WO2017072055A1 - Système et procédé de surveillance d'impulsion spontanée et de compressions au moyen de la pression artérielle endovasculaire pendant une réanimation cardio-pulmonaire - Google Patents

Système et procédé de surveillance d'impulsion spontanée et de compressions au moyen de la pression artérielle endovasculaire pendant une réanimation cardio-pulmonaire Download PDF

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Publication number
WO2017072055A1
WO2017072055A1 PCT/EP2016/075472 EP2016075472W WO2017072055A1 WO 2017072055 A1 WO2017072055 A1 WO 2017072055A1 EP 2016075472 W EP2016075472 W EP 2016075472W WO 2017072055 A1 WO2017072055 A1 WO 2017072055A1
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iabp
signal
cpr
component
chest compressions
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PCT/EP2016/075472
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English (en)
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Ralph Wilhelm Christianus Gemma Rosa WIJSHOFF
Jens MÜHLSTEFF
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Koninklijke Philips N.V.
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Publication of WO2017072055A1 publication Critical patent/WO2017072055A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H31/00—Artificial respiration or heart stimulation, e.g. heart massage
    • A61H31/004—Heart stimulation
    • A61H31/005—Heart stimulation with feedback for the user
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2505/00—Evaluating, monitoring or diagnosing in the context of a particular type of medical care
    • A61B2505/01—Emergency care
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient ; user input means
    • A61B5/742—Details of notification to user or communication with user or patient ; user input means using visual displays
    • A61B5/7425—Displaying combinations of multiple images regardless of image source, e.g. displaying a reference anatomical image with a live image
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/01—Constructive details
    • A61H2201/0173—Means for preventing injuries
    • A61H2201/0184—Means for preventing injuries by raising an alarm
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5023—Interfaces to the user
    • A61H2201/5043—Displays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5058—Sensors or detectors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5058—Sensors or detectors
    • A61H2201/5061—Force sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5058—Sensors or detectors
    • A61H2201/5084—Acceleration sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/04—Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
    • A61H2230/06—Heartbeat rate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/30—Blood pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H31/00—Artificial respiration or heart stimulation, e.g. heart massage
    • A61H31/004—Heart stimulation
    • A61H31/006—Power driven

Definitions

  • FIELD The following relates generally to the medical arts, medical emergency response arts, patient monitoring arts, cardiopulmonary resuscitation arts, and related arts.
  • Cardiopulmonary resuscitation is indicated for cardiac arrest and is applied by manual chest compressions and rescue breaths.
  • Automated CPR devices employing a compression robot are also known.
  • the goal of CPR is to achieve return of spontaneous circulation (ROSC) in which the beating heart drives life-sustaining blood circulation.
  • ROSC spontaneous circulation
  • Quantitative blood pressure measurement is a key metric in assessing ROSC; however the blood pressure needed to provide life- sustaining circulation is variable from one patient to the next.
  • ROSC spontaneous circulation
  • the clinician should evaluate other factors such as skin color, patient age, overall appearance, and so forth.
  • VF Ventricular fibrillation
  • AED automated external defibrillator
  • Modern AED units are highly automated, and include an electrocardiography (ECG) signal and signal processing that automatically assesses the cardiac rhythm.
  • ECG electrocardiography
  • the AED recommends defibrillation only if a "shockable" rhythm is detected, and the AED may be programmed to deliver the shock only if a shockable rhythm is detected.
  • Appropriate emergency care for a person suffering from cardiac distress requires rapid and accurate assessment of the state of the heart.
  • a person in cardiac arrest should always receive CPR, whereas it depends on the electrical activity of the heart if electric defibrillation should be applied in conjunction with CPR.
  • CPR chest compressions are continued after ROSC is achieved, the continued chest compressions can result in re-arrest via compression-induced re-fibrillation.
  • the ECG component of the AED generally does not provide reliable detection of ROSC, because cardiac electrical activity, even if organized, does not necessarily translate into physical heart contractions effective to deliver life-sustaining circulation.
  • Manual palpation to detect arterial pulsations is the method currently employed most to assess whether the patient has ROSC.
  • the wrist, femoral or carotid artery is usually palpated for this purpose.
  • manual palpation cannot distinguish between a spontaneous pulse and blood circulation driven by CPR chest compressions. Therefore, chest compressions must be stopped to allow for pulse check by palpation. Such interruptions reduce the effectiveness of the chest compressions, and a trade-off must be made between the goal of delivering continuous chest compressions and the goal of rapid detection of ROSC.
  • a cardiopulmonary resuscitation (CPR) monitoring device includes an invasive arterial blood pressure (iABP) transducer configured for connection with an arterial cannula or catheter to measure an iABP signal, a CPR chest compressions sensor configured to measure a CPR chest compressions signal, and one or more electronic processors programmed to: (i) extract a CPR chest compression rate from the CPR chest compressions signal; (ii) compute a CPR chest compressions component of the iABP signal by fitting to the iABP signal a harmonic series whose fundamental frequency is set to the CPR chest compression rate; and (iii) compute a compressions free component of the iABP signal as a difference between the iABP signal and the CPR chest compressions component of the iABP signal.
  • iABP invasive arterial blood pressure
  • the CPR monitoring device further includes a display component configured to display at least the compressions free component of the iABP signal, and in some embodiments is configured to display the CPR chest compressions component of the iABP signal and the compressions-free component of the iABP signal as parallel trend lines.
  • the one or more electronic processors may be further programmed to identify time intervals over which CPR chest compressions are interrupted in the CPR chest compressions signal, and set the CPR chest compressions component of the iABP signal to zero in operation (iii) during the identified time intervals over which CPR chest compressions are interrupted.
  • the one or more electronic processors may be further programmed to, prior to the computing operations (ii) and (iii), high-pass filter the iABP signal using a high-pass filter with a cut-off frequency of 0.7 Hz or lower.
  • the one or more electronic processors may be further programmed to detect a spontaneous pulse of amplitude greater than a ROSC-indication threshold amplitude and/or with a rate greater than a ROSC- indication threshold rate and/or with pulse intervals with variability below a ROSC-indication threshold variability in the compressions-free component of the iABP signal (30) and cause the display component to display an indication of ROSC and/or operate an alarm loudspeaker to sound in response to the detection.
  • the one or more electronic processors may be further programmed to detect the amplitude of the CPR chest compressions component of the iABP signal being lower than a minimum threshold and cause the display component to display an indication and loudspeaker to sound a message that deeper CPR chest compressions are needed in response to detecting the amplitude of the CPR chest compressions component of the iABP signal is lower than the minimum threshold, and to detect the rate of the CPR chest compressions component of the iABP signal being outside a target range and cause the display component to display an indication and loudspeaker to sound a message that faster / slower CPR chest compressions are needed in response to detecting the rate of the CPR chest compressions component of the iABP signal is outside the target range.
  • the foregoing CPR monitoring device embodiments may comprise a patient monitoring device including as a unitary assembly the display component and an electronic processor programmed to perform at least the computing operations (ii) and (iii).
  • a non-transitory storage medium stores instructions readable and executable by an electronic processing device to perform a CPR monitoring method comprising: computing a CPR chest compressions component of an invasive arterial blood pressure (iABP) signal by fitting to the iABP signal a harmonic series whose fundamental frequency is set to a CPR chest compression rate; and computing a compressions free component of the iABP signal as a difference between the iABP signal and the CPR chest compressions component of the iABP signal.
  • the CPR monitoring method may further include identifying time intervals over which CPR chest compressions are interrupted, and setting the CPR chest compressions component of the iABP signal to zero during the time intervals over which CPR chest compressions are interrupted.
  • the CPR monitoring method may further include, prior to the computing operations, high-pass filtering the iABP signal using a high-pass filter with a cut-off frequency of 0.7 Hz or lower.
  • One advantage resides in providing support for detection of ROSC during CPR chest compressions including quantitative assessment of blood pressure provided by the spontaneously beating heart. Another advantage resides in providing the foregoing advantage using medical diagnostics that are often already in place at the time of cardiac arrest of a hospitalized patient.
  • the invention may take form in various components and arrangements of components, and in various steps and arrangements of steps.
  • the drawings are only for purposes of illustrating the preferred embodiments and are not to be construed as limiting the invention.
  • FIGURE 1 diagrammatically illustrates a device for monitoring a subject undergoing cardiopulmonary resuscitation (CPR) using invasive arterial blood pressure (iABP).
  • CPR cardiopulmonary resuscitation
  • iABP invasive arterial blood pressure
  • FIGURE 2 diagrammatically illustrates an embodiment of the iABP compression component separator of the CPR monitoring device of FIGURE 1.
  • FIGURE 3 presents experimental porcine iABP data acquired using the CPR monitoring device of FIGURE 1 during cardiac arrest (left side) and after ROSC (right side).
  • a person 10 under cardiac arrest receives manual cardiopulmonary resuscitation (CPR) provided by an emergency responder 12.
  • FIGURE 1 illustrates the emergency responder 12 providing manual CPR chest compressions.
  • the emergency responder could strap a CPR compression robot 14 (if immediately available) onto the chest of the person 10 under cardiac arrest, and activate the CPR compression robot 14 to provide automated CPR chest compressions.
  • the person 10 under cardiac arrest also has an invasive arterial blood pressure (iABP) sensor connected.
  • the illustrative iABP sensor comprises an invasive arterial line including an arterial cannula or catheter 16 that is inserted into an artery of the patient 10 and attached fluid- filled tubing 18, typically filled with saline.
  • the end of the tubing 18 distal from the arterial cannula or catheter 16 is connected with a pressure transducer 20 (preferably with automatic flushing).
  • a pressure bag 22 is installed to maintain a pressurized fluid column.
  • the iAPB transducer 20 outputs an iABP signal 30 that can be quantitatively correlated with arterial blood pressure (both in terms of waveform and amplitude).
  • the iABP signal 30 can be obtained via a catheter with an electronic pressure-tip transducer which does not need a fluid-filled tubing, such as a Millar catheter.
  • the person 10 under cardiac arrest is typically a hospitalized patient in an intensive care unit (ICU), cardiac care unit (CCU), regular hospital room, or so forth, and the arterial line is commonly administered in such a hospital setting.
  • ICU intensive care unit
  • CCU cardiac care unit
  • regular hospital room or so forth
  • the person 10 may be located elsewhere, such as in an ambulance en-transit between medical facilities, or may be a non-hospitalized person who has collapsed due to cardiac arrest and the arterial line has been installed "in the field" by a doctor or other trained emergency responder.
  • the iABP signal 30 will exhibit pulsations due to CPR chest compressions delivered manually by the emergency responder 12 or by the CPR compression robot 14. If these CPR chest compressions are successful in achieving a return of spontaneous circulation (ROSC), then the spontaneous pulse generated by the beating heart will also manifest as pulsations in the iABP signal 30. However, during CPR chest compressions it is difficult or impossible for a doctor or other medical professional to accurately discriminate between pulsations in an iABP signal trend line due to cardiac contractions versus pulsations due to CPR chest compressions.
  • ROSC return of spontaneous circulation
  • an iABP compression component separator 40 processes the iABP signal 30, in conjunction with the CPR compression rate, to separate the iABP signal 30 into (I) a CPR chest compressions component 42 of the iABP signal 30 and (II) a compressions-free component 44 of the iABP signal 30. Both of these iABP signal components 42, 44 can be usefully consulted by an emergency responder providing CPR.
  • the CPR chest compressions iABP component 42 provides information, in real-time, about whether the CPR chest compressions are effective to provide life-sustaining blood circulation.
  • the CPR chest compressions iABP component 42 provides the arterial blood pressure waveform and also provides quantitative information about the amplitude (and rate) of the arterial blood pressure pulsations created by the CPR chest compressions. The latter provides valuable feedback based upon which the emergency responder can assess whether deeper (and faster / slower) CPR chest compressions are needed.
  • the compressions-free iABP component 44 is consulted to assess whether ROSC has been achieved by the CPR. Until ROSC is achieved, the compressions-free iABP component 44 will exhibit no pulsations (i.e., it will be approximately "flat-line").
  • the compressions-free iABP component 44 will exhibit pulsations attributable to the spontaneous pulse.
  • the compressions-free iABP component 44 provides the arterial blood pressure waveform generated by the spontaneous pulse and also provides quantitative information about the amplitude of the arterial blood pressure pulsations created by the spontaneous pulse. The latter enables the emergency responder to assess whether the spontaneous pulse could be strong enough to provide life-sustaining blood circulation, i.e., this waveform can support the emergency responder in determining whether ROSC has been achieved.
  • Illustrative FIGURE 1 depicts a patient monitoring device 50 which includes a display component 51 (e.g., an LCD display, OLED display, or so forth) on which a trend line 52 of the CPR chest compressions iABP component 42 is displayed, and on which a trend line 54 of the compressions-free iABP component 44 is displayed.
  • a display component 51 e.g., an LCD display, OLED display, or so forth
  • a trend line 52 of the CPR chest compressions iABP component 42 is displayed, and on which a trend line 54 of the compressions-free iABP component 44 is displayed.
  • only the CPR chest compressions iABP component 42 is displayed as a trend line.
  • only the compressions-free iABP component 44 is displayed as a trend line.
  • Either one or both components 42, 44 may additionally or alternatively be displayed in another format, such as a real-time numeric value.
  • the emergency responder can view the parallel trend lines 52, 54 to assess progress of the CPR, in the CPR monitoring system of FIGURE 1. It is additionally or alternatively contemplated to provide visual and/or audio alarms to indicate key events during the CPR.
  • a ROSC indicator 60 monitors the compressions-free iABP component 44 to detect whether a spontaneous pulse of amplitude greater than a ROSC-indication threshold amplitude and/or with a rate greater than a ROSC- indication threshold rate and/or with pulse intervals with variability below a ROSC-indication threshold variability (these thresholds are generically denoted as threshold T R0SC in FIGURE 1) is present in the compressions-free iAPB component 44.
  • the ROSC indicator 60 causes the display component 51 of the patient monitor 50 to display a ROSC indicator 62. Additionally or alternatively, the ROSC indicator 60 can activate an alarm loudspeaker 64 of the patient monitor 50 to alert the emergency responder of a potential ROSC.
  • the emergency responder is trained to perform a standard protocol upon noticing the visual or audible indication of ROSC, such as continuing CPR chest compressions for a standard time interval and then stopping compressions and performing a pulse check by palpation and other assessment (e.g. assessing skin color) to confirm ROSC; or, stopping compressions immediately and performing the pulse check by palpation and other ROSC assessment.
  • the patient monitor 50 can be programmed to issue a visual and/or audio alarm in response to a deficiency in the CPR chest compressions detected by automated analysis of the CPR chest compressions iABP component 42.
  • the CPR chest compressions iABP component 42 provides quantitative assessment of the amplitude of arterial blood pressure pulsations generated by the CPR chest compressions, if the amplitude of the CPR chest compressions iABP component 42 is lower than a minimum threshold then an indicator 66 can be displayed informing the emergency responder that deeper CPR chest compressions are needed and/or an audible message can be sounded by the loudspeaker (which can be advantageous since the emergency responder providing chest compressions may not be looking at the patient monitor 50).
  • This feedback can advantageously assist the emergency responder in setting the depth of the compressions (that is, adjusting how much force is used in compressing the chest during CPR chest compressions) to be enough to maintain life-sustaining blood circulation while not being excessive so as to limit the likelihood of physically injuring the person 10.
  • an indicator 66 can be displayed informing the emergency responder that faster / slower CPR chest compressions are needed and/or an audible message can be sounded by the loudspeaker. This feedback can advantageously assist the emergency responder in setting the rate of the compressions.
  • the iABP compression component separator 40 processes the iABP signal 30 in conjunction with the CPR compression rate to separate the CPR chest compressions iABP component 42 and the compressions-free iABP component 44.
  • the CPR compression rate can be determined in various ways.
  • the arrested person 10 has defibrillator pads 70 attached to the torso, via which an automated external defibrillator (AED) 72 may be used to deliver an electric defibrillation shock.
  • AED automated external defibrillator
  • cardiac defibrillation is only administered to a person who has an unorganized electrocardiography (ECG) signal, i.e., who is in ventricular fibrillation (VF).
  • ECG electrocardiography
  • VF ventricular fibrillation
  • the emergency responder 12 is usually initially uncertain as to whether the person 10 has an organized ECG signal or is in VF. Therefore, it is appropriate to attach the defibrillator pads 70 and start up the AED 72 so as to ensure its availability in the normal course of providing emergency assistance to the person 10. If the AED 72 is programmed to measure trans-thoracic impedance (TTI) between the defibrillator pads 70, then the TTI signal 74 can be input to the iABP compression component separator 40 which can determine the compression rate from periodicity of the TTI signal 74.
  • TTI trans-thoracic impedance
  • any sensor that provides a signal that cycles with the CPR compressions can be analyzed to extract the compression rate: for example, an accelerometer, force sensor, a camera or radar attached to the torso of the patient 10 will provide such a signal.
  • the compression rate can be received from the CPR compression robot 14, for example as a signal 76 indicating the programmed compression rate or as a reading of the analog control signal sent to the compression motor control component of the robot 14.
  • the iABP compression component separator 40 is suitably implemented as one or more electronic processors programmed to perform the functionality of these components 40, 60.
  • the patient monitoring device 50 includes as a unitary assembly the display component 51 and an electronic processor programmed to perform at least the separation of the iABP signal 30 into the component signals 42, 44.
  • the electronic processor of the patient monitoring device 50 may also perform processing on the reference signal 74, 76 in order to derive the CPR chest compression rate.
  • the patient monitoring device 50 may also include the defibrillation functionality and measurement of the TTI signal.
  • the processing of the reference signal 74, 76 to derive the CPR chest compression rate may be performed, for example, by an electronic processor of the AED 72 ancillary to the TTI sensor functionality, or may be performed by the CPR compression robot 14 to generate the signal 76 as a quantitative CPR chest compression rate value (e.g., as a digital rate value communicated by a USB cable or wirelessly by state-of-the-art technologies).
  • a quantitative CPR chest compression rate value e.g., as a digital rate value communicated by a USB cable or wirelessly by state-of-the-art technologies.
  • the illustrative computational components 40, 60 may be embodied as a non-transitory storage medium storing instructions executable by an electronic processor (e.g. the patient monitoring device 50 and/or the AED 72) to perform the disclosed operations.
  • the non-transitory storage medium may, for example, comprise a hard disk drive, RAID, or other magnetic storage medium; a solid state drive, flash drive, electronically erasable read-only memory (EEROM) or other electronic memory; an optical disk or other optical storage; various combinations thereof; or so forth.
  • the iABP compression component separator 40 receives as inputs the iABP signal 30 and the trans-thoracic impedance (TTI) signal 74.
  • Digital signal processing (DSP) 78 is performed on the TTI signal 74 to extract CPR compressions information 80 including compression rate, denoted herein as R [k], and also a CPR chest compressions "envelope", denoted A[k], which indicates when chest compressions are interrupted (typically to perform ventilation and/or a pulse check by palpation).
  • DSP digital signal processing
  • the CPR compressions information 80 includes identification of time intervals over which chest compressions are interrupted.
  • the illustrative iABP compression component separator 40 operates using digital signal processing (DSP), and as is conventional in DSP literature data samples as a function of time are indexed by time index k).
  • DSP digital signal processing
  • the envelope A[k] may be extracted, for example, by applying a peak detector or a low-pass filter and thresholding and digitizing the peak or low-pass filtered signal.
  • the compression rate R [k] can be extracted by a technique such as a Fast Fourier Transform (FFT) or other frequency-domain DSP to detect the fundamental frequency component of the TTI signal 74.
  • FFT Fast Fourier Transform
  • the compression rate R [k] can also be determined by detecting the individual compressions in the TTI signal time-trace, which allows adjustment of R [k] from one compression to the next.
  • the iABP signal 30 is optionally pre-processed to facilitate extraction of the component(s) corresponding to blood circulation pulsations due to chest compressions and/or spontaneous beating of the heart.
  • the iABP signal 30 is high-pass filtered using a high-pass filter 82 with a cut-off frequency of 0.7 Hz or lower to generate a high- pass filtered iABP signal 30HP.
  • the cut-off frequency of the high-pass filter 82 is preferably chosen to pass the fundamental frequency component due to CPR chest compressions and (if present) spontaneous pulses while removing lower-frequency components that are too low to be due to CPR chest compressions or a life-sustaining pulse.
  • a cut-off frequency of 0.5 Hz corresponds to 30 beats (or compressions) per minute, which is well below the recommended compression rate of 80-120 compressions per minute and is below a bradycardic heart rate of about 50 beats/minute.
  • a lower cut-off frequency can be used, or the high-pass filter 82 can be omitted entirely, at the cost of increased noise.
  • a higher cut-off frequency can remove more extraneous signal but at increasing possibility of removing relevant compressions and/or pulse signal components.
  • the high-pass filter can have a cut-off frequency of 0.7 Hz (42 beats/min) or lower, but this could result in filtering out a very low heart rate.
  • a high-pass filter with a cut-off frequency of 0.3 Hz (18 beats/min) was used.
  • the illustrative embodiment of the iABP compression component separator 40 shown in FIGURE 2 employs an adaptive algorithm that estimates the CPR chest compression component 42 in the iABP signal 30 by making use of the chest compression reference signal (e.g., the TTI signal 74).
  • the estimate of the CPR chest compressions iABP component 42 is by way of an operation 84 in which a harmonic series whose fundamental frequency is set to the CPR chest compression rate R [k] is fit to the iABP signal 30 (optionally after high-pass filtering, i.e. high-pass filtered iABP signal 30HP).
  • high-pass filtering i.e. high-pass filtered iABP signal 30HP
  • the compression-free iABP component 44 is obtained, which provides an estimate of the spontaneous pulse pressure component (if present and thereby indicating that ROSC may have been achieved).
  • the IABP HP signal 30HP (denoted in digitized form iABP H p [k]) is assumed to be a summation of a spontaneous pulse component sp [k], compression component cmp [k], and residual component r[k] :
  • iABP HP [k] sp [k] + cmp [k] + r[k] ( 1) with the index k again denoting sample number k.
  • the trans-thoracic impedance (TTI) signal 74 measured between the defibrillation pads 70 of the cardiac defibrillator 72 is used as an auxiliary input signal providing information on the chest compression frequency (and optionally the compressions phase).
  • This information is subsequently used in a signal model or a physical model (e.g., a harmonic signal model is employed in operation 84) that describes the compression component cmp [k] of the high-pass filtered iABP signal iABP HP [k].
  • This provides an estimate of the compression component in the iABP signal, indicated herein as cmp est [k] and indicated in FIGURES 1 and 2 as the compressions iABP component 42.
  • This signal sp est [k] is indicated in FIGURES 1 and 2 as the compressions-free iABP component 44.
  • the emergency responder is provided with feedback on the status of the heart of the patient 10 which supports determining when it is appropriate to interrupt the CPR chest compressions in order to further investigate the condition of the heart, e.g., by interrupting CPR chest compressions and performing a pulse check by palpation.
  • the clinician may decide that it is most appropriate to continue the CPR chest compressions.
  • the ROSC indicator 60 monitors the compressions-free iABP component 44 to detect whether a spontaneous pulse of amplitude greater than a ROSC-indication threshold amplitude is present and/or with a rate greater than a ROSC-indication threshold rate and/or with pulse intervals with variability below a ROSC- indication threshold variability, and activates a suitable human-perceptible alarm 62, 64 if this is the case.
  • displaying the trend line 52 of the estimate of the compression component 42 of the iABP signal 30 provides the emergency responder with feedback on the effectiveness of the CPR chest compressions when the heart has resumed beating.
  • the amplitude of the compression iABP component 42 is a quantitative indication of effectiveness of the CPR compressions, and can optionally be measured automatically to automatically issue a human-perceptible alarm 66 if, for example, the compressions provide insufficient circulation.
  • the compressions iABP component 42 is modelled in the operation 84 by a harmonic signal model of N H sinusoidal harmonic components:
  • N H is the number of harmonic components
  • ⁇ [/c] is an instantaneous compression phase (in radians): where R [k] is the CPR chest compression rate (in Hertz, i.e. compressions per second) extracted from the CPR chest compressions signal, T s is the sample interval [s], and ⁇ 0 is an arbitrary constant phase offset (in radians).
  • the coefficients m [/c] and b m [k] of the harmonic series of Expression (3) can be estimated using a least mean-square (LMS) algorithm or other optimization algorithm to fit the harmonic model of Expression (3) to the high-pass filtered iABP signal iABP HP [k].
  • LMS least mean-square
  • the resulting compressions iABP signal component cmp est [k] is input to the difference operation 86 suitably implemented as Expression (2) to generate the compressions- free iABP component sp est [k] .
  • cmp est [k] A (5) where in this formulation the fitted parameters of the harmonic series are now the harmonic component amplitude P m [k] and phase ⁇ [k] in radians.
  • the harmonic model is adaptive - that is, it can adapt to changes in the CPR compressions rate R [k] or phase ⁇ ⁇ [k] over time.
  • an emergency responder trained in providing CPR should provide relatively steady chest compressions for which the compression rate R [k] and phase ⁇ ⁇ [k] are expected to vary relatively slowly in time. If automated CPR is performed using the compressions robot 14 then the CPR compression rate and phase should be constant (R [k] ⁇ R).
  • PLL phase-locked loop
  • FLL frequency-locked loop
  • the top trend line 30P,HP shown in FIGURE 3 is the iABP signal acquired for a test pig subject after high-pass filtering using a high-pass filter with cut-off frequency of 0.3 Hz. This corresponds to the digitized signal iAPB HP [k] described herein and indicated as high-pass filtered iABP signal 30HP in FIGURE 2.
  • the center trend line 42p shown in FIGURE 3 is the compression iABP component cmp est [k] indicated as compressions component 42 in FIGURES 1 and 2.
  • the bottom trend line 44p shown in FIGURE 3 is the compression-free iABP component sp est [k] indicated as compression-free component 44 in FIGURES 1 and 2.
  • the trend lines of FIGURE 3 illustrate the pig in cardiac arrest (left hand portion 90) and after ROSC (right hand portion 92) responsive to a defibrillation shock 94 (indicated by a dashed line).
  • time intervals during which chest compressions were administered are indicated by the notation "CC"; while time intervals during which chest compressions were interrupted for ventilation are indicated by the notation "V”.
  • the CPR protocol employed was 30 compressions alternated by two ventilations, with CPR chest compressions delivered at a rate of 100 compressions/minute.
  • the pig Prior to the cardiac defibrillation shock 94 the pig was in cardiac arrest (left side 90), and this is reflected by a nearly flat line for the compression-free iABP component sp est [k] (trend line 44p in region 90). After delivery of the defibrillation shock 94, the pig's heart was restarted so that ROSC was achieved, and this is reflected in an observed spontaneous pulse in the compression-free iABP component sp est [k] (trend line 44p in region 92).
  • the high-pass filtered trend line 30HP exhibits increased complexity after ROSC (i.e.
  • the compressions iABP signal component 42p remains relatively steady in amplitude after ROSC (region 92) albeit with some quasi- random amplitude modulation due to incomplete signal separation.
  • the emergency responder can observe the compression depth translated to iABP modulation in the compressions iABP signal component 42p in region 92. Both the amplitude and frequency of the spontaneous pulse is readily observed in the compressions-free iABP signal component 44p in region 92.

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Abstract

L'invention concerne un dispositif de surveillance de réanimation cardio-pulmonaire (RCP) comprenant un transducteur (20) de la pression artérielle endovasculaire (iABP) relié à une canule artérielle ou à un cathéter (16) pour mesurer un signal iABP (30). Un capteur de compression thoracique RCP (14, 70, 72) mesure un signal de compression thoracique RCP (74, 76). Un ou plusieurs processeurs électroniques sont programmés : (i) pour extraire un taux de compression thoracique RCP à partir du signal de compression thoracique RCP; (ii) pour calculer une composante de compression thoracique RCP (42) du signal iABP en appliquant au signal iABP une série harmonique dont la fréquence fondamentale est réglée sur le taux de compression thoracique RCP, et (iii) pour calculer une composante sans compression (44) du signal iABP en tant que différence entre le signal iABP et la composante de compression thoracique RCP du signal iABP. Un élément d'affichage (51) affiche au moins la composante sans compression du signal iABP.
PCT/EP2016/075472 2015-10-27 2016-10-21 Système et procédé de surveillance d'impulsion spontanée et de compressions au moyen de la pression artérielle endovasculaire pendant une réanimation cardio-pulmonaire WO2017072055A1 (fr)

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EP3556281A1 (fr) 2018-04-17 2019-10-23 Koninklijke Philips N.V. Dispositif, système et procédé pour soutenir la détection du retour de la circulation spontanée pendant la réanimation cardiorespiratoire
WO2019201689A1 (fr) 2018-04-17 2019-10-24 Koninklijke Philips N.V. Dispositif, système et méthode pour supporter la détection du retour de la circulation spontanée pendant une réanimation cardio-pulmonaire
CN111989034A (zh) * 2018-04-17 2020-11-24 皇家飞利浦有限公司 用于支持在心肺复苏期间检测自发循环的恢复的设备、系统和方法
JP2021519639A (ja) * 2018-04-17 2021-08-12 コーニンクレッカ フィリップス エヌ ヴェＫｏｎｉｎｋｌｉｊｋｅ Ｐｈｉｌｉｐｓ Ｎ．Ｖ． 心肺蘇生中の自発循環再開の検出をサポートする装置、システム及び方法
JP7319995B2 (ja) 2018-04-17 2023-08-02 コーニンクレッカ フィリップス エヌ ヴェ 心肺蘇生中の自発循環再開の検出をサポートする装置、システム及び方法
CN108769391A (zh) * 2018-05-14 2018-11-06 谭诗涵 一种防猝死人工智能生命监测心肺复苏手机和方法
EP3766411A1 (fr) 2019-07-18 2021-01-20 Koninklijke Philips N.V. Dispositif, système et procédé de contrôle de l'activation et de la configuration des mesures de détection et d'oxymétrie de pouls pendant la réanimation cardio-pulmonaire
WO2021008925A1 (fr) 2019-07-18 2021-01-21 Koninklijke Philips N.V. Dispositif, système et procédé pour commander l'activation et la configuration de mesures de pulsations et de mesures d'oxymétrie de pouls pendant une réanimation cardio-respiratoire
US11406562B2 (en) 2019-07-18 2022-08-09 Koninklijke Philips N.V. Device, system, and method to control activation and configuration of pulse detection and pulse oximetry measurements during CPR
CN116643268A (zh) * 2023-04-23 2023-08-25 中国医学科学院北京协和医院 一种基于毫米波雷达的心肺复苏按压检测评估方法及系统
CN116643268B (zh) * 2023-04-23 2024-03-22 中国医学科学院北京协和医院 一种基于毫米波雷达的心肺复苏按压检测评估方法及系统

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