ted external home defibrillator for home consumer innovation
DESCRIPTION
Sudden Cardiac Arrest (SCA)-ventricular fibrillation (VF)- kills 350000 people in the US alone, each year, about 3 million worldwide, at the prime-time of their life, mostly witnessed and at home /office. Defibrillation procedure must be performed as soon as possible: survival decreases by 10% for every minute of delay-therefore ambulance help at home-too late! At present, only very few of SCA victims at home survive and many- in coma, in nursing homes. TED is a home consumer solution that is much more affordable and reliable. The novelty in our defibrillator device is based on a computerized modification of the alternating current, from the mains , existing in every home, to the FDA-approved biphasic defibrillatory wave . Inventors and patent holders: Prof. A. Teddy Weiss & team at Hadassah Hospital, Jerusalem, Israel Contact: [email protected]TRANSCRIPT
TED-‐Time and life-‐saving External Defibrillator: a Home AED
Inventors and patent holders: Prof. A. Teddy Weiss & team at Hadassah Hospital, Jerusalem, Israel [email protected]
• Sudden Cardiac Arrest (SCA)-‐ventricular fibrilla<on (VF)-‐ kills 350000 people in the US alone, each year, about 3 million worldwide, at the prime-‐<me of their life, mostly witnessed and at home /office.
• Defibrilla<on procedure must be performed as soon as possible: survival decreases by 10% for every minute of delay-‐therefore ambulance help at home-‐too late! At present, only very few of SCA vic<ms at home survive and many-‐ in coma, in nursing homes.
• TED is a home consumer solu<on that is much more affordable and reliable. The novelty in our defibrillator device is based on a computerized modifica<on of
the alterna<ng current, from the mains , exis<ng in every home, to the FDA-‐approved biphasic defibrillatory wave.
Sudden Cardiac Arrest The Need
• External Defibrillators-‐ used in hospitals, since 1960s • AICD-‐for the very high risk pts-‐since 1980s • AED used by trained emergency personnel have become an
essen<al link in the “Chain of Survival”(CPR), since 1980s • The logical extension of the AED concept is the Public Access
Defibrillator (in airplanes, airport, casino)-‐infrequent use, by laymen and since safe-‐ FDA approved its use at home-‐2000
• A further logical extension of the Public Access Defibrillator is our TED -‐ Personal Defibrillator to be used at home/office
Sudden Cardiac Arrest The Evolu<on
• VERY HIGH COST (20,000$) • NEEDS OPERATIVE PROCEDURE (RISKY) • MAY DELIVER INAPROPRIATE SHOCKS • NEEDS CARE AND REPLACEMENT • PSYCHOLOGIC BURDEN • END-‐OF-‐LIFE PROBLEMS
Current Solu<ons AICD
• HIGH COST PER UNIT (1000-‐2000$) • HIGH COST FOR MAINTENANCE (about 2000$ PER YEAR). -‐-‐ SINCE INTENDED FOR LONG STORAGE-‐ MAY NEVER BE USED OR
CHECKED
-‐-‐WHEN NEEDED IN EMERGENCY-‐MAY NOT WORK: BATTERY OR CAPACITOR FAILURE
• NO PACING CAPABILITIES IN CASE OF VERY SLOW HEART RATE OR ASYSTOLE
• NOT CLOSE ENOUGH TO SCA VICTIMS (ONLY 7% OF SCA-‐WERE IN 4 MINUTE DISTANCES FROM AEDs LOCATED IN PUBLIC PLACES).
Current Solu<ons AEDs-‐ in public places
• MAINTENANCE COST IS HIGH-‐2363$/YEAR
• AS REPORTED BY ZOLL
Current Solutions AED
• Use the AC mains as source of energy
• Shape by computer the sinusoidal waveform-‐to a similar defibrilla<on wave as that of a standard AED
• Maximum flexibility in future waveform genera<on achieving bener results with less Energy • Use a High Voltage Step Up Transformer
TED Solu<on Main ideas
A Typical Monophasic Waveform Basic Output Waveform Classic Style
0 5 10 15 20 25 30 35 40 45 50
Time (msec)
A Typical AC-‐derived Biphasic Waveform Basic Biphasic Output Waveform Classic Style
0 5 10 15 20 25 30 35 40 45 50
Time (msec)
TED Solu<on
• Immediately opera<onal • No delay in repeated opera<on allowing: – Repeated defibrilla<on , no need to recharge – Pacing in case of Cardiac Stands<ll or Bradycardia – Pacing override for VT termina<on
• No Need for baneries and capacitor • Lower cost , more reliable than AEDs Therefore-‐ideal for home-‐use
Advantages TED Solu<on
Leading to …
• Lower cost per unit
• Maintenance Free
• Reliable
Therefore ideal for Use at Home Preferable to existing AEDs
• It should be recommended by physicians to pa<ents at increased risk
of SCA-‐following myocardial infarc<on(MI), hypertrophic or dilated cardiomyopathy or gene<c inclina<on for ventricular arrhythmias
• It could be an alterna<ve treatment for pa<ents who are candidates for surgically implanted defibrillator-‐ AICDs: poor Leo Ventricular Func<on-‐in US alone, A. Moss es<mates about 10 million pts=200 billion $-‐NO state economy can afford it! Its use in developing countries-‐limited
• Pa<ents post MI, or at risk for MI, or with heart failure
• 50% of men and 63% of women SCA vic<ms previously reported no CHD symptoms,-‐it may afflict anyone, any<me...
Sudden Cardiac Arrest The market
AICD candidates
LVD-‐CHF
Post MI Good LV
High risk for MI Age> 40
TED targets by risk group
AICD Automa<c Internal Cardiac Defibrilla<on (X20) LVD Leo Ventricular Dysfunc<on (X10) CHF Conges<ve Heart Failure (X8) MI Myocardial Infarc<on (X5)
Sudden Cardiac Arrest The market
Ideally a personal AED should be present in every home exactly like fire ex<nguishing equipment.
Lower Cost will lead to an almost unlimited market.
Sudden Cardiac Arrest The market
First Animal Study: Defibrilla<on 5 small pigs (30-‐40 Kg body weight) General anesthesia with ketamin and isofluoran A single quadripolar pacing catheter was inserted percutaneously
through one of the femoral veins or jugular vein VF was induced with rapid ventricular burst pacing or T wave shock Defibrilla<on of stable VF aoer 15 seconds If failed , immediate rescue shock with a higher energy or DC shock DFT determined with AC shock, than again with DC shock delivered
with a commercial external defibrillator (Zoll) using a step-‐down protocol
Comparison of DFT between modified AC and standard DC shock
49 J AC
First Animal Study: Defibrilla<on
Successful Defibrilla<on
Successful Defibrilla<on 50 J DC
An Advanced Biphasic Waveform
Advanced Biphasic Output Waveform
0 5 10 15 20 25 30 35 40 45 50
Time (msec)
Comparison of AC and DC DFT in each pig
a b
DFT with MAC versus DC Shocks
First Animal Study: Defibrilla<on
Rescue Shock-‐18 sec aoer first shock First Animal Study: Defibrilla<on
• Six rats • Mean weight 491.7±123.7 grams • mid LAD was occluded at 3 moths age • 3-‐6 months for complete recovery • MAC defibrilla<on-‐successful in all • External pacing-‐at a rate above sinus rhythm-‐successful in all
Second Animal Study
Pacing Sinus 8 Volts Threshold
Second Animal Study: External pacing
Conclusions
• Modified AC Shock Defibrilla<on is feasible and as effec<ve as the standard biphasic DC Defibrilla<on
• Repeated higher energy shocks are quickly available • External Pacing is feasible and durable due to unlimited
energy
We suggest this type of defibrilla<on shock to be implemented in Automa<c External Home Defibrillators
This low-‐cost new technology should be used to treat sudden cardiac arrest occurring at home/office and to save lives
Europace Shimon Rosenheck, Shraga Gorni, Ioni Katz, Asaf Rabin, Uri Shpoliansky, Mendel Mandelbaum, and Abraham Teddy Weiss (2009) Modified alterna2ng current defibrilla2on: a new defibrilla2on technique, Europace 11, 239–244. Awards: Neufeld prize for the best paper from the Israeli Heart Society (2010)
Publica<ons
Thank you