Patent Publication Number: US-2019175443-A1

Title: Mechanical cpr with selective zero-position &amp; compression depth adjustment

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority to co-pending U.S. Provisional Application No. 62/370,654, filed Aug. 3, 2016, and U.S. Provisional Application No. 62/378,651, filed Aug. 23, 2016, both of which are incorporated herein in their entirety for all purposes. This application is also related to International Application No. PCT/US2015/060926, filed Nov. 16, 2015; U.S. application Ser. No. 14/616,056, filed Feb. 2, 2015; and U.S. Provisional Application No. 62/080,969, filed Nov. 17, 2014, each of which are incorporated herein by reference in their entirety for all purposes. 
    
    
     BACKGROUND 
     In certain types of medical emergencies, a patient&#39;s heart stops working, which stops the blood from flowing. Without the blood flowing, organs like the brain will start being damaged, and the patient will soon die. Cardiopulmonary Resuscitation (CPR) can forestall these risks. CPR includes performing repeated chest compressions to the chest of the patient, so as to cause the patient&#39;s blood to circulate. CPR also includes delivering rescue breaths to the patient, so as to create gas exchange in the lungs. CPR is intended to maintain circulation to the patient until a more definite therapy is made available, such as defibrillation or other therapeutic interventions to reverse the underlying cause of the cardiac arrest. Defibrillation is an electrical shock deliberately delivered to a person in the hope of restoring their heart rhythm. 
     To ensure that CPR circulate blood effectively, guidelines by medical experts such as the American Heart Association provide parameters for the chest compressions. The parameters include the frequency, the depth reached, fully releasing after a compression, and so on. Currently, the recommended depth is to exceed 5 cm (2 in.). The parameters also include instructions for the rescue breaths. 
     Traditionally, CPR has been performed manually. A number of people have been trained in CPR, including some who are not in the medical professions, just in case they are bystanders in an emergency event. Manual CPR might be ineffective and the rescuer might not be able to recall their training, especially under the stress of the moment. And even the best trained rescuer become fatigued from performing the chest compressions for a long time, at which point their performance might be degraded. In the end, chest compressions that are not frequent enough, not deep enough, or not followed by a full release may fail to maintain the blood circulation required to forestall organ damage and death. 
     The risk of ineffective chest compressions has been addressed with chest compression devices. Such machines have been known by a number of names, for example chest compression machines, CPR devices, mechanical CPR devices, cardiac compressors and so on. 
     Chest compression devices are used with the patient in supine position, which means lying on his or her back. Such machines then repeatedly compress and release the chest of the patient. In fact, they can be programmed so that they will automatically compress and release at the recommended rate or frequency, and can reach a specific depth within the range recommended by the guidelines. 
     The repeated chest compressions of CPR are actually compressions alternating with releases. The compressions cause the chest to be compressed from its original shape. During the releases the chest is decompressing, which means that the chest is undergoing the process of returning to its original shape. This process starts immediate upon release, but it might return to its original position before the time the next compression starts. In addition, the chest may start collapsing due to the repeated compressions, which means that it does not fully return to its original height after compressions are administered for some time. Conversely, if the patient is not suffering from chest collapse, the patient&#39;s chest returns to its resting height from before the chest compression was administered. 
     Some chest compression devices compress the chest by a piston or a band. Some may even have a suction cup at the end of the piston, with which they lift the chest during the releases. This lifting may actively assist the decompression of the chest faster than the chest would accomplish by itself and by this improve venous return and improve circulation. This type of lifting is sometimes called active decompression. 
     Active decompression may also improve air circulation in the patient, which is a component of CPR. The improved air circulation may be especially critical, given that the chest could be collapsing due to the repeated compressions, and would thus be unable by itself to intake the necessary air. 
     SUMMARY 
     The present description gives examples of CPR devices, software, and methods that may help overcome problems and limitations of the prior art. 
     An example CPR device includes a chest compression mechanism and a processor. The chest compression mechanism is structured to administer chest compressions to the chest of a patient. Each of the chest compressions have a compression depth and the chest of the patient has a resting chest height. The processor is configured to determine a present zero-position and a maximum or minimum zero-position of the CPR device for one or more of the chest compressions. The processor is also configured to determine one or both of a maximum or minimum chest compression depth or a maximum change in zero-position for the CPR device. The processor also receives one or more of rescuer input on chest collapse, one or more patient parameters indicative of chest collapse, or device derived chest collapse data indicative of a change in the resting chest height of the patient over multiple chest compressions and generates chest collapse data based on the received input. In response to the generated chest collapse data, the processor generates instructions to adjust or retain the zero-position of the CPR device based on the chest collapse data up to the maximum or minimum zero-position for the CPR device and adjusts a compression depth for the chest compressions based on the chest collapse data up to the maximum or minimum chest compression depth. 
     In another embodiment, the CPR device has a similar chest compression mechanism to the one described in the previous embodiment and a similar processor. However, the processor in this embodiment determines a present zero-position of the CPR device for at least one of the chest compressions to be administered to the chest of the patient and determines an initial chest compression depth of the chest compression mechanism. It also receives one or more of rescuer input on chest collapse, patient parameter data indicative of chest collapse, or device derived chest collapse data indicative of a change in the resting chest height of the patient over multiple administered chest compressions and generates chest collapse data based on the received input. In response to the generated chest collapse data, the processor generates instructions to adjust or retain the zero-position of the CPR device based on the chest collapse data and to adjust or retain a compression depth for the chest compressions based on the chest collapse data. The processor also generates instructions to adjust or retain chest compression depth to the chest of the patient based on the adjusted or retained zero-position and the adjusted or retained compression depth of the CPR device. 
     In yet another embodiment, the CPR device again has a similar chest compression mechanism to the previous examples and a processor. This processor is configured to determine a first zero-position of the CPR device for at least one of the chest compressions to be administered to the chest of the patient and determine a first chest compression depth of the chest compression mechanism. The processor is also configured to detect a change in the resting chest height. In response to the detected change in resting chest height while administering chest compressions to the chest of the patient, the processor is also configured to automatically adjust or retain the zero-position of the CPR device and administer and adjust or retain chest compressions to the chest of the patient based on the adjusted zero-position. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Non-limiting and non-exhaustive embodiments of the invention are described with reference to the following drawings. In the drawings, like reference numerals refer to like parts throughout the various figures, unless otherwise specified. 
         FIG. 1  is a diagram of components of an abstracted example CPR device. 
         FIG. 2  is a composite diagram showing a sample way in which a motion-time profile may be adjusted according to a detected compression force. 
         FIG. 3  is a flowchart of the operation of an example CPR device. 
         FIG. 4  is another flowchart of a different example CPR device. 
         FIG. 5  shows a cross-section of a patient&#39;s torso with the chest at a neutral position. 
         FIG. 6  is a chart mapping compression depth as it follows chest collapse up to a maximum compression depth. 
         FIG. 7  is a chart mapping compression depth linearly as it follows chest collapse up to a maximum compression depth. 
         FIG. 8  is a chart mapping compression depth non-linearly as it follow chest collapse up to a maximum compression depth. 
         FIG. 9  shows a cross-section of the patient&#39;s torso shown in  FIG. 3  with a chest compression mechanism in position to apply chest compressions. 
         FIG. 10  shows a cross-section of the patient&#39;s torso shown in  FIG. 3  with the chest compression mechanism applying a chest compression. 
         FIG. 11  shows a cross-section of the patient&#39;s torso shown in  FIG. 3  with the chest compression mechanism applying active decompression. 
     
    
    
     DETAILED DESCRIPTION 
     The subject matter of embodiments disclosed herein is described with specificity to meet statutory requirements, but this description does not intend to limit the scope of the claims. The claimed subject matter may be embodied in other ways, may include different elements or steps, and may be used in conjunction with other existing or future technologies. This description should not be interpreted as implying any particular order or arrangement among or between various steps or elements except when the order of individual steps or arrangement of elements is explicitly described. Embodiments will be described more fully hereinafter with reference to the accompanying drawings, which form a part hereof, and which show, by way of illustration, exemplary embodiments by which the systems, devices, and methods described may be practiced. 
     The disclosed cardio-pulmonary resuscitation (“CPR”) chest compression devices, machines, systems, methods, and software perform CPR chest compressions on a patient. Embodiments are now described in more detail. 
       FIG. 1  shows a diagram of components  100  of an abstracted CPR device according to example embodiments. The abstracted CPR device can be configured to perform compressions on a chest of a supine patient  182 . The components  100  include a back plate  139 . In  FIG. 1 , an abstracted version of a patient  182  placed supine on the back plate  139 . A midpoint  138  of the back plate  139  is also shown. An elevation axis  137  starts from midpoint  138  and can be used for determining a resting height of the chest of the patient. The resting chest height can determine the zero-position of the CPR device. The zero-position of the CPR device is the position from which the chest compression mechanism of the CPR device administers chest compressions to the patient. 
     The chest compression mechanism  148  is shown as the arrow indicating motion towards the anterior surface of the patient&#39;s chest and can be a piston or plunger style compression mechanism, one or more rigid arms, or a belt or strap that tightens and releases to apply chest compressions. Any suitable chest compression mechanism that can apply a proper CPR chest compression can be used and following the teachings of the present disclosure those skilled in the art will appreciate that alternative options may be substituted or added to the chest compression mechanisms described herein. 
     The back plate  139  can be part of a retention structure. An abstracted retention structure  140  of a CPR chest compression device is shown in  FIG. 1 . The patient  182  is placed supine within the retention structure  140 . The retention structure  140  retains the body of the patient  182  on the back plate  139 . While the retention structure  140  typically reaches the chest and the back of patient  182 , it does not reach the patient&#39;s head  183 . 
     The retention structure  140  may be implemented in a number of ways. Examples embodiments are disclosed in U.S. Pat. No. 7,569,021, which is incorporated by reference in its entirety; such retention mechanism available from Physio-Control, Inc. in Redmond, Wash. under the trademark LUCAS®. In other embodiments, the retention structure  140  includes a backboard, of which the back plate  139  is a part, and a belt that can be placed around the patient&#39;s chest to apply the chest compressions. 
     The components  100  of the CPR device also include a compression mechanism  148 . The compression mechanism  148  can be configured to perform the compressions to the patient&#39;s chest. The chest compression mechanism  148  administers a chest compression by applying a compression force through activation of the mechanism—a piston, plunger, one or more rigid arms, belt, strap, or the like—towards a target organ, which is typically the patient&#39;s heart in CPR. When the compression mechanism is released, the patient&#39;s chest naturally decompresses, which means it returns to all or some portion of its previous chest height before the chest compression began. Alternatively, the CPR device can include techniques and attachments that can actively apply a decompression force to the patient&#39;s chest to aid in returning it as close as possible to its chest height before the chest compression began or to a target chest height. Active decompression is the application of decompression force to aid the patient&#39;s chest to decompress. Active decompression attachments can include a suction cup, an adhesive surface, or some combination of elements that secures the compression mechanism to the patient&#39;s chest to be able to apply the decompression force. 
     Returning again to  FIG. 1 , the components  100  can also include a driver system  141 . The driver system  141  can be configured to automatically drive compression mechanism  148  according to a compression profile or any set of instructions relating to compressions and active decompressions, if the CPR device includes active decompression capabilities. The compression profile can be a standard or default profile or could be customized in any number of ways, as described below by way of examples. The driving mechanism may cause the compressions to be performed repeatedly in some examples. 
     The compression mechanism  148  and driver system  141  may be implemented in combination with the retention structure  140  in a number of ways. In the above mentioned example of U.S. Pat. No. 7,569,021 the compression mechanism  148  includes a piston, and the driver system  141  includes a rack-and-pinion mechanism. The piston is also called a plunger. In embodiments where the retention structure  140  includes a belt, the compression mechanism  148  may include a spool for collecting and releasing the belt so as to correspondingly squeeze and release the patient&#39;s chest, and the driver system  141  can include a motor for driving the spool with respect to the back plate. 
     The components  100  may further include a controller  110 . The driver system  141  may be controlled by a controller  110  in some examples, such as by the compression profile discussed above. The compression profile is a set of instructions for the manner in which the chest compressions are to be administered to the patient&#39;s chest, including information like the compression depth of the chest compressions to be applied by the chest compression mechanism. The compression depth can be measured by the chest compression mechanism stroke, for example, which is the distance traveled by the chest compression mechanism from its zero-position. One embodiment has a piston-style chest compression mechanism and the compression depth is measured as the piston amplitude that it travels during a chest compression. Another way to measure compression depth is the distance that the patient&#39;s chest moves during a compression. For example, the compression depth can be measured as a difference in the patient&#39;s initial chest height compared to the patient&#39;s residual chest height at a full compression, either internally or externally of the patient&#39;s torso, depending on the devices. Either measurement for chest compression can be used in the example CPR devices disclosed herein. Those skilled in the art will appreciate that additional techniques for measuring chest compression depth can also be used either alternatively or in addition to the two examples previously described. 
     The controller  110  may include a processor  120  that can be implemented in a number of ways, such as with a microprocessor, Application Specific Integration Circuits (ASICs), programmable logic circuits, general processors, etc. While a specific use is described for the processor  120 , it will be understood that processor  120  can either be standalone for this specific use, or also perform other acts, operations or process steps. In some examples, the controller  110  is integrated into the chest compression mechanism  148  and in other examples, the controller is wirelessly coupled to the chest compression mechanism  148  to drive it. 
     The controller  110  can additionally include a memory  130  coupled with the processor  120 . The memory  130  can be implemented by one or more memory chips. The memory  130  can be a non-transitory storage medium that stores programs  132 , which contain instructions for machines. The programs  132  can be configured as a set of instructions to be read and generated by the processor  120 , and to be executed upon reading. The processor executes the instructions by physically manipulating physical quantities, and may result in functions, processes, actions, operations and/or methods to be performed, and/or the processor  120  can cause other devices or components to perform such functions, processes, actions, operations and/or methods. Often, for the sake of convenience only, it is preferred to implement and describe a program as various interconnected distinct software modules or features, individually and collectively also known as software. This is not necessary, however, and there may be cases where modules are equivalently aggregated into a single program. In some instances, software is combined with hardware in a mix called firmware. 
     While one or more specific uses are described for the memory  130 , it will be understood that the memory  130  can further hold additional data  134 , such as event data, patient data, data of the CPR device, and so on. For example, data gathered according to embodiments could be aggregated in a database over a period of months or years and used to search for evidence that one pattern or another of CPR is consistently better (in terms of a selected criterion) than the others, of course correlating with the patient. For example, the outcome of the administered CPR could be tracked and/or linked to the particular CPR technique and/or cardiac event type suffered by the patient. Data could be de-identified so as to protect the patient privacy. If so, this could be used to adapt the devices to use that pattern either continuously or at least as one of their operating modes. 
     The controller  110  may include or cooperate with a communication module  190 , which may communicate with other modules or functionalities wirelessly, or via hard-wired connections. The controller  110  may include or be communicatively coupled with a user interface  114  that receives and displays user instructions and settings, outputs data, alerts and/or prompts the rescuer, etc. The communication module  190  may further be communicatively coupled with another communication device  192  and/or another medical device  194  and can also transmit data  134  to a post-processing module  196 , in some examples. Wireless communications may be by Bluetooth, Wi-Fi, cellular, satellite, near field, etc. Data  134  may also be transferred via removable storage such as a flash drive. Other communication device  192  can be a mobile display device, such as a tablet or smart phone. Other medical device  194  can be a defibrillator, monitor, monitor-defibrillator, ventilator, capnography device, pulse oximeter, regional oximetry device, and the like. 
     In some example embodiments, the communication module  190  can be configured to receive transmissions from such other devices or networks. Therapy can be synchronized, such as ventilation or defibrillation shocks with the operation of the CPR device. For example, the CPR device may pause its operations for delivery of a defibrillation shock, after detection of a patient&#39;s electrocardiogram (ECG), and if the device operation needs to be restarted. If the defibrillation shock has been successful, then operation of the CPR device might not need to be restarted. 
     The controller  110  can also include a post-processing module  196  that can include a medical system network in the cloud, a server such as in the LIFENET® system, available from Physio-Control in Redmond, Wash. The data  134  can then be used in post-event analysis to determine how the CPR device was used, whether it was used properly, and to find ways to improve performance, training, or for any other use. The controller  110  can be configured to control driver system  141 , as indicated by arrow  118 , and can be implemented by wired or wireless signals and so on. Accordingly, chest compressions can be performed on the chest of patient  182  as controlled by controller  110 . 
     In some embodiments, one or more physiological parameters of patient  182  are sensed, for example measured end-tidal CO 2  (EtCO 2 ), return of spontaneous circulation (ROSC) detection, pulse oximetry, regional oximetry, or any other patient parameter. Upon a physiological parameter being sensed, a value of it can be transmitted to controller  110 , as suggested via arrow  119 , through wired or wireless transmission. The transmitted values may further affect how the controller  110  controls the driver system  141 . 
     The controller  110  may be implemented together with the retention structure  140 , in a single CPR chest compression device. In such embodiments, arrows  118 ,  119  are internal to such a CPR chest compression device. Alternately, the controller  110  may be hosted by a different device that communicates with the CPR chest compression device and uses the retention structure  140 . Such communication can be wired or wireless. The different device can be any kind of device, such as the other communication device  192  or the other medical device  194 . An example is described in U.S. Pat. No. 7,308,304, titled “COOPERATING DEFIBRILLATORS AND EXTERNAL CHEST COMPRESSION MACHINES,” the description of which is incorporated by reference in its entirety. Similarly, the user interface  114  may be integrated on the CPR chest compression machine, or on another device. 
     In some examples, the compressions are performed automatically in one or more series, and perhaps with pauses between them, as controlled by the controller  110  and instructed by the processor  120 . A single resuscitation event can be sets of compressions for a single patient and can include active decompression if the device has active decompression capabilities. The driver system  141  can be configured to drive the compression mechanism automatically according to the compression profile. The compression profile can be such that the driving can cause the compression mechanism to repeatedly perform the compressions and active decompression, if present. The chest can be compressed downward from the resting height for the compressions, and then decompress at least partially after each applied compression. Several of the compressions can thus compress the patient&#39;s chest by at least 2 cm downward from the resting height, and frequently more, such as 5 cm or 6 cm, for example. 
     In some embodiments, a force sensing system  149  is included. In embodiments, the force sensing system  149  can be configured to sense an amount of a compression force exerted by the driver system  141  when the chest of the patient has been compressed downward by a certain amount from the resting height. That certain amount can be, for example, 1 cm, 2 cm, or more. 
     The force sensing system  149  may be implemented in different ways. For example, it may include a force sensor, or it may include a strain gauge or a measuring spring with a known spring constant. Such a strain gauge or a measuring spring can be coupled between the compression mechanism  148  and the driver system  141  or the retention structure  140 . In some embodiments, the driver system  141  operates by receiving an electrical current, and the force sensing system  149  includes an electrical detector configured to detect an amount of the electrical current. In other embodiments, the force sensing system  149  includes an accelerometer, a force-sensing resistor, a piezoelectric force sensor, and/or a pressure sensor within a suction cup and/or in a back plate of retention structure  140 . In still other embodiments, the force sensing system  149  measures a difference between forces and infers a force on the patient. In yet other embodiments, a force on a patient stabilization strap is measured which may have a lateral component, for example, from the patient shifting within retention structure  140 . 
     The sample CPR device described in  FIG. 1  can be configured so its chest compressions, zero-position of the device, or both are adjusted. The adjustment can occur by determining one or both of a chest compression depth of applied compression, which can occur before chest compressions begin or after any one or more single or groups of chest compressions are administered to the patient. Oftentimes, patients experience chest collapse during a cardiac event or while chest compressions are being administered. Chest collapse occurs because bones, such as the patient&#39;s ribcage bones, cartilage or organs are move, reshaped or damaged from the cardiac event, from the applied chest compressions or decompression force if any, or for any other reason. Chest collapse is a decrease in the chest height of the patient over time. The disclosed CPR devices account for chest collapse as the CPR chest compressions are administered by adjusting one or both of the zero-position, which is the “starting” position of the chest compression mechanism or the compression depth of the chest compressions, which is the distance the chest compression travels to administer the chest compressions. The zero-position of the CPR device is determined based on the patient&#39;s resting chest height measured before the chest compressions begin or after one or more chest compressions or a group of chest compressions are administered. The zero-position of the CPR device can be evaluated in its “present” state, which means the current zero-position of the CPR device, whether that is prior to chest compressions have begun or between chest compressions or groups of chest compressions. Similarly, the initial depth of the chest compression can be the compression depth of the first chest compression or the first in a series of chest compressions that are applied to the patient. As discussed above, the zero-position, the chest compression depth, or both can be adjusted throughout CPR administered to a patient. In some embodiments, the CPR device may be configured to estimate the initial chest height based on whether the patient has received manual chest compressions from a rescuer prior to application of the CPR device. For example, the CPR device may have a user interface allowing the operator to input whether manual CPR has been performed on the patient. 
     Turning now to  FIG. 2 , as seen in diagram  270 , the chest compressions of a group  210  start from the initially determined chest resting height (EAGO), and reach a maximum compression depth D 5 , measured on minor axis  275 . As seen in diagram  271 , the sensed amount of the compression force is plotted as a line  272  that is different from line  273 . In other words, the sensed amount of the compression force is different from what was expected, or from what was previously sensed in the same session, which could indicate that the resting chest height has changed, and it is now lower, at depth D 2 . The change in chest height can happen because the chest may lose its compactness, and starts breaking down, due to the chest compressions, i.e., the patient is suffering from chest collapse. 
     The resting height lowering means that the compressions of group  210 , which start from the earlier-determined chest resting height EAGO, now impact the chest as their depth crosses the value of D 2 . In some examples, the resting chest height is determined at a first time instant, such as at the beginning of a session with the patient. The resting chest height may then be determined at a second time instant, which occurs after a set of the compressions has been performed after the first time instant. The resting height in the second instant may be updated from what was determined in the first instant. The resting height is measured in any suitable way, such as various sensors like the output of the force sensing system discussed above in  FIG. 1 . 
     In the example of diagram  271 , the updated resting height is determined, after compressions group  210 , to be D 2 . In such embodiments, the applied chest compressions, through a compression profile, can be adjusted in view of the resting height which is determined at the second time instant. In the example of  FIG. 2 , the compression profile is adjusted by setting the new resting height at D 2 , or EAG 2 , and thus resetting the zero-position of the CPR device to a new value. 
     The updated resting height may be discovered also in different ways. The CPR device may pause occasionally, and search for the resting height, for example with small oscillations. In some embodiments, a force value is stored in memory  130  for the force(s) detected by the force sensing system, if one is included in the CPR device. The force value may encode the sensed amount of the compression force, especially if an alert condition has been met. The force value can be of one point, or many, such as in creating line  272 . In some embodiments, communication module  190  is configured to communicate the force value. 
     This approach also can be used for systems that can apply active decompression, such as through using a suction cup or other adhesive attachment, to keep the compression device “attached” to the patient&#39;s chest, as well as systems that do not have such “decompression attachment” mechanisms. In systems without an “attachment” mechanism, some embodiments disclosed herein do not use a “counter force” mechanism to control the force of the chest compression mechanism to keep the pressure plate in contact with the chest during natural decompression, as described in US 2013/0218056, which is incorporated by reference herein in its entirety. In some alternative embodiments, the CPR device includes structures that are configured to apply lateral support and/or lateral forces to the sides of the patient&#39;s chest, as described in US 2015/0272822, which is incorporated by reference herein in its entirety. 
     In some example embodiments, in addition to changing the zero-position of the mechanical CPR device to follow the diminishing rest height, as discussed above in reference to  FIG. 2 , the disclosed mechanical CPR devices also vary the compression depth as a function of the diminishing rest height or with the changing zero-position of the CPR device. The mechanical CPR device may adjust the compression depth by adjusting the chest compression mechanism movement (e.g., such as a piston stroke), adjusting the position of the compression unit relative to the patient, adjusting both the chest compression mechanism movement and the compression unit position, adjusting the distance traveled by the patient&#39;s chest during a compression, or any combination of these system parameters. Following the teachings of this disclosure, those skilled in the art of mechanical CPR devices may adapt other mechanisms to adjust the zero-position of the mechanical CPR device in addition to the examples discussed above and in combination with the adjustment of the compression depth. 
     As mentioned above, the components of the disclosed CPR device shown in  FIG. 1  have a chest compression mechanism and a processor. When driven, the chest compression mechanism administers chest compressions to the chest of a patient suffering a cardiac event. The chest compressions each have a chest compression depth. The patient&#39;s chest has a resting chest height, both before chest compressions begin and again between each delivered chest compression. As discussed above, the chest compression depth can be measured either by the distance traveled by the patient&#39;s chest from its resting height, by the distance traveled by the chest compression mechanism itself or as the patient&#39;s initial chest height compared to the patient&#39;s residual chest height at a full compression. The processor generates instructions for the chest compression mechanism to deliver chest compressions to the patient according to a default or a customized routine, such as a compression profile, for example. The instructions are transmitted to the controller that then drives the chest compression mechanism to carry out the routine. 
       FIG. 3  shows an example system  300  in which a processor analyses various data, including input, and generates additional data and instructions based on that additional data. For example, the processor is configured to determine a present zero-position  302  and a maximum zero-position of the CPR device  304  for one or more of the chest compressions, in some examples. Also, the processor is configured to determine the chest compression depth  306  for any compressions to be administered and one or more, in any combination, of a maximum chest compression depth  308 , a maximum change in zero-position of the CPR device  310 , and/or a minimum compression depth  312 . The processor can also be configured to receive information about whether the patient suffers from chest collapse  314  and/or can receive information from a rescuer about the patient  316 , patient parameter data  318  like as patient physiological data sensed by one or more sensors, stored data like medical records  320 , connected modules  322  like ECG and imaging modules, and the like. The processor can also receive data from any source about the patient&#39;s change in resting chest height or as the patient&#39;s initial chest height compared to the patient&#39;s residual chest height at a full compression  324 . The processor can receive any relevant data about the patient from any source that is either integrated within the CPR device or remotely situated and electrically coupled to the CPR device through a wireless or hard-wired connection. The processor can also receive rescuer data from a rescuer, including observed patient condition data. 
     For example, the processor receives one or more of rescuer input relating to a patient&#39;s chest collapse, one or more patient parameters that indicate that the patient suffers from chest collapse, or chest collapse data indicative of a change in the resting chest height of the patient over multiple administered chest compressions whether those chest compressions are manually administered or administered mechanically by the CPR device disclosed here or any other CPR device. The processor can receive any combination, including multiples of each type of data that relate to a patient&#39;s chest collapse. 
     The processor is configured to generate chest collapse data  326  based on all or any combination of the input or data it receives about a patient&#39;s chest collapse. In response to generating the chest collapse data, the processor generates instructions that can be sent to the controller  328  or other driver system that drives the chest compression device to administer chest compressions to the patient. The generated instructions can include an instruction for the controller or other driver system to adjust the zero-position of the CPR device  330  and the compression depth of the chest compression  332 , which can be either the distance the patient&#39;s chest is compressed or the distance traveled by the chest compression mechanism or the patient&#39;s initial chest height compared to the patient&#39;s residual chest height at a full compression, based on the chest collapse data. In some examples, if a maximum zero-position for the CPR device is set, then the zero-position can be adjusted up to the maximum zero-position of the CPR device  334 , as shown in  FIG. 3 . For those CPR devices that have active decompression, such as the example shown in  FIG. 3 , the processor can also adjust the zero-position of the CPR device based on the active decompression as well. In some embodiments, some or all of this data is stored in non-volatile memory so that it is not lost if the CPR device&#39;s power is interrupted (e.g., a battery runs out of stored power or is swapped out of the CPR device). This allows the CPR device to “know” the chest heights, zero-positions, etc. when power is restored. 
       FIG. 3  shows that the processor also adjusts the compression depth  332  of the administered compressions. In this example, the compression depth is adjusted up to a maximum compression depth  338 , which can also affect the depth of the active decompressions  340  as well, in the examples that include active decompression, such as shown in  FIG. 3 . As discuss further below, the compression depth can be adjusted linearly or non-linearly  342  or according to some other profile in some examples. The compression depth only changes up to its maximum compression depth at which point it remains constant at the maximum depth for the remainder of any additionally administered chest compressions, if any. Likewise, if a maximum chest compression depth is set, then the compression depth can be adjusted up to the maximum chest compression depth. The processor&#39;s generated instructions include an instruction to adjust the zero-position of the CPR device and the chest compression depth of the administered chest compressions. The instructions can also include an instruction for the controller to drive the chest compression mechanism to administer chest compressions to the chest of the patient based on the adjusted zero-position and the adjusted compression depth of the CPR device  344 . 
     In another example shown in  FIG. 4 , the processor is configured to determine a zero-position of the CPR device for at least one of the chest compressions to be administered to the chest of the patient and also determine a chest compression depth of the chest compression mechanism  400 . The processor can then detect a change in a resting chest height of the patient  402 . In response to the detected changes in the resting chest height of the patient while administering chest compressions, the processor can also be configured to automatically adjust the zero-position of the CPR device  404  and generate instructions to transmit to the controller to drive the chest compression mechanism to administer chest compressions to the chest of the patient based on the adjusted zero-position. This kind of adjustment to the zero-position of the CPR device can occur before chest compressions begin or after any administered chest compression prior to a subsequently administered chest compression. It can occur after each chest compression, after a series of chest compressions, after a period of time, or after a threshold or target change in the resting height of the patient. 
     For example, as a patient&#39;s chest collapses while receiving CPR, the mechanical CPR device determines a change in “resting” chest height (i.e., the change in chest height due to chest collapse, as discussed above) and, in response: (1) adjusts the zero-position of the mechanical CPR device to match the change in “resting” chest height; and (2) also adjusts a “compression depth” of the CPR device (either a chest compression mechanism position, such as piston stroke or the distance the patient&#39;s chest travels during an applied chest compression) to change the chest compression depth to map the change in chest height. The change in compression depth can mirror the change in chest height or can be some variation of the change in chest height, such as a fraction of the change in chest height or the like. Also, the change in compression depth can also change with the change in chest height but at a slower pace, such as tracking a particular target change in chest height or a target pace at which the patient&#39;s chest height is changing or collapsing. 
     In the example shown in  FIG. 4 , the chest compression depth also can be adjusted up to a maximum compression depth  406 , and/or maximum change in zero-position, in some examples. The maximum compression depth can be a depth that would avoid injury to the patient&#39;s organs, blood vessels, or the like or is customized to the patient&#39;s biological or physiological parameters. The maximum compression depth can be measured by any suitable means including measuring the distance traveled by the chest compression mechanism, such as a piston stroke, or by the distance traveled by a patient&#39;s chest during a compression. Similarly, the active decompression, if the CPR device includes active decompression capabilities, can also be automatically adjusted based on the changes in the resting height of the patient  408 , as shown in  FIG. 4 . 
       FIG. 5  shows the patient&#39;s torso  500  with its chest height at a neutral position prior to any chest compressions being administered  502 . The dashed line shows the start position or “resting height” of the patient&#39;s chest  504 . When the CPR device is positioned to administer chest compressions, it is be positioned to contact the anterior surface of the patient&#39;s chest so that the chest compression mechanism is aligned with the patient&#39;s heart  506  to compress the heart  506  towards the patient&#39;s spine  508 . 
     As discussed above, the patient&#39;s chest height can be determined before chest compressions begin or between chest compressions or a series of chest compressions. 
       FIG. 6  shows a chart of the compression depth  600  being adjusted with the changing chest height  602  up to a maximum allowable compression depth  604 . The chest height  602  and zero point  606  of the chest are slightly offset in the figure to clearly illustrate their progression over a series of chest compressions. The compression depth  608  changes over the applied chest compression in a way that mirrors the change in the chest height  602  of the patient until it reaches the maximum compression depth  604  set by the CPR device. Once the compression depth reaches its maximum  604 , it remains at a constant depth  610  equal to the maximum depth until chest compression terminate in the example shown in  FIG. 6 . The chest compression depth is limited by the set maximum chest compression depth for the remaining chest compression or a specific number of or time period of additional chest compressions, in this example. In other examples, the compressions can terminate when the maximum chest compression depth is reached. 
     In one embodiment, the maximum compression depth is set so that the distance between a pressure plate of a piston-type chest compression mechanism and the top surface of the back plate on which the patient is supine is 7 cm. The pressure plate is integrated in the chest compression mechanism and the back plate is the surface on which the patient&#39;s back rests in the supine position. The maximum compression depth can be measured by the distance traveled by the piston from the initial zero-position or the estimated initial zero-position (e.g., when manual CPR was previously performed), in some examples. In some embodiments, the CPR device includes a back plate or support structure with a pressure plate integrated within the chest compression mechanism that detects the force applied to the patient&#39;s chest during chest compressions. The back plate is mechanically designed so that the maximum extension of the pressure plate of the chest compression mechanism during a compression is 7 cm above the highest point of the back plate. In other embodiments, this distance can be programmed or set into the CPR device to allow users to select a different minimum distance between the pressure plate and back plate, such as within a range of 7-10 cm. 
     In this example, the processor receives input from a rescuer and generates instructions for the controller to drive the chest compression mechanism to this upper limit of the maximum chest compression depth or maximum extension of the pressure plate in this example. At the maximum compression depth, the processor can be configured to either limit the compression depth at the maximum compression depth and continue chest compressions or terminate chest compressions when it reaches the maximum compression depth. In other embodiments, in addition to the maximum compression depth, the device is also configured with a maximum change in zero-position, which can also be measured from the initial zero-position measured before chest compressions began in some examples. The maximum change in zero-position can be set at 5 cm. In other embodiments, a user, such as a rescuer, can select or set the maximum change in the zero-position of the CPR device. For example, a rescuer sets the maximum change in zero-position of the CPR device within a range of 4-10 cm. In this example, the user is the rescuer although in other examples, discussed further below, the user can include others involved in treating the patient, such as remotely-located medical professionals at a central command center. The term user or rescuer includes both a single rescuer and multiple rescuers and extends to all rescuers providing CPR treatment to the patient regardless of physical location or proximity to the patient. 
     In other embodiments, the maximum depth and/or zero-position change can be configured as a fraction of the initial chest height of the patient or the initial zero-position of the CPR device. For example, in some embodiments measuring the compression depth as the distance traveled by the chest compression mechanism from its zero-position, the maximum compression depth and/or zero-position change for adults ⅔ for compression depth and/or ⅓ for zero-position change. For children, the maximum compression depth is ⅓ and/or the maximum zero-position change is ⅙. In some embodiments, the maximum compression depth can be set or programmed into the CPR device by a rescuer as a default setting, such as by the processor receiving the rescuer input, which can be either manually input or the processor could generate a prompt to request that the rescuer set the maximum compression depth and/or maximum zero-position. In another embodiment, the maximum compression depth and/or maximum zero-position can be automatically determined by the mechanical CPR device as a function of the initial zero position or can be adjusted by a rescuer after examining the patient, etc. In some embodiments, the CPR device is configured to “automatically adjust” the zero-position at a defined rate, e.g., over a set time period or changing time period, tracking a pace of the chest collapse, or the like. For example, the CPR device can be configured to automatically adjust every 2 minutes while chest compressions are being administered, or any other time period, or when a force threshold is reached or a particular pace of the chest collapse is sensed. 
     In a further enhancement of the above embodiment, in CPR devices that also have active decompression, the amount of active decompression can also depend on the zero-position of the patient&#39;s chest as it changes due to chest collapse. For example, the CPR device can be configured to implement a maximum “uplift” of the patient&#39;s chest from the zero-position during active decompression. The maximum uplift is the maximum amount of active decompression that can be applied, including any characteristics of active decompression, like uplift force or distance, for example. In one example, the maximum uplift is 5 cm, while in other embodiments it can range from 1-10 cm. In other embodiments, the maximum “uplift” from the zero-position can be based on a force measurement, such as the active decompression can be set by default or rescuer input to be set or selected in the range of 13-550 N. 
     In another embodiment, as the chest collapses during CPR, the mechanical CPR device determines the change in “resting” chest height and, in response: (1) adjusts the zero-position of the mechanical CPR device to match the change in “resting” chest height; and (2) also adjusts its chest compression mechanism position to change the compression depth linearly with the change in chest height as measured from the initial chest height. In this example, the compression depth is measured as the chest compression mechanism&#39;s amplitude. This linear mapping of the chest compression depth to the change in the zero-position of the patient can occur up to a maximum compression depth as measured from the initial zero-position, in some examples, although in other examples CPR device may have a maximum compression depth that is limited by the dimensions and/or implementation of its hardware. For example, if the reduction from the initial chest height is ΔD CH , then the change in compression depth ΔD CD  is: 
       Δ D   CD− =α(Δ D   CH ), where α is less than 1
 
     This linear change in compression depth with the change in chest height  700  is illustrated in  FIG. 7  with the chest height  702  and zero-position  704  slightly offset in the figure so that both can be easily illustrated. The maximum compression depth  706  measured from the initial zero-position of the patient&#39;s chest can be determined and set as described in any of the disclosed examples. The compression depth  708  changes linearly with the change in the chest height. That is, the compression depth steadily decreases in a linear progression with each chest compression and each change in compression depth consistently is smaller until it reaches the maximum compression depth. In addition, in embodiments having a maximum change in zero-position, such as the example shown in  FIG. 7 , this maximum change in zero-position can be determined in any suitable manner discussed herein. In embodiments using bands or belts instead of pistons or plungers, chest collapse may be detected in other ways, such as by detecting a change in intra-thoracic impedance, which may be related to chest volume. In the corresponding examples with a belt or band for the chest compression mechanism, the maximum chest compression depth relates to a maximum constricting force and/or reduction in circumferential length of the band or belt. As discussed above, any suitable chest compression mechanism can be adapted to the disclosed technique of mapping the compression depth and/or the zero-position to the chest collapse of the patient. 
     In another embodiment, as the chest collapses during CPR, the mechanical CPR device determines the change in “resting” chest height and, in response: (1) adjusts the zero-position of the mechanical CPR device to match the change in chest height; and (2) also adjusts its compression depth to change non-linearly with the change in chest height or zero-position. In this example, the compression depth is measured as the chest compression mechanism&#39;s amplitude. In this case, the mapping occurs differently than the above example with linear mapping, but the techniques to determine chest compression depth and/or zero-position of the CPR device can be performed in a similar or the same manner. The compression depth change shown in  FIG. 8  in this example can be mapped non-linearly up to a maximum compression depth as measured from the initial chest height  800 . As shown in  FIG. 8 , the chest height changes  802  can be divided into ranges  804 , with the compression depth remaining constant  806  while the chest height is within that range of heights  804 . Each range has a compression depth that is different from one or more of the other ranges. Additionally, the zero-position  808  can change linearly with the change in the patient&#39;s chest height, as shown by the solid line of the zero-position in  FIG. 8  or can also be changed non-linearly as shown in the dashed line  810  in  FIG. 8 . For the non-linear changes in zero-position, it can follow a similar non-linear pattern as the change in compression depth or it could differ from the change in compression depth depending on the desired configuration of the CPR device. Following the teachings of this disclosure, those skilled in the art of mechanical CPR devices can implement other linear and non-linear functions to “map” chest height to compression depth and/or zero-position. In other embodiments, the CPR device can have a maximum compression depth  812  which may also depend on a maximum compression force threshold for the chest compression mechanism. For example, if the compression force reaches 600 N, the processor generates an instruction for the CPR device to limit the chest compressions to the associated maximum compression depth  812  or to terminate the chest compressions or to change one or more characteristics of the administered chest compressions, such as force, compression depth, zero-position, etc. 
     In another embodiment, as the chest collapses during CPR, the mechanical CPR device determines the change in “resting” chest height and, in response: (1) adjusts the zero-position of the mechanical CPR device to match the change in chest height; (2) adjusts compression depth, either the compression mechanism&#39;s amplitude or the distance the patient&#39;s chest travels during a compression; and (3) in a subsequent detection of chest collapse, the device while keeping the same zero-position, administers active decompressions and alters the compression depth so the compressions reach the same anatomical structure during each compression as before the change in chest height or chest collapse occurred, i.e., increasing the stroke length of a piston- or plunger-style compression mechanism but not changing the in-patient or depth to target anatomical structure depth. For example, the target anatomical structure is the patient&#39;s heart, as shown in  FIGS. 9-11  below. 
     Some of the example CPR devices disclosed here have or communicate with an imaging module, such as an ultrasound imaging module, which is configured to detect the anatomical structure. The position of the anatomical structure can then be used to further adjust the zero-position of the CPR device and/or the chest compression depth. The imaging module is electrically coupled, either by wireless or hard-wired connection, to the processor that receives the imaging input and determines the adjusted zero-position and/or compression depth additionally based on the imaging input. The imaging module can be any suitable imaging device including, but not limited to, ultrasound, ultra-wide band (UWB) imaging systems, or other imaging technology. In a further enhancement, the CPR device may be configured to change the zero-position of a subsequent chest compression if the chest height further decreases or may also be configured not to change the zero-position on a subsequent change in “resting” chest height based on the imaging input. 
     In another embodiment, the mapping of the change in chest height to a change in compression depth may depend on other patient or other parameters, such as the age of the patient, the size of the patient, the gender of the patient, whether the patient has an implanted cardiac assist device, whether a ventilator is being used, whether a defibrillator is being used, etc. For example, the CPR device may be configured to receive input from a rescuer for one or more of these parameters. The rescuer input can be observed data, such as the rescuer observing the condition of the patient or other input like whether the patient received prior manual or mechanical CPR prior to using the disclosed CPR device. As with any of the other sensed, observed, generated, measured, stored, or other input discussed in this application, the processor receives the input and can generate instructions regarding adjusting the zero-position and/or the compression depth of the CPR device. 
     Some of the example CPR devices have a communication module that is configured to request and/or receive information from ventilators, defibrillators, etc., and/or data (e.g., age, gender, implanted devices) from a patient care record database. The communication module transmits the data to the processor that determines whether to additional adjust the zero-position and/or the compression depth of the CPR device based on this information. For example, the increase in compression depth as the chest collapses may be reduced more quickly for children and elderly patients. Patients concurrently receiving ventilation therapy with CPR may have an inflated chest cavity which alters the patient parameters if the same patient were not receiving the ventilation therapy. 
     The communication module can also communicate with a remote computing device. The remote computing device can be any type of remote computing system such as a central server that stores medical data about a patient or addition algorithms or routines that can be used to help the processor of the CPR device determine the adjusted zero-position and/or the adjusted compression depth. The remote computing device can also be a command center in which the rescuer of the CPR device can communicate with other medical or other types of professionals or rescuers that are physically located at a remote station from the patient receiving CPR. For example, the remote professional are medical professionals that can help aid the rescuer in administering emergency care to the patient, operating the CPR device, and also those at a medical facility that can help prepare for the arrival of the patient during patient transport to the medical facility. 
     Following the teachings of this disclosure, those skilled in the art of mechanical CPR devices will appreciate that other embodiments of the present invention can have different functions or mappings to adjust the compression depth in response to a change chest height and/or other parameters. Also, those skilled in the art will appreciate that data from anywhere can be transmitted to or from the CPR device to be used by the processor in determining the adjusted zero-position and/or the adjusted compression depth. Further, the processor is electrically coupled to the chest compression mechanism although it may or may not be integrated into the same housing or physical device. In the example above with a remote command center, the remote command central could control the operation of the CPR device from afar. In the alternative examples with an integrated processor and chest compression device, the rescuer controls the CPR device from the patient&#39;s location. 
     The disclosed CPR devices can be configured to capture, record, and/or transmit (including making the data accessible to rescuers and other users via a port or connector) data related to the changes in zero-position, patient resting chest height, and other parameters of the compressions or the CPR device. 
     In the disclosed CPR devices that include a decompression attachment mechanism (e.g., suction cup), the CPR device can administer active decompression, the CPR device can capture, record, and/or transmits data related to automatic adaptation of the CPR device compression duty cycle, which can include compression depth/distance, rate, speed up and down of the chest compression mechanism, compression and decompression phase duration, over-decompression distance, overall chest compression mechanism amplitude or movement, and any other data or parameters associated with the active decompression. The CPR devices with active decompression can also capture, record, and/or transmit data related to the automatic adaptation of the CPR device compression initial zero-position to the resting position of the chest before chest compressions start, which is the zero-position from which both compression depth and over-decompression distance are calculated. 
     Still further, some of the disclosed CPR devices capture, record, and/or transmit, either alone or in combination with each other or any of the data discussed above, data relating to the patient chest height, which is the patient&#39;s neutral chest height at rest. Such resting chest height data can include the distance measured by device or user or adjunct technology, and/or the zero force exerted on the chest compression device, such as a piston and or pressure pad and or suction cup if the CPR device has active decompression, and absolute data points or changes in same patient over time. 
     The disclosed CPR devices can also capture, record, and/or transmit, either alone or in combination with each other, residual patient chest distance at the starting position or default position of the CPR device itself (from the patient&#39;s back to the start position of the CPR device), the distance from the patient&#39;s back to the start position of CPR device, and/or the force exerted on the chest compression mechanism, such a piston and or pressure pad and/or suction cup (if the CPR device can perform active decompression), at a starting or default position of the CPR device, and the absolute data points throughout administration of the CPR to the patient or changes to it over time.  FIG. 9  shows an example CPR device  509  positioned to administer chest compressions to the patient shown in  FIG. 5  with the resting chest position  502  of the patient guiding the zero-position of the CPR device  504 . In  FIG. 9 , the chest compression mechanism  510  has a suction cup  512  to perform active decompression and is positioned over an anterior surface of the patient&#39;s chest, just above the patient&#39;s heart  506 . The chest compression mechanism  510  is positioned at the start position or zero-position  504  of the CPR device at which time the patient either has not yet experienced chest collapse or chest compressions with the mechanical CPR device have just begun so this starting point is the zero-position  504  from which the CPR device will be adjusted. 
     The disclosed CPR devices can further capture, record and/or transmit, either alone or in combination with each other, a residual patient chest distance at full compression (from patient back to deepest compression point of chest), for example.  FIG. 10  shows a full compression of the CPR device  509  on the patient&#39;s chest in which the chest compression mechanism  510  applies a force to the patient&#39;s chest to compress the heart  506 . The chest compression mechanism  510  moves from the its starting zero-position to the compression depth  514 , which in this example is measured as the distance that the compression mechanism travels during a chest compression. The chest compression mechanism  510  compresses the heart towards the patient&#39;s spine  508 . The full compression extends the chest compression mechanism to its greatest compression distance for that chest compression, which may or may not be a maximum chest compression depth, if one exists for the CPR device. At the full chest compression depth  514 , the patient&#39;s chest compresses to a residual chest height  516 , which is less than the patient&#39;s resting chest height  502  shown in  FIG. 9 . 
     The residual patient chest distance at the full compression is the distance that the patient&#39;s chest was compressed at the full compression. Also, the disclosed CPR devices can capture, record, and/or transmit the this distance measured by the CPR device or the rescuer or other device component or ancillary technology, and/or the force exerted on the chest compression mechanism, such as the piston and/or a pressure pad and/or a suction cup at the full chest compression. The CPR device can additionally capture, record, and/or transmit the absolute data points or changes over time related to any aspect of the chest compressions that are administered, the adjustments made to the chest compression depth and/or the zero-position, the parameters of the CPR device, and/or any other absolute data points or changes. For example, other data points include tilt, orientation and/or angle of the patient and/or CPR device, Further, the CPR devices can capture, record, and/or transmit data relating to the gap between the resting or neutral position of the patient&#39;s chest and the start position or zero-position of the CPR device, the internal distance from the patient&#39;s chest to the device pressure pad, and/or the absence of force or a defined amount of force (negative or positive) that is exerted on the chest compression mechanism, such as the piston and/or pressure pad, and/or suction cup at the start position or zero-position of the CPR device, including the absolute data points or changes to this data over time. 
     For those example devices that have active decompression, such as those shown in  FIGS. 9-11 , the disclosed CPR devices  509  can further capture, record, and/or transmit, either alone or in combination with each other, an expanded patient chest height at a full decompression or over-decompression position  520 , such as shown in  FIG. 11 . The expanded chest height at the full decompression  520  is greater than the patient&#39;s resting chest height before the chest compression or decompression began. The position of the chest compression mechanism at the full decompression  518  is shown to exceed the start position  504  of the chest compression mechanism  510 . Example data that can be captured about the over-decompression includes the internal distance from patient&#39;s back to the full height of the over-decompression point of chest and/or an absence of force or a defined amount of force (negative or positive) exerted on the chest compression mechanism, such as the piston, pressure pad, and/or suction cup at the start position. Any of this data relating to active decompression can be absolute data points or changes over time, as with the other capture, recorded, and/or transmitted data disclosed here. 
     The CPR device can still further be configured to capture, record, and/or transmit, either alone or in combination with each other, data relating to the patient&#39;s gender, age, length or height, weight, chest circumference, and chest width. Other patient data relating to the patient&#39;s cardiac event and/or the CPR treatment can also be captured, recorded, and/or transmitted in a similar manner, such as the duration of the chest compressions administered, whether the chest compressions were manual, mechanical, or assisted. Still further the patient&#39;s suspected cause of the cardiac event can be captured, recorded, and/or transmitted, such as coronary or pulmonary thrombosis, accidental hypothermia, pregnancy, trauma, electrolyte imbalances, and the like. Even further data can be captured, recorded, and/or transmitted, either alone or in combination, relating to the CPR device measurements, rescuer input provided to the device, physiological measurements of any kind including, but not limited to, end-tidal CO 2  (EtCO 2 ), saturation of peripheral O 2  (SpO 2 ), regional oxygen saturation, cerebral oxygen saturation, blood pressure, blood flow, intra-thoracic pressures, ventilation data, and the like, in both absolute data and/or changes over time. 
     Also in some embodiments, the data can include the change in depth/over-decompression/chest compression mechanism amplitude in relation to the above parameters when chest compressions are designed to, alone or in combination: (1) linearly change compression depth, zero-position, and/or active decompression based on a percentage of anterior posterior chest size; (2) linearly change depth between a minimum and maximum compression depth value or active decompression value or overall chest compression mechanism zero-position; and/or (3) non-linearly change the compression depth or active decompression or overall chest compression mechanism zero-position based on ranges of chest sizes. Also in some embodiments, the data can include the change in force (positive or negative) of the chest compression mechanism, such as the pressure pad, piston, or suction cup, in relation to the above parameters when the chest compressions are designed to: (1) linearly change in compression force or active decompression or overall chest compression mechanism force based on a percentage of chest stiffness; (2) linearly change in force between a minimum and maximum force value or active decompression value or overall chest compression mechanism force; and/or (3) non-linearly change in force based on segments of chest stiffness. 
     In some embodiments, the mechanical CPR device has a “collapse” mode for use with patients with a collapsed chest, as described above. In the “collapse” mode, various embodiments of the mechanical CPR device operate as described above to diminish compression depth, with or without changing the zero-position of the chest compression mechanism. The processor can receive certain data and then generate instructions to the controller to drive the chest compression mechanism in collapse mode. In some embodiments, the mechanical CPR device has a user interface (UI) that allows the rescuer to input a signal to cause the CPR device to enter the collapse mode. For example, a rescuer may be informed that the patient has been undergoing manual CPR prior to the rescuer&#39;s arrival, which caused the patient&#39;s chest to collapse before the mechanical CPR device has been deployed for this patient. The rescuer can then use the UI to configure the CPR device into a collapse mode. Accordingly, the CPR device&#39;s first compressions can be “reduced” from a default depth, which may initially be set at a depth recommended by the American Heart Association® or European Resuscitation Council® guidelines. In some embodiments, the CPR device is configured to issue one or more prompts to the rescuer to request rescuer input on whether the patient has already received CPR, such as manual CPR. For example, the CPR device issues these prompts when it is initially deployed for the patient. In some embodiments, the UI is electrically coupled to the CPR device through a wireless or hard-wired connection. The UI may be separate or separable from the CPR device and remotely communicate with the CPR device to enter/exit a collapse mode or can be integrated into the CPR device to perform the same function. 
     In other “collapse mode” embodiments, the mechanical CPR device is configured to automatically detect if the patient has a collapsed chest without rescuer input. For example, some embodiments with automatic collapse mode detection have one or more suction cups or other “attachment” mechanisms. In such embodiments, when the CPR device is initially deployed for a patient, it is configured to attach the one or more attachment mechanisms to the patient&#39;s chest and perform an active decompression and/or detect an initial zero-position, as disclosed in U.S. patent application Ser. No. 14/137,721 filed Dec. 20, 2013, which is incorporated herein by reference in its entirety. The CPR device is configured to sense the decompression force during this active decompression and the distance traveled by the suction cup or pressure plate during the decompression to reach a predetermined decompression force. In some examples, the predetermined decompression force is 3 N, but it could be other values in alternative examples, such as a range of 1-25 N. Further, the CPR device can be configured to measure the decompression distance, which if the decompression distance is greater than a threshold, the patient&#39;s chest is deemed to be collapsed and the CPR device would automatically enter a “collapse mode.” For example, the decompression distance can be 3 cm in one embodiment or a range of distances in other examples. 
     In other embodiments, the imaging modules discussed above can be used to detect chest collapse. They can either be integrated with or separate but in electrically communication with the mechanical CPR device. The processor can be configured to automatically request data from the imaging module upon activation of the CPR device, which can occur at powering on or upon a rescuer deploying the CPR device for treatment. In another example, upon detection of chest collapse using any of the disclosed methods, the CPR device can be further configured to provide active decompression to a predetermined “height” above the initial chest height detected by the CPR device and/or a predetermined force. In this example, the initial chest height is already collapsed. For example, the active decompression height can range from 0 to 10 cm and the active decompression force can range from 1 to 1000 N. 
     Other embodiments include combinations and sub-combinations of features described or shown in the drawings herein, including for example, embodiments that are equivalent to: providing or applying a feature in a different order than in a described embodiment, extracting an individual feature from one embodiment and inserting such feature into another embodiment; removing one or more features from an embodiment; or both removing one or more features from an embodiment and adding one or more features extracted from one or more other embodiments, while providing the advantages of the features incorporated in such combinations and sub-combinations. As used in this paragraph, feature or features can refer to the structures and/or functions of an apparatus, article of manufacture or system, and/or the steps, acts, or modalities of a method.