Non-invasive device for synchronizing chest compression and ventilation parameters to residual myocardial activity during cardiopulmonary resuscitation
A method for improving the cardiac output of a patient who is suffering from pulseless electrical activity or shock and yet still displays some myocardial wall motion including sensing myocardial activity to determine the presence of residual left ventricular pump function having a contraction or ejection phase and a filling or relaxation phase. In such cases, a compressive force is repeatedly applied to the chest based on the sensed myocardial activity such that the compressive force is applied during at least some of the ejection phases and is ceased during at least some of the relaxation phases to permit residual cardiac filling, thereby enhancing cardiac output and organ perfusion. Also incorporated may be a logic circuit capable of utilizing multiple sensing modalities and optimizing the synchronization pattern between multiple phasic therapeutic modalities and myocardial residual mechanical function.
1. A method to treat a patient in shock comprising:
determining the patient is in a pulseless electrical activity (PEA) condition;
during the PEA condition, sensing actual myocardial motion or residual pulsatile blood flow in the patient and determining whether the actual myocardial motion or residual pulsatile blood flow is occurring in the patient during the PEA condition;
in response to the determination that the actual myocardial motion or residual pulsatile blood flow is occurring, repeatedly applying a phasic therapy to the patient synchronized to the sensed actual myocardial motion or pulsatile blood flow, wherein the phasic therapy includes repeatedly applying a compressive force to the chest or an electrical shock to the heart of the patient, and
adjusting the compressive force or electrical shock depending on whether the force or shock coincides with a heart beat as indicated by sensed myocardial motion or pulsatile blood flow, wherein the compressive force or the electrical shock is sufficient to cause the circulation of blood through the patient in the PEA condition.
2. A method as in claim 1 wherein the repeated application of the phasic therapy augments cardiac ejection of blood and the cessation of the application of the compressive force and the electrical shock avoids interfering with filling of the heart.
3. A method as in claim 1 wherein the phasic therapy includes a second phasic therapy selected from a group consisting of active chest decompression, abdominal compression, ventilation, phasic limb-compression, myocardial electrical stimulation, intravascular fluid shifting, intravascular or internal visceral balloon inflation-deflation, and application of transthoracic electromagnetic irradiation.
4. A method as in claim 1 wherein the compressive force is applied to at least one of a sternal, a parasternal or an intercostal area of the chest.
5. A method as in claim 1 wherein the compressive force or electrical shock is applied during each ejection phase of the heart in which the phasic therapy is applied.
6. A method as in claim 1 wherein the compressive force or electrical shock is applied during less than all of the ejection phase of the heart during a period in which the phasic therapy is applied.
7. A method as in claim 1 wherein the compressive force or electrical shock is applied during a predetermined portion of the ejection phase and the cessation occurs during another portion of the ejection phase.
8. A method as in claim 1 wherein the phasic therapy comprises actively lifting or actively decompressing of the chest during the relaxation phase and during the cessation of the compressive force.
9. A method as in claim 8 wherein the lifting or decompression is applied during an entirety of the relaxation phase.
10. A method of claim 8 wherein the lifting or decompression is applied during a predetermined portion of the relaxation phase and is not applied during another portion of the relaxation phase.
11. A method as in claim 1 further comprising applying or altering ventilations, gas flow or airway pressure of the patient based on the sensed myocardial motion or pulsatile blood flow.
12. A method as in claim 1 wherein the compressive force is applied using equipment selected from a group consisting of mechanical compression devices; inflatable vests, nerve or muscle stimulators; and a suction based compression-decompression device.
13. A method as in claim 1 wherein a sensing system directly senses the actual myocardial motion or pulsatile blood flow.
14. A method as in claim 13 wherein the sensing system comprises one or more sensors in a group consisting sensors of echocardiography, Doppler ultrasonography, plethysmography and phonocardiography.
15. A method as in claim 13 wherein the sensing system comprises an array of sensors applied to the patient.
16. A method as in claim 1 further comprising displaying or broadcasting information indicating the sensed actual myocardial motion or the residual pulsatile blood flow.
17. A method as in claim 16 wherein the repeated application of the phasic therapy is applied manually in synchronization with the displayed or broadcasted information.