WO2025119970A1

WO2025119970A1 - Defibrillation vector indication and selection

Info

Publication number: WO2025119970A1
Application number: PCT/EP2024/084660
Authority: WO
Inventors: Giuseppe Ristagno; Dawn Blilie Jorgenson; Stacy Earl Gehman; Chenguang Liu
Original assignee: Koninklijke Philips NV
Current assignee: Koninklijke Philips NV
Priority date: 2023-12-08
Filing date: 2024-12-04
Publication date: 2025-06-12
Anticipated expiration: 2026-06-08

Abstract

A defibrillation controller for executing an optimal vector defibrillation of a patient by a plurality of electrode pad pairs attached to the patient. In operation, the defibrillation controller Determines, for each electrode pad pair, a probability indicator of at least one of a return of spontaneous circulation (ROSC) or a successful shock of the patient responsive to an application of a shock by the electrode pad pair to the patient based on a defibrillation vector associated with the electrode pad pair derived from an electrocardiogram signal associated with the electrode pad pair. The defibrillation controller, further in operation, determines the electrode pad pair among the plurality of electrode pad pairs having the highest probability indicator, and controls the application of the shock to the patient by the electrode pad pair determined to have the highest probability indicator.

Description

DEFIBRILLATION VECTOR INDICATION AND SELECTION

FIELD OF THE INVENTION

The present disclosure generally relates to defibrillation for a patient experiencing cardiac arrythmias, and more particularly to a defibrillation controller implementing an optimal vector defibrillation.

BACKGROUND OF THE INVENTION

FIG. 1A exemplary illustrates a standard anterolateral electrode placement on an adult patient 10 as known in the art of the present disclosure. Specifically, an electrode pad 20a is placed on an upper right torso of adult patient 10 below a collarbone of patient 10, and an electrode pad 21a is placed on a lower left torso of adult patient 10 below a pectoral muscle of adult patient 10. During defibrillation of patient 10, an anterolateral defibrillation vector 23a in terms of defibrillation waveform magnitude and direction extends between electrode pads 21a and 22a to thereby deliver a shock to a heart 11 of adult patient 10.

FIGS. IB and 1C exemplary illustrate an anteroposterior electrode placement on adult patient 10 as known in the art of the present disclosure. Specifically, an electrode pad 21b is placed over a cardiac apex of patient 10 between the midline of the chest and nipple on patient 10, and an electrode pad 22b is placed to a left of a spine of patient 10 below a scapula of patient 10 at the heart level. During defibrillation of patient 10, an anteroposterior defibrillation vector (symbolized by the X in electrode pads 21b and 22b) in terms of a defibrillation waveform magnitude and direction extends between electrode pads 21b and 22b to thereby deliver a shock to heart 11 of adult patient 10.

FIG. ID exemplary illustrates a bi-axial electrode placement on an adult patient 10 as known in the art of the present disclosure. Specifically, an electrode pad 20c is placed under a right armpit of patient 10, and an electrode pad 21c is placed on a left armpit of adult patient 10. During defibrillation of patient 10, a bi-axial defibrillation vector 22c in terms of defibrillation waveform magnitude and direction extends between electrode pads 20c and 21c to thereby deliver a shock to heart 11 of adult patient 10. The field of resuscitation, as exemplarily shown in FIGS. 1 A-1D, is heavily focused on increasing a quality of care by identifying and providing optimal CPR/shock treatment for a patient experiencing cardiac arrythmia.

More particularly, during a shock, different amounts of current flow through the different parts of the heart and the current distribution is highly uneven. This current distribution is affected by changes in the shock potential gradient through the heart, changes in fiber orientation, and changes in myocardial conductivity caused by connective tissue barriers. The current distribution will vary from person to person and can depend on patient anatomy, underlying conditions, medications and other factors. Various techniques of the art, such as, for example, vector change defibrillation, a double sequential defibrillation, and double simultaneous defibrillation, have been developed to address an efficiency of defibrillation in view of the challenge of current distribution.

SUMMARY OF THE INVENTION

The present disclosure is directed to an optimal vector defibrillation involving an analysis of ECG signals whereby, for each defibrillation vector, a probability indicator of at least one of a return of spontaneous circulation (ROSC) or a successful shock responsive to a shock can be determined and the defibrillation vector having the highest probability indicator can be determined and utilized during the next shock. In this manner the shock vector is optimized, and the patient receives the most effective shock.

The present disclosure may be embodied as (1) a defibrillation controller for implementing an optimal vector defibrillation and (2) an optimal vector defibrillation method.

Various exemplary embodiments of a defibrillation controller of the present disclosure encompass a non-transitory machine-readable storage medium encoded with instructions for execution by one or more processors for executing an optimal vector defibrillation of a patient by a plurality of electrode pad pairs attached to the patient. The non-transitory machine-readable storage medium including instructions to (1) for each electrode pad pair, determine a probability indicator of at least one of a return of spontaneous circulation (ROSC) or a successful shock of the patient responsive to an application of a shock by the electrode pad pair to the patient based on a defibrillation vector associated with the electrode pad pair derived from an electrocardiogram signal associated with the electrode pad pair, (2) determine the electrode pad pair among the plurality of electrode pad pairs having the highest probability indicator, and (3) control the application of the shock to the patient by the electrode pad pair determined to have the highest probability indicator.

Various exemplary embodiments of optimal vector defibrillation method of the present disclosure executable by a defibrillation controller of the present disclosure when of a plurality of electrode pad pairs are attached to the patient. The optimal vector defibrillation method involves (1) for each electrode pad pair, determining, by the defibrillation controller, a probability indicator of at least one of a return of spontaneous circulation (ROSC) or a successful shock of the patient responsive to an application of a shock by the electrode pad pair to the patient based on a defibrillation vector associated with the electrode pad pair derived from an electrocardiogram signal associated with the electrode pad pair, (2) determining, by the defibrillation controller, the electrode pad pair among the plurality of electrode pad pairs having the highest probability indicator; and (3) controlling, by the defibrillation controller, the application of the shock to the patient by the electrode pad pair determined to have the highest probability indicator.

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

BRIEF DESCRIPTION OF THE DRAWINGS

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

FIGS. 1 A-1D illustrate conventional defibrillation electrode placements for defibrillation of a patient as known in the art of the present disclosure;

FIGS. 2 A and 2B illustrate exemplary embodiments of optimal vector defibrillation in accordance with the present disclosure; FIGS. 3A-3C illustrate flowcharts representative of exemplary embodiments of an optimal vector defibrillation method in accordance with the present disclosure;

FIGS. 4A and 4B illustrate exemplary embodiments of an optimal vector defibrillation system in accordance with the present disclosure;

FIG. 5 illustrates an exemplary embodiment of an optimal vector defibrillation controller in accordance with the present disclosure;

FIG. 6 illustrates an exemplary embodiment of patient having pneumothorax in accordance with the present disclosure; and

FIG. 7 illustrates an exemplary embodiment of chart plotting transthoracic impedance (TH) as an indication of whether a patent has pneumothorax in accordance with the present disclosure.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present disclosure is directed to an optimal vector defibrillation involving an analysis of ECG signals whereby, for each defibrillation vector, a probability indicator of at least one of a return of spontaneous circulation (ROSC) or a successful shock (e.g., converting an arrhythmia to a normal and/or stable rhythm) responsive to a shock can be determined and the defibrillation vector having the highest probability indicator can be determined and utilized during the next shock. In this manner the shock vector is optimized, and the patient receives the most effective shock.

To facilitate an understanding of the present disclosure, the following description of FIGS. 2A and 2B teaches exemplary embodiments of an optimal vector defibrillation in accordance with the present disclosure. From the description of FIGS. 2A and 2B, those having ordinary skill in the art of the present disclosure will appreciate how to apply the present disclosure to make and use additional embodiments of optimal vector defibrillation in accordance with the present disclosure.

Further, while FIGS. 2A and 2B are described in the context of anterolateral electrode placement, an anteroposterior electrode placement and a bi-axil electrode placement on a patient as known in the art of the present disclosure, those having ordinary skill in the art will appreciate the present disclosure is applicable to two or more of different types of electrode placement on a patient as known in the art of the present disclosure and hereinafter conceived. For purpose of claiming and describing the present disclosure, the term “electrode pad” broadly encompasses any device, as known in the art of the of the present disclosure or hereinafter conceived, including one or more defibrillation electrodes for conducting shock energy from a defibrillator to a patient and material for affixing the electrode to the patient. Examples of an electrode pad include, but are not limited to, electrode pads utilized in the Automated External Defibrillators (AED) and Semi -Automated External Defibrillators as known in the art of the present disclosure. In practice, the electrode pad may have any geometrical configuration in support of a placement of the electric pad on a patient of a defibrillation of the patient.

For example, in one embodiment, the present disclosure may incorporate very large electrode pad(s) covering relative portions of a patient torso that is composed of individual (electrically isolated) pads. The ECG from these individual pads would be simultaneously used to capture the ECG from the vector and analyze the to identify the optimal defibrillation pad pair with the highest ROSC and/or successful shock probability indicator for the defibrillation shock delivery. The advantage of the large pads, that incorporate smaller individual pads, would be to make this technique easier for the care provider so they do not have to manually move pads to new locations.

Also in practice, an optimal vector defibrillation of the present disclosure can occur pre- CPR procedure of the patient and/or during the CPR procedure of the patient.

FIGS. 2A and 2B illustrate the anterolateral electrode placement of FIG. 1A, an anteroposterior electrode placement of FIGS. IB and 1C and the bi-axil electrode placement of FIG. ID simultaneously on patient 10.

As shown in FIG. 2A, in operation, as known in the art of the present disclosure, a defibrillation controller 40 or a conventional AED controller will implement a generation of an exemplary ECG signal 20d between the anterolateral defibrillation electrodes 20a and 21a, a generation of an exemplary ECG signal 21 d between the anteroposterior defibrillation electrodes 20b and 21b, and a generation of an exemplary ECG signal 22d between the bi-axial defibrillation electrodes 20c and 21c.

Also as known in the art of the present disclosure, defibrillation controller 40 or a conventional AED controller will derive an anterolateral defibrillation vector between electrodes 20a and 21a (e.g., anterolateral defibrillation vector 22a of FIG. 1A), derive an anteroposterior defibrillation vector between electrodes 20b and 21b (e.g., anteroposterior defibrillation vector of FIGS. IB and 1C), and derive a bi-axial defibrillation vector between electrodes 20c and 21c (e.g., bi-axial defibrillation vector 22c of FIG. ID).

As shown in FIG. 2B, in operation, as known in the art of the present disclosure, a defibrillation controller 40 or a conventional AED controller will control a generation of an exemplary ECG VF signal 31 from a conventional 12-lead set 30a, a EASI lead set 30b or any other lead set known in the art of the present disclosure and hereinafter conceived.

Also as known in the art of the present disclosure, defibrillation controller 40 or a conventional AED controller will derive, from ECG VF signal 31 , an anterolateral defibrillation vector between electrodes 20a and 21a (e.g., anterolateral defibrillation vector 22a of FIG. 1A), derive an anteroposterior defibrillation vector between electrodes 20b and 21b (e.g., anteroposterior defibrillation vector of FIGS. IB and 1C), and derive a bi-axial defibrillation vector between electrodes 20c and 21c (e.g., bi-axial defibrillation vector 22c of FIG. ID).

Referring to FIGS. 2 A and 2B, in accordance with the present disclosure, defibrillation controller 40 will implement an optimal vector defibrillation 41 involving, for each defibrillation vector, a determination of a probability indicator of a return of spontaneous circulation (ROSC) and/or successful shock responsive to a shock can be determined.

In one embodiment, defibrillation controller 40 will sample and digitize the ECG signals, which will be analyzed to determine whether application of a shock is advised. The digitized ECG samples may also be subsampled to a lower data rate. For instance, a data stream of 200 samples/sec may be down sampled to 100 samples/sec. The down sampled ECG data is processed to determine the ROSC and/or successful shock probability from the ECG signals as a rhythm score as known in the art of the present disclosure.

The processing may be operated in several ways. For one example, the rhythm score is calculated as the mean magnitude of the bandwidth limited first derivative (or first difference, which is a discrete -time analog) of the ECG over a period of a few seconds. Since the bandwidth limited first derivative may already be calculated for arrhythmia detection by the controller 40, the additional computation may involve only the additional calculation of an average absolute value. This process can be implemented as a real-time measure by means of a moving average requiring only one addition and one subtraction per sample. For instance, the difference of successive samples may be taken for a stream of samples received over a period of 4.5 seconds at a 100 sample/sec rate. The signs of the differences are discarded to produce absolute values, which are summed over the 4.5 second period. This produces a rhythm score value which is equivalent to a frequency weighted average amplitude of the ECG waveform. The score may be scaled or further processed in accordance with the architecture and demands of the instant system.

Since the spectrum of the first derivative is proportional to frequency, the rhythm score is largely unaffected by CPR artifact, most of which will be very low frequency.

Another alternative way to calculate a mean value is to square the differences of the consecutive samples, then sum the products and take the square root of the sum. This produces an RMS (root mean square) form of rhythm score.

As an alternative to the mean value computation, another approach is to use the median magnitude of the first derivative. This approach is more computationally intensive, but can advantageously be more robust to noise. Care must be taken to avoid de-emphasizing the signal that gives the measure its discriminating power. In another embodiment, a trimmed mean or min-max calculation can offer a favorable compromise. By eliminating the largest outliers, greater immunity to impulse artifacts (e.g. physical disturbances of the electrode pads) can be provide, and the occasional high amplitude artifact which would occur relatively infrequently can be eliminated without significantly reducing the discriminating power associated with the data of cardiac origin.

Still referring to FIGS. 2A and 2B, in another embodiment, as known in the art of the present disclosure, controller 40 may determine an impedance between the anterolateral defibrillation electrodes 20a and 21a as a weighting factor to the rhythm score of the anterolateral defibrillation vector, an impedance between the anteroposterior defibrillation electrodes 20b and 21b as a weighting factor to the rhythm score of the anteroposterior defibrillation vector, and an impedance between the bi-axial defibrillation electrodes 20c and 21c as a weighting factor to the rhythm score of the bi-axial defibrillation vector. In practice, this may increase or decrease the values of the rhythm score of the defibrillation vectors. To further facilitate an understanding of the present disclosure, the following description of FIGS. 3A-3C teaches exemplary embodiments of an optimal vector defibrillation method in accordance with the present disclosure. From the description of FIGS. 3A-3C, those having ordinary skill in the art of the present disclosure will appreciate how to apply the present disclosure to make and use additional embodiments of optimal vector defibrillation methods in accordance with the present disclosure.

Referring to FIG. 3 A, a flowchart 100 represents a base optimal vector defibrillation method. A stage SI 02 of flowchart 100 encompasses, for each defibrillation vector, a determination of the ROSC and/or successful shock probability indicator as previously described herein, preferably as a vRhythm score or an impedance weighted vRhythm score. One having ordinary skill in the art of the present disclosure shall understand and appreciate how a vRhythm score and an impedance weighted vRhythm score can be determined in view of the present disclosure and the prior art. See, e.g., US Patent No. US 8,825,154 B2, granted Sep. 2, 2014, the entire disclosure of which is hereby incorporated by reference herein. Further, one having ordinary skill in the art of the present disclosure shall understand and appreciate that, as used herein, determining an impedance weighted vRhythm score can include identifying the optimal vector accounting for both the vRhythm score and the impedance for each specific vector in order to identify an optimal vector. For example, some vectors may have a low impedance but a high vRhythm score or other combination. An optimal vector would have both a lower impedance and a higher vRhythm score. A patient specific analysis can take both vRhythm score and impedance into account in order to maximize the ROSC and/or successful shock outcome.

Stage SI 04 of flowchart 100 encompasses a determination of the defibrillation vector having the highest ROSC and/or successful shock probability indicator.

Stage SI 02 and SI 04 will be repeated until such time a shock decision is made during stage SI 06 of flowchart 100 whereby a stage S8 of flowchart 100 encompasses a control of application of the defibrillation vector having the highest ROSC and/or successful shock indicator to the patient.

Referring to FIG. 3B, a flowchart 110 represents a mode optimal vector defibrillation method. A stage SI 12 of flowchart 110 encompasses, for each defibrillation vector, a determination of the ROSC and/or successful shock probability indicator as previously described herein, preferably as a vRhythm score or an impedance weighted vRhythm score.

Stage SI 14 of flowchart 110 encompasses a determination of the defibrillation vector having the highest ROSC and/or successful shock probability indicator.

If the highest ROSC and/or successful shock probability indicator exceeds a threshold during a stage SI 16 of flowchart 110, then a stage SI 18a of flowchart 110 encompasses a shock first protocol including a control of application of the defibrillation vector having the highest ROSC and/or successful shock indicator to the patient.

If the highest ROSC and/or successful shock probability indicator is less than the threshold during a stage SI 16 of flowchart 110, then a stage SI 18b of flowchart 110 encompasses a CPR first protocol including a control of application of the defibrillation vector having the highest ROSC and/or successful shock indicator to the patient.

Referring to FIG. 3B, a flowchart 120 represents a trending optimal vector defibrillation method. A stage SI 22 of flowchart 120 awaits a prompt for the indicator whereby stage SI 24 of flowchart 120 encompasses, for each defibrillation vector, a determination of the ROSC and/or successful shock probability indicator as previously described herein, preferably as a vRhythm score or an impedance weighted vRhythm score.

Stage SI 26 of flowchart 120 encompasses a determination of the defibrillation vector having the highest ROSC and/or successful shock probability indicator.

If a shock decision is made during stage SI 28 of flowchart 100, then a stage SI 30 of flowchart 120 encompasses a control of application of the defibrillation vector having the highest ROSC and/or successful shock indicator to the patient.

To further facilitate an understanding of the present disclosure, the following description of FIGS. 4A and 5 teaches exemplary embodiments of an optimal vector defibrillation system and controller in accordance with the present disclosure. From the description of FIGS. 4A and 5, those having ordinary skill in the art of the present disclosure will appreciate how to apply the present disclosure to make and use additional embodiments of optimal vector defibrillation systems and controllers in accordance with the present disclosure.

Referring to FIG. 4A, a controller 40 is installed within an external defibrillator 50 connected to two or all of an anterolateral defibrillation electrode pad pair 51, an anteroposterior defibrillation electrode pad pair 52, and a bi-axial defibrillation electrode pad pair 53. In practice, controller 40 may be configured to control a display by external defibrillator 50 of which electrode pad pair has the highest probability indicator and its associated impedance. Alternatively, controller 40 may be configured to control a display by external defibrillator 50 of the probability indicator and associated impedance of each electrode pad pair.

Referring to FIG. 4B, a controller 40 is wired to an external defibrillator 60 connected to an anterolateral defibrillation electrode pad pair 61, to an external defibrillator 62 connected to a anteroposterior defibrillation electrode pad pair 63, and to an external defibrillator 64 connected to a bi-axial defibrillation electrode pad pair 65. In practice, controller 40 may be configured to control a display by external defibrillators 60, 62 and/or 64 of the probability indicator and associated impedance of the electrode pad pair connected thereto.

Referring to FIG. 5, shown is an exemplary embodiment of an ACLS controller 140 that includes one or more processor(s) 141, memory 142, a user interface 143, a network interface 144, and a storage 145 interconnected via one or more system bus(es) 146.

Each processor 141 can be any hardware device, as known in the art of the present disclosure or hereinafter conceived, capable of executing instructions stored in memory 142 or storage or otherwise processing data. In a non-limiting example, the processor(s) 141 can include a microprocessor, field programmable gate array (FPGA), application-specific integrated circuit (ASIC), or other similar devices.

The memory 142 can include various memories, as known in the art of the present disclosure or hereinafter conceived, including, but not limited to, LI, L2, or L3 cache or system memory. In a non-limiting example, the memory 142 can include static random access memory (SRAM), dynamic RAM (DRAM), flash memory, read only memory (ROM), or other similar memory devices.

The user interface 143 can include one or more devices, as known in the art of the present disclosure or hereinafter conceived, for enabling communication with a user such as an administrator. In a non-limiting example, the user interface can include a command line interface or graphical user interface that can be presented to a remote terminal via the network interface 144. The network interface 144 can include one or more devices, as known in the art of the present disclosure or hereinafter conceived, for enabling communication other components of a medical device. In a non-limiting example, the network interface 144 can include a network interface card (NIC) configured to communicate according to the Ethernet protocol. Additionally, the network interface 144 may implement a TCP/IP stack for communication according to the TCP/IP protocols. Various alternative or additional hardware or configurations for the network interface 144 will be apparent.

The storage 145 can include one or more machine-readable storage media, as known in the art of the present disclosure or hereinafter conceived, including, but not limited to, read-only memory (ROM), random-access memory (RAM), magnetic disk storage media, optical storage media, flash-memory devices, or similar storage media. In various non-limiting embodiments, the storage 145 can store instructions for execution by the processor(s) 141 or data upon with the processor(s) 141 may operate. For example, the storage 145 may store a base operating system for controlling various basic operations of the hardware.

The storage 145 can also store an application modules in the form of executable software/firmware for implementing the various functions of the method of FIG. 3 as previously described in the present disclosure.

In one exemplary embodiment as shown, storage 145 stores application modules 147 including a ROSC and/or successful shock indication manager 147a, a shock delivery manager 147b and a CPR manager 147c.

As one having ordinary sill in the art shall appreciate in view of the present disclosure, pneumothorax can occur in cardiac arrest either occurring during CPR (e.g., as a result of incorrectly performed chest compressions and/or ventilation) or as a primary cause of cardiac arrest (PEA/asystole cardiac arrest). Using transthoracic impedance, measured through defibrillation pads, during a resuscitation to monitor for changes in transthoracic impedance (TTI) that can indicate presence of a pneumothorax.

For example, a pneumothorax is a condition where air accumulates in the space between the lung and the chest wall, causing the lung to collapse. Traditional diagnosis uses auscultation, chest x-ray or ultrasound to visualize the pneumothorax. Severe pneumothorax can occur in people on mechanical ventilators due to pressure imbalances.

When CPR is performed chest injuries can occur.

Further, a pneumothorax can also be the primary cause of a cardiac arrest.

For example, tension pneumothorax occurs when the air accumulation is so sizable that it compresses the mediastinum and pushes it to the contralateral side. Compression of the superior vena cava impairs venous return and, consequently, cardiac output. Tracheal deviation results from mediastinal shifting. The reduced cardiac output aggravates the hypoxemic state because it increases pulmonary vascular resistance. Circulatory collapse can produce acidosis. These complications can lead to cardiac arrest if tension pneumothorax is not managed in a timely fashion.

Fig. 6. shows an example of a patient with pneumothorax.

As one having ordinary skill in the art shall appreciate in view of the present disclosure , transthoracic impedance is routinely measured by defibrillators. The magnitude and the distribution of the applied current play critical roles in defibrillation and are directly related to the transthoracic impedance (TTI) across the capacitor discharge of the defibrillator. By definition, the TTI in dictates the resistance of the thorax to the flow of current and is measured to check whether the defibrillation electrodes are correctly attached to the patient’s thorax. This can affect the current amplitude and energy and thus the success rate of defibrillation.

As can be seen in Fig. 6, patient 600 has pneumothorax, with one normal lung 601 and one collapsed lung 602.

The use of TTI data to detect a pneumothorax is a new use of the TTI signal.

For example, as can be seen in Fig. 7, Chart 700 plots TTI in ohms. The data points on the left show a relatively lower grouping of TTI plots indicating no pneumothorax 701. In contrast, the data points on the right show a relatively higher grouping of TTI plots indicating pneumothorax 702.

From the description of FIGS. 2A-7 herein, those having ordinary skill in the art will appreciate the numerous benefits of the present disclosure including, but not limited to, supplements a vector change defibrillation, a double sequential defibrillation and a double simultaneous defibrillation. For example, one having ordinary skill in the art in view of the present disclosure shall appreciate that the present invention can also be useful to achieve a successful shock, e.g., converting an arrhythmia to a normal and/or stable rhythm with circulation.

The present disclosure has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. For example, one having ordinary skill in the art in view of the present disclosure shall appreciate that an Amplitude spectrum area (AMSA) score can be used in place of a vRhythm score. It is intended that the invention be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.

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

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

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

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

Claims

1. A defibrillation controller for executing an optimal vector defibrillation of a patient by a plurality of electrode pad pairs attached to the patient, the defibrillation controller comprising: a non-transitory machine-readable storage medium encoded with instructions for execution by at least one processor, the non-transitory machine-readable storage medium including instructions to: for each electrode pad pair, determine a probability indicator of at least one of a return of spontaneous circulation (ROSC) or a successful shock of the patient responsive to an application of a shock by the electrode pad pair to the patient based on a defibrillation vector associated with the electrode pad pair derived from an electrocardiogram signal associated with the electrode pad pair; determine the electrode pad pair among the plurality of electrode pad pairs having the highest probability indicator; and control the application of the shock to the patient by the electrode pad pair determined to have the highest probability indicator.

2. The defibrillation controller of claim 1, wherein the plurality of electrode pad pairs includes at least two of: an anterolateral electrode pad pair; an anteroposterior electrode pad pair; and a bi-axial electrode pad pair.

3. The defibrillation controller of claim 1, wherein the defibrillation controller is installed within an external defibrillator; and wherein the plurality of electrodes pad pairs are operable in communication with the external defibrillator.

4. The defibrillation controller of claim 1 , wherein the defibrillation controller is operable in communication with a plurality of external defibrillators; and wherein each electrode pad pair among the plurality of electrode pad pairs is operable in communication with a different external defibrillator among the plurality of external defibrillators.

5. The defibrillation controller of claim 1, wherein, for each electrode pad pair, the probability indicator of the at least one of ROSC or successful shock of the patient responsive to the application of the shock by the electrode pad pair to the patient is further based on an impedance associated with the electrode pad pair, and wherein the probability indicator is at least one of a vRhythm score or an impedance weighted vRhythm score.

6. The defibrillation controller of claim 1 , wherein the control of the application of the shock to the patient by the electrode pad pair determined to have the highest probability indication is based on a shock delivery decision generated by or received by the defibrillation controller, wherein the decision is based on .

7. The defibrillation controller of claim 1 , wherein the control of the application of the shock to the patient by the electrode pad pair determined to have the highest probability indication is based on at least one of a comparison of the probability indicator of the electrode pad pair to a threshold delineating a shock first protocol and a cardiac resuscitation protocol or a conditional delineation between a shock first protocol and cardiac resuscitation protocol.

8. The defibrillation controller of claim 1,

Wherein the instructions further include using a transthoracic impedance (TTI) signal to detect a pneumothorax.

9. An optimal vector defibrillation method executable by a defibrillation controller when of a plurality of electrode pad pairs are attached to the patient, the optimal vector defibrillation method comprising: for each electrode pad pair, determining, by the defibrillation controller, a probability indicator of at least one of a return of spontaneous circulation (ROSC) or a successful shock of the patient responsive to an application of a shock by the electrode pad pair to the patient based on a defibrillation vector associated with the electrode pad pair derived from an electrocardiogram signal associated with the electrode pad pair; determining, by the defibrillation controller, the electrode pad pair among the plurality of electrode pad pairs having the highest probability indicator; and controlling, by the defibrillation controller, the application of the shock to the patient by the electrode pad pair determined to have the highest probability indicator.

10. The optimal vector defibrillation method of claim 9, wherein the plurality of electrode pad pairs includes at least two of: an anterolateral electrode pad pair; an anteroposterior electrode pad pair; and a bi-axial electrode pad pair.

11. The optimal vector defibrillation method of claim 9, wherein, the controlling, by the defibrillation controller, the application of the shock to the patient by the electrode pad pair determined to have the highest probability indicator includes one of; controlling an operation of a shock source connected with the electrode pad pair to deliver the shock to the patient by the electrode pad pair; or instructing an additional controller to control an operation of the shock source connected with the electrode pad pair to deliver the shock to the patient by the electrode pad pair.

12. The optimal vector defibrillation method of claim 9, wherein, for each electrode pad pair, determine, by the defibrillation controller, the probability indicator of the at least one of ROSC or successful shock of the patient responsive to the application of the shock by the electrode pad pair to the patient further based on an impedance associated with the electrode pad pair, and wherein the probability indicator is at least one of a vRhythm score or an impedance weighted vRhythm score.

13. The optimal vector defibrillation method of claim 9, wherein the controlling, by the defibrillation controller, of the application of the shock to the patient by the electrode pad pair determined to have the highest probability indication is based on a shock delivery decision generated by or received by the defibrillation controller.

14. The optimal vector defibrillation method of claim 9, wherein the controlling, by the defibrillation controller, of the application of the shock to the patient by the electrode pad pair determined to have the highest probability indication is based on a comparison of the probability indicator of the electrode pad pair to at least one of a threshold delineating a shock first protocol and a cardiac resuscitation protocol or a conditional delineation between a shock first protocol and a cardiac resuscitation protocol.

15. The optimal vector defibrillation method of claim 9, further comprising using a transthoracic impedance (TTI) signal to detect a pneumothorax.