Customizing cardiac arrest treatment during CPR

Abstract

A defibrillator for customizing cardiac therapy treatment of a patient while a responder is administering cardiopulmonary resuscitation (CPR) to the patient's heart. During operation, the defibrillator monitors an electrocardiogram (ECG) waveform of the patient's heart while the responder is administering CPR to the patient's heart. When the ECG waveform monitored by the defibrillator while the responder is administering CPR to the patient's heart indicates a shockable rhythm of the patient's heart, the defibrillator derives a treatment advisory from the quality of the CPR administered to the patient's heart by the responder, the vitality of the shockable rhythm of the patient's heart, and optionally other factors.

Description

[Technical Field]

[0001] The present disclosure relates generally to cardiac arrest treatment, including cardiopulmonary resuscitation (“CPR”), administered to a patient's heart by a responder, and more particularly to customizing cardiac arrest treatment for a patient during CPR. [Background technology]

[0002] 1 shows a CPR monitor 30 positioned on the sternum of a patient 10, with a responder 20 placing one hand on top of the other to deliver chest compressions in a traditional two-handed manner. However, rather than placing hands directly on the patient 10, the responder's 20 hands are placed on the CPR monitor 30 and chest compressions are delivered to the patient 10 via the CPR monitor 30. Chest compressions are delivered by the responder 20 to the heart of the patient 10 as prescribed by a traditional CPR protocol. As is known in the art, the CPR monitor 30 monitors the quality of the CPR delivered by the responder 20 to the heart of the patient 10, e.g., the depth and rate of compressions, chest release and recoil, and the placement of the responder's hands on the chest of the patient 10, to determine whether the CPR is effective or ineffective. Cable 31 is attached to defibrillator 40 to connect CPR quality monitoring to defibrillator 40 and provide audible CPR instructions through the defibrillator 40 speaker.

[0003] FIG. 1 further illustrates a defibrillator 40 attached to the patient 10 by electrodes 41 a and 41 b. Defibrillators 40, as known in the art, are used to deliver defibrillation shocks to the patient 10 as needed during CPR. More specifically, the defibrillator 40 operates to deliver high-voltage impulses to the heart of the patient 10 to restore normal rhythm and contractile function in patients experiencing arrhythmias without spontaneous circulation (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)). During operation, the defibrillator 40 automatically analyzes the electrocardiogram (ECG) rhythm of the patient 10's heart to determine whether defibrillation is necessary. If necessary, the defibrillator 40 prompts the responder 20 to terminate CPR and press a shock button to deliver a defibrillation shock to the patient when a shock is advised by the defibrillator 40. Summary of the Invention [Problem to be solved by the invention]

[0004] As illustrated illustratively in Figure 1, the field of resuscitation is focused on improving the quality of care by identifying and delivering optimal CPR / shock therapy to patients experiencing cardiac arrest. [Means for solving the problem]

[0005] The present disclosure is directed to customizing cardiac therapy treatment of a patient while cardiopulmonary resuscitation (CPR) is being administered to the patient's heart by a responder by deriving and communicating a treatment advisory from the responder's assessment of the quality of the CPR (e.g., with respect to compression depth and rate, chest release and recoil, and the responder's hand placement on the chest of the patient 10) combined with a determination of the vitality of a detected shockable rhythm of the patient's heart (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)).

[0006] The treatment advisory may be audible, visual, textual or graphical instructing the responder to continue, modify or discontinue CPR administered by the responder to the patient's heart.

[0007] The treatment advisory may also provide audio, visual, textual or graphical instructions to the responder to deliver a shock to the patient's heart.

[0008] The present disclosure is embodied in (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 cardiac therapy treatment for a patient while a responder is administering CPR to the patient's heart. The ECG monitor is configured to monitor an ECG waveform of the patient's heart while the responder is administering CPR to the patient's heart. The defibrillation controller is configured, when an ECG waveform monitored by the ECG monitor indicates a shockable rhythm of the patient's heart while the responder is administering CPR to the patient's heart, to derive a therapy advisory from at least the quality of the CPR administered to the patient's heart by the responder and the vitality of the shockable rhythm of the patient's heart. The defibrillation controller is further configured to customize cardiac therapy treatment for the patient by communicating the therapy advisory to the responder.

[0010] Various exemplary embodiments of the presently disclosed defibrillation controller include a non-transitory machine-readable storage medium encoded with instructions for execution by one or more processors for adapting cardiac therapy treatment of a patient while administering CPR to the patient's heart. The exemplary non-transitory machine-readable storage medium includes instructions for (1) deriving a therapy advisory from at least the quality of CPR administered to the patient's heart and the vitality of the patient's shockable rhythm when an ECG waveform indicates a shockable rhythm of the patient's heart during CPR administered to the patient's heart by a responder, and (2) communicating the therapy advisory to the responder to customize cardiac therapy treatment of the patient.

[0011] Various exemplary embodiments of defibrillation methods according to the present disclosure include: (1) a defibrillator monitoring an electrocardiogram (ECG) waveform of a patient's heart while cardiopulmonary resuscitation is being administered to the patient's heart; (2) when the ECG waveform monitored by the defibrillator indicates a shockable rhythm of the patient's heart while CPR is being administered to the patient's heart by a responder, the defibrillator deriving a therapy advisory from at least the quality of the CPR administered to the patient and the vitality of the shockable rhythm of the patient's heart; and (3) the defibrillator communicating the therapy advisory to a responder to customize cardiac therapy treatment for the patient, thereby applying the cardiac therapy treatment to the patient while CPR is being administered to the patient's heart.

[0012] The above-described exemplary embodiments and other embodiments of the present disclosure, as well as various features and advantages of the present disclosure, will become more apparent to those skilled 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 illustrative of the present disclosure, rather than limiting, the scope of which is defined by the appended claims and equivalents thereof. [Brief explanation of the drawings]

[0013] The present disclosure is set forth in detail in the following description of exemplary embodiments with reference to the following figures: [Figure 1] FIG. 1 illustrates cardiopulmonary resuscitation administered to a patient's heart by a responder, as known in the art of this disclosure. [Figure 2] FIG. 2 illustrates an exemplary embodiment of a cardiac arrest treatment system according to the present disclosure. [Figure 3] FIG. 3 illustrates an exemplary embodiment of a defibrillator according to the present disclosure. [Figure 4] FIG. 4 shows a flow chart representative of an exemplary embodiment of a pre-shock defibrillation method according to the present disclosure. [Figure 5A] FIG. 5A illustrates an exemplary treatment advisory communication according to FIG. 4 of the present disclosure. [Figure 5B] FIG. 5B illustrates an exemplary treatment advisory communication according to FIG. 4 of the present disclosure. [Figure 5C] FIG. 5C illustrates an exemplary treatment advisory communication according to FIG. 4 of the present disclosure. [Figure 5D] FIG. 5D illustrates an exemplary treatment advisory communication according to FIG. 4 of the present disclosure. [Figure 6] FIG. 6 shows a flow chart representative of an exemplary embodiment of a post-shock defibrillation method according to the present disclosure. [Figure 7A] FIG. 7A shows an exemplary ECG waveform of refractory ventricular fibrillation as known in the art of this disclosure. [Figure 7B] FIG. 7B shows an exemplary ECG waveform of recurrent ventricular fibrillation as known in the art of this disclosure. [Figure 8A] FIG. 8A illustrates an exemplary treatment advisory communication according to FIG. 6 of the present disclosure. [Figure 8B] FIG. 8B illustrates an exemplary treatment advisory communication according to FIG. 6 of the present disclosure. [Figure 11] FIG. 9 illustrates an exemplary embodiment of a defibrillation controller according to the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0014] The present disclosure is directed to customizing cardiac therapy treatment of a patient during the administration of cardiopulmonary resuscitation (CPR) to the patient's heart by deriving and communicating a treatment advisory from the responder's assessment of the quality of the CPR (e.g., with respect to compression depth and rate, chest release and recoil, and the responder's hand placement on the patient's chest) combined with a determination of the vitality of a detected shockable rhythm (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)) of the patient's heart.

[0015] To facilitate understanding of the present disclosure, the following description of Figure 2 teaches an exemplary embodiment of a cardiac arrest treatment system according to the present disclosure. From the description of Figure 2, those skilled in the art will understand how to apply the present disclosure to make and use further embodiments of a cardiac arrest treatment system according to the present disclosure.

[0016] Referring to FIG. 2, an exemplary cardiac arrest treatment system of the present disclosure uses a CPR monitor 20a and a defibrillator 40a.

[0017] In practice, the CPR monitor 20a is any device known or hereinafter contemplated in the art of the present disclosure for analyzing the quality of CPR administered to the heart 11 of the patient 10a by a responder (not shown).

[0018] In a first exemplary embodiment, the CPR monitor 20a is configured as a CPR coaching device in accordance with U.S. Patent No. 8,532,765 B2, entitled "CPR Coaching Device with Reduced Sensitivity to Motion," inventors Ochs et al., the contents of which are incorporated herein by reference.

[0019] In a second exemplary embodiment, the monitor 20a is a CPR machine that incorporates the CPR analysis principles described by Ochs et al.

[0020] With further reference to FIG. 2, in practice, defibrillator 40a may be any type of defibrillator known in the art of the present disclosure or contemplated below that incorporates the inventive principles of the present disclosure for customizing cardiac therapy treatment of heart 11 of patient 10a while CPR is being administered to heart 11 of patient 10a by a responder.

[0021] During operation, the defibrillator 40a receives CPR feedback 22 from the CPR monitor 20a as a basis for assessing the quality of CPR administered by the responder to the heart 11 of the patient 10a.

[0022] In one example embodiment, the CPR feedback 22 is an indication of whether the quality of the CPR is effective or ineffective.

[0023] In a second exemplary embodiment, CPR feedback 22 includes data quantifying various CPR parameters (e.g., compression depth and rate, chest release and recoil, and the responder's hand placement on the patient's chest) so that defibrillator 40a determines whether the data indicates effective or ineffective quality of CPR.

[0024] Furthermore, during operation, the defibrillator 40a monitors the ECG waveform of the patient's 10a's heart 11 via electrodes 41a and 41b attached to the patient 10a, as known in the art of the present disclosure, and analyzes the ECG waveform to detect any shockable rhythms in the patient's 10a's heart 11, as known in the art of the present disclosure.

[0025] If the defibrillator 40a detects a shockable rhythm in the heart 11 of the patient 10a, the defibrillator 40a determines the vitality of the detected shockable rhythm in the heart 11 of the patient 10a.

[0026] In one exemplary embodiment, the defibrillator 40a performs an estimation of the probability (0-100%) of return of rhythm (ROR) after delivering a shock to the heart 11 of the patient 10a, as known in the art of the present disclosure.

[0027] The defibrillator 40a then derives a treatment advisory from the analytical combination of the CPR quality and the vitality of the shockable rhythm, thereby directing the responder toward optimal CPR / shock treatment of the heart 11 of the patient 10a.

[0028] In one exemplary embodiment, the defibrillator 40a implements a decision matrix that determines whether the quality of CPR is effective or ineffective, and whether the vitality of the shockable rhythm is likely to result in ROR or unlikely to result in ROR.

[0029] For example, if the quality of CPR is deemed effective and the vitality score indicates that ROR is unlikely, the treatment advisory instructs the responder to continue CPR on the patient's 10 heart 11 .

[0030] By way of further example, if the quality of CPR is deemed ineffective and the vitality score indicates that ROR is unlikely, the treatment advisory instructs the responder to modify CPR to the patient's 10 heart 11 in a manner that will increase the effectiveness of the CPR.

[0031] Also, by way of example, if the vitality score indicates a high probability of ROR, the treatment advisory instructs the responder to discontinue CPR to the patient's 10a's heart 11 and immediately implement a shock protocol to the patient's 10a's heart 11.

[0032] Indeed, CPR quality / shockable rhythm vitality and other combinations of related information may be additional factors in deriving a treatment advisory, 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 minutes, the treatment advisory may instruct the responder to discontinue CPR to the patient's 10a heart 11 and immediately implement a shock protocol to the patient's 10a heart 11.

[0033] Continuing to refer to FIG. 1, defibrillator 40a implements a display 42, a CPR advisory 43, a shock advisory 44, and a speaker 45 as means for communicating treatment advisories to a responder.

[0034] For example, the defibrillator 40a may communicate treatment advisories to the responder via the display 42, CPR advisory 43 and / or speaker 45, thereby instructing the responder to continue, modify or discontinue CPR administered by the responder to the patient's heart.

[0035] By way of further example, the defibrillator 40a may communicate a treatment advisory to the responder via the display 42, shock advisory 44, and / or speaker 45, thereby instructing the responder to implement a shock protocol.

[0036] To further facilitate understanding of the present disclosure, the following description of Figure 3 teaches an exemplary embodiment of a defibrillator according to the present disclosure. From the description of Figure 3, one skilled in the art of the present disclosure will understand how to apply the present disclosure to make and use further embodiments of a defibrillator according to the present disclosure.

[0037] 3, a defibrillator 40b of the present disclosure uses a pair of electrode pads / paddles 41a and 41b, an optional ECG lead 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.

[0038] Electrode pads / paddles 41 a and 41 b are structurally configured to be conductively affixed to patient 10 a in a precordial-apical position as shown in FIG. 1 , or alternatively in a precordial-posterior position (not shown), as known in the art. Electrode pads / paddles 41 a and 41 b conduct defibrillation shocks from a shock source 60 to patient 10 a's heart 11 as controlled by a defibrillation controller 70, as known in the art, and conduct electrical activity of patient 10 a's heart 11 to an ECG monitor 50, as known in the art. Alternatively, or simultaneously, ECG leads 46, as known in the art, can be connected to patient 10 a and conduct electrical activity of patient 10 a's heart 11 to ECG monitor 50.

[0039] As is known in the art, the ECG monitor 50 is structurally configured to generate an ECG waveform of the heart 11 of the patient 10a as an indication that the patient 10a is experiencing an organized or unorganized heartbeat. An example of an ECG waveform indicative of an organized heartbeat is ECG waveform 51a, shown in Figure 3, which represents organized contractions of the ventricles of the heart 11 that are capable of pumping blood. An example of an ECG waveform indicative of the patient 10a is ECG waveform 51b, shown in Figure 3, which is a random ECG waveform with zero discernible waves, representing the absence of organized heartbeat activity of the heart 11 of the patient 10a.

[0040] In one exemplary embodiment, ECG monitor 50 uses a digital signal processor (not shown) to stream ECG waveform data 52 to defibrillation controller 70 .

[0041] Shock source 60 is structurally configured to store electrical energy for delivering a defibrillation shock to heart 11 of patient 10a via electrode pads / paddles 41a and 41b as controlled by defibrillation controller 70, as known in the art. In practice, the defibrillation shock may have any waveform known in the art. Examples of such waveforms include, but are not limited to, a monophasic sinusoidal waveform (positive sine wave) 61a and a biphasic truncated waveform 61b, as shown in FIG. 3.

[0042] In one exemplary embodiment, shock source 60 uses a high-voltage capacitor bank (not shown) to store high voltage via a high-voltage charger and power supply upon pressing a charge button. Shock source 60 further uses switching / isolation circuitry (not shown) to selectively apply a charge of electrical energy of a particular waveform from the high-voltage capacitor bank to electrode pads / paddles 41 a and 41 b, as controlled by defibrillation controller 70.

[0043] Defibrillation controller 60 implements an ECG analyzer 80 for analyzing and interpreting ECG waveform data 52 from ECG monitor 50 as known in the art of this disclosure and as discussed below.

[0044] The defibrillation controller 60 further implements a treatment advisor 90 for customizing cardiac therapy treatment of a patient while cardiopulmonary resuscitation (CPR) is being administered to the patient's heart by a responder by deriving and communicating a treatment advisory from the responder's assessment of the quality of CPR (e.g., with respect to depth and rate of compressions, chest release and recoil, and the responder's hand placement on the patient's chest) combined with a determination of the vitality of a detected shockable rhythm (e.g., ventricular fibrillation (VF) or ventricular tachycardia (VT)) of the patient's heart.

[0045] In one exemplary embodiment, defibrillation controller 70 includes all of the structural components of a main circuit board or integrated circuit for controlling the application of various inventive principles of this disclosure, as understood in the art and illustratively described herein, as contemplated below. The structural components of defibrillation controller 70 may include, but are not limited to, a processor, computer usable / computer readable storage media, an operating system, application modules, peripheral controllers, slots, and ports.

[0046] Also, in exemplary embodiments, the ECG analyzer 80 and therapy advisor 90 broadly include applications implemented within or accessible by the defibrillation controller 70, which is comprised of electronic circuitry (e.g., electronic components and / or hardware), and / or executable programs for executing particular applications (e.g., executable software stored on non-transitory computer-readable media and / or firmware).

[0047] In operation, when ECG analyzer 80 detects a shockable rhythm in the ECG waveform, such as ventricular fibrillation 81 as shown in Figure 3, it communicates detection 82 of the shockable rhythm to therapy advisor 90. ECG analyzer 80 further communicates segments 83 of the shockable rhythm in the ECG waveform.

[0048] In response, the treatment advisor 90 generates a vitality score for the shockable rhythm of the ECG waveform and interprets the CPR feedback 22 from the CPR coaching device 20a, enabling the treatment advisor 90 to also implement flowchart 100 (FIG. 4) and flowchart 120 (FIG. 6) representative of the cardiac arrest treatment method of the present disclosure for communicating a treatment advisory 94 to a user of the defibrillator 70.

[0049] 4 and 6 are described herein in the context of detecting VF in an ECG waveform. Nevertheless, those skilled in the art will understand how to apply the principles of FIG. 4 and 6 to other shockable rhythms.

[0050] Referring to FIG. 4, stage S102 of flowchart 100 includes a step of determining whether the vitality of ventricular fibrillation 81 indicates that restoration of rhythm (ROR) of heart 11 of patient 10a is likely or unlikely.

[0051] If the treatment advisor 90 determines that the vitality of the ventricular fibrillation 81 indicates a high probability of return of rhythm (ROR) of the patient 11a's heart 10 (e.g., the vitality score of the ventricular fibrillation 81 is 75% or greater), the treatment advisor 90 proceeds to stage S104 of the flowchart 100, derives a treatment advisory 94a of "Stop CPR / Deliver Shock," as illustrated in FIG. 5A, and communicates the treatment advisory 94a to the responder.

[0052] On the other hand, if the treatment advisor 90 determines that the vitality of the ventricular fibrillation 81 indicates that the likelihood of restoration of rhythm (ROR) of the patient 11a's heart 10 is low (e.g., the vitality score of the ventricular fibrillation 81 is less than 75%), the treatment advisor 90 proceeds to stage S106 of the flowchart 100 and determines whether the quality of the CPR indicates that the CPR is effective or ineffective.

[0053] If the treatment advisor 90 determines that the quality of the CPR indicates that the CPR is effective (e.g., the compression depth and rate are acceptable, the chest release and recoil are acceptable, and the responder's hands are in an acceptable position on the patient's chest), the treatment advisor 90 proceeds to stage S108 of the flowchart 100, derives a treatment advisory 94b of "Continue CPR," as illustrated in FIG. 5B, and communicates this treatment advisory 94b to the responder.

[0054] On the other hand, if the treatment advisor 90 determines that the quality of the CPR indicates that the CPR is ineffective (e.g., compression depth and rate are not within acceptable ranges, chest release and recoil are not within acceptable ranges, and the responder's hand placement on the patient's chest is not in an acceptable position), the treatment advisor 90 proceeds to stage S110 of flowchart 100, derives a "Modify CPR" treatment advisory 94c, and communicates this treatment advisory 94c to the responder, as illustrated in FIG. 5C. The "Modify CPR" treatment advisory 94c includes instructions on how to improve the effectiveness of the quality of the CPR.

[0055] Upon completing stage S108 or stage S110, the treatment advisor 90 proceeds to stage S112 of the flowchart 100 to determine whether the vitality of the ventricular fibrillation 81 still indicates that restoration of rhythm (ROR) of the patient's 10a's heart 11 is unlikely, or whether ROR is now likely.

[0056] If the treatment advisor 90 determines that the vitality of the ventricular fibrillation 81 still indicates that the likelihood of restoration of rhythm (ROR) of the patient 11a's heart 10 is low (e.g., the vitality score of the ventricular fibrillation 81 is still less than 75%), the treatment advisor 90 proceeds to stage S114 of the flowchart 100, derives a treatment advisory 94d of "Complete CPR / Deliver Shock" as illustrated in FIG. 5D, and communicates this treatment advisory 94d to the responder.

[0057] On the other hand, if the treatment advisor 90 determines that the vitality of the ventricular fibrillation 81 now indicates that there is a high probability of return of rhythm (ROR) of the patient 11a's heart 10 (e.g., the vitality score of the ventricular fibrillation 81 is now 75% or greater), the treatment advisor 90 proceeds to stage S116 of the flowchart 100 and derives a treatment advisory 94a of "Stop CPR / Deliver Shock," as illustrated in FIG. 5A, and communicates this treatment advisory 94a to the responder.

[0058] Indeed, relevant information, including but not limited to the length of time the patient's 10a heart 11 has been in ventricular fibrillation (VF), may be additional factors in deriving a treatment advisory.

[0059] For example, stage S102 may include a determination that the vitality score must indicate a high probability of ROR in order to proceed immediately to stage S104 and convey the treatment advisory "Stop CPU / Deliver Shock."

[0060] As a further example, stage S102 may include detecting that the VF81 vitality score is low, and since the score cannot be improved even after high-quality CPR in stage S108, a shock is delivered anyway in stage S114.

[0061] Again, by way of example, stage S102 may include a determination that the vitality score must indicate a high probability of ROR for a specified time period (e.g., 3 minutes) before proceeding to stage S104 to convey the treatment advisory "discontinue CPU / deliver shock."

[0062] By way of further example, stage S102 may include detecting a non-shockable rhythm before detecting VF81 and either reduce the vitality score of VF81 accordingly or proceed immediately to stage S106.

[0063] Flowchart 100 ends upon completion of stage S114 or stage S116, or returns to stage S102.

[0064] FIG. 6 shows a flowchart 120 representative of an exemplary embodiment of the post-shock cardiac arrest therapy method of the present disclosure.

[0065] 6, once the therapy advisor 90 decides to deliver a shock during stage S122 of flowchart 120, stage S124 of flowchart 120 involves the therapy advisor 90 determining whether refractory VF is present in the ECG waveform. A refractory shock is an "unsuccessful shock" (i.e., VF persists after the shock). FIG. 7A illustrates an exemplary refractory VF 140 in an ECG waveform known in the art of the present disclosure.

[0066] 6, if the therapy advisor 90 determines that refractory VF is present in the ECG waveform, the therapy advisor 90 proceeds to stage S126 of flowchart 120, derives a therapy advisory 94e, "Execute Refractory VF Protocol," and communicates the therapy advisory 94e to the responder, as illustratively shown in FIGURE 8A. The therapy advisory 94e may include instructions to (1) change the defibrillation vector, (2) apply dual sequential defibrillation, (3) increase the defibrillation energy, or (4) deliver sequential shocks.

[0067] On the other hand, if the therapy advisor 90 determines that refractory VF is not present in the ECG waveform, the therapy 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 patient's 10a heart 11 re-fibrillates. Figure 7B shows an exemplary recurrent VF 141 in an ECG waveform known in the art of the present disclosure.

[0068] If the therapy advisor 90 determines that recurrent VF is present in the ECG waveform, the therapy advisor 90 derives a therapy advisory 94f, "Execute Recurrent VF Protocol," and communicates the therapy advisory 94f to the responder, as illustratively shown in Figure 8B. The therapy advisory 94f may include instructions to (1) administer an antiarrhythmic drug to the patient 10a, (2) perform CPR, and (3) deliver a shock at the end of the CPR.

[0069] On the other hand, if therapy advisor 90 determines that recurrent VF is not present in the ECG waveform, therapy advisor 90 proceeds to the end of flowchart 120 or returns to stage S122.

[0070] To further facilitate understanding of the present disclosure, the following description of Figure 9 teaches an exemplary embodiment of a defibrillation controller according to the present disclosure. From the description of Figure 9, those skilled in the art will understand how to apply the present disclosure to make and use further embodiments of a defibrillation controller according to the present disclosure.

[0071] Referring to FIG. 9, an exemplary embodiment of a defibrillation controller 160 is shown, which includes one or more processors 161, memory 162, a user interface 163, a network interface 164, and a storage device 165 interconnected via one or more system buses 166.

[0072] Each processor 161 may be any hardware device known in the art of this disclosure or as contemplated below that is capable of executing instructions or processing data stored in memory 162 or a storage device. By way of non-limiting example, processor 161 may include a microprocessor, a field programmable gate array (FPGA), an application specific integrated circuit (ASIC), or other similar device.

[0073] Memory 162 may include various memories as known in the art or as contemplated below, including, but not limited to, L1, L2, or L3 cache, or system memory. By way of non-limiting example, memory 162 may include static random access memory (SRAM), dynamic RAM (DRAM), flash memory, read-only memory (ROM), or other similar memory devices.

[0074] User interface 163 may include one or more devices as known in the art or as contemplated below for enabling communication with a user, e.g., an administrator. By way of non-limiting example, the user interface may include a command line interface or a graphical user interface that may be presented to a remote terminal via network interface 164.

[0075] The network interface 174 may include one or more devices, such as those known in the art or as contemplated below, for enabling communication with other components of the medical device. In a non-limiting example, the network interface 174 may include a network interface card (NIC) configured to communicate according to the Ethernet protocol. Additionally, the network interface 164 may implement a TCP / IP stack for communication according to the TCP / IP protocol. Various alternative or additional hardware or configurations for the network interface 164 will become apparent.

[0076] Storage device 165 may include one or more machine-readable storage media known in the art of this 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, storage device 165 may store instructions for execution by processor 161 or data on which processor 161 operates. For example, storage device 165 may store a basic operating system for controlling various basic operations of the hardware.

[0077] The storage device 165 may also store application modules in the form of executable software / firmware for implementing various functions of the methods of FIGS. 4 and 6, as described above in this disclosure.

[0078] In one exemplary embodiment shown, the memory device 165 includes an ECG analyzer 168 for analyzing an ECG waveform to detect a shockable rhythm as known in the art of the present disclosure, a CPR analyzer 169a for analyzing the quality of CPR administered to the patient's heart by a responder as known in the art of the present disclosure, and a vital ventricular fibrillation scorer 169b for scoring the likelihood of recovery of the patient's heart rhythm after a shock is delivered to the patient's heart as known in the art of the present disclosure.

[0079] The application module 167 further includes an advisory generator 169c that derives a treatment advisory from the quality of CPR administered to the patient's heart by the responder, as analyzed by the CPR analyzer 169a, and from a likelihood score of recovery of the patient's heart rhythm after a shock is delivered to the patient's heart, as analyzed by the vital ventricular fibrillation scorer 169b, in accordance with the present disclosure, as described above in this specification.

[0080] From the description of Figures 1-9 of the present disclosure, one skilled in the art will appreciate the numerous advantages of the present disclosure, including, but not limited to, customizing a patient's cardiac arrest treatment to facilitate optimal administration of CPR and shock delivery to the patient.

[0081] The present disclosure has been described with reference to preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.

[0082] Furthermore, as one skilled in the art will appreciate in view of the teachings provided in this disclosure, the features, elements, components, etc. disclosed and described in this disclosure / specification and / or shown in the accompanying drawings and / or recited in the claims can be implemented in various combinations of hardware and software, providing functionality that can 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 figures and / or recited in the claims 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 functionality can be provided by a single dedicated processor, by a single shared processor, or by multiple individual processors, some of which are shared and / or multiplexed. Furthermore, express use of the terms "processor" or "controller" should not be construed to refer exclusively to hardware capable of executing software, but can implicitly include, without limitation, digital signal processor ("DSP") hardware, memory (e.g., read-only memory ("ROM"), random access memory ("RAM"), non-volatile storage that stores software, etc.), and substantially any means and / or machine (including hardware, software, firmware, combinations thereof, etc.) that can perform processing and / or control (and / or be configured to do so).

[0083] 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, such equivalents are intended to include both currently known equivalents and equivalents now or in the future developed (e.g., any elements developed that can perform the same or substantially similar function, regardless of structure). Thus, for example, in light of the teachings provided in this disclosure, those skilled in the art will understand that any block diagrams presented herein may represent a conceptual view of the components and / or circuitry of illustrative systems embodying the principles of the invention. Similarly, in light of the teachings provided in this disclosure, those skilled in the art will understand that any flowcharts, flow diagrams, etc., may be substantially represented on a computer-readable storage medium and may represent various processes performed by a computer, processor, or other device having processing capabilities, whether or not such a computer or processor is explicitly shown.

[0084] While preferred and exemplary embodiments of the present disclosure have been described, it should be noted that these embodiments are intended to be illustrative and not limiting, and modifications and variations may be made by those skilled in the art in view of the teachings provided in this disclosure, including the accompanying drawings and claims. Thus, it should be understood that changes can be made in the preferred and exemplary embodiments of the present disclosure that are within the scope of the disclosure and exemplary embodiments disclosed, described, and taught in this disclosure.

[0085] Moreover, corresponding and / or related systems incorporating and / or implementing the devices, or the like used / implemented with devices according to the present disclosure, are also contemplated and considered to be within the scope of the present disclosure. 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. 1. A defibrillator for customizing cardiac therapy treatment of a patient while a responder is administering cardiopulmonary resuscitation (CPR) to the patient's heart, the defibrillator comprising: an ECG monitor configured to monitor an ECG waveform of the patient's heart while CPR is being administered to the patient's heart by the responder; Defibrillation controller and the defibrillation controller is configured, when an ECG waveform monitored by the ECG monitor indicates a shockable rhythm of the patient's heart while the responder is administering CPR to the patient's heart, to derive a therapy advisory from at least a quality of CPR administered to the patient's heart by the responder and a vitality of the shockable rhythm of the patient's heart; the defibrillation controller is further configured to customize the cardiac therapy treatment by communicating the treatment advisory to the responder. Defibrillator.

2. 10. The defibrillator of claim 1, wherein the treatment advisory instructs the responder to discontinue CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the patient's shockable rhythm indicating that recovery of the patient's heart rhythm is likely after a shock to the patient's heart.

3. After the treatment advisory instructing the responder to discontinue CPR administered by the responder to the patient's heart and administer a shock to the patient, the treatment advisory instructs the responder to execute a refractory ventricular fibrillation protocol in response to the ECG waveform monitored by the ECG monitor indicating refractory ventricular fibrillation of the patient's heart after the shock of the patient's heart; and the refractory ventricular fibrillation protocol includes at least one additional shock to the patient's heart.

3. The defibrillator of claim 2.

4. After the treatment advisory instructing the responder to discontinue CPR administered by the responder to the patient's heart and administer a shock to the patient, the treatment advisory instructs the responder to execute a recurrent ventricular fibrillation protocol in response to the ECG waveform monitored by the ECG monitor indicating recurrent ventricular fibrillation of the patient's heart after the shock to the patient's heart; and the recurrent ventricular fibrillation protocol includes a continuation or modification of CPR administered to the patient's heart by the responder followed by an additional shock to the patient's heart.

3. The defibrillator of claim 2.

5. 2. The defibrillator of claim 1, wherein the treatment advisory instructs the responder to continue CPR administered to the patient's heart by the responder in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart, and further in response to the quality of CPR administered to the patient's heart by the responder indicating that the CPR administered to the patient's heart by the responder is effective.

6. 4. The defibrillator of claim 3, wherein after the treatment advisory instructing the responder to continue CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to discontinue CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is likely after a shock to the patient's heart.

7. 4. The defibrillator of claim 3, wherein after the treatment advisory instructing the responder to continue CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to complete CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart.

8. 2. The defibrillator of claim 1, wherein the treatment advisory instructs the responder to modify CPR administered to the patient's heart by the responder in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart and further in response to the quality of CPR administered to the patient's heart by the responder indicating that the CPR administered to the patient's heart by the responder is ineffective.

9. 7. The defibrillator of claim 6, wherein after the treatment advisory instructing the responder to modify CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to discontinue CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is likely after a shock to the patient's heart.

10. 7. The defibrillator of claim 6, wherein after the treatment advisory instructing the responder to modify CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to complete CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart.

11. 1. A defibrillation controller having a non-transitory machine-readable storage medium encoded with instructions for execution by at least one processor for adapting cardiac therapy treatment of a patient while a responder is administering cardiopulmonary resuscitation (CPR) to the patient's heart, the non-transitory machine-readable storage medium comprising: When an ECG waveform indicates a shockable rhythm of the patient's heart while the responder is administering CPR to the patient's heart, deriving a treatment advisory from at least the quality of the CPR administered to the patient's heart by the responder and the vitality of the shockable rhythm of the patient's heart; and customizing cardiac therapy treatment for the patient by communicating the treatment advisory to the responder. a defibrillation controller including instructions to:

12. 12. The defibrillation controller of claim 11, wherein the therapy advisory instructs the responder to discontinue the CPR administered to the patient's heart by the responder and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is likely after a shock to the patient's heart.

13. after the treatment advisory instructing the responder to discontinue the CPR administered by the responder to the patient's heart and administer a shock to the patient, the treatment advisory instructs the responder to execute a refractory ventricular fibrillation protocol in response to the ECG waveform monitored by an ECG monitor indicating refractory ventricular fibrillation of the patient's heart after the shock to the patient's heart; the refractory ventricular fibrillation protocol includes at least one additional shock to the patient's heart; after the treatment advisory instructing the responder to discontinue the CPR administered by the responder to the patient's heart and administer a shock to the patient, the treatment advisory instructs the responder to execute a recurrent ventricular fibrillation protocol in response to an ECG waveform monitored by the ECG monitor indicating recurrent ventricular fibrillation of the patient's heart after the shock of the patient's heart; the recurrent ventricular fibrillation protocol includes a continuation or modification of the CPR administered to the patient's heart by the responder followed by an additional shock to the patient's heart.

13. The defibrillation controller of claim 12.

14. the treatment advisory instructs the responder to continue the CPR administered to the patient's heart by the responder in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart, and further in response to the quality of the CPR administered to the patient's heart by the responder indicating that the CPR administered to the patient's heart by the responder is ineffective; After the treatment advisory instructing the responder to continue the CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to discontinue the CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that restoration of the patient's cardiac rhythm is likely after a shock to the patient's heart; and After the treatment advisory instructing the responder to continue the CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to complete the CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart.

12. The defibrillation controller of claim 11.

15. the treatment advisory instructs the responder to modify the CPR administered to the patient's heart by the responder in response to, after a shock to the patient's heart, the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely, and further in response to the quality of the CPR administered to the patient's heart by the responder indicating that the CPR administered to the patient's heart by the responder is ineffective; After the treatment advisory instructing the responder to modify the CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to discontinue the CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is likely after a shock to the patient's heart; and After the treatment advisory instructing the responder to modify the CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to complete the CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart.

12. The defibrillation controller of claim 11.

16. 1. A defibrillation method for customizing cardiac therapy treatment of a patient while a responder is administering cardiopulmonary resuscitation (CPR) to the patient's heart, the method comprising: monitoring an electrocardiogram (ECG) waveform of the patient's heart with the defibrillator while a responder administers cardiopulmonary resuscitation to the patient's heart; When an electrocardiogram waveform monitored by the defibrillator indicates a shockable rhythm of the patient's heart while the CPR is being administered to the patient's heart by the responder, the defibrillator deriving a treatment advisory from at least the quality of the CPR administered to the patient's heart by the responder and the vitality of the shockable rhythm of the patient's heart; customizing the cardiac therapy treatment for the patient by communicating the treatment advisory to the responder; A defibrillation method comprising:

17. 17. The defibrillation method of claim 16, wherein the treatment advisory instructs the responder to discontinue the CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is likely after a shock to the patient's heart.

18. after the treatment advisory instructing the responder to discontinue the CPR administered by the responder to the patient's heart and administer a shock to the patient, the treatment advisory instructs the responder to execute a refractory ventricular fibrillation protocol in response to the ECG waveform monitored by the defibrillator indicating refractory ventricular fibrillation of the patient's heart after the shock to the patient's heart; the refractory ventricular fibrillation protocol includes delivering at least one additional shock to the patient's heart; After the treatment advisory instructing the responder to discontinue the CPR administered by the responder to the patient's heart and administer a shock to the patient, the treatment advisory instructs the responder to execute a recurrent ventricular fibrillation protocol in response to the ECG waveform monitored by the defibrillator indicating recurrent ventricular fibrillation of the patient's heart after the shock of the patient's heart; and the recurrent ventricular fibrillation protocol includes a continuation or modification of CPR administered to the patient's heart by the responder followed by an additional shock to the patient's heart.

18. The defibrillation method of claim 17.

19. the treatment advisory instructs the responder to continue CPR administered to the patient's heart by the responder in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart, and further in response to the quality of CPR administered to the patient's heart by the responder indicating that the CPR administered to the patient's heart by the responder is effective; After the treatment advisory instructing the responder to continue CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to discontinue CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that restoration of rhythm of the patient's heart is likely after a shock to the patient's heart; and After the treatment advisory instructing the responder to continue CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to complete CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart.

17. The defibrillation method of claim 16.

20. After the treatment advisory instructs the responder to modify CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to discontinue CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that restoration of rhythm of the patient's heart is likely after a shock to the patient's heart; and After the treatment advisory instructs the responder to modify CPR administered by the responder to the patient's heart, the treatment advisory instructs the responder to complete the CPR administered by the responder to the patient's heart and administer a shock to the patient in response to the vitality of the shockable rhythm of the patient's heart indicating that recovery of the patient's heart rhythm is unlikely after a shock to the patient's heart.

17. The defibrillation method of claim 16.

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