CA2503544A1 - Method of determining depth of compressions during cardio-pulmonary resuscitation - Google Patents

Method of determining depth of compressions during cardio-pulmonary resuscitation Download PDF

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Publication number
CA2503544A1
CA2503544A1 CA002503544A CA2503544A CA2503544A1 CA 2503544 A1 CA2503544 A1 CA 2503544A1 CA 002503544 A CA002503544 A CA 002503544A CA 2503544 A CA2503544 A CA 2503544A CA 2503544 A1 CA2503544 A1 CA 2503544A1
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signal
chest compressions
ecg signal
compression
chest
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CA002503544A
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French (fr)
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CA2503544C (en
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James A. Palazzolo
Ronald D. Berger
Henry R. Halperin
Darren R. Sherman
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Zoll Circulation Inc
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Individual
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Abstract

A method of processing a raw acceleration signal, measured by an acceleromet er- based compression monitor, to produce an accurate and precise estimated actu al depth of chest compressions. The raw acceleration signal is filtered during integration and then a moving average of past starting points estimates the actual current starting point. An estimated actual peak of the compression i s then determined in a similar fashion. The estimated actual starting point is subtracted from the estimated actual peak to calculate the estimated actual depth of chest compressions. In addition, one or more reference sensors (suc h as an ECG noise sensor) may be used to help establish the starting points of compressions. The reference sensors may be used, either alone or in combination with other signal processing techniques, to enhance the accuracy and precision of the estimated actual depth of compressions.

Claims (112)

1. A device for measuring depth of chest compressions, said device comprising:
an accelerometer capable of producing an acceleration signal corresponding to the acceleration of chest compressions;
a means for integrating the acceleration signal, said means for integrating operably connected to the accelerometer, and said means for integrating capable of producing a measured depth signal corresponding to the measured depth of chest compressions; and a processor operably connected to the means for integrating, said processor programmed to produce an estimated actual depth signal corresponding to the estimated actual depth of chest compressions by calculating an autoregressive moving average of the measured depth signal.
2. The device of claim 1 further comprising a display operably connected to the processor, and wherein the display is capable of displaying the estimated actual depth signal.
3. The device of claim 1 further comprising a means for user feedback operably connected to the processor, wherein the means for user feedback is capable of providing feedback that indicates whether chest compressions fall within a predetermined range of values.
4. The device of claim 1 further comprising:
a means for measuring an ECG signal of a patient, said ECG signal having a noise component and an actual component;

a means for estimating the noise component of the ECG
signal operably connected to the means for measuring the ECG signal and to the processor;
wherein the processor is further programmed to produce the estimated actual depth signal when the noise component of the ECG signal falls within a predetermined range.
5. The device of claim 4 further comprising a display operably connected to the processor, and wherein the display is capable of displaying the estimated actual depth signal.
6. The device of claim 4 further comprising a means for user feedback operably connected to the processor, wherein the means for user feedback is capable of providing feedback that indicates whether chest compressions fall within a predetermined range of values.
7. The device of claim 6 wherein the processor is further capable of measuring the rate of chest compressions and wherein the means for user feedback is further capable of displaying the rate of chest compressions.
8. The device of claim 6 wherein the processor is further capable of measuring the duty cycle of chest compressions and wherein the means for user feedback is further capable of displaying the duty cycle of chest compressions.
9. The device of claim 1 further comprising a means for performing ventilation capable of ventilating the patient during CPR.
10. The device of claim 9 wherein the means for ventilation comprises a means for performing electro-ventilation.
11. A device for performing chest compressions, said device comprising:
a means for performing chest compressions on a patient;
an accelerometer capable of producing an acceleration signal corresponding to the acceleration of chest compressions;
a means for integrating the acceleration signal, said means for integrating operably connected to the accelerometer, and said means for integrating capable of producing a measured depth signal corresponding to the measured depth of chest compressions;
a processor operably connected to the means for integrating and to the means for performing chest compressions, said processor capable of producing an estimated actual depth signal corresponding to the estimated actual depth of chest compressions by calculating an autoregressive moving average of the measured depth signal;
wherein the means for performing chest compressions is capable of adjusting the depth of chest compressions based on the estimated actual depth signal.
12. The device of claim 11 wherein the means for performing chest compressions comprises an automatic chest compression device.
13. The device of claim 11 further comprising:
a means for measuring an ECG signal of a patient, said ECG signal having a noise component and an actual component;

a means for estimating the noise component of the ECG
signal operably connected to the means for measuring the ECG signal and to the processor;
wherein the processor is further programmed to produce the estimated actual depth signal when the noise component of the ECG signal falls within a, predetermined range.
14. The device of claim 13 wherein the means for performing chest compressions comprises an automatic chest compression device.
15. The device of claim 11 further comprising a means for performing ventilation capable of ventilating the patient during CPR.
16. The device of claim 15 wherein the means for ventilation comprises a means for performing electro-ventilation.
17. The device of claim 11 further comprising a display operably connected to the processor, and wherein the display is capable of displaying the estimated actual depth signal.
18. The device of claim 11 further comprising a means for user feedback operably connected to the processor, wherein the means for user feedback is capable of providing feedback that indicates whether chest compressions fall within a predetermined range of values.
19. The device of claim 18 wherein the processor is further capable of measuring the rate of chest compressions and wherein the means for user feedback is further capable of displaying the rate of chest compressions.
20. The device of claim 18 wherein the processor is further capable of measuring the duty cycle of chest compressions and wherein the means for user feedback is further capable of displaying the duty cycle of chest compressions.
21. A device for measuring depth of chest compressions, said device comprising:
an accelerometer capable of producing an acceleration signal corresponding to the acceleration of chest compressions, said acceleration signal having a noise component and an actual component;
a processor operably connected to the accelerometer, said processor capable of producing, from the acceleration signal, an estimated actual acceleration signal corresponding to the estimated actual acceleration of chest compressions;
wherein the processor further comprises:
a system identifier operably connected to the accelerometer, said system identifier capable of producing an estimated noise signal corresponding to the noise component of the acceleration signal;
wherein the system identifier produces the estimated noise signal by processing the measured acceleration and at least one error source reference;
a means for combining signals operably connected to the system identifier and to the accelerometer, said means for combining signals capable of combining the acceleration signal and the estimated noise signal to produce the estimated actual acceleration signal; and a means for integrating the estimated actual acceleration signal, said means for integrating operably connected to the processor, and said means for integrating capable of integrating the estimated actual acceleration, signal to produce an estimated actual depth signal corresponding to the estimated actual depth of chest compressions.
22. The device of claim 21 further comprising a display operably connected to the processor, and wherein the display is capable of displaying the estimated actual depth signal.
23. The device of claim 21 further comprising a means for user feedback operably connected to the processor, wherein the means for user feedback is capable of providing feedback that indicates whether chest compressions fall within a predetermined range of values.
24. The device of claim 23 wherein the processor is further capable of measuring the rate of chest compressions and wherein the means for user feedback is further capable of displaying the rate of chest compressions.
25. The device of claim 23 wherein the processor is further capable of measuring the duty cycle of chest compressions and wherein the means for user feedback is further capable of displaying the duty cycle of chest compressions.
26. The device of claim 21 further comprising:
a means for measuring an ECG signal of a patient, said ECG signal having a noise component and an actual component;
a means for estimating the noise component of the ECG
signal operably connected to the means for measuring the ECG signal and to the processor;

wherein the processor is further programmed to produce the estimated actual depth signal when the noise component of the ECG signal falls within a predetermined range.
27. The device of claim 26 further comprising a display operably connected to the processor, and wherein the display is capable of displaying the estimated actual depth signal.
28. The device of claim 26 further comprising a means for user feedback operably connected to the processor, wherein the means for user feedback is capable of providing feedback that indicates whether chest compressions fall within a predetermined range of values.
29. The device of claim 28 wherein the processor is further capable of measuring the rate of chest compressions and wherein the means for user feedback is further capable of displaying the rate of chest compressions.
30. The device of claim 28 wherein the processor is further capable of measuring the duty cycle of chest compressions and wherein the means for user feedback is further capable of displaying the duty cycle of chest compressions.
31. The device of claim 21 further comprising a means for performing ventilation capable of ventilating the patient during CPR.
32. The device of claim 31 wherein the means for ventilation comprises a means for performing electro-ventilation.
33. A device for performing chest compressions, said device comprising:

a means for performing chest compressions on a patient;

an accelerometer capable of producing an acceleration signal corresponding to the acceleration of chest compressions, said acceleration signal having a noise component and an actual component;

a processor operably connected to the accelerometer, said processor capable of producing, from the acceleration signal, an estimated actual acceleration signal corresponding to the estimated actual acceleration of chest compressions;

wherein the processor further comprises:

a system identifier operably connected to the accelerometer, said system identifier capable of producing an estimated noise signal corresponding to the noise component of the acceleration signal;

wherein the system identifier produces the estimated noise signal by processing the measured acceleration and at least one error source reference;

a means for combining signals operably connected to the system identifier and to the accelerometer, said means for combining signals capable of combining the acceleration signal and the estimated noise signal to produce the estimated actual acceleration signal; and a means for integrating the estimated actual acceleration signal, said means for integrating operably connected to the processor, and said means for integrating capable of integrating the estimated actual acceleration signal to produce an estimated actual depth signal corresponding to the estimated actual depth of chest compressions;

wherein the means for performing chest compressions is capable of adjusting the depth of chest compressions based on the estimated actual depth signal.
34. The device of claim 33 further comprising a display operably connected to the processor, and wherein the display is capable of displaying the estimated actual depth signal.
35. The device of claim 33 further comprising a means for user feedback operably connected to the processor, wherein the means for user feedback is capable of providing feedback that indicates whether chest compressions fall within a predetermined range of values.
36. The device of claim 35 wherein the processor is further capable of measuring the rate of chest compressions and wherein the means for user feedback is further capable of displaying the rate of chest compressions.
37. The device of claim 35 wherein the processor is further capable of measuring the duty cycle of chest compressions and wherein the means for user feedback is further capable of displaying the duty cycle of chest compressions.
38. The device of claim 33 further comprising:

a means for measuring an ECG signal of a patient, said ECG signal having a noise component and an actual component;

a means for estimating the noise component of the ECG
signal operably connected to the means for measuring the ECG signal and to the processor;

wherein the processor is further programmed to produce the estimated actual depth signal when the noise component of the ECG signal falls within a predetermined range.
39. The device of claim 38 further comprising a display operably connected to the processor, and wherein the display is capable of displaying the estimated actual depth signal.
40. The device of claim 38 further comprising a means for user feedback operably connected to the processor, wherein the means for user feedback is capable of providing feedback that indicates whether chest compressions fall within a predetermined range of values.
41. The device of claim 40 wherein the processor is further capable of measuring the rate of chest compressions and wherein the means for user feedback is further capable of displaying the rate of chest compressions.
42. The device of claim 40 wherein the processor is further capable of measuring the duty cycle of chest compressions and wherein the means for user feedback is further capable of displaying the duty cycle of chest compressions.
43. The device of claim 33 further comprising a means for performing ventilation capable of ventilating the patient during CPR.
44. The device of claim 33 wherein the means for ventilation comprises a means for performing electro-ventilation.
45. A device for estimating an actual ECG signal of a patient while performing chest compressions, said device comprising:

a means for performing chest compressions on a patient;

a means for sensing the ECG signal of the patient, said means for sensing the ECG signal capable of producing a measured ECG signal corresponding to the measured value of the ECG signal of the patient, wherein the ECG
signal comprises an actual component and a noise component;

a compression sensor operably connected to the means for performing chest compressions, said compression sensor capable of producing a compression signal corresponding to the presence of a chest compression;

a processor operably connected to the compression sensor and to the means for sensing the ECG signal, said processor capable of producing an estimated actual ECG
signal corresponding to the estimated actual ECG signal of the patient;

wherein the processor further comprises:

a system identifier operably connected to the compression sensor, said system identifier capable of producing the estimated noise component of the ECG signal;

wherein the system identifier produces the estimated noise component of the ECG signal by processing the measured ECG signal and the compression signal; and a means for combining signals operably connected to the system identifier and to the means for sensing the ECG signal, said means for combining signals capable of combining the measured ECG signal and the estimated noise component of the ECG signal to produce the estimated actual ECG signal.
46. The device of claim 45 wherein the compression sensor comprises a load sensor.
47. The device of claim 46 wherein the load sensor is disposed beneath the patient.
48. The device of claim 45 wherein the compression sensor comprises a means for measuring the displacement of a compression belt.
49. The device of claim 48 wherein the means for measuring the displacement of a compression belt comprises an encoder.
50. The device of claim 49 wherein the encoder comprises a rotary encoder.
51. The device of claim 49 wherein the encoder comprises an optical encoder.
52. The device of claim 45 wherein the compression sensor comprises an accelerometer.
53. The device of claim 45 wherein the system identifier comprises a moving average filter.
54. The device of claim 45 wherein the system identifier comprises an autoregressive moving average filter.
55. The device of claim 45 wherein the system identifier comprises an autoregressive moving average with truncated derivative filter.
56. The device of claim 45 wherein the system identifier comprises a Kalman filter.
57. The device of claim 45 wherein the system identifier comprises a recursive least squares filter
58. The device of claim 45 wherein the system identifier comprises a recursive instrumental variable filter.
59. The device of claim 45 wherein the system identifier comprises a recursive prediction error filter.
60. The device of claim 45 wherein the system identifier comprises a recursive pseudolinear regression filter.
61. The device of claim 45 wherein the system identifier comprises a recursive Kalman filter for time-varying systems filter.
62. The device of claim 45 wherein the system identifier comprises a recursive Kalman filter with parametric variation filter.
63. A method of determining the estimated actual depth of chest compressions during chest compressions, wherein the method comprises the steps of:

providing an accelerometer capable of sensing accelerations caused by chest compressions;

performing chest compressions, wherein the accelerometer measures an acceleration signal during chest compressions;

double integrating the acceleration signal to produce a measured depth signal corresponding to the measured depth of chest compressions;

calculating an autoregressive moving average of the measured compression depth signal;

wherein the estimated actual depth of compressions comprises the autoregressive moving average of the measured compression depth signal.
64. The method of claim 63 comprising the further steps of:

providing a reference sensor capable of identifying the start of a compression;

identifying the start of a compression with the reference sensor; and calculating estimated actual depth of compressions when the start of a compression has been identified.
65. The method of claim 64 wherein the step of providing the reference sensor comprises providing a sensor capable of measuring an ECG signal of a patient, and wherein the method comprises the further steps of:

measuring the ECG signal of the patient during compressions, wherein the ECG signal comprises a noise component and an actual component;

identifying the noise component of the ECG signal;

wherein the start of each compression is identified by a predetermined change in the noise component of the ECG
signal.
66. A method of estimating the actual depth of chest compressions during chest compressions, wherein the method comprises the steps of:

providing an accelerometer capable of measuring the acceleration caused by chest compressions;

performing compressions, wherein the accelerometer produces an acceleration signal corresponding to the acceleration of chest compressions;

providing the acceleration signal to a first filter, said first filter producing a filtered acceleration signal;

providing the filtered acceleration signal to a processor, said processor producing a velocity signal corresponding to the velocity of chest compressions upon integrating the filtered acceleration signal;

providing the velocity signal to a second filter, said second filter producing a filtered velocity signal;

providing the filtered velocity signal to the processor, said processor producing a chest depth signal corresponding to the depth of chest compressions upon integrating the filtered velocity signal;

providing the chest depth signal to a baseline limiter, said baseline limiter producing a chest depth signal with a processed baseline component;

providing the chest depth signal with a processed baseline component to a starting point detector, said starting point detector identifying the starting points of chest compressions, and further providing a starting point signal corresponding to the starting points of chest compressions to a means for combining signals;

providing the chest depth signal with a processed baseline component to a peak limiter, said peak limiter producing a chest depth signal with a processed peak component;

providing the chest depth signal with a processed peak component to a peak detector, said peak detector identifying the peaks of chest compressions corresponding to the maximum depths of compressions, and further providing a peak signal corresponding to the peaks of chest compressions to the means for combining signals;

calculating the estimated actual depth of chest compressions by combining the starting point signal with the peak signal.
67. The method of claim 66 comprising the further step of filtering the chest depth signal with a processed baseline component.
68. The method of claim 66 comprising the further step of filtering the chest depth signal with a processed peak component.
69. The method of claim 66 comprising the further steps of:

providing the estimated actual depth of compressions to a means for user feedback operably connected to the processor; and providing feedback to a user that indicates whether chest compressions fall within a predetermined range of values.
70. The method of claim 66 comprising the further steps of:

providing a reference sensor capable of identifying the start of a compression;

identifying the start of a compression with the reference sensor; and calculating estimated actual depth of compressions when the start of a compression has been identified.
71. The method of claim 70 wherein the step of providing the reference sensor comprises providing a sensor capable of measuring an ECG of a patient, and wherein the method comprises the further steps of:

measuring the ECG signal of the patient during compressions, wherein the ECG signal comprises a noise component and an actual component;

identifying the noise component of the ECG signal;
wherein the start of each compression is identified by a predetermined change in the noise component of the ECG
signal.
72. A method of estimating the actual depth of chest compressions during chest compressions, wherein the method comprises the steps of:

providing a means for performing chest compressions on a patient;

providing a sensor capable of measuring an ECG signal of the patient and providing an accelerometer capable of measuring the acceleration of chest compressions;

performing chest compressions on the patient, wherein the accelerometer produces an acceleration signal corresponding to the acceleration of chest compressions;

measuring the ECG signal of the patient, wherein the measured ECG signal comprises an actual component and a noise component, and wherein at least part of the noise component is caused by chest compressions;

identifying the noise component of the ECG signal, wherein a starting point of a compression is identified by a change in the noise component of the ECG signal;

calculating the estimated actual depth of compressions by double integrating the acceleration signal when the starting point of a compression has been identified.
73. A method of performing CPR on a patient, wherein the method comprises the steps of:

providing an accelerometer capable of sensing accelerations caused by chest compressions;
performing chest compressions, wherein the accelerometer measures an acceleration signal during chest compressions;
double integrating the acceleration signal to produce a measured depth signal corresponding to the measured depth of chest compressions;
calculating an autoregressive moving average of the measured compression depth signal;
wherein the estimated actual depth of compressions comprises the autoregressive moving average of the measured compression depth signal;
providing a means for ventilating the patient; and ventilating the patient during CPR.
74. The method of claim 73 wherein the step of providing a means for ventilating the patient comprises providing a means for electro-ventilation.
75. The method of claim 73 comprising the further steps of:
providing a reference sensor capable of identifying the start of a compression;
identifying the start of a compression with the reference sensor; and calculating estimated actual depth of compressions when the start of a compression has been identified.
76. The method of claim 75 wherein the step of providing the reference sensor comprises providing a sensor capable of measuring an ECG signal of a patient, and wherein the method comprises the further steps of:
measuring the ECG signal of the patient during compressions, wherein the ECG signal comprises a noise component and an actual component;
identifying the noise component of the ECG signal;
wherein the start of each compression is identified by a predetermined change in the noise component of the ECG
signal.
77. A method of estimating an actual ECG signal of a patient while performing chest compressions with an automatic chest compressions device, wherein the method comprises the steps of:
providing an ECG sensor capable of measuring an ECG
signal of the patient, said ECG sensor producing a measured ECG signal having an actual component and a noise component;
providing an automatic chest compression device disposed to provide chest compressions to the patient, said chest compression device having a load sensor capable of determining the presence of a chest compression when the load sensed by the load sensor exceeds a predetermined value, said load sensor producing a compression signal corresponding the presence a chest compression;
performing compressions;
providing the measured ECG signal to a system identifier;

providing the compression signal to the system identifier;

estimating the noise component of the measured ECG signal with the system identifier by processing the measured ECG signal and the compression signal;

providing the measured ECG signal and the estimated noise component of the measured ECG signal to a means for combining signals;

calculating the estimated actual ECG with the means for combining signals by combining the measured ECG signal and the noise component of the measured ECG signal.
78. The method of claim 77 wherein the step of providing an automatic chest compression device a load sensor comprises providing an automatic chest compression device having a load sensor that is disposed beneath the patient during compressions.
79. The method of claim 77 wherein the system identifier comprises a moving average filter.
80. The method of claim 77 wherein the system identifier comprises an autoregressive moving average filter.
81. The method of claim 77 wherein the system identifier comprises an autoregressive moving average with truncated derivative filter.
82. The method of claim 77 wherein the system identifier comprises a Kalman filter.
83. The method of claim 77 wherein the system identifier comprises a recursive least squares filter
84. The method of claim 77 wherein the system identifier comprises a recursive instrumental variable filter.
85. The method of claim 77 wherein the system identifier comprises a recursive prediction error filter.
86. The method of claim 77 wherein the system identifier comprises a recursive pseudolinear regression filter.
87. The method of claim 77 wherein the system identifier comprises a recursive Kalman filter for time-varying systems filter.
88. The method of claim 77 wherein the system identifier comprises a recursive Kalman filter with parametric variation filter.
89. A method of estimating an actual ECG signal of a patient while performing chest compressions with an automatic chest compressions device, wherein the method comprises the steps of:

providing an ECG sensor capable of measuring an ECG
signal of the patient, said ECG sensor producing a measured ECG signal having an actual component and a noise component;

providing an automatic chest compression device disposed to provide chest compressions to the patient, said chest compression device having an encoder capable of determining the presence of a chest compression, said encoder producing a compression signal corresponding the presence a chest compression;

performing compressions;

providing the measured ECG signal to a system identifier;

providing the compression signal to the system identifier;

estimating the noise component of the measured ECG signal with the system identifier by processing the measured ECG signal and the compression signal;

providing the measured ECG signal and the estimated noise component of the measured ECG signal to a means for combining signals;

calculating the estimated actual ECG with the means for combining signals by combining the measured ECG signal and the noise component of the measured ECG signal.
90. The method of claim 89 wherein the step of providing an automatic chest compression device having an encoder comprises providing an automatic chest compression device having an optical encoder.
91. The method of claim 89 wherein the step of providing an automatic chest compression device having an encoder comprises providing an automatic chest compression device having a rotary encoder.
92. The method of claim 89 wherein the system identifier comprises a moving average filter.
93. The method of claim 89 wherein the system identifier comprises an autoregressive moving average filter.
94. The method of claim 89 wherein the system identifier comprises an autoregressive moving average with truncated derivative filter.
95. The method of claim 89 wherein the system identifier comprises a Kalman filter.
96. The method of claim 89 wherein the system identifier comprises a recursive least squares filter
97. The method of claim 89 wherein the system identifier comprises a recursive instrumental variable filter.
98. The method of claim 89 wherein the system identifier comprises a recursive prediction error filter.
99. The method of claim 89 wherein the system identifier comprises a recursive pseudolinear regression filter.
100. The method of claim 89 wherein the system identifier comprises a recursive Kalman filter for time-varying systems filter.
101. The method of claim 89 wherein the system identifier comprises a recursive Kalman filter with parametric variation filter.
102. A method of estimating an actual ECG signal of a patient while performing chest compressions with an automatic chest compressions device, wherein the method comprises the steps of:

providing an ECG sensor capable of measuring an ECG
signal of the patient, said ECG sensor producing a measured ECG signal having an actual component and a noise component;
providing an automatic chest compression device disposed to provide chest compressions to the patient, said chest compression device having an accelerometer capable of determining the presence of a chest compression, said accelerometer producing a compression signal corresponding the presence a chest compression;

performing compressions;

providing the measured ECG signal to a system identifier;

providing the compression signal to the system identifier;

estimating the noise component of the measured ECG signal with the system identifier by processing the measured ECG signal and the compression signal;

providing the measured ECG signal and the estimated noise component of the measured ECG signal to a means for combining signals;

calculating the estimated actual ECG with the means for combining signals by combining the measured ECG signal and the noise component of the measured ECG signal.
103. The method of claim 102 wherein the system identifier comprises a moving average filter.
104. The method of claim 102 wherein the system identifier comprises an autoregressive moving average filter.
105. The method of claim 102 wherein the system identifier comprises an autoregressive moving average with truncated derivative filter.
106. The method of claim l02 wherein the system identifier comprises a Kalman filter.
107. The method of claim 102 wherein the system identifier comprises a recursive least squares filter
108. The method of claim 102 wherein the system identifier comprises a recursive instrumental variable filter.
109. The method of claim 102 wherein the system identifier comprises a recursive prediction error filter.
110. The method of claim 102 wherein the system identifier comprises a recursive pseudolinear regression filter.
111. The method of claim 102 wherein the system identifier comprises a recursive Kalman filter for time-varying systems filter.
112. The method of claim 102 wherein the system identifier comprises a recursive Kalman filter with parametric variation filter.
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