TEE-based resuscitative guidance

Abstract

An ultrasound system for resuscitative transesophageal echocardiography includes a memory that stores instructions and a processor that executes the instructions. When executed by the processor, the instructions cause the ultrasound system to: receive a plurality of transesophageal echocardiography images during resuscitative transesophageal echocardiography; interpret each of the plurality of transesophageal echocardiography images; output each of the plurality of transesophageal echocardiography images; and generate and output guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.

Description

TEE-BASED RESUSCITATIVE GUIDANCEGOVERNMENT INTEREST

[0001] This invention was made with United States government support awarded by the United States Department of Health and Human Services under the grant number HHS / ASPR / BARDA 75A50120C00097. The United States has certain rights in this invention.BACKGROUND

[0002] Sudden cardiac arrest is one of the primary causes of death globally, with a survival rate for patients outside of the hospital that may be below 10%. For patients inside of the hospital, echocardiography is sometimes used as a bedside modality to determine causes of sudden cardiac arrest and guide cardiac arrest resuscitation (CAR). Transesophageal echocardiography (TEE) is a form of echocardiography and involves passing a specialized probe with an ultrasound transducer through a patient’s mouth and into the patient’s esophagus to monitor the patient’s heart. Transthoracic echocardiography (TTE) is another form of echocardiography and involves placing a specialized probe with an ultrasound transducer on a patient’s chest or abdomen to monitor the patient’s heart. The use of TEE in cardiac arrest resuscitation (CAR) has been demonstrated to have clinically impactful outcomes in critically ill and hemodynamically unstable patients in extremis compared to TTE. TEE provides an ability to guide resuscitative procedures by optimizing chest compressions, minimizing the need for chest compression interruptions, and shortening CPR interruptions. TEE also provides continuous monitoring of cardiopulmonary activity, an unhindered view of continuous myocardial activity, and superior image quality for diagnosing disease states and identifying potential reversible causes of cardiac arrest. While TEE is considered the standard of care to improve resuscitative outcomes, current barriers to entry for introducing TEE into emergency resuscitative care include technical inexperience and time pressures in the workflow to add TEE to practice. For example, there are sometimes challenges with the ability to get the right view and image quickly, particularly with inexperienced users.

[0003] Medical professionals in the context of emergency medicine and critical care environments may leverage focused cardiac ultrasound (FoCUS) as a goal-directed framework to quickly determine causes of cardiac arrest and guide resuscitative care. In the context ofemergency medicine and critical care environments, TEE use is relatively focused and may involve 4 to 12 views (for a goal-directed protocol recommended by the ACEP) in a resuscitative TEE protocol as compared to 28 views for experienced medical professionals using TEE comprehensively in non-emergency and non-critical care practice. FoCUSed transthoracic echocardiography (TTE) is the diagnostic modality most commonly used by emergency physicians today but comes with significant limitations in managing critically ill patients undergoing cardiac arrest.

[0004] Automated software solutions may enhance workflow efficiency and clinical performance of cardiac ultrasound. Spatial orientation and a sound understanding of cardiac anatomy are the bedrock to competency in TEE acquisition. Inexperienced users often struggle when transitioning from TTE to TEE due to differences in spatial orientation. For example, the TEE Mid-Esophageal 4-chamber view is the retrocardiac equivalent of the TTE apical 4- chamber view, and the Mid-Esophageal Long Axis View is the mirror image of the PLAX view. Inexperienced users also struggle to obtain the proper acoustic window for TEE imaging due to the fine motor skills required. A need exists to develop TEE applications for point-of-care users in the context of emergency medicine and critical care environments, where exams are time- constrained, decisions are immediate, and there is greater variability in user experience.SUMMARY

[0005] According to an aspect of the present disclosure, an ultrasound system for resuscitative transesophageal echocardiography includes a memory that stores instructions and a processor that executes the instructions. When executed by the processor, the instructions cause the ultrasound system to: receive a plurality of transesophageal echocardiography images during resuscitative transesophageal echocardiography; interpret each of the plurality of transesophageal echocardiography images; output each of the plurality of transesophageal echocardiography images; and generate and output guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.

[0006] According to another aspect of the present disclosure, a method of operating an ultrasound system for resuscitative transesophageal echocardiography comprising a memory that stores instructions and a processor that executes the instructions includes receiving a plurality oftransesophageal echocardiography images during resuscitative transesophageal echocardiography. The method also includes interpreting each of the plurality of transesophageal echocardiography images; outputting each of the plurality of transesophageal echocardiography images; and generating and outputting guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.

[0007] According to another aspect of the present disclosure, a tangible, non-transitory computer-readable medium stores instructions for resuscitative transesophageal echocardiography. When executed by a processor, the instructions cause the processor to receive a plurality of transesophageal echocardiography images during resuscitative transesophageal echocardiography; interpret each of the plurality of transesophageal echocardiography images; output each of the plurality of transesophageal echocardiography images; and generate and output guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.BRIEF DESCRIPTION OF THE DRAWINGS

[0008] The example embodiments are best understood from the following detailed description when read with the accompanying drawing figures. It is emphasized that the various features are not necessarily drawn to scale. In fact, the dimensions may be arbitrarily increased or decreased for clarity of discussion. Wherever applicable and practical, like reference numerals refer to like elements.

[0009] FIG. 1 illustrates a system for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0010] FIG. 2 illustrates another system for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0011] FIG. 3 illustrates a method for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0012] FIG. 4A illustrates a user interface in TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0013] FIG. 4B illustrates another user interface in TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0014] FIG. 4C illustrates a hybrid flow for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0015] FIG. 5 illustrates a user interface showing a table with sets of corresponding information for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0016] FIG. 6 illustrates a computer system, on which a method for TEE-based resuscitative guidance is implemented, in accordance with another representative embodiment.DETAILED DESCRIPTION

[0017] In the following detailed description, for the purposes of explanation and not limitation, representative embodiments disclosing specific details are set forth to provide a thorough understanding of embodiments according to the present teachings. However, other embodiments consistent with the present disclosure that depart from specific details disclosed herein remain within the scope of the appended claims. Descriptions of known systems, devices, materials, methods of operation and methods of manufacture may be omitted so as to avoid obscuring the description of the representative embodiments. Nonetheless, systems, devices, materials, and methods that are within the purview of one of ordinary skill in the art are within the scope of the present teachings and may be used in accordance with the representative embodiments. It is to be understood that the terminology used herein is for purposes of describing particular embodiments only and is not intended to be limiting. Definitions and explanations for terms herein are in addition to the technical and scientific meanings of the terms as commonly understood and accepted in the technical field of the present teachings.

[0018] It will be understood that, although the terms first, second, third etc. may be used herein to describe various elements or components, these elements or components should not be limited by these terms. These terms are only used to distinguish one element or component from another element or component. Thus, a first element or component discussed below could be termed a second element or component without departing from the teachings of the inventive concept.

[0019] As used in the specification and appended claims, the singular forms of terms ‘a,’ ‘an’ and ‘the’ are intended to include both singular and plural forms, unless the context clearly dictates otherwise. Additionally, the terms "comprises", and / or "comprising," and / or similar terms when used in this specification, specify the presence of stated features, elements, and / or components, but do not preclude the presence or addition of one or more other features,elements, components, and / or groups thereof. As used herein, the term "and / or" includes any and all combinations of one or more of the associated listed items.

[0020] Unless otherwise noted, when an element or component is said to be “connected to,” “coupled to,” or “adjacent to” another element or component, it will be understood that the element or component can be directly connected or coupled to the other element or component, or intervening elements or components may be present. That is, these and similar terms encompass cases where one or more intermediate elements or components may be employed to connect two elements or components. However, when an element or component is said to be “directly connected” to another element or component, this encompasses only cases where the two elements or components are connected to each other without any intermediate or intervening elements or components.

[0021] The present disclosure, through one or more of its various aspects, embodiments and / or specific features or sub-components, is thus intended to bring out one or more of the advantages as specifically noted below.

[0022] As described herein, medical personnel may be provided workflow guidance tailored to the immediate needs of the circumstances they face when performing focused TEE cardiac arrest resuscitation. Resuscitative care as described herein may include the interventional strategies used to manage critically ill / hemodynamically unstable patients, patients in shock, cardiac arrest, or needing procedural guidance. The scope of resuscitative care can include the management of peri-arrest, intra — arrest, or post-arrest care. The workflow guidance may help lower barriers to entry for TEE use in emergency and critical care settings by providing guidance to medical personnel in TEE acquisition and interpretation for identification of cardiogenic disease states, as well as to improve patient outcomes in patients undergoing cardiac arrest by standardizing the quality of resuscitative care through guided resuscitation.

[0023] FIG. 1 illustrates a system 100 for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0024] The system 100 in FIG. 1 is a system for TEE-based resuscitative guidance and includes components that may be provided together. The system 100 includes an ultrasound probe 110, an ultrasound base 120, and a display 180.

[0025] The ultrasound probe 110 includes a processing circuit 115 and a transducer array 113. The processing circuit 115 may comprise a memory for storing data and instructions, anapplication-specific integrated circuit (ASIC) and / or a processor for processing data and instructions. The transducer array 113 includes an array of transducer elements including at least a first transducer element 1131, a second transducer element 1132, and an Xth transducer element 113X. The transducer array 113 converts electrical energy into sound waves which - reflect off of body tissue and receives echoes of the sound waves and converts the echoes into electrical energy. The transducer array 113 may include dozens, hundreds, or thousands of individual transducer elements. The ultrasound probe 110 may transmit a beam to produce images and may detect the echoes. The processing circuit 115 may process ultrasound images captured by the transducer array 113 of the ultrasound probe 110. The processing circuit 115 in FIG. 1 is shown in the ultrasound probe 110, though the processing circuit 115 may be alternatively placed in or otherwise coupled to the processor 152 in the ultrasound base.

[0026] The ultrasound base 120 may comprise an ultrasound cart. The ultrasound base 120 includes a first interface 121, a second interface 122, a third interface 123, and a controller 150. A computer that can be used to implement the ultrasound base 120 is depicted in FIG. 6, though an ultrasound base 120 may include more elements than depicted in FIG. 1 and more or fewer elements than depicted in FIG. 6. One or more of the interfaces may include ports, disk drives, wireless antennas, or other types of receiver circuitry that connect the controller 150 to other electronic elements. The first interface 121 connects the ultrasound base 120 to the ultrasound probe 110, and may comprise a port, an antenna, and / or another type of physical component for wired or wireless communications. The second interface 122 connects the ultrasound base 120 to the display 180, and may also comprise a port, an antenna, and / or another type of physical component for wired or wireless communications. The third interface 123 is a user interface, and may comprise buttons, keys, a mouse, a microphone, a speaker, switches, a touchscreen, or other type of display separate from the display 180, and / or other types of physical components that allow medical personnel to interact with the ultrasound base 120 such as to enter instructions and receive output.

[0027] The controller 150 includes at least a memory 151 that stores instructions and a processor 152 that executes the instructions. The instructions stored in the memory 151 may comprise one or more software program(s) for generating and outputting guidance (e.g., via the display 180) for capturing one or more additional transesophageal echocardiography image based on interpreting each of a plurality of transesophageal echocardiography images captured by theultrasound probe 110. The software program(s) in the memory 151 may include an image classification model and / or a feature detection model used to classify ultrasound images and detect features in ultrasound images. In the system 100, the user interface may be generated by the instructions stored in the memory 151 and may be displayed on the display 180.

[0028] The display 180 may be local to the ultrasound base 120 or may be remotely connected to the ultrasound base 120, such as wirelessly. The display 180 includes a graphical user interface 181 (GUI) that displays ultrasound images and guidance to users.

[0029] The display 180 may be connected to the ultrasound base 120 via a local wired interface such as an Ethernet cable or via a local wireless interface such as a Wi-Fi connection. The display 180 may be interfaced with other user input devices by which medical personnel can input instructions, including mouses, keyboards, thumbwheels and so on. The display 180 may be a monitor such as a computer monitor, a display on a mobile device, an augmented reality display, a television, an electronic whiteboard, or another screen configured to display electronic imagery. The display 180 may also include one or more input interface(s) such as those noted above that may connect to other elements or components, as well as an interactive touch screen configured to display prompts to medical personnel and collect touch input from medical personnel.

[0030] The controller 150 may perform some of the operations described herein directly and may implement other operations described herein indirectly. For example, the controller 150 may indirectly control operations such as by generating and transmitting content to be displayed on the display 180. The controller 150 may directly control other operations such as logical operations performed by the processor 152 executing instructions from the memory 151 based on input received from electronic elements and / or medical personnel via the interfaces.Accordingly, the processes implemented by the controller 150 when the processor 152 executes instructions from the memory 151 may include steps not directly performed by the controller 150.

[0031] As set forth above, the system 100 may comprise an ultrasound system with a memory 151 that stores instructions and a processor 152 that executes the instructions. When executed by the processor 152, the instructions cause the ultrasound system to implement a method as described with respect to some or all features of the method in FIG. 3. The method performed by the system 100 may include the controller 150 of the ultrasound base 120 receiving a plurality oftransesophageal echocardiography images from the ultrasound probe 110. The transesophageal echocardiography images may be received in real-time or near real-time and interpreted by the controller 150. The instructions stored in the memory 151 may be executed by the processor 152 to cause the controller 150 to interpret each of the plurality of transesophageal echocardiography images received from the ultrasound probe 110. The method performed by the system 100 may also include outputting output each of the plurality of transesophageal echocardiography images on the graphical user interface 181 of the display 180. The method performed by the system 100 may further include the controller 150 generating and outputting guidance on the display 180 for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.

[0032] FIG. 2 illustrates another system for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0033] In FIG. 2, an ultrasound probe 210 and a smart device A and a smart device B are connected over a network 201.

[0034] The network 201 may comprise a local wireless network such as a WiFi network, though the network 201 may also or alternatively include wired elements such as wires connected to smart device A and smart device B via USB cables.

[0035] The ultrasound probe 210 may comprise a portable transducer. The ultrasound probe 210 includes a transducer array 213, a lens 214, a user interface 223, a controller 250 and a wireless communication circuit 290. The transducer array 213 includes at least a first transducer element 2131, a second transducer element 2132, and an Xth transducer element 213X. The transducer array 213 converts electrical energy into sound waves which reflects off of body tissue and receives echoes of the sound waves and converts the echoes into electrical energy. The transducer array 213 may include dozens, hundreds, or thousands of individual transducer elements. The ultrasound probe 210 may transmit a beam to produce images and may detect the echoes. The processor 252 may process ultrasound images captured by the transducer array 213 of the ultrasound probe 210. The lens 214 may be used to focus the transmit ultrasound beams and to receive echoes of ultrasound beams. The user interface 223 may be used by medical personnel to interact with the ultrasound probe 210. The wireless communication circuit 290 may be used to communicate with smart device A and smart device B via the network 201. The ultrasound probe 210 may be configured to link to an external device such as the smart device Aand smart device B via applications installed on the external device(s). In some embodiments, instead of the wireless communication circuit 290, one or more wire(s) may be used to connect the ultrasound probe 210 to smart device A and / or smart device B via an alternative interface for the ultrasound probe 210.

[0036] Smart device A stores and executes an ultrasound application 299 A. Smart device B stores and executes an ultrasound application 299B. The ultrasound application 299A and the ultrasound application 299B may be configured to enable smart device A and smart device B to interact with the ultrasound probe 210 via the network 201. For example, ultrasound application 299A and ultrasound application 299B may be configured to enable displays of ultrasound images from the ultrasound probe 210. Ultrasound application 299 A and ultrasound application 299B may also be configured to generate and output guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images captured by the ultrasound probe 210. In some embodiments, the controller 250 may generate the output and send the output to the ultrasound application 299A and / or the ultrasound application 299B for outputting on screen(s) of smart device A and / or smart device B.

[0037] The controller 250 includes at least a memory 251 that stores instructions and a processor 252 that executes the instructions. The memory 251 may store one or more software program(s). The software program(s) may include an image classification model and / or a feature detection model used to classify ultrasound images and detect features in ultrasound images. In FIG. 2, the user interface may be generated by the instructions stored in the memory 251 and may be displayed on a display of the smart device A or smart device B.

[0038] The controller 250 may perform some of the operations described herein directly and may implement other operations described herein indirectly. For example, the controller 250 may indirectly control operations such as by generating and transmitting content to be displayed on a display of the smart device A or smart device B. The controller 250 may directly control other operations such as logical operations performed by the processor 252 executing instructions from the memory 251 based on input received from electronic elements and / or medical personnel via the interfaces. Accordingly, the processes implemented by the controller 250 when the processor 252 executes instructions from the memory 251 may include steps not directly performed by the controller 250.

[0039] The system 100 in FIG. 1 and the system 200 in FIG. 2 are provided to address user inexperience and technical competency in TEE acquisition and interpretation for cardiac arrest resuscitation. TEE provides some benefits relative to TTE, such as superior image quality that can provide valuable diagnostic information for reversible causes in cardiac arrest. A program executed by the controller 150 and / or the controller 250 may help reduce barriers to entry for introducing TEE acquisition and interpretation for cardiac arrest resuscitation, including in somewhat chaotic emergency care and critical care contexts when medical personnel are using the TEE on / in a patient while attempting to resuscitate the patient.

[0040] As described herein, new and / or inexperienced users in emergency and critical care environments may be enabled successfully use TEE in cardiac arrest resuscitation through passive and active guidance. Features of this guidance solution that may be provided by the programs executed by the controller 150 and / or the controller 250 include automatic cardiac chamber labelling, view quality detection, acquisition support, and interpretation assistance. As a result, TEE-based resuscitative guidance may shorten a learning curve for new and inexperienced users by providing support when experts are not present. TEE-based resuscitative guidance may also enhance diagnostic confidence and help standardize the quality of resuscitative care.

[0041] FIG. 3 illustrates a method for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0042] The method of FIG. 3 may be performed by the system 100 including the controller 150 or by the system 200 including the controller 250.

[0043] At S310, an ultrasound procedure is started with the probe insertion and esophageal intubation. A condition for starting the ultrasound procedure at S310 may be when a patient presents as unstable with suspected cardiac arrest. The ultrasound procedure may be started for the system 100 in FIG. 1 or by the system 200 in FIG. 2. The ultrasound procedure may be started at S310 by activating the ultrasound probe 110 and / or the ultrasound base 120 in FIG. 1, or by activating the ultrasound probe 210 and / or ultrasound application 299A and / or ultrasound application 299B in FIG. 2.

[0044] At S315, a patient is intubated, and a TEE transducer is inserted into the esophagus . When a user begins a cardiac ultrasound procedure, the system 100 in FIG. 1 or smart device A or smart device B in FIG. 2 may assist with intubation and insertion of the TEE transducer withverbal prompts.

[0045] At S320, one or more TEE image(s) is or are received. A plurality of transesophageal echocardiography images may be received by the ultrasound base 120 from the ultrasound probe 110 in FIG. 1, or by either or both of the controller 250 and / or smart device A and / or smart device B in FIG. 2. In FIG. 2, S320 may be performed by whichever of the controller 250 or the smart device(s) is performing the logical processing described herein. Once the system 100 in FIG. 1 or smart device A or smart device B in FIG. 2 begins receiving TEE image(s), an acquisition assistance workflow may be enabled. In addition to providing active guidance to the user on obtaining a good view, if the user is slightly off axis, the workflow may automatically adjust to get the correct cardiac chambers in the frame. Once the first TEE image(s) are received, an image acquisition workflow is enabled, providing active guidance to the user in order to obtain a suitable view. At S330, one or more TEE image(s) are interpreted. The interpretation at S330 may help ensure that the ultrasound probe 110 or the ultrasound probe 210 is in a correct position, as such feedback may be useful in reassuring a user or prompting a user to correct the position. The interpretation at S330 may include an assessment of view quality. The view quality assessment at S330 may include that the ultrasound image appears to reflect cardiological anatomy of a patient, that each ultrasound image is properly focused, and that each ultrasound image has a proper resolution. The view quality assessment at S330 may also include checking for characteristics of different cardiological disease states, so that a clinical disease state may be detected based on the interpretation. View quality assessment at S330 may also include checking for characteristics of cardiac standstill, so as to trigger measurement of duration of cardiac standstill when cardiac standstill is detected. Each of plurality of transesophageal echocardiography images may be interpreted individually or as a set. For example, a set of ultrasound images may be compared to detect differences, such as to ensure that they are not entire or substantial duplicates. View quality assessment at S330 may include detecting and quantifying predetermined anatomical features in each of a plurality of transesophageal echocardiography images to determine the guidance to output.

[0046] The interpretation may be performed at S330 by applying an image classification model to each of a plurality of transesophageal echocardiography images and detecting and quantifying predetermined anatomical features. The guidance output based on the interpretation at S330 may include instructions for improving the view quality such that the acoustic window is suitable forinterpretation. For example, a physician may begin by acquiring a Mid-Esophageal 4 Chamber view to get a full view of the heart where all four cardiac chambers are seen in this view.

[0047] The system may provide visual and or verbal guidance to the user to advance the probe to proper depth and ensure the center of the heart is in the middle of the sector to avoid foreshortening of the chambers. If the user is close to getting a suitable view but the view is slightly off axis, the ultrasound base 120 in the system 100 in FIG. 1 or smart device A or smart device B in FIG. 2 may automatically adjust the view to make it suitable. If the transducer gets moved out of plane during compressions, the ultrasound base 120 in the system 100 in FIG. 1 or smart device A or smart device B in FIG. 2 may guide the user to correct the transducers positioning by re-triggering the view quality acquisition workflow or automatically adjust the view to keep the image centered. In some embodiments, an automated sweep may be obtained through robotic probe manipulation and signal path control feedback, such as when the ultrasound probe 110 or the ultrasound probe 210 are manipulated by a robot. For example, a robot may be configured to automatically control an ultrasound probe to capture a set of transesophageal echocardiography images. An optimal imaging plane for viewing cardiac anatomy may be identified based on interpreting the set of transesophageal echocardiography images.

[0048] At S335, a determination is made whether the view quality from interpreting the TEE image(s) at S330 is okay. If the view quality is determined to be poor (S335 = poor), at S337 guidance is generated and output and the method of FIG. 3 returns to S320. In some embodiments, if the views are close to being suitable but slightly off-axis, the system may automatically adjust the view to make it suitable without requiring the guidance at S337. Key characteristic of the view quality would be to visualize fully the chambers, valves and tissue surrounding clearly for interpretation. For example, with the Mid-esophageal 4-chamber view all four chambers should be adequately seen in order to accurately label the images, identify the presence or absence of cardiac activity, identify potentially treatable pathologies, characterize the type of cardiac activity, and perform quantitative analyses. View quality may also be determined based on the transducer positioning and clarity of the image. For example, a good quality mid- esophageal long axis image should have proper alignment to display the long axis of the heart in a single plane without excessive angulation or foreshortening. Moreover, the mid-esophageal long axis view could be defined by having adequate image depth to visualize the entire length ofthe heart and surrounding structures, such as the ascending aorta and aortic arch, and be free from significant artifacts, such as shadowing, noise, or reverberation that could interfere with interpretation.

[0049] Once the first view is of good quality as determined at S335, the system 100 in FIG. 1 or the smart device A or smart device B in FIG. 2 may enable a preset called “focus view” which triggers some or all of the assistive features that are enabled by default, such as: customized display, labelling, disease state detection, compression monitoring, cardiac monitoring, and autosave. If at any time the transducer gets positioned out of frame, the acquisition assistance workflow may be retriggered. The customized display which is enabled may vary based on whether the transducer in the ultrasound probe 110 or the ultrasound probe 210 is a 2- dimensional transducer or a 3 -dimensional transducer. If the view quality is determined to be okay (S335 = okay), at S339 the view reflected in the TEE image(s) is classified.

[0050] Once a suitable view is obtained for interpretation and the view is classified, at S340 a determination is made as to whether to generate one or more label(s). The determination at S340 may be based, for example, on whether a current TEE image is both focused and includes relevant anatomical cardiological characteristics of the patient. The labels to be generated may be for different cardiac anatomical characteristics, such as for different cardiological chambers.

[0051] At S345, if the one or more label(s) are to be generated (S340 = Yes), the one or more label(s) is or are generated. The label(s) generated at S345 may be automatically generated as cardiac labels for anatomical cardiological characteristics of the patient. The labelling at S345 may be automatic and selective cardiac chamber labelling in relevant resuscitative TEE views based on the determination at S340.

[0052] Once the user has obtained a suitable view, the user may select a view acquisition tool tailored to the resuscitative TEE protocol. Imaging in multiple planes may be used to create a custom display of resuscitative TEE views for resuscitative monitoring. If a FoCUSed TEE view is selected, a custom display of resuscitative TEE views and diagnostic information may be presented to the user to provide a continuous monitor of myocardial activity and to guide decision making. By leveraging the multiplanar imaging capabilities of the 3D TEE transducer, the user may obtain a simultaneous view of the relevant imaging planes for FoCUSed TEE through a volumetric sweep. This may enable the user to identify reversible causes of cardiac arrest (likely found in the ME4Chamber view) and subsequently begin observing / optimizingcompressions in the MELAX view without having to move the transducer. If an omniplane TEE is used that does not have 3D imaging capabilities, the user may choose an “autosweep mechanism” where an automated sweep in the omniplane is done and the software chooses the best view for myocardial activity based on the clinical interpretation. For example, an automated sweep may be performed between the ME4CH view and MELAX view by having the software automatically steer the omniplane from 0 degrees to -130 degrees and select the best plane for resuscitation. The 2D workflow could also enable a “FoCUS view” where there is an automated workflow tailored to the resuscitation. For example, the workflow could start in the ME4Ch view to check for reversible causes of cardiac arrest and then automatically go to the next view to begin compressions without the user needing to manipulate the transducer. In some embodiments, an automated sweep may be obtained through robotic probe manipulation, such as when the ultrasound probe 110 or the ultrasound probe 210 are manipulated by a robot. For example, a robot may be configured to automatically control an ultrasound probe to capture a set of transesophageal echocardiography images. An optimal imaging plane for viewing cardiac anatomy may be identified based on interpreting the set of transesophageal echocardiography images.

[0053] Customized displays for 2-dimensional and 3 -dimensional TEE imaging may vary as shown in and explained below with reference to Figure 4A and 4B, respectively. If the user has a 3 -dimensional TEE ultrasound probe, volumetric imaging may enable the simultaneous display of multiple planes of the heart. Each plane may represent an imaging view within the TEE resuscitation protocol and convey relevant information on disease states / clinical decisions that are noted in the table in FIG. 5. As an example, the ME4CH view shown in the user interface 481 in FIG. 4A may be reviewed first to detect reversible causes of cardiac arrest. Subsequently, the user may begin chest compressions and move the transducer to the MELAX as shown in a second view 481B to look at the left ventricle and other disease states (box labels info on disease states). In a FoCUS view, a soft button 481 J which is preset and selectable to be used as a FoCUS view button, these two views can be displayed side by side with relevant information on disease states, compression quality, and detection of cardiac events as shown in Figure 4A. If technically feasible, all relevant TEE views may be displayed simultaneously by leveraging the multiplanar image capabilities of a 3 -dimensional TEE ultrasound probe. If the transducer is moved out of plane during compressions, the user may be guided to correct the transducerspositioning by re-triggering the view quality acquisition workflow provided by the window 481H used for acquisition guidance or the view may be automatically adjusted to keep the image centered. If the user has a 2-dimensional TEE ultrasound probe, the customized display may be more of a workflow automation where the display automatically progresses to the next view in the protocol by automatically adjusting the omni plane rather than the user having to adjust the transducer. This can be shown with respect to Figure 4B. For example, two common views in the resuscitation protocol are the ME4CH view for identifying disease states and the MELAX for performing compressions. The only difference between these two views is an adjustment in the omniplane from 0 degrees to -130 degrees. So, for example, at the start of the protocol the system 100 in FIG. 1 or smartphone A or smartphone B in FIG. 2 may attempt to detect any reversible causes of cardiac arrest in the ME4CH view. If none are identified, the omniplane may be automatically tilted to the MELAX view and the user may be notified to begin compressions.

[0054] At S350, if the one or more label(s) are not to be generated (S340 = No) or otherwise after generating the one or more label(s) at S345, a determination is made whether a disease state can be identified. The processor 152 or the processor 252 or smart device A or smart device B may be configured to detect a clinical disease state associated with cardiac arrest based on interpreting each of a plurality of transesophageal echocardiography images at S330. The determination at S350 may be based on view quality from S335, such as whether anatomical characteristics are in view, whether the view is properly focused, and other qualitative characteristics of a view. Examples of a disease state that can be detected include disease states associated with the cardiac arrest. Such disease states include, for example, right ventricle (RV) collapse, left ventricle (LV) collapse, ventricular fibrillation (VF), asystole, cardiac tamponade, hemothorax, pulmonary embolism, and pericardial effusion. Similarly, the determination at S350 may reflect whether cardiac standstill can be identified. An example of the labelling at S350 is shown in FIG. 5, and the use of the labelling at S350 is automated and may reduce the time for users during a critical life-saving event.

[0055] If the disease state can be identified (S350 = Yes), at S360 a determination is made whether the patient is suffering from cardiac standstill. Cardiac standstill is known as asystole, and once identified medical personnel may be provided visual and audio queues on timing on standstill. The timing may start at S365 when a timer is started. In cases of asystole, the system 100 or the system 200 may detect the absence of cardiac activity, alert the user, andautomatically time the duration in which asystole occurs.

[0056] If the disease state cannot be identified (S350 = No), at S380 guidance is generated. The guidance may be generated and output to reassure medical personnel that a cardiological disease state is not identifiable from the TEE imaging, though guidance may also indicate when the TEE imaging can be improved if there is a possibility that the absence of a disease state identification is based on deficiencies in the TEE imaging.

[0057] At S365, if the patient is suffering from cardiac standstill (S360 = Yes), a timer is started to measure duration of the cardiac standstill. The timer may bs used as a function of a cardiac event monitor to alert when cardiac standstill (asystole) is identified and to track the duration. An indication of the duration of the cardiac standstill may be output in the guidance once for each transesophageal echocardiography images or continuously as a running output.

[0058] If the patient is not suffering from cardiac standstill (S360 = No) or otherwise after starting the timer is started at S365, disease state information is generated at S370. The disease state information may simply reflect a determined disease state identified at S350.

[0059] If a disease state cannot be identified (S350 = No) or otherwise after generating disease state information at S370, guidance is generated at S380. Guidance may include suggestions for capturing an additional transesophageal echocardiography image based on the interpreting at S330 or may include reassurance that a cardiological disease state is not identified from the transesophageal echocardiography imaging in FIG. 3.

[0060] At S385 the guidance is autosaved. The autosaving at S385 may be for record keeping. TEE may be used to make a differential diagnosis between ventricular fibrillation and asystole (cardiac standstill). Autosave be enabled and triggered when cardiac events are detected.Autosaving saves time for the user in acquisition and documentation, allowing the user to place greater focus on effective resuscitation of the patient in extremis. The autosaving may be performed for a subset of transesophageal echocardiography images corresponding to a detected cardiac event and metadata for the subset of transesophageal echocardiography images. For example, metadata may include information of the time and date each image is taken, the sequential location of each image in a sequence, the patient name or other identification information, the identified disease state, and any guidance that was provided with the image.

[0061] At S390, the TEE image(s) and guidance is or are output. Each of a plurality of transesophageal echocardiography images may be output individually or as a set. The guidancemay be for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images. For example, one or more first transesophageal echocardiography image(s) may be used as the basis for capturing one or more subsequent second transesophageal echocardiography image(s). The output at S390 may provide automated acquisition assistance in real-time or near real-time to obtain the proper acoustic window during a single TEE imaging session. The assistance provided in the method of FIG. 3 may be automated so as to assist a user in acquiring a proper acoustic view as feedback during an emergency or critical care context. The steps in the method of FIG. 3 may be developed for acquisition and interpretation within each of the 4 to 12 views of a resuscitative TEE protocol, and together provide guidance tailored to improve the quality of TEE resuscitation.

[0062] In some embodiments, a clinical disease state identified at S350 may also be output at S390 as part of the guidance. Identifying a clinical disease state as part of guidance in an emergency may lead to an immediate change in treatment. For example, when performing the resuscitative TEE protocol on a patient presenting symptoms associated with cardiogenic or obstructive shock(such as shortness of breath, chest pain, or syncope), the user may start in the Mid-Esophageal 4 chamber view to rule out the presence of pericardial effusion or tamponade. A pericardial effusion is a condition where there is accumulation of excess fluid in the pericardial sac surrounding the heart. This buildup of fluid can induce cardiac tamponade, which is a life- threatening condition where an increased pressure from the surrounding fluid in the pericardial sac impairs ventricular filling and the heart is unable to pump out enough blood. In cases associated with tamponade, the physician may choose to perform a pericardiocentesis, which is a life-saving procedure to remove the excess fluid in the pericardial sac using a needle or small catheter. Relieving this pressure can help reduce the risk of asystole and help relieve symptoms of cardiogenic shock by returning stroke volume to normal levels. This allows for greater time for the physician to determine the cause of the condition.

[0063] In some embodiments, identification of a disease state at S350 may result in a selection of a protocol or a change to a previous selection of a protocol being used to resuscitate a patient. Also, or alternatively, in some embodiments, checking of view quality at S335 may detect that placement of a TEE probe may be improved so as to improve the view quality.

[0064] While the steps of FIG. 3 are shown as a method flow, some, or all of the steps in FIG. 3may be performed in a different order or simultaneously. For example, TEE image(s) may be received one at a time and individually processed so that a first TEE image is being interpreted at S330 as a second TEE image is being received at S320. As another example, the autosaving at S385 may be performed after a procedure is completed or after a set number of TEE image(s) are processed, or both simultaneously and sequentially. As yet another example, a determination whether a disease state can be identified may be performed individually for each TEE image at S350 and / or also for a set of multiple TEE images together at S350.

[0065] Although the method of FIG. 3 is shown primarily as a sequence, some of the features may be performed simultaneously and repeatedly. For example, TEE image(s) may continue to be received at S320 and interpreted at S330 as feedback for previous TEE image(s) is generated at S380. Similarly, functions such as auto-sweeping may be performed automatically based on interpretations at S330, though the results of such auto-sweeping may be new TEE image(s) to be received at S320. Additionally, some or most of the features in FIG. 3 may be implemented as a preset configuration where all of the various assistive features are enabled by default and the user can begin performing resuscitation.

[0066] A resuscitative TEE protocol using the method of FIG. 3 may involve multiple cycles of CPR and pulse checks. During each CPR cycle, the TEE imaging may be used to check for any signs of reversible causes of cardiac arrest so that the user may be notified, and feedback may be provided for compression quality. When CPR is in progress, a user may check for any reversible causes of cardiac arrest in the ME4CH. Although a FoCUS view is not specified in FIG. 3, some embodiments based on the method of FIG. 3 may include an option for FoCUS view(s). For example, if no signs of reversible causes of cardiac arrest are identified, the FoCUS view(s) may highlight the MELAX view and CPR compressions may begin. Compression quality may be monitored, giving the user a countdown on compressions, and highlighting relevant hemodynamic information. The user may be oriented back to the ME4CH view (a) and helped to perform a pulse check to determine the presence of a shockable rhythm. If no shockable rhythm is identified, the presence of potential cardiac arrhythmias(e) such as asystole, pseudo pulseless electrical activity or pulseless electrical activity may be highlighted. If asystole is detected, the cardiac event may be detected until a timer expires and the information is autosaved. The user may perform additional cycles of CPR and the same workflow may be triggered for monitoring compression quality, and other parts of the body may be monitored for other causes of cardiacarrest. If asystole is detected, the system 100 or smart device A or smart device B may recommend that the user terminate resuscitation. If there is a return of spontaneous circulation detected, the user may be guided on post-cardiac arrest care.

[0067] FIG. 4A illustrates a user interface showing the results of a multiplanar sweep in TEE- based resuscitative guidance, in accordance with a representative embodiment.

[0068] The user interface 481 in FIG. 4A shows a Focus TEE workflow for a 3D TEE transducer. The user interface 481 in FIG. 4A can include one view shown as the first view 481 A or the second view 48 IB or multiple views showing both of the first view 481 A and the second view 481B simultaneously, a CPR timer 481E, a hemodynamic monitor 481F, a visualization of an interpretation of TEE image(s) or protocol guidance as feedback 481 G, window 481H used for acquisition guidance to show view quality as good or poor, a soft button 4811 for autolabelling, a soft button 481 J to select a FoCUS view, and a soft button 48 IK to save one or more views on the user interface 481. For example, two plane views may be obtained simultaneously with a 3-dimensional TEE, and three views may be obtained with an automated probe manipulation to obtain a Bicaval view. The first view 481 A in FIG. 4A represents a Mid esophageal 4 Chamber view. Each of the first view 481 A, the second view 48 IB, may include an image, and collectively the images illustrate the concept of an automated sweep through two or more key views associated with focused TEE resuscitation. From top to bottom, the first view 481 A shows a mid-esophageal 4-chamber (ME4C) view, the second view 481B shows a mid- esophageal long axis (MELAX) and the third shows a Mid Esophageal Bicaval View. By leveraging the multiplanar imaging capability of the three-dimensional TEE transducer, an ultrasound probe may automatically sweep and highlight the optimal imaging plane for the scope of the resuscitation. For example, an automated sweep may scan through two or more resuscitative TEE cardiac views at the push of a physical / soft button or just happen automatically with a display highlighting that auto-sweep is engaged so the user may quickly assess for any reversible causes of cardiac arrest and then intervene. By eliminating the need for the user to manipulate the transducer using this automated sweeping capability, time for a TEE exam in an emergency or critical care context may be saved and efficacy of resuscitation interventions may be improved.

[0069] The user interface 481 in FIG 4A. includes three labeled images labelled as image 481a, image 481b, and image 481c. Image 481a includes four labels including LA, LV, RA, and RVfor a midesophageal 4-chamber view. Image b includes four labels including LA, LV, Ao, and RV for a midesophageal long axis view. Image c includes four labels including LA, SVC, IAS, and RA for a midesophageal bicaval view. The labels may be applied automatically using a feature detection model that checks views and characteristics of each image and then applies labels as shown on the user interface 581.

[0070] The user interface 481 in Figure 4A provides an example automatic cardiac chamber labelling in two or more views associated with current resuscitative TEE protocols and is catered towards resuscitation TEE. The feature labelling may prioritize labelling in the four most commonly used views of focused transesophageal echocardiography (TEE) during cardiac arrest resuscitation. The four most commonly used views of focused TEE during cardiac arrest resuscitation include midesophageal 4 chamber (ME4C), midesophageal long axis (MELAX), transgastric short axis (TGSAX) and bicaval. However, the labelled views are not limited to this set.

[0071] FIG. 4B illustrates another user interface in TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0072] The user interface 491 in FIG. 4B shows a TEE workflow for a 2-dimensional TEE transducer with an adjustment in the omniplane to switch between views. The user interface 491 includes a disease state window 491 A, an instruction window 49 IB, and a CPR monitoring window 491 C. The disease state window 491 A includes a TEE image with labels, a view quality indicator, a disease state indicator, and a soft button top perform a “FoCUS View”. The instruction window 49 IB shows a progression for the order of TEE views to be obtained. The CPR monitoring window 491 C includes a CPR timer, a compression count, compression feedback, and hemodynamic parameters.

[0073] FIG. 4C illustrates a hybrid flow for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0074] The hybrid flow in FIG. 4C includes a 3 -dimensional sweep capability. In the workflow in FIG. 4C, the user first achieves a sufficient view to enable a FoCUS sweep to scan for reversible causes of cardiac arrest. The user may press a soft auto sweep button shown on the left. The auto sweep function results in an automatic sweep in planes and results in image a, image b, and image c. In other embodiments, the auto sweep may be engaged automatically, and the soft button may be highlighted so that the user understands that the autosweep is on. Next,frames are processed for potential disease states. The best view is identified and chosen. The user interface on the right in FIG. 4C shows that view quality is good and identifies a disease state as suspected right atrial thrombus.

[0075] For the workflow in FIG. 4C, the controller 150 or the controller 250 may provide autoview selection by leveraging the multiplanar imaging capabilities of a three-dimensional transesophageal echocardiography probe such as the ultrasound probe 110 or the ultrasound probe 210 and the automatic robotic assist to obtain a Bicaval view. As a time-critical exam, the auto- view selection may expand the use of resuscitative TEE acquisition by lowering the training barrier of entry required to obtain the correct proper acoustic window.

[0076] FIG. 5 illustrates a user interface showing a Table with sets of corresponding information for TEE-based resuscitative guidance, in accordance with a representative embodiment.

[0077] Table 1 on user interface 581 in FIG. 5 provides information of clinical applications of focused TEE views in cardiac arrest. Table 1 shows an example of the clinical pathologies that can be detected in each of the 4 resuscitative views and how it can be highlighted to the user.

[0078] Some clinical pathologies can be identified in one or more of the different focused TEE views used for focused TEE cardiac resuscitation. These disease states may include but are not limited to cardiac tamponade, ventricular fibrillation identification, asystole, cardiogenic shock, RV dilation, pericardial effusion, intra-cardiac thrombus, pulmonary embolism, aortic dissection, wall motion abnormalities, hypovolemia, pulseless electrical activity(PEA), pseudo-PEA, and ventricular arrhythmias.

[0079] Insofar as a first step of the resuscitation TEE protocol is to detect potential reversible causes of cardiac arrest, detection of abnormalities associated with cardiogenic disease states that can be found in each of the resuscitative TEE cardiac views may provide important information to medical personnel performing resuscitation TEE. Table 1 in FIG. 5 provides examples of relevant structures identified, questions answered, and clinical decisions made in a focused TEE protocol. Feature detection of relevant cardiogenic states may support the user’s decision-making in ruling out potential causes of cardiac arrest. Identification of the presence or absence of some of these clinically significant disease states may be achieved through feature detection and image classification models commonly used in deep learning techniques and applied by the controller 150 or the controller 250. For example, a trained neural network algorithm may be trained to identify cardiac pathologies, such as fine ventricular fibrillation or cardiac tamponade, based onan annotated dataset of images acquired in the relevant resuscitative TEE views.

[0080] FIG. 6 illustrates a computer system, on which a method for TEE-based resuscitative guidance is implemented, in accordance with another representative embodiment.

[0081] Referring to FIG. 6, computer system 600 includes a set of software instructions that can be executed to cause the computer system 600 to perform any of the methods or computer-based functions disclosed herein. The software instructions may include an image classification model and / or a feature detection model used to classify ultrasound images and detect features in ultrasound images. The computer system 600 may operate as a standalone device or may be connected, for example, using a network 601, to other computer systems or peripheral devices. In embodiments, a computer system 600 performs logical processing based on digital signals received via an analog-to-digital converter.

[0082] In a networked deployment, the computer system 600 operates in the capacity of a server or as a client user computer in a server-client user network environment, or as a peer computer system in a peer-to-peer (or distributed) network environment. The computer system 600 can also be implemented as or incorporated into various devices, such as an ultrasound base, an ultrasound probe, a smart device, a workstation that includes a controller, a stationary computer, a mobile computer, a personal computer (PC), a laptop computer, a tablet computer, or any other machine capable of executing a set of software instructions (sequential or otherwise) that specify actions to be taken by that machine. The computer system 600 can be incorporated as or in a device that in turn is in an integrated system that includes additional devices. In an embodiment, the computer system 600 can be implemented using electronic devices that provide voice, video, or data communication. Further, while the computer system 600 is illustrated in the singular, the term “system” shall also be taken to include any collection of systems or sub-systems that individually or jointly execute a set, or multiple sets, of software instructions to perform one or more computer functions.

[0083] As illustrated in FIG. 6, the computer system 600 includes a processor 610. Processor 610 may be considered a representative example of a processor of a controller and executes instructions to implement some, or all aspects of methods and processes described herein. The processor 610 is tangible and non-transitory. As used herein, the term “non-transitory” is to be interpreted not as an eternal characteristic of a state, but as a characteristic of a state that will last for a period. The term “non-transitory” specifically disavows fleeting characteristics such as 1characteristics of a carrier wave or signal or other forms that exist only transitorily in any place at any time. The processor 610 is an article of manufacture and / or a machine component. The processor 610 is configured to execute software instructions to perform functions as described in the various embodiments herein. The processor 610 may be a general-purpose processor or may be part of an application specific integrated circuit (ASIC). The processor 610 may also be a microprocessor, a microcomputer, a processor chip, a controller, a microcontroller, a digital signal processor (DSP), a state machine, or a programmable logic device. The processor 610 may also be a logical circuit, including a programmable gate array (PGA), such as a field programmable gate array (FPGA), or another type of circuit that includes discrete gate and / or transistor logic. The processor 610 may be a central processing unit (CPU), a graphics processing unit (GPU), or both. Additionally, any processor described herein may include multiple processors, parallel processors, or both. Multiple processors may be included in, or coupled to, a single device or multiple devices.

[0084] The term “processor” as used herein encompasses an electronic component able to execute a program or machine executable instruction. References to a computing device comprising “a processor” should be interpreted to include more than one processor or processing core, as in a multi-core processor. A processor may also refer to a collection of processors within a single computer system or distributed among multiple computer systems. The term computing device should also be interpreted to include a collection or network of computing devices each including a processor or processors. Programs have software instructions performed by one or multiple processors that may be within the same computing device or which may be distributed across multiple computing devices.

[0085] The computer system 600 further includes a main memory 620 and a static memory 630, where memories in the computer system 600 communicate with each other and the processor 610 via a bus 608. Either or both of the main memory 620 and the static memory 630 may be considered representative examples of a memory of a controller, and store instructions used to implement some, or all aspects of methods and processes described herein. Memories described herein are tangible storage mediums for storing data and executable software instructions and are non-transitory during the time software instructions are stored therein. As used herein, the term “non-transitory” is to be interpreted not as an eternal characteristic of a state, but as a characteristic of a state that will last for a period. The term “non-transitory” specificallydisavows fleeting characteristics such as characteristics of a carrier wave or signal or other forms that exist only transitorily in any place at any time. The main memory 620 and the static memory 630 are articles of manufacture and / or machine components. The main memory 620 and the static memory 630 are computer-readable mediums from which data and executable software instructions can be read by a computer (e.g., the processor 610). Each of the main memory 620 and the static memory 630 may be implemented as one or more of random access memory (RAM), read only memory (ROM), flash memory, electrically programmable read only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), registers, a hard disk, a removable disk, tape, compact disk read only memory (CD-ROM), digital versatile disk (DVD), floppy disk, blu-ray disk, or any other form of storage medium known in the art. The memories may be volatile or non-volatile, secure and / or encrypted, unsecure and / or unencrypted.

[0086] “Memory” is an example of a computer-readable storage medium. Computer memory is any memory which is directly accessible to a processor. Examples of computer memory include, but are not limited to RAM memory, registers, and register files. References to “computer memory” or “memory” should be interpreted as possibly being multiple memories. The memory may for instance be multiple memories within the same computer system. The memory may also be multiple memories distributed amongst multiple computer systems or computing devices.

[0087] As shown, the computer system 600 further includes a video display unit 650, such as a liquid crystal display (LCD), an organic light emitting diode (OLED), a flat panel display, a solid-state display, or a cathode ray tube (CRT), for example. Additionally, the computer system 600 includes an input device 660, such as a keyboard / virtual keyboard or touch-sensitive input screen or speech input with speech recognition, and a cursor control device 670, such as a mouse or touch-sensitive input screen or pad. The computer system 600 also optionally includes a disk drive unit 680, a signal generation device 690, such as a speaker or remote control, and / or a network interface device 640.

[0088] In an embodiment, as depicted in FIG. 6, the disk drive unit 680 includes a computer- readable medium 682 in which one or more sets of software instructions 684 (software) are embedded. The sets of software instructions 684 are read from the computer-readable medium 682 to be executed by the processor 610. Further, the software instructions 684, when executed by the processor 610, perform one or more steps of the methods and processes as described herein. In an embodiment, the software instructions 684 reside all or in part within the mainmemory 620, the static memory 630 and / or the processor 610 during execution by the computer system 600. Further, the computer-readable medium 682 may include software instructions 684 or receive and execute software instructions 684 responsive to a propagated signal, so that a device connected to a network 601 communicates voice, video, or data over the network 601. The software instructions 684 may be transmitted or received over the network 601 via the network interface device 640.

[0089] In an embodiment, dedicated hardware implementations, such as application-specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), programmable logic arrays and other hardware components, are constructed to implement one or more of the methods described herein. One or more embodiments described herein may implement functions using two or more specific interconnected hardware modules or devices with related control and data signals that can be communicated between and through the modules. Accordingly, the present disclosure encompasses software, firmware, and hardware implementations. Nothing in the present application should be interpreted as being implemented or implementable solely with software and not hardware such as a tangible non-transitory processor and / or memory.

[0090] In accordance with various embodiments of the present disclosure, the methods described herein may be implemented using a hardware computer system that executes software programs. Further, in an exemplary, non-limited embodiment, implementations can include distributed processing, component / object distributed processing, and parallel processing. Virtual computer system processing may implement one or more of the methods or functionalities as described herein, and a processor described herein may be used to support a virtual processing environment.

[0091] Accordingly, TEE-based resuscitative guidance enables automated guidance for users using TEE. While the teachings herein are primarily described in the context of emergencies, such as for paramedics or emergency room professionals, the teachings herein may be used in other contexts such as for intubated patients undergoing cardiac or high-risk surgery and postsurgery in the cardiac or surgical intensive care unit.

[0092] Although TEE-based resuscitative guidance has been described with reference to several exemplary embodiments, it is understood that the words that have been used are words of description and illustration, rather than words of limitation. Changes may be made within the purview of the appended claims, as presently stated, and as amended, without departing from thescope and spirit of TEE-based resuscitative guidance in its aspects. Although TEE-based resuscitative guidance has been described with reference to particular means, materials and embodiments, TEE-based resuscitative guidance is not intended to be limited to the particulars disclosed; rather TEE-based resuscitative guidance extends to all functionally equivalent structures, methods, and uses such as are within the scope of the appended claims.

[0093] The illustrations of the embodiments described herein are intended to provide a general understanding of the structure of the various embodiments. The illustrations are not intended to serve as a complete description of all of the elements and features of the disclosure described herein. Many other embodiments may be apparent to those of skill in the art upon reviewing the disclosure. Other embodiments may be utilized and derived from the disclosure, such that structural and logical substitutions and changes may be made without departing from the scope of the disclosure. Additionally, the illustrations are merely representational and may not be drawn to scale. Certain proportions within the illustrations may be exaggerated, while other proportions may be minimized. Accordingly, the disclosure and the figures are to be regarded as illustrative rather than restrictive.

[0094] One or more embodiments of the disclosure may be referred to herein, individually and / or collectively, by the term “invention” merely for convenience and without intending to voluntarily limit the scope of this application to any particular invention or inventive concept. Moreover, although specific embodiments have been illustrated and described herein, it should be appreciated that any subsequent arrangement designed to achieve the same or similar purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all subsequent adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the description.

[0095] The Abstract of the Disclosure is provided to comply with 37 C.F.R. § 1.72(b) and is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing Detailed Description, various features may be grouped together or described in a single embodiment for the purpose of streamlining the disclosure. This disclosure is not to be interpreted as reflecting an intention that the claimed embodiments require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter may be directed to less than all of the featuresof any of the disclosed embodiments. Thus, the following claims are incorporated into the Detailed Description, with each claim standing on its own as defining separately claimed subject matter.

[0096] The preceding description of the disclosed embodiments is provided to enable any person skilled in the art to practice the concepts described in the present disclosure. As such, the above disclosed subject matter is to be considered illustrative, and not restrictive, and the appended claims are intended to cover all such modifications, enhancements, and other embodiments which fall within the true spirit and scope of the present disclosure. Thus, to the maximum extent allowed by law, the scope of the present disclosure is to be determined by the broadest permissible interpretation of the following claims and their equivalents and shall not be restricted or limited by the foregoing detailed description.

Claims

CLAIMS:

1. An ultrasound system (100 / 200) for resuscitative transesophageal echocardiography, comprising: a memory (151 / 251) that stores instructions; and a processor (152 / 252) that executes the instructions, wherein, when executed by the processor, the instructions cause the ultrasound system to: receive (S320) a plurality of transesophageal echocardiography images during resuscitative transesophageal echocardiography; interpret (S330) each of the plurality of transesophageal echocardiography images; output (S390) each of the plurality of transesophageal echocardiography images; and generate (S380) and output (S390) guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.

2. The ultrasound system of claim 1, wherein, when executed by the processor, the instructions further cause the ultrasound system to: generate (S345) at least one label for at least one cardiac chamber in at least one transesophageal echocardiography image of the plurality of transesophageal echocardiography images; and output (S390) the at least one transesophageal echocardiography image with the at least one label for the at least one cardiac chamber.

3. The ultrasound system of claim 2, wherein, when executed by the processor, the instructions further cause the ultrasound system to: selectively identify (S340) which of the plurality of transesophageal echocardiography images to label.

4. The ultrasound system of claim 1, wherein, when executed by the processor, the instructions further cause the ultrasound system to:detect (S350) a clinical disease state associated with cardiac arrest based on interpreting each of the transesophageal echocardiography images; and output (S390) the clinical disease state.

5. The ultrasound system of claim 4, wherein the clinical disease state is detected based on identifying abnormalities associated with the clinical disease state in at least one of the transesophageal echocardiography images.

6. The ultrasound system of claim 1, wherein, when executed by the processor, the instructions further cause the ultrasound system to: detect (S335) view quality based on interpreting each of the plurality of transesophageal echocardiography images, wherein the guidance includes instructions for improving the view quality.

7. The ultrasound system of claim 6, wherein the view quality is detected by applying an image classification model to each of the plurality of transesophageal echocardiography images and detecting and quantifying predetermined anatomical features in each of the plurality of transesophageal echocardiography images to determine the guidance to output.

8. The ultrasound system of claim 1, wherein the guidance includes instructions for obtaining an acoustic window.

9. The ultrasound system of claim 1, wherein, when executed by the processor, the instructions further cause the ultrasound system to: identify (S360) cardiac standstill based on interpreting each of the plurality of transesophageal echocardiography images; measure (S365) duration of the cardiac standstill; and output (S390) an indication of the duration of the cardiac standstill in the guidance.

10. The ultrasound system of claim 1, further comprising: a display (180 / Smart Device A and / or Smart Device B) for outputting the plurality of transesophageal echocardiography images and the guidance.

11. The ultrasound system of claim 1, wherein, when executed by the processor, the instructions further cause the ultrasound system to: automatically control (S335 = No) an ultrasound probe to capture a set of transesophageal echocardiography images among the plurality of transesophageal echocardiography images; and identify an optimal imaging plane for viewing cardiac anatomy based on interpreting the set of transesophageal echocardiography images among the plurality of transesophageal echocardiography images.

12. The ultrasound system of claim 1, wherein, when executed by the processor, the instructions further cause the ultrasound system to: autosave (S385) a subset of transesophageal echocardiography images corresponding to a detected cardiac event and metadata for the subset of transesophageal echocardiography images.

13. A method of operating an ultrasound system for resuscitative transesophageal echocardiography comprising a memory that stores instructions and a processor that executes the instructions, the method comprising: receiving (S320) a plurality of transesophageal echocardiography images during resuscitative transesophageal echocardiography; interpreting (S330) each of the plurality of transesophageal echocardiography images; outputting (S390) each of the plurality of transesophageal echocardiography images; and generating (S380) and outputting (S390) guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.

14. The method of claim 13, further comprising: generating (S345) at least one label for at least one cardiac chamber in at least one transesophageal echocardiography image of the plurality of transesophageal echocardiography images;outputting (S390) the at least one transesophageal echocardiography image with the at least one label for the at least one cardiac chamber; and selectively identifying (S340) which of the plurality of transesophageal echocardiography images to label.

15. The method of claim 13, further comprising: detecting (S350) a clinical disease state associated with cardiac arrest based on interpreting each of the transesophageal echocardiography images; and outputting (S390) the clinical disease state, wherein the clinical disease state is detected based on identifying abnormalities associated with the clinical disease state in at least one of the transesophageal echocardiography images.

16. The method of claim 13, further comprising: detecting (S335) view quality based on interpreting each of the plurality of transesophageal echocardiography images, wherein the guidance includes instructions for improving the view quality, wherein the view quality is detected by applying an image classification model to each of the plurality of transesophageal echocardiography images and detecting and quantifying predetermined anatomical features in each of the plurality of transesophageal echocardiography images to determine the guidance to output.

17. The method of claim 13, wherein the guidance includes instructions for obtaining an acoustic window.

18. The method of claim 13, further comprising: identifying (S360) cardiac standstill based on interpreting each of the plurality of transesophageal echocardiography images; measuring (S365) duration of the cardiac standstill; and outputting (S390) an indication of the duration of the cardiac standstill in the guidance.

19. The method of claim 13, further comprising:automatically controlling (S335 = No) by a robot an ultrasound probe to capture a set of transesophageal echocardiography images among the plurality of transesophageal echocardiography images; and identifying an optimal imaging plane for viewing cardiac anatomy based on interpreting the set of transesophageal echocardiography images among the plurality of transesophageal echocardiography images.

20. The method of claim 13, further comprising: autosaving (S385) a subset of transesophageal echocardiography images corresponding to a detected cardiac event and metadata for the subset of transesophageal echocardiography images.

21. A tangible, non-transitory computer-readable medium that stores instructions for resuscitative transesophageal echocardiography, which when executed by a processor, cause the processor to: receive (S320) a plurality of transesophageal echocardiography images during resuscitative transesophageal echocardiography; interpret (S330) each of the plurality of transesophageal echocardiography images; output (S390) each of the plurality of transesophageal echocardiography images; and generate (S380) and output (S390) guidance for capturing an additional transesophageal echocardiography image based on interpreting each of the plurality of transesophageal echocardiography images.

Images