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Automatic External Defibrillation Past, Present Future Prof. John McC Anderson CTO HeartSine Technologies Ltd

THE DISTRIBUTION OF ACUTE CORONARY DEATHS Mc NEILLY (BELFAST), 1965-66, 818 DEATHS. . . . . Modern Developments in Out-of-Hospital Defibrillation. . The Semi-Automatic Defibrillator. Flow Diagram for Ventricular Fibrillation Detection. Energy Ratio Characteristic. Energy Ratio i.e. Yellow/Red ratio constant in Sinus Rhythm.

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Automatic External Defibrillation Past, Present Future Prof. John McC Anderson CTO HeartSine Technologies Ltd

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    2. THE DISTRIBUTION OF ACUTE CORONARY DEATHS Mc NEILLY (BELFAST), 1965-66, 818 DEATHS

    14. Defibrillators in the Home (PDU) The development of a CPR-ICG PAD The evolution of Smart Defibrillation

    16. More than 650,000 deaths per year from cardiovascular diseases In the US around 800,000 patients suffer an AMI annually of whom 550,000 die Over 80% of the deaths occur in the home PEA accounts for over 65% of cardiac arrests In 2005 the ERC and AHA guidelines were updated to emphasize the importance of effective chest compressions with minimal interruptions In 2008 the AHA introduced the hands-only protocol

    20. Transthoracic Impedance: Change in thoracic impedance may be due to any change in physical shape or content of the thorax, including ventilation, cardiopulmonary blood flow . Miller JC, Horvath SM. Impedance Cardiography. Psychophysiology 1978; 15: 80-91

    24. Blood Flow in the aorta Blood Flow through the pulmonary vessels Contracting heart Changing resistivity of blood Improved contact with electrodes

    25. PEA accounts for over 65% of cardiac arrests In 2005 the ERC and AHA guidelines were updated to emphasize the importance of effective chest compressions with minimal interruptions. In 2008 the AHA introduced the hands-only protocol to further minimize interruptions.

    26. ICG can offer feedback on cardiac output during chest compressions The morphology of the ICG waveform during CPR is distinctive HeartSine has developed an algorithm based on the RVH database of CPR cases which uses a number of parameters to enable feedback on CPR efficacy for the user

    31. Noise due to motion artifact Noise due to incorrect pad or hand placement Initial ICG algorithm classified some cases of noise as CPR

    32. It was found through a number of bench tests that excessive noise could be eliminated by measuring the rate and pulse width of the signal and by focusing efforts on good CPR training to ensure the correct hand positioning and applied force

    41. Animal Study Results

    43. The Development of a SMART Defibrillator

    44. Optimal treatment for Sudden Cardiac Arrest (SCA) Interactive CPR Accurate decision to defibrillate/CPR Management of PEA

    45. Features to be included in the SMART AED: CPR-ICG Indicator Pulse checker (Uses ICG to discriminate between PEA and SR) Therapy Advisor (Uses DSP to extract information on frequency content of the ECG signal during cardiac arrest to determine whether CPR or defibrillation is the most appropriate therapy) Using ICG to discriminate between CPR and shockable rhythms during the hands-off period Continuous chest compressions until administration of shock The FUTURE of Defibrillation

    46. 3-Phases of a Sudden Cardiac Arrest

    47. Majority of customer queries result from non-adherence to the hands-off or analysis period of the PAD Using ICG technology we plan to develop an algorithm to discriminate between CPR and a shockable rhythm to prevent the device from charging and then disarming following the discontinuation of CPR The algorithm can output audio voice prompts which will advise the user to discontinue CPR

    48. Failure to adhere to CPR prompts

    49. HeartSine Technologies currently has the basic science to build a SMART defibrillator. A SMART defibrillator will provide the optimal treatment for Sudden Cardiac Death SMART defibrillation will position HeartSine Technologies as a world leader in this field.

    51. Any Questions?

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