Electrocardiogram monitoring and cardiac therapy pulse delivery system and method

Abstract

A cardiac therapy pulse delivery system includes a plurality of electrodes, an ECG signal processor circuit, and a pulse generator circuit. Each of the electrodes has at least one therapy element and at least one monitor element that are electrically insulated from one another. The ECG signal processor circuit is electrically coupled to each monitor element on each electrode and is operable to convert ECG signals detected by the monitor elements into ECG data. The cardiac pulse generator circuit is electrically coupled to each therapy element on each electrode and is operable to supply one or more cardiac therapy pulses thereto.

1 . A method of monitoring electrocardiogram (ECG) signals during cardiac therapy pulsing, comprising:
 applying two or more electrodes to the skin of a patient, each electrode having at least a therapy element and a monitor element coupled thereto;   supplying one or more cardiac therapy pulses to the therapy element and not to the monitor element on each of the applied electrodes; and   monitoring one or more ECG signals via the monitor element on each of the applied electrodes.   
     
     
         2 . The method of  claim 1 , wherein the one or more ECG signals are monitored between each of the supplied cardiac therapy pulses. 
     
     
         3 . The method of  claim 1 , further comprising:
 determining whether one or more additional cardiac therapy pulses is needed based at least in part on the monitored ECG signals; and   if so, supplying the additional cardiac therapy pulses.   
     
     
         4 . The method of  claim 1 , further comprising:
 determining an appropriate voltage magnitude for each of the supplied cardiac therapy pulses based at least in part on the monitored ECG signals; and   supplying the cardiac therapy pulses at the determined appropriate voltage magnitude.   
     
     
         5 . The method of  claim 4 , further comprising:
 supplying one or more initial cardiac therapy pulses at a first predetermined voltage magnitude; and   incrementally adjusting the voltage magnitude a predetermined amount until the appropriate voltage magnitude is attained, based at least in part on the monitored ECG signals.   
     
     
         6 . The method of  claim 1 , further comprising:
 determining an appropriate current magnitude for each of the supplied cardiac therapy pulses based at least in part on the monitored ECG signals; and   supplying the cardiac therapy pulses at the determined appropriate current magnitude.   
     
     
         7 . The method of  claim 6 , further comprising:
 supplying one or more initial cardiac therapy pulses at a first predetermined current magnitude; and   incrementally adjusting the current magnitude a predetermined amount until the appropriate current magnitude is attained, based at least in part on the monitored ECG signals.   
     
     
         8 . The method of  claim 1 , further comprising:
 supplying a plurality of cardiac therapy pulses to each therapy element at a predetermined periodicity; and   monitoring ECG signals via each monitor element between each of the supplied cardiac therapy pulses.   
     
     
         9 . The method of  claim 8 , further comprising:
 varying the predetermined periodicity based at least on part on the monitored ECG signals.   
     
     
         10 . The method of  claim 1 , further comprising:
 automatically supplying one or more cardiac therapy pulses to the therapy element on each of the applied electrodes in response to the ECG signals monitored via the monitor element on each of the applied electrodes.   
     
     
         11 . The method of  claim 1 , wherein the cardiac therapy pulsing is applied from an automatic external defibrillator. 
     
     
         12 . The method of  claim 1 , wherein the cardiac therapy pulsing is applied from a manual defibrillator. 
     
     
         13 . A cardiac pulse therapy delivery system, comprising:
 a plurality of electrodes, each electrode having at least one therapy element and at least one monitor element electrically insulated from one another and adapted to be applied to a patient's skin;   an electrocardiogram (ECG) signal processor circuit electrically coupled to each monitor element on each electrode and operable to convert ECG signals detected by the monitor elements into ECG data; and   a pulse generator circuit electrically coupled to each therapy element on each electrode and operable to supply one or more cardiac therapy pulses to the therapy element and not to the monitor element on each of the electrodes.   
     
     
         14 . The system of  claim 13 , wherein the ECG signal processor circuit is operable to monitor the one or more ECG signals between each of the supplied cardiac therapy pulses. 
     
     
         15 . The system of  claim 13 , further comprising:
 a processor coupled to receive the ECG data from the ECG signal processor circuit and operable, in response thereto, to determine whether one or more additional cardiac therapy pulses is needed.   
     
     
         16 . The system of  claim 15 , wherein:
 the processor is further operable to supply one or more pulse delivery commands if it determines one or more additional cardiac therapy pulses is needed; and   the pulse generator circuit is coupled to receive the pulse delivery commands from the processor and is further operable, in response thereto, to supply the additional cardiac therapy pulses.   
     
     
         17 . The system of  claim 15 , wherein:
 the processor is further operable to determine an appropriate voltage magnitude for each of the supplied cardiac therapy pulses; and   the pulse delivery commands include information representative of the determined appropriate voltage magnitude.   
     
     
         18 . The system of  claim 17 , wherein the pulse generator circuit is further responsive to the command signals to supply the cardiac therapy pulses at the determined voltage magnitude. 
     
     
         19 . The system of  claim 18 , wherein:
 the processor is further operable to supply one or more initial pulse delivery commands; and   the pulse generator circuit, in response to the initial pulse delivery commands, supplies cardiac therapy pulses at a first predetermined voltage magnitude.   
     
     
         20 . The system of  claim 19 , wherein:
 the processor is further operable, based at least in part on the ECG data, to supply commands to the pulse generator circuit that cause the pulse generator circuit to incrementally adjust the voltage magnitude of the supplied therapy pulses a predetermined amount until the appropriate voltage magnitude is attained.   
     
     
         21 . The system of  claim 15 , wherein:
 the processor is further operable to determine an appropriate current magnitude for each of the supplied cardiac therapy pulses; and   the pulse delivery commands include information representative of the determined appropriate current magnitude.   
     
     
         22 . The system of  claim 21 , wherein the pulse generator circuit is further responsive to the command signals to supply the cardiac therapy pulses at the determined current magnitude. 
     
     
         23 . The system of  claim 22 , wherein:
 the processor is further operable to supply one or more initial pulse delivery commands; and   the pulse generator circuit, in response to the initial pulse delivery commands, supplies cardiac therapy pulses at a first predetermined current magnitude.   
     
     
         24 . The system of  claim 22 , wherein:
 the processor is further operable, based at least in part on the ECG data, to supply commands to the pulse generator circuit that cause the pulse generator circuit to incrementally adjust the current magnitude of the supplied therapy pulses a predetermined amount until the appropriate current magnitude is attained.   
     
     
         25 . The system of  claim 13 , wherein:
 the pulse generator circuit is further operable to supply a plurality of cardiac therapy pulses to each therapy element at a supply periodicity; and   the ECG signal processor circuit monitors ECG signals via each monitor element between each of the supplied cardiac therapy pulses.   
     
     
         26 . The system of  claim 25 , further comprising:
 a processor coupled receive the ECG data from the ECG signal processor circuit and operable, in response thereto, to determine the supply periodicity.   
     
     
         27 . The system of  claim 26 , wherein:
 the processor is further operable to supply one or more pulse delivery commands that include at least information representative of the determined supply periodicity; and   the pulse generator circuit is coupled to receive the pulse delivery commands from the processor and is further operable, in response thereto, to supply the cardiac therapy pulses at the determined supply periodicity.   
     
     
         28 . A method of monitoring electrocardiogram (ECG) signals during transthoracic pacing, comprising:
 applying two electrodes to the skin of a patient;   supplying one or more pacing pulses to the patient via a first portion of each of the electrodes, whereby said first portion of each of the electrodes accumulates an electrical charge that decays after each pulse is supplied; and   monitoring one or more ECG signals via a second portion of each of the electrodes before the accumulated electrical charge on the first portion of each of the electrodes has decayed.   
     
     
         29 . The method of  claim 28 , wherein the one or more ECG signals are monitored between each of the supplied pacing pulses. 
     
     
         30 . The method of  claim 28 , further comprising:
 determining an appropriate current magnitude for each of the supplied pacing pulses; and supplying the pacing pulses at the determined appropriate voltage magnitude.   
     
     
         31 . The method of  claim 30 , further comprising:
 supplying one or more initial pacing pulses at a first predetermined current magnitude; and   incrementally adjusting the current magnitude a predetermined amount until the appropriate current magnitude is attained, based at least in part on the monitored ECG signals.   
     
     
         32 . The method of  claim 28 , further comprising:
 supplying a plurality of pacing pulses at a predetermined periodicity; and   monitoring the ECG signals via each electrode between each of the supplied pacing pulses.   
     
     
         33 . The method of  claim 32 , further comprising:
 varying the predetermined periodicity based at least in part on the monitored ECG signals.   
     
     
         34 . The method of  claim 28 , further comprising:
 automatically supplying one or more pacing pulses to the patient via the electrodes in response to the ECG signals monitored via the electrodes.   
     
     
         35 . A system for monitoring electrocardiogram (ECG) signals during transthoracic pacing, comprising:
 electrode means adapted to be applied to a patient's skin for (i) receiving and applying one or more pacing pulses and (ii) sensing one or more ECG signals substantially immediately after a pacing pulse is delivered;   ECG signal processing means for converting the ECG signals detected by the electrode means into ECG data; and   pacing pulse generation means for supplying one or more pacing pulses to the electrode means.   
     
     
         36 . The system of  claim 35 , further comprising:
 ECG data processing means for processing the ECG data from the ECG signal processing means and determining whether one or more additional pacing pulses is needed.   
     
     
         37 . The system of  claim 36 , further comprising:
 pulse delivery command supply means for supplying one or more pulse delivery commands if the ECG data processing means determines one or more additional pacing pulses are needed, wherein the pacing pulse generation means is responsive to the pulse delivery commands for supplying one or more additional pacing pulses.   
     
     
         38 . The system of  claim 37 , further comprising:
 pacing current magnitude determination means for determining an appropriate current magnitude for each of the supplied pacing pulses, based at least in part on the ECG data, wherein the pulse delivery commands include information representative of the determined pacing pulse current magnitude.