End of Resuscitation Advisory During CPR

Abstract

The defibrillator uses an ECG monitor and a defibrillation controller to support a responder in determining termination of resuscitation (TOR) during cardiopulmonary resuscitation (CPR) administered by the responder to the patient's heart. In operation during administration of CPR by the responder to the patient's heart, the ECG monitor monitors ECG waveforms of the patient's heart, and the defibrillation controller monitors TOR parameters of the CPR and ECG waveforms, derives a TOR advisory from the monitoring of the TOR parameters, and communicates the TOR advisory to the responder based on at least one of a request by the responder or the occurrence of a TOR event.

Description

[Technical Field]

[0001] The present disclosure relates generally to cardiac arrest treatment involving cardiopulmonary resuscitation ("CPR") administered by a responder to a patient's heart, and more particularly to supporting end of resuscitation ("TOR") decisions during the administration of CPR by a responder to a patient's heart. [Background technology]

[0002] 1 shows a CPR monitor 30 positioned on the sternum of a patient 10 as a responder 20 applies chest compressions in a conventional manner with their hands clasped together. Instead of placing their hands directly on the patient 10, however, 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 to the patient 10's heart by the responder 20 as prescribed by a conventional CPR protocol. As known in the art of this disclosure, the CPR monitor 30 monitors the quality of the CPR delivered to the patient 10's heart by the responder 20, such as whether the CPR is effective or ineffective with respect to, for example, the depth and rate of compressions, chest release and recoil, and the placement of the responder's hands on the patient's 10's chest. A cable 31 is attached to the defibrillator 40 to couple the monitoring of CPR quality to the defibrillator 40 and to issue audible CPR instructions through the defibrillator's 40 speaker.

[0003] FIG. 1 further shows 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 during CPR, as needed. More specifically, the defibrillator 40 is operable to deliver high-voltage impulses to the heart of the patient 10 to restore normal rhythm and contractile function to a patient 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 and determines whether defibrillation is necessary. If so, the defibrillator 40 instructs the responder 20 to press a shock button to terminate CPR and deliver a defibrillation shock to the patient when a shock is advised by the defibrillator 40.

[0004] As illustrated in Figure 1, the field of resuscitation focuses on improving the quality of care by identifying and providing optimal CPR / shock therapy to patients experiencing cardiac arrest. Summary of the Invention [Problem to be solved by the invention]

[0005] The present invention is directed to an improvement over existing defibrillators (e.g., automated external defibrillators and advanced life support defibrillators) by providing a termination of resuscitation (TOR) advisory to assist responders in making TOR decisions while performing cardiopulmonary resuscitation (CPR) on a patient's heart. [Means for solving the problem]

[0006] For purposes of describing and claiming this disclosure, the term "termination of resuscitation" broadly encompasses criteria for objectively terminating a responder's administration of CPR to a patient's heart based on TOR parameters of the patient's CPR and ECG waveforms, and, optionally, criteria for subjectively terminating a responder's administration of CPR to a patient's heart based on the patient's CPR and ECG waveforms.

[0007] Examples of objective criteria for TOR during CPR include, but are not limited to, (1) initial or sustained non-shockable rhythm (e.g., cardiac arrest) on the ECG waveform, (2) absence of shock delivery on the ECG waveform, and (3) absence of return of spontaneous circulation (ROSC) on the ECG waveform.

[0008] In the absence of objective criteria, examples of subjective criteria for TOR during CPR include, but are not limited to, (1) the duration of CPR administration; (2) the detection or non-detection of refractory ventricular fibrillation in the ECG waveform, which can indicate whether the patient is likely to develop an acute coronary artery occlusion; (3) the presence or absence of shortness of breath in the patient, which can be determined from the impedance signal as an indication of the potential effectiveness of CPR; (4) heart rate at various times during CPR as an indicator of blood flow level, particularly the presence or absence of bradycardial rhythm, or the likelihood of some blood flow if the patient has been in regular rhythm for any length of time; and (5) the detection or non-detection of cardiac arrest in the ECG waveform after shock delivery.

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

[0010] Various exemplary embodiments of the defibrillator of the present disclosure include an ECG monitor and a defibrillation controller for supporting a responder in determining TOR while the responder is administering CPR to the patient's heart. The ECG monitor is configured to monitor ECG waveforms of the patient's heart while the responder is administering CPR to the patient's heart. The defibrillation controller is configured to monitor TOR parameters of the CPR and ECG waveforms while the responder is administering CPR to the patient's heart, derive a TOR advisory from the monitoring of the TOR parameters, and communicate the TOR advisory to the responder upon request by the responder or upon the occurrence of a TOR event.

[0011] Various exemplary embodiments of a defibrillation controller of the present disclosure include a non-transitory machine-readable storage medium encoded with instructions executed by one or more processors to support a responder in determining a TOR during the responder's administration of CPR to a patient's heart. During the responder's administration of CPR to a patient's heart, the non-transitory machine-readable storage medium includes instructions for (1) monitoring TOR parameters of the CPR and the patient's ECG waveform, (2) deriving a TOR advisory from the monitoring of the TOR parameters, and (3) communicating the TOR advisory to the responder upon a request by the responder or the occurrence of a TOR event.

[0012] Various exemplary embodiments of a defibrillation method according to the present disclosure include supporting a responder in determining TOR while the responder is administering CPR to the patient's heart. The defibrillation method includes a defibrillator monitoring an ECG waveform of the patient's heart while the responder is administering CPR to the patient's heart. The defibrillation method includes the defibrillator (1) monitoring TOR parameters of the CPR and ECG waveforms, (2) deriving a TOR advisory from the monitoring of the TOR parameters, and (3) communicating the TOR advisory to the responder upon a request by the responder or upon the occurrence of a TOR event while the responder is administering CPR to the patient's heart.

[0013] The foregoing 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 merely illustrative of the present disclosure and are not limiting, the scope of the present disclosure being defined by the appended claims and equivalents thereof.

[0014] The present disclosure is set forth in detail in the following description of exemplary embodiments with reference to the following drawings: [Brief explanation of the drawings]

[0015] [Figure 1]1 illustrates cardiopulmonary resuscitation being performed on a patient's heart by a responder, as known in the art of the present disclosure. [Figure 2] 1 illustrates an exemplary embodiment of a cardiac arrest treatment system according to the present disclosure. [Figure 3] 1 illustrates an exemplary embodiment of a defibrillator according to the present disclosure. [Figure 4] 1 shows a flowchart depicting an exemplary embodiment of a defibrillation method according to the present disclosure. [Figure 5] 1 illustrates an exemplary embodiment of a defibrillation controller according to the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0016] The present invention is directed to an improvement over existing defibrillators (e.g., automated external defibrillators and advanced life support defibrillators) by providing a termination of resuscitation (TOR) advisory to assist responders in making termination of resuscitation (TOR) decisions while they are administering cardiopulmonary resuscitation (CPR) to a patient's heart.

[0017] For purposes of describing and claiming this disclosure, the term "termination of resuscitation" broadly encompasses criteria for objectively terminating a responder's administration of CPR to a patient's heart based on TOR parameters of the patient's CPR and ECG waveforms, and, optionally, criteria for subjectively terminating a responder's administration of CPR to a patient's heart based on the patient's CPR and ECG waveforms.

[0018] Examples of objective criteria for TOR during CPR include, but are not limited to, (1) initial or sustained non-shockable rhythm (e.g., cardiac arrest) on the ECG waveform, (2) non-occurrence of shock delivery on the ECG waveform, and (3) non-occurrence of return of spontaneous circulation (ROSC) on the ECG waveform.

[0019] In the absence of objective criteria, examples of subjective criteria for TOR during CPR include, but are not limited to, (1) the duration of CPR administration; (2) the detection or non-detection of refractory ventricular fibrillation in the ECG waveform, which can indicate whether the patient is likely to develop an acute coronary artery occlusion; (3) the presence or absence of shortness of breath in the patient, which can be determined from the impedance signal as an indication of the potential effectiveness of CPR; (4) heart rate at various times during CPR as an indicator of blood flow level, particularly the presence or absence of bradycardial rhythm, or the likelihood of some blood flow if the patient has been in regular rhythm for any length of time; and (5) the detection or non-detection of cardiac arrest in the ECG waveform after shock delivery.

[0020] As those skilled in the art will understand in light of this disclosure, exemplary embodiments of the present invention can be used to provide information to answer TOR questions typically asked of responders, such as "Was the rhythm shockable at any time?", and to provide related information in accordance with the present disclosure.

[0021] 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, one skilled in the art will understand how to apply the present disclosure to make and use additional embodiments of a cardiac arrest treatment system according to the present disclosure.

[0022] Referring to FIG. 2, an exemplary cardiac arrest treatment system of the present disclosure employs a CPR monitor 20a and a defibrillator 40a.

[0023] In practice, the CPR monitor 20a is any device known in the art of the present disclosure or as envisioned below for analyzing the quality of CPR administered to the heart 11 of the patient 10a by a responder (not shown).

[0024] In a first exemplary embodiment, the CPR monitor 20a is configured as a CPR coaching device according to U.S. Pat. No. 8,532,765 B2 to Ochs et al., entitled "CPR Coaching Device with Reduced Sensitivity to Motion," which is incorporated herein by reference in its entirety.

[0025] In a second exemplary embodiment, the monitor 20a is a CPR machine that incorporates the CPR analysis principles described in Ochs et al.

[0026] Referring to FIG. 2, defibrillator 40a may, in fact, 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 supporting responder TOR determinations during the responder's administration of cardiopulmonary resuscitation (CPR) on a patient's heart.

[0027] During operation, the defibrillator 40a receives CPR feedback 22 from the CPR monitor 20a as a basis for monitoring the delivery of CPR by the responder to the patient's heart.

[0028] Furthermore, during operation, the defibrillator 40a monitors the ECG waveform of the heart 11 of the patient 10a via electrodes 41a and 41b attached to the patient 10a, as known in the art of the present disclosure, to detect any shockable rhythm in the heart 11 of the patient 10a, as known in the art of the present disclosure.

[0029] If the defibrillator 40a detects a shockable rhythm in the heart 11 of the patient 10a, the defibrillator 40a may transmit a shock indicator to a responder as known in the art of the present disclosure, thereby enabling the responder to issue a shock delivery to the patient's heart.

[0030] In practice, the defibrillator 40a further monitors the TOR parameter within the ECG waveform as a basis for verifying that the TOR parameter represents an objective or subjective TOR criterion in support of the responder's TOR determination.

[0031] For purposes of describing and claiming this disclosure, the term "TOR parameter" broadly encompasses any parameter known in the art of this disclosure or contemplated below that measures the success or failure of cardiac arrest therapy, including CPR and shock delivery.

[0032] Examples of TOR parameters include, but are not limited to, the rhythm and rate of the ECG waveform, the shock indicator of the ECG waveform, the patient's respiratory status, and the duration of CPR.

[0033] Still referring to FIG. 2, the defibrillator 40a incorporates a user interface including a display 42, a TOR advisory button 43, a shock button 44, and a speaker 45 as a means of communicating a TOR advisory to a responder to assist the responder in making a TOR decision.

[0034] For example, if the defibrillator 40a determines that the TOR parameters are indicative of objective TOR criteria, the defibrillator 40a communicates to the responder via the display 42 and / or speaker 45 that "TOR is recommended."

[0035] Alternatively, for example, if the defibrillator 40a determines that the TOR parameters do not indicate an objective TOR criterion and the responder activates the TOR advisory button 43, the defibrillator 40a communicates to the responder via the display 42 and / or speaker 45 the subjective TOR criterion indicating that TOR is recommended and the subjective TOR criterion indicating that TOR is not recommended.

[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 additional embodiments of a defibrillator according to the present disclosure.

[0037] 3, a defibrillator 40b of the present invention employs pairs of electrode pads / paddles 41a and 41b, optional ECG leads 46, an ECG monitor 50 (internal or external), a shock power supply 60, and a defibrillation controller 70. Also shown is a CPR coaching device 20a communicatively coupled to the defibrillation controller 70. 1 or alternatively, in a front-to-back configuration (not shown), as is known in the art. The electrode pads / paddles 41 a and 41 b conduct defibrillation shocks from a shock generator 60 to the patient's 10 a's heart 11 as controlled by a defibrillation controller 70, as is known in the art, and conduct the patient's 10 a's heart 11's electrical activity to an ECG monitor 50, as is known in the art. Alternatively, or simultaneously, an ECG lead 46, as is known in the art, may be connected to the patient 10 a to conduct the patient's 10 a's heart 11's electrical activity to the ECG monitor 50.

[0038] The ECG monitor 50 is structurally configured, as known in the art, to generate an ECG waveform of the heart 11 of the patient 10a as an indication that the patient 10a is experiencing a regular or irregular heartbeat condition. An example of an ECG waveform indicative of a regular heartbeat condition is the ECG waveform 51a shown in FIG. 3, which represents regular 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 experiencing an irregular heartbeat condition is the random ECG waveform 51b shown in FIG. 3, which has no discernible waves (0) that represent irregular heartbeat activity of the heart 11 of the patient 10a.

[0039] In one example embodiment, ECG monitor 50 uses a digital signal processor (not shown) to stream ECG waveform data 52 to defibrillation controller 70 .

[0040] Shock power source 60 is structurally configured to store electrical energy for delivery of a defibrillation shock via electrode pads / paddles 41 a and 41 b to heart 11 of patient 10 a as controlled by defibrillation controller 70, as known in the art of the present disclosure. In practice, the defibrillation shock may have any waveform known in the art of the present disclosure. Examples of such waveforms include, but are not limited to, a monophasic sinusoidal waveform (positive sine wave) 61 a and a biphasic cutting waveform 61 b, as shown in FIG. 3 .

[0041] In one example embodiment, shock power supply 60 uses a high-voltage capacitor bank (not shown) to store high voltage via a high-voltage charger and power supply upon depression of a charge button. Shock power supply 60 further employs switching / isolation circuitry (not shown) to selectively apply electrical energy charges of specific waveforms from the high-voltage capacitor bank to electrode pads / paddles 41 a and 41 b as controlled by defibrillation controller 70.

[0042] Defibrillation controller 60 incorporates an ECG analyzer 80 that analyzes and interprets ECG waveform data 52 from ECG monitor 50, as known in the art and discussed below.

[0043] The defibrillation controller 60 further incorporates a TOR advisor 90 that derives a TOR advisory 91 from the ECG feedback data 82 and the CPR feedback data 22 .

[0044] In effect, the TOR Advisory 91 informs responders whether their performance of CPR should be objectively terminated based on one or more criteria established, among others, by the American Heart Association.

[0045] Examples of standard criteria for objectively terminating CPR include (1) an initial or sustained non-shockable rhythm (e.g., cardiac asystole) on the ECG waveform, (2) the absence of an occurrence of shock delivery on the ECG waveform, and (3) the absence of return of spontaneous circulation (ROSC) on the ECG waveform.

[0046] In the absence of objective criteria, examples of subjective criteria for TOR during CPR include, but are not limited to, (1) the duration of CPR administration; (2) the detection or non-detection of refractory ventricular fibrillation in the ECG waveform, which can indicate whether the patient is likely to develop an acute coronary artery occlusion; (3) the presence or absence of shortness of breath in the patient, which can be determined from the impedance signal as an indication of the potential effectiveness of CPR; (4) heart rate at various times during CPR as an indicator of blood flow level, particularly the presence or absence of bradycardial rhythm, or the likelihood of some blood flow if the patient has been in regular rhythm for any length of time; and (5) the detection or non-detection of cardiac arrest in the ECG waveform after shock delivery.

[0047] In one embodiment, the flowchart 100 shown in FIG. 4 is executed by the TOR advisor 90 at the initiation of CPR by responders.

[0048] Referring to FIG. 4, step S102 of flowchart 100 involves TOR advisor 90 monitoring the TOR parameter of the ECG waveform during CPR.

[0049] After the specified time has elapsed, the TOR advisor 90 proceeds to flowchart step S104 to determine whether a TOR event has occurred. For purposes of describing and claiming this disclosure, the term "TOR event" broadly encompasses the achievement of all objective TOR criteria for terminating CPR.

[0050] If the TOR advisor 90 determines that a TOR event has occurred, the TOR advisor proceeds to step S110 of flowchart 100, derives and communicates a TOR advisory of the TOR event to responders, and then ends flowchart 100 if CPR has been terminated as determined by the TOR advisor 90 during step S110 of flowchart 100.

[0051] If not, the TOR advisor 90 determines that a TOR event has not occurred, and then the TOR advisor proceeds to step S116 of flowchart 100 to determine whether the responder has requested a TOR advisory.

[0052] If the TOR advisor 90 determines that the responder has requested a TOR advisory, the TOR advisor proceeds to step S108 of flowchart 100, derives and communicates a subjective TPC-based TOR advisory to the responder, and then proceeds to end flowchart 100 if CPR is terminated as marked by the TOR advisor 90 during step S110 of flowchart 100.

[0053] Otherwise, if the TOR advisor 90 determines that the responder has not requested a TOR advisory, the TOR advisor proceeds to end the flowchart 100 if CPR has ended as determined by the TOR advisor 90 during stage S110 of the flowchart 100.

[0054] In practice, the TOR advisory for a TOR event (i.e., TOR is recommended) may or may not be followed by the responder. Nevertheless, this disclosure was intended to support this decision by the responder either way during CPR when the ECG waveform indicates continued CPR and shock delivery is likely to be unsuccessful.

[0055] Also, in practice, subjective TOR criteria TOR advisories (i.e., TOR may be recommended) facilitate a responder's decision as to whether TOR is warranted. Nevertheless, this disclosure was intended to support this decision by responders during CPR when the ECG waveform indicates continued CPR and shock delivery may or may not be successful.

[0056] To facilitate a further understanding of the present disclosure, the following description of Figure 5 teaches an exemplary embodiment of a defibrillation controller according to the present disclosure. From the description of Figure 5, those skilled in the art of the present disclosure will understand how to apply the present disclosure to make and use additional embodiments of a defibrillation controller according to the present disclosure.

[0057] Referring to FIG. 5, shown is an exemplary embodiment of a defibrillation controller 170 including one or more processors 171, memory 172, a user interface 173, a network interface 174, and a storage device 175 interconnected via one or more system buses 176.

[0058] Each processor 171 can be any hardware device known in the art of this disclosure or as contemplated below that can execute instructions or other forms of electronic processing data stored in memory 172 or a storage device. In non-limiting examples, processor 171 can include a microprocessor, a field programmable gate array (FPGA), an application specific integrated circuit (ASIC), or other similar device.

[0059] Memory 172 may include various memories known in the art or as contemplated below, including, but not limited to, L1, L2, or L3 cache or system memory. In non-limiting examples, memory 172 may include static random access memory (SRMA), dynamic RAM (DRAM), flash memory, read-only memory (ROM), or other similar memory devices.

[0060] User interface 173 may include one or more devices as known in the art or as contemplated below to enable communication with a user, such as an administrator. In non-limiting examples, 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 174.

[0061] The network interface 174 may include one or more devices for enabling communication with other components of the medical device, as known in the art of this disclosure or as contemplated below. In a non-limiting example, the network interface 174 may include a network interface card (NIC) configured to communicate according to the Ethernet protocol. Additionally, the network interface 174 may implement a TCP / IP stack for communicating according to the TCP / IP protocol. Various alternative or additional hardware or configurations for the network interface 174 will be apparent.

[0062] Storage device 175 may include one or more machine-readable storage media as known in the art 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 175 may store instructions for execution by processor 171 or data on which processor 171 may operate. For example, storage device 175 may store a basic operating system for controlling various basic operations of the hardware.

[0063] The storage device 175 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 previously described in this disclosure.

[0064] In the illustrated example embodiment, the storage device 175 stores application modules 177 including an ECG analyzer 178 for monitoring ECG waveforms as known in the art of the present disclosure, and a TOR advisory 189 for deriving a TOR advisory as previously described in this disclosure, particularly according to the flowchart 100 of FIG. 4 . From the description of Figures 1-5 herein, one skilled in the art will appreciate the many advantages of the present disclosure, including, but not limited to, supporting responder decisions to terminate resuscitation (TOR) while the responder is performing cardiopulmonary resuscitation (CPR) on a patient's heart. 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 present invention be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims and their equivalents.

[0065] Furthermore, as those skilled in the art should understand in view of the teachings provided herein, 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 to provide functionality that may be combined in a single element or multiple elements. For example, the functionality of the various features, elements, components, etc. shown / illustrated / depicted in the figures and / or recited in the claims can be provided through the use of dedicated hardware and 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, a single shared processor, or multiple individual processors, some of which can be shared and / or multiplexed. Furthermore, explicit use of the terms "processor" or "controller" should not be construed to refer exclusively to hardware capable of executing software, but can implicitly include digital signal processor ("DSP") hardware, memory (e.g., read-only memory ("ROM"), random access memory ("RAM"), non-volatile storage, etc. for storing software), and virtually any means and / or machine (including hardware, software, firmware, combinations thereof, etc.) that can execute and / or control a process (and / or is configurable).

[0066] 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. Moreover, such equivalents are intended to include both currently known equivalents and equivalents developed in the future (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 herein, those skilled in the art will understand that any block diagrams presented herein may represent conceptual views of illustrative system components and / or circuitry embodying the principles of the invention. Similarly, in light of the teachings provided herein, those skilled in the art will understand that any flowcharts, flow diagrams, and the like, may be substantially represented on a computer-readable storage medium and, therefore, may represent various processes performed by a computer, processor, or other device having processing capability, whether or not such a computer or processor is explicitly shown.

[0067] While preferred and exemplary embodiments of the present disclosure have been described, it should be noted that these embodiments are illustrative and not limiting, and modifications and variations may be made by those skilled in the art in view of the teachings provided herein, including the accompanying drawings and claims. Accordingly, it should be understood that changes can be made in and to the preferred and exemplary embodiments of the present disclosure that fall within the scope of the present disclosure and the embodiments disclosed, described, and taught herein.

[0068] Additionally, corresponding and / or related systems that incorporate and / or implement apparatus or that may be used / implemented in apparatus according to the present disclosure are also contemplated and are considered to be within the scope of the present disclosure. Additionally, corresponding and / or related methods for making and / or using apparatus and / or systems according to the present disclosure are also contemplated and are considered to be within the scope of the present disclosure.

Claims

1. 1. A defibrillator for assisting a responder in determining when to terminate resuscitation (TOR) while the responder is administering cardiopulmonary resuscitation (CPR) to a patient's heart, comprising: an ECG monitor configured to monitor an ECG waveform of the patient's heart while the responder is administering CPR to the patient's heart; during the responder's administration of CPR to the patient's heart; monitoring the CPR TOR parameters and the ECG waveform; deriving a TOR advisory from monitoring said TOR parameters; communicating the TOR advisory to the responder upon at least one of a request by the responder or the occurrence of a TOR event; a defibrillation controller configured to: A defibrillator having:

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

3. The TOR objective criteria are: an initial or continuing non-shockable rhythm in the ECG waveform; the absence of shock delivery in the ECG waveform; and the absence of restoration of spontaneous circulation in the ECG waveform; 3. The defibrillator of claim 2, comprising:

4. 2. The defibrillator of claim 1, wherein the defibrillation controller is configured to derive the TOR advisory based on the TOR parameter indicative of a subjective measure of TOR of at least one of the ECG waveform and the CPR.

5. The TOR subjective criteria are: the duration of the administration of CPR; detection or non-detection of refractory ventricular fibrillation in the ECG waveform; the presence or absence of shortness of breath in said patient as indicated by an impedance signal; the patient's heart rate within the ECG waveform at various times during the CPR as an indicator of blood flow level; and detection or non-detection of asystole in the ECG waveform after shock delivery; 5. The defibrillator of claim 4, comprising at least one of:

6. a non-transitory machine-readable storage medium encoded with instructions that are executable by at least one processor to support a responder in determining whether to terminate resuscitation (TOR) while the responder is performing cardiopulmonary resuscitation (CPR) on a patient's heart; 1. A defibrillation controller comprising: During the administration of CPR by the responder to the patient's heart, the non-transitory machine-readable storage medium instructions for analyzing the ECG waveform and deriving a TOR advisory from the analysis of the ECG waveform related to the TOR determination; instructions to communicate the TOR advisory to the responder upon at least one of a request by the responder or the occurrence of a TOR event; a defibrillation controller.

7. The defibrillation controller of claim 6 , wherein the TOR advisory is based on the TOR parameter indicating an objective measure of TOR for the ECG waveform.

8. The TOR objective criteria are: an initial or continuing non-shockable rhythm in the ECG waveform; the absence of shock delivery in the ECG waveform; and the absence of restoration of spontaneous circulation in the ECG waveform; 8. The defibrillation control device of claim 7, comprising:

9. The defibrillation controller of claim 6 , wherein the TOR advisory is based on the TOR parameter indicative of a subjective measure of TOR of at least one of the ECG waveform and the CPR.

10. The TOR subjective criteria are: the duration of the administration of CPR; detection or non-detection of refractory ventricular fibrillation in the ECG waveform; the presence or absence of shortness of breath in said patient as indicated by an impedance signal; the patient's heart rate in the ECG waveform at various times during the CPR as an indicator of blood flow level; and detection or non-detection of asystole in the ECG waveform after shock delivery; 10. The defibrillation controller of claim 9, comprising at least one of:

11. 1. A defibrillation method for supporting a responder's decision to terminate resuscitation (TOR) during cardiopulmonary resuscitation (CPR) administered by the responder to a patient's heart, comprising: monitoring, with the defibrillator, an ECG waveform of the patient's heart while the responder is administering CPR to the patient's heart; during the responder's administration of CPR to the patient's heart; analyzing, by the defibrillator, the ECG waveform; deriving, by the defibrillator, a TOR advisory from analysis of the ECG waveform related to the TOR determination; transmitting, by the defibrillator, the TOR advisory to the responder upon at least one of a request by the responder or the occurrence of a TOR event; A defibrillation method comprising:

12. 12. The defibrillation method of claim 11, wherein the TOR advisory is based on the TOR parameter indicative of an objective measure of TOR for the ECG waveform.

13. The TOR objective criteria are: an initial or continuing non-shockable rhythm in the ECG waveform; the absence of shock delivery in the ECG waveform; and the absence of restoration of spontaneous circulation in the ECG waveform; 13. The defibrillation method of claim 12, comprising:

14. 12. The defibrillation method of claim 11, wherein the TOR advisory is based on the TOR parameter indicative of a subjective measure of TOR of at least one of the ECG waveform and the CPR.

15. The TOR subjective criteria are: the duration of the administration of CPR; detection or non-detection of refractory ventricular fibrillation in the ECG waveform; the presence or absence of shortness of breath in said patient as indicated by an impedance signal; the patient's heart rate in the ECG waveform at various times during the CPR as an indicator of blood flow level; and detection or non-detection of asystole in the ECG waveform after shock delivery; The method of claim 14, comprising at least one of:

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