Systems and methods of synchronizing chest compressions with myocardial activity

A system for providing chest compressions to a patient during cardiopulmonary resuscitation, the system comprising:

• at least one electrocardiogram (ECG) sensor configured to obtain ECG signals of the patient;
• at least one hemodynamic activity sensor configured to detect hemodynamic activity of the patient;
• an automated chest compressor configured to provide chest compressions to the patient, the automated chest compressor being at least one of:
• piston based or compression belt based;
• and
• at least one processor, memory and associated circuitry of a defibrillator device communicatively coupled with the at least one ECG sensor and the automated chest compressor, the at least one processor configured to:
• receive and analyze the ECG signals of the patient,
• receive and analyze signals from the at least one hemodynamic activity sensor,
• determine whether the patient is in asystole based on the analysis of the ECG,
• in response to determining that the patient is in asystole, transmit a signal to the automated chest compressor to begin delivering chest compressions,
• in response to determining that the patient is not in asystole, determine whether a shockable cardiac rhythm is detected based on the analysis of the ECG signals,
• in response to determining that a shockable cardiac rhythm is detected, initiate shock protocol,
• automatically estimate a refractory period following a heartbeat for excluding R-wave identification based on the analyzed ECG signals and for withholding chest compressions during the estimated refractory period,
• adjust the estimated refractory period for withholding chest compressions such that a faster heart rate results in a smaller estimated refractory period and a slower heart rate results in a longer estimated refractory period,
• in response to determining that no shockable cardiac rhythm is detected, determine, based on the analysis of the ECG and hemodynamic signals, whether the patient is in a condition of unconscious hypotension with organized ECG,
• analyze, in response to a determination that the patient is in the condition of unconscious hypotension with organized ECG, the received ECG signals to detect a QRS complex,
• detect a slope of an ECG waveform comprising the QRS complex,
• after the estimated refractory period for withholding chest compressions, identify an R-wave within the QRS complex based on the detected slope for initiating a chest compression timed according to the detected R-wave and at a predetermined time relative to the QRS complex, and
• generate an output to cause the automated chest compressor to initiate the chest compressions outside of the estimated refractory period and at the predetermined time relative to the detected QRS complex based on detection of a leading edge of the R-wave of the QRS complex.