System and method for providing resuscitation guidance based on physical characteristics of a patient measured during an acute care event
阅读说明：本技术 用于基于在急性护理事件期间测量到的患者的身体特征来提供复苏指导的系统和方法 (System and method for providing resuscitation guidance based on physical characteristics of a patient measured during an acute care event ) 是由 A·西尔弗 G·A·弗雷曼 F·J·吉布 P·贾科梅蒂 于 2019-06-28 设计创作，主要内容包括：一种用于辅助用户进行胸部按压的系统,包括：至少一个输入装置,用于提供表示患者的多个身体特征的信息；至少一个胸部按压传感器；反馈装置,用于为用户提供胸部按压反馈；以及至少一个处理器。该至少一个处理器被配置为：接收并处理表示患者的多个身体特征的信息,以确定患者的目标胸部按压标准；接收并处理来自至少一个胸部按压传感器的指示胸部按压的信号,以计算至少一个胸部按压参数；判断至少一个胸部按压参数是否满足目标胸部按压标准；以及使所述反馈装置为用户提供胸部按压参数是否满足目标标准的指示。(A system for assisting a user in chest compressions, comprising: at least one input device for providing information representative of a plurality of physical characteristics of a patient; at least one chest compression sensor; feedback means for providing chest compression feedback to a user; and at least one processor. The at least one processor is configured to: receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target chest compression criterion for the patient; receiving and processing signals indicative of chest compressions from at least one chest compression sensor to calculate at least one chest compression parameter; determining whether the at least one chest compression parameter meets a target chest compression criterion; and causing the feedback device to provide an indication to the user whether the chest compression parameter meets a target criterion.)
1. A system for assisting a user in chest compressions of a patient during an acute care event, the system comprising:
at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event;
at least one chest compression sensor configured to obtain a signal indicative of chest compressions performed on the patient during the acute care event;
feedback means for providing chest compression feedback to the user; and
at least one processor communicatively coupled with the at least one input device for providing information representative of the plurality of physical features and communicatively coupled with the at least one chest compression sensor, the at least one processor configured to:
Receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target chest compression criterion for the patient,
receive and process signals indicative of the chest compressions from the at least one chest compression sensor to calculate at least one chest compression parameter,
determining whether the at least one chest compression parameter meets the target chest compression criterion, an
Cause the feedback device to provide an indication to the user whether the at least one chest compression parameter meets the target chest compression criterion.
2. The system of claim 1, wherein the plurality of physical features comprises at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
3. The system of claim 1, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient comprises at least one of: a user interface for manually inputting at least one measurement of the physical feature, a two-dimensional camera, a stereo camera, a three-dimensional sensor, a three-dimensional imaging system, a light field camera, and a position sensor or marker positioned on the patient.
4. The system of claim 3, wherein the at least one input device includes a three-dimensional imaging system for obtaining information representative of a plurality of physical features of the patient, and the processor is configured to generate a three-dimensional representation of at least a portion of the patient's body based on the information obtained from the three-dimensional imaging system.
5. The system of claim 1, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient is mounted to at least one of: the patient, the feedback device, and the user.
6. The system of claim 1, further comprising a smart phone or computer tablet,
wherein the at least one input device for providing information representative of a plurality of physical features of the patient comprises a camera of the smartphone or the computer tablet and the at least one processor comprises a processor of the smartphone or the computer tablet.
7. The system of claim 6, wherein the feedback device comprises a visual display of the smartphone or the computer tablet.
8. The system of claim 1, wherein the plurality of physical characteristics are measured during inspiration or expiration.
9. The system of claim 1, wherein at least one of the plurality of physical features comprises an anthropometric characteristic of the patient.
10. The system of claim 9, wherein the anthropometric characteristics of the patient include at least one of: chest shape, ratio between AP distance and lateral width of the chest, chest volume, and total patient volume.
11. The system of claim 1, wherein the chest compression sensor comprises at least one of: single axis accelerometers, multiple axis accelerometers, and gyroscopes.
12. The system of claim 1, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a defibrillator, and a chest compression guidance device configured to be placed on the chest of the patient.
13. The system of claim 1, wherein the feedback device is configured to provide at least one of audio feedback, visual feedback, and tactile feedback.
14. The system of claim 1, wherein the target chest compression criteria and the measured chest compression parameters include at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
15. The system of claim 14, wherein the target chest compression criteria for compression depth comprises a depth of 0.2 inches to 3.5 inches.
16. The system of claim 14, wherein the target chest compression criteria for compression depth comprises at least one of: 0.2 inches to 0.75 inches for patients with an AP distance of less than 3 inches; 0.75 inches to 1.25 inches for patients with AP distances of 4.0 inches to 5.0 inches; 1.25 inches to 1.75 inches for patients with AP distances of 6.0 inches to 8.0 inches; 1.75 inches to 2.25 inches for patients with AP distances of 9.0 inches to 11.0 inches; 2.25 inches to 2.75 inches for patients with AP distances of 10 inches to 12 inches; and 2.75 inches to 3.5 inches for patients with an AP distance of 13 inches or greater.
17. The system of claim 14, wherein the target chest compression criteria for chest compression rate comprises a rate of 100cpm to 160 cpm.
18. The system of claim 14, wherein the target chest compression criteria for compression rate comprises at least one of: 140 to 160cpm for patients with an AP distance of less than 3.0 inches; 130 to 150cpm for patients with an AP distance of 4.0 to 5.0 inches; 120 to 140cpm for patients with AP distances of 6.0 to 8.0 inches; 110 to 130cpm for patients with an AP distance of 9.0 to 11 inches; and 100 to 120cpm for patients with AP distances of 12 inches or more.
19. The system of claim 14, wherein the target chest compression criteria for a target chest compression release rate comprises 150 inches/minute to 600 inches/minute.
20. The system of claim 14, wherein the target chest compression criteria for a target chest compression release rate comprises at least one of: 150 to 250 inches/minute for patients with an AP distance of less than 3.0 inches; 200 to 300 inches/minute for patients with AP distances of 4.0 to 5.0 inches; 250 to 400 inches/minute for patients with AP distances of 6.0 to 8.0 inches; and 250 to 600 inches/minute for patients with AP distances of 10 inches or more.
21. The system of claim 1, wherein the plurality of physical characteristics of the patient include an anterior-posterior distance of a thoracic region of the patient and at least one of: lateral width of chest, circumference of chest, total patient volume, chest volume, waist size, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and Body Mass Index (BMI), and
the target chest compression criteria include a target chest compression depth for the patient.
22. The system of claim 21, wherein the indication for the user provided by the feedback device includes an instruction to increase chest compression depth, decrease chest compression depth, or maintain chest compression depth determined based on the determination of whether the chest compression parameter meets the target chest compression criterion.
23. The system of claim 1, wherein the at least one processor determines a target chest compression criterion for the patient based on the plurality of physical features and values determined from a look-up table and/or calculated by a linear regression formula.
24. The system of claim 1, wherein the at least one processor is further configured to determine a type of patient based on the plurality of physical features and to cause the feedback device to provide an indication of the type of patient to the user.
25. The system of claim 24, wherein the type of patient comprises a pediatric patient or an adult patient.
26. The system of claim 24, wherein the type of patient comprises at least one of: neonates, infants, small children, large children, small adults, average sized adults, and large adults.
27. The system of claim 1, wherein the at least one processor is further configured to:
after the chest compression has been performed for a predetermined period of time,
receive and process updated information from at least one device representative of a plurality of physical characteristics of the patient to determine a modified target chest compression criterion,
determining whether the at least one chest compression parameter meets the modified target chest compression criterion, an
Cause the feedback device to provide an indication to the user whether the at least one chest compression parameter meets the modified target chest compression criteria.
28. The system of claim 27, wherein the updated information representative of the plurality of physical features includes updated information related to an anterior-posterior distance of the patient's cardiothoracic region, and the modified target chest compression criterion includes modifying a target chest compression depth based at least in part on the updated information related to the anterior-posterior distance of the patient's cardiothoracic region.
29. The system of claim 27, wherein the at least one processor is further configured to compare an initial target chest compression criterion with the modified target chest compression criterion and to cause the feedback device to provide an indication to the user if the modified target chest compression criterion is different from the initial target chest compression criterion.
30. The system of claim 27, wherein the at least one processor is configured to maintain a record of past modified target chest compression criteria and record chest compression parameters corresponding to each of the past modified target chest compression criteria.
31. The system of claim 27, wherein the predetermined time period prior to receiving the updated information comprises a time period determined based on initial information representative of the plurality of physical features and the target chest compression criteria.
32. The system of claim 1, wherein the at least one processor is further configured to determine a suggested chest compression technique for the patient based on a plurality of physical features of the patient and to cause the feedback device to provide the user with an indication to make the suggested chest compression technique.
33. The system of claim 32, wherein the suggested chest compression technique is based on a change in at least one of a plurality of physical characteristics of the patient over a predetermined period of time.
34. The system of claim 32, wherein the suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
35. The system of claim 32, wherein the suggested chest compression technique comprises active chest decompression.
36. The system of claim 35, wherein the plurality of physical features includes an anterior-posterior sternal distance, and the active chest decompression as the suggested chest compression technique is based on a reduction in the anterior-posterior sternal distance.
37. The system of claim 35, wherein the indication of active chest decompression comprises an indication of chest decompression using at least one of a suction cup device, an attachment device, and a hook and loop fastener device, and/or an instruction to compress a side or abdomen of the patient.
38. The system of claim 1, wherein the at least one processor is further configured to determine a percentage of time that the chest compression parameter measured during a rescue effort does not meet the target chest compression criteria, and to cause the feedback device to provide an indication to the user if the percentage of time exceeds a predetermined value.
39. The system of claim 38, wherein the indication to the user if the percentage of time exceeds the predetermined value comprises an instruction to begin performing a second chest compression technique different from an initial chest compression technique performed during a predetermined time period.
40. The system of claim 39, wherein the initial chest compression technique comprises two-palm chest compression and the second chest compression technique comprises chest compression with active chest decompression.
41. The system of claim 39, wherein the initial chest compression technique comprises one-handed or two-handed chest compression, and the second chest compression technique comprises two-fingered chest compression.
42. The system of claim 39, wherein the at least one processor is configured to receive confirmation from the user when the user initiates the second chest compression technique.
43. The system of claim 1, further comprising at least one ventilation sensor configured to measure at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
44. A system as defined in claim 43, wherein the ventilation sensor comprises a flow sensor and/or a pressure sensor positioned in a flow path of a ventilation unit in fluid communication with the airway of the patient.
45. A system as defined in claim 43, wherein the ventilation sensor comprises at least a first and second absolute air pressure sensor separated by a flow restrictor for measuring air flow rate and pressure in the air flow path.
46. The system of claim 1, wherein the target chest compression criteria comprises an initial range of acceptable chest compressions, and the at least one processor is further configured to:
after a predetermined period of time, receiving and processing information representative of a second physical characteristic of the patient that is different from a first physical characteristic of the plurality of physical characteristics, and
Determining an updated range of acceptable chest compressions based on the first and second physical characteristics.
47. The system of claim 46, wherein the at least one processor is further configured to:
determining whether the at least one chest compression parameter is within the updated range of acceptable chest compressions, an
Cause the feedback device to provide an indication to the user of whether the at least one chest compression parameter is within the updated range of acceptable chest compressions.
48. The system of claim 1, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient also provides an age or gender of the patient, and the target chest compression criterion is determined based at least in part on the plurality of physical characteristics and the age or gender of the patient.
49. The system of claim 1, wherein the feedback device comprises a defibrillator, and the at least one processor is configured to receive and process updated information from at least one device representative of a plurality of physical characteristics of the patient to determine a modified target chest compression criterion while the defibrillator is providing a defibrillating shock to the patient.
50. The system of claim 49, wherein the at least one processor is configured to:
causing the feedback device to provide instructions to the user to resume chest compressions after the defibrillation shock is delivered;
receiving and processing signals from the at least one chest compression sensor indicative of resumed chest compressions to calculate at least one chest compression parameter of the resumed chest compressions;
determining whether at least one chest compression parameter of the resumed chest compression meets modified target chest compression criteria; and
causing the feedback device to provide an indication to the user whether at least one chest compression parameter of the resumed chest compression meets the modified target chest compression criteria.
51. The system of claim 1, wherein the plurality of physical characteristics of the patient include an anterior-posterior distance of a thoracic region of the patient and at least one of: lateral width of the chest, circumference, chest volume, and chest shape, an
The target chest compression criteria include a target chest compression depth for the patient.
52. The system of claim 1, wherein the plurality of physical characteristics of the patient include an anterior-posterior distance of a thoracic region of the patient and at least one of: a length, a volume, and a weight of the body region of the patient, an
The target chest compression criteria include a target chest compression depth for the patient.
53. The system of claim 1, wherein the plurality of physical features of the patient includes an anterior-posterior distance of a thoracic region of the patient and a feature or characteristic indicative of an overall size of the patient.
54. The system of claim 1, wherein the processor is configured to process the plurality of physical features to estimate the patient's weight.
55. The system of claim 54, wherein the processor is configured to determine a treatment parameter of the patient based at least in part on an estimated weight of the patient.
56. A system for assisting a user in chest compressions of a patient during an acute care event, the system comprising:
at least one input device for providing information representative of at least one physical characteristic of the patient measured during the acute care event;
feedback means for providing guidance on how chest compressions should be performed on the patient; and
at least one processor communicatively coupled with at least one apparatus for providing information representative of the at least one physical characteristic, the at least one processor configured to:
Receiving and processing information representative of at least one physical characteristic of the patient to determine a suggested chest compression technique for the patient, an
Causing the feedback device to provide an indication of the suggested chest compression technique to the user.
57. The system of claim 56, wherein the at least one input device provides information representative of a plurality of physical characteristics of the patient measured during the acute care event.
58. The system of claim 56, wherein the plurality of physical features comprises at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
59. The system of claim 56, wherein the at least one input device for providing information representative of at least one physical characteristic of the patient comprises at least one of: a user interface for manually inputting at least one measurement of the physical feature, a two-dimensional camera, a stereo camera, a three-dimensional sensor, a three-dimensional imaging system, a light field camera, and a position sensor or marker positioned on the patient.
60. The system of claim 59, wherein the at least one apparatus comprises a three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient, and the at least one processor is configured to generate a three-dimensional representation of at least a portion of the patient's body based on the information obtained from the three-dimensional sensor.
61. The system of claim 56, further comprising a smart phone or computer tablet,
wherein the at least one means for providing information representative of at least one physical feature of the patient comprises a camera of the smartphone or the computer tablet, and the at least one processor comprises a processor of the smartphone or the computer tablet.
62. The system of claim 61, wherein the feedback device comprises a visual display of the smartphone or the computer tablet.
63. The system of claim 56, wherein the at least one physical characteristic is measured during inspiration or expiration.
64. The system of claim 56, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a defibrillator, and a chest compression guidance device configured to be placed on the chest of the patient.
65. The system according to claim 56, wherein the feedback device is configured to provide at least one of audio feedback, visual feedback, and tactile feedback.
66. The system of claim 56, further comprising at least one chest compression sensor configured to obtain signals indicative of chest compressions performed on the patient during the acute care event, and the at least one processor is configured to:
receiving and processing information representative of at least one physical characteristic of the patient to determine a target chest compression criterion for the patient,
receive and process signals indicative of the chest compressions from the at least one chest compression sensor to calculate at least one chest compression parameter,
determining whether the at least one chest compression parameter meets the target chest compression criterion, an
Cause the feedback device to provide an indication to the user whether the at least one chest compression parameter meets the target chest compression criterion.
67. The system of claim 66, wherein the target chest compression criteria and the measured chest compression parameters include at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
68. The system of claim 67, wherein the at least one physical characteristic of the patient includes an anterior-posterior sternal distance and at least one of: chest width and circumference, an
The target chest compression criteria include a target chest compression depth for the patient.
69. The system of claim 68, wherein the indication for the user provided by the feedback device includes an instruction to increase chest compression depth, decrease chest compression depth, or maintain chest compression depth determined based on a determination of whether the chest compression parameter meets the target chest compression criterion.
70. The system of claim 66, wherein the at least one processor is configured to:
after chest compressions have been delivered for a predetermined period of time, determining a modified suggested chest compression technique based at least in part on whether the at least one chest compression parameter meets the target chest compression criteria, an
Causing the feedback device to provide an indication of the modified suggested chest compression technique to the user.
71. The system of claim 66, wherein the processor is further configured to determine a percentage of time that the chest compression parameters measured during a rescue effort do not meet the target chest compression criteria and cause the feedback device to provide an indication to the user if the percentage of time exceeds a predetermined value.
72. The system of claim 71, wherein the indication for the user if the percentage of time exceeds the predetermined value comprises an instruction to begin making a second suggested chest compression technique different from the suggested chest compression technique made during the initial time period.
73. The system of claim 72, wherein the suggested chest compression technique performed during the initial time period comprises palmar chest compression and the second suggested chest compression technique comprises chest compression with active chest decompression.
74. The system of claim 72, wherein the suggested chest compression technique performed during the initial time period comprises a one-handed chest compression or a two-handed chest compression, and the second suggested chest compression technique comprises a two-finger chest compression.
75. The system of claim 72, wherein the at least one processor is configured to receive a confirmation from the user when the user initiates the second suggested chest compression technique.
76. The system of claim 56, wherein the processor is further configured to:
after chest compressions have been performed for a predetermined period of time, receiving and processing updated information from the at least one device representative of at least one physical characteristic of the patient to determine a modified suggested chest compression technique,
Causing the feedback device to provide an indication of the modified suggested chest compression technique to the user.
77. The system of claim 56, wherein the suggested chest compression technique is based on a change in at least one physical characteristic of the patient over a predetermined period of time.
78. The system of claim 56, wherein the suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
79. The system of claim 56, wherein the suggested chest compression technique comprises active chest decompression.
80. The system of claim 79, wherein the at least one physical feature comprises an anterior-posterior sternal distance, and the active chest decompression as the suggested chest compression technique is based on a reduction in the anterior-posterior sternal distance.
81. The system of claim 80, wherein the indication of active chest decompression comprises an indication of chest decompression using at least one of a suction cup device, an attachment device, and a hook and loop fastener device, and/or an instruction to compress a side or abdomen of the patient.
82. The system of claim 56, wherein the feedback device comprises a defibrillator, and the at least one processor is configured to receive and process updated information from the at least one device representative of at least one physical characteristic of the patient while the defibrillator is providing a defibrillating shock to the patient to determine a modified suggested chest compression technique.
83. The system of claim 56, further comprising at least one ventilation sensor configured to measure at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
84. A system as defined in claim 83, wherein the ventilation sensor comprises a flow sensor and/or a pressure sensor positioned in a flow path of a ventilation unit in fluid communication with the airway of the patient.
85. A method of providing chest compressions to a patient during an acute care event, the method comprising:
measuring a plurality of physical characteristics of the patient during the acute care event;
determining a target chest compression criterion based on the measured plurality of physical features;
Applying chest compressions to the patient;
using at least one chest compression sensor to measure at least one chest compression parameter during the applied chest compressions; and
providing feedback guidance on how a user should adjust chest compressions applied to the patient based on whether the at least one chest compression parameter meets the target chest compression criteria.
86. The method of claim 85, wherein the plurality of physical features includes at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
87. The method of claim 85, wherein measuring a plurality of physical features of the patient during the acute care event comprises capturing at least one image of the patient with a handheld electronic device and processing the at least one captured image with at least one processor of the handheld electronic device to determine at least one measurement of the physical features.
88. The method of claim 87, wherein the at least one processor of the handheld electronic device determines the target chest compression criterion based on the measurements of the plurality of physical features and determines the at least one chest compression parameter by processing signals generated by the chest compression sensor.
89. The method of claim 87, wherein the feedback guidance is provided on a display screen of the handheld electronic device.
90. The method of claim 85, wherein measuring a plurality of physical features of the patient during the acute care event comprises using a three-dimensional sensor to obtain information representative of the plurality of physical features.
91. The method of claim 85, further comprising: manually inputting measurements of a plurality of physical characteristics of the patient on a user interface.
92. The method of claim 85, wherein the plurality of physical features includes an anterior-posterior distance of the patient's cardiothoracic region and at least one of: the width and circumference of the cardiothoracic region of the patient, an
The target chest compression criteria include a target chest compression depth for the patient.
93. The method of claim 85, further comprising:
recording at least one updated measurement of a plurality of physical characteristics of the patient after a predetermined period of time;
determining a modified target chest compression criterion based on the updated measurements; and
providing feedback guidance on how a user should adjust chest compressions applied to the patient based on whether the at least one chest compression parameter meets the modified target resuscitation criteria.
94. The method of claim 93, wherein the at least one updated measurement includes an anterior-posterior sternal distance.
95. The method of claim 85, wherein the target chest compression criterion and the measured at least one chest compression parameter include at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
96. The method of claim 85, wherein providing the feedback guidance comprises providing an indication to increase chest compression depth, decrease chest compression depth, or maintain chest compression depth based on whether the at least one chest compression parameter meets the target chest compression criteria.
97. The method of claim 85, further comprising: determining a suggested chest compression technique based on the measured plurality of physical features and providing feedback guidance to provide an indication of the suggested chest compression technique to the user.
98. The method of claim 97, wherein the suggested chest compression technique is based on a change in at least one of a plurality of physical characteristics of the patient over a predetermined period of time.
99. The method of claim 97, wherein the suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
100. The method of claim 85, wherein the feedback guidance includes an indication to begin conducting a second chest compression technique different from an initial chest compression technique based at least in part on whether the measured chest compression parameter does not meet the target chest compression criteria.
101. The method of claim 100 wherein the initial chest compression technique comprises two-palm chest compression and the second chest compression technique comprises chest compression with active chest decompression.
102. The method of claim 100, wherein the initial chest compression technique comprises one-handed or two-handed chest compression, and the second chest compression technique comprises two-fingered chest compression.
103. A method of providing chest compressions to a patient during an acute care event, the method comprising:
measuring a plurality of physical characteristics of the patient during the acute care event;
determining a suggested chest compression technique based on the measured plurality of physical features;
providing feedback guidance to provide an indication of the suggested chest compression technique to a user; and
applying chest compressions to the patient in accordance with the suggested chest compression technique.
104. The method of claim 103, wherein the plurality of physical features includes at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
105. The method of claim 103, wherein measuring a plurality of physical features of the patient during the acute care event comprises using a three-dimensional imaging system to obtain information representative of the plurality of physical features.
106. The method of claim 103, wherein the suggested chest compression technique is based on a change in at least one of a plurality of physical characteristics of the patient over a predetermined period of time.
107. The method of claim 103, further comprising: the method includes determining a target chest compression criterion based on the measured plurality of physical characteristics, measuring at least one chest compression parameter during the applied chest compressions using at least one chest compression sensor, and providing feedback guidance on how the user should adjust the chest compressions applied to the patient based on whether the at least one chest compression parameter meets the target chest compression criterion.
108. The method of claim 107, wherein the target chest compression criteria and the at least one measured chest compression parameter include at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
109. The method of claim 108, wherein the plurality of physical features includes a sternal anterior-posterior distance and at least one of: chest width and circumference, an
The target chest compression criteria include a target chest compression depth for the patient.
110. The method of claim 107, further comprising:
recording at least one updated measurement of a plurality of physical characteristics of the patient after a predetermined period of time;
determining a modified target chest compression criterion based on the updated measurements; and
providing feedback guidance on how a user should adjust chest compressions applied to the patient based on whether the at least one chest compression parameter meets the modified target resuscitation criteria.
111. The method of claim 107, wherein the feedback guidance includes an indication to begin conducting a second chest compression technique different from an initial chest compression technique based at least in part on whether the measured chest compression parameter meets the target chest compression criterion.
112. The method of claim 111 wherein the initial chest compression technique comprises two-palm chest compression and the second chest compression technique comprises chest compression with active chest decompression.
113. A system for assisting a user in ventilating a patient during an acute care event, the system comprising:
at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event;
at least one ventilation sensor configured to obtain a signal indicative of ventilation performed on the patient during the acute care event;
feedback means for providing guidance on how the patient should be ventilated; and
at least one processor communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics and communicatively coupled with the at least one ventilation sensor, the at least one processor configured to:
receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target ventilation standard for the patient,
receive and process signals indicative of the ventilation from the at least one ventilation sensor to calculate at least one ventilation parameter,
determining whether the at least one ventilation parameter meets the target ventilation criteria, an
Causing the feedback device to provide an indication to the user whether the at least one ventilation parameter meets the target ventilation criteria.
114. The system of claim 113, wherein the plurality of physical characteristics includes at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
115. The system of claim 114, wherein the patient's thoracic volume is determined based on at least one of: an anterior-posterior distance of the patient's thoracic region, a width of the patient's thoracic region, and a circumference of the patient's thoracic region.
116. The system of claim 113, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient comprises at least one of: a user interface for manually inputting at least one measurement of the physical feature, a two-dimensional camera, a stereo camera, a three-dimensional imaging system, a three-dimensional sensor, a light field camera, and a position sensor or marker positioned on the patient.
117. The system of claim 116, wherein the camera, the three-dimensional sensor, or the three-dimensional imaging system is mounted to at least one of: the patient, the feedback device, and the user.
118. The system of claim 113, wherein the at least one input device for providing information indicative of a plurality of physical characteristics of the patient further provides an age or gender of the patient, and the target ventilation criteria is determined based at least in part on the plurality of physical characteristics and the age or gender of the patient.
119. The system of claim 113, wherein at least one of the plurality of physical features includes a shape of a chest of the patient.
120. A system as in claim 113, wherein the ventilation sensor comprises a flow sensor and/or a pressure sensor positioned in a flow path of a ventilation unit in fluid communication with the airway of the patient.
121. The system of claim 113, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a ventilator, and a ventilation guidance device configured to be placed in an airflow path between the ventilator and the patient.
122. The system of claim 113, wherein the target ventilation criteria and measured ventilation parameters include at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
123. The system of claim 113, wherein the processor is further configured to:
receiving and processing updated information from the at least one input device representing physical characteristics of the patient after ventilation has been performed for a predetermined period of time to determine a modified target ventilation criterion,
determining whether the at least one ventilation parameter meets the modified target ventilation criteria, an
Causing the feedback device to provide an indication to the user whether the at least one ventilation parameter meets the modified target ventilation criteria.
124. The system of claim 113, wherein at least one of the plurality of physical characteristics of the patient comprises a height of the patient.
125. The system of claim 113 or 124, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient further provides an age or gender of the patient, and the at least one processor is further configured to provide at least one of a recommended endotracheal tube placement depth and a recommended tidal volume based on the height and gender of the patient.
126. A system as claimed in claim 125, wherein the target ventilation criteria is based at least in part on the patient's height and sex.
127. The system of claim 126, wherein the at least one processor is configured to determine the recommended endotracheal tube placement depth or the recommended tidal volume based on a height and gender of the patient and values of estimated airway length from a lookup table.
128. The system of claim 113, wherein the at least one processor is further configured to receive an age of the patient and to determine a target ventilation criterion for the patient based on the plurality of physical characteristics and the age of the patient.
129. The system of claim 113, further comprising at least one chest compression sensor configured to obtain signals indicative of chest compressions performed on the patient during the acute care event, and the at least one processor is configured to:
receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target chest compression criterion for the patient,
receive and process signals indicative of the chest compressions from the at least one chest compression sensor to calculate at least one chest compression parameter,
Determining whether the at least one chest compression parameter meets the target chest compression criterion, an
Cause the feedback device to provide an indication to the user whether the at least one chest compression parameter meets the target chest compression criterion.
130. The system of claim 113, wherein the at least one processor is further configured to determine a suggested chest compression technique for the patient based on a plurality of physical characteristics of the patient and to cause the feedback device to provide the user with an indication to make the suggested chest compression technique.
131. A method of providing ventilation to a patient during an acute care event, the method comprising:
measuring a plurality of physical characteristics of the patient during the acute care event;
determining a target ventilation criterion based on the at least one measurement;
applying ventilation to the patient;
using at least one ventilation sensor to measure at least one ventilation parameter during the applied ventilation; and
providing feedback guidance on how a user should adjust ventilation provided to the patient based on whether the at least one ventilation parameter meets the target ventilation criteria.
132. The method of claim 131, wherein at least one of the plurality of physical features comprises: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
133. The method of claim 131, wherein measuring a plurality of physical features of the patient during the acute care event comprises capturing at least one image of a pediatric patient with a handheld electronic device and processing the at least one captured image with at least one processor of the handheld electronic device to determine at least one measurement of the plurality of physical features.
134. The method of claim 133, wherein at least one processor of the handheld electronic device determines the target ventilation criterion based on the at least one measurement and determines the at least one ventilation parameter by processing the signal generated by the ventilation sensor.
135. The method of claim 131, wherein measuring a plurality of physical features of the patient during the acute care event comprises using a three-dimensional imaging system to obtain information representative of the plurality of physical features.
136. The method of claim 131, further comprising: manually inputting measurements of a plurality of physical characteristics of the patient on a user interface.
137. The method of claim 131, wherein the target ventilation criteria and measured ventilation parameters include at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
138. The method of claim 131, wherein at least one of the plurality of physical features of the patient comprises a height of the patient, the method further comprising determining a suggested endotracheal tube placement depth based at least in part on the height of the patient.
139. The method of claim 138, further comprising inserting an endotracheal tube to a suggested depth, and wherein applying ventilation to the patient comprises applying ventilation to the patient through the inserted endotracheal tube.
140. The method of claim 138, further comprising providing an input of at least one of an age and a gender of the patient, wherein the recommended endotracheal tube placement depth is based on the height and gender of the patient.
141. The method of claim 131, further comprising: the method further includes determining a target chest compression criterion based on at least one of the plurality of physical characteristics, using at least one chest compression sensor to measure at least one chest compression parameter during the applied chest compressions, and providing feedback guidance on how the user should adjust the chest compressions applied to the patient based on whether the at least one chest compression parameter meets the target chest compression criterion.
142. The method of claim 131, further comprising: a suggested chest compression technique is determined based on the measured plurality of physical features and feedback guidance is provided to provide an indication of the suggested chest compression technique to the user.
143. A system for assisting a user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event, the system comprising:
at least one three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient;
At least one of a chest compression sensor or a ventilation sensor for obtaining a signal indicative of at least one resuscitation activity applied to the patient;
feedback means for providing guidance on how the user should administer the at least one resuscitation activity to the patient; and
at least one processor communicatively coupled with the at least one three-dimensional imaging system and communicatively coupled with at least one chest compression sensor or ventilation sensor, the at least one processor configured to:
receiving and processing information from the three-dimensional imaging system representing the at least one body feature to generate a three-dimensional representation of at least a portion of the patient's body,
determining a target resuscitation criterion based on the generated three-dimensional representation,
receiving and processing a signal indicative of the at least one resuscitation activity to calculate at least one resuscitation parameter,
determining whether the at least one resuscitation parameter meets the target resuscitation criterion, and
cause the feedback device to provide an indication of whether the at least one resuscitation parameter meets the target resuscitation criterion.
144. The system of claim 143, wherein the at least one physical characteristic comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
145. The system according to claim 143, wherein the information indicative of the at least one physical characteristic comprises information indicative of the at least one physical characteristic recorded during inspiration and/or information indicative of the at least one physical characteristic recorded during expiration.
146. The system of claim 143, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a defibrillator, a ventilator, a chest compression guidance device configured to be placed on the chest of the patient, or a ventilation guidance device configured to be placed in the airflow path between a ventilator and the patient.
147. The system of claim 143, wherein the at least one processor is configured to cause the feedback device to display at least a portion of the three-dimensional representation of the patient to the user.
148. The system of claim 143 wherein the processor is further configured to determine a type of patient based on the generated three-dimensional representation of the patient and to cause the feedback device to provide an indication of the type of patient to the user.
149. The system of claim 148, wherein the patient type comprises a neonate, an infant, a small child, a large child, a small adult, an average sized adult, or a large adult.
150. The system of claim 143, wherein the processor is further configured to determine a suggested chest compression technique for the patient based on the generated three-dimensional representation of the patient and to cause the feedback device to provide the user with an indication to perform the suggested chest compression technique.
151. The system of claim 150, wherein the resuscitation activity is chest compression, and the suggested chest compression technique includes at least one of: palmar chest compressions, circumthumb chest compressions, or double finger chest compressions.
152. The system of claim 150, wherein the resuscitation activity is chest compression and the suggested chest compression technique includes active chest decompression.
153. The system of claim 152, wherein the indication to perform active chest decompression comprises a recommendation to perform chest decompression using a suction cup device, an attachment device, a hook and loop device, and/or an instruction to compress the side or abdomen of the patient.
154. A system for assisting a user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event, the system comprising:
at least one input device for providing information representative of at least one physical characteristic of the patient measured during the acute care event;
feedback means for providing information to a user, the patient, and information to the user relating to the acute care event; and
at least one processor communicatively coupled with at least one apparatus for providing information representative of at least one physical characteristic of the patient, the at least one processor configured to:
receiving and processing information representative of at least one physical characteristic measured during an initial time period of the acute care event,
determining an initial target resuscitation criterion based on at least one physical characteristic during the initial time period,
causing the feedback device to provide an indication to the user regarding the initial target resuscitation criteria,
receiving and processing information indicative of at least one physical characteristic measured during a subsequent time period of the acute care event,
Determining a modified target resuscitation criterion based on at least one physical characteristic during the subsequent time period, an
Causing the feedback device to provide an indication to the user regarding the modified target resuscitation criteria.
155. The system of claim 154, wherein the at least one physical characteristic comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
156. The system of claim 154, wherein the at least one means for providing information representative of at least one physical characteristic of the patient comprises at least one of: a user interface for manually entering body measurements, a two-dimensional camera, a stereo camera, a light field camera, a three-dimensional sensor, a three-dimensional imaging system, and a position sensor or marker positioned on the patient.
157. The system of claim 154, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a smart watch, a patient monitoring device, a defibrillator, a ventilator, a chest compression guidance device configured to be placed on the chest of the patient, and a ventilation guidance device configured to be placed in an airflow path between a ventilator and the patient.
158. The system of claim 154, wherein a duration of the initial period of time is selected based on at least one physical characteristic of the acute care event and the initial target resuscitation criteria.
159. The system of claim 154, wherein the at least one processor is further configured to determine a modified recommendation technique for the resuscitation activity based on at least one physical feature measured during a subsequent time period of the acute care event, and to cause the feedback device to provide the user with an indication to conduct the modified recommendation technique for the resuscitation activity.
160. The system of claim 159, wherein the resuscitation activity includes chest compressions, and the modified suggested chest compression technique includes at least one of: palmar chest compressions, circumthumb chest compressions, or double finger chest compressions.
161. The system of claim 159, wherein the resuscitation activity is chest compression, and the modified chest compression technique comprises chest compression and active chest decompression.
162. The system of claim 161, wherein the instructions to perform active chest decompression comprise instructions to perform chest decompression using a suction cup device, an attachment device, a hook and loop fastener device, and/or instructions to compress the side or abdomen of the patient.
163. The system of claim 154, further comprising at least one of a chest compression sensor and a ventilation sensor communicatively coupled to the at least one processor and configured to obtain a signal indicative of CPR applied to the patient, and wherein the at least one processor is further configured to:
receiving and processing a signal indicative of CPR applied to the patient during an initial period of the acute care event to calculate at least one resuscitation parameter,
determining whether the at least one resuscitation parameter meets the initial target resuscitation criteria, and
causing the feedback device to provide an indication to the user whether the at least one resuscitation parameter meets the initial target resuscitation criteria.
164. The system of claim 163, wherein the at least one processor is further configured to:
receiving and processing a signal indicative of CPR applied to the patient during a subsequent period of the acute care event to calculate at least one resuscitation parameter,
determining whether the at least one resuscitation parameter meets the modified target resuscitation criterion, and
causing the feedback device to provide an indication to the user whether the at least one resuscitation parameter meets the modified target resuscitation criteria.
165. The system of claim 163 wherein the chest compression sensor comprises at least one of: a single-axis accelerometer, a multi-axis accelerometer, and a gyroscope, and the ventilation sensor comprises at least one of a flow sensor and a pressure sensor in a flow path in fluid communication with the airway of the patient.
166. The system of claim 163, wherein the at least one physical characteristic of the patient includes an anterior-posterior distance of the cardiothoracic region of the patient and at least one of: the width and circumference of the cardiothoracic region of the patient, an
The initial target resuscitation criterion and the modified target resuscitation criterion each include a target chest compression depth for the patient.
167. The system of claim 163, wherein feedback includes a summary report for a rescue effort, the summary report including an indication for an initial time period comparing resuscitation parameters measured during the initial time period to the initial target resuscitation criteria and an indication for a subsequent time period comparing resuscitation parameters measured during the subsequent time period to the modified target resuscitation criteria.
168. The system of claim 163, wherein summary report includes a map comparing resuscitation parameters measured during the initial time period to the initial target resuscitation criteria and a map for a subsequent time period comparing resuscitation parameters measured during the subsequent time period to the modified target resuscitation criteria.
169. A computer-implemented method for a feedback device to provide feedback to a user to assist the user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event, the method comprising:
receiving and processing information representative of at least one physical characteristic of the patient measured during an initial period of the acute care event from at least one device for providing information representative of the at least one physical characteristic;
Determining an initial target resuscitation criterion based on at least one physical feature during the initial time period;
receiving and processing information representative of at least one physical characteristic measured during a subsequent time period of the acute care event;
determining a modified target resuscitation criterion based on at least one physical feature during the subsequent time period; and
causing the feedback device to provide an indication to the user regarding the modified target resuscitation criteria.
170. The method of claim 169, wherein the at least one physical characteristic includes at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
171. The method of claim 169, wherein a duration of the initial time period is selected based on at least one physical characteristic of the patient and the initial target resuscitation criteria.
172. The method of claim 169, further comprising determining a modified technique of the resuscitation activity based on at least one physical feature measured during a subsequent time period of the acute care event, and causing the feedback device to provide instructions to the user to conduct the modified technique of the resuscitation activity.
173. The method of claim 172, wherein the resuscitation activity comprises chest compression, and the modified chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
174. The method of claim 172, wherein the resuscitation activity is chest compression and the modified chest compression technique comprises performing chest compression and active chest decompression.
175. The method of claim 172, wherein the instructions to perform active chest decompression comprise instructions to perform chest decompression using a suction cup device, an attachment device, a hook and loop fastener device, and/or instructions to compress the side or abdomen of the patient.
176. The method of claim 169, further comprising:
Receiving and processing a signal from at least one resuscitation sensor indicative of CPR applied to the patient during an initial period of the acute care event, the at least one resuscitation sensor including at least one of a chest compression sensor and a ventilation sensor;
calculating at least one resuscitation parameter based on the signal indicative of CPR from the at least one resuscitation sensor;
determining whether the at least one resuscitation parameter meets the initial target resuscitation criteria; and
causing the feedback device to provide an indication to the user whether the at least one resuscitation parameter meets the initial target resuscitation criteria.
177. The method of claim 176, further comprising:
receiving and processing a signal indicative of CPR applied to the patient during a subsequent time period of the acute care event to calculate at least one resuscitation parameter;
determining whether the at least one resuscitation parameter meets the modified target resuscitation criteria; and
causing the feedback device to provide an indication to the user whether the at least one resuscitation parameter meets the modified target resuscitation criteria.
178. The method of claim 177, further comprising:
Causing the feedback device to provide a summary report to a user, the summary report including an indication for an initial time period comparing resuscitation parameters measured during the initial time period to the initial target resuscitation criteria, and an indication for a subsequent time period comparing resuscitation parameters measured during the subsequent time period to the modified target resuscitation criteria.
179. The method of claim 178, wherein the summary report includes a map comparing resuscitation parameters measured during the initial time period to the initial target resuscitation criteria and a map for a subsequent time period comparing resuscitation parameters measured during the subsequent time period to the modified target resuscitation criteria.
180. A system for providing ventilatory treatment to a patient, the system comprising:
at least one three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient;
a ventilator device for providing the ventilatory treatment to the patient; and
at least one processor communicatively coupled with the at least one three-dimensional imaging system and communicatively coupled with the ventilator, the at least one processor configured to:
Receiving and processing information representative of at least one physical feature of the patient to generate a three-dimensional representation of the patient,
determining at least one ventilation criterion of the ventilation device based on the generated three-dimensional representation, an
Causing the ventilation device to provide ventilation based on the at least one ventilation criterion.
181. The system of claim 180, wherein the at least one physical characteristic comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
182. The system of claim 181, wherein the thoracic volume is calculated based on an anterior-posterior distance of the patient's thoracic region, a length of the patient's thoracic region, and at least one of: a width of the thoracic region and a circumference of the thoracic region.
183. The system of claim 180, wherein the information indicative of the at least one physical characteristic comprises information indicative of the at least one physical characteristic recorded during inspiration and/or information indicative of the at least one physical characteristic recorded during expiration.
184. The system of claim 180, wherein the ventilation parameters include at least one of the following during an acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
185. The system of claim 180, wherein the ventilation device comprises an automatic mechanical ventilator configured to deliver a plurality of ventilations to the patient in accordance with at least one ventilation criterion.
186. The system of claim 180, wherein the ventilator comprises a ventilation unit, and the at least one processor causes the ventilator to provide ventilation based on the at least one ventilation criterion by providing guidance to a user to deliver ventilation in accordance with the at least one ventilation criterion.
187. The system of claim 186, wherein the ventilation unit comprises a ventilation bag in fluid communication with the airway of the patient and a gas flow path.
188. The system of claim 180, wherein the processor is further configured to:
after a predetermined period of time, receiving and processing updated information from the three-dimensional imaging system representing at least one physical feature of the patient to generate an updated three-dimensional representation of the patient;
Determining at least one modified ventilation criterion based on the updated three-dimensional representation of the patient; and
adjusting a function of the ventilator based on the at least one modified ventilation criterion.
189. The system of claim 188, wherein the predetermined period of time is determined based on an initially generated three-dimensional representation of the patient.
190. The system of claim 180, wherein the at least one processor is further configured to receive an age of the patient and determine the at least one ventilation criterion based at least in part on the age of the patient.
191. A system for assisting a user in providing medical care to a patient during an acute care event, the system comprising:
at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event;
a user interface for providing acute care treatment information for the patient; and
at least one processor communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics, the at least one processor configured to:
Receiving and processing information representative of a plurality of physical characteristics of the patient to estimate the patient's weight,
determining at least one treatment parameter of the patient based at least in part on the estimated weight of the patient, an
Cause the user interface to provide an indication of the at least one treatment parameter of the patient.
192. The system of claim 191, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient comprises at least one of: two-dimensional cameras, stereo cameras, three-dimensional imaging systems, three-dimensional sensors, light field cameras, and position sensors or markers positioned on the patient.
193. The system of claim 191, wherein the at least one input device includes the user interface, and the user interface is configured for the user to manually input at least one measurement for each of the plurality of physical characteristics.
194. The system of claim 191, wherein the plurality of physical characteristics includes at least one of: a sternum anterior-posterior distance, i.e., a sternum AP distance, a lateral width of the patient's chest, a chest circumference, a waist circumference, a hip circumference, a neck circumference, a shoulder width, a chest shape, a height, a waist-to-hip ratio, and a waist height ratio.
195. The system of claim 191, wherein the at least one processor is configured to process information representative of the plurality of physical features to estimate a volume of at least a portion of the patient's body.
196. The system of claim 195, wherein the at least one processor is configured to estimate the patient's weight based on an estimated volume and an estimated mean density of the body.
197. The system of claim 196, wherein the estimated average density of a body is about 900kg/m3To about 1050kg/m3。
198. The system of claim 196, wherein the estimated average density of a body comprises a predetermined value for a population of individuals.
199. The system of claim 196, wherein the estimated average density of a body is a patient-specific value based on at least one of a plurality of body characteristics of the patient.
200. The system of claim 195, wherein estimated volume comprises a thoracic volume of the patient or a total volume of the patient.
201. The system of claim 191, wherein the at least one treatment parameter includes at least one of: defibrillator shock energy, ventilation tidal volume, and drug delivery dose.
202. The system of claim 191, wherein the at least one treatment parameter includes a tidal volume of ventilation, and the tidal volume of ventilation is calculated based at least in part on a weight of the patient.
203. The system of claim 191, wherein the at least one input device for providing information indicative of a plurality of physical characteristics of the patient provides at least one of an age or a gender of the patient, and the at least one treatment parameter is determined based at least in part on the plurality of physical characteristics and the at least one of the age or the gender of the patient.
Technical Field
The present invention relates to electronic devices that assist acute caregivers by providing guidance and feedback for resuscitation activities on patients, and in some examples to systems that perform criteria for resuscitation activities based at least in part on physical characteristics of patients measured during acute care events.
Background
Cardiopulmonary resuscitation (CPR) is a process by which one or more acute care providers may attempt to resuscitate a patient who may have suffered an adverse cardiac event by taking one or more actions (e.g., providing chest compressions and ventilation to the patient). Chest compressions are an important component of CPR, primarily because they help to maintain blood circulation through the body and in the heart. Ventilation is also a critical part of CPR, as ventilation helps to provide the circulating blood with the very necessary gas exchange (e.g., oxygen supply and carbon dioxide deposition).
CPR may be performed by a team of one or more acute care providers (e.g., an Emergency Medical Services (EMS) team consisting of Emergency Medical Technicians (EMTs), a hospital team including medical caregivers (e.g., doctors, nurses, etc.), and/or bystanders responding to emergency events). In some cases, one acute care offer The person may provide chest compressions to the patient while another acute care provider may provide ventilation to the patient, where the chest compressions and ventilation may be timed and/or coordinated according to an appropriate CPR protocol. When a professional such as an EMT provides care, ventilation may be provided via an air bag squeezed by, for example, an acute care provider, rather than mouth-to-mouth. CPR may be performed in conjunction with a shock to the patient provided by an external defibrillator, such as an Automated External Defibrillator (AED) or professional defibrillator/monitor. Such AEDs typically provide guidance and instructions (e.g., in the form of audible feedback) to the acute care provider, such as "push more" (when the acute care provider does not make chest compressions to the desired depth), "stop CPR", and "stand-by" (because a shock is to be delivered), among others. To determine the quality of ongoing chest compressions, some defibrillators may have CPR D from one or more accelerometers (such as provided with CPR D manufactured by ZOLL MEDICAL of Chems-Folder, Mass.)CPR STATAnd ONE STEPTMAn accelerometer of the pad, etc.) to obtain information, where the accelerometer or accelerometers can be used to provide data to determine information such as the depth of chest compressions (e.g., determine that compressions are too shallow or too deep and cause the defibrillator to provide appropriate prompts). The AED may also provide feedback to encourage the acute care provider to conduct resuscitation activities according to recommendations or protocols. For example, such an AED may emit an instruction or display icon informing an acute care provider when chest compressions are too shallow or too deep.
However, an improved system for providing guidance, information and feedback to an acute care provider regarding the performance of resuscitation activities would be useful for improving patient care and outcome. The apparatus, systems, and techniques discussed herein are intended to provide such benefits.
Disclosure of Invention
According to an aspect of the invention, a system for assisting a user in chest compressions of a patient during an acute care event comprises: at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event; at least one chest compression sensor configured to obtain a signal indicative of chest compressions performed on the patient during the acute care event; feedback means for providing chest compression feedback to the user; and at least one processor. The at least one processor may be communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics and with the at least one chest compression sensor. The at least one processor is configured to: receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target chest compression criterion for the patient; receive and process signals indicative of the chest compressions from the at least one chest compression sensor to calculate at least one chest compression parameter; determining whether the at least one chest compression parameter meets the target chest compression criteria; and cause the feedback device to provide an indication to the user whether the at least one chest compression parameter meets the target chest compression criterion.
According to another aspect of the invention, a system for assisting a user in chest compressions of a patient during an acute care event comprises: at least one input device for providing information representative of at least one physical characteristic of the patient measured during the acute care event; feedback means for providing guidance on how chest compressions should be performed on the patient; and at least one processor. The at least one processor may be communicatively coupled with at least one device for providing information representative of the at least one physical characteristic. The at least one processor is configured to: receiving and processing information representative of at least one physical characteristic of the patient to determine a suggested chest compression technique for the patient; and causing the feedback device to provide an indication of the suggested chest compression technique to the user.
According to another aspect of the invention, a method of providing chest compressions to a patient during an acute care event includes: measuring a plurality of physical characteristics of the patient during the acute care event; determining a target chest compression criterion based on the measured plurality of physical features; applying chest compressions to the patient; using at least one chest compression sensor to measure at least one chest compression parameter during the applied chest compressions; and providing feedback guidance on how a user should adjust chest compressions applied to the patient based on whether the at least one chest compression parameter meets the target chest compression criteria.
According to another aspect of the invention, a method of providing chest compressions to a patient during an acute care event includes: measuring a plurality of physical characteristics of the patient during the acute care event; determining a suggested chest compression technique based on the measured plurality of physical features; providing feedback guidance to provide an indication of the suggested chest compression technique to a user; and applying chest compressions to the patient in accordance with the suggested chest compression technique.
According to another aspect of the invention, a system for assisting a user in ventilating a patient during an acute care event comprises: at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event; at least one ventilation sensor configured to obtain a signal indicative of ventilation performed on the patient during the acute care event; feedback means for providing guidance on how the patient should be ventilated; and at least one processor. The at least one processor may be communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics and with the at least one ventilation sensor. The at least one processor is configured to: receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target ventilation criteria for the patient; receiving and processing signals indicative of the ventilation from the at least one ventilation sensor to calculate at least one ventilation parameter; determining whether the at least one ventilation parameter meets the target ventilation criteria; and causing the feedback device to provide an indication to the user whether the at least one ventilation parameter meets the target ventilation criteria.
According to another aspect of the invention, a method of providing ventilation to a patient during an acute care event comprises: measuring a plurality of physical characteristics of the patient during the acute care event; determining a target ventilation criterion based on the at least one measurement; applying ventilation to the patient; measuring at least one ventilation parameter during the applied ventilation using at least one ventilation sensor; and providing feedback guidance on how a user should adjust the ventilation provided to the patient based on whether the at least one ventilation parameter meets the target ventilation criteria.
According to another aspect of the invention, a system for assisting a user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event comprises: at least one three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient; at least one of a chest compression sensor and a ventilation sensor for obtaining a signal indicative of at least one resuscitation activity applied to the patient; feedback means for providing guidance on how the user should administer the at least one resuscitation activity to the patient; and at least one processor. The at least one processor may be communicatively coupled with the at least one three-dimensional imaging system and with at least one chest compression sensor or at least one ventilation sensor. The at least one processor is configured to: receiving and processing information from the three-dimensional imaging system representative of the at least one body feature to generate a three-dimensional representation of at least a portion of the patient's body; determining a target resuscitation criterion based on the generated three-dimensional representation; receiving and processing a signal indicative of the at least one resuscitation activity to calculate at least one resuscitation parameter; determining whether the at least one resuscitation parameter meets the target resuscitation criteria; and causing the feedback device to provide an indication of whether the at least one resuscitation parameter meets the target resuscitation criterion.
According to another aspect of the invention, a system for assisting a user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event comprises: at least one input device for providing information representative of at least one physical characteristic of the patient measured during the acute care event; feedback means for providing information to a user, the patient, and information to the user relating to the at least one resuscitation activity; and at least one processor. The at least one processor is communicatively coupled with at least one device for providing information representative of at least one physical characteristic of the patient. The at least one processor is configured to: receiving and processing information representative of at least one physical characteristic measured during an initial time period of the acute care event; determining an initial target resuscitation criterion based on at least one physical feature during the initial time period; causing the feedback device to provide an indication to the user regarding the initial target resuscitation criteria; receiving and processing information representative of at least one physical characteristic measured during a subsequent time period of the acute care event; determining a modified target resuscitation criterion based on at least one physical feature during the subsequent time period; and causing the feedback device to provide an indication to the user regarding the modified target resuscitation criteria.
According to another aspect of the invention, a computer-implemented method for causing a feedback device to provide feedback to a user to assist the user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event comprises: receiving and processing information representative of at least one physical characteristic of the patient measured during an initial period of the acute care event from at least one device for providing information representative of the at least one physical characteristic; determining an initial target resuscitation criterion based on at least one physical feature during the initial time period; receiving and processing information representative of at least one physical characteristic measured during a subsequent time period of the acute care event; determining a modified target resuscitation criterion based on at least one physical feature during the subsequent time period; and causing the feedback device to provide an indication to the user regarding the modified target resuscitation criteria.
According to another aspect of the invention, a system for providing ventilatory treatment to a patient comprises: at least one three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient; a ventilator device for providing the ventilatory treatment to the patient; and at least one processor. The at least one processor may be communicatively coupled with the at least one three-dimensional imaging system and with the ventilator. The at least one processor is configured to: receiving and processing information representative of at least one physical feature of the patient to generate a three-dimensional representation of the patient; determining at least one ventilation criterion of the ventilation device based on the generated three-dimensional representation; and causing the ventilation device to provide ventilation based on the at least one ventilation criterion.
According to another aspect of the invention, a system for assisting a user in drug delivery to a patient during an acute care event comprises: at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event; feedback means for providing dosage information for delivering a drug to the patient; and at least one processor. The at least one processor may be communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics. The at least one processor is configured to: receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target drug delivery dose for the patient; and causing the feedback device to provide the user with an indication of the target drug delivery dose for the patient.
According to another aspect of the invention, a system for assisting a user in providing medical care to a patient during an acute care event comprises: at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event; a user interface for providing acute care treatment information for the patient; and at least one processor. The at least one processor is communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics. The at least one processor is configured to: receiving and processing information representative of a plurality of physical characteristics of the patient to estimate the patient's weight; determining at least one treatment parameter for the patient based at least in part on the estimated weight of the patient; and cause the user interface to provide an indication of the at least one treatment parameter of the patient.
Examples of the present invention will now be described in the following numbered clauses:
clause 1: a system for assisting a user in chest compressions of a patient during an acute care event, the system comprising: at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event; at least one chest compression sensor configured to obtain a signal indicative of chest compressions performed on the patient during the acute care event; feedback means for providing chest compression feedback to the user; and at least one processor communicatively coupled with the at least one input device for providing information representative of the plurality of physical features and communicatively coupled with the at least one chest compression sensor, the at least one processor configured to: receiving and processing information representative of a plurality of physical characteristics of the patient to determine a target chest compression criterion for the patient; receive and process signals indicative of the chest compressions from the at least one chest compression sensor to calculate at least one chest compression parameter; determining whether the at least one chest compression parameter meets the target chest compression criteria; and cause the feedback device to provide an indication to the user whether the at least one chest compression parameter meets the target chest compression criterion.
Clause 2: the system of clause 1, wherein the plurality of physical characteristics includes at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 3: the system of clause 1 or clause 2, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient comprises at least one of: a user interface for manually inputting at least one measurement of the physical feature, a two-dimensional camera, a stereo camera, a three-dimensional sensor, a three-dimensional imaging system, a light field camera, and a position sensor or marker positioned on the patient.
Clause 4: the system of clause 3, wherein the at least one input device includes a three-dimensional imaging system for obtaining information representative of a plurality of physical features of the patient, and the processor is configured to generate a three-dimensional representation of at least a portion of the patient's body based on the information obtained from the three-dimensional imaging system.
Clause 5: the system of any of clauses 1-4, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient is mounted to at least one of: the patient, the feedback device, and the user.
Clause 6: the system of any of clauses 1-5, further comprising a smartphone or computer tablet, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient comprises a camera of the smartphone or computer tablet, and the at least one processor comprises a processor of the smartphone or computer tablet.
Clause 7: the system of clause 6, wherein the feedback device comprises a visual display of the smartphone or the computer tablet.
Clause 8: the system of any of clauses 1-7, wherein the plurality of physical characteristics are measured during inspiration or expiration.
Clause 9: the system of any of clauses 1-8, wherein at least one of the plurality of physical characteristics comprises a anthropometric characteristic of the patient.
Clause 10: the system of clause 9, wherein the anthropometric characteristics of the patient include at least one of: chest shape, ratio between AP distance and lateral width of the chest, chest volume, and total patient volume.
Clause 11: the system of any of clauses 1-10, wherein the chest compression sensor comprises at least one of: single axis accelerometers, multiple axis accelerometers, and gyroscopes.
Clause 12: the system of any of clauses 1-11, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a defibrillator, and a chest compression guidance device configured to be placed on the chest of the patient.
Clause 13: the system of any of clauses 1-12, wherein the feedback device is configured to provide at least one of audio feedback, visual feedback, and tactile feedback.
Clause 14: the system of any of clauses 1-13, wherein the target chest compression criteria and the measured chest compression parameters include at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
Clause 15: the system of clause 14, wherein the target chest compression criteria for compression depth comprises a depth of 0.2 to 3.5 inches.
Clause 16: the system of clause 14 or clause 15, wherein the target chest compression criteria for compression depth comprises at least one of the following depths: 0.2 inches to 0.75 inches for patients with an AP distance of less than 3 inches; 0.75 inches to 1.25 inches for patients with AP distances of 4.0 inches to 5.0 inches; 1.25 inches to 1.75 inches for patients with AP distances of 6.0 inches to 8.0 inches; 1.75 inches to 2.25 inches for patients with AP distances of 9.0 inches to 11.0 inches; 2.25 inches to 2.75 inches for patients with AP distances of 10 inches to 12 inches; and 2.75 inches to 3.5 inches for patients with an AP distance of 13 inches or greater.
Clause 17: the system of any of clauses 14-16, wherein the target chest compression criteria for the chest compression rate comprises a rate of 100cpm to 160 cpm.
Clause 18: the system of any of clauses 14-17, wherein the target chest compression criteria for compression rate comprises at least one of the following rates: 140 to 160cpm for patients with an AP distance of less than 3.0 inches; 130 to 150cpm for patients with an AP distance of 4.0 to 5.0 inches; 120 to 140cpm for patients with AP distances of 6.0 to 8.0 inches; 110 to 130cpm for patients with an AP distance of 9.0 to 11 inches; and 100 to 120cpm for patients with AP distances of 12 inches or more.
Clause 19: the system of any of clauses 14-18, wherein the target chest compression criteria for a target chest compression release rate comprises 150 to 600 inches per minute.
Clause 20: the system of any of clauses 14-19, wherein the target chest compression criteria for a target chest compression release rate comprises at least one of: 150 to 250 inches/minute for patients with an AP distance of less than 3.0 inches; 200 to 300 inches/minute for patients with AP distances of 4.0 to 5.0 inches; 250 to 400 inches/minute for patients with AP distances of 6.0 to 8.0 inches; and 250 to 600 inches/minute for patients with AP distances of 10 inches or more.
Clause 21: the system of any of clauses 1-20, wherein the plurality of physical characteristics of the patient includes an anterior-posterior distance of a thoracic region of the patient and at least one of: lateral width of chest, circumference of chest, patient's total volume, chest volume, waist size, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, or BMI, and the target chest compression criterion comprises the patient's target chest compression depth.
Clause 22: the system of clause 21, wherein the indication for the user provided by the feedback device includes an instruction to increase chest compression depth, decrease chest compression depth, or maintain chest compression depth determined based on the determination of whether the chest compression parameter meets the target chest compression criterion.
Clause 23: the system of any of clauses 1-22, wherein the at least one processor determines a target chest compression criterion for the patient based on the plurality of physical features and values determined from a look-up table and/or calculated by a linear regression formula.
Clause 24: the system of any of clauses 1-23, wherein the at least one processor is further configured to determine a type of patient based on the plurality of physical characteristics and to cause the feedback device to provide an indication of the type of patient to the user.
Clause 25: the system of clause 24, wherein the type of patient comprises a pediatric patient or an adult patient.
Clause 26: the system of clause 24 or clause 25, wherein the type of patient comprises at least one of: neonates, infants, small children, large children, small adults, average sized adults, and large adults.
Clause 27: the system of any of clauses 1-26, wherein the at least one processor is further configured to: after chest compressions have been performed for a predetermined period of time, receiving and processing updated information from at least one device representing a plurality of physical characteristics of the patient to determine modified target chest compression criteria, determining whether the at least one chest compression parameter meets the modified target chest compression criteria, and causing the feedback device to provide the user with an indication of whether the at least one chest compression parameter meets the modified target chest compression criteria.
Clause 28: the system of clause 27, wherein the updated information representative of the plurality of physical features comprises updated information related to an anterior-posterior distance of the patient's cardiothoracic region, and the modified target chest compression criteria comprises modifying a target chest compression depth based at least in part on the updated information related to the anterior-posterior distance of the patient's cardiothoracic region.
Clause 29: the system of clause 27 or clause 28, wherein the at least one processor is further configured to compare an initial target chest compression criterion to the modified target chest compression criterion and to cause the feedback device to provide an indication to the user if the modified target chest compression criterion is different from the initial target chest compression criterion.
Clause 30: the system of any of clauses 27-29, wherein the at least one processor is configured to maintain a record of past modified target chest compression criteria and record chest compression parameters corresponding to each of the past modified target chest compression criteria.
Clause 31: the system of any of clauses 27-30, wherein the predetermined time period prior to receiving the updated information comprises a time period determined based on initial information representative of the plurality of physical features and the target chest compression criteria.
Clause 32: the system of any of clauses 1-31, wherein the at least one processor is further configured to determine a suggested chest compression technique for the patient based on a plurality of physical characteristics of the patient and to cause the feedback device to provide the user with an indication to perform the suggested chest compression technique.
Clause 33: the system of clause 32, wherein the suggested chest compression technique is based on a change in at least one of the patient's plurality of physical characteristics over a predetermined period of time.
Clause 34: the system of clause 32 or clause 33, wherein the suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
Clause 35: the system of any of clauses 32-34, wherein the suggested chest compression technique comprises active chest decompression.
Clause 36: the system of clause 35, wherein the plurality of physical features includes an anterior-posterior sternal distance, and the active chest decompression as the suggested chest compression technique is based on a reduction in the anterior-posterior sternal distance.
Clause 37: the system of clause 35 or clause 36, wherein the indication to perform active chest decompression comprises an indication to perform chest decompression using at least one of a suction cup device, an attachment device, and a hook and loop fastener device, and/or an instruction to compress a side or abdomen of the patient.
Clause 38: the system of any of clauses 1-37, wherein the at least one processor is further configured to determine a percentage of time that the chest compression parameters measured during a rescue effort do not meet the target chest compression criteria, and to cause the feedback device to provide an indication to the user if the percentage of time exceeds a predetermined value.
Clause 39: the system of clause 38, wherein the indication to the user if the percentage of time exceeds the predetermined value comprises an instruction to begin performing a second chest compression technique different from the initial chest compression technique performed during a predetermined time period.
Clause 40: the system of clause 39, wherein the initial chest compression technique comprises two-palm chest compression and the second chest compression technique comprises chest compression with active chest decompression.
Clause 41: the system of clause 39 or clause 40, wherein the initial chest compression technique comprises one-handed or two-handed chest compression and the second chest compression technique comprises two-fingered chest compression.
Clause 42: the system of any of clauses 39-41, wherein the at least one processor is configured to receive a confirmation from the user when the user initiates the second chest compression technique.
Clause 43: the system of any of clauses 1-42, further comprising at least one ventilation sensor configured to measure at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
Clause 44: the system of clause 43, wherein the ventilation sensor comprises a flow sensor and/or a pressure sensor positioned in a flow path of a ventilation unit in fluid communication with the airway of the patient.
Clause 45: the system of clause 43, wherein the ventilation sensor comprises at least a first absolute air pressure sensor and a second absolute air pressure sensor separated by a flow restrictor for measuring the air flow rate and pressure in the air flow path.
Clause 46: the system of any of clauses 1-45, wherein the target chest compression criteria comprises an initial range of acceptable chest compressions, and the at least one processor is further configured to: after a predetermined period of time, receiving and processing information representative of a second physical characteristic of the patient that is different from a first physical characteristic of the plurality of physical characteristics, and determining an updated range of acceptable chest compressions based on the first and second physical characteristics.
Clause 47: the system of clause 46, wherein the at least one processor is further configured to: determining whether the at least one chest compression parameter is within the updated range of acceptable chest compressions, and causing the feedback device to provide the user with an indication of whether the at least one chest compression parameter is within the updated range of acceptable chest compressions.
Clause 48: the system of any of clauses 1-47, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient also provides an age or gender of the patient, and the target chest compression criterion is determined based at least in part on the plurality of physical characteristics and the age or gender of the patient.
Clause 49: the system of any of clauses 1-48, wherein the feedback device comprises a defibrillator, and the at least one processor is configured to receive and process updated information from at least one device representative of a plurality of physical characteristics of the patient to determine a modified target chest compression criterion while the defibrillator is providing a defibrillating shock to the patient.
Clause 50: the system of clause 49, wherein the at least one processor is configured to: causing the feedback device to provide instructions to the user to resume chest compressions after the defibrillation shock is delivered; receiving and processing signals from the at least one chest compression sensor indicative of resumed chest compressions to calculate at least one chest compression parameter of the resumed chest compressions; determining whether at least one chest compression parameter of the resumed chest compression meets modified target chest compression criteria; and causing the feedback device to provide an indication to the user whether at least one chest compression parameter of the resumed chest compression meets the modified target chest compression criteria.
Clause 51: the system of any of clauses 1-50, wherein the plurality of physical characteristics of the patient includes an anterior-posterior distance of a thoracic region of the patient and at least one of: a lateral width of a chest, a circumference, a chest volume, and a chest shape, and the target chest compression criterion comprises a target chest compression depth of the patient.
Clause 52: the system of any of clauses 1-51, wherein the plurality of physical characteristics of the patient include an anterior-posterior distance of a thoracic region of the patient and at least one of: a length, a volume, and a weight of the body region of the patient, and the target chest compression criteria comprises a target chest compression depth of the patient; and optionally, wherein the body region of the patient comprises at least one of: chest area, hands, arms, feet, legs, face, and skull of the patient.
Clause 53: the system of any of clauses 1-51, wherein the plurality of physical features of the patient includes an anterior-posterior distance of a thoracic region of the patient and a feature or characteristic indicative of an overall size of the patient; and optionally, wherein the feature or characteristic indicative of the overall size of the patient comprises one or more of: height, weight, arm extension, body volume, and Body Mass Index (BMI) of the patient.
Clause 54: the system of any of clauses 1-53, wherein the processor is configured to process the plurality of physical features to estimate the weight of the patient.
Clause 55: the system of clause 54, wherein the processor is configured to determine a treatment parameter for the patient based at least in part on the estimated weight of the patient.
Clause 56: a system for assisting a user in chest compressions of a patient during an acute care event, the system comprising: at least one input device for providing information representative of at least one physical characteristic of the patient measured during the acute care event; feedback means for providing guidance on how chest compressions should be performed on the patient; and at least one processor communicatively coupled with at least one apparatus for providing information representative of the at least one physical characteristic, the at least one processor configured to: receive and process information representative of at least one physical characteristic of the patient to determine a suggested chest compression technique for the patient, and cause the feedback device to provide an indication of the suggested chest compression technique to the user.
Clause 57: the system of clause 56, wherein the at least one input device provides information representative of a plurality of physical characteristics of the patient measured during the acute care event.
Clause 58: the system of clause 56 or clause 57, wherein the plurality of physical characteristics comprises at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and Body Mass Index (BMI).
Clause 59: the system of any of clauses 56-58, wherein the at least one input device for providing information representative of at least one physical characteristic of the patient comprises at least one of: a user interface for manually inputting at least one measurement of the physical feature, a two-dimensional camera, a stereo camera, a three-dimensional sensor, a three-dimensional imaging system, a light field camera, and a position sensor or marker positioned on the patient.
Clause 60: the system of clause 59, wherein the at least one apparatus comprises a three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient, and the at least one processor is configured to generate a three-dimensional representation of at least a portion of the patient's body based on the information obtained from the three-dimensional sensor.
Clause 61: the system of any of clauses 56-60, further comprising a smartphone or computer tablet, wherein the at least one means for providing information representative of at least one physical feature of the patient comprises a camera of the smartphone or computer tablet, and the at least one processor comprises a processor of the smartphone or computer tablet.
Clause 62: the system of clause 61, wherein the feedback device comprises a visual display of the smartphone or the computer tablet.
Clause 63: the system of any of clauses 56-61, wherein the at least one physical characteristic is measured during inspiration or expiration.
Clause 64: the system of any of clauses 56-63, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a defibrillator, and a chest compression guidance device configured to be placed on the chest of the patient.
Clause 65: the system of any of clauses 56-64, wherein the feedback device is configured to provide at least one of audio feedback, visual feedback, and tactile feedback.
Clause 66: the system of any of clauses 56-65, further comprising at least one chest compression sensor configured to obtain signals indicative of chest compressions performed on the patient during the acute care event, and the at least one processor configured to: receive and process information representative of at least one physical characteristic of the patient to determine a target chest compression criterion for the patient, receive and process signals indicative of the chest compressions from the at least one chest compression sensor to calculate at least one chest compression parameter, determine whether the at least one chest compression parameter meets the target chest compression criterion, and cause the feedback device to provide the user with an indication of whether the at least one chest compression parameter meets the target chest compression criterion.
Clause 67: the system of clause 66, wherein the target chest compression criteria and the measured chest compression parameters comprise at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
Clause 68: the system of clause 67, wherein the at least one physical characteristic of the patient includes a sternal anterior-posterior distance and at least one of: a chest width and a chest circumference, and the target chest compression criterion comprises a target chest compression depth of the patient.
Clause 69: the system of clause 68, wherein the indication for the user provided by the feedback device includes an instruction to increase chest compression depth, decrease chest compression depth, or maintain chest compression depth determined based on the determination of whether the chest compression parameter meets the target chest compression criterion.
Clause 70: the system of any of clauses 66-69, wherein the at least one processor is configured to: after chest compressions have been performed for a predetermined period of time, determining a modified suggested chest compression technique based at least in part on whether the at least one chest compression parameter meets the target chest compression criteria, and causing the feedback device to provide the user with an indication of the modified suggested chest compression technique.
Clause 71: the system of any of clauses 66-70, wherein the processor is further configured to determine a percentage of time that the chest compression parameters measured during a rescue effort do not meet the target chest compression criteria, and to cause the feedback device to provide an indication to the user if the percentage of time exceeds a predetermined value.
Clause 72: the system of clause 71, wherein the indication for the user if the percentage of time exceeds the predetermined value comprises an instruction to begin making a second suggested chest compression technique different from the suggested chest compression technique made during the initial time period.
Clause 73: the system of clause 72, wherein the suggested chest compression technique performed during the initial time period comprises palmar chest compression and the second suggested chest compression technique comprises chest compression with active chest decompression.
Clause 74: the system of clause 72 or clause 73, wherein the suggested chest compression technique performed during the initial time period comprises one-handed chest compression or two-handed chest compression, and the second suggested chest compression technique comprises two-finger chest compression.
Clause 75: the system of any of clauses 72-74, wherein the at least one processor is configured to receive a confirmation from the user when the user initiates the second suggested chest compression technique.
Clause 76: the system of any of clauses 56-75, wherein the processor is further configured to: after chest compressions have been performed for a predetermined period of time, receiving and processing updated information from the at least one device representative of at least one physical characteristic of the patient to determine a modified suggested chest compression technique, causing the feedback device to provide an indication of the modified suggested chest compression technique to the user.
Clause 77: the system of any of clauses 56-76, wherein the suggested chest compression technique is based on a change in at least one physical characteristic of the patient over a predetermined period of time.
Clause 78: the system of any of clauses 56-77, wherein the suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
Clause 79: the system of any of clauses 56-78, wherein the suggested chest compression technique comprises active chest decompression.
Clause 80: the system of clause 79, wherein the at least one physical feature comprises an anterior-posterior sternal distance and the active chest decompression as the suggested chest compression technique is based on a reduction in the anterior-posterior sternal distance.
Clause 81: the system of clause 80, wherein the indication to perform active chest decompression comprises an indication to perform chest decompression using at least one of a suction cup device, an attachment device, and a hook and loop fastener device, and/or an instruction to compress a side or abdomen of the patient.
Clause 82: the system of any of clauses 56-81, wherein the feedback device comprises a defibrillator, and the at least one processor is configured to receive and process updated information from the at least one device representative of at least one physical characteristic of the patient while the defibrillator is providing a defibrillating shock to the patient to determine a modified suggested chest compression technique.
Clause 83: the system of any of clauses 56-82, further comprising at least one ventilation sensor configured to measure at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
Clause 84: the system of clause 83, wherein the ventilation sensor comprises a flow sensor and/or a pressure sensor positioned in a flow path of a ventilation unit in fluid communication with the airway of the patient.
Clause 85: a method of providing chest compressions to a patient during an acute care event, the method comprising: measuring a plurality of physical characteristics of the patient during the acute care event; determining a target chest compression criterion based on the measured plurality of physical features; applying chest compressions to the patient; using at least one chest compression sensor to measure at least one chest compression parameter during the applied chest compressions; and providing feedback guidance on how a user should adjust chest compressions applied to the patient based on whether the at least one chest compression parameter meets the target chest compression criteria.
Clause 86: the method of clause 85, wherein the plurality of physical features comprises at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 87: the method of clause 85 or clause 86, wherein measuring a plurality of physical features of the patient during the acute care event comprises capturing at least one image of the patient with a handheld electronic device, and processing the at least one captured image with at least one processor of the handheld electronic device to determine at least one measurement of the physical features.
Clause 88: the method of clause 87, wherein the at least one processor of the handheld electronic device determines the target chest compression criterion based on the measurements of the plurality of physical features and determines the at least one chest compression parameter by processing the signals generated by the chest compression sensor.
Clause 89: the method of clause 87 or clause 88, wherein the feedback guidance is provided on a display screen of the handheld electronic device.
Clause 90: the method of any of clauses 85-89, wherein measuring a plurality of physical features of the patient during the acute care event comprises using a three-dimensional sensor to obtain information representative of the plurality of physical features.
Clause 91: the method of any of clauses 85-90, further comprising: manually inputting measurements of a plurality of physical characteristics of the patient on a user interface.
Clause 92: the method of any of clauses 85-91, wherein the plurality of physical features comprises an anterior-posterior distance of the patient's cardiothoracic region and at least one of: a width and circumference of the patient's cardiothoracic region, and the target chest compression criterion comprise a target chest compression depth of the patient.
Clause 93: the method of any of clauses 85-92, further comprising: recording at least one updated measurement of a plurality of physical characteristics of the patient after a predetermined period of time; determining a modified target chest compression criterion based on the updated measurements; and providing feedback guidance on how a user should adjust chest compressions applied to the patient based on whether the at least one chest compression parameter meets the modified target resuscitation criteria.
Clause 94: the method of clause 93, wherein the at least one updated measurement comprises an anterior-posterior sternal distance.
Clause 95: the method of any of clauses 85-94, wherein the target chest compression criteria and the measured at least one chest compression parameter include at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
Clause 96: the method of any of clauses 85-95, wherein providing the feedback guidance comprises providing an indication to increase chest compression depth, decrease chest compression depth, or maintain chest compression depth based on whether the at least one chest compression parameter meets the target chest compression criteria.
Clause 97: the method of any of clauses 85-96, further comprising: determining a suggested chest compression technique based on the measured plurality of physical features and providing feedback guidance to provide an indication of the suggested chest compression technique to the user.
Clause 98: the method of clause 97, wherein the suggested chest compression technique is based on a change in at least one of the patient's plurality of physical characteristics over a predetermined period of time.
Clause 99: the method of clause 97 or clause 98, wherein the suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
Clause 100: the method of any of clauses 85-99, wherein the feedback guidance comprises an indication to begin conducting a second chest compression technique different from an initial chest compression technique based at least in part on whether the measured chest compression parameter does not meet the target chest compression criteria.
Clause 101: the method of clause 100, wherein the initial chest compression technique comprises two-palm chest compression and the second chest compression technique comprises chest compression with active chest decompression.
Clause 102: the method of clause 100 or clause 101, wherein the initial chest compression technique comprises one-handed or two-handed chest compression and the second chest compression technique comprises two-fingered chest compression.
Clause 103: a method of providing chest compressions to a patient during an acute care event, the method comprising: measuring a plurality of physical characteristics of the patient during the acute care event; determining a suggested chest compression technique based on the measured plurality of physical features; providing feedback guidance to provide an indication of the suggested chest compression technique to a user; and applying chest compressions to the patient in accordance with the suggested chest compression technique.
Clause 104: the method of clause 103, wherein the plurality of physical features comprises at least two of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 105: the method of clause 103 or clause 104, wherein measuring a plurality of physical features of the patient during the acute care event comprises using a three-dimensional imaging system to obtain information representative of the plurality of physical features.
Clause 106: the method of any of clauses 103-105, wherein the proposed chest compression technique is based on a change in at least one of the patient's plurality of physical characteristics over a predetermined period of time.
Clause 107: the method as set forth in any of clauses 103-106, further comprising: the method includes determining a target chest compression criterion based on the measured plurality of physical characteristics, measuring at least one chest compression parameter during the applied chest compressions using at least one chest compression sensor, and providing feedback guidance on how the user should adjust the chest compressions applied to the patient based on whether the at least one chest compression parameter meets the target chest compression criterion.
Clause 108: the method of clause 107, wherein the target chest compression criteria and the at least one measured chest compression parameter comprise at least one of: compression depth, compression rate, compression release speed, compression pause, and compression release.
Clause 109: the method of clause 108, wherein the plurality of physical features includes a sternal anterior-posterior distance and at least one of: a chest width and a chest circumference, and the target chest compression criteria comprises a target chest compression depth for the patient.
Clause 110: the method according to any one of clauses 107-109, further comprising: recording at least one updated measurement of a plurality of physical characteristics of the patient after a predetermined period of time; determining a modified target chest compression criterion based on the updated measurements; and providing feedback guidance on how a user should adjust chest compressions applied to the patient based on whether the at least one chest compression parameter meets the modified target resuscitation criteria.
Clause 111: the method according to any of clauses 107-110, wherein the feedback guidance comprises an indication to start performing a second chest compression technique different from the initial chest compression technique based at least in part on whether the measured chest compression parameter meets the target chest compression criterion.
Clause 112: the method of clause 111, wherein the initial chest compression technique comprises two-palm chest compression and the second chest compression technique comprises chest compression with active chest decompression.
Clause 113: a system for assisting a user in ventilating a patient during an acute care event, the system comprising: at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event; at least one ventilation sensor configured to obtain a signal indicative of ventilation performed on the patient during the acute care event; feedback means for providing guidance on how the patient should be ventilated; and at least one processor communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics and communicatively coupled with the at least one ventilation sensor, the at least one processor configured to: receive and process information representative of a plurality of physical characteristics of the patient to determine a target ventilation criterion for the patient, receive and process signals indicative of the ventilation from the at least one ventilation sensor to calculate at least one ventilation parameter, determine whether the at least one ventilation parameter meets the target ventilation criterion, and cause the feedback device to provide the user with an indication of whether the at least one ventilation parameter meets the target ventilation criterion.
Clause 114: the system of clause 113, wherein the plurality of physical characteristics comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 115: the system of clause 114, wherein the patient's thoracic volume is determined based on at least one of: an anterior-posterior distance of the patient's thoracic region, a width of the patient's thoracic region, and a circumference of the patient's thoracic region.
Clause 116: the system according to any of clauses 113-115, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient comprises at least one of: a user interface for manually inputting at least one measurement of the physical feature, a two-dimensional camera, a stereo camera, a three-dimensional imaging system, a three-dimensional sensor, a light field camera, and a position sensor or marker positioned on the patient.
Clause 117: the system of clause 116, wherein the camera, the three-dimensional sensor, or the three-dimensional imaging system is mounted to at least one of: the patient, the feedback device, and the user.
Clause 118: the system according to any of clauses 113-117, wherein the at least one input device for providing information indicative of a plurality of physical characteristics of the patient further provides an age or gender of the patient, and the target ventilation criterion is determined based at least in part on the plurality of physical characteristics and the age or gender of the patient.
Clause 119: the system of any of clauses 113-118 wherein at least one of the plurality of physical characteristics comprises a shape of the patient's chest.
Clause 120: the system of any of clauses 113-119 wherein the ventilation sensor comprises an airflow sensor and/or a pressure sensor positioned in an airflow path of a ventilation unit in fluid communication with the airway of the patient.
Clause 121: the system of any of clauses 113-120, wherein the feedback means comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a ventilator, and a ventilation guidance device configured to be placed in an airflow path between the ventilator and the patient.
Clause 122: the system according to any of clauses 113-121, wherein the target ventilation criteria and measured ventilation parameters comprise at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
Clause 123: the system of any of clauses 113-122, wherein the processor is further configured to: after a predetermined period of time of ventilation, receiving and processing updated information from the at least one input device representative of physical characteristics of the patient to determine a modified target ventilation criterion, determining whether the at least one ventilation parameter meets the modified target ventilation criterion, and causing the feedback device to provide the user with an indication of whether the at least one ventilation parameter meets the modified target ventilation criterion.
Clause 124: the system of any of clauses 113-123 wherein at least one of the plurality of physical characteristics of the patient comprises the height of the patient.
Clause 125: the system according to any of clauses 113-124, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient further provides an age or gender of the patient, and the at least one processor is further configured to provide at least one of a recommended endotracheal tube placement depth and a recommended tidal volume based on the height and gender of the patient.
Clause 126: the system of clause 125, wherein the target ventilation criteria is based, at least in part, on the patient's height and gender.
Clause 127: the system of clause 126, wherein the at least one processor is configured to determine the recommended endotracheal tube placement depth or the recommended tidal volume based on the patient's height and gender and values of estimated airway length from a lookup table.
Clause 128: the system of any of clauses 113-127, wherein the at least one processor is further configured to receive an age of the patient and determine a target ventilation criterion for the patient based on the plurality of physical characteristics and the age of the patient.
Clause 129: the system according to any of clauses 113-128, further comprising at least one chest compression sensor configured to obtain signals indicative of chest compressions performed on the patient during the acute care event, and the at least one processor configured to: receive and process information representative of a plurality of physical characteristics of the patient to determine a target chest compression criterion for the patient, receive and process signals indicative of the chest compressions from the at least one chest compression sensor to calculate at least one chest compression parameter, determine whether the at least one chest compression parameter meets the target chest compression criterion, and cause the feedback device to provide the user with an indication of whether the at least one chest compression parameter meets the target chest compression criterion.
Clause 130: the system of any of clauses 113-129, wherein the at least one processor is further configured to determine a suggested chest compression technique for the patient based on a plurality of physical characteristics of the patient and to cause the feedback device to provide the user with an indication to perform the suggested chest compression technique.
Clause 131: a method of providing ventilation to a patient during an acute care event, the method comprising: measuring a plurality of physical characteristics of the patient during the acute care event; determining a target ventilation criterion based on the at least one measurement; applying ventilation to the patient; using at least one ventilation sensor to measure at least one ventilation parameter during the applied ventilation; and providing feedback guidance on how a user should adjust the ventilation provided to the patient based on whether the at least one ventilation parameter meets the target ventilation criteria.
Clause 132: the method of clause 131, wherein at least one physical feature of the plurality of physical features comprises: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 133: the method of clause 131 or clause 132, wherein measuring the plurality of physical characteristics of the patient during the acute care event comprises capturing at least one image of a pediatric patient with a handheld electronic device, and processing the at least one captured image with at least one processor of the handheld electronic device to determine at least one measurement of the plurality of physical characteristics.
Clause 134: the method of clause 133, wherein the at least one processor of the handheld electronic device determines the target ventilation criterion based on the at least one measurement and determines the at least one ventilation parameter by processing the signal generated by the ventilation sensor.
Clause 135: the method of any of clauses 131-134, wherein measuring a plurality of physical characteristics of the patient during the acute care event comprises using a three-dimensional imaging system to obtain information representative of the plurality of physical characteristics.
Clause 136: the method of any of clauses 131-135, further comprising: manually inputting measurements of a plurality of physical characteristics of the patient on a user interface.
Clause 137: the method according to any of clauses 131-136, wherein the target ventilation criteria and measured ventilation parameters comprise at least one of the following during the acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
Clause 138: the method of any of clauses 131-137, wherein the at least one of the plurality of physical characteristics of the patient comprises a height of the patient, the method further comprising determining a recommended endotracheal tube placement depth based at least in part on the height of the patient.
Clause 139: the method of clause 138, further comprising inserting an endotracheal tube to a suggested depth, and wherein applying ventilation to the patient comprises applying ventilation to the patient through the inserted endotracheal tube.
Clause 140: the method of clause 138 or clause 139, further comprising providing an input of at least one of an age and a gender of the patient, wherein the recommended endotracheal tube placement depth is based on the height and gender of the patient.
Clause 141: the method according to any one of clauses 131-140, further comprising: the method further includes determining a target chest compression criterion based on at least one of the plurality of physical characteristics, using at least one chest compression sensor to measure at least one chest compression parameter during the applied chest compressions, and providing feedback guidance on how the user should adjust the chest compressions applied to the patient based on whether the at least one chest compression parameter meets the target chest compression criterion.
Clause 142: the method according to any one of clauses 131-141, further comprising: a suggested chest compression technique is determined based on the measured plurality of physical features and feedback guidance is provided to provide an indication of the suggested chest compression technique to the user.
Clause 143: a system for assisting a user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event, the system comprising: at least one three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient; at least one of a chest compression sensor or a ventilation sensor for obtaining a signal indicative of at least one resuscitation activity applied to the patient; feedback means for providing guidance on how the user should administer the at least one resuscitation activity to the patient; and at least one processor communicatively coupled with the at least one three-dimensional imaging system and communicatively coupled with at least one chest compression sensor or ventilation sensor, the at least one processor configured to: receiving and processing information from the three-dimensional imaging system representing the at least one body feature to generate a three-dimensional representation of at least a portion of the patient's body,
Determining a target resuscitation criterion based on the generated three-dimensional representation, receiving and processing a signal indicative of the at least one resuscitation activity to calculate at least one resuscitation parameter, determining whether the at least one resuscitation parameter meets the target resuscitation criterion, and causing the feedback device to provide an indication of whether the at least one resuscitation parameter meets the target resuscitation criterion.
Clause 144: the system of clause 143, wherein the at least one physical characteristic comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 145: the system of clause 143 or clause 144, wherein the information representative of the at least one physical characteristic comprises information representative of the at least one physical characteristic recorded during inspiration and/or information representative of the at least one physical characteristic recorded during expiration.
Clause 146: the system of any of clauses 143-145, wherein the feedback device comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a patient monitoring device, a defibrillator, a ventilator, a chest compression guidance device configured to be placed on the chest of the patient, or a ventilation guidance device configured to be placed in the airflow path between a ventilator and the patient.
Clause 147: the system according to any of clauses 143-146, wherein the at least one processor is configured to cause the feedback device to display at least a portion of the three-dimensional representation of the patient to the user.
Clause 148: the system of any of clauses 143-147 wherein the processor is further configured to determine a type of patient based on the generated three-dimensional representation of the patient and to cause the feedback device to provide an indication of the type of patient to the user.
Clause 149: the system of clause 148, wherein the type of patient includes a neonate, an infant, a small child, a large child, a small adult, an average sized adult, or a large adult.
Clause 150: the system of any of clauses 143-149, wherein the processor is further configured to determine a suggested chest compression technique for the patient based on the generated three-dimensional representation of the patient and to cause the feedback device to provide the user with an indication to perform the suggested chest compression technique.
Clause 151: the system of clause 150, wherein the resuscitation activity is chest compression and the suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, or double finger chest compressions.
Clause 152: the system of clause 150 or clause 151, wherein the resuscitation activity is chest compression and the suggested chest compression technique comprises active chest decompression.
Clause 153: the system of clause 152, wherein the indication to perform active chest decompression comprises a recommendation to perform chest decompression using a suction cup device, an attachment device, a hook and loop device, and/or an instruction to compress the side or abdomen of the patient.
Clause 154: a system for assisting a user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event, the system comprising: at least one input device for providing information representative of at least one physical characteristic of the patient measured during the acute care event; feedback means for providing information to a user, the patient, and information to the user relating to the acute care event; and at least one processor communicatively coupled with at least one apparatus for providing information representative of at least one physical characteristic of the patient, the at least one processor configured to: receiving and processing information representative of at least one physical characteristic measured during an initial time period of the acute care event, determining an initial target resuscitation criterion based on the at least one physical characteristic during the initial time period, causing the feedback device to provide the user with an indication related to the initial target resuscitation criterion, receiving and processing information representative of at least one physical characteristic measured during a subsequent time period of the acute care event, determining a modified target resuscitation criterion based on the at least one physical characteristic during the subsequent time period, and causing the feedback device to provide the user with an indication related to the modified target resuscitation criterion.
Clause 155: the system of clause 154, wherein the at least one physical characteristic comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 156: the system of clause 154 or clause 155, wherein the at least one means for providing information representative of at least one physical characteristic of the patient comprises at least one of: a user interface for manually entering body measurements, a two-dimensional camera, a stereo camera, a light field camera, a three-dimensional sensor, a three-dimensional imaging system, and a position sensor or marker positioned on the patient.
Clause 157: the system as set forth in any of clauses 154-156 wherein the feedback means comprises at least one of: a computer tablet, a smart phone, a personal digital assistant, a smart watch, a patient monitoring device, a defibrillator, a ventilator, a chest compression guidance device configured to be placed on the chest of the patient, and a ventilation guidance device configured to be placed in an airflow path between a ventilator and the patient.
Clause 158: the system of any of clauses 154-157, wherein the duration of the initial period of time is selected based on at least one physical characteristic of the acute care event and the initial target resuscitation criteria.
Clause 159: the system according to any of clauses 154-158, wherein the at least one processor is further configured to determine a modified recommendation technique for the resuscitation activity based on at least one physical characteristic measured during a subsequent time period of the acute care event and to cause the feedback device to provide the user with an indication to conduct the modified recommendation technique for the resuscitation activity.
Clause 160: the system of clause 159, wherein the resuscitation activity comprises chest compressions and the modified suggested chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, or double finger chest compressions.
Clause 161: the system of clause 159, wherein the resuscitation activity is chest compression, and the modified chest compression technique comprises chest compression and active chest decompression.
Clause 162: the system of clause 161, wherein the instructions to perform active chest decompression comprise instructions to perform chest decompression using a suction cup device, an attachment device, a hook and loop device, and/or instructions to compress the side or abdomen of the patient.
Clause 163: the system of any of clauses 154-162, further comprising at least one of a chest compression sensor and a ventilation sensor communicatively coupled to the at least one processor and configured to obtain a signal indicative of CPR applied to the patient, and wherein the at least one processor is further configured to: receive and process a signal indicative of CPR applied to the patient during an initial period of the acute care event to calculate at least one resuscitation parameter, determine whether the at least one resuscitation parameter meets the initial target resuscitation criteria, and cause the feedback device to provide the user with an indication of whether the at least one resuscitation parameter meets the initial target resuscitation criteria.
Clause 164: the system of clause 163, wherein the at least one processor is further configured to:
receive and process a signal indicative of CPR applied to the patient during a subsequent period of the acute care event to calculate at least one resuscitation parameter, determine whether the at least one resuscitation parameter meets the modified target resuscitation criteria, and cause the feedback device to provide the user with an indication of whether the at least one resuscitation parameter meets the modified target resuscitation criteria.
Clause 165: the system of clause 163 or clause 164, wherein the chest compression sensor comprises at least one of: a single-axis accelerometer, a multi-axis accelerometer, and a gyroscope, and the ventilation sensor comprises at least one of a flow sensor and a pressure sensor in a flow path in fluid communication with the airway of the patient.
Clause 166: the system of any of clauses 163-165, wherein the at least one physical characteristic of the patient comprises an anterior-posterior distance of the cardiothoracic region of the patient and at least one of: the width and circumference of the patient's cardiothoracic region, and the initial and modified target resuscitation criteria each include a target chest compression depth of the patient.
Clause 167: the system according to any of clauses 163-166, wherein the feedback comprises a summary report for the rescue effort, the summary report comprising an indication for an initial period of time comparing the resuscitation parameters measured during the initial period of time with the initial target resuscitation criteria and an indication for a subsequent period of time comparing the resuscitation parameters measured during the subsequent period of time with the modified target resuscitation criteria.
Clause 168: the system according to any of clauses 163-167, wherein the summary report comprises a map comparing the resuscitation parameters measured during the initial time period to the initial target resuscitation criteria and a map for a subsequent time period comparing the resuscitation parameters measured during the subsequent time period to the modified target resuscitation criteria.
Clause 169: a computer-implemented method for a feedback device to provide feedback to a user to assist the user in providing at least one cardiopulmonary resuscitation (CPR) activity to a patient during an acute care event, the method comprising: receiving and processing information representative of at least one physical characteristic of the patient measured during an initial period of the acute care event from at least one device for providing information representative of the at least one physical characteristic; determining an initial target resuscitation criterion based on at least one physical feature during the initial time period; receiving and processing information representative of at least one physical characteristic measured during a subsequent time period of the acute care event; determining a modified target resuscitation criterion based on at least one physical feature during the subsequent time period; and causing the feedback device to provide an indication to the user regarding the modified target resuscitation criteria.
Clause 170: the method of clause 169, wherein the at least one physical characteristic comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 171: the method of clause 169 or clause 170, wherein the duration of the initial time period is selected based on the at least one physical characteristic of the patient and the initial target resuscitation criteria.
Clause 172: the method according to any of clauses 169-171, further comprising determining a modified technique of the resuscitation activity based on at least one physical characteristic measured during a subsequent time period of the acute care event and causing the feedback device to provide instructions to the user to conduct the modified technique of the resuscitation activity.
Clause 173: the method of clause 172, wherein the resuscitation activity comprises chest compression, and the modified chest compression technique comprises at least one of: palmar chest compressions, circumthumb chest compressions, and double-fingered chest compressions.
Clause 174: the method of clause 172, wherein the resuscitation activity is chest compression and the modified chest compression technique comprises performing chest compression and active chest decompression.
Clause 175: the method of any of clauses 172-174 wherein the instructions to perform active chest decompression comprise instructions to perform chest decompression using a suction cup device, an attachment device, a hook and loop device, and/or instructions to compress the side or abdomen of the patient.
Clause 176: the method of any of clauses 169-175, further comprising: receiving and processing a signal from at least one resuscitation sensor indicative of CPR applied to the patient during an initial period of the acute care event, the at least one resuscitation sensor including at least one of a chest compression sensor and a ventilation sensor; calculating at least one resuscitation parameter based on the signal indicative of CPR from the at least one resuscitation sensor; determining whether the at least one resuscitation parameter meets the initial target resuscitation criteria; and causing the feedback device to provide an indication to the user whether the at least one resuscitation parameter meets the initial target resuscitation criteria.
Clause 177: the method of clause 176, further comprising: receiving and processing a signal indicative of CPR applied to the patient during a subsequent time period of the acute care event to calculate at least one resuscitation parameter; determining whether the at least one resuscitation parameter meets the modified target resuscitation criteria; and causing the feedback device to provide an indication to the user whether the at least one resuscitation parameter meets the modified target resuscitation criteria.
Clause 178: the method of clause 177, further comprising: causing the feedback device to provide a summary report to a user, the summary report including an indication for an initial time period comparing resuscitation parameters measured during the initial time period to the initial target resuscitation criteria, and an indication for a subsequent time period comparing resuscitation parameters measured during the subsequent time period to the modified target resuscitation criteria.
Clause 179: the method of clause 178, wherein the summary report includes a map comparing the resuscitation parameters measured during the initial time period to the initial target resuscitation criteria and a map for a subsequent time period comparing the resuscitation parameters measured during the subsequent time period to the modified target resuscitation criteria.
Clause 180: a system for providing ventilatory treatment to a patient, the system comprising:
at least one three-dimensional imaging system for obtaining information representative of at least one physical feature of the patient; a ventilator device for providing the ventilatory treatment to the patient; and at least one processor communicatively coupled with the at least one three-dimensional imaging system and communicatively coupled with the ventilator, the at least one processor configured to: receiving and processing information representative of at least one physical feature of the patient to generate a three-dimensional representation of the patient, determining at least one ventilation criterion of the ventilation device based on the generated three-dimensional representation, and causing the ventilation device to provide ventilation based on the at least one ventilation criterion.
Clause 181: the system of clause 180, wherein the at least one physical characteristic comprises at least one of: sternal anterior-posterior distance, i.e., sternal AP distance, lateral chest width, circumference of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, height, weight, and body mass index, i.e., BMI.
Clause 182: the system of clause 181, wherein the thoracic volume is calculated based on an anterior-posterior distance of the patient's thoracic region, a length of the patient's thoracic region, and at least one of: a width of the thoracic region and a circumference of the thoracic region.
Clause 183: the system according to any of the clauses 180-182, wherein the information indicative of the at least one physical characteristic comprises information indicative of the at least one physical characteristic recorded during inspiration and/or information indicative of the at least one physical characteristic recorded during expiration.
Clause 184: the system of any of clauses 180-183 wherein the ventilation parameter comprises at least one of the following during an acute care event: tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate.
Clause 185: the system according to any of clauses 180-184, wherein the ventilation device comprises an automated mechanical ventilator configured to deliver a plurality of ventilations to the patient according to at least one ventilation criterion.
Clause 186: the system of any of clauses 180-185, wherein the ventilation device comprises a ventilation unit and the at least one processor causes the ventilation device to provide ventilation based on the at least one ventilation criterion by providing guidance to a user to deliver ventilation in accordance with the at least one ventilation criterion.
Clause 187: the system of clause 186, wherein the ventilation unit comprises a ventilation bag in fluid communication with the airway of the patient and a gas flow path.
Clause 188: the system of any of clauses 180-187, wherein the processor is further configured to: after a predetermined period of time, receiving and processing updated information from the three-dimensional imaging system representing at least one physical feature of the patient to generate an updated three-dimensional representation of the patient; determining at least one modified ventilation criterion based on the updated three-dimensional representation of the patient; and adjusting a function of the ventilator based on the at least one modified ventilation criterion.
Clause 189: the system of clause 188, wherein the predetermined time period is determined based on the initially generated three-dimensional representation of the patient.
Clause 190: the system of any of clauses 180-189, wherein the at least one processor is further configured to receive an age of the patient and determine the at least one ventilation criterion based at least in part on the age of the patient.
Clause 191: a system for assisting a user in providing medical care to a patient during an acute care event, the system comprising: at least one input device for providing information representative of a plurality of physical characteristics of the patient measured during the acute care event; a user interface for providing acute care treatment information for the patient; and at least one processor communicatively coupled with at least one input device for providing information representative of the plurality of physical characteristics, the at least one processor configured to: receive and process information representative of a plurality of physical features of the patient to estimate a weight of the patient, determine at least one treatment parameter of the patient based at least in part on the estimated weight of the patient, and cause the user interface to provide an indication of the at least one treatment parameter of the patient.
Clause 192: the system of clause 191, wherein the at least one input device for providing information representative of a plurality of physical characteristics of the patient comprises at least one of: two-dimensional cameras, stereo cameras, three-dimensional imaging systems, three-dimensional sensors, light field cameras, and position sensors or markers positioned on the patient.
Clause 193: the system of clause 191 or clause 192, wherein the at least one input device comprises the user interface and the user interface is configured for the user to manually input at least one measurement for each of the plurality of physical characteristics.
Clause 194: the system of any of clauses 191-193, wherein the plurality of physical characteristics comprises at least one of: a sternum anterior-posterior distance, i.e., a sternum AP distance, a lateral width of the patient's chest, a chest circumference, a waist circumference, a hip circumference, a neck circumference, a shoulder width, a chest shape, a height, a waist-to-hip ratio, and a waist height ratio.
Clause 195: the system according to any of clauses 191-194, wherein the at least one processor is configured to process the information representative of the plurality of physical characteristics to estimate the volume of the at least a portion of the patient's body.
Clause 196: the system of clause 195, wherein the at least one processor is configured to estimate the weight of the patient based on the estimated volume and the estimated average density of the patient's body.
Clause 197: the system of clause 196, wherein the estimated average density of the body is about 900kg/m3 to about 1050kg/m 3.
Clause 198: the system of clause 196 or clause 197, wherein the estimated average density of the body comprises a predetermined value for a population of individuals.
Clause 199: the system according to any of the clauses 196-198, wherein the estimated average density of the body is based on a patient-specific value of at least one of a plurality of physical characteristics of the patient.
Clause 200: the system of any of clauses 195-199, wherein the estimated volume comprises a thoracic volume of the patient or a total volume of the patient.
Clause 201: the system as in any of clauses 191-200, wherein the at least one treatment parameter comprises at least one of: defibrillator shock energy, ventilation tidal volume, and drug delivery dose.
Clause 202: the system as in any of clauses 191-201, wherein the at least one treatment parameter comprises a ventilation tidal volume, and the ventilation tidal volume is calculated based at least in part on an ideal weight of the patient.
Clause 203: the system according to any of clauses 191-202, wherein the at least one input device for providing information indicative of a plurality of physical characteristics of the patient provides at least one of an age or a gender of the patient, and the at least one treatment parameter is determined based at least in part on the plurality of physical characteristics and the at least one of the age or the gender of the patient.
These and other features and characteristics of the present invention, as well as the methods of operation and functions of the related elements of structure and the combination of parts and economies of manufacture, will become more apparent upon consideration of the following description and the appended claims with reference to the accompanying drawings, all of which form a part of this specification, wherein like reference numerals designate corresponding parts in the various figures. It is to be expressly understood, however, that the drawings are for the purpose of illustration and description only and are not intended as a definition of the limits of the invention.
Drawings
Fig. 1A illustrates an overhead view of an acute care scenario including an apparatus and system for recording and/or measuring physical characteristics of a patient at the acute care scenario and providing guidance to a user (such as an acute care provider, etc.) for performing resuscitation activities, according to various examples;
FIG. 1B shows a schematic diagram of electrical components of the system of FIG. 1A, according to an example of the invention;
FIG. 2A shows a diagram of an adult patient illustrating physical characteristics of the patient that may be measured in accordance with the system of the present invention;
FIG. 2B is a diagram of another perspective of the adult patient of FIG. 2A;
FIG. 3A shows a diagram of an infant patient illustrating physical characteristics of the patient that may be measured by the system according to the present invention;
FIG. 3B is a diagram of another perspective of the infant patient of FIG. 3A;
FIGS. 4A and 4B are schematic diagrams comparing a cross-section of a cardiothoracic region of a pediatric patient (such as a small child, etc.) with a cross-section of a cardiothoracic region of an adult patient;
FIGS. 5A and 5B are schematic diagrams comparing a cross-section of a cardiothoracic region of a flat-chest patient with a cross-section of a cardiothoracic region of a barrel-chest patient;
FIG. 6A is a diagram of an acute care provider performing a palmar chest compression of a patient using a resuscitation guidance system, according to an embodiment of the present invention;
FIG. 6B is a diagram of a single-handed palm chest compression of a patient by an acute care provider using a resuscitation guidance system, according to an embodiment of the present invention;
FIG. 6C is a diagram of an acute care provider performing double-fingered chest compressions on an infant patient using a resuscitation guidance system, according to an embodiment of the present invention;
FIG. 6D is a diagram of an acute care provider performing a thumbaround chest compression on an infant patient using a resuscitation guidance system, according to an embodiment of the present invention;
FIGS. 7A and 7B are diagrams showing cross-sections of a patient before and after chest compressions, the diagrams illustrating the remodeling or change in the shape of the patient's chest resulting from chest compressions;
figure 7C illustrates an acute care provider applying an Active Compression Decompression (ACD) device to a patient using ACD therapy, according to an embodiment of the invention;
FIG. 8A is a display of a portable medical device including an indicator to provide resuscitation guidance to an acute care provider, according to an embodiment of the present invention;
FIG. 8B is a display of a portable medical device including an indicator for providing ventilation guidance to an acute care provider according to an embodiment of the present invention;
FIG. 9 is a schematic diagram of electrical components of another example of a resuscitation guidance system including a portable computer device, according to an embodiment of the present invention;
FIG. 10 is a flowchart illustrating steps for determining measurements of physical characteristics of a patient and providing feedback and guidance to an acute care provider providing resuscitation activities to the patient according to an embodiment of the present invention;
FIG. 11 is a flowchart illustrating steps for determining a type of patient and a type of resuscitation activity to be performed on the patient based on measurements of physical characteristics of the patient, in accordance with an embodiment of the present invention;
FIG. 12A is a flowchart illustrating steps for determining modified or updated target resuscitation criteria for resuscitation activities to be performed on a patient, in accordance with an embodiment of the present invention;
FIG. 12B is a flow diagram of a process for determining target parameters for a patient and for refining the target parameters based on received additional information about physical characteristics of the patient, according to an embodiment of the invention;
figure 13 is a schematic diagram of a patient ventilation system that determines ventilation criteria for delivering ventilation to a patient based on physical characteristics of the patient, in accordance with an embodiment of the present invention; and
figure 14 is a flow diagram of a process for providing ventilation to a patient according to a ventilation criterion based on measurements of physical characteristics of the patient obtained using the system of figure 13, in accordance with an embodiment of the present invention.
Detailed Description
As used herein, the singular forms of "a", "a" and "the" include plural references unless the context clearly dictates otherwise.
As used herein, the terms "right," "left," "upper," and derivatives thereof shall relate to aspects of the invention as they are oriented in the drawing figures. It is to be understood, however, that the embodiments of the invention can assume various alternative orientations and, accordingly, such terms are not to be considered as limiting. In addition, it is to be understood that embodiments of the invention may assume various alternative variations and step sequences, except where expressly specified otherwise. It is also to be understood that the specific devices and processes illustrated in the attached drawings, and described in the following specification, are provided as examples. Hence, specific dimensions and other physical characteristics relating to the embodiments disclosed herein are not to be considered as limiting.
As used herein, the terms "communicate" and "communicating" refer to receiving or transmitting one or more signals, messages, commands, or other types of data. By one unit or component to be in communication with another unit or component, it is meant that the one unit or component is capable of directly or indirectly receiving data from and/or transmitting data to the other unit or component. This may refer to a direct or indirect connection that may be wired and/or wireless in nature. In addition, two units or components may communicate with each other even though the transmitted data may be modified, processed, routed, etc., between the first unit or component and the second unit or component. For example, a first unit may communicate with a second unit even if the first unit passively receives data and does not actively transmit data to the second unit. As another example, if an intermediate unit processes data from one unit and sends the processed data to a second unit, the first unit may communicate with the second unit. It will be appreciated that many other arrangements are possible.
The present invention relates generally to systems, methods, and techniques for providing guidance to a care provider or medical professional (such as an acute care provider or the like) for use in an acute care or emergency medical context. "acute care" may refer to: situations where the patient receives active but short term treatment for injury, seizure; an urgent or emergency medical condition; or planning a recovery period after surgery. An "acute care provider" may refer to any individual (including Emergency Medical Technicians (EMTs), doctors, nurses, and caregivers) who provides short-term care to a patient during an episode, condition, or event of such "acute care".
The devices and systems described herein may be used in a variety of environments including, for example, emergency scenes, ambulances, hospitals, emergency rooms, and outpatient treatment facilities. The individual being treated by the medical professional may be an emergency victim at a rescue scenario, such as an individual suffering from a physical event or arrest (e.g., cardiac arrest, respiratory arrest/distress, and/or traumatic arrest). In other examples, the individual may be a hospital patient, such as a patient receiving treatment in an emergency room, or the like. In other examples, the individual may be a hospital resident that receives treatment more regularly (e.g., an inpatient resident that has already been admitted to the hospital). For convenience, any medical professional is described herein as an "acute care provider" and the individual being treated is described as a "patient," but it should be understood that a "patient" may be an emergency victim, an individual who has suffered trauma but has not yet been treated by medical personnel, or any other individual who needs to be medically treated or evaluated by medical personnel. An "acute care provider" may refer to an individual who provides treatment for any patient seeking urgent medical assistance, some examples of which are provided herein.
Physical habits vary widely among human populations. Thus, during acute care efforts to provide cardiopulmonary resuscitation (CPR), the preferred manner of applying quality CPR may also vary depending on the physical habits of the person receiving the treatment. The systems and methods described herein relate to measuring physical characteristics of a patient to determine recommended target CPR criteria for treating the patient. For example, "physical characteristics" may refer to an aspect of a patient that may be determined by visual inspection or analysis of a captured image of the patient, rather than by direct measurement of the patient. Such target CPR criteria may be, for example, a target chest compression criteria and/or a target ventilation criteria. In the embodiments described herein, more than one physical characteristic or multiple physical characteristics of the patient may be used as input to one or more processors to determine the manner in which chest compression and/or ventilation feedback is provided to a caregiver giving CPR. Thus, the criteria for CPR feedback can be effectively tailored to the various physical characteristics of the patient (e.g., size, shape, dimensions, height) and how these physical characteristics evolve over time (e.g., during CPR). The weight may be, for example, a physical characteristic that may be manually input by the user.
CPR criteria may also be determined using patient characteristics, which may include physical aspects that cannot be determined by visual inspection. For example, the patient weight may be a physical characteristic used to determine certain CPR criteria. In some examples, as described herein, patient weight may be estimated from patient physical characteristics including, for example, height, waist circumference, chest circumference, and other physical characteristics (e.g., physical characteristics that may be determined by visual inspection, such as by three-dimensional scanning techniques or other such measurements). That is, the patient weight may be estimated using methods that measure or otherwise determine patient volume, with appropriate multiplications for density (e.g., fat volume multiplied by approximate fat density, muscle volume multiplied by approximate muscle density, bone volume multiplied by approximate bone density, etc.). In some examples, non-body patient characteristics (such as age and/or gender, etc.) may be used in addition to physical characteristics to determine target CPR criteria. For example, if the patient is a child or adult, or if the patient is a male or female, the manner in which CPR should be applied to the patient (e.g., according to target CPR criteria) may vary. Alternatively, the physical characteristics may be effectively used as a surrogate to infer the non-physical characteristics, which are then used to determine the target CPR criteria.
As an illustrative example, for a relatively large adult patient, the recommended target depth (or rate or release rate, etc.) to apply chest compressions may be greater than the recommended target depth for a small child or infant, for example. Such a target depth may result in an efficient transport of blood from the heart to the surrounding tissues of the body while also balancing the risk of traumatic injury to the patient's chest. Similarly, larger (or taller) adult patients are expected to have greater lung capacity than, for example, smaller (or shorter) pediatric patients. The recommended target tidal volume for ventilating the patient may vary according to the estimated lung volume of the patient. The suggested technique of applying chest compressions may also depend on one or more physical characteristics of the patient, sometimes on the manner in which physical characteristics change during the course of a resuscitation event.
The physical characteristics and/or non-physical characteristics of the patient may be manually entered into a CPR feedback system (e.g., a patient monitor, defibrillator, CPR device, or other acute care device). Additionally or alternatively, one or more sensors or other devices (e.g., three-dimensional sensors or scanning devices for generating three-dimensional representations of various portions of a patient's body) may be used to automatically measure certain body dimensions (e.g., anteroposterior chest distance, side-to-side chest distance, chest circumference, chest/chest aspect ratio, patient height, facial features, etc.). As discussed in further detail herein, such body measurements may be used as input for determining recommended CPR criteria.
While several embodiments described herein relate to providing treatment to a person suffering from cardiac arrest, it should be understood that embodiments of the present invention relate to providing acute care to a person suffering from a disease other than cardiac arrest, such as respiratory distress or other conditions. In various embodiments, chest compressions, ventilation, drug delivery, or other forms of acute care treatment may be indicated for a patient, either alone or in combination, depending on the medical issue.
System for guiding an acute care provider to resuscitate
A system 10 for guiding and providing feedback to an acute care provider conducting resuscitation activities (including but not limited to chest compressions and ventilation) on a patient is shown in fig. 1A and 1B. The system 10 may be adapted for use at an emergency scenario to record information about a patient (including measuring physical characteristics of the patient), process the patient information to determine criteria for performing resuscitation activities on the patient, and provide feedback and guidance to an acute care provider to encourage the acute care provider to perform resuscitation activities according to the determined criteria.
Fig. 1A shows an exemplary rescue scenario 100 where acute care providers 104, 106 are present to resuscitate an adult patient 102 at the scenario 100 and include elements of the system 10 for providing resuscitation guidance and feedback. The acute care provider 104 is providing chest compressions to the torso of the patient 102. The acute care provider 106 is providing ventilation to the patient using a manual ventilation unit that includes a ventilation bag 112. Although two acute care providers 104, 106 are shown here for purposes of explanation, there may be only one acute care provider at an acute care scenario, or an acute care team may include three or more acute care providers to help care for the patient 102. Additional acute care providers may perform tasks such as setting up medical devices or monitoring the physiological condition of a patient (e.g., checking patient vital signs). For example, one of the acute care providers may be responsible for setting up a medical device such as a patient monitor or defibrillator 108 while one or more other acute care providers are performing other resuscitation activities on the patient 102. For example, an acute care provider setting up the monitor and/or defibrillator 108 may be responsible for attaching electrodes that may be contained in the electrode package 110 to the patient 102. The defibrillator 108 may be a conventional Automatic External Defibrillator (AED), or may be a professional defibrillator (such as X SERIES, R SERIES, M SERIES, or E SERIES, etc., available from ZOLL Medical Corporation of C.C., Mass.) or an Automatic External Defibrillator (AED) (including AED PLUS or AED PRO from ZOLL Medical Corporation).
In fig. 1A, the electrode package 110 is shown in a normal position on the patient 102. In this example, the electrode package 110 is an assembly that combines therapy and/or ECG sensing electrodes located at a high position to the right of the patient's torso, separate therapy and/or ECG sensing electrodes located at a low position to the left of the patient's torso, and a sensor package located on the patient's sternum. The electrode package 110 (which in this example is obscured in the figure by the hand of the acute care provider 104) may also include a motion sensor (such as an accelerometer, laser interferometer, magnetic induction velocity sensor, etc.) or a proximity sensor (such as an optical or capacitive sensor, etc.) that may be configured to transmit data to the portable computer device or defibrillator 108 to monitor the progress of chest compressions.
In other examples, motion information related to the performance of chest compressions may be collected by a separate device located on the patient's sternum. The device, which may be generally referred to as a "CPR pointer (CPR pointer)", generally comprises a plastic housing comprising electronic circuitry, in particular a motion sensor and/or a proximity sensor.
In some examples, once the electrodes (e.g., electrode package 110) are connected to the patient, the defibrillator 108 may monitor the patient's status to identify the patient's physiological events and determine whether a shockable rhythm exists, and provide treatment to the patient if a shockable rhythm exists. A non-exhaustive list of cardiac patient events that may be detected by an external medical device such as the defibrillator 108 (e.g., via ECG electrodes and appropriate analysis algorithms) includes, for example: bradycardia, Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF), atrial arrhythmias (such as Premature Atrial Contractions (PACs), multifocal atrial tachycardia, atrial flutter, atrial fibrillation, etc.), supraventricular tachycardia (SVT), borderline arrhythmia, tachycardia, borderline arrhythmia, borderline tachycardia, borderline premature and ventricular arrhythmias (such as Premature Ventricular Contractions (PVC) and accelerated ventricular spontaneous rhythms, etc.).
In some examples, ventilation to the patient is provided by a ventilation bag 112 connected to the patient via an airflow path 114 or by a mechanical ventilator (not shown in the figures). The passage may comprise means for measuring the air flow to the patient and +Or a ventilation sensor 22 (such as a flow sensor) for exhalation information. The information collected by ventilation sensor 22 may be used to determine ventilation parameters (including, for example, tidal volume, minute ventilation, ventilation rate, airway pressure, flow rate in the patient's airway, inspiratory flow rate, and/or expiratory flow rate). Information related to ventilation activities performed by acute care providers may be used to provide feedback to the acute care providers, and in some cases to confirm that ventilation activities are properly synchronized and/or optimized with other resuscitation activities being performed by other acute care providers. In some examples, an electromechanical ventilator may be used to provide ventilation to the patient 102. In other examples, ventilation may be performed or initiated by a mechanical ventilation device, such as a band or a breastplate that wraps around the abdomen of the patient. In other embodiments, RESQCPR, manufactured by ZOLL Medical Corporation, may be usedTMThe system,OrAn Impedance Threshold Device (ITD) to perform ventilation.
The system 10 is configured to assist the acute care providers 104, 106 in performing resuscitation activities on the patient 102, such as chest compressions, ventilation, and/or other CPR activities, such as drug delivery. The system 10 includes at least one information input device 12, such as a manual data entry accessory (e.g., a keyboard, touch screen display, mouse, buttons, or other computer accessory). In fig. 1A, buttons or touch screen elements of the defibrillator 108 or mobile device may be used as the manual data entry accessory 14 for manually entering information and measurements of the system 10. The input device 12 also includes a camera 16 and a three-dimensional imaging system 18 or sensor for providing information indicative of at least one physical characteristic of the patient 102 measured during an acute care event. The system 10 also includes at least one resuscitation sensor, such as a chest compression sensor 20 or a ventilation sensor 22, configured to obtain a signal indicative of resuscitation activity (e.g., chest compressions or ventilation) performed on the patient during the acute care event. Chest compression sensor 20 may be, for example, an accelerometer-based sensor located on the chest of a patient. In some examples, the chest compression sensor 20 is enclosed in an electrode package 110 (shown in fig. 1A). Ventilation sensor 22 may be a pressure sensor or a flow sensor located in airway path 114 of the patient. The system 10 also includes a feedback device 24, the function of which feedback device 24 may be performed, for example, by a defibrillator 108 as shown in fig. 1A. For example, the visual display 26 and speaker 28 of the defibrillator 108 may be used to provide resuscitation guidance and feedback to the acute care provider. The visual display 26 and speaker 28 may also be components of other therapeutic devices or patient monitoring devices (such as a ventilator or heart monitor, etc.) at the rescue scene 100.
The system 10 also includes at least one processor 30 (shown in FIG. 1B) communicatively coupled to the at least one input device 12 and the resuscitation sensors 20, 22, such as a computer controller, microprocessor, or virtual processor of a computer device. In some examples, the at least one processor 30 is also a component of a medical device, such as the defibrillator 108 (shown in fig. 1A). In other examples, the at least one processor 30 may be a component of a portable computing device 32, such as a computer tablet, smart phone, cellular phone, or laptop computer, present at the rescue scene 100. In other examples, the at least one processor 30 may be a component of a computer terminal or server that is remote from the rescue scenario and in wired or wireless communication with the sensors 20, 22, the portable computer device 32, and the medical device (e.g., defibrillator 108) at the rescue scenario 100.
As described in further detail in connection with fig. 10-12 and 14 (which provide flowcharts of computer processing by the at least one processor 30), the at least one processor 30 is configured to: receiving and processing information representative of at least one physical characteristic of the patient 102 from an input device 12, such as a manual data input assembly 14, a camera 16, and/or a three-dimensional imaging system 18 or sensor, to determine a target resuscitation criteria for the patient 102; receive and process signals from resuscitation sensors (e.g., chest compression sensor 20 and ventilation sensor 22) indicative of resuscitation activity performed by the acute care providers 104, 106 on the patient 102 to calculate resuscitation parameters for the ongoing resuscitation activity; judging whether the resuscitation parameters meet target resuscitation standards; and causes the feedback device 24 to provide the acute care provider 104, 106 with an indication of whether the resuscitation parameters meet the target resuscitation criteria.
While not intending to be bound by theory, it is believed that patients of different sizes, particularly patients with differently shaped cardiothoracic regions, may benefit from resuscitation activities performed according to different standards, protocols, or techniques. Thus, it is believed that adjusting resuscitation criteria based on the physical characteristics of the patient improves the effectiveness of resuscitation, thereby improving patient outcomes such as survival and physical condition.
Physical characteristics of the patient
The physical characteristic of the patient 102 may refer to a quantifiable measurement of the patient, such as a length, width, or height of the patient's external anatomy (e.g., the patient's height, the length of the patient's arms or legs, the lateral width of the patient's chest, the circumference of the patient's chest or waist, the anterior-posterior (AP) distance of the patient's chest, the patient's total volume, the chest volume, the waist circumference, the neck size, the shoulder width, the skull volume, the pupil distance, the eye-nose spacing, the finger length, the finger width, the hand length, the toe width, the foot length, the chest shape, the Body Mass Index (BMI), etc.), or may refer to a distance between the patient's anatomies (e.g., a distance between scapulas bones). The physical characteristics described herein may include anthropometric features, which may refer to relationships between measurements of different physical characteristics of a person (e.g., the ratio between the sternal AP distance and the lateral width, the ratio between the sternal AP distance and the circumference, the shape of the chest, the volume of the chest, etc.). Body weight is a physical characteristic of the patient 102. As described herein, body weight may be estimated based on body characteristic measurements in combination with other data such as density (described further below). However, from the information recorded by the camera or three-dimensional sensor at the rescue scene and without relying on estimated density data, it would be more difficult to determine the weight. If certain physical characteristics (such as body weight, etc.) cannot be determined immediately by analyzing the recorded information, such physical characteristics may be manually entered via the input device 12. In some examples, the physical characteristics of the patient 102 include overall patient measures such as height, other body dimensions, and the like. In other examples, the body characteristic may include an overall measurement (e.g., height, AP distance) combined with one or more measurements of a particular body region. Patient age or gender or other non-physical characteristics may also be relevant factors for determining a resuscitation criterion for a patient.
Other non-body characteristics such as age and gender may be estimated based on analysis of the patient's image or three-dimensional scan, for example by using certain body features (e.g. pupillary distance, eye-nose separation for a certain age) or appropriate densities (of body weight) for estimation. In some embodiments, non-body patient characteristic information such as age and gender may be manually entered by the acute care provider 104, 106 as further inputs of a plurality of body characteristics to determine target CPR criteria (e.g., chest compression depth/rate, tidal volume of ventilation, ET catheter depth, drug dose, etc.).
In some examples, the patient's height, weight, and gender may be used to calculate an ideal weight of the patient 102 and/or a Body Mass Index (BMI) of the patient 102 using equations derived for the calculation. Ideal Body Weight (IBW) may be related to lung volume and as such may provide suitable parameters for estimating certain recommended or target ventilation criteria. As described in equation 1 below, BMI is based on weight and height. As shown in equation 2 below, IBW is based on height and gender. As such, when the height, weight, and in some cases the sex of the patient are known, useful information regarding the target ventilation parameters for different sized patients can be determined. It will be appreciated that physical characteristics other than height and weight may be used as input to determine target ventilation (or other resuscitation) criteria. For example, chest volume, circumference, AP distance, etc. may be an indicator of the circumference of the patient, and thus may be the volume of the patient's lungs. Thus, a plurality of physical characteristics may be used to determine the target ventilation parameter/criterion.
Equation 1: body Mass Index (BMI) ═ massWeight (kg)/height2(m2)。
Equation 2: ideal Body Weight (IBW)
IBW man 50kg +2.3 x [ height (in) -60 ]
IBW women ═ 45.5kg +2.3 [ body height (in) -60 ]
Fig. 2A to 3B show diagrams of different types of patients 102, 302, wherein the different types of patients 102, 302 can be treated with the system 10 and comprise physical characteristics that can be recorded, detected or measured by the system 10. In some examples, the patient 102 is an adult patient (shown in fig. 2A and 2B). In other examples, the patient is a pediatric patient 302 (shown in fig. 3A and 3B). In some examples, the physical characteristic is an overall physical measurement of the patient, such as height (shown in fig. 2A and 3A with H1), or the like.
In other examples, the physical characteristic is a characteristic of a cardiothoracic region 118 of the patient. For example, the physical characteristics may include: an anterior-posterior (AP) distance D1 of a cardiothoracic region 118 of the patient, the AP distance D1 being a maximum distance between an anterior portion of the chest of the patient and a posterior portion of the back of the patient; a width W1 of the patient's cardiothoracic region 118; a length L1 of the patient's cardiothoracic region 118 (e.g., a length from the bottom of the patient's neck to the base of the ribs); and a circumference C1 of the patient's cardiothoracic region 118. Such measurements may be obtained manually (e.g., a user may determine the measurement using a tape measure or caliper), as described herein. In other examples, measurements of body characteristics are determined by analyzing images of a patient and a rescue scene obtained by a camera and/or a three-dimensional imaging system. For example, as described herein, images captured by a stereo camera and a light field camera may be analyzed to determine distance information between objects in the captured images. In a similar manner, measurements of body features may be determined from the generated three-dimensional representation of the rescue scene. For example, the three-dimensional representation may comprise position information of objects in the scene, in particular of various anatomical structures of the patient. Since the position information is known, the distance between the anatomical structures can be determined by mathematical analysis. Information collected from a three-dimensional imaging system (e.g., sensor, camera, scanning device) may be used to generate a three-dimensional representation of the patient, and body measurements may be obtained therefrom.
As will be appreciated by those skilled in the art, patient size may vary widely, for example, based on factors other than age or gender. Generally, the AP distance D1 may vary between about 2 inches to about 6 inches for newborns and infants, and the AP distance D1 may vary between about 8 inches to about 18 inches for large adults. For small patients (e.g., neonates and children), cardiothoracic width W1 may vary between about 2 inches and 10 inches, and for large adults, cardiothoracic width W1 may vary between about 16 inches and about 24 inches. For the smallest patients (e.g., neonates and children), the circumference of the cardiothoracic region of the patient may vary between about 4 inches and 20 inches, and for large adults, the circumference may vary between about 40 inches and 60 inches. While general ranges of these parameters are discussed above, it should be understood that there may be significant interpersonal variation in AP distance, cardiothoracic width, circumference, and other dimensional attributes.
In other examples, the physical feature may be a thoracic volume or a maximum cross-sectional area of a cardiothoracic region of the patient, as such physical feature may be used as an approximation of a lung volume. While Ideal Body Weight (IBW) in terms of height and gender may be used as a relevant input parameter for determining a recommended ventilation criterion (e.g., tidal volume), in some cases (as alluded to above) chest volume, cross-sectional area, chest circumference, AP distance or other measurements may also be used as a relevant input for ventilation criteria (such as tidal volume, etc.). The cardiothoracic volume can be estimated based on the AP distance and cardiothoracic length and width. The chest volume can also be estimated using circumference. The maximum cross-sectional area of the thoracic region may be calculated based on circumference.
Resuscitation criteria for patients of different sizes
When chest compressions are administered, in general, the recommended chest compression depth for adults is typically about 2.0 inches, and a suitable range of chest compression depths is between about 2.0 inches and 2.4 inches. The target chest compression rate during chest compressions may be between about 100 compressions per minute (cpm) and 120cpm, and is preferably about 105cpm for an adult patient. For pediatric patients, the target compression rate may be 100cpm to 120 cpm. However, according to embodiments presented herein, the target chest compression depth and rate may be different (e.g., for infants and young children, the target chest compression depth may be lower and the target chest compression rate may be higher).
Current guidelines for resuscitation activities (e.g., american heart association guidelines) generally do not consider the patient's physical characteristics in determining the resuscitation criteria. Rather, current guidelines generally determine resuscitation criteria based on patient age, such as pediatric patients (8 years and below) and adult patients (8 years and above). For example, guidelines for chest compressions show that the target compression depth for an adult patient should be 2.0 inches to 2.4 inches, and the target compression rate for an adult patient should be 100 to 120 compressions per minute; and the depth of compression for children (1 to 8 years old) is one third of the anterior-posterior (AP) distance of the cardiothoracic region of the child.
For ventilation, the target parameters may include ventilation rate and ventilation volume. For adults, the target ventilation rate may be about 10 ventilation breaths/minute (e.g., approximately 30 compressions per 2 ventilation breaths), and for children and infants, the target ventilation rate may be about 20 ventilation breaths/minute (e.g., approximately 15 compressions per 2 ventilation breaths). The target parameter may also relate to the synchronization or sequence of chest compressions and ventilation. For example, an acute care provider may be instructed to provide multiple compressions (e.g., about 15 compressions or about 30 compressions), and then pause the compressions while delivering a specified number of ventilations (e.g., 2 ventilations).
As will be understood by those skilled in the art, both pediatric and adult patients vary in size and shape. In some cases, the height and weight of a large child in particular may be similar to the height and weight of a small adult. The proposed target criteria provided by current guidelines do not take into account such differences in patient size. The system 10 is configured to take into account such differences in patient size and shape when determining resuscitation criteria. Further, the system 10 may be configured to update or adjust resuscitation criteria and provide instructions for improving CPR techniques during a rescue effort.
For chest compressions, the criteria and parameters may be at least one of compression depth, compression rate, compression release rate, compression pause, or compression release. In some examples and depending on patient physical characteristics (e.g., height, AP distance, etc.), the suggested target compression depth may be 0.2 to 3.5 inches for the entire population, or 0.5 to 3.0 inches for a smaller subset, or 2.0 to 2.4 inches for an adult patient, consistent with current AHA guidelines. In some cases, the range of recommended target compression depths may be offset according to the physical characteristics of the patient. For example, for relatively large adults (e.g., AP distance between 12 and 18 inches, circumference between 50 and 60 inches), it is recommended that the target chest compression depth may be offset from 2.0 to 2.4 inches to 3.0 to 3.5 inches, 2.8 to 3.2 inches, 2.5 to 3.0 inches, or other suitable compression range. For relatively small children (e.g., AP distance between 2 and 10 inches, circumference between 10 and 20 inches), it is suggested that the target chest compression depth may be offset in other directions to 1.0 to 1.5 inches, 0.5 to 1.0 inches, 0.2 to 0.5 inches, etc.
The target compression rate may also vary depending on the measured physical characteristics of the patient. For example, for pediatric patients, the recommended target compression rate may vary between 100 and 160 compressions per minute (cpm), which may be indicated by relatively small physical features, examples of which are illustrated herein. For elderly patients, the recommended target compression rate may be between 100 and 120cpm, which may be indicated by relatively large physical features. In general, since the natural heart rate of a young patient is greater than the natural heart rate of an older patient, the target compression rate of a young patient may be greater than the target compression rate of an older patient. However, it will be appreciated that the target compression rate may be different for different types of patients.
Similarly, the target CCRV (chest compression release rate) may vary based on the measured physical characteristics of the patient. For example, the recommended target CCRV may be between 100 and 650 inches/minute, where meeting the proper CCRV may suitably allow natural recoil of the chest to improve venous return of blood to the heart. For example, the CCRV may be 150 to 300 inches/minute for small children, and 250 to 600 inches/minute (e.g., 250 to 400 inches/minute, 350 to 500 inches/minute, or 400 to 600 inches/minute) for adults. Thus, the target CCRV will vary depending on the physical attributes of the patient.
In a simplified example, the physical characteristic of the patient 102, 302 that is used to determine one or more initial target recommendations for various CPR criteria may be the AP distance of the chest. For example, the target compression depth for patients with smaller AP distances may generally be less than the target compression depth for patients with larger AP distances. However, as discussed further below, a single body measurement may not be able to determine what the target CPR criteria should be, and may only provide a set of initial CPR criteria that need further refinement. Thus, the AP distance of the patient provides a quick, easy to measure indication of whether the patient's size/thickness is large or small, and can be used to set an initial range of recommended target compression depths. However, measurements of other physical characteristics of the patient may be used in conjunction with the initial measurements to narrow the range of recommended depths once such measurements are available. As described further herein, while measurements of a single physical characteristic may be useful for providing an initial indication for advising of a target compression depth (or other CPR criteria), input of measurements of multiple physical characteristics may allow for even further refinement of the output within the range of target CPR criteria as feedback to the caregiver.
For example, the AP distance of the patient may provide an initial recommendation for a target range of compression depths and/or compression rates or other CPR parameters. In an exemplary implementation for illustrative purposes and not by way of limitation, system 10 may be configured to provide the following initial recommendations for a target chest compression depth based on the AP distance of the patient. For patients with an AP distance less than 3 inches (e.g., infants or neonates), the initial recommendation for a target chest compression depth may be 0.2 inches to 0.75 inches. For patients with an AP distance of 4 to 5 inches (e.g., small children), the initial recommendation for a target chest compression depth may be 0.75 inches to 1.25 inches. For patients with an AP distance of 6 to 8 inches (e.g., large children or small adult females), the initial recommendation for a target chest compression depth may be 1.25 inches to 1.75 inches. For patients with an AP distance of 9 to 11 inches (e.g., average women or large men), the initial recommendation for a target chest compression depth may be 1.75 inches to 2.25 inches. For patients with an AP distance of 12 to 14 inches (e.g., larger women or average men), the initial recommendation for a target chest compression depth may be 2.25 inches to 2.75 inches. For patients with an AP distance of 15 inches or greater (e.g., large males), the initial recommendation for a target chest compression depth may be 2.75 inches to 3.5 inches. As other information (physical or non-physical) is provided, the initial recommendation for the target range of CPR parameters can be further refined or confirmed.
The AP distance of the patient may also provide a basis for an initial recommended target range of compression parameters for compression rate and release speed, which may be further refined or confirmed with more information (physical or non-physical). For example, in an exemplary implementation, for a patient (e.g., an infant or neonate) with an AP distance less than 3 inches, the initial recommendation for a target chest compression rate may be 150 to 160cpm, and the initial recommendation for a target chest compression release rate may be 200 to 300 inches/minute. For patients with an AP distance of 4 to 5 inches (e.g., small children), the initial recommendation for a target chest compression rate may be 140 to 150cpm, and the initial target chest compression release rate may be 150 to 250 inches/minute. For patients with an AP distance of 6 to 8 inches (e.g., large children or small adult females), the initial recommendation for a target chest compression rate may be 120 to 140cpm, and the initial target chest compression release rate may be 250 to 400 inches/minute. For patients with an AP distance of 9 to 11 inches (e.g., average women or small men), the initial recommendation for a target chest compression rate may be 110 to 130cpm, and the initial target chest compression release rate may be 250 to 400 inches/minute. For patients with an AP distance of 12 to 14 inches (e.g., larger women or average men), the initial recommendation for a target chest compression rate may be 100 to 120cpm, and the initial target chest compression release rate may be 250 to 600 inches/minute. For patients with an AP distance of 15 inches or greater (e.g., large males), the initial recommendation for a target chest compression rate may be 100 to 120cpm, and the initial target chest compression release rate may be 250 to 600 inches/minute.
Other physical characteristics, such as the patient's circumference, height, measure of lateral width, etc., may also be used, alone or in combination with the AP distance, to confirm or otherwise determine the proposed target range of compression depths, as explained herein. For example, other measured physical or non-physical characteristics of the patient (e.g., age, gender) may be used as a confirmation of the patient type, where a single physical measurement is insufficient. As discussed further below, the type of patient may vary widely for a given AP distance (or other physical characteristic), and therefore, it may be advantageous to provide multiple measurements of a physical characteristic or a non-physical characteristic as input to a feedback system that subsequently results in an output of appropriate CPR criteria.
In some examples, the target chest compression depth may be based on a combination of the AP distance and one or more of the following physical characteristics: chest transverse width, chest circumference, patient total volume, chest volume, waist circumference, neck circumference, shoulder width, skull volume, pupil distance, eye-nose spacing, finger length, finger width, hand length, toe width, foot length, chest shape, and height.
In other examples, the target chest compression depth may be based on a combination of the AP distance and one or more physical characteristics of the patient's chest. The physical characteristics of the patient's chest may include one or more of the following: lateral width of the chest, bust, chest volume and chest shape.
In other examples, the target chest compression depth may be based on a combination of the AP distance and the length, volume, and/or weight of the body region of the patient. The body region of the patient may be any convenient body region that can be readily identified and measured using the manual or automatic measurement techniques disclosed herein. For example, the body region may be a patient's hand, arm, foot, leg, face, or skull.
In other examples, the target chest compression depth may be based on a combination of the AP distance and a physical feature or physical characteristic that represents or indicates the overall size of the patient. For example, the physical characteristic or physical property representing the overall size of the patient may be one or more of the patient's height, patient's weight, patient's arm extension, body volume, waist height ratio, or Body Mass Index (BMI).
Patient weight may also be used to provide a general indication to distinguish between smaller and larger patients. However, as illustrated, multiple body measurements may be used as input to determine a target CPR criterion to give feedback to the acute care provider. For example, the patient's weight may be used as a physical characteristic to provide an initial target chest compression depth. In an exemplary implementation, the initial target chest compression depth may be 0.2 inches to 0.75 inches for a patient weighing less than 20 pounds (e.g., an infant or a neonate). For patients weighing 20 to 50 pounds (e.g., small children), the initial target chest compression depth may be 0.75 to 1.25 inches. For patients weighing 50 to 100 pounds (e.g., large children or small female adults), the initial target chest compression depth may be 1.25 to 1.75 inches. For patients weighing 100 to 150 pounds (e.g., average adult female or small adult male), the initial target chest compression depth may be 1.75 to 2.25 inches. For patients weighing 150 to 50 pounds (e.g., large adult females or average adult males), the initial target chest compression depth may be 0.75 to 1.25 inches. For patients weighing 200 pounds or more (e.g., large males), the initial target chest compression depth may be 2.75 inches to 3.5 inches.
When the resuscitation activity is providing ventilation, the ventilation criteria and the ventilation parameter may be at least one of tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, or ventilation rate during an acute care event. The target ventilation criteria for the patient may be based in part on the patient's age. For example, ventilation parameters such as tidal volume or ventilation rate may be determined based on whether the patient is a pediatric patient (neonate, small child, or adolescent) or an adult. According to the present invention, the target ventilation criteria may also be based on one or more physical characteristics of the patient, such as the height of the patient, etc. An exemplary table illustrating the correspondence between patient height and tidal volume for an adult male patient is shown in table 1. The values of the table may be determined experimentally by, for example, considering patient outcome data from previous rescue efforts. In other examples, the values in the table may be determined from anatomical modeling of the lung and respiratory system. In some embodiments, the ventilation rate for an adult is generally approximately 8 to 12 breaths/minute regardless of the patient's height/weight, but in various cases the target ventilation rate may fall outside this range.
Height of a person
Tidal volume (mL)
60 inches to 63 inches
300 to 400
64 inches to 66 inches
350 to 450
67 to 69 inches
400 to 500
69 inches to 72 inches
400 to 500
72 inches to 75 inches
450 to 550
76 inches or more
500 to 600
TABLE 1
The tidal volume of ventilation may also be calculated according to an equation based on Ideal Body Weight (IBW), which is determined by gender and height. For example, according to equation 3, the ventilation parameters may be related to the patient's Ideal Body Weight (IBW) as calculated by equation 2 shown above.
Equation 3: the tidal volume target (6 to 8mL/kg) × IBW may be used
As explained above, for various embodiments, improved optimization of target resuscitation criteria may be achieved by determining resuscitation criteria based on a plurality of physical characteristics of a patient. For example, resuscitation parameters may be determined based on two or more of height, weight, or body feature dimensions (e.g., anterior-posterior (AP) distance, circumference of the chest, lateral width of the chest, total patient volume, chest volume, waist circumference, neck size, shoulder width, skull volume, facial feature spacing, etc.) in combination, rather than considering these features alone. One reason that determining target resuscitation criteria based on multiple physical characteristics of a patient may be useful is due to differences in the positioning of organs (such as the heart and lungs) and other anatomical structures (e.g., soft tissue, sternum or spine, etc.) between children and adults. For example, a child may have a small heart and lungs compared to an adult of similar size (e.g., similar height and weight). Thus, the optimal target resuscitation criteria, such as compression depth, may be different for patients with similar anteroposterior diameters. Thus, when combined with AP distance, as an alternative to age, using one or more physical features (such as height, skull, volume, facial feature spacing such as eye spacing or eye-nose spacing, hand or foot feature measurements (e.g., finger or toe length/width, hand or foot length/width), etc.) may result in more accurate target resuscitation criteria (e.g., compression depth feedback). For the various embodiments, physical characteristics as described in the references "Standards in Pediatric Orthopaedics: Tables, Charts, and Graphs illuminating Growth", published by Robert N.Hensinger in 1986, and "Three-dimensional human facial morphology as robust imaging markers", published by Weiyang Chen et al in Cell Research (2015) volume 25, phase 5, 25: 574-587, can be used as an alternative to estimate non-physical characteristics of patients (such as age or gender, etc.). In some examples, when an imaging tool (e.g., a camera, a three-dimensional imaging system) is used to measure a body feature, a reference object or scale may be positioned in the field of view so that measurements of a particular feature (e.g., a part of a hand) may be accurately measured. As an example, it may be preferable to take an image of a patient's hands or feet to measure physical characteristics that are used as input to determine a target resuscitation criterion. The optimal target resuscitation criteria may also be based on non-physical characteristics of the patient (such as age and gender). For example, as described above, a younger patient may have a faster heart rate and require a faster rate of chest compressions regardless of patient size as compared to an older patient. Target ventilation parameters, such as tidal volume, may also depend at least in part on patient gender.
To illustrate these differences, a diagram comparing a cross-section 400a of the cardiothoracic region of an adult patient (fig. 4A) and a cross-section 400B of the cardiothoracic region of a pediatric patient (fig. 4B) is shown. A cross-section 400a of an adult patient includes a heart 404a, lungs 406a, sternum 408a, and spine 410 a. In the uncompressed state, the heart 404a is spaced a distance D2 from the spine 410 a. During the downward stroke of chest compressions, the heart 404a moves in a downward direction toward the spine 410a, thereby reducing the intrathoracic volume and compressing the heart and large blood vessels to move blood in a forward direction.
By way of comparison, a cross-section 400B of a pediatric patient is shown in fig. 4B. The pediatric patient's organs (heart 404b and lungs 406b) may be smaller than the organs of an adult. Thus, the distance D3 between the heart and the spine may be greater than the distance D3 for an adult patient with a similarly shaped thorax. In this case, the compression depth may be increased to account for the smaller relative size of the heart within the ribcage of pediatric (0 to 7 years old) patients. This difference between pediatric and adult patients will not be understood if only one physical characteristic is considered. However, when multiple physical characteristics, such as the height of the patient, or other physical characteristics, such as the skull volume or circumference or facial feature separation and weight, are considered together, a narrower range of acceptable target resuscitation criteria may be determined for the patient. Additional patient characteristics (such as estimated or actual patient age or gender, etc.) may also enhance the plurality of physical characteristics to further refine the range of acceptable target resuscitation criteria.
In some examples, even greater optimization of the target resuscitation criteria may be achieved by considering in more detail a number of physical characteristics related to the size and shape of the patient's cardiothoracic region. Such considerations of the size and shape of the cardiothoracic region can be useful because the size, shape and configuration of the cardiothoracic region can vary widely even for patients of similar height and weight.
As explained above, the AP distance is a physical feature of the cardiothoracic region of the patient that may be relevant for determining the target depth of chest compressions. Generally, the chest compression depth corresponds to the AP distance. For patients with a particularly large chest, deeper chest compressions may be required. Thus, consideration of AP distance in combination with physical characteristics, physical characteristics (e.g., weight), gender, and/or other information may provide more accurate target criteria for chest compressions and other resuscitation activities. However, AP distance alone may not be sufficient to adequately characterize the shape of the patient's cardiothoracic region in all cases. For example, some patients are flat chest, while others have a round or barrel shaped chest. A diagram of a cross-section 500a of the cardiothoracic region of a flat-chest patient is shown in fig. 5A. The cross-section 500a includes the patient's heart 504a, lungs 506a, sternum 508a, and spine 510 a. Distance D1 represents the AP distance of the patient's cardiothoracic region. D2 is the distance between the heart 504a and the spine 510 a. During chest compressions, the heart 504a moves a distance D2 and presses against the spine 510 a.
A diagram of a cross-section 500B of a cardiothoracic region of a patient with a barrel chest is shown in fig. 5B. The flat chest patient and the barrel chest patient have similar AP distances (shown as D1 in fig. 5A and 5B). However, due to the curvature of the barrel chest of the patient, the distance D3 between the heart 504b and the spine 510b of the barrel chest patient 502b is greater than the distance D2 of the flat chest patient. As a result, a barrel chest patient may require deeper chest compressions to ensure that the heart 504b moves the entire distance D3 and presses against the spine 510b to push blood from the heart during compressions.
To more fully characterize the shape of the patient's cardiothoracic region to determine the target resuscitation criteria, other physical characteristics may be considered in conjunction with the AP distance. For example, the width W1 or circumference of the cardiothoracic region may be used in conjunction with the AP distance to more fully characterize the shape of the patient's cardiothoracic region. The measured thoracic volume based on the three-dimensional scan/image of the patient may also be used to determine and characterize the shape of the thoracic region. Table 2 shows exemplary target chest compression depths for adult patients of similar height and weight based on the AP distance D1 in combination with chest width W1. As shown in the illustrative example of table 2, the target chest compression depth values may vary from 1.5 inches to 3.8 inches. However, since both the AP distance (D1) and the chest width (W1) are considered, the system may provide a more exact suggested chest compression depth or at least a narrower range of suggested depths.
TABLE 2
Determining patient type
In some examples, the at least one processor 30 of the system 10 may be further configured to determine the type of patient based at least in part on the measured physical characteristics of the patient. For example, the at least one processor 30 may process information from the input device 12 to determine the sex of the patient. In the simplest example, the system 10 may be manually entered for gender using, for example, a manual data entry accessory 14. Optionally, information related to physical features of the patient (e.g., patient height, chest dimension) may be considered to determine the predicted gender of the patient. In a more sophisticated example, image processing techniques may be applied to images of the rescue scene 100 captured by the camera 16 associated with the system 10 to estimate or predict the patient's gender. For example, facial image processing techniques may be applied to the captured images to estimate patient gender. In other examples, anthropometric relationships between various parts of a patient's body may be used to predict gender. For example, the at least one processor 30 may be configured to determine a hip-to-waist ratio ("waist-to-hip ratio") of the patient. The at least one processor may also determine a waist-to-body ratio ("waist-height ratio"). The determined ratio may be compared to known ratios for males and females to predict the gender of the patient.
In a similar manner, the at least one processor 30 may be configured to automatically distinguish between adult patients and pediatric patients based on measurements of physical characteristics provided by the system 10. For example, the at least one processor 30 may be configured to determine whether the patient is most likely a child or an adult based on the patient's height and weight. In other examples, the at least one processor 30 may be configured to distinguish between newborns, infants, small children, large children, small adults, average sized adults, or large adults based on the measured height and/or weight of the patient.
Recommendation techniques to determine resuscitation activity
In some examples, the at least one processor 30 may be further configured to cause the feedback apparatus to provide an indication to the patient related to the suggested chest compression technique based on at least one physical characteristic of the patient. Further, in some cases, the at least one processor 30 may be configured to suggest a first chest compression technique based on initially received physical characteristics of the patient, monitor the progress of the rescue effort and/or changes in the physical characteristics of the patient during the rescue effort, or determine the degree to which CPR criteria have been met, and provide instructions to switch from a previously provided chest compression technique to a new technique after a predetermined period of time. For example, an acute care provider may begin chest compressions with a first or initial chest compression technique. For most adult patients, the first or initial technique is conventional palmar chest compressions. At least one process if, after a predetermined period of time, system 10 determines that the applied chest compressions are invalid and/or not proceeding properly The device 30 may cause the feedback device 24 to provide instructions to the acute care provider to perform different chest compression techniques, such as active compression decompression, single-handed palm chest compression, or to perform automated mechanical chest compressions. In some cases, it may be preferable to switch to an automated mechanical chest compression system (such as the AutoPulse provided by ZOLL Medical Corporation) if manual chest compression is ineffectiveTMResuscitation System or Lucas, supplied by Physio-Control CorporationTMChest compression systems, etc.) that will provide a more consistent chest compression pattern than manually applied compressions.
Chest compression techniques may include, for example, palmar chest compressions, double-fingered chest compressions, and chest compressions around the thumb. Generally, the decision of which chest compression technique to apply is based on the patient size and/or age. For example, table 3 shows a correlation between patient weight and chest compression technique that may be used by the at least one processor 30 to provide an initial recommendation of chest compression technique.
Patient's weight
Pressing technique
Less than 10 pounds
Double finger press
10 to 25 pounds
Double finger or around thumb presses
25 to 50 pounds
Pressing with single palm
50 pounds or more
Pressing with both hands
TABLE 3
The decision to suggest or prefer chest compression techniques may also be based on the skill level or experience of the acute care provider or user. For example, bystanders and other untrained individuals may more comfortably perform palmar chest compressions because the outsiders are typically taught palmar technique during CPR coaching. However, if the system 10 determines that a certain chest compression technique is not performing well and/or does not result in the desired improvement for the patient, the system 10 may advise the acute care provider or the user to begin another type of chest compression.
Palmar chest compressions are typically performed on adults and older children. For example, current guidelines specify that palmar chest compressions may be performed on patients aged 8 and older. In some examples, the patient's height and/or weight may be used to determine whether palmar chest compressions are appropriate for the patient. For example, the system may be configured to recommend palmar chest compressions for patients over 50 pounds (22.7 kg).
Fig. 6A shows acute care provider 604 performing a palmar chest compression on patient 602. As shown in fig. 6A, the acute care provider 604 positions (e.g., kneels) himself/herself near the torso of the patient and extends the arms 606, 608 toward the patient 602. The root of the bottom hand 612 of the acute care provider is placed a few inches above the xiphoid process on the sternum of the patient 602. The top hand 610 of the acute provider is placed on the lower hand 612. In some cases, acute care provider 604 may lock his/her fingers together to remain in place. The acute care provider 604 performs compressions by leaning forward so that his or her weight pushes the patient's chest in a downward direction. The acute care provider 604 releases the compressions by removing the hands from the chest so that the chest can expand via natural recoil of the chest wall. Compressions are repeated at a compression rate of about 100 to 120 compressions per minute, depending on the patient's size and age.
One-handed chest compressions are typically performed on young children, particularly in the case of acute care providers of large size, to avoid injury to the patient 602 due to compression forces. For example, a single palm press may be performed on a child aged 1 to 8 years. The system 10 may be configured to recommend a palm chest compression for a child weighing 25 to 50 pounds (11.3 to 22.7 kg). Fig. 6B shows acute care provider 604 making one-handed chest compressions to patient 602. For the first hand 610, the acute care provider 604 holds the patient's head. The second hand 612 of the acute care provider is placed on the sternum in a position similar to the position of the bottom hand 612 when the palms of the hands are chest compressed. The target depth of single-palm chest compressions may be about one-third of the AP distance. Thus, for a normal sized child with an AP distance of 3 inches, the target compression depth may be about 1 inch. The target compression rate may be 120 to 160 compressions/minute, as the heart rate of pediatric patients is typically faster than the heart rate of adult patients. However, it will be appreciated that other target compression depths and rates may be appropriate depending on the physical characteristics or other characteristics of the patient.
Two-finger chest compressions and thumb-around chest compressions are typically performed on infants and newborns (e.g., patients less than 1 year of age and/or less than 25 pounds (22.3kg) in weight). Fig. 6C shows acute care provider 604 performing a two-finger chest compression for infant patient 602. As shown in fig. 6C, the acute care provider 604 optionally places a first hand 610 on the patient's forehead in a manner similar to the single-handed palm chest compressions described herein. Alternatively, first hand 606 may be placed under the patient's back or other location, rather than on the forehead. Second hand 612 is positioned over the chest of the patient. The acute care provider 604 presses two fingers (e.g., a middle finger and a ring finger) against the chest of the infant patient for compression. In some embodiments, the target compression depth for an infant patient may be between about 0.25 inches and 0.75 inches, depending on the size and age of the patient. The target compression rate for a pediatric patient may be about 120 to 160 compressions/minute.
Fig. 6D shows acute care provider 604 making a chest compression of patient 602 around the thumb. To perform a chest compression around the thumb, the acute care provider 604 wraps his/her bracelet around the chest area of the infant patient so that the thumbs 614 of the hands 610, 612 are placed against the patient's chest and the fingers 616 are placed against the patient's back. In some cases, the acute care provider 604 may hold the patient 602 in a substantially upright position while performing chest compressions around the thumb. In other embodiments, the patient 602 may be lying against a solid flat surface, as shown in fig. 6D. To perform the compressions, acute care provider 604 moves his/her finger 616 toward thumb 614, thereby compressing the patient's chest and back toward each other. The target compression depth for chest compressions around the thumb should be similar to two-finger chest compressions (e.g., about 0.25 to 0.75 inches). The target compression rate for a pediatric patient may be about 120 compressions/minute to 160 compressions/minute.
Active decompression and thoracic remodeling
The at least one processor 30 may also be configured to provide instructions to the acute care provider to begin applying active reduced pressure to the patient at an appropriate time. For example, the at least one processor 30 may be configured to continuously or periodically monitor physical characteristics of the patient (such as AP distance, etc.) as chest compressions are being performed. If a physical characteristic such as AP distance (e.g., due to chest remodeling from repetitive forces applied to the chest) changes significantly (e.g., by about 20% or more) during an acute care event, it may be indicated that the shape of the patient's chest and/or the elasticity of the chest has changed and active decompression is required to maintain blood flow. That is, as a result of the chest becoming substantially flatter, it may be preferable to adjust the target chest compression depth to a lower value and also provide active chest decompression to assist blood flow into and out of the heart.
In general, active decompression refers to the application of force to the patient's chest between compressions to pull or otherwise force the chest back to an expanded state, which has the benefit of reducing intrathoracic pressure, thereby enhancing venous return of blood from the surrounding tissues back to the heart. One scenario in which active decompression may be particularly beneficial is after chest remodeling caused by chest compressions. Applying chest compressions to a patient's chest can reposition certain anatomical structures (e.g., ribs, soft tissue, etc.) and/or reduce the elasticity of such structures. For example, when the chest is fully expanded as shown in fig. 7A, the heart is spaced a distance D2 from the sternum and mitral valve 712a is fully open. At this location, blood is drawn into the heart and can be recirculated with each chest compression. Desirably, upon complete release of the chest between chest compressions, the chest returns to this expanded state (shown in fig. 7A). However, after prolonged compressions, the chest may remain partially collapsed or compressed as shown in fig. 7B, even after the acute care provider releases the chest between compressions. In the compressed state of fig. 7B, the heart 704 is pressed against the sternum, and the mitral valve 712B may be closed or partially closed, meaning that only a small amount of blood is drawn into the heart between presses. Since blood is not effectively delivered to the heart between compressions, the amount of blood circulating through each chest compression is significantly reduced. Active decompression not only can generate negative intrathoracic pressures within the chest, but can also counteract the loss of elasticity of the chest and ensure that the chest returns to an expanded state between compressions.
As shown in fig. 7C, active decompression may be performed using a suction device (such as a plunger device 750) attached to the chest of the patient 702. The suction device 750 includes a handle connected to a dome-shaped suction cup 756 that is placed on the chest of the patient, the handle including grips 752, 754 of the hand of the acute care provider. The device 750 may also include a depth indicator 758 located on the grip portions 752, 754 of the handle. In use, the acute care provider 744 grasps the grips 752, 754 of the handle and pushes the handle in a downward direction during the compression portion of the compression cycle until the indicator 758 shows that the target compression depth has been reached. Once the target depth is reached, the acute care provider 744 pulls the grips 752, 754 in an upward direction during the decompression phase of the compression cycle. Pulling the grips 752, 754 in an upward direction causes the chest to move to its expanded state due to the suction force between the suction cup 756 and the patient's chest, thereby drawing blood into the heart.
Can be used in conjunction with resuscitation feedbackAn exemplary plunger or suction cup device for use with the guidance system 10 to deliver active reduced pressure to a patient is provided with a ResQCPR, supplied by ZOLL Medical Corporation TMResqpump of systemTM。ResQPUMPTMThe system includes a suction system that forces the chest of the patient back to an expanded state between compressions by applying a lifting force of up to 10kg to the chest during decompression. An exemplary device for providing active reduced pressure to a patient, which includes a suction cup configured to adhere to the Chest of the patient, is also disclosed in U.S. patent application publication No. 2017/0079876 entitled "Chest Compliance Directed to Chest Compression" by Freeman, and may be implemented in an embodiment of the present invention. Other devices that may be attached or adhered to the chest and may be lifted for active chest decompression include for example using hook and loop fasteners for connecting the device to the patient (e.g.,) And a device including an adherent material for mounting the device to a chest of a patient and coupling the device to the chest of the patient to enable pulling up of the chest during decompression.
In other examples, active decompression may be performed by applying compressions to other areas of the patient's body in between chest compressions. For example, the feedback device 24 of the system 10 may instruct the acute care provider to squeeze the sides of the patient's cardiothoracic region together to force the chest back to an expanded state. In a similar manner, compressions applied to the patient's abdomen between chest compressions may exert sufficient force on the chest cavity to return the chest cavity to its expanded state between chest compressions and enhance venous return of blood to the heart. Alternatively, the feedback device may provide instructions or advice to the patient to apply automated mechanical chest compressions, particularly in situations where manual compressions are inadequate.
In some examples, system 10 may be configured to continuously or periodically obtain measurements representative of physical characteristics of the patient to determine when remodeling has occurred. For example, the system 10 may be configured to monitor the AP distance D1 of the patient (shown in fig. 7A and 7B) during an acute care event. Upon determining that the AP distance has decreased a substantial amount (e.g., by 10% to 20%) from the initial (e.g., before chest compressions begin) AP distance upon complete chest release, the at least one processor 30 may cause the feedback device 24 to provide an indication to the user that remodeling has occurred and/or a further indication to the acute care provider that active reduced pressure may be preferentially applied.
Where Active Compression Decompression (ACD) therapy is suggested to an acute care provider as a technical adjustment (e.g., via a display screen, audio speaker, or other suitable form of feedback device), upon confirmation that ACD therapy is being provided, the type of feedback may be modified accordingly to ACD-type feedback. ACD treatment may be confirmed by waveform analysis, for example, via manual input or detection of appropriate sensors (e.g., motion sensors, accelerometers, force sensors). An exemplary Feedback technique for ACD treatment is disclosed in U.S. application publication No. 2018/0092803 entitled "Active Compression Decompression cardio utilization check Compression Feedback" and may be incorporated into embodiments of the present invention.
In some examples, the at least one processor 30 may be further configured to modify or adjust the target chest compression criteria for compression depth and/or rate to account for changes in AP distance caused by prolonged application of chest compressions or remodeling. For example, the reduced AP distance caused by cardiothoracic remodeling means that the chest does not travel too far between compressions. Similarly, the heart may be located closer to the spine, meaning that it travels a shorter distance before contacting the spine and beginning compression. In view of this variation, the target compression depth and target release rate may be reduced to account for the fact that the chest does not travel too far between compressions. In some examples, the at least one processor 30 may be configured to reduce the target criteria for compression depth and release rate based on a linear relationship between compression depth and/or release rate and AP distance. In other examples, the relationship between depth and/or release rate may be non-linear and may be determined, for example, based on experimental data relating to chest compression efficiency and/or from patient outcome data.
Exemplary Electrical Components of Resuscitation guidance System
Having described how the system 10 may be used at a rescue scenario 100 to provide guidance to a user for performing resuscitation activities on a patient, the electrical components of the system will now be described in detail. A schematic diagram of the electrical components of an embodiment of the system is shown in fig. 1B.
Body characteristic measurement input device
As described herein, the system 10 includes at least one input device 12, such as a manual data entry accessory 14, a camera 16, and/or a three-dimensional imaging system 18 or sensor, or the like, for providing information representative of at least one physical characteristic of the patient measured during an acute care event. Generally, the input device 12 is a computer device, medical device, or imaging device present at an acute care setting that records or receives information representative of a physical characteristic of the patient. For example, as previously described, the input device 12 may be a data entry accessory such as a manual data entry accessory 14. The input device 12 may also include a three-dimensional imaging system such as a camera and scanner (such as a camera 16 and/or a three-dimensional imaging system 18 for recording information related to the rescue scene 100 and the patient 102 (shown in fig. 1A)), etc. Information from the input device 12 may be processed to determine a measure of at least one physical characteristic of the patient. In some cases, one or more input devices 12 are positioned on or mounted to a medical device, such as a defibrillator 108 (shown in fig. 1A) at the rescue scenario 100. For example, the camera 16 may be connected to the defibrillator 108 or a patient monitor positioned adjacent the patient and configured to periodically or continuously obtain images of the patient 102 during a rescue effort. In other examples, the input device 12 may be a handheld device carried by an acute care provider, such as a handheld digital camera or smart phone. In other examples, the input device 12 may be worn by a user. For example, the input device 12 may be a digital camera that is clipped to the acute care provider's clothing or attached to the edge of, for example, a hat or mask.
The manual data entry assembly 14 may be electronically coupled to the at least one processor 30 and configured to allow a user, such as an acute care provider, to manually enter data related to the patient 102 and rescue efforts. For example, the data may include measurements of physical characteristics of the patient 102. The measurement results may be obtained manually using conventional measuring devices such as tape measures and/or calipers. Once the measurements are manually obtained, the acute care provider may manually enter the measurements into the system 10 using the manual data entry accessory 14. In some cases, the data entry accessory includes a user interface for guiding the user or acute care provider through the process of obtaining measurements of the patient 102. For example, the user interface may display instructions such as "measure the bust with a tape measure" or "measure the AP distance with a caliper". The user interface may also display data entry fields allowing the acute care provider to manually enter measurements.
The camera 16 may be a conventional digital camera for capturing two-dimensional images of the rescue scene 100. Although the design varies from vendor to vendor, cameras such as camera 16 typically include a Charge Coupled Device (CCD) or Complementary Metal Oxide Semiconductor (CMOS) imaging sensor, a lens, a multi-function video control chip, and a set of discrete components (e.g., capacitors, resistors, and connectors), as is known in the art. The image is recorded by an imaging sensor and can be processed by a video control chip. The captured images may also be processed by, for example, three-dimensional information and/or image processing modules configured to identify anatomical structures, distances, and physical objects contained in the captured images. The captured images may be stored on computer memory associated with the input device 12 and/or with the at least one processor 30.
In some examples, the cameras used to capture images of the rescue scene 100 and the patient 102 may include one or more of a digital camera, an RGB camera, a digital video camera, a red-green-blue sensor, and/or a depth sensor used to capture visual information and still or video images of the patient and the acute care scene. The camera 16 may also include a plurality of image capture features for obtaining stereoscopic images of the acute care scene. The stereoscopic images may be processed to determine depth information for objects in the acute care scene.
In other examples, the camera 16 may be a wide-angle or fisheye camera, a three-dimensional camera, a light field camera, or similar device for obtaining images. A light field or three dimensional camera may refer to an image capture device with an extended depth of field. Advantageously, extended depth of field means that during image processing, a user can change the focus, viewpoint or perceived depth of field of a captured image after the image has been recorded. As such, it has been suggested that images captured using a light field or three-dimensional camera contain all the information needed to compute the three-dimensional form of the recorded scene. See "Single Lens 3D-Camera with Extended Depth-of-Field" by Christian Perwass et al, Raytrix GmbH, Schauenburgstr.116, 241169uel, Germany (2012), which describes the implementation of a light Field 3D Camera that can be implemented in embodiments of the present invention.
The camera 16 is desirably positioned so that multiple images of the patient can be obtained. In some cases, images are automatically captured continuously or at predetermined intervals during the course of a rescue effort. In other examples, the acute care provider 104, 106 may capture digital images of the rescue scene 100 and the patient 102 prior to beginning a resuscitation activity by, for example, holding an electronic device including a camera (such as a smartphone or similar handheld electronic device) near the patient and capturing the images by pressing an appropriate button or touching a designated area of a touchscreen of the handheld device.
The three-dimensional imaging system 18 or sensors may also be used to obtain three-dimensional information related to the positioning of the objects, the size of the objects, and the distance between the objects at the rescue scene. The three-dimensional information may include distance or depth information regarding how far the physical object is from the three-dimensional imaging system 18, as well as size/dimensional information of objects and individuals present at the rescue scene. Three-dimensional information and/or images from the three-dimensional imaging system 18 or sensors may be processed to produce a three-dimensional representation of the acute care scene. The three-dimensional representation may include position information 102 for different anatomical structures of the patient, including, for example, the patient's hands, feet, elbows, knees, shoulders, neck, head, eyes, mouth, chest, sternum, and other anatomical structures.
In some embodiments, the three-dimensional imaging system 18 may be configured to project a grid of markers to capture high resolution patient anatomical features. For example, a camera using a technology similar to that of the Kinect motion-sensing input device provided by Microsoft Corporation may be employed. Such a camera may include a depth sensor that employs an infrared laser projector in combination with a monochrome CMOS sensor, allowing 3D video data to be captured under ambient light conditions. It will be appreciated that any suitable three-dimensional imaging system may be used. The three-dimensional representation may be generated by a 3D surface imaging technique with anatomical integrity (e.g. 3D mdthorax System (3D md LLC, Atlanta GA)).
The three-dimensional imaging system 18 may include one or more of a digital camera, an RGB camera, a digital video camera, a red green blue sensor, and/or a depth sensor for capturing visual information and still or video images of the rescue scene. In some examples, the three-dimensional imaging system 18 may include optical and depth sensing components, such as Microsoft's Kinect motion sensing input device or Apple TrueDepth 3D sensing system, which may include infrared cameras, flood lights, proximity sensors, ambient light sensors, speakers, microphones, 700 thousand pixel conventional cameras, and point projectors (which project up to 30000 points on an object during scanning).
In some examples, the three-dimensional imaging system 18 is positioned to substantially correspond with the field of view of the acute care provider. In other examples, the three-dimensional imaging system 18 may include multiple cameras. For example, a camera may be positioned adjacent to each eye of an acute care provider to generate a three-dimensional representation of a patient while a caregiver is nursing the patient. Alternatively, the three-dimensional imaging system 18 may be mounted on a tripod facing the patient, either mounted on or built into a resuscitation device (such as an AED or defibrillator or ventilator, etc.), or held by a caregiver, such as an iPhoneX (which has a built-in three-dimensional imaging system 18) using Apple Corporation.
Cameras typically include a charge-coupled device (CCD) or complementary metal-oxide-semiconductor (CMOS) imaging sensor, a lens, a multi-function video control chip, and a set of discrete components (e.g., capacitors, resistors, and connectors), although the design varies from vendor to vendor. The image is recorded by an imaging sensor and can be processed by a video control chip. The processed image may be provided to an image processing module of the controller for further processing and identification of the object contained in the captured image. The image processing module may also prepare certain images or three-dimensional representations to be transmitted from the device to other electronic devices through the communication interface. In some examples, the image or three-dimensional representation may be transmitted to the remote electronic device in substantially real-time. In other examples, the obtained images or three-dimensional representations may be stored locally on the three-dimensional imaging system 18, such as in a computer-readable memory associated with the controller. The stored images may be sent to the remote electronic device by the communication interface as a batch download at predetermined intervals.
The three-dimensional representation of the patient is analyzed by the image processing module and a volume of a specified region of the patient (e.g., a thoracic volume) may be calculated, or a total volume of the patient may be calculated.
Based on the calculated volume and the average density of the human body (e.g., at about 900 kg/m)3To about 1050kg/m3Between, and generally about 985kg/m3) The weight of the patient may be estimated as the product of the two. As an example, the average density of a human body after maximum intake of air may be from approximately 985kg/m3The change is approximately 945kg/m3. On average, the fat density can be estimated to be approximately 0.9 g/mL. Muscle density can be estimated to be about 1.1 g/mL.
Based on analysis of the patient shape or other anthropometric features and the relative densities of the various body components, more accurate mean densities can be used to calculate estimated patient body weight, for example as described in references to Swainson MG, Batterham AM, Tsakirides, C, Rutherford ZH, Hind K (2017) differentiation of hold-body fat percentage and vitamin administration tissue mass from free anti-inflammatory metrics variables measuress// doi. org/10.1371/journal. bone.0177175, which can be implemented in the examples of the present invention (hereinafter "Swainson"). Swainson describes the use of the following anthropometric measurements to calculate or otherwise estimate the average density. The waist circumference ("WC") was measured closest to 0.1cm at the midpoint between the iliac crest and the lowest rib. The hip circumference ("HC") was measured at the widest point of the buttocks to be closest to 0.1cm to calculate the waist-to-hip ratio ("WHR") by simple division of WC/HC. Subsequently, the waist height ratio (WHtR) was calculated by WC/height. Also calculate/estimate WC/height 0.5Index of (1) ("WHT.5R"). The wht.5r index is proposed as a better predictor of cardiometabolic risk compared to the WHR or WHtR ratio. Swainson also describes that the percent fat mass (% FM) can be calculated from these ratios as follows:
equation 4:% FM 99.7 WHtR-24.7
Swainson describes that a relatively accurate estimate of the patient's weight can be determined based on the calculated% FM and the relative densities of the various body tissues. For example, measurements of certain parts of the body are closely related to the relative amounts of fat, muscle and other tissues of the body. Once the relative amounts of the various body tissues are estimated, the weights of these body tissues can be calculated by using the densities as multiplicative factors.
For example, the estimated weight may be calculated using the following equation:
equation 5 estimated body weight total volume (% FM fat density + (1-% FM) average non-adipose tissue, bone and cartilage density)
As previously discussed, fat density is typically about 0.9g/mL and the average non-adipose tissue density is about 1.1 g/mL. Thus, by substituting these accepted density values, the following equation for estimating body weight can be used.
Equation 6 estimated body weight to total volume (% FM 0.9g/mL + (1-%) FM 1.1gr/mL
According to other embodiments, anthropometry of the patient may be used to determine or otherwise advise treatment volumes such as defibrillation shock energy, ventilation tidal volume, and drug dose without directly knowing the patient's weight, but using measurable patient characteristics to estimate the patient's weight, and then determine approximate treatment parameters. For example, estimating a patient's weight may be used to determine or set treatment parameters of the patient and/or operating parameters of a therapeutic medical device, such as a defibrillator, ventilator, or other medical device. In some examples, estimating the patient weight may be used to determine a defibrillation shock energy (e.g., at 3 joules per kilogram of patient weight), a drug dose (cc/kg), a ventilation tidal volume (mL), and/or the like. As will be appreciated by those skilled in the art, the defibrillation shock energy, ventilation tidal volume, and/or drug delivery dose may be greater for patients with relatively large volumes and/or weights (total or thoracic). Conversely, for patients with relatively small volumes and/or weights (total or thoracic), the shock energy, ventilation tidal volume, and/or drug dose is typically low. Thus, once the patient size and/or weight is estimated, e.g., via three-dimensional representation and density analysis, the feedback device or user interface may provide a recommendation (e.g., a visual or audio indication) to the user regarding the defibrillation energy and/or drug dose that should be delivered that corresponds to the patient size and/or weight. In some examples, operating parameters of a therapeutic medical device, such as a defibrillator, ventilator, or other medical device, may be automatically updated based on the calculated patient treatment parameters. As previously discussed, the measured or provided physical characteristics and/or physical characteristics of the patient may also be used to determine ventilated patient treatment parameters. For example, the ventilation tidal volume (mL) may be calculated based on the ideal body weight of the patient using equation 3 listed above. The ideal weight is calculated from the patient's height and sex as shown in equation 2. In some examples, the ventilation tidal volume may also be calculated or adjusted based on the estimated patient weight.
In addition, the optimal target resuscitation criteria, such as compression depth, may be different for patients with similar anterior-posterior distances. Thus, when combined with AP distance, using one or more additional body features (such as height, skull, volume, facial feature spacing such as eye spacing or eye-nose spacing, hand or foot feature measurements (e.g., finger or toe width, finger or toe length, hand or foot width, hand or foot length) as a proxy for age may result in more accurate target resuscitation criteria (i.e., compression depth feedback).
The at least one processor 30 may be configured to determine distance values for the body feature based on the generated three-dimensional representation. Wherever the three-dimensional imaging system/sensor is located, the relevant body feature can be determined therefrom, provided that a three-dimensional representation of the patient is sufficiently captured. For example, based on the three-dimensional representation of the patient, the at least one processor may determine an AP distance of the chest, a circumference of the chest, a lateral width of the chest, a height of the patient, and other relevant physical features. As discussed herein, the three-dimensional representation of the patient may be updated substantially continuously or otherwise periodically as the patient undergoes CPR treatment. As a result, the target CPR criteria, the recommended CPR technique, and the associated feedback to the acute care provider may also change based on the time-varying physical characteristics (e.g., due to remodeling).
Additionally, the at least one processor 30 may track movement of the anatomy over time to monitor changes in the physical characteristics of the patient 102 that occur during the rescue effort. Further, in some examples, information collected by the three-dimensional imaging system or sensor relating to the rescue scene 100 may also be used to identify and track the location of objects in the rescue scene 18. For example, the at least one processor 30 may analyze the generated three-dimensional representation to identify and provide feedback regarding patients, bystanders, therapeutic medical devices, monitoring devices, medical supplies, and environmental objects such as streets or driveways, trees, buildings, power lines, cars, trucks, trains, and other objects present at acute care scenes that may affect how and where treatment is provided to the patient. An example of the use of a camera in an Emergency care event is disclosed, for example, in U.S. patent publication No. 2014/0342331 entitled "camera for Emergency response," which may be implemented in embodiments of the present invention.
In some examples, the input device 12, such as the camera 16 or the three-dimensional imaging system 18, includes both image capture capabilities and depth sensing capabilities. For example, the input device 12 may be Microsoft's Kinect motion sensing input device, an Intel RealSense D415 camera, or an Apple TrueDepth 3D sensing system employing a Vertical Cavity Surface Emitting Laser (VCSEL) such as that provided by Finisar (Sunnyvale, CA). The Apple TrueDepth 3D sensing system may also include an infrared camera, a floodlight, a proximity sensor, an ambient light sensor, a speaker, a microphone, a 700-thousand pixel conventional camera, and/or a point or grid projector (which projects up to 30000 points or a fairly dense grid into the field of view during scanning to effectively track real 3D objects detected in the field of view).
Resuscitation sensor
With continued reference to fig. 1B, the system 10 also includes a resuscitation sensor, such as a chest compression sensor 20 or a ventilation sensor 22. The resuscitation sensors 20, 22 are configured to obtain signals indicative of resuscitation activity performed on the patient by the acute care provider.
For example, the chest compression sensor 20 may be configured to measure chest compression parameters such as compression depth, compression rate, compression release rate, compression pause or compression release, and the like. Various different types of chest compression sensors are known for recording information relating to compressions performed on a patient. As previously described, a common chest compression sensor is an accelerometer-based "CPR pointer" that includes a housing and a single-or multi-axis accelerometer. The "CPR pointer" is configured to be placed on the sternum of the patient during compression. For example, a "CPR pointer" may be located under the hands of an acute care provider. In some examples, a "CPR pointer" includes a grip for the acute care provider to grasp during compressions to hold the hand in place. In other examples as shown in fig. 1A, the CPR pointer is enclosed in the electrode package 110. Acceleration waveforms captured by an accelerometer during chest compressions are processed to determine compression parameters. The rate may be determined by identifying an inflection point or a change in direction in the acceleration waveform, where the inflection point or change in direction indicates a time for the acute care provider to release the patient's chest between compressions. The rate of compression or release may be determined by integration of the measured acceleration. The depth is determined by double integration of the measured acceleration. Exemplary systems and methods for Determining Chest compression parameters from measured accelerometer signals are disclosed in U.S. patent No. 7,122,014 entitled "Method for Determining Depth of Chest compression CPR" to Palazzolo et al and may be implemented in embodiments of the present invention.
Generally, the acute care provider should fully release the chest between compressions to ensure that the chest cavity is expanded and blood is drawn into the heart between compressions. To confirm the compression release, the "CPR pointer" may include a release sensor, such as a capacitive touch sensor, light sensor, or pressure sensor, for confirming that the acute care provider released the chest between compressions. For example, the light sensor may be any device for detecting light. Exemplary light sensors include photocells or photoresistors that change resistance when illuminated by light, Charge Coupled Devices (CCDs) that transport electrical signals, photomultipliers that detect and multiply light, and the like. The light sensor may be configured to detect when it is covered by the hand of the acute care provider and when the hand is lifted from the sensor to indicate a complete release of chest compressions. Capacitive sensing is a technique based on capacitive coupling between conductors or has a different dielectric than air and the dielectric of the sensor. When the hand of the acute care provider approaches or touches the capacitive sensor, the touch is recognized by the change in capacitance. The processor or device may use the capacitance level and/or the degree of change in capacitance to determine the proximity of the rescuer's hand to the capacitor sensor pad. An exemplary device for Assisting an acute care provider in Performing CPR, which includes a proximity sensor for determining whether complete release from compressions has occurred, is disclosed in U.S. patent No. 9,387,147 entitled "System for Assisting users in Performing Cardio-Pulmonary Resuscitation (CPR) on a Patient" by elgazzawi et al, and may be implemented in an embodiment of the present invention.
Another resuscitation parameter that may be monitored to assess the quality of chest compressions delivered to a patient is compression pauses or compression scores. During delivery of chest compressions, pauses between or during chest compressions should be minimized so that adequate blood perfusion is maintained throughout the rescue procedure. The compression pauses track the amount of time between compressions during the compression cycle. In a similar manner, when providing chest compressions to a patient, the compression score tracks the percentage of time during a rescue effort. During a rescue effort, compressions may be interrupted or delayed by tasks such as providing rescue breathing, pulse check, and rhythm analysis. It has been determined that patient outcomes improve significantly when any such interruptions are minimized. Information and feedback regarding the compression pauses and compression fractions can be determined from the acceleration waveform captured by the CPR pointer.
Ventilation sensor 22 is configured to measure ventilation parameters including tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate during an acute care event. For example, the ventilation sensor may be configured to monitor ventilation provided to the patient using a manual ventilation unit that includes a ventilation bag (such as ventilation bag 112 shown in fig. 1A). One example of a ventilation sensor 22 that may be located in the airflow path is an airflow sensor that includes a differential pressure sensor. Such a differential pressure sensor may be attached to a venturi mechanism in the airflow path. The differential pressure sensor may also be arranged in coordination with a beam that substantially bisects the airflow path within the sensor. Taps from the differential pressure sensor may extend from separate sides of the beam so that the presence and amount of airflow may be determined by the differential pressure measured between the taps. The beam may be positioned and shaped in a known manner to provide a more accurate reading. In some embodiments, the differential pressure sensor may comprise an absolute air pressure sensor separated by a flow restrictor for measuring the air flow rate and pressure in the air flow path. In other examples, ventilation sensor 22 may be a strain gauge or strain sensor disposed on ventilation bag 112 that is configured to determine the frequency at which the bag is squeezed, and by extension, the rate at which assisted ventilation is provided to the patient. Exemplary Ventilation sensors that may be used with system 10 are described, for example, in U.S. patent No. 9,364,625 entitled "Wireless Ventilator Reporting" to Silver et al and U.S. patent application publication No. 2017/0266399 entitled "Flow Sensor for Ventilation" to Campana et al, and may be implemented in embodiments of the present invention.
Feedback device
The system 10 further comprises at least one feedback device 24 for providing information, instructions and guidance to the user for performing resuscitation activities. In some examples, the feedback includes specific instructions to cause the user to perform an action. For example, an audio, visual, and/or tactile indicator may sound, illuminate, or vibrate, thereby instructing the acute care provider to perform an action such as initiating chest compressions, releasing chest compressions, compressing an airbag, or releasing an airbag, etc. In other examples, the feedback includes quantitative information related to resuscitation activity being performed or having been performed on the patient. For example, the feedback may include displaying measured values of different resuscitation parameters. The feedback may also include graphs and other visual reports summarizing the change in resuscitation parameters over time.
A number of different types of feedback devices may be used with the system 10 to provide feedback to the acute care provider. In some examples, the feedback device 24 may be a portable electronic or computer device 32, such as a tablet computer, smartphone, smart watch, or personal digital assistant, configured to provide guidance to the acute care provider to encourage the acute care provider to provide resuscitation activity according to the targeted resuscitation criteria. The portable computer device 32 may include a visual feedback component (e.g., a display screen 34, an LED indicator, etc.), an audio feedback component (e.g., a speaker 28), and a haptic feedback component (e.g., a linear actuator 38). In some cases, portable computer device 32 may also include other electronic components of system 10. For example, the input device 12 may be a touch screen display and user interface of the portable computer device 32. In a similar manner, at least one processor 30 of system 10 may be a processor of a portable computer device 32 in wired or wireless communication with sensors 20, 22 and other electrical components of system 10.
Information related to the resuscitation activity performed for the patient 102 may also be displayed on the visual display 34 of the portable computer device 32 or the defibrillator 108 to provide additional guidance for performing the resuscitation activity. Information related to the patient, such as identifying information (e.g., name, gender, known allergies) and physiological information (e.g., ECG waveform, heart rate, ventilation parameters, etc.) may also be displayed on the visual display along with the resuscitation guidance. In some examples, the feedback device 24 may also provide a summary report after cessation of resuscitation activities and/or after a rescue effort so that the acute care provider may review his performance during the rescue effort. In some embodiments, the summary review may include a goal of compression and ventilation parameters based on a goal used during resuscitation and that may have changed (e.g., based on patient physical characteristics).
In some cases, the visual feedback may be provided as a numerical value on the visual display 34. For example, the measured value of a resuscitation parameter may be displayed on the visual display adjacent to the target resuscitation criterion value for that parameter, so that the acute care provider may see if he or she is matching the target criterion value. In other examples, the feedback may include instructions or instructions that encourage the acute care provider to adjust how to perform the resuscitation activity. For example, the feedback device 24 may be configured to provide instructions to the acute care provider to increase the rate and/or depth, decrease the rate and/or depth, or maintain the rate and/or depth, as determined based on the measured resuscitation parameters and the target resuscitation criteria. As another example, feedback device 24 may provide a display showing measured values of related resuscitation parameters (e.g., chest compression depth, chest compression rate, tidal volume of ventilation, ventilation rate, etc.). If the value is outside of the target criteria, the display may provide an indication that the acute care provider is not performing in accordance with the current target CPR criteria (e.g., chest compression depth, chest compression rate, tidal volume of ventilation, and/or a target range of ventilation rates). For example, such an indication may be provided as a message on the display, a color change of the displayed value, a highlighting of the displayed value, or other suitable indication that the measured value is out of range. The feedback means may also include audio or tactile feedback, such as an audio and/or vibratory metronome that can be activated to assist the acute care provider in achieving the appropriate rate, and the like. By providing such an indication, the acute care provider may be made aware that the relevant CPR criteria are not met, and thus the manner in which the CPR treatment is applied may be altered.
In other examples, the feedback device includes a medical device for treatment or monitoring at an acute care setting, such as defibrillator 108 (shown in fig. 1A), a mechanical ventilator, or a patient monitor (such as a heart rate or ECG monitor, etc.), among others. The information and instructions for performing the resuscitation activity may be displayed on a screen of the medical device or issued from a speaker of the medical device. For example, an instruction or reminder such as "start compression" or "full release" may be displayed on the screen instructing the acute care provider to provide chest compressions at the target rate and depth.
In other examples, feedback device 24 may be a dedicated electronic device for providing feedback related to a particular resuscitation activity. For example, a "CPR pointer" device may include a feedback component, such as a tactile feedback component (e.g., a linear actuator or a vibrating motor configured to vibrate when activated) or a visual feedback component (e.g., an LED light illuminated to inform an acute care provider when compressions are initiated and/or released). Ventilation sensor 22, which is connected to the patient's airflow path, may also include a feedback assembly for instructing the acute care provider to provide ventilation at a target volume and rate. For example, ventilation sensor 22 may include an LED indicator light or speaker mounted to the housing of ventilation sensor 22. The indicator light or speaker may be configured to provide an indication to the acute care provider if the ventilation provided is too fast or if the ventilation meets or does not meet target criteria. In some examples, an indicator light or speaker lights up or sounds to instruct the acute care provider to press or release the bag when the target ventilation is obtained.
Resuscitation feedback display
In some examples, resuscitation feedback and guidance is provided to the acute care provider in the form of a visual display that includes information such as scales, values, and text for conveying information related to the patient, resuscitation activities, and rescue efforts. The visual display may be provided on a portable computer device, such as portable computer device 32 (an example shown in fig. 1B, such as a smartphone, a smartwatch, a tablet, etc.), or on a screen 26 of the medical device, such as a screen of defibrillator 108 (shown in fig. 1A), etc. For example, the visual display may include information related to a rescue effort (e.g., duration of the rescue effort or time until cessation of resuscitation activity), information related to a rescue scenario (e.g., location information, environmental hazards), and/or information related to the patient (e.g., patient age/weight, downtime, known allergies, or taking medications).
In some cases, the information is derived from manual data entry or keypad 14 and resuscitation sensors 20, 22. Information may also be derived from images captured by input devices present at the rescue scene, such as the camera 16 and three-dimensional imaging system 18. For example, captured images/video may be processed and analyzed to determine resuscitation quality parameters (including chest compression depth, chest compression rate, and the like). The visual display may also include information from other sources connected to the patient, such as patient monitors, therapeutic medical devices, physiological sensors, and the like.
An exemplary visual display 800 of the system 10 that may be used to provide resuscitation guidance and feedback to an acute care provider is shown in fig. 8A. The display 800 includes a patient information portion 810, a physiological condition portion 812, and a resuscitation guidance portion 814. The patient information section 810 includes information relating to physical characteristics of the patient. For example, information related to the patient's height, weight, gender, AP distance, chest (e.g., chest) width, chest circumference, or other measurements may be displayed in the information portion 810. Patient information may be manually entered into the system 10 by one of the acute care providers at the rescue scene. In other examples, as described herein, the physical characteristics of the patient may be determined from information captured by a three-dimensional imaging system (such as a camera and/or a three-dimensional scanner, etc.). In some cases, the patient information portion 810 may also include an image or graphical representation of the patient and/or a portion of the patient's body. For example, a portion of the generated three-dimensional representation of the patient may be shown on display 800. The message or notification may be displayed with a three-dimensional representation that overlaps or is adjacent to the portion of the patient's body to which the message or notification relates.
In some examples, the physiological information portion 812 of the display 800 includes a visual indication representative of a patient physiological measurement. For example, the physiological information portion 812 may include graphs or waveforms of different physiological parameters of the patient related to rescue efforts and/or resuscitation activities performed by the acute care provider. For example, as shown in FIG. 8A, an ECG waveform 816 and a carbon dioxide waveform 818 are illustrated. The physiological information portion 812 can also include a numerical value representing a physiological measurement of the patient. For example, the values of the patient's blood pressure, pulse oxygen (SPO2), and other parameters of interest may be displayed in the physiological information portion 812.
The resuscitation guidance or feedback portion 814 of the display 800 may include measured resuscitation parameters and target resuscitation criteria for the resuscitation activity being performed on the patient. For example, as shown in fig. 8A, the display 800 includes a compression depth icon 824, the compression depth icon 824 including an indicator 826 that displays the compression depth and a target range indicator 828 that represents a lower limit (e.g., 2.0 inches) and an upper limit (e.g., 2.4 inches) of the target depth range. The acute care provider may be instructed to continue applying pressure to the chest until the indicator 826 remains within the area identified by the target range indicator 828. When indicator 826 is located within the area of indicator 828, the compression depth has remained within the target depth range and the acute care provider may be instructed to release the compression.
A value corresponding to each compression depth (1.8 inches in the example shown in fig. 8A) and a value for the chest compression rate may be provided on the display at a resolution of at least one tenth. When the acute care provider is not performing according to current target CPR criteria (e.g., criteria for depth of 2.0 to 2.4 inches and rate of 100 to 120cpm, which may be default criteria), the value itself may change color or highlight to alert the person performing the chest compression that a particular parameter is out of range. In fig. 8, the depth of 1.8 inches is outside the target compression depth range of 2.0 to 2.4 inches, and the rate of 154cpm is outside the target compression rate range of 100 to 120 cpm. However, consistent with embodiments disclosed herein, the CPR criteria may differ from the default criteria based on measured physical characteristics of the patient. For example, a relatively small pediatric patient may have physical characteristics corresponding to a target compression depth range of 1.5 to 2.0 inches and a target compression rate range of 140 to 160 cpm; in this case, the depth of 1.8 inches and the rate of 154cpm are within the target standards. Thus, the feedback device will provide an indication (visual, audio, tactile) that the CPR parameters are within range; or rather, the feedback device will only provide CPR parameters on the display, but will not provide an explicit indication that the CPR parameters are not within range (e.g., will not provide an obvious message, color change, or highlight to indicate to the rescuer that the manner in which CPR should be applied should be changed).
The resuscitation guidance portion 814 may also include textual instructions that guide the user through different aspects of the resuscitation activity. For example, when the press reaches the target depth, a "full release" text instruction 830 or release reminder may be displayed. Textual instructions to the user to "start compressions" or "stop compressions" may also be displayed to the acute care provider at the appropriate time, for example, to initiate compressions at the beginning of a CPR interval or to stop compressions for a short period of time for ECG shock analysis to occur. In some examples, feedback 814 may also include a numerical value indicative of the quality of the chest compressions over time. For example, as shown in fig. 8A, numerical values of the average compression depth and the average compression rate (number of compressions per minute) may be displayed. Target standard ranges of depth and rate may be displayed adjacent to the mean for comparison. When the system is configured to periodically update the measurements of the patient's physical characteristics, the display 800 may also include a countdown timer 836 for indicating the time remaining until the target criteria are updated.
Another exemplary visual display 850 is shown in fig. 8B, which provides ventilation guidance and feedback to the acute care provider. Display 850, which may be configured to appear on the display screen of the feedback device when flow through the patient flow path is detected, includes, for example, patient information 852, ventilation history information 854, and numerical ventilation indicators (such as ventilation rate indicator 856 and ventilation indicator 862). The display 850 may also include a numerical value 860 of the inspiratory and/or expiratory volume of each positive pressure respiratory ventilation. The display 850 may also include a ventilation performance indicator 858 based on a target ventilation criterion (e.g., target tidal volume, target ventilation rate).
As in the previous exemplary display screens, the patient information 852 may include information related to physical characteristics of the patient, including, for example, information related to the patient's height, AP distance, chest (e.g., chest) width, chest circumference, or other measurements. Other non-physical characteristics that cannot be measured (such as age or gender, etc.) may also be included, although as discussed herein, certain physical characteristic measurements may be used as an alternative to estimating non-physical characteristics such as age or gender. The patient information 852 may be manually entered into the system by one of the acute care providers at the rescue scene. In other examples, as described herein, the physical characteristics of the patient may be determined from information captured by a three-dimensional imaging system (such as a camera and/or a three-dimensional scanner, etc.).
Ventilation indicator 962 includes a measured ventilation of 433 mL. A target ventilation of 400mL is also displayed next to the measurement. Since the 533mL measurement value excessively exceeds the target value (e.g., by 10% of the target), the 533 measurement value is highlighted or enclosed in a color box to indicate to the acute care provider that the measurement value is outside of the target range. The ventilation rate indicator 856 displays a measured ventilation rate of 7 breaths/minute. The target rate of 7 breaths/min is also shown alongside the measured rate. Since the measured rate of 7 breaths/minute is consistent with the target rate, the measured rate is displayed in normal text and is not highlighted or enclosed in a shaded box. If the measured rate is found to exceed the target rate or be insufficient, the rate indicator 856 can be highlighted to indicate to the acute care provider that the measured value does not meet the target value.
The visual display 850 also includes a ventilation performance indicator 858 for providing feedback to the acute care provider regarding the quality and/or possible impact of the ventilation provided to the patient. In some examples, the ventilation performance indicator 858 may include a graphic of a circular area that fills as the airflow sensor detects inhaled air in the airflow path of the patient. After the end of breathing, the circular area may change color depending on whether the sensed ventilation rate and/or ventilation is within a target range of the corresponding ventilation parameter (such as a target range determined based on the physical characteristics of the patient provided by system 10 and the processing disclosed herein). In some cases, the circular area may display green or another suitable color if both the measured ventilation rate and ventilation fall within the target range. If either of the ventilation volume or the ventilation rate falls outside of the target range, the circular area may display a different color, such as yellow, orange, red, or another color, indicating that one of the plurality of parameters is out of range. For example, if the patient is hypoventilation (e.g., given an amount below the lower limit of the target range) or over ventilation (e.g., given an amount above the upper limit of the target range), the circular area of the ventilation performance indicator 858 may depict a yellow alarm color or other suitable color, and the numerical ventilation indicator 860 may also change to a similar color (e.g., yellow). Similarly, if the measured ventilation rate does not fall within the generated target range, the circular area of the ventilation performance indicator 858 may illuminate a yellow alarm color or other suitable color, and the numerical ventilation rate indicator 860 may also exhibit a similar color change.
As shown in fig. 8B, the ventilation performance indicator 858 may include a numerical countdown timer 864 located within the circular area. Once the numeric countdown timer counts down to zero (e.g., by seconds or another time period), the circular area empties and a "ventilation" prompt may appear in place of the countdown timer 864. The prompt instructs the acute care provider to apply positive pressure ventilation to the patient (e.g., by squeezing the ventilation bag). If no breath is detected after a period of time (e.g., 3 to 5 seconds), the "ventilation" prompt may begin flashing. If no breathing is detected after a subsequent period of time (e.g., another 3 to 5 seconds), the circular area itself may flash and optionally change color to alert the user that ventilation should be given. An alert (e.g., audible, visual, tactile) may also be triggered to provide the user with an additional alert to take a ventilation action.
Resuscitation guidance system using portable computer device
Another exemplary system 910 for providing resuscitation guidance based at least in part on physical characteristics of a patient is shown in fig. 9. As in the previously described examples, the system 910 may be configured to obtain information relating to a physical characteristic of the patient and process the information to determine a target resuscitation criterion for the patient based on the physical characteristic. The system 910 may also be configured to determine resuscitation parameters for resuscitation activities performed on the patient and provide feedback as to whether the measured resuscitation parameters match target resuscitation criteria. Advantageously, many of the electrical components of the system 910 may be contained in a single handheld electronic device 932, such as a smartphone, computer tablet, or personal digital assistant device, which handheld electronic device 932 may be easily carried by an acute care provider to a rescue scenario.
The system 910 includes at least one input component for providing information indicative of at least one physical characteristic of the patient measured during the acute care event. For example, the input component may be a touch screen 912 or button 914 of the device 910 that allows the user to manually enter information related to the rescue effort and the patient (including measurements of physical characteristics of the patient). The input component 912 may also include a camera 916 of the portable electronic device 932. A camera 916 may be used to capture images of the rescue scene and the patient. The captured images may be processed to determine information related to physical characteristics of the patient. In some cases, the portable electronic device 932 is configured to provide instructions to the acute care provider regarding how and when to capture images of the patient. For example, prior to beginning a resuscitation activity, an acute care provider may be instructed or otherwise trained to hold the portable electronic device 932 a specified distance above the patient's chest and capture images of the patient at specified locations. In other examples, the acute care provider may be instructed or trained to move the camera 916 along the patient's body to maintain a specified distance between the camera 916 and the patient to obtain video images of the patient.
The system 910 also includes at least one processor 930 communicatively coupled to the camera 916 and the touch screen 914. The at least one processor 930 may be a processor of the portable electronic device 932. In other examples, the at least one processor 930 is remote from the portable electronic device 932 and is configured to transmit and receive data and/or signals with respect to the remote electronic device 932. For example, the portable electronic device 932 may be configured to transmit data including information relevant for determining a physical characteristic of a patient, as well as resuscitation parameter information and patient physiological information to a remote processor. The remote processor may be configured to send resuscitation feedback and/or instructions to the portable electronic device 932 for obtaining additional information.
To facilitate communication between the at least one processor 930 and other components of the system 910, the portable electronic device 932 may include a communication interface 938 configured to transmit patient information, physical characteristic information, and other data between the portable electronic device 932 and other system components. Communication interface 938 may include short-range and/or long-range data communication features, such as a wireless data transceiver, for wireless communication between device 932 and other components. Exemplary short-range wireless data transmitters or transceivers that may be used with system 910 include, for example Or a transceiver of ZigBee or the like. Communication interface 938 may also include circuitry for long-range data transmission using a long-range data transmitter or transceiver, such as a WiFi transmitter or a cellular transmitter (e.g., 3G or 4G enabled systems). The data collected by the device 932 may be transmitted by a long-range data transmitter or transceiver to an external source. For example, the data may be transmitted to an external electronic device, a computer network, or a database using the long-range data transmission capabilities of the portable electronic device 932.
The system 910 also includes at least one resuscitation sensor, such as a chest compression sensor 920 or a ventilation sensor 922, configured to obtain a signal indicative of resuscitation activity performed on the patient during the rescue event. In some examples, chest compression sensor 920 or ventilation sensor922 is for example obtained byEtc. to a portable electronic device 932 and at least one processor 930. For example, the sensors 920, 922 may be part of the defibrillator 108 or the ventilation unit 150. In this case, the chest compression sensor 920 and/or the ventilation sensor 922 function in a similar manner to the sensors described in connection with the previous embodiments.
In some examples, the resuscitation sensor may be a component of the portable electronic device 932. For example, the resuscitation sensor may be an accelerometer 940 or a gyroscope 942 of the portable electronic device 932 contained within the housing of the device 932. The accelerometer 940 and gyroscope 942 may be configured to sense movement of the portable electronic device 932 and thus may be used to determine information related to resuscitation activity being performed for the patient. For example, the portable electronic device 932 may be placed on the chest of a patient and used to detect information indicative of chest compressions made for the patient. As described in the previous examples, the acceleration and direction information recorded by the accelerometer 940 and gyroscope 942 may be used to determine parameters of chest compressions (including compression depth and compression rate).
With continued reference to fig. 9, the system 910 also includes feedback means for providing guidance on how the patient should be subjected to resuscitation activities. In some examples, the feedback device may be any of the feedback devices described in the previous examples, including a computer tablet, a smart phone, a smart watch, a medical device, a CPR pointer, or a ventilation feedback device in wired or wireless communication with the portable electronic device 932. In this case, the portable electronic device 932 may be configured to send instructions to the feedback device causing the feedback device to provide an indication to the acute care provider whether the at least one chest compression parameter meets the target chest compression criteria. The feedback device may be configured to receive the transmitted signals and provide feedback regarding the resuscitation activity performed according to instructions provided by the portable electronic device 932 and/or the at least one processor 930.
In other examples, the feedback may be provided on the portable electronic device 932 itself. For example, the at least one processor 930 may cause the portable electronic device 932 to provide visual feedback, e.g., on the touch screen display 912 of the portable electronic device 932. The portable electronic device 932 may cause the touch-screen 912 to display an indication of whether the measured resuscitation parameters match the target resuscitation criteria. The portable electronic device 932 may also display instructions for the user to improve the quality of the resuscitation activity being performed for the patient, such as instructions to increase the compression/ventilation rate, decrease the compression/ventilation rate, or maintain the current compression/ventilation rate. Feedback may also be provided from other components of the portable electronic device 932. For example, audio feedback may be emitted from the speaker 928 of the portable electronic device 932. Tactile or vibratory feedback may be provided from the linear actuator 944 of the portable electronic device 932.
Process for determining target resuscitation criteria and providing feedback
The at least one processor 930 of the system 10, 910 may be configured to perform a number of different processes for receiving data from system sensors and input devices, processing the received data to determine target resuscitation criteria, and providing feedback to a user, such as an acute care provider, related to resuscitation activities performed on a patient. In some cases, the at least one processor 30, 930 may also be configured to periodically update resuscitation criteria or provide a recommendation of the type of chest compressions to be performed based on changes in the patient's physical characteristics.
Referring to fig. 10, at 1010, the at least one processor is configured to receive and process information from the input device indicative of at least one physical characteristic of the patient according to one exemplary process performed by the at least one processor. The type of physical characteristic received by the processor generally depends on the type of resuscitation activity being performed on the patient. For example, physical characteristics relevant to providing feedback related to chest compressions can include the anterior-posterior (AP) distance of the patient's cardiothoracic region, the width of the patient's cardiothoracic region, and the circumference of the patient's cardiothoracic region. The relevant physical characteristics may also include the height of the patient or other aspects of the patient. Physical characteristics such as patient weight, age, or gender may also be received by the at least one processor and used to determine a target resuscitation criteria (e.g., age may provide an indication or confirmation of whether the patient is an adult or a pediatric, gender may provide an indication of a target ventilation). Physical characteristics relevant to providing feedback regarding the quality of ventilation provided to a patient may include patient height, weight, Body Mass Index (BMI), and Ideal Body Weight (IBW). Relevant parameters and target criteria for ventilation may include tidal volume, minute ventilation, end-inspiratory pressure, maximum ventilation pressure, and ventilation rate during an acute care event. Some target criteria may be determined based on individual physical characteristics of the patient. In other examples, the target resuscitation criterion value is determined based on a plurality of patient parameters. For example, chest compression depth may be based on a combination of AP distance and at least one of cardiothoracic width or girth.
The input device for receiving information representative of the at least one body characteristic may be a manual data entry accessory or a three-dimensional imaging system (such as a camera or three-dimensional scanner, etc.) depending on the type of body characteristic data being collected and the monitoring or recording device present at the rescue scene. As described in connection with various embodiments of the system 10, 910, the processor may be electrically connected to the input device through a wired or wireless connection. Depending on the processing power of the system, the location of the input device or camera, and other factors, information may be continuously or periodically sent from the input device to the at least one processor, which may allow for updating of body characteristics and thus target CPR criteria and/or advising of CPR techniques. In some examples, the information transfer is initiated by a user. For example, information may be transferred from the input device to the at least one processor each time the user captures an image of the patient and/or the acute care setting.
At 1012, the processor uses the received and processed information to determine a target resuscitation criterion based on at least one physical characteristic of the patient. The target resuscitation criteria may include compression targets (e.g., compression depth, compression rate, or compression fraction) and/or ventilation targets (e.g., tidal volume and rate) as previously described. In some cases, determining the target CPR criteria includes obtaining information from a lookup table (such as a lookup table organized based on AP distance and/or patient height and weight, etc.). An exemplary look-up table relating AP distance, cardiothoracic width and compression depth is shown in table 5.
In other cases, the resuscitation criterion value is calculated using an equation for generating the resuscitation criterion value based on the physiological characteristics of the patient as input. For example, an equation (e.g., a linear or non-linear regression equation) may be used to determine an optimal compression depth based on body features such as AP distance, circumference, and/or chest width. For example, a target compression depth for a patient with a height in the range of 20 to 48 inches may be determined using the following equation: the compression depth is 0.75 AP- (H × AP)/96, where "H" is the patient's height and "AP" is the AP distance. In some embodiments, additional non-physical characteristics such as patient gender, etc. may be used, for example, by assigning a binary value (e.g., "0"; "male;" 1 "; female) or an estimated or actual age.
In some cases, the received information related to the physical characteristics of the patient is also used to determine the type of patient being treated. For example, the at least one processor may be configured to identify whether the patient is a pediatric patient or an adult patient, e.g., based on the patient's physical characteristics such as height, head circumference, hand or foot characteristics, facial characteristics, or other anthropometric characteristics or estimated or actual weight. In some cases, the at least one processor may also distinguish between types of pediatric patients. For example, the pediatric patient may be classified as at least one of a neonate, an infant, a small child, or a large child based on the patient physical characteristics determined by the at least one processor.
At 1014, the at least one processor is further configured to receive a signal from a resuscitation sensor, such as a chest compression sensor and/or a ventilation sensor. At 1016, the processor processes the received signals to identify resuscitation parameters for the resuscitation activity being performed on the patient. The signals may include, for example, accelerometer data from the CPR pointer and data from a sensor (e.g., a proximity sensor), a pressure sensor, or a gyroscope used to determine whether a release of the chest has occurred to provide additional information about the quality of chest compressions provided to the patient. The data from the ventilation sensor may include, for example, pressure measurements indicative of the pressure in the patient's air path. The pressure data may be used to calculate the flow or velocity of air through the airflow path. The data indicative of the pressure in the air path may also be used to calculate parameters such as ventilation rate (e.g., number of ventilations per minute) and/or maximum ventilation pressure, which may also be relevant in determining the quality of the ventilation provided to the patient.
Once the target resuscitation criteria and resuscitation parameters are known, at 1018, the at least one processor is configured to compare the measured resuscitation parameters to the target resuscitation criteria. The result of the comparison may be indicative of the quality of the treatment being provided to the patient. The results of the comparison may also be used to provide feedback or guidance to the acute care provider, encouraging the acute care provider to more closely match its performance to the target values. In some cases, the comparison between the measured resuscitation parameters and the target criteria is a determination of whether the parameters match the target. In other cases, the at least one processor may be configured to record information such as the frequency with which the measured parameter matches the goal, the percentage of time during a rescue effort during which the acute care provider meets and/or does not meet the goal, or the average difference between the measured parameter and the goal. For example, the at least one processor may be configured to determine a percentage of time during a rescue effort when the measured chest compression parameter meets or does not meet the chest compression criteria, and to cause the feedback device to provide an indication to the user if the percentage of time exceeds a predetermined value. In some cases, where the difference between the measured resuscitation parameter and the target resuscitation criterion is greater than 5%, the measured resuscitation parameter and the target resuscitation criterion do not substantially match.
In some examples, the at least one processor may be configured to provide a recommendation to the user to improve the quality of chest compressions if, for example, an acute care provider fails to periodically match target criteria. The at least one processor may be configured to cause the feedback device to suggest to the acute care provider to begin applying chest compressions using a different technique. For example, if the acute care provider is providing single-palm chest compressions for a pediatric patient, but the target compression depth is difficult to achieve, the at least one processor may cause the feedback device to provide instructions to switch to double-palm chest compressions. In a similar manner, if an acute care provider performing palmar chest compressions on the patient periodically exceeds the target compression depth, the at least one processor may cause the feedback device to instruct the acute care provider to switch to a one-handed palm compression. To ensure that the acute care provider sees and understands the instruction to switch technology, the acute care provider may need to select a confirmation button on the portable computer device or medical device to indicate that he/she has seen and understood the instruction to switch the press technology.
The at least one processor is further configured to provide feedback to the acute care provider based on the comparison between the resuscitation parameters and the target resuscitation criteria, as shown at 1020. The feedback may include a momentary indication of whether the resuscitation activity matches the target criteria. For example, the system may display indicia such as a scale, icon, or numerical value to indicate to the acute care provider whether the ongoing resuscitation activity matches the target value. In other examples, the feedback may include a summary report provided during the rescue effort or after cessation of resuscitation activity showing a comparison between the resuscitation parameters and target values measured over a predetermined time interval or throughout the rescue effort.
Another exemplary process for providing guidance and feedback related to resuscitation activity based on patient characteristics is shown in fig. 11. As shown at 1110, at least one processor receives information indicative of at least one physical characteristic or a plurality of physical characteristics of a patient. At 1112, the received information is processed to determine the type of patient being treated. For example, the patient type may be a pediatric patient or an adult patient determined based on the patient's height or weight. In some examples, the patient is further classified as a neonate, an infant, a small child, a large child, a small adult, an average sized adult, or a large adult. At 1114, the at least one processor may be configured to select a suggested type of chest compression or chest compression technique for the patient based on the physical characteristics of the patient. As described above, palmar chest compressions are typically performed on patients aged 8 years or older. Single-handed chest compressions were performed on patients between 1 and 8 years of age. Infants and neonates under 1 year of age are usually given two finger or thumb chest compressions. Once the suggested chest compression type or technique is selected, the at least one processor causes the feedback device to provide an indication to the user regarding the suggested chest compression type at 1116. In some cases, the guidance may include displayed text that informs or suggests to the acute care provider what chest compression technique to perform. In some cases, the at least one processor may cause the feedback device to provide more detailed instructions on how the chest compression technique should be performed. In some cases, the acute care provider may be required to affirmatively confirm the instruction. For example, an acute care provider may press a button on a portable computer device or medical device, indicating that he/she has seen instructions suggesting chest compression techniques and will begin to proceed with the suggested techniques. In some examples, the acute care provider may be able to reject the suggested technique or request the system to provide a new suggestion by pressing an appropriate button on the portable computer device or medical device.
Once the instructions are confirmed, the acute care provider may begin providing chest compressions using the suggested technique, and may continue providing chest compressions for a predetermined or indeterminate period of time. While chest compressions are being performed, the at least one processor may be configured to monitor the quality of chest compressions provided to the patient based on signals received from resuscitation sensors associated with the patient and/or an acute care provider. After a predetermined period of time, at 1118, the at least one processor may be configured to receive new information regarding at least one or more physical characteristics of the patient. This new information about the physical characteristics of the patient may indicate that remodeling of the patient's chest has occurred as a result of chest compressions. At 1120, the at least one processor may determine whether different types of chest compressions will be more effective in providing treatment to the patient.Similarly, at 1122, the at least one processor determines whether active reduced pressure should be applied to the patient based on the received updated information representative of the physical characteristics of the patient. As previously described, the instruction to initiate active decompression may include initiating use of a suction cup device, an attachment device configured to attach to the chest of a patient, or a hook and loop fastener (e.g., ) Instructions for the device. In some cases, the instructions to perform active decompression may include instructions to perform compression on the side or abdomen of the patient.
Referring to fig. 12A, a process for determining and updating target chest compression criteria based on updated information related to physical features or based on information related to one or more new physical features of a patient is shown. At 1210, information representative of physical characteristics of the patient is received from an input device of the system, as occurs in the previously described exemplary process. At 1212, the at least one processor is configured to process the received information to determine a target resuscitation criterion for the patient. As in the previous example, the target resuscitation criteria may be extracted from a look-up table populated with target resuscitation criteria values based on patient physical characteristics. In other examples, the target resuscitation criteria are calculated based on an equation derived from experimental data. At 1214, the at least one processor receives a signal from at least one resuscitation sensor (such as a chest compression sensor configured to measure a signal indicative of chest compressions performed on the patient, etc.). At 1216, the processor determines resuscitation parameters for chest compressions performed on the patient based on the signals received from the chest compression sensor.
When chest compressions are being performed, the at least one processor may be configured to cause the feedback device to provide resuscitation guidance at 1218. In some cases, as described herein, the guidance informs the acute care provider whether an ongoing chest compression matches the target criteria for chest compression determined based on the physical characteristics of the patient. In other examples, the feedback may include instructions that encourage the acute care provider to more closely follow a target standard value (e.g., "start press," "release press completely," "accelerate press," "slow press").
After a predetermined period of time, the at least one processor may be configured to receive updated physical characteristic information of the patient, as shown at 1220. In some cases, the processor automatically receives information representative of the updated physical characteristic. For example, a three-dimensional imaging system (such as a camera or three-dimensional scanner, etc.) at a rescue scene may be configured to automatically obtain images of a patient according to a predetermined schedule. In other cases, the acute care provider may be instructed to manually acquire images of the patient after performing chest compressions for a predetermined period of time. The time period may be a value pre-selected, for example, based on an estimate related to the time required for cardiothoracic region remodeling to occur or based only on a typical length of time for a chest compression interval. In other examples, the predetermined time period may be a time period selected by the at least one processor. In some cases, the duration of the predetermined period of time may be based on physical characteristics of the patient or the type of resuscitation activity being performed on the patient. For example, physical characteristics relevant for determining ventilation parameters such as ventilation volume and ventilation rate (e.g., patient height and weight) do not change during a rescue effort. Thus, when ventilation is being provided to a patient, it may not be necessary to obtain new physical characteristic information and periodically recalculate the target value. In contrast, performing chest compressions may result in remodeling of the chest cavity. Due to this remodeling, the target resuscitation criteria for chest compressions may need to be recalculated periodically. The duration of the predetermined time period between receiving the updated physical characteristic information may also be based on the physical characteristics of the patient. For example, the effect of remodeling caused by chest compressions may be more pronounced for smaller or lighter patients (e.g., patients with lower weight relative to height, smaller AP distance, and/or smaller bust). For larger, heavier, or stronger patients, remodeling may be less likely to occur, meaning that the body characteristic information needs to be updated less frequently (e.g., the predetermined time period between updates may be longer).
At 1222, upon receiving updated information representative of the physical characteristics of the patient, the at least one processor may be configured to calculate a modified target chest compression criterion based on the received updated physical characteristics information of the patient. At 1224, the at least one processor is configured to determine whether the chest compression parameters of compressions by the acute care provider meet the modified target chest compression criteria. At 1226, the at least one processor may be configured to cause the feedback device to provide an indication to the user of whether the at least one chest compression parameter meets the modified target chest compression criteria. The feedback device may also be configured to provide feedback to the acute care provider regarding changes in the targeted chest compression parameters. For example, when the modified target chest compression criterion is different from the initial target chest compression criterion, the processor may cause the feedback device to provide an indication to the acute care provider.
In other examples, the at least one processor may be configured to receive information of new or different physical characteristics of the patient and use the new information to determine modified chest compression target criteria. For example, at an initial setup of the system, the at least one processor may receive physical characteristics of the patient, such as height and/or weight. The at least one processor may determine a wide acceptable range of target chest compression criteria. During a rescue event, the at least one processor may receive information from the input device indicative of other physical characteristics of the patient (e.g., AP distance, circumference, lateral width of chest). When additional information is received or existing measurements of physical characteristics are updated, the at least one processor may determine a modified target resuscitation criterion (e.g., including a narrower range of acceptable target values) based on a combination of the initially received physical characteristics and other physical characteristic information received during the acute care event.
In some examples, the at least one processor may be configured to generate and maintain a record of past modified target chest compression criteria and recorded chest compression parameters corresponding to each past modified target chest compression criteria during a rescue event. For example, the modified target chest compression criteria and the recorded chest compression parameter information may be stored on a computer-readable memory associated with the at least one processor. The recorded information may also be continuously or periodically transmitted to a remote computer device or server for further processing and/or long term storage. Information related to past target chest compression criteria and/or comparisons between target criteria and measured parameters may be used to generate a visual summary of the acute care provider's performance during a rescue effort. For example, the summary may include graphs showing target criteria for different time periods during the rescue effort and whether the acute care provider meets the target for different time periods. These graphs may help acute care providers understand which goals are most often met and which are more difficult to meet. The graph may also show the effect of, for example, rescuer fatigue on the quality of care provided to the patient during a rescue effort.
A flow chart showing a process for determining, refining or honing appropriate target parameters of a patient is illustrated in fig. 12B. As described herein, the process shown in fig. 12B may be performed by at least one processor of a system for assisting a user in chest compressions. As described herein, the results of the processing including the target parameter value, the confidence level of the target parameter value, the estimate of the patient type (e.g., pediatric or adult), and the physical characteristic measurements of the patient may be displayed to the user using a suitable user interface display or feedback device. The displayed information may be updated during the course of a rescue event as additional information relating to the patient becomes available. The user interface or feedback device may also be configured to provide an alert or alarm to the acute care provider when the value of chest compressions performed by the acute care provider is outside or substantially outside of a target range (e.g., greater than 5% or greater than 10% from the target range). It should be noted, however, that the values displayed in the flowchart of fig. 12B are exemplary values of a target chest compression parameter for an exemplary patient. The values shown in fig. 12B are not meant to limit the types of feedback or chest compression guidance that may be provided by the guidance system described herein.
As shown in fig. 12B, initially, as shown at 1230, the at least one processor has not been provided with sufficient information to distinguish pediatric patients from adult patients. Furthermore, as shown at 1232, the target parameter values for depth and rate are unknown. To determine or estimate parameter values for chest compressions or other resuscitation activities, information is provided relating to the AP distance of the patient. For example, information from the sensors and/or from the generated three-dimensional representation of the patient may be processed to determine that the AP distance of the patient is 12cm, as shown at 1234. Based on the 12cm AP distance, the processor determines that the patient is a pediatric patient and may be one of a baby, infant, or child at 1236. Further, at 1238, the processor estimates with a 75% confidence level that the target compression depth is 3cm to 5cm, preferably about 4 cm. The processor estimates the target compression rate to be 90cpm to 110cpm, preferably about 100 cpm. Information relating to the AP distance and the target compression parameter may be displayed on a feedback device or a display screen of a user interface. At 1240, the processor receives the patient height (e.g., 80cm) to further refine the target parameter value. Based on the received patient height, the processor determines 1242 that the pediatric patient is a baby or infant because the child is typically above 80 cm. Based on the received patient height, the processor determines at 1244 with a 95% confidence level that the target depth is 2cm to 4cm, preferably about 3cm, and the target rate is 100cpm to 120cpm, preferably about 110 cpm. The display screen or user interface may be updated to include the received patient characteristics and the newly calculated parameter values. For example, the display screen or user interface may be updated to display the patient type (e.g., pediatric baby or infant), the patient's physical characteristics (e.g., AP distance and height), and the target compression parameters. At 1246, a measurement of the patient's chest width (shown as the LL distance in fig. 12B) is received (15 cm). Based on the received LL distance, the processor determines that the patient is a baby 1248. Further, at block 1250, the processor determines with a 99% confidence level that the target compression depth is 2cm to 4cm, preferably about 3cm, and the target compression rate is 110cpm to 130cpm, preferably about 120 cpm. As described above, the display screen or user interface may be updated to display the newly calculated value and the patient LL distance.
System for providing ventilation to a patient
According to another aspect of the invention, the systems and methods described herein may be adapted to provide guidance for manual ventilation (e.g., rescue breathing) of a patient, or to provide settings for operating an electro-mechanical patient ventilator device.
Referring to fig. 13, a patient ventilation system 1310 configured to determine a target patient ventilation criterion based on physical characteristics of the patient measured at a rescue scenario is shown. The system 1310 comprises at least one input device 1312 for obtaining information representative of at least one physical characteristic of the patient, such as a three-dimensional imaging system 1318 or a sensor or the like. For example, the physical characteristic may be the height of the patient, the chest volume of the patient, or other physical characteristic as previously described. The thoracic volume may represent a lung volume and may therefore be relevant for target criteria for determining parameters such as tidal volume. The thoracic volume may be calculated based on one of an AP distance of a thoracic region of the patient, a length of the thoracic region of the patient, and a width of the thoracic region and a circumference of the thoracic region. Other non-body characteristics such as age and gender may also be input to determine target criteria, or body characteristics may be input as an estimate or judgment thereof, as explained herein. In other examples, the target criteria for tidal volume may be calculated based on the Ideal Body Weight (IBW) of the patient using equation 3 above. As previously described, equation 3 estimates the available tidal volume of the patient based on IBW. The IBW of a man or woman is calculated according to equation 2 based on the height of the patient. The target ventilation tidal volume may vary depending on whether ventilation is administered in a cardiac arrest setting or a non-cardiac arrest setting. For example, for resuscitation (CPR) given in a cardiac arrest scenario, the target tidal volume of ventilation may be in the range of 6 to 10mL/kg, while in a non-cardiac arrest scenario, the target tidal volume of ventilation may be in the range of 6 to 8 mL/kg. The feedback system may include inputs for determining whether the patient is suffering from cardiac arrest, and based on such inputs, the target ventilation tidal volume may be adjusted accordingly.
The system 1310 may also include a ventilator 1350 for providing ventilation treatment to the patient. As shown in fig. 13, the ventilator 1350 is a manual ventilation unit that includes a ventilation bag 1352 connected to a patient vent mask 1354 by an airflow path 1356. To provide manual ventilation to the patient, in some examples, the acute care provider grasps the ventilation bag 1352 with his or her hand such that his/her thumb is positioned near the top of the bag 1350 and his/her fingers are positioned below the bag 1352. The acute care provider presses the bag 1352 by moving his/her thumb and fingers together.
In other examples, ventilation device 1350 comprises an electromechanical and/or automatic mechanical ventilator (not shown in the figures) configured to deliver a plurality of ventilations to a patient according to at least one ventilation criterion. As is known in the art, an electro-mechanical and/or automated mechanical ventilation device is a mechanical device that delivers positive pressure forced air ventilation to a patient through an airflow path (such as airway path 1356 described above) in fluid communication with the patient's airway. Since mechanical ventilators may require a period of time to set, upon reaching a rescue scenario, an acute care provider may manually provide rescue breaths to the patient while the mechanical ventilator is being set up. Once a mechanical ventilator is available, the acute care provider may attach the patient's airflow path 1356 to the mechanical ventilator so that automatic ventilation may be provided to the patient.
With continued reference to fig. 13, the system 1310 also includes at least one processor 1330 communicatively coupled to the at least one three-dimensional sensor 1318 and the ventilator 1350. In some cases, the at least one processor 1330 is an electronic component of a medical device (such as a mechanical ventilator, etc.) at a rescue scene. In other examples, the at least one processor 1330 may be a component of a portable computer device at a rescue scene, as was the case in the previously described systems. In other examples, the at least one processor 1330 may be remote from the rescue scene and in wired or wireless communication with a device at the scene. The at least one processor 1330 may be configured to receive and process information representative of at least one physical feature of the patient to generate a three-dimensional representation of the patient. As in the previously described examples, the three-dimensional representation of the patient may be processed to determine measurements of physical features of the patient. The at least one processor 1330 may also be configured to determine at least one ventilation criterion of the ventilator 1350 based on the generated three-dimensional representation.
The at least one processor is further configured to cause the ventilator 1350 to provide ventilation to the patient based on at least one ventilation criterion. In the case of an automatic mechanical ventilator, having the ventilation device provide ventilation in accordance with the calculated target ventilation criteria may include automatically adjusting ventilator settings such that the desired ventilation is provided to the patient.
For a system in which the ventilator 1350 is a manual ventilation unit, as shown in fig. 13, having the ventilator 1350 provide ventilation to the patient according to the target criteria may include having a feedback device associated with the ventilator 1350 at the rescue scenario provide feedback to the acute care provider instructing the acute care provider to provide ventilation according to the target value. For example, as described in connection with previous examples, feedback may be provided on a visual display 1334, a speaker 1336, or a linear actuator 1338 of a feedback device 1332 (such as a portable computer device or a medical device, etc.). Alternatively or additionally, feedback may be provided by a ventilatory feedback device mounted to the ventilatory bag 1352 or the airflow path 1356. For example, the ventilation feedback means may comprise a linear actuator or a vibrating motor that signals to the user when to start pressing the ventilation bag and when to release the ventilation bag. Alternatively or additionally, the feedback provided by the ventilation feedback device may be audio feedback (e.g., a press, squeeze, or release instruction issued from a speaker of the feedback device) or visual feedback (e.g., an LED indicator on the feedback device may blink or turn on, signaling the acute care provider to press or release the bag 1352).
In some examples, system 1310 also includes a sensor, such as ventilation sensor 1322 or the like, for measuring the flow of gas provided to the patient to confirm that ventilation is being provided according to the determined ventilation criteria. For a system 1310 that uses a mechanical ventilator, the sensors 1322 are generally not needed because the ventilation parameters may be determined from the settings of the ventilator. However, in some cases, ventilation sensors 1322 may be positioned in the patient's airflow path 1356 as a way to confirm that the ventilation provided to the patient by the mechanical ventilator matches the ventilator settings.
For a system 1310 that includes a manual patient ventilation unit, measurements from ventilation sensor 1322 may be used to confirm that the ventilation being provided to the patient using the manual ventilation unit matches the determined ventilation criteria. If the at least one processor 1330 determines that the ventilation parameters of the ventilation provided to the patient do not match the ventilation criteria, the at least one processor 1330 may cause feedback to be provided to the acute care provider regarding the difference between the measured parameters and the target criteria values. Further, in some examples, if the at least one processor 1330 determines that the ventilation being provided results in a flow rate and pressure that are substantially higher than the target ventilation criteria, the at least one processor 1330 may cause the feedback device 1332 of the system 1310 to provide an indication to the acute care provider of a potential risk for alerting the acute care provider of over-ventilation of the patient. In particular, ventilation provided at high flow rates and/or pressures may not be suitable for smaller or younger patients.
Another use of the ventilation system 1310 disclosed herein is to assist a user in the placement of an endotracheal tube or a breathing tube. The challenge in inserting an endotracheal or breathing tube for a patient is to determine the correct insertion depth. Desirably, the distal end of the endotracheal or respiratory tube should be inserted below the vocal cords to avoid the risk of laryngeal trauma. However, the distal end of the endotracheal tube should be spaced from the carina of the trachea by a distance of at least 2.0cm to avoid the risk of endobronchial intubation. The physical characteristics of the patient determined by system 1310 may be used to determine the correct insertion distance of the endotracheal tube. For example, the insertion depth may be based on physical characteristics of the patient, such as the height or chest length of the patient. The at least one processor 1330 may be configured to receive information related to the height of the patient and determine an estimated catheterization distance. The at least one processor may also cause a feedback device (such as a display screen of an automatic ventilator, etc.) to display the determined estimated endotracheal tube insertion depth. In an exemplary embodiment, the system 1310 may provide the following initial recommendation for endotracheal tube depth based on patient height. As used herein, endotracheal tube depth can refer to the depth of insertion of the endotracheal tube measured between the mouth of the patient and the tip of the endotracheal tube. For patients less than 20 inches in height (e.g., infants/newborns), the recommended catheterization depth may be 4.0 inches to 5.0 inches. For patients with a height of 20 inches to 40 inches (e.g., small children), the recommended catheterization depth may be 5.0 inches to 6.0 inches. For patients 40 inches to 60 inches in height (e.g., large children or small adult females), it is recommended that the catheter insertion depth be 6.0 inches to 7.5 inches. For patients 60 inches to 68 inches in height (e.g., average adult female or small adult male), it is recommended that the catheter insertion depth be 7.5 inches to 8.25 inches. For patients that are 68 inches to 75 inches in height (e.g., large adult females or average adult males), it is recommended that the catheter insertion depth be 8.25 inches to 9.0 inches. For patients 75 inches in height or greater (e.g., large adult males), it is recommended that the catheter insertion depth be 9.0 inches to 10.0 inches.
Fig. 14 shows a flow diagram illustrating a process by at least one processor for providing ventilation to a patient using system 1310. At 1410, the processor is configured to receive information representative of at least one physical feature of the patient from an input device, such as a three-dimensional imaging system. At block 1412, the at least one processor is configured to generate a three-dimensional representation of the patient from a three-dimensional scan of the patient recorded by the three-dimensional imaging system. As discussed herein, the three-dimensional representation may be a three-dimensional representation of a portion of a patient's body, such as a generated cardiothoracic region of the patient. In this case, the three-dimensional representation may be processed to identify cardiothoracic measurements such as AP distance or cardiothoracic width. In other examples, the three-dimensional representation is a three-dimensional representation of the entire body of the patient. In this case, the three-dimensional representation may be processed to determine both cardiothoracic measurements as well as overall body feature information (such as patient height, thoracic volume, etc.).
At 1414, optionally, the at least one processor may provide advice (or other feedback instructions, such as targeted CPR criteria and CPR techniques, etc.) for placement of the endotracheal tube based on physical features of the patient determined or extracted from the generated three dimensional representation of the patient. For example, the at least one processor may be configured to provide a suggested endotracheal tube placement depth based on a physical feature of the patient (such as the patient's height, etc.). Studies show a correlation between patient height and catheter insertion depth. Desirably, the catheter should be inserted for the patient so that the distal end of the catheter is at least 2cm above the carina and at least 2cm below the vocal cords. In some cases, the at least one processor may be configured to obtain the optimal endotracheal tube depth from a look-up table based on patient height and gender organization.
At 1416, the at least one processor may be configured to cause the feedback device to provide an indication to the acute care provider related to the recommended catheter placement depth. For example, the suggested depth may be displayed on a screen of the feedback device. In some cases, the acute care provider may need to press a button or take another action to confirm that he/she has seen the estimated catheter depth value. The acute care provider may then catheterize the patient to the recommended depth. Traditionally, the acute care provider may monitor the trial catheter depth based on graduations or markings on the catheter itself. In other examples, the endotracheal tube may include a sensor or monitor to provide information to the acute care provider regarding the depth of insertion of the tube. In this case, the acute care provider may monitor sensory information related to cannula insertion to determine when the desired depth has been obtained.
At 1418, the at least one processor is configured to determine at least one ventilation criterion of the ventilator based on the generated three-dimensional representation and/or based on a physical feature of the patient extracted from the generated three-dimensional representation. As described herein, ventilation parameters that may be calculated from the physical features and/or the generated three-dimensional representation include, for example, tidal volume, minute ventilation, end-of-inspiration pressure, maximum ventilation pressure, and ventilation rate during an acute care event. For example, as described above, the available tidal volume may be calculated based on the Ideal Body Weight (IBW) of the patient according to equation 3.
At 1420, the at least one processor is configured to cause the ventilation apparatus to provide ventilation based on at least one ventilation criterion. As discussed herein, for an electromechanical ventilator, having the ventilation device provide ventilation according to the determined criteria may include automatically adjusting the settings of the mechanical ventilator to provide appropriate ventilation. For a manual ventilation unit, having the ventilator provide ventilation according to the determined criteria may include providing feedback and guidance to the acute care provider for manual ventilation according to the determined ventilation criteria. The feedback may also include instructions or guidance regarding whether the ventilation being performed on the patient matches or substantially matches the determined criteria.
As in the previously described embodiments, ventilation may continue to be provided to the patient during a rescue effort based on the determined ventilation criteria. Ventilation may be stopped if the patient's physiological assessment indicates that continuous ventilation is no longer needed. Further, the at least one processor may be configured to periodically receive updated information related to physical characteristics of the patient during the rescue effort and generate an updated three-dimensional representation of the patient. A modified ventilation standard may be determined from the updated three-dimensional representation and used to adjust the settings of the mechanical ventilator or change the feedback being provided to the acute care provider such that the patient receives ventilation according to the modified ventilation standard.
While the systems, methods and techniques for providing resuscitation guidance based on physical characteristics of a patient have been described in detail for the purpose of illustration based on what is currently considered to be the most practical example, it is to be understood that such detail is solely for that purpose and that the invention is not limited to the disclosed examples, but, on the contrary, is intended to cover modifications and equivalent arrangements. For example, it is to be understood that the present invention contemplates that, to the extent possible, one or more features of any example can be combined with one or more features of any other example.
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