Monitor / defibrillator with advanced patient specific treatment protocol

Abstract

The present disclosure provides methods, systems and devices for guiding, a treatment of a patient experiencing sudden cardiac arrest, by a responder and / or a mechanical CPR device, in accordance with a patient specific treatment protocol. This protocol conditionally implements a pulseless electrical activity protocol when a rhythm classification of an electrocardiogram of the patient is a non-shockable cardiac rhythm with electrical activity and a pulse indication is the absence of the pulse of the patient, or an asystole protocol when the rhythm classification of the electrocardiogram of the patient is a non-shockable cardiac rhythm without electrical activity, or a return of spontaneous circulation protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm with electrical activity and the pulse indication is the presence of the pulse of the patient, or a ventricular fibrillation / ventricular tachycardia protocol when the rhythm classification of the electrocardiogram of the patient is a shockable cardiac rhythm.

Description

[0001] MONITOR / DEFIBRILLATOR

[0002] WITH ADVANCED PATIENT SPECIFIC TREATMENT PROTOCOL

[0003] FIELD OF THE INVENTION

[0004] The present disclosure relates generally to emergency care and resuscitation, and more particularly to defibrillation and cardiopulmonary resuscitation (CPR), and even more particularly to device, system and method that uses advanced patient specific treatment protocols for guiding responders while treating sudden cardiac arrest.

[0005] BACKGROUND OF THE INVENTION

[0006] FIG. 1 depicts a flowchart 100 representative of an exemplary American Heart Association (AHA) advanced responder protocol as known in the art of the present disclosure. In general, this protocol incorporates drug delivery, shock delivery and electrocardiogram (ECG) analysis whereby typically the responder will stop cardiopulmonary resuscitation (CPR) chest compressions to interpret the ECG. The responder must also remember / manually record the rhythms of the patient, drugs provided, effect of drugs and which stages of the protocol have been performed by the responder (e.g., how many shocks were delivered).

[0007] More particularly, referring to FIG. 1, a stage SI 02 of flowchart 100 encompasses a preparation of an administration of CPR by the responder to a patient experiencing cardiac arrest. In one embodiment of stage SI 02, the responder can commence providing oxygen to the patient and attach an Advanced Life Support (ALS) monitor / defibrillator to the patient.

[0008] A stage SI 04 of flowchart 100 encompasses a determination of whether an initial cardiac rhythm of an electrocardiogram (ECG) of the patient is a shockable cardiac rhythm or a non- shockable cardiac rhythm. If the cardiac rhythm of the ECG of the patient is determined to be a shockable cardiac rhythm during stage SI 04, then a stage SI 06 of flowchart 100 encompasses a delivery of a first shock to the patient and a stage SI 08 of flowchart 100 encompasses an administration of a first CPR protocol to the patient.

[0009] In one embodiment of stage SI 06, a biphasic shock energy of 120-200 joules can be delivered to the patient, or alternatively, a maximum available biphasic shock energy. In a second embodiment of stage SI 06, a monophasic shock energy of 360 joules can be delivered to the patient. In one embodiment of stage SI 08, the responder is guided to administer a quality CPRto the patient for a set time period (e.g., two (2) minutes). For example, during the set time period, the responder can be guided to push hard (e.g., 2-2.4 inches / 5-6 centimeters) and fast (e.g., 100- 120 compressions / minute) while allowing for a complete chest recoil. Furthermore, interruptions in compressions should be minimized, excessive ventilation should be avoided and a compressor, if applicable, should be rotated at the end of the set time period. Moreover, a 30:2 compression-ventilation ratio should be maintained if the patient does not have an advanced airway, a maximum partial pressure of CO2 at the end a breath should be > 10 mm Hg, and a relaxation phase diagnostic pressure should be > 20 mm Hg. Additionally, IV / IO access to the patient can be established.

[0010] Still referring to FIG. 1, subsequent to an expiration of the set time period of stage SI 08, a stage SI 10 of flowchart 100 encompasses a determination of whether an ongoing cardiac rhythm of the ECG of the patient is a shockable cardiac rhythm or a non-shockable cardiac rhythm. If the ongoing cardiac rhythm of ECG of the patient is determined to be a shockable cardiac rhythm during stage SI 10, then a stage SI 12 of flowchart 100 encompasses a delivery of a second shock to the patient and a stage SI 14 of flowchart 100 encompasses an administration of a second CPR protocol to the patient.

[0011] In one embodiment of stage SI 12, a biphasic shock energy of at least 120-200 joules can be delivered to the patient, or alternatively, a maximum available biphasic shock energy. In a second embodiment of stage SI 12, a monophasic shock energy of 360 joules can be delivered to the patient.

[0012] In one embodiment of stage SI 14, the responder is guided to administer a quality CPR to the patient as set forth in the first CPR protocol of stage S108 for a set time period (e.g., two (2) minutes). Additionally, a Epinephrine IV / IO dose of Img can be delivered every 3-5 minutes to the patient by the responder and advanced airway capnography can be considered (e.g., supraglottic advanced airway or endotracheal intubation, and / or waveform capnography to confirm and monitor ET tube placement, and / or 8-10 breaths per minute with continuous chest compressions).

[0013] Still referring to FIG. 1, subsequent to an expiration of the set time period of stage SI 14, a stage SI 16 of flowchart 100 encompasses a determination of whether an ongoing cardiac rhythm of the ECG of the patient is a shockable cardiac rhythm or a non-shockable cardiac rhythm. If the ongoing cardiac rhythm of ECG of the patient is determined to be a shockable cardiac rhythm during stage SI 16, then a stage SI 18 of flowchart 100 encompasses a delivery of a third shock to the patient and a stage SI 20 of flowchart 100 encompasses an administration of a third CPR protocol to the patient.

[0014] In one embodiment of stage SI 18, a biphasic shock energy of at least 120-200 joules can be delivered to the patient, or alternatively, a maximum available biphasic shock energy. In a second embodiment of stage SI 18, a monophasic shock energy of 360 joules can be delivered to the patient.

[0015] In one embodiment of stage SI 20, the responder is guided to administer a quality CPR to as set forth in the second CPR protocol the patient for a set time period (e.g., two (2) minutes). Additionally, an Amiodarone IV / IO dose of 3000 mg bolus can be delivered to the patient, and reversible causes can be treated (e.g., hypovolemia, hypoxia, hydrogen ion (acidosis), hypo- / hypercaloric, hypothermia, tension pneumothorax, cardiac tamponade, toxins, pulmonary thrombosis and coronary thrombosis).

[0016] Still referring to FIG. 1, if the ongoing cardiac rhythm of ECG of the patient is determined to be a non-shockable cardiac rhythm during an initial execution or iteration of stage SI 10 or stage SI 16, then a stage SI 30 of flowchart 100 encompasses a determination of a return of spontaneous circulation (ROSC) of the patient or no signs of ROSC of the patient. In one embodiment of stage SI 30, a determination of ROSC can be derived from pulse and blood pressure of the patient, an abrupt sustained increase in a maximum partial pressure of CO2 at the end a breath should be > 40 mm Hg, and / or a spontaneous arterial wave with intra-arterial monitoring.

[0017] If a ROSC of the patient is determined during SI 30, then a stage SI 32 of flowchart 100 encompasses a post-cardiac arrest care of the patient as known in the art of the present disclosure.

[0018] If a ROSC of the patient is not determined during S130, then a stage S122 of flowchart 100 encompasses an administration of the second CPR protocol of stage SI 14.

[0019] Still referring to FIG. 1, subsequent to an expiration of the set time period of stage SI 22, a stage SI 24 of flowchart 100 encompasses a determination of whether an ongoing cardiac rhythm of the ECG of the patient is a shockable cardiac rhythm or a non-shockable cardiac rhythm. If the ongoing cardiac rhythm of ECG of the patient is determined to be a shockable cardiac rhythm during stage SI 24, then flowchart 100 proceeds to stage SI 12 or SI 18 for shock delivery as previously described. If the ongoing cardiac rhythm of ECG of the patient is determined to be a non-shockable cardiac rhythm during stage SI 24, then a stage SI 26 of flowchart 100 encompasses an administration of a fourth CPR protocol directed to treating reversible causes as previously described.

[0020] Still referring to FIG. 1, subsequent to an expiration of the set time period of stage SI 26, a stage SI 28 of flowchart 100 encompasses a determination of whether an ongoing cardiac rhythm of the ECG of the patient is a shockable cardiac rhythm or a non-shockable cardiac rhythm. If the ongoing cardiac rhythm of ECG of the patient is determined to be a shockable cardiac rhythm during stage SI 28, then flowchart 100 proceeds to stage SI 12 or SI 18 for shock delivery as previously described. If the ongoing cardiac rhythm of ECG of the patient is determined to be a non-shockable cardiac rhythm during stage SI 24, then flowchart 100 proceeds to stage SI 30 for ROSC determination or non-existence as previously described.

[0021] Still referring to FIG. 1, subsequent to the CPR prep stage of SI 02, if the cardiac rhythm of the ECG of the patient is determined to be a non-shockable cardiac rhythm during stage SI 04, then flowchart 100 proceeds to stage SI 22 as previously described.

[0022] Modern defibrillation protocols, such as the protocol of FIG. 1, generally follow the same treatment for all Sudden Cardiac Arrest (SCA) patients and do not take into account the particular circumstances of the patient and the cardiac arrest (e.g., how long the patient has been in ventricular fibrillation, if shocks delivered were successful in converting the arrhythmia, the quality of the CPR, and the patient’s response to the CPR). In addition, these protocols may incorporate the availability of resuscitation drugs delivered by advanced responders but the responders do not have access to information from the defibrillator / monitor that details the patient’s sequence of arrhythmias and reactions to drugs and shocks. The protocols can also incorporate manual (palpation) pulse checks, however it is well known that pulse check by palpation is unreliable and very difficult to perform. SUMMARY OF THE INVENTION

[0023] The present disclosure describes exemplary embodiments of a device, system and method that include advanced protocols for a defibrillator / monitor to guide responders treating sudden cardiac arrest to follow a patient specific treatment protocol that is optimized for the patient.

[0024] The present disclosure can be embodied as (1) a defibrillation controller, (2) a defibrillator, and (3) a defibrillation method.

[0025] Various embodiments of a defibrillation controller of the present disclosure employ a non-transitory machine-readable storage medium encoded with instructions for execution by one or more processors for guiding a responder and / or a mechanical CPR device in treating a patient experiencing sudden cardiac arrest in accordance with a patient specific treatment protocol.

[0026] The non-transitory machine-readable storage medium includes the instructions to

[0027] (1) execute a generation or an acquisition of a cardiopulmonary resuscitation indication of a presence or an absence of chest compressions being administered to the patient by a responder and / or a mechanical CPR device,

[0028] (2) dependent upon the cardiopulmonary resuscitation indication, execute a rhythm classification of an electrocardiogram of the patient as a shockable cardiac rhythm, a non- shockable cardiac rhythm with electrical activity or a non-shockable rhythm without electrical activity,

[0029] (3) dependent upon the rhythm classification of the electrocardiogram of the patient, execute a generation or an acquisition of a pulse indication of a presence or an absence of a pulse of the patient, and

[0030] (4) execute one of the following protocols including

[0031] (a) a pulseless electrical activity protocol when the rhythm classification of the electrocardiogram of the patient is a non-shockable cardiac rhythm with electrical activity and the pulse indication is the absence of the pulse of the patient,

[0032] (b) an asystole protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm without electrical activity, (c) a return of spontaneous circulation protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm with electrical activity and the pulse indication is the presence of the pulse of the patient; and

[0033] (d) a ventricular fibrillation / ventricular tachycardia protocol when the rhythm classification of the electrocardiogram of the patient is a shockable cardiac rhythm.

[0034] Various embodiments of a defibrillator of the present disclosure employ a defibrillation shock module and a controller for guiding a responder and / or a mechanical CPR device in treating a patient experiencing sudden cardiac arrest in accordance with a patient specific treatment protocol.

[0035] The defibrillating shock module is operable to deliver one or more shocks to the patient, and the controller is configured to

[0036] (1) execute a generation or an acquisition of a cardiopulmonary resuscitation indication of a presence or an absence of chest compressions being administered to the patient by a responder and / or a mechanical CPR device,

[0037] (2) dependent upon the cardiopulmonary resuscitation indication, execute a rhythm classification of an electrocardiogram of the patient as a shockable cardiac rhythm, a non-shockable cardiac rhythm with electrical activity or a non-shockable rhythm without electrical activity,

[0038] (3) dependent upon the rhythm classification of the electrocardiogram of the patient, execute a generation or an acquisition of a pulse indication of a presence or an absence of a pulse of the patient, and

[0039] (4) execute one of the following protocols including

[0040] (a) a pulseless electrical activity protocol when the rhythm classification of the electrocardiogram of the patient is a non-shockable cardiac rhythm with electrical activity and the pulse indication is the absence of the pulse of the patient,

[0041] (b) an asystole protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm without electrical activity,

[0042] (c) a return of spontaneous circulation protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm with electrical activity and the pulse indication is the presence of the pulse of the patient; and (d) a ventricular fibrillation / ventricular tachycardia protocol when the rhythm classification of the electrocardiogram of the patient is a shockable cardiac rhythm.

[0043] Various embodiments of a defibrillation method of the present disclosure involve are executable by a controller for guiding, a responder and / or a mechanical CPR device, in treating a patient experiencing sudden cardiac arrest in accordance with a patient specific treatment protocol. The defibrillation method involves

[0044] (1) the controller executing a generation or an acquisition of a cardiopulmonary resuscitation indication of a presence or an absence of chest compressions being administered to the patient by a responder and / or a mechanical CPR device,

[0045] (2) dependent upon the cardiopulmonary resuscitation indication, the controller executing a rhythm classification of an electrocardiogram of the patient as a shockable cardiac rhythm, a non-shockable cardiac rhythm with electrical activity or a non-shockable rhythm without electrical activity,

[0046] (3) dependent upon the rhythm classification of the electrocardiogram of the patient, the controller executing a generation or an acquisition of a pulse indication of a presence or an absence of a pulse of the patient, and

[0047] (4) the controller executing one of the following protocols including

[0048] (a) a pulseless electrical activity protocol when the rhythm classification of the electrocardiogram of the patient is a non-shockable cardiac rhythm with electrical activity and the pulse indication is the absence of the pulse of the patient,

[0049] (b) an asystole protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm without electrical activity,

[0050] (c) a return of spontaneous circulation protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm with electrical activity and the pulse indication is the presence of the pulse of the patient; and

[0051] (d) a ventricular fibrillation / ventricular tachycardia protocol when the rhythm classification of the electrocardiogram of the patient is a shockable cardiac rhythm.

[0052] The foregoing exemplary embodiments and other embodiments of the present disclosure as well as various structures and advantages of the present disclosure will become further apparent to those having ordinary skill in the art from the following detailed description of various embodiments of the present disclosure read in conjunction with the accompanying drawings. The detailed description and drawings are merely illustrative of the present disclosure rather than limiting, the scope of the present disclosure being defined by the appended claims and equivalents thereof.

[0053] BRIEF DESCRIPTION OF THE DRAWINGS

[0054] The present disclosure will present in detail the following description of exemplary embodiments with reference to the following figures wherein:

[0055] FIG. 1 illustrates a flowchart representative of an exemplary embodiment of an American Heart Association advanced responder protocol as known in the art of the present disclosure;

[0056] FIG. 2 illustrates a flowchart representative of an exemplary embodiment of a Patient Specific Treatment Protocol in accordance with the present disclosure;

[0057] FIG. 3 illustrates a flowchart representative of an exemplary embodiment of a ventricular fibrillation (VF) / ventricular tachycardia (VT) protocol in accordance with the present disclosure;

[0058] FIG. 4 illustrates an exemplary embodiment of a defibrillator in accordance with the present disclosure; and

[0059] FIG. 5 illustrates an exemplary embodiment of a controller in accordance with the present disclosure.

[0060] DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0061] For purposes of describing and claiming the present disclosure, the terms of the art of the present disclosure, but not limited to, "defibrillator", “shock” “electrocardiogram (ECG)”, “cardiopulmonary resuscitation (CPR)”, and “cardiac rhythm”, are to be interpreted as known in the art of the present disclosure and as exemplary described in the present disclosure.

[0062] To facilitate an understanding of the present disclosure, the following description of FIGS. 2 and 3 describes and teaches exemplary embodiments of various methods in accordance with the present disclosure. From the description of FIGS. 2 and 3, those having ordinary skill in the art of the present disclosure will appreciate how to apply the present disclosure to make and use additional embodiments of methods of the present disclosure. FIG. 2 illustrates a flowchart 200 representative of an exemplary embodiment of a patient specific treatment protocol in accordance with the present disclosure.

[0063] Referring to FIG. 2, a phase Pl of flowchart 100 includes a stage S202 of flowchart 200 encompassing a generation or an acquisition of a CPR indicator by a defibrillator of a presence or an absence of an administration of CPR on the patient, and a stage S204 of flowchart 200 encompassing a temporal sampling of the CPR indicator by the defibrillator to determine a presence or an absence of an administration of CPR on the patient.

[0064] In one embodiment of phase Pl, the defibrillator executes a CPR detection algorithm as known in the art of the present disclosure during stage S202 for generating a CPR indicator of a presence or an absence of an administration of CPR on the patient, and the defibrillator temporally samples the CPR indicator during stage S204 to determine a presence or an absence of an administration of CPR on the patient. A non-limiting example of a CPR detection algorithm is a Z-CPR algorithm as known in the art of the present disclosure.

[0065] In a second embodiment of phase Pl, the defibrillator further executes a CPR monitoring algorithm during stage S204 for measuring a CPR rate and / or a CPR depth to thereby ascertain a quality level of any CPR being administered on the patient, and the defibrillator temporally samples the CPR indicator and the CPR measurements during stage S204 to determine to a presence or an absence of a quality administration of CPR on the patient. A non-limiting example of a CPR monitoring algorithm is an A-CPR algorithm as known in the art of the present disclosure.

[0066] Still referring to FIG. 2, a phase P2 of flowchart 200 includes a stage S206 of flowchart 200 encompassing a defibrillator executing rhythm classification of a corrupt ECG including CPR artifacts as known in the art of the present disclosure as a shockable cardiac rhythm, a non- shockable cardiac rhythm with electrical activity or a non-shockable without electrical activity, and the defibrillator generating or acquiring a pulse indicator of a presence or an absence of a pulse as known in the art of the present disclosure.

[0067] Phase P2 of flowchart 208 further includes a stage S208 of flowchart 200 encompassing a defibrillator executing rhythm classification of a clean ECG excluding CPR artifacts as known in the art of the present disclosure as a shockable cardiac rhythm, a non-shockable cardiac rhythm with electrical activity or a non-shockable without electrical activity, and the defibrillator generating a pulse indicator of a presence or an absence of a pulse as known in the art of the present disclosure.

[0068] If the defibrillator samples a presence of CPR being administered on the patient (or alternatively a presence of a quality CPR being administered on the patient) during stage S204, then stage S206 is executed by the defibrillator during phase P2 of flowchart 200. Otherwise, if the defibrillator samples an absence of CPR being administered on the patient (or alternatively an absence of a quality CPR being administered on the patient) during stage S204, then stage S208 is executed by the defibrillator during phase P2 of flowchart 200.

[0069] The rhythm classification and pulse detection of phase P2 of flowchart 200 directs the defibrillator to proceed to (1) a stage S210 of flowchart 200 for executing a pulseless electrical activity (PEA) protocol in view of a non-shockable rhythm classification with electrical activity and no pulse detection, (2) a stage S212 of flowchart 200 for executing asystole protocol based on a non-shockable rhythm classification associated without electrical activity and no pulse detection, (3) a stage S214 of flowchart 200 for executing a return of spontaneous circulation (ROSC) protocol based of a non-shockable rhythm classification with electrical activity and pulse detection, and (4) a stage S216 of flowchart 200 for executing a Ventricular Fibrillation (VF) / Ventricular Tachycardia based on a shockable rhythm classification.

[0070] Still referring to FIG. 2, the PEA protocol of stage S210 encompasses an administration of CPR on the patient suitable for a patient having a PEA including, but not limited to, advanced airway techniques, capnography, and reversible cause treatments as known in the art of the present disclosure. The PEA protocol of stage S210 further encompasses a delivery of recommended dosage(s) of drug(s) as specified by guidelines (e.g., epinephrine or alternatively vasopressin). In practice, the defibrillator will provide audio / textual guidance to the responder for executing the PEA protocol during stage S210. Concurrently or alternatively in circumstances involving a mechanical CPR device, the defibrillator will provide instructions to the mechanical CPR device for administering the CPR to the patient during stage S210.

[0071] The asystole protocol of stage S212 encompasses an administration of CPR on the patient suitable for a patient having an asystole including, but not limited to, advanced airway techniques, capnography, and reversible cause treatments as known in the art of the present disclosure. The asystole protocol of stage S212 further encompasses a delivery of recommended dosage(s) of drug(s) as specified by guidelines (e.g., epinephrine or alternatively vasopressin).

[0072] In practice, the defibrillator can provide audio / textual guidance to the responder for executing the asystole protocol during stage S212. Concurrently or alternatively in circumstances involving a mechanical CPR device, the defibrillator can provide instructions to the mechanical CPR device for administering the CPR to the patient during stage S212.

[0073] Still referring to FIG. 2, the ROSC protocol of stage S214 encompasses an administration of post cardiac arrest care to the patient as known in the art of the present disclosure. In practice, the defibrillator can provide audio / textual guidance to the responder for administering the post cardiac arrest care to the patient during stage S214.

[0074] The VF / VT protocol of stage S216 encompasses a termination of CPR being administered by the responder to the patient followed by an immediate shock as known in the art of the present disclosure, or a conditional shock of the patient as known in the art of the present disclosure or in accordance with a VF / VT protocol of the present disclosure.

[0075] FIG. 3 illustrates a flowchart 300 representative of a VF / VT protocol of the present disclosure.

[0076] Referring to FIG. 3, a stage S302 of flowchart 300 encompasses a defibrillator generating a VF / VT prognosis, as known in the art of the present disclosure and hereinafter conceived, of a vitality of a shock converting the shockable cardiac rhythm to a non-shockable cardiac rhythm with electrical activity.

[0077] If the VF / VT prognosis of stage S302 indicates a shock will not likely convert the shockable cardiac rhythm to a non-shockable cardiac rhythm with electrical activity (an “inconvertible rhythm outcome”), then a stage S316 encompasses an administration of CPR on the patient including, but not limited to, advanced airway techniques, capnography, and reversible cause treatments as known in the art of the present disclosure. Stage S316 further encompasses a delivery of recommended dosage(s) of drug(s) as specified by guidelines (e.g., epinephrine or amiodarone). Upon completion, stage S316 will return to stage S202 of flowchart 200 (FIG. 2).

[0078] In practice, the defibrillator can provide audio / textual guidance to the responder for executing stage S316. Concurrently or alternatively in circumstances involving a mechanical CPR device, the defibrillator can provide instructions to the mechanical CPR device for administering the CPR to the patient during stage S316.

[0079] Still referring to FIG. 3, if the VF / VT prognosis of stage S302 indicates a shock will likely convert the shockable cardiac rhythm to a non-shockable cardiac rhythm (a “convertible rhythm outcome”), then a stage S306 of flowchart 300 encompasses the defibrillator delivery a shock to the patient, automatic, semi-automatic or manually as known in the art of the present disclosure and hereinafter conceived and a stage S308 of flowchart 300 encompasses the defibrillator executing a rhythm classification of a post-shock ECG of the patient.

[0080] If the post-shock ECG of the patient is rhythm classified by the defibrillator as having a non-shockable cardiac rhythm, then flowchart 300 will proceed to stage S316 as previously described.

[0081] If the post-shock ECG of the patient is rhythm classified by the defibrillator as having a shockable cardiac rhythm and a maximum number of shocks have not been delivered to the patient as determined by the defibrillator during a stage S312 of flowchart, then flowchart 300 will return to stage S302 as previously described. Otherwise, if the post-shock ECG of the patient is rhythm classified by the defibrillator as having a shockable cardiac rhythm and a maximum number of shocks have been delivered to the patient as determined by the defibrillator during stage S312 of flowchart, then a stage S314 of flowchart 300 encompasses the defibrillator changing or contemplating a change of the shock delivery method including, but not limited to, switching from a single vector defibrillation to a double sequential defibrillation, or a double simultaneous defibrillation or dual axis defibrillation if a second defibrillator is present, or conducting a vector change defibrillation. The defibrillator can provide audio / textual instructions for the responder for any changes in the defibrillation technique, and flowchart 300 proceeds from stage S314 to stage S316 as previously described.

[0082] In practice of flowchart 200 (FIG. 2) and flowchart 300 (FIG. 3) as well as other methods of the present disclosure, the defibrillator or other devices of the present disclosure can incorporate the following features and functionalities as known in the art of the present disclosure.

[0083] First, detecting the presence of CPR and measuring CPR rate (Z-CPR / A-CPR) and depth (A-CPR), and automatically applying different algorithms for ECG with and without CPR artifacts. (Note: Z-CPR is an algorithm to detect the presence of CPR and the CPR rate. A-CPR is an algorithm that measures both CPR rate and CPR depth.) These algorithms can be used in conjunction with a sensor (e.g. force sensor) to also provide compression depth and leaning, for example.

[0084] Second, detecting and tracking over time shockable and non-shockable rhythms by analysis of ECG during resuscitation, and identification of presenting rhythm (i.e., the first rhythm seen when the defibrillator / device is attached to the patient).

[0085] Third, for non-shockable rhythms, the defibrillator / device can further differentiate asystole (flatline) versus ECG that contains QRS complexes and estimate the heart rate.

[0086] Fourth, measuring the length of time the patient remains in a particular rhythm during the resuscitation and the cumulative rhythms time (e.g., total time in asystole) and rhythms pre and post shock.

[0087] Fifth, the identification of the success or failure of a shock to convert a rhythm to a non- shockable rhythm, a rhythm with complexes or asystole.

[0088] Sixth, an identification of refibrillation time as detected in the ECG.

[0089] Seventh, an identification of recurrent or incessant VF.

[0090] Eighth, an assessment of the quality of CPR based on the detection of whether CPR is being done or not and the estimation of the compression rate from the impedance signal. If the defibrillator / device incorporates a sensor for compression depth and leaning (e.g., QCPR) that information will also be used in the patient specific protocol.

[0091] Ninth, additional information in some configurations of the defibrillator / devices will provide a method for an advanced responder to indicate when an antiarrhythmic (e.g., amiodarone) or vasopressor (e.g., epinephrine) has been administered at a specific point in time. For example, a button on the defibrillator / device can be pushed when a drug is administered.

[0092] Tenth, a protocol can also incorporate additional information provided as input to the defibrillator / device algorithm from the responders, e.g., witnessed or unwitnessed arrest, provider skill level, patient age, or known history.

[0093] Eleventh, defibrillator / device can incorporate a sensor for pulse detection (e.g., an ultrasound-based sensor that is placed over the carotid artery of the patient, the defibrillator / device may use PW, CW, tissue doppler imaging (measures the motion of the vessel wall or heart valves), or cardiac M-mode placed on the chest (measures the motion of the heart wall, e.g., left ventricle) that detects pulse both during compression and when compressions have stopped. If the defibrillator / device cannot differentiate the presence of a pulse during compressions, it may wait until the next clean analysis period (e.g., compression pause, ventilation, and change of responder) or prompt the user to stop compressions briefly for a clean pulse detection analysis period.

[0094] Twelfth, the defibrillator / device can incorporate an ECG-based algorithm for pulse detection during CPR.

[0095] Thirteenth, the defibrillator / device can enhance the accuracy of pulse detection during chest compression by incorporating detection results from multiple sources, e.g., ultrasoundbased and ECG-based. The coordination could be rule-based (e.g., choosing the result from one source if certain condition is met), or probability-based (e.g., thresholding the final probability of pulse which is multiplication of the probability predicted from each source).

[0096] Fourteenth, for organized rhythm, if pulse is detected -> ROSC -> post cardiac arrest care (e.g., stop CPR); if pulse is not detected, continue CPR and give proper treatments.

[0097] Fifteenth and finally, the defibrillator / device can detect the vitality of VF (VF prognosis algorithm for ECG with and without CPR) and recommend defibrillation or CPR.

[0098] Referring to FIGS. 2 and 3, exemplary embodiments of the methods of the present disclosure provide a patient specific protocol for responder(s) and / or mechanical CPR devices to optimize patient treatment by providing clinical guidance to the responder(s) and / or medical CPR devices for following the adaptable protocol. The guidance is adjusted based as delineated in FIGS. 2 and 3, and in practice, configuration and input from medical direction can be used to setup some factors or choose protocol boundaries and flow, e.g., to follow local guidelines.

[0099] For example, if the post-shock rhythm is ventricular fibrillation (VF), the defibrillator / device can analyze the vitality of VF during CPR. If another shock is recommended, the defibrillator / device can guide the responder to provide defibrillation after CPR (double sequential defibrillation / new vector can be recommended depending on the number of prior shocks and the length of patients’ time interval in VF), otherwise if CPR is recommended, rhythm analysis will be performed after CPR ends. By further example, if the patient shock impedance is high, this information can be conveyed to the responder or used by the defibrillator / device to guide a responder to (a) check the pads and (b) consider moving to a new vector. Pads contact impedance can also be evaluated.

[0100] By further example, if the post-shock rhythm contains QRS complexes, the defibrillator / device can for the presence of a pulse and if the pulse is correlated in time with the QRS complexes. If a pulse is absent, then the defibrillator / device can prompt to begin CPR / drug delivery. Otherwise, if a pulse is present, the defibrillator / device can prompt not to begin CPR administration / drug delivery

[0101] By further example, using ultrasound technology can enhance the accuracy of pulse detection during chest compression by incorporating detection results from multiple sources, (e.g., ultrasound-based and ECG-based). The coordination can be rule-based (e.g., choosing the result from one source if certain condition is met), or probability -based (e.g., thresholding the final probability of pulse which is multiplication of the probability predicted from each source). The correlation in time of the ECG algorithm detection of QRS complexes with the ultrasound sensor detection of a pulse could be simply one OR the other, or it may produce some probability from both algorithm’s prediction, and then multiply them to get a final probability of pulse, and then threshold it.

[0102] By further example, if the patient refibrillates post-shock or is in VF for a predetermined (set thru device configuration) cumulative time, the defibrillator / device can prompt the responder to consider administering antiarrhythmics. Alternatively, the responder can be provided with the timing information for how long the patient has been in VF.

[0103] By further example, if the patient is in asystole or PEA for a predetermined (set thru device configuration) cumulative time, the responder will be prompted to administer a vasopressor. Alternatively, the responder will be provided with the timing information for how long the patient has been in asystole or PEA.

[0104] In practice, exemplary principles of the methods of the present disclosure can be (1) to deliver drug(s) (epi) early for non-shockable rhythms, (2) to give epi if a normal pulse is present, (3) if no contraction or pulse, give epi, (4) if pseudo-PEA or weak pulse, inform responder (epi may or may not be useful), (5) no antiarrhythmics given during asystole or bradycardia, (6) for recurrent VF, shock and give antiarrhythmics quickly and (7) for refractory VF, continue to shock or change vector and then continue to shock.

[0105] Additionally, a step can be added to differentiate true PEA and pseudo-PEA. If the post shock rhythm is asystole, the defibrillator / device can prompt the responder to wait for a period of time (e.g. 30 seconds configurable), then if no QRS complex or pulse is present, the responder will be prompted to begin CPR. If the heart rate (HR) is low (e.g. < 30 BPM, configurable) and no pulse is detectable, then the responder will be prompted to begin CPR.

[0106] Also in practice, the timing of the protocol can be modified for each patient as follows by the defibrillator / device providing clinical guidance for the optimized protocol /

[0107] First, the timing for the responders to start CPR or stop CPR can be modified.

[0108] Second, methods of the present disclosure can incorporate a modified vRhythm score for use during compressions. For, if a pre shock OR post-shock the score is low, then the responder will be instructed to immediately begin CPR. If the score is high post-shock, the defibrillator / device will charge for shock and the responder will be prompted to immediately deliver a shock.

[0109] Third, if CPR quality is poor as indicated by poor compression rate, depth or no CPR detected, then the protocol will move forward to a shock if a shockable rhythm is detected. If the patient is not in a shockable rhythm, the responder will be prompted to improve CPR.

[0110] Fourth, if pulse (not pseudo-PEA) is detected during chest compressions, then the responder will be prompted to pause chest compressions and allow the defibrillator / device algorithms to confirm the presence of a pulse. If false positive (no pulse is present), then the responder will be instructed to continue chest compressions. If a pulse is confirmed, the responder will be instructed to not perform chest compressions. The defibrillator / device can signal to the responder when QRS complexes are detected so the responder may use this information if they want to palpate and identify QRS -correlated pulses.

[0111] Further, exemplary embodiments of the present disclosure can include:

[0112] (1) if an EMS system uses a 30:2 protocol (30 compressions followed by 2 ventilations), there can be a pause for pulse detection while ventilations are provided, and (2) for patients with bradycardia, it is clinically beneficial to avoid chest compressions during the T-wave (known as the ‘R on T phenomenon’). To avoid compressing on a T-wave, exemplary embodiments of the present disclosure can detect QRS complexes and automatically pause mechanical chest compressions during the subsequent period of time when the T-wave is expected to occur. After the T-wave period, the compressions will continue. This can be achieved by synchronization between the defib and the mCPR from different manufacturers, provided that there is communication channel and protocol between the two. This can also be achieved by combining both monitor / defib and mCPR into one device or an integrated solution.

[0113] Exemplary embodiments in accordance with the present disclosure can also be used for the following:

[0114] Termination of Resuscitation (ToR): to provide guidance for when a resuscitation can be terminated in the field and end resuscitation effort, direction of the patient transports urgency and best location. The criteria below are generally used for ToR and would generally be used in conjunction with information from a device in accordance with the present disclosure, e.g., if any shocks had been delivered or if ROSC had occurred to inform the TOR decision.

[0115] For Basic Life Support (BLS) providers: (1) Cardiac arrest not witnessed by EM, (2) Patient never had ROSS, and (3) No shocks delivered (never in a shockable rhythm).

[0116] For (Advanced Life Support (ALS) providers (1) BLS criteria listed above, (2) cardiac arrest not witnessed by bystander and (3) no bystander CPR.

[0117] Initiating advanced care such as extracorporeal CPR (aka ECMO) to identify an effective treatment strategy. The decision to implement ECMO must be made early in the patients care and can be facilitated by the defibrillator / device protocol. The following criteria can be used for ECMO enrollment and would be used in conjunction with information from the defibrillator / device e.g., presenting rhythm to inform the ECMO decision: (1) Witnessed Cardiac Arrest, (2) CPR provided by witness and (3) Pt presented in VF or VT (shockable rhythm) or pt presented in asystole / PEA.

[0118] For an ALS defibrillator / monitor additional parameters can be incorporated into the patient specific protocol, for example ventilation monitoring of ETCO2, 02, RS02 and C02 for avoidance of hypoxaemia, maintaining arterial blood oxygenation in a specified range and avoiding hypoxia and hypercapnia. Or evidence of coronary cause for the SCA by evaluation of the ECG used to prioritize care / direct transport to a cardiac catheterization lab. Further, for advanced users e.g., paramedics: The defibrillation / monitor can track changes in a patient’s state pre and post drugs. ECG changes, resulting from drugs delivered, can indicate optimal timing for shock delivery via changes in VF vitality.

[0119] For example. Providers give epinephrine-> changes in ECG due to epinephrine ->VF vitality reflects changes in ECG -> timing for shock delivery optimized.

[0120] By further example, vRhythm estimates the vitality of the ECG. vRhythm is related mathematically to AMSA (amplitude spectral area) which has been studied extensively for cardiac arrest. Philips studied use of vRhythm to predict optimal benefit for either a shock first or CPR first protocol (see Freese publication).

[0121] By further example, epinephrine increases arterial blood pressure and coronary perfusion during CPR. This ‘primes’ the myocardium to receive the shock. The effect of the epinephrine can be measured by the trending of the vRhythm value pre and post drug delivery. If the vRhythm score increases from its baseline, this indicates improved myocardial substrate to receive the shock. If vRhythm does not improve with epi, then CPR can continue and the shock can be delayed for a finite time.

[0122] Note vRhythm (and AMSA) are calculated during pauses in chest compression. The vRhythm calculation can be modified to account for compression artifact.

[0123] In accordance with the present disclosure, when drugs are given, exemplary embodiments of the present disclosure (e.g., ALS device) can monitor the blood pressure (BP) and other vital signs (e.g., respiratory rate, EtCO2) and notify a responder or care giver if there is no response.

[0124] The exemplary ALS device is informed when drugs are given (e.g., via a button) and the defibrillator / device then tracks the response of the patient to the drugs. The responder / caregiver, especially during a cardiac arrest, is generally not able to keep track of this, at least not easily. The clinical guidance in accordance with the present disclosure would notify the responder / caregiver, e.g., that there was no BP or heart rate in response to epi.

[0125] Additionally, as described above, exemplary embodiments of the present disclosure can also provide valuable information with regard to Termination of Resuscitation (ToR).

[0126] The information tracked by the exemplary ALS device, e.g., timing / resuscitation data, can also be used to direct / impact the patient’s post-arrest treatments (like hypothermia) and neuroprotective care options and prognostication. To facilitate a further understanding of the present disclosure, the following description of FIGS. 4 and 5 teaches an exemplary embodiment of systems and devices in accordance with the present disclosure. From the description of FIGS. 4 and 5, those having ordinary skill in the art of the present disclosure will appreciate how to apply the present disclosure to make and use additional embodiments of systems and devices in accordance with the present disclosure.

[0127] FIG. 4 illustrates a defibrillator 400 of the present disclosure employing a controller 410 and a defibrillating shock module 420.

[0128] Controller 410 encompasses all structural configurations, as understood in the art of the present disclosure and as exemplary described in the present disclosure, of an application specific main board or an application specific integrated circuit for controlling an application of various inventive principles of various methods of the present disclosure as previously described in the present disclosure. The structural configuration of controller 410 can include, but is not limited to, processor(s), computer-usable / computer readable storage medium(s), an operating system, application module(s), peripheral device controller(s), slot(s) and port(s). The application module(s) encompass an application incorporated within or accessible controller 410 including an electronic circuit (e.g., electronic components and / or hardware) and / or an executable program (e.g., executable software stored on non-transitory computer readable medium(s) and / or firmware) for executing a specific application of the method(s) of the present disclosure, particularly as described in FIGS. 2 and 3 of the present disclosure.

[0129] FIG. 5 illustrates an exemplary embodiment 410a of controller 410 (FIG. 4) that includes one or more processor(s) 411, memory 412, a user interface 413, a network interface 414, and a storage 415 interconnected via one or more system bus(es) 416.

[0130] Referring to FIG. 5, each processor 411 can be any hardware device, as known in the art of the present disclosure or hereinafter conceived, capable of executing instructions stored in memory 412 or storage or otherwise processing data. In a non-limiting example, the processor(s) 411 can include a microprocessor, field programmable gate array (FPGA), application-specific integrated circuit (ASIC), or other similar devices.

[0131] The memory 412 can include various memories, as known in the art of the present disclosure or hereinafter conceived, including, but not limited to, LI, L2, or L3 cache or system memory. In a non-limiting example, the memory 412 can include static random access memory (SRAM), dynamic RAM (DRAM), flash memory, read only memory (ROM), or other similar memory devices.

[0132] The user interface 413 can include one or more devices, as known in the art of the present disclosure or hereinafter conceived, for enabling communication with a user such as an administrator. In a non-limiting example, the user interface can include a command line interface or graphical user interface that can be presented to a remote terminal via the network interface 414.

[0133] In practice, controller 410a also provides control of the user interface (UI) output functions. Specifically, user interface 413 is the primary means for guiding the responder through the protocols of the present disclosure, and so includes at least one of an aural instruction output and a visual display. In particular, user interface 413 may comprise an audio speaker 214 to issue an aural verbal or signal prompt to the responder regarding a state of the rescue, an instruction as to a next step to be taken in the rescue, or regarding instructions responsive to an execution of a particular protocol (e.g., administering CPR and / or delivering a drug). User interface 413 can also convey audible information via a beeper 209. User interface 413 can also provide visual text or graphical indications on a display 215. User interface 413 can also convey visual information via a flashing light LED, which may illuminate adjacent graphics or buttons to be pressed. Preferably, controller 410 controls the user interface 413 such that each of these cues is provided in a manner that optimizes the desired response of the responder in the execution of protocols of the present disclosure.

[0134] Still referring to FIG. 5, network interface 414 can include one or more devices, as known in the art of the present disclosure or hereinafter conceived, for enabling communication with other components of defibrillator 400 or another device, particularly a mechanical CPR device or a CPR coaching device, as known in the art of the present disclosure or hereinafter conceived, in the administration of CPR / chest compression to a patient in accordance with the protocols of the present disclosure and / or in the acquisition of CPR data indicative of the quality of CPR being administered to the patient.

[0135] In a non-limiting example, the network interface 414 can include a network interface card (NIC) configured to communicate according to the Ethernet protocol. Additionally, the network interface 414 may implement a TCP / IP stack for communication according to the TCP / IP protocols. Various alternative or additional hardware or configurations for the network interface 414 will be apparent.

[0136] The storage 415 can include one or more machine-readable storage media, as known in the art of the present disclosure or hereinafter conceived, 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 415 can store instructions for execution by the processor(s) 411 or data upon with the processor(s) 411 may operate. For example, the storage 415 may store a base operating system for controlling various basic operations of the hardware.

[0137] The storage 415 can also store application module(s) 417 in the form of executable software / firmware for implementing various methods of the present disclosure, such as, for examples, the methods of the present disclosure as shown in FIGS. 2 and 3.

[0138] Referring back to FIG. 4, defibrillating shock module 420 is structurally configured as known in the art of the present disclosure to deliver an electric therapy to a heart of a patient as controlled by controller 410.

[0139] In one exemplary embodiment, defibrillating shock module 420 employs a high voltage capacitor bank (not shown) for storing a high voltage via a high voltage charger and a power supply upon a pressing of a charge button. Defibrillating shock module 420 further employs a switching / isolation circuit (not shown) for selectively applying a specific waveform of an electric energy charge from the high voltage capacitor bank to electrode pads / paddles attached to the patient as controlled by controller 410. In practice, the defibrillating shock may have any waveform as known in the art of the present disclosure. A non-limiting example of such a waveform is a biphasic truncated waveform.

[0140] Still referring to FIG. 4, in practice, defibrillator 400 can be embodied in any form as would be appreciated by those having ordinary skill in the art. Non-limiting examples include an automatic external defibrillator, a semi-automatic external defibrillator, a manual external defibrillator, a monitor / defibrillator and an advance life support (ALS) device.

[0141] From the description of FIGS. 2-5 herein, those having ordinary skill in the art will appreciate the numerous benefits of the present disclosure including, but not limited to, a guidance of one or more responders treating a patient experiencing sudden cardiac arrest to follow a patient specific treatment protocol that is optimized for a patient.

[0142] The present disclosure has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the present disclosure be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.

[0143] Further, as one having ordinary skill in the art shall appreciate in view of the teachings provided herein, features, elements, components, etc. disclosed and described in the present disclosure / specification and / or depicted in the appended Figures can be implemented in various combinations of hardware and software, and provide functions which can be combined in a single element or multiple elements. For example, the functions of the various features, elements, components, etc. shown / illustrated / depicted in the Figures can be provided through the use of dedicated hardware as well as hardware capable of executing software in association with appropriate software. When provided by a processor, the functions can be provided by a single dedicated processor, by a single shared processor, or by a plurality of individual processors, some of which can be shared and / or multiplexed. Moreover, explicit use of the term “processor” or “controller” should not be construed to refer exclusively to hardware capable of executing software, and can implicitly include, without limitation, digital signal processor (“DSP”) hardware, memory (e.g., read only memory (“ROM’) for storing software, random access memory (“RAM’), non-volatile storage, etc.) and virtually any means and / or machine (including hardware, software, firmware, combinations thereof, etc.) which is capable of (and / or configurable) to perform and / or control a process.

[0144] Moreover, all statements herein reciting principles, aspects, and exemplary embodiments of the present disclosure, as well as specific examples thereof, are intended to encompass both structural and functional equivalents thereof. Additionally, it is intended that such equivalents include both currently known equivalents as well as equivalents developed in the future (e.g., any elements developed that can perform the same or substantially similar functionality, regardless of structure). Thus, for example, it will be appreciated by one having ordinary skill in the art in view of the teachings provided herein that any block diagrams presented herein can represent conceptual views of illustrative system components and / or circuitry embodying the principles of the present disclosure. Similarly, one having ordinary skill in the art should appreciate in view of the teachings provided herein that any flow charts, flow diagrams and the like can represent various processes which can be substantially represented in computer readable storage media and so executed by a computer, processor or other device with processing capabilities, whether or not such computer or processor is explicitly shown.

[0145] Having described preferred and exemplary embodiments of the present disclosure, which embodiments are intended to be illustrative and not limiting, it is noted that modifications and variations can be made by persons having ordinary skill in the art in view of the teachings provided herein, including the appended Figures and claims. It is therefore to be understood that changes can be made in / to the preferred and exemplary embodiments of the present disclosure which are within the scope of the present disclosure and exemplary embodiments disclosed, described and taught herein.

[0146] Moreover, it is contemplated that corresponding and / or related systems incorporating and / or implementing the defibrillator / device, system or method or such as can be used / implemented in a device, system or method in accordance with the present disclosure are also contemplated and considered to be within the scope of the present disclosure. Further, corresponding and / or related method for manufacturing and / or using a device and / or system in accordance with the present disclosure are also contemplated and considered to be within the scope of the present disclosure.

Claims

WHAT IS CLAIMED IS:

1. A controller (410) for guiding, at least one of a responder and / or a mechanical CPR device, a treatment of a patient experiencing sudden cardiac arrest in accordance with a patient specific treatment protocol, the controller (410) comprising: a non-transitory machine-readable storage medium encoded with instructions for execution by at least one processor, the non-transitory machine-readable storage medium including the instructions to: execute a generation or an acquisition of a cardiopulmonary resuscitation indication of a presence or an absence of chest compressions being administered to the patient by the at least one of the responder and / or the mechanical CPR device; dependent upon the cardiopulmonary resuscitation indication, execute a rhythm classification of an electrocardiogram of the patient as a shockable cardiac rhythm, a non- shockable cardiac rhythm with electrical activity or a non-shockable rhythm without electrical activity; dependent upon the rhythm classification of the electrocardiogram of the patient, execute a generation or an acquisition of a pulse indication of a presence or an absence of a pulse of the patient; and execute one of the following protocols: a pulseless electrical activity protocol when the rhythm classification of the electrocardiogram of the patient is a non-shockable cardiac rhythm with electrical activity and the pulse indication is the absence of the pulse of the patient; an asystole protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm without electrical activity; a return of spontaneous circulation protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm with electrical activity and the pulse indication is the presence of the pulse of the patient; and a ventricular fibrillation / ventricular tachycardia protocol when the rhythm classification of the electrocardiogram of the patient is a shockable cardiac rhythm.

2. The controller (410) of claim 1, wherein the pulseless electrical activity protocol includes a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment of the patient including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification of the electrocardiogram of the patient being the non-shockable cardiac rhythm with electrical activity and based on the pulse indication being the absence of the pulse of the patient.

3. The controller (410) of claim 1, wherein the asystole protocol includes a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification of the electrocardiogram of the patient being the non-shockable cardiac rhythm without electrical activity.

4. The controller (410) of claim 1, wherein the return of spontaneous circulation protocol includes a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including a post cardiac arrest care of the patient on the rhythm classification of the electrocardiogram of the patient being the non-shockable cardiac rhythm with electrical activity and based on the pulse indication being the presence of the pulse of the patient.

5. The controller (410) of claim 1, wherein ventricular fibrillation / ventricular tachycardia protocol includes the non-transitory machine-readable storage medium further including instructions to: execute a vitality prognosis of a delivery of an initial shock to the patient as a convertible rhythm outcome or an inconvertible rhythm outcome; when the vitality prognosis of the delivery of the initial shock to the patient is the inconvertible rhythm outcome, execute a guidance, by the controller (410) of the at least one ofthe responder and / or the mechanical CPR device, of the treatment including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification of the electrocardiogram of the patient being the shockable cardiac rhythm; and when the vitality prognosis of the shock is the convertible rhythm outcome, execute the delivery of the initial shock to the patient.

6. The controller (410) of claim 1, wherein the ventricular fibrillation / ventricular tachycardia protocol further includes the non-transitory machine-readable storage medium further including instructions to: subsequent to a delivery of an initial shock to the patient, execute a rhythm classification of a post-shock electrocardiogram of the patient as the shockable cardiac rhythm or a non- shockable cardiac rhythm; when the rhythm classification of the post-shock electrocardiogram of the patient is the non-shockable cardiac rhythm, execute a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification the post-shock electrocardiogram of the patient being a non-shockable cardiac rhythm; and when the rhythm classification of the post-shock electrocardiogram of the patient is the shockable cardiac rhythm, execute a delivery of an additional shock to the patient.

7. The controller (410) of claim 5, wherein the ventricular fibrillation / ventricular tachycardia protocol further includes the non-transitory machine-readable storage medium further including instructions to: subsequent to a delivery of an initial shock to the patient, execute a rhythm classification of a post-shock electrocardiogram of the patient as a shockable cardiac rhythm or a non- shockable cardiac rhythm; when the rhythm classification of the post-shock electrocardiogram of the patient is a non-shockable cardiac rhythm, execute a guidance, by the controller (410) of the at least one ofthe responder and / or the mechanical CPR device, of the treatment including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification the post-shock electrocardiogram of the patient being a non-shockable cardiac rhythm; and when the rhythm classification of the post-shock electrocardiogram of the patient is a shockable cardiac rhythm and dependent upon the total number of deliveries of shocks to the patient, execute one of: a delivery of an additional shock to the patient; or a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including at least one of the administering the cardiopulmonary resuscitation to the patient and the delivering at least one drug to the patient based on the rhythm classification of the post-shock electrocardiogram of the patient being the shockable cardiac rhythm.

8. A defibrillator (400) for guiding, at least one of a responder and / or a mechanical CPR device, a treatment of a patient experiencing sudden cardiac arrest in accordance with a patient specific treatment protocol, the defibrillator (400) comprising: a defibrillating shock module (420) operable to deliver at least one shock to the patient ; a controller (410) configured to: execute a generation or an acquisition of a cardiopulmonary resuscitation indication of a presence or an absence of chest compressions being administered to the patient by the at least one of the responder and / or the mechanical CPR device; dependent upon the cardiopulmonary resuscitation indication, execute a rhythm classification of an electrocardiogram of the patient as a shockable cardiac rhythm, a non- shockable cardiac rhythm with electrical activity or a non-shockable rhythm without electrical activity; dependent upon the rhythm classification of the electrocardiogram of the patient, execute a generation or an acquisition of a pulse indication of a presence or an absence of a pulse of the patient; execute one of the following protocols:a pulseless electrical activity protocol when the rhythm classification of the electrocardiogram of the patient is a non-shockable cardiac rhythm with electrical activity and the pulse indication is the absence of the pulse of the patient; an asystole protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm without electrical activity; a return of spontaneous circulation protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm with electrical activity and the pulse indication is the presence of the pulse of the patient; and a ventricular fibrillation / ventricular tachycardia protocol when the rhythm classification of the electrocardiogram of the patient is a shockable cardiac rhythm, wherein the ventricular fibrillation / ventricular tachycardia protocol includes a conditional operation of the defibrillating shock module (420) by the controller (410).

9. The defibrillator (400) of claim 8, wherein, for the pulseless electrical activity protocol, the controller (410) is further configured to guide the at least one of the responder and / or the mechanical CPR device in treating the patient including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification of the electrocardiogram of the patient being the non-shockable cardiac rhythm with electrical activity and based on the pulse indication being the absence of the pulse of the patient.

10. The defibrillator (400) of claim 8, wherein, for the asystole protocol includes, the controller (410) is further configured to guide the at least one of the responder and / or the mechanical CPR device in treating the patient including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification of the electrocardiogram of the patient being the non-shockable cardiac rhythm without electrical activity.

11. The defibrillator (400) of claim 8, wherein, for the return of spontaneous circulation protocol, the controller (410) is further configured to guide the at least one of the responderand / or the mechanical CPR device in treating the patient including a post cardiac arrest care of the patient based on the rhythm classification of the electrocardiogram of the patient being the non-shockable cardiac rhythm with electrical activity and based on the pulse indication being the presence of the pulse of the patient.

12. The defibrillator (400) of claim 8, wherein ventricular fibrillation / ventricular tachycardia protocol includes the non-transitory machine-readable storage medium further including instructions to: execute a vitality prognosis of a delivery of an initial shock to the patient as a convertible rhythm outcome or an inconvertible rhythm outcome; when the vitality prognosis of the delivery of the initial shock to the patient is the inconvertible rhythm outcome, execute a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification of the electrocardiogram of the patient being the shockable cardiac rhythm; and when the vitality prognosis of the shock is the convertible rhythm outcome, execute the delivery of the initial shock to the patient.

13. The defibrillator (400) of claim 8, wherein, for the ventricular fibrillation / ventricular tachycardia protocol, the controller (410) is further configured to: subsequent to a delivery of an initial shock to the patient, execute a rhythm classification of a post-shock electrocardiogram of the patient as the shockable cardiac rhythm or a non- shockable cardiac rhythm; when the rhythm classification of the post-shock electrocardiogram of the patient is the non-shockable cardiac rhythm, execute a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification the post-shock electrocardiogram of the patient being a non-shockable cardiac rhythm; andwhen the rhythm classification of the post-shock electrocardiogram of the patient is the shockable cardiac rhythm, execute a delivery of an additional shock to the patient.

14. The defibrillator (400) of claim 8, wherein, for the ventricular fibrillation / ventricular tachycardia protocol, the controller (410) is further configured to: subsequent to a delivery of an initial shock to the patient, execute a rhythm classification of a post-shock electrocardiogram of the patient as a shockable cardiac rhythm or a non- shockable cardiac rhythm; when the rhythm classification of the post-shock electrocardiogram of the patient is a non-shockable cardiac rhythm, execute a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including at least one of administering the cardiopulmonary resuscitation to the patient and delivering at least one drug to the patient based on the rhythm classification the post-shock electrocardiogram of the patient being a non-shockable cardiac rhythm; and when the rhythm classification of the post-shock electrocardiogram of the patient is a shockable cardiac rhythm and dependent upon the total number of deliveries of shocks to the patient, execute one of: a delivery of an additional shock to the patient; or a guidance, by the controller (410) of the at least one of the responder and / or the mechanical CPR device, of the treatment including at least one of the administering the cardiopulmonary resuscitation to the patient and the delivering at least one drug to the patient based on the rhythm classification of the post-shock electrocardiogram of the patient being the shockable cardiac rhythm.

15. A method executable by a controller (410) for guiding, at least one of a responder and / or a mechanical CPR device, a treatment of a patient experiencing sudden cardiac arrest in accordance with a patient specific treatment protocol, the method comprising: executing, by the controller (410), a generation or an acquisition of a cardiopulmonary resuscitation indication of a presence or an absence of chest compressions being administered to the patient by the at least one of the responder and / or the mechanical CPR device;dependent upon the cardiopulmonary resuscitation indication, executing, by the controller (410), a rhythm classification of an electrocardiogram of the patient as a shockable cardiac rhythm, a non-shockable cardiac rhythm with electrical activity or a non-shockable rhythm without electrical activity; dependent upon the rhythm classification of the electrocardiogram of the patient, executing, by the controller (410), a generation or an acquisition of a pulse indication of a presence or an absence of a pulse of the patient; and executing, by the controller (410) one of the following protocols: a pulseless electrical activity protocol when the rhythm classification of the electrocardiogram of the patient is a non-shockable cardiac rhythm with electrical activity and the pulse indication is the absence of the pulse of the patient; an asystole protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm without electrical activity; a return of spontaneous circulation protocol when the rhythm classification of the electrocardiogram of the patient is the non-shockable cardiac rhythm with electrical activity and the pulse indication is the presence of the pulse of the patient; and a ventricular fibrillation / ventricular tachycardia protocol when the rhythm classification of the electrocardiogram of the patient is a shockable cardiac rhythm.

Images