# Patent

## Title
ECG electrode and electrode support

## Abstract

An electrically non-conductive back plate for supporting the back of a patient in a supine position comprises on its front face facing the back of the patient a pair or more of ECG electrodes capable of maintaining electrically conductive skin contact with the patient's back. The pair of ECG electrodes is disposed at a sharp angle with the mean heart vector, in particular so as to form an angle β of about 45°±25° with the projection S of the patient's spine on the back plate. Also disclosed is an ECG electrode for mounting in a recess of the back plate and an apparatus for treating cardiac arrest by compression of the sternum comprising the back plate.

## Background
PRIORITY CLAIM
This application is a division of co-pending application Ser. No. 12/304,575 having a filing date of Aug. 19, 2009, titled “ECG ELECTRODE AND ELECTRODE SUPPORT”, which is a national stage entry of International Application No. PCT/SE2007/000559 having a filing date of Jun. 11, 2007, titled “ECG ELECTRODE AND ELECTRODE SUPPORT”, which claims the benefit of Swedish Application No. 0601300-7, filed Jun. 14, 2006, the disclosures of which are hereby incorporated by reference.


FIELD OF THE INVENTION
The present invention relates to an ECG electrode and a support on which the ECG electrode is mounted, in particular for use in apparatus for treating sudden cardiac arrest.
BACKGROUND OF THE INVENTION
Sudden cardiac arrest is commonly treated mechanically and/or by electrical defibrillation. Mechanical treatment may be given manually or by a chest compression apparatus. A number of chest compression apparatus are known in the art, such as the pneumatically driven LUCASTM mechanical chest compression system (“LucasTM system”; an apparatus for compression and physiological in Cardio-Pulmonary Resuscitation, CPR, manufactured by Jolife AB, Lund, Sweden). Specifically the LucasTM system comprises a support structure and a compression unit. The support structure includes a back plate for positioning the patient's back posterior to the patient's heart and a front part for positioning around the patient's chest anterior to the heart. The front part has two legs, each having a first end pivotally connected to at least one hinge of the front part and a second end removably attachable to the back plate. The front part is devised to centrally receive the compression unit which is arranged to repeatedly compress the patient's chest when the front part is attached to the back plate. The compression unit comprises a pneumatic unit arranged to drive and control compression, an adjustable suspension unit to which a compression pad is attached, and a means for controlling the position of the pad in respect of the patient's chest. Defibrillation may be provided independently of and concomitant.
In deciding when and for how long time to administer compressions to the patient it is important to measure the electrical activity of the heart. This is accomplished by using a movable ECG apparatus separate of the mechanical compression system.
ECG apparatus of this kind comprise a number of ECG electrodes connected to the apparatus by flexible conductors. Before the start of measurement the ECG electrodes have to be attached to the chest of the patient in a given pattern. In a situation of urgency such as one of cardiac arrest this is time consuming and should be avoided.
EP 459 239 A2 discloses a portable device for sensing cardiac function and automatically delivering electrical therapy comprising torsion spring operated electrode assemblies.
WO 2004/112683 A1 discloses an electrical means for providing electrostimulation comprising two electrodes, a front electrode to be applied on the chest of the patient adjacent to the pad, plate or disc, etc. of the reciprocating means or integrated in the pad, plate or disc, etc., and a rear electrode to be applied to the back of the patient integrated into the back plate so as to be disposed about perpendicularly under the sternum if the patient is resting in a correct position on the back plate. The electrodes of the means for providing electrostimulation may be additionally used for picking up ECG signals and forwarding them to an ECG registration and analysis unit. The ECG signals obtainable in this manner are however strongly affected by the movement of sternum during compression, which impairs their quality. The present invention seeks to remedy this problem.
OBJECTS OF THE INVENTION
It is an object of the present invention to provide an ECG electrode for use in apparatus for treating sudden cardiac arrest in a patient by compression of the sternum, which is easily attached to the skin of the patient's back.
It is a another object of the invention to provide an ECG electrode for use in apparatus for treating sudden cardiac arrest by compression of the sternum, which is not or only moderately affected by the movement of sternum.
It is a further object of the invention to provide a support, in particular a back plate, comprising one or more ECG electrodes in a given pattern.
Still further objects of the invention will be evident from the following summary of the invention, the description of preferred embodiments thereof illustrated in a drawing, and the appended claims.
SUMMARY OF THE INVENTION
According to the present invention is disclosed a support for supporting the back of a patient in a supine position comprising a pair or more of ECG electrodes capable of maintaining electrically conductive skin contact with the patient's back. The support is electrically non-conductive, generally flat and adapted to the portion of the back which it is intended to receive for support. It may have, for instance, about rectangular or other symmetric oblong form, in which case the long side of the rectangle or similar extends about perpendicular to a projection the patient's spine on the support. The support is preferably of a kind allowing the patient to be centered on the support in a supine position. In the following the support of the invention will be termed “back plate”; the face of the back plate facing the back of the patient will be termed “front face”.
According to a first preferred aspect of the invention the back plate is comprised by an apparatus for treating cardiac arrest by compression of the sternum.
According to a second preferred aspect of the invention the line connecting the at least one pair of the one or more pairs of ECG electrodes is disposed at an angle α of 5°±25°, more preferred of 5°±15°, with the perpendicular projection on the back plate of the long heart axis of a person of whom the chest is supported by the back plate; the angle α is the one defined by the line/projection in a caudal direction from their point of intersection. In this application “long heart axis” denotes the direction of a line connecting the center of the mitral annulus and the left ventricular apex at the end of the diastolic phase. The direction of the long heart axis in a frontal plane is about 40°±20° (H Engblom et al, Am Heart J 2005, 150(3); 507-512). According to the invention it is thus preferred for a line connecting said at least one pair of the one pair or more of ECG electrodes to be comprised by an angle β of about 45°±25°, more preferred of about 45°±15°, formed with the projection S of the spine of a person of which the chest is supported by the back plate. In a generally symmetric back plate the projection S may be equalled with an imagined short minor line disposed on the front face of the back plate. The angle β is the one defined by the line connecting the pair of electrodes and the projection S in a caudal direction from their point of intersection.
According to the present invention is also disclosed an apparatus for treating cardiac arrest by compression of the sternum, comprising the aforementioned back plate of the invention provided with one pair or more of the ECG electrodes. It is preferred for the back plate to be easily mountable on/detachable from the main portion of the apparatus for treating cardiac arrest.
According to a third preferred aspect of the invention is disclosed an ECG electrode capable of being mounted on the back plate so as to face the patient's back and maintaining electrically conductive skin contact. It is preferred for the ECG electrode to be mounted on the back plate in a manner to make it adapt to slight movements of the patient in respect of the back plate without losing contact; such movements comprise horizontal movements but, in particular, perpendicular and skew movements with an important perpendicular component caused, for instance, by the patient's sternum being repeatedly compressed to establish or maintain circulation. It is thus preferred for the ECG electrode to be displaceable in a horizontal (lateral) direction and/or a vertical direction in respect to the back plate. It is however also possible to use electrodes with the back plate that are rigidly mounted in the back plate and thus are not laterally displaceable in respect of it, for instance needle electrodes such as the electrode disclosed in U.S. Pat. No. 5,509,822, the adaptation for mounting in the back plate is within the easy reach of a person skilled in the art.
According to a fourth preferred aspect the ECG electrode of the invention is mounted displaceable in a horizontal and/or vertical direction in a recess provided in the front face of the back plate.
According to a fifth preferred aspect of the invention the ECG electrode comprises an electrically conductive electrode disk, a resiliently compressible spring means disposed between the electrode disk and the support, and a flexible conducting means for connecting the electrode disk to an ECG monitoring unit. This arrangement minimizes disturbances of the ECG signal by body geometry changes caused by the compression of the sternum. The electrode of the invention is freely movable in the recess in a direction perpendicular to the support while its lateral movement is rather restricted. By the force of a spring means the front face of the electrode is pressed against the skin of the patient's back to provide good electrical contact. Its front face may be provided with electrical contact enhancing means, such as with an electrically conducting gel or paste known in the art.
It is preferred for the electrode disk to be supported by an electrically nonconductive support element, preferably of a rigid polymer material, disposed between the electrode disk and the spring element. Preferably the support element is integral with the electrode disk. The compressible spring means may be a coil, a disc of a resilient foam such as polyurethane foam, a hollow rubber ring or similar. The electrode disk, the support element and/or their combination preferably comprise a cylindrical portion or are substantially cylindrical.
The recess for mounting of the electrode of the invention on the support is disposed on an essentially flat face thereof and has a form preferably allowing the electrode to be fully inserted into the recess against the resilient force of the spring means which, with their one end, abut the bottom of the recess. It is preferred that, in a non-load bearing state, the electrode disk extends from the recess for a short distance. It is preferred for the circumference of the recess and of the electrode disk, the support element, and the combination of electrode disk and support element to be of similar form and diameter similar so as to provide guidance by the side walls of the recess for the movement of the electrode with little play.
According to a sixth preferred aspect of the invention is disclosed an ECG electrode for mounting on a support, in particular the back plate of the invention, capable of lateral displacement in regard of the support.
The invention will now be explained in more detail by reference to preferred embodiments illustrated by a rough drawing.



DESCRIPTION OF THE FIGURES
In the attached drawing is shown in:
FIG. 1a a patient resting with his transparently shown trunk in a supine position on a back plate pertaining to an apparatus for treating cardiac arrest by compression of the sternum, in a perspective view;
FIG. 1b the patient and the back plate of FIG. 1a, with the remainder of the apparatus mounted to the back plate, in the same view;
FIG. 2 an ECG electrode of the invention, mounted on a support, in a unrestrained condition and in a sectional view;
FIG. 3 the ECG electrode of FIG. 2, in the same view but in a restrained condition with the back of a patient resting un the support;
FIG. 4 the back plate of FIGS. 1-3, with the trunk of the patient shown transparent and provided with a first and a second pair of ECG electrodes and their disposition in regard of a positioning grid, in a top view;
FIG. 5 the chest portion of the patient resting on the back plate, with the first electrode pair of FIG. 4 and electric heart vector shown projected on the back plate, in an oblique lateral view;
FIG. 6a an electrocardiogram obtained by recording the ECG signal of the first electrode pair of FIG. 4;
FIG. 6b an electrocardiogram obtained by recording the ECG signal of the second electrode pair of FIG. 4;
FIG. 6c an electrocardiogram obtained by recording the ECG signal of the third electrode pair of FIG. 4.



DESCRIPTION OF PREFERRED EMBODIMENTS
FIG. 1a shows a seemingly lifeless patient in a supine position, the trunk 500 of whom has been placed on a back plate 100 resting on a floor. All clothing on the trunk has been removed in preparation for resuscitation by a central unit 182 (FIG. 1b) for compression of the sternum. In FIG. 1b the remainder of the apparatus is shown in a state mounted to the back plate 100. Mounting is accomplished in the following manner: the free ends of curved right 180 and left 181 legs swivelingly attached by means of joints 184 and 185, respectively, to the central pneumatic compression unit 182 from which a reciprocating plunger ending in a suction cup 183 extends towards the sternum of the patient are mounted in lateral brackets 154; 158 and 156; 159 of the back plate 100 provided with bores 155 for releasable insertion of short shafts (not shown) extending from said free ends. “Left” and “right” designate positions from the patient's perspective. The apparatus, which shares the general design of the LucasTM system, encloses the patient in the sternum region. By a reciprocating movement of the plunger and the suction cup 183 the patient's chest is compressed periodically. In its top or apical position the cup 183 abuts the uncompressed chest at the sternum, from which position the compression cycle starts. The compressor unit is driven by compressed air in a gas flask (not shown).
On its side facing the patient's back the back plate is provided with two ECG electrodes 105 and 132. One of them, electrode 105, is shown in greater detail in FIGS. 2 and 3.
The cylindrical electrode 105 comprises an electrically conductive electrode disk 161 adhesively attached to a non-conductive support element 160 of a suitable polymer like polypropene or polycarbonate, which surrounds a central stem 162 extending from and integral with the electrode disk 161. The electrode disk/support element 161; 160 is mounted in a cylindrical recess 151 in the front face 150 the back plate 100, which rests on a floor 170. The diameter of the recess 151 is slightly larger than the diameter of electrode disk/support element 161; 160 to allow the displacement of the latter combination in a direction perpendicular to the front face 150. A spring coil 165 is firmly attached to the rear side of the support element 160 with its one end and to the bottom 152 of the recess 151 at its other. In its unloaded state shown in FIG. 2 the electrode 105 extends somewhat above the front face 150 of the back plate 100. In its state loaded by the trunk 500 of the patient the front face of the electrode disk 161 is in electrically conducting contact with the patient's skin 501 and level with the front face 150 of the back plate 100. The front face of the electrode disk 161 may even be pressed slightly into the recess 151 by the weight of the trunk and the flexible nature of its soft tissues. This loaded state of the electrode 102 is shown in FIG. 3. Electrical connection of the ECG electrode 102 with an ECG unit (not shown) is provided by means of a flexible electrical conductor 166 attached to the electrode stem 162 at its one end, and to a copper wire 167 molded into the back plate 100 at its other end. The copper wire 167 is coupled to a contact manifold 169 (FIG. 4) to which also the corresponding copper wire 168 of the other electrode 132 and further electrodes, if any, are coupled. Via the manifold 169 the electrodes 105, 132 can be connected with an ECG monitoring unit, which can be integrated into, for instance, the central pneumatic unit 182 for compression of the sternum, or with a separate hand-held ECG monitoring unit or similar. Connection can be physical or wireless.
FIG. 4 illustrates an area for dorsal electrode placement on the front face of the back plate 100. For easy identification of possible electrode positions the area is defined by a grid of squares comprising ten columns in four rows. The squares are consecutively numbered 1-40 starting at the left upper corner and ending at the right lower corner.
The importance of correct positioning of the electrode pairs is illustrated in FIGS. 6a-6c. While the ECG trace obtained by the electrode pair 102-135 (FIG. 4) disposed on the back of a healthy person in squares 2 and 35, respectively, of the positioning grid of FIG. 4 does not contain useful information, the trace obtained by the electrode pair 105-132 disposed in squares 5 and 32 of the positioning grid (FIG. 4) reflects the sinus rhythm of a normal heartbeat. The ECG trace of the electrode pair 2/32 occupying the intermediate position 102-132 (FIG. 6c) has a form between the extremes 105-132 and 102-135. An ECG signal obtained by electrode pair 105-132 (FIG. 6b) thus can be used to monitor the heartbeat of a patient being administered compressions of the sternum by the apparatus of FIG. 2.
Useful ECG electrode pair positions on a back plate are comprised by an angle β of about 45°±25°, preferably of about 45°±15°, formed by the line connecting them with the projection S of the spine on the back plate 100 (FIG. 5) or by an angle α of about 400±25°, preferably of about 400±15°, by the line connecting them with the projection 502 on the back plate 100 of the long heart axis 501; in this assessment it is understood that the position of the heart and thus the direction of the long heart axis 501 varies between individuals. The angles α and β are measured in a caudal direction from the point of intersection of the respective lines.

## Claims

1. An electrocardiogram (“ECG”) electrode for obtaining an ECG reading of a patient in a structure, comprising:
a front face;
a spring to be brought in contact with the structure for pressing the front face against the patient's skin; and
an electrically non-conductive support element integral with the electrode and at least a portion of the electrically non-conductive support element positioned between the electrode and the spring.

2. The ECG electrode of claim 1, in which
the front face is provided with an electrical contact enhancing means.

3. The ECG electrode of claim 1, further comprising:
a stem electrically coupled to the front face, and
a flexible wire coupled to the stem.

4. The ECG electrode of claim 3, in which
the stem is formed integrally with the front face.

5. The ECG electrode of claim 3, in which
the flexible wire is coupled to the structure.

6. The ECG electrode of claim 1, in which
the front face is a portion of an electrode disk, and the electrically non-conductive support element is a rigid polymer material.

7. The ECG electrode of claim 1, in which
the structure defines a recess, and the ECG electrode is located such that the spring is within the recess.

8. The ECG electrode of claim 7, in which
the recess is structured such that the ECG electrode is displaceable within the recess along a direction.

9. The ECG electrode of claim 7, in which
when the spring is in a non-load bearing state, the front face extends from the recess by a short distance.