in response to the ECG waveform monitored by an ECG monitor (50) indicating that the patient's heart is in refractory ventricular fibrillation after the shock to the patient's heart, the treatment recommendation instructs the bystander to implement a refractory ventricular fibrillation protocol; wherein the refractory ventricular fibrillation protocol includes at least one additional shock to the patient's heart; wherein, after the treatment recommendation instructs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient, in response to the ECG waveform monitored by the ECG monitor indicating recurrent ventricular fibrillation in the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the bystander to implement a recurrent ventricular fibrillation protocol; and wherein the recurrent ventricular fibrillation protocol includes continuing or modifying the CPR performed on the patient's heart by the bystander followed by an additional shock to the patient's heart.

14. The defibrillation controller according to claim 11, in, responsive to the viability of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after a shock to the patient's heart and further responsive to the quality of the bystander CPR performed on the patient's heart indicating effective bystander CPR performed on the patient's heart, the disposition recommendation directs the bystander to continue the bystander CPR performed on the patient's heart; wherein, after the treatment recommendation instructs the bystander to continue the bystander's CPR on the patient's heart, in response to the viability of the shockable rhythm of the patient's heart indicating a likely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the bystander to discontinue the bystander's CPR on the patient's heart and shock the patient; and wherein, after the treatment recommendation instructs the witness to continue the CPR performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to complete the CPR performed by the witness on the patient's heart and to shock the patient.

15. The defibrillation controller according to claim 11, in, responsive to the viability of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after a shock to the patient's heart and further responsive to the quality of the bystander CPR performed on the patient's heart indicating ineffective bystander CPR performed on the patient's heart, the disposition recommendation directs the bystander to modify the bystander CPR performed on the patient's heart; wherein, after the treatment recommendation instructs the bystander to modify the CPR being performed by the bystander on the patient's heart, in response to the viability of the shockable rhythm of the patient's heart indicating a likely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the bystander to discontinue the CPR being performed by the bystander on the patient's heart and shock the patient; and wherein, after the treatment recommendation instructs the witness to modify the CPR performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to complete the CPR performed by the witness on the patient's heart and to shock the patient.

16. A defibrillator method for customizing cardiac therapy treatment of a patient during bystander cardiopulmonary resuscitation (CPR) of the patient's heart, the defibrillator comprising: During the cardiopulmonary resuscitation performed on the patient's heart by the witness, monitoring an ECG waveform of the patient's heart by a defibrillator; when the ECG waveform monitored by the defibrillator indicates a shockable rhythm in the patient's heart during the CPR performed on the patient's heart by the bystander, deriving, by the defibrillator, a treatment recommendation based at least on the quality of the CPR performed on the patient's heart by the bystander and the vigor of the shockable rhythm in the patient's heart; and The cardiac therapy treatment is customized for the patient by communicating the treatment recommendation to the witness via the defibrillator (40a).

17. The defibrillation method according to claim 16, wherein: In response to the viability of the shockable rhythm of the patient's heart indicating a likely rhythm recovery of the patient's heart after a shock to the patient's heart, the treatment recommendation directs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient.

18. The defibrillation method according to claim 17, in, After the treatment recommendation instructs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient, in response to the ECG waveform monitored by the defibrillator indicating that the patient's heart is in refractory ventricular fibrillation after the shock to the patient's heart, the treatment recommendation instructs the bystander to implement a refractory ventricular fibrillation protocol; wherein the refractory ventricular fibrillation protocol includes at least one additional shock to the patient's heart; wherein, after the treatment recommendation instructs the bystander to interrupt the CPR being performed on the patient's heart by the bystander and to shock the patient, in response to the ECG waveform monitored by the defibrillator indicating recurrent ventricular fibrillation in the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the bystander to implement a recurrent ventricular fibrillation protocol; and wherein the recurrent ventricular fibrillation protocol includes continuing or modifying the CPR performed on the patient's heart by the bystander followed by an additional shock to the patient's heart.

19. The defibrillation method according to claim 16, in, responsive to the viability of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after a shock to the patient's heart and further responsive to the quality of the bystander CPR performed on the patient's heart indicating effective bystander CPR performed on the patient's heart, the disposition recommendation directs the bystander to continue the bystander CPR performed on the patient's heart; wherein, after the treatment recommendation instructs the bystander to continue the bystander's CPR on the patient's heart, in response to the viability of the shockable rhythm of the patient's heart indicating a likely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the bystander to discontinue the bystander's CPR on the patient's heart and shock the patient; and wherein, after the treatment recommendation instructs the witness to continue the CPR performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to complete the CPR performed by the witness on the patient's heart and to shock the patient.

20. The defibrillation method according to claim 16, in, After the treatment recommendation instructs the bystander to modify the CPR being performed by the bystander on the patient's heart, in response to the viability of the shockable rhythm of the patient's heart indicating a likely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the bystander to discontinue the CPR being performed by the bystander on the patient's heart and shock the patient; and wherein, after the treatment recommendation instructs the witness to modify the CPR performed by the witness on the patient's heart, in response to the vitality of the shockable rhythm of the patient's heart indicating an unlikely rhythm recovery of the patient's heart after the shock to the patient's heart, the treatment recommendation instructs the witness to complete the CPR performed by the witness on the patient's heart and to shock the patient.

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