CN1787796B - Systems and procedures for treating cardiac arrest - Google Patents
Systems and procedures for treating cardiac arrest Download PDFInfo
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- CN1787796B CN1787796B CN200480012890.2A CN200480012890A CN1787796B CN 1787796 B CN1787796 B CN 1787796B CN 200480012890 A CN200480012890 A CN 200480012890A CN 1787796 B CN1787796 B CN 1787796B
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Abstract
An apparatus for resuscitating a person under cardicac arrest comprises a reciprocating means for mechanical cardiac stimulation, a means for electric cardiac stimulation, a means for controlling such provision of stimulation t o allow electric stimulation to be provided once the time average mean volume of blood in the right atrium at asystole or ventricular fibrillation has been reduced by 50% or more and/or 20 ml or more of blood has accumulated in the left ventricle and/or a positive coronary perfusion pressure has been obtained; a tracheal tube, facial mask or similar for adducing breathing gas ; a source of compressed breathing gas; a means for controlling the pressure o f pressing gas provided. Also disclosed is a corresponding method of treatment , an apparatus for establishing circulation in a person under cardiac arrest, and a disposable tracheal tube.
Description
Technical field
The present invention relates to be used for the treatment of the method and apparatus of sudden cardiac arrest, relate in particular to the treatment of the cardiac arrest that causes because of ventricular fibrillation, asystole and PEA (pulse free electrical activity) etc.
Background technology
Sudden cardiac arrest usually mechanically and/or the electric heart fibrillation that goes treat.Mechanotherapy comprises manual cardiac massage, and perhaps the compression of (if can access) mechanical chest adds passive or the active decompress(ion), and wherein compression/decompression cycle is about half second to one second usually.Many devices that are used for machinery cardiac stimulus when cardiac arrest all are well known in the art, such as air operated LUCAS
TMMechanical chest the compression/decompression system (" Lucas that the Jolife AB of Sweden Lund makes
TMSystem "; The device that is used for cardio-pulmonary resuscitation CPR compression and physiological decompress(ion)).Lucas particularly
TMSystem comprises supporting structure and the compression/decompression unit that is used for patient's cardio-pulmonary resuscitation.This supporting structure comprises the support plate at the back that is used to be positioned at the heart of patient back, be used to be positioned at the chest front portion on every side of facies anterior cordis, this front portion has two supports, each support all has first end that links to each other with this forward at least one hinge pivotly, and be attached to second end on the support plate removedly, this front portion is designed to hold described compression/decompression unit, and this compression/decompression unit is designed to when this front portion links to each other with support plate compression automatically or decompress(ion) patient's chest.This compression/decompression unit comprises: the pneumatic unit that is used to move and control compression and decompress(ion); The attached scalable suspension unit thereon of compression/decompression pad; And handle, by the position of this handle may command pad.
Go heart fibrillation to be independent of mechanical stimulus and carry out therewith.At United States Patent (USP) 4,273, disclosed the equipment that will be used for the device of mechanical breast compressions and go the device of heart fibrillation to combine among 114 (people such as Barkalow).
United States Patent (USP) 6,312,399B1 discloses a kind of method, be used for when the compression repeatedly of passing through chest and decompress(ion) execution cardio-pulmonary resuscitation, increasing the cardiopulmonary circulation, this method comprises that the electricity irritation of respiratory muscle breathes to impel patient, impel the amplitude and the cycle of intrathoracic negative pressure in decompression phase, to increase to some extent thus, thereby the vein blood volume of inflow cardiopulmonary also is increased.
United States Patent (USP) 5,692,498A discloses a kind of endotracheal tube, it is included in this and manages pressure responsive valve in first inner chamber, this valve keeps cutting out to prevent that sucking gas flows into pulmonary always, drop to and be lower than the intrathoracic negative pressure threshold value that is produced by breast compressions and decompress(ion) up to the pipe internal pressure, make in the atmospheric pressure breathing gas inflow lung down so this valve is opened to the apnea patient.Thereby intrathoracic negative pressure during decompress(ion) amplitude and cycle be improved, it is said that this venous blood around making when carrying out cardio-pulmonary resuscitation flows into cardiopulmonary.
When cardiac arrest, the most importantly as quickly as possible, promptly in a few minutes of cardiac arrest outbreak, rebuild appropriate blood circulation." appropriate blood circulation " can be regarded as is enough to prevent that vitals and tissue (further) from being destroyed, particularly the destructive blood circulation that causes because of the oxygen supply deficiency.
Goal of the invention
An object of the present invention is to provide and a kind ofly in the people of cardiac arrest, rebuild appropriate sanguimotor non-intrusion type method than existing known method is more efficiently.
Another object of the present invention provides the device that is used to realize this method.
Other purpose of the present invention will be apparent from the description of following summary of the invention, the preferred embodiment shown in the accompanying drawing and claims.
Summary of the invention
According to the present invention, disclosed a kind of appropriate sanguimotor non-intrusion type method of in the people of cardiac arrest, rebuilding.This method comprises that the respiratory tract to patient provides positive pressure respiration gas, make this patient breathe a period of time that is enough to set up the coronary perfusion malleation, simultaneously by compressing the heart that mechanically stimulates patient with the decompress(ion) chest repeatedly to the speed of 200 cycles per minute with 60 cycles per minute at the direct draught of breathing gas.
After having applied breathing gas malleation and compression/decompression, electricity irritation can pace-making and/or the form of removing heart fibrillation of heart is used.Electricity irritation is only available or provide after having set up the coronary perfusion malleation, even continues applying of mechanical stimulus and barotropic gas simultaneously.Electricity irritation and mechanical stimulus can replace or apply simultaneously.
An important supplemental characteristic of the present invention is to provide mechanical stimulus to heart by the reciprocating pneumatic device, and this pneumatic means is driven by the breathing gas that uses in this method.Particularly preferably be, after breathing gas has been used to drive reciprocating drive unit, re-use this gas and suck, thereby after the reciprocating pneumatic device is discharged, it is imported patient's respiratory tract at this extruding gas to patient.Breathing gas provides from airway or other pressurized gas source with compressive state, and the breathing gas mixture of oxygen or oxygen and noble gas preferably wherein is in mist more than the best 50 volume % of oxygen content.Pneumatic means of the present invention comprises the pad that can place near patient's chest, disk, plate or the like.
Preferably by providing breathing gas to patient's intubate or by the face shield that covers on mouth and/or the nose.Provide breathing gas from gas container or airway, preferably airway to the near-end of intubate or face shield air inlet pipe by face shield or intubate are linked to each other with the air vent of above-mentioned reciprocating pneumatic device.
Preferred compression depth is to be about 20% of the breastbone degree of depth, and the so-called breastbone degree of depth is that breastbone is to the distance between the plane that patient's back is leaned on.The breastbone degree of depth is about 175 millimeters to 260 millimeters in the adult; Thereby preferable compression depth is about 35 millimeters to 52 millimeters according to the standard of European Resuscitation council and american heart community.
In environment of the present invention, importantly compression and decompress(ion) should be carried out in unexpected mode, that is, from the full compression state to the complete solution pressure condition time-vice versa-should be littler than compression/decompression Cycle Length, such as the length of its time period corresponding to about 1/6 cycle to about 1/10 cycle.In other words, the pressure curve of the time/tonogram of compression/decompression cycle should be near the trapezoidal wave curve.Compression/decompression cycle comprises compression stage (CP) and decompression phase thereafter (DCP).Compression stage (CP) comprises dynamic part (DNCP), during chest constantly compression up to reaching full compression, and static part (STCP), during chest keep the full compression state.Similarly, decompression phase (DCP) comprises dynamic part (DNDCP), the continuous decompress(ion) of chest is pressed up to reaching complete solution during this time, and static part (STDCP), chest keeps the complete solution pressure condition during this time, if just as chest when the decompress(ion)-allow to do like this-the physiological complete solution pressure condition that can present naturally.
The mean positive pressure of breathing gas is preferably during decompress(ion) from 1 millimetres of mercury to 30 millimetress of mercury in the lung, particularly from about 8 millimetress of mercury to about 25 millimetress of mercury, preferably about 20 millimetress of mercury.Thereby, the most important thing is to keep malleation in decompression phase.
Being preferably in once obtaining the coronary perfusion malleation and beginning to provide electricity irritation, is 10 millimetress of mercury in the coronary perfusion malleation particularly, preferably is 15 millimetress of mercury, more preferably is 25 millimetress of mercury or when above.
Be preferably in compression stage (STCP) static part last 1/3rd during the electricity irritation (DF) of heart fibrillation is provided.
Be preferably in compression stage (CP) begins time period before decompression phase (DCP) beginning pace-making electricity irritation (PC) is provided, then better during the first half in back half and the Static Compression stage (STCP) of compression stage dynamic part (DNCP).Particularly preferred then is to provide the pace-making electricity irritation in 0.10 to 0.15 second the time period that will begin when the dynamic compression stage (DNCP) finishes.
The speed of mechanical stimulus is from 80 cycles per minute to 120 cycles per minute or 150 cycles per minute, in addition from 60 cycles per minute to 200 cycles per minute.
The time period that special-purpose machinery stimulates preferably can reach 180 seconds, if there is asystolic situation of short time the front, such as the asystole that continues 10 seconds to 50 seconds, preferably can reach more than 30 seconds, if and there is the asystolic situation of long period the front, such as the asystole more than two minutes, preferably can reach more than 5 minutes.Observe according to the inventor, the compression chest is to a certain degree, and such as 30 millimeters to 45 millimeters even up to 50 millimeters, required power can descend more than 25% when beginning to compress in 20 to 60 seconds of beginning to compress; Continuing the required correct compression of compression keeps power to estimate by the resistance to compression pression of measuring chest off and on.Preferably correspondingly control the driving power of this reciprocating drive unit by the pressure breathing gas that correct number is provided to reciprocal pneumatic means.In this environment, the breathing gas of " correct number " is meant and keeps required compression/decompression situation, particularly keeps same compression/decompression situation basically and essential breathing gas quantity in whole treatment time section." compression/decompression situation " is meant the situation of compression depth to the curve of time.Such control is with the save compressed breathing gas.
According to first preferred aspect of the present invention, mechanical stimulus will continue after the reconstruction of electricity irritation and blood circulation is provided.
According to second preferred aspect of the present invention, electricity irritation is to spend heart fibrillation, such as in the situation of ventricular fibrillation.
According to the 3rd preferred aspect of the present invention, electricity irritation provides with pace-making (pacing) form, such as do not have ventricular fibrillation but asystole appears or bradycardic situation in.Pace-making preferably provides with constant basic rate, such as per minute about 80 times; If compression speed surpasses this basic rate, then pace-making is deferred to compression speed.
According to the 4th preferred aspect of the present invention, being implemented in the adult left ventricle once being accumulated at least 20 milliliters or above blood (or the child reaches respective amount) of electricity irritation begins.
According to the 5th preferred aspect of the present invention, electricity irritation be implemented in asystole or ventricular fibrillation the time right ventricle inner blood time all measure and reduced 50% or abovely just begin.
According to the 6th preferred aspect of the present invention, the breathing gas that provides by intubate has the temperature that is lower than ambient temperature, particularly than low 5 ℃ even 10 ℃ of ambient temperature.
According to the 7th preferred aspect of the present invention, rely on breathing gas to provide the cooling water spray to patient, such as the cooling normal saline as carrier.
According to the 8th preferred aspect of the present invention, rely on breathing gas and/or breathing gas to provide the medicament that alleviates the cardiac arrest effect to patient as the aqueous spray of its carrier, such as disclosed heart paralysis solution in WO 02/11741, and/or help the medicament of sanguimotor reconstruction, such as vasodilation or epinephrine.
According to the present invention, a kind of device that is used to make people's recovery of cardiac arrest also is provided, this device comprises the reciprocating apparatus that is used for the mechanical stimulus heart; The device that is used for the electricity irritation heart; Being used to control in time development provides the device of machinery and electricity irritation, when taking place, provide electricity irritation in following situation: the right ventricle inner blood time during at asystole or ventricular fibrillation all measure reduced 50% or more than, and/or left ventricle in cumulative blood the adult reach at least 20 milliliters or above, when the child reaches respective amount, and/or to obtain the coronary perfusion malleation, be 10 millimetress of mercury particularly in the coronary perfusion malleation, preferably be 15 millimetress of mercury, more preferably be 25 millimetress of mercury or more than; Airway or face shield or be used for pressure breathing gas is introduced other device of this patient's respiratory tract, and being used for, and the device that is used to control the pressure of the breathing gas that offers patient to the compression respiratory gas source that breathing gas just is provided the people of resuscitation therapy that is connected to airway or other breathing gas introducing device.
According to the 9th preferred aspect of the present invention, the compression respiratory gas source is designed to be provided for driving the gas of reciprocating apparatus.
For reciprocating apparatus, preferably can provide mechanical stimulus to the speed of 200 cycles per minute, especially with about 80 to 120 cycles per minute or above speed with 60 cycles per minute.
According to the tenth preferred aspect of the present invention, the device that provides that is used to control machinery and electricity irritation comprises the device of the pressure that is used to control the breathing gas that offers patient.
According to the 11 preferred aspect of the present invention, a kind of doser also is provided, be used for providing the medicament that alleviates the cardiac arrest effect to patient, such as disclosed heart paralysis solution in WO 02/11741, and/or help the medicament of sanguimotor reconstruction, such as epinephrine or noradrenaline, vassopressin, cortisone, insulin, Ciclosporin A, this doser links to each other with airway or other breathing gas introducing device or integrates, and can produce aqueous mist or the spraying that comprises medicament.
According to the present invention, also disclosed a kind of being used for and rebuild sanguimotor device the patient of cardiac arrest, comprise a compression respiratory gas source; Be used for the described breathing gas of direct draught is offered the device of described patient's respiratory tract; Be used for by compressing the reciprocating pneumatic device that mechanically stimulates patient's heart with the decompress(ion) chest repeatedly to the speed of 200 cycles per minute with 60 cycles per minute; With pace-making and/or go the heart fibrillation form that the electric device of electricity irritation is provided to heart; Wherein said compression breathing gas is used to drive described reciprocating pneumatic device, and the breathing gas of wherein discharging from the reciprocating pneumatic device is used for positive pressure respiration gas is offered this patient's respiratory tract.
Be used for providing the device of breathing gas to preferably include breathing mask or being used for intubate is inserted the device in patient respiration road to patient.But breathing gas also can be by offering patient through tracheal intubation.
Be used to provide the electric device of electricity irritation to comprise two electrodes, a preceding electrode is used in patient's chest, is adjacent to or is integrated in pad, plate or the disk etc. of reciprocating apparatus, and a rear electrode, with being added in patients back.Chest electrode is preferably disposable.Rear electrode preferably is integrated in the support plate of patient's dependence; It is integrated by this way: if patient rests on the correct position on the support plate, then it can be perpendicular under breastbone.Advantageously, be used to provide the electric device of electricity irritation to comprise the device that is used for the analysing ECG signal, these ECG signals are collected and are imported the ECG analytical equipment by electrode.
At first, pacing frequency is adjusted to the frequency of deferring to mechanical compression/decompression, and does corresponding control.As long as (not pace-making) heart rate is lower than mechanical compression/decompression frequency patient, and this is with regard to particular importance.Yet in case patient's heart rate has surpassed the setpoint frequency of mechanical compression/decompression, it just can be used to control this frequency.More strong with the contraction that pulse rates provides mechanical compress will make heart.In the situation of PEA (pulseless electrical activity), the speed of mechanical compression/decompression can be controlled by for example pulse oxymetry, so that patient's best blood oxygen saturation is provided.In addition, by scan the effect that heart is provided electricity irritation on the time point of in some cycles, selecting empirically, determine the interior optimum time point of cardiac cycle, also within the scope of the invention to heart electric stimulating.Yet, in the PEA situation, do not have reason at the QT of ECG stage cardiac stimulus.Be equipped with for device of the present invention to be used to manifest the heart contraction situation ultrasonic imaging apparatus also within the scope of the invention; Perhaps, this information also can be used for control go heart fibrillation or pacing signal to be applied to heart electricity.
According to the present invention, a kind of face shield that is provided also has been provided, comprise disposable plastic flexible pipe, it can be connected to the downstream of the integrated pipe of valve that invests reciprocal compression/decompression device directly or indirectly, is used to compress the recovery that breathing gas drives.
In addition, disclosed a kind of disposable endotracheal tube according to the present invention, had plastic flexible pipe at its near-end, it can be connected to the downstream that is attached to the integrated pipe of valve on the reciprocal compression/decompression device that is used to recover directly or indirectly.
Also disclosed a kind of reciprocal compression/decompression device, drive the recovery that is used for patient by the compression breathing gas, it comprises detachable apparatus, be used for 1 minute or more than, particularly in 5 minutes or above time period with a part of malleation of breathing gas that drive compression/decompression device consumes be provided in patient's the respiratory tract.Breathing gas preferably includes the oxygen of volume at least 50%.Detachable apparatus is selected from face shield, endotracheal tube or trachea outer tube.
Preferred embodiment shown in the present invention with reference to the accompanying drawings illustrates in greater detail.
Description of drawings
In the accompanying drawings,
Fig. 1 a is a side view of using the apparatus of the present invention on the cardiac arrest victim;
Fig. 1 b is the A-A sectional view of Fig. 1 device;
Fig. 2 illustrates the flow chart for the treatment of cardiac arrest according to the present invention;
Fig. 3 is the included ECG diagnosis of the inventive method, and the flow chart of considering the available treatment art selection of diagnostic result;
Fig. 4 is the sketch map that drives and control the block diagram form of apparatus of the present invention;
Fig. 5 is the driving of reciprocating apparatus, and the sketch map of pressure controlled block diagram form that offers the breathing gas of discharging from reciprocating apparatus in patient respiration road with wanting malleation;
Mechanical compress and pace-making that offers the adult in time or the view that goes following of heart fibrillation to provide are provided Fig. 6.
The specific embodiment
Example 1. is used to rebuild the people's of cardiac arrest sanguimotor device
The sanguimotor device that is used to rebuild the people of cardiac arrest according to of the present invention schematically is shown in Fig. 1 a and 1b.This is based on and comprises Lucas
TMPortable compression/decompression system (TCDC system; The Jolife AB of Sweden Lund).This TCDC system comprises a support plate 2 and york piece or anterior 3.The patient 1 of cardiac arrest lies on the back on support plate 2, thereby the central authorities of support plate 2 place under the breastbone S.Support plate 2 is in the horizontal expansion of patient's both sides.One of elongated end is provided with springlock 23, and the free end of york piece 3 (it is installed in another elongated end 24 by hinge) is fixed on the support plate 2 fast.Thus, patient's chest is surrounded by the TCDC unit of its cross section (Fig. 1 b) as stirrup.The middle body of york piece 3 places apart from breastbone S a distance.The middle body of york piece 3 comprises one pneumatic compression/decompress(ion) unit, this unit comprise with the two chambers 8,9 of cylinder in the compression/decompression pad 5 that links to each other by bar 7 of piston 6.From the forced air of the pipeline of gas cylinder 10 or this gas or oxygen or other breathing gas inlet valve by flexible reinforced plastic pipe 11 and the integrated pipe 12 of valve two chambers 8,9 of feed-in cylinder alternately.The import of integrated pipe 12 and corresponding outlet are controlled by a main control unit 13 that comprises rechargeable battery and microprocessor.This main control unit is the reciprocal speed of control piston 6 and compression/decompression pad 5 in theory.They are arranged to the desired rate that changes from 60 to 150 strokes/minute reciprocal in back/ventral direction.The surface that pad 5 is attached to patient's chest has the cohesive material (not shown) on every side, so that it can be attached on the skin.This makes that chest can the physiological decompress(ion) in reciprocating ventral direction phase.The oxygen pressure that leaves the two chambers 8,9 of cylinder is controlled, and promptly relies on the following breathing gas pressure control circuit shown in Figure 5 that describes in detail to make it remain on required substantially invariablely just press.Breathing gas is imported into mid-face (comprising nose and mouth) that places patient and the face shield 15 with outlet tube 16 by flexible pipe 14 from the delivery valve of integrated pipe 12.Thus to the fresh breathing gas of patient's sustainable supply (adding some malleations if necessary).Providing the positive pressure respiration gas of full control according to the device of Fig. 5 is particular importance when breathing gas applies by intubate; When relying on the respiratory mask supply, if the pressure in the mask according to the width of mask gas outlet or control in a similar manner, then the control loop among Fig. 5 can partly or entirely omit.
Preceding (chest) electrode 17 that is attached to patient's chest places contiguous pad 5 parts, and by adhesive.Also can withstand on the chest by spring or the elastic-like element that invests york piece 3.Can also imagine preceding electrode 17 is integrated into pad 5 on the surface of patient's chest.Second electrode, back (back) electrode 18 is installed in going up on (interior) surface of support plate 2.Electrode 17,18 is used as the ECG electrode, and as pace-making and the electrode that removes heart fibrillation.They are connected in the electrode control unit 26 by lead 20,21.This electrode control unit 26 can be carried out simple ECG and measure distinguishing the distribution of removing the heart fibrillation pulse to electric flux between asystole and ventricular fibrillation, and the pace-making of heart on desired rate.Electrode 17,18 usefulness act on the electrode that ECG measures, removes heart fibrillation and pace-making.This electrode control unit 26 also comprises the electric energy of the rechargeable battery form that can share with main control unit 13.As safeguard, control unit can be by integrated transformer/rectifier unit from mains powered.
The support plate 2 that is provided with neck brace 19 is placed under patient's neck.The height of neck brace 19 is enough to make patient's head layback, leans against the outer end of support plate 2 up to it.As described below, place patient head like this and be convenient to intubate safely.
Example 2. endotracheal tubes
Be applicable to that endotracheal tube of the present invention is open in WO94/00174.The air bag that the flexible tube head of being made by moulding material that it comprises plastic flexible pipe, axially link to each other with flexible pipe and comprising places the pipe box on endotracheal tube and the tube head and links to each other with inflation/deflation system near the endotracheal tube near-end, this air bag links to each other by the passage along the hose wall longitudinal extension with the inflation/deflation system.The endotracheal tube that belongs to this design is sold with the trade name of " Boussignac adult endotracheal tube (Boussignac be grown up endotracheal tube) " by the Laboratories Pharmaceutiques VYGON of French Ecouen.Importantly provide have wide as far as possible with respect to outer diameter tube, such as the breather that constitutes pipe cross-sectional area 90% or above breathing gas channel lumen.
(that is, by avoiding over-decompression in) the situation, can be observed breathing gas and enter the strong of pulmonary by trachea and flow initiatively unziping to physiological decompress(ion) position.This is using Lucas
TMCan in heart, produce the malleation (about 15 liters/minute respiratory air flow) of about 8 millimetress of mercury during the system decompress(ion), by comparison, in passive (manually or other) decompress(ion) situation, then have from 0 to the negative pressure of-5 millimetress of mercury approximately.The air-flow of trachea is increased to about 25 liters/minute if flow through, and then the malleation during decompress(ion) rises to about 15 millimetress of mercury.Between compression period, Lucas
Device itself has been created the malleation of about 15 to 20 millimetress of mercury.Because pulmonary can be bad by the respiratory gas crushing more than 40 millimetress of mercury, so use Lucas
Respiratory air flow by trachea during device active decompress(ion) should be limited to 20 liters/minute.
Example 3. recoveries
Referring now to the flow process Figure 200 among Fig. 2.When cardiac arrest one outbreak, just the patient in halted state aroused in interest (201) applies mechanical breast compressions (202) as early as possible.Compression during beginning may have to finish by hand (202).When device of the present invention has been installed in patient on one's body the time, just begin mechanical compress immediately.Simultaneously or after a while, the measurement of cardiac electrical activity relies on the application (203) of electrode 17,18 to begin.Handle in CPU by the signal of telecommunication that electrode 17,18 receives, with the heart that detects patients by ECG 203 is to be in asystole (EMD, electromechanical is separated), still ventricular fibrillation (VF) state, pulseless electrical activity state or normal condition (" normally " state is meant and does not need to go heart fibrillation or pace-making but may not be the state of health status in this environment).Then can be on demand to patient's intubate (204).The ECG diagnosis discloses patient and has ventricular fibrillation (VF) or PEA (pulseless electrical activity) or asystole.In first kind of situation (206a), go heart fibrillation electricity pulse to carry out by electrode 17,18, continue mechanical compression/decompression simultaneously.In second kind of situation (206b), the pace-making electric pulse is carried out by electrode 17,18, continues mechanical compression/decompression simultaneously.ECG diagnosis (205) repeats off and on, also constitutes the basis that further treatment is judged with the effect that monitors treatment.
In the situation of ventricular fibrillation, execution is had or do not have the compression of physiological decompress(ion) and remove heart fibrillation (206a), reappear up to spontaneous blood circulation (ROSC).Continue to carry out compression (202), can randomly accompany by pace-making (206b) thereafter.Being adapted to be incorporated into the heart fibrillation device that goes that goes in the device of the present invention is Heartstart FR2AED (the Leardal Medical A/S of Norway Stavanger produces).
In the situation of asystole/PEA, will carry out the compression (202) have or not have the physiological decompress(ion) in conjunction with pace-making (206b), up to observing ROSC, but preferably carry out the much longer time, such as under the nursing of patient in hospital.
According to various situations, all if any the people who does not have to implement intubate (204), will be to this patient's intubate or non-intubate.Intubate 204 can be used to provide medicament to the user, such as potassium chloride solution.Provide this or other active agents aqueous solution also is feasible with the cold state (such as 10 ℃ or following) that is markedly inferior to room temperature.
Example 4. iatrotechnics are judged
As for the treatment book judgement order of relevant the inventive method, can be with reference to the flow chart among Fig. 3 300.Activate device of the present invention (301) afterwards, promptly during carrying out compression/decompression (202), measuring and analyzing (303) patient's ECG signal (302).First iatrotechnics judges whether be in cardiac arrest (304), because some patient seems cardiac arrest, be in the faint dancing state of heart but be actually if being based on patient, be lower than such as the body temperature patient in the state of some degree under the normal body temperature.
Particularly, as shown in Figure 3, the analysing ECG signal sees whether be cardiac arrest.Though, so stop compression/decompression (305) immediately if detect slowly but the pulse of " normally " does not then have cardiac arrest.If be in cardiac arrest, then in next step, determine to stop type, the analysing ECG signal sees whether be ventricular fibrillation (306) in this step.If detect the characteristic ECG signal mode (307) of ventricular fibrillation, then patient removed heart fibrillation (310).If do not detect such signal mode, then patient is carried out pace-making electric pulse (308).
If desired, can automatically take the aforementioned therapies art to judge by device of the present invention.This has increased it to lacking the human effectiveness of enough medical science trainings.On the other hand, this device provides the demonstration of the diagnostic result of each step, believes treatment fully most to allow the user to start in particular condition.The medical worker who participates in during removing heart fibrillation (310) must not touch patient (310).
Example 5. device control and drivings
All principles of device control and driving as shown in Figure 4.This device is by microprocessor (CPU) 420 controls, it comprises the data storage device of wherein having stored suitable software, such as the software that is used for the digitized electrode signal, be used for the comparative figures signal and represent all kinds of cardiomotilitys signal software and be used to control the pneumatic means of apparatus of the present invention and the software of electric device.This control unit 410 is by internal electric source 440 power supplies such as rechargeable battery.This control unit 410 comprises the user display 450 that is used to read electrode measurement and other data.It also can comprise speech interfaces 460, and CPU 420 can send stereotyped command to the related personnel by this interface, changes the instruction of respiratory gas source etc. such as relevant needs.
Control and driver element 410 also comprise have a changer go heart fibrillation and pace-making module 470.Go to be integrated with the ECG analytic function in heart fibrillation and the pace-making module 470 at this.Suitably, the heart fibrillation device that goes that has on the market can be integrated in the device of the present invention, go heart fibrillation device (Sweden Artema Medical AB product such as having the unitary Cardio-Aid Model 200 of pacemaker; The said firm calendar year 2001 by U.S. Cardiac Science, Inc. merges).
In addition, control and driver element comprise Pneumatic module 430, and its functional design as shown in Figure 5.It is by the pressurised oxygen of feed-in from breathing gas level oxygen cylinder 100.By blood pressure lowering control valve unit 101, the pressure of breathing gas is descended and is kept constant.Pressurised oxygen valve thus is imported into the integrated pipe of valve (valve manifold) 102, and its each valve is controlled by device control units 120 (for example CPU 420).Pressurised oxygen is by pipeline 108,109 one of both sides (105,106) of piston 103 in the feed-in cylinder 107 alternately, so that this piston 103 moves back and forth.The bar 104 that moves through of piston 106 is transmitted to pad, so that alternately compression and decompress(ion) patient's chest (not shown).Basically but all the gas of decompress(ion)s does not leave the chamber 105,106 of cylinder 107 by the bleed valve of integrated pipe 102, and from be imported into the near-end (110) of one of cannula passage there by airway 112, this passage comprises attenuator 114, relief valve 113 and holds gas pond 111.The oxygen pressure of the integrated pipe 110 of feed-in can be done further control by surge damping circuit 116,117,118 by control unit 120, will repeat no more this.
Example 6. endotracheal tubes
Be applicable to that endotracheal tube of the present invention is open in WO 94/00174.The air bag that the flexible tube head of being made by moulding material that it comprises plastic flexible pipe, axially link to each other with flexible pipe and comprising places the pipe box on endotracheal tube and the tube head and links to each other with inflation/deflation system near the endotracheal tube near-end, this air bag links to each other by the passage along the hose wall longitudinal extension with the inflation/deflation system.The endotracheal tube of this design is sold with the trade name of " Boussignac adult endotracheal tube " by the LaboratoriesPharmaceutiques VYGON of French Ecouen.
Example 7
View among Fig. 6 shows in time and provides mechanical compress to the adult, and pace-making is provided simultaneously or goes heart fibrillation (PC, pace-making electricity irritation; DF goes the heart fibrillation electricity irritation; CP, compression stage; DCP, decompression phase; DNCP, the dynamic part of compression stage; STCP, the static part of compression stage; DNDCP, the dynamic part of decompression phase; STDCP, the static part of decompression phase).Compression curve 600 has the trapezoidal wave shape.
Further set forth each key element of the present invention with following three case histories report.
Case history report 1
The woman, 73 years old.Move the coronary artery bypass operation before 5 years, must cross myocardial infarction before 3 years.Stupor (hereinafter time representation is relevant with the stupor time) during concert.Just doctor at the scene finds not had to touch pulse.He implements CPR (15 breasts of per minute are pressed and 2 mouth-to-mouth insufflations) immediately.The ambulance of cardio-pulmonary resuscitation tissue arrived in the time of 6 minutes.They use the LUCAS device and begin breast compressions patient.Show ventricular fibrillation at 7.5 timesharing ECG.Use airway (Boussignac pipe) to patient's intubate by the oral cavity then, wherein oxygen channel and the Lucas in the airway
TMThe oxygen supply pipe of device links to each other.Supply with 15 liters/minute gas at Boussignac pipe far-end, inject (CIO) as the oxygen that continues.In 8.5 timesharing, the pulse oxymeter is connected to a finger.Observe oxygen saturation and be 100% pulse, patient's skin is little red, expression advantages of good skin blood circulation.Can touch good pulse in neck arteries even groin place.In the ECG demonstration, can see ventricular fibrillation chap gradually.In the time of LUCAS-CPR9 minute, between the compression period of well afoot, added and once gone heart fibrillation electric shock (360J).Patient's asystole, but can see after about 10 seconds that frequency is the sinus rhythm of per minute 60 times.Mechanical compress continues, up to rising to per minute 90 times in 12 timesharing frequencies.Turn off this device then.Pulse weakened in 1 minute, and contain oxygen value and reduce to 70 from 100.Implement compression again, move on to patient on the stretcher and send into ambulance, continue LUCAS-CPR and CIO treatment simultaneously.When arriving at the emergency room of hospital (about 25 timesharing), the oxygen saturation of pulse has increased to 100%.Arterial needle is placed into Radial artery, and by using the Seldinger technology, the central vein conduit puts in place by external jugular vein.Flood gas shows that tremulous pulse oxygen is better than normal value (PaO
2=49), pH7.45, PaCO
23.5, base excess-1.Present shutoff device.The frequency of patient's sinus rhythm is 90, and keeps blood pressure 110/70, intermediate value 90.Patient is admitted to the intensive care district, and tightly observes 24 hours.Do not observe differences in growth and overall health status.Patient is stable also to revive fully.She was removed urgent monitoring in second day; She has left hospital after the normal care in one week.Patient has recovered health after one month the control.
Case history report 2
The man, 36 years old.Ambient temperature is for being found absence of vital signs-1 ℃ early morning in the park.Ambulance arrived in the time of about 5 minutes.Patient is pulseless, apnea at that time.ECG shows the bradycardia extremely, is 2-3 heart beating of per minute.Patient's body temperature is 22 ℃.The first aid doctor in charge obtains Advise By Wire at home.He is being with LUCAS
TMDevice is on the scene.When the pupil of seeing patient did not spread as yet, his decision was used this device to patient and is begun compression.With the Boussignac pipe to patient's intubate, and by making oxygen channel and the Lucas in the airway
TMThe oxygen supply pipe of device is connected in Boussignac pipe far-end mutually and sets up CIO.The low pressure ECG of device shows that patient has sinus rhythm, and frequency is per minute 3-5 time.Can touch good pulse at carotid artery now.Patient is sent to hospital together with the device in the work, and he is directly sent to operating room there, and links the cardiopulmonary machine by the femoral artery tissue.His body temperature rises to 32 ℃ lentamente.His heart is effectively being beated in this stage, is per minute 70 times, and the blood pressure of generation is 110/60.After the cardiopulmonary machine disconnects, he is admitted to the intensive care district, and is able to nature subsequently 6 hours and is warmed to normal body temperature.He returns to one's perfect health and leaves hospital after one week.
Case history report 3
The man, 48 years old.10 AM is gone into a coma in office.Called out the heart ambulance immediately, and after 4 minutes, arrived at.Still do not begin recovery this moment as yet.The rescue personnel comprises two nursing stafves and a driver.Main nursing staff checks carotid artery at once, but pulseless.Pushing of skin produced a white point, and the expression blood circulation stops.At once patient is used LUCAS
TMDevice, and mechanical breast compressions began in 30 seconds.ECG shows patient's asystole.Nursing staff lifts patient's cheek to ensure respiration smooth and easy, and begin with and Lucas
TMThe Rubens self expandable air bag ventilation that the oxygen supply pipe of device links to each other, the oxygen that charges into the Rubens air bag is about 15 liters/minute.This Rubens air bag has the pop off valve that the control intracapsular pressure is no more than 30 centimeter water columns.Like this, patient is taken a breath with 100% oxygen with 100 times/minute compression/decompression frequency.The pulse oxymeter that is connected to finger shows that oxygen saturation is 98% good pulses.Giving more powerful ventilation then makes saturation rise to 100%.ECG shows that patient remains asystolic.Enable LUCAS now
TMThe pacemaker effect of device, and between each compression period the pace-making heart.The very fast pulse that can feel in the carotid artery.Patient's pupil spreads when beginning recovery, but shrinks now.Stop compression, and only keep pacemaker function.Because pulse begins to die down and saturation descends, device starts once more makes oxygen saturation get back to 100% immediately.Anaesthetist troop (doctor and nurse) and ambulance arrived at after 7 minutes, and that see is the good patient of oxygen supply and blood circulation, and device is with the frequency work of 100 compression/decompression of per minute, and the frequency of pacemaker ECG is 100.After stopping this device, see the decline of oxygen saturation immediately.Start this device once more, stop face shield and ventilate, and with the Boussignac pipe to patient's intubate, its oxygen channel and Lucas
TMThe oxygen supply pipe of device links to each other.25 liters/minute Oxygen Flow offers airway at Boussignac pipe far-end.The frequency of compression increases to per minute 120 times, continues to press 100 pace-makings of per minute simultaneously.After 5 minutes, stop pace-making and compression frequency and reduce to per minute 80 times.Can see that now frequency is the sinus rate of about per minute 65 times.Arterial needle is placed into Radial artery, stop compression, and to measure arterial pressure is 115/80.Patient is moved on the stretcher, simultaneously the supervision of the installation of holding device, decompressed state continuing, ECG.In being sent to the hospital way, observe the bradycardia extremely.Systolic pressure is reduced to less than 60.Restart frequency and be 100 compression (per minute 100 times), and activate pacemaker function.When arriving at hospital, stop compression and pace-making.ECG shows that now heart-block is the III level, and pulse frequency is about 35.Restart compression and pace-making (per minute 100 times) immediately.Arterial pressure rises to 120/80 rapidly, and it is saturated to obtain total oxygen simultaneously.Patient is admitted to operating room, and in the right ventricle transvenous pacemaker of packing into, at the right atrium electrode of packing into, starts inner pace-making thereafter.During inserting pacemaker electrode, device is with the frequency work of 100 compressions and per minute 100 times.After the lasting pacemaker of packing into as mentioned above, stop the compression and the pace-making of Lucas device.Patient's status praesens is stable, and the pacemaker rhythm and pace of moving things is per minute 100 times.He is sent to severe disease monitoring district and puts on respiratory organ, up to next day.He revives fully after removing pipe, but not memory fully as to this.He is discharged from hospitals upon recovery after one week.
Claims (19)
1. one kind is used for rebuilding sanguimotor device the patient of cardiac arrest, comprising:
The compression respiratory gas source;
Be used for described compression breathing gas is offered the device of described patient's respiratory tract;
Be used for by compressing the reciprocating pneumatic device that mechanically stimulates patient's heart with the decompress(ion) chest repeatedly to the speed of 200 cycles per minute with 60 cycles per minute;
With pace-making and/or go the heart fibrillation form that the electric device of electricity irritation is provided;
Wherein said compression breathing gas is used to drive described reciprocating pneumatic device, and the breathing gas of wherein discharging from the reciprocating pneumatic device is used to provide positive pressure respiration gas to described patient's respiratory tract.
2. device as claimed in claim 1 is characterized in that, being used for provides the device of breathing gas to comprise breathing mask or be used for intubate is inserted the device in patient respiration road to patient.
3. device as claimed in claim 1 or 2, it is characterized in that, described reciprocating pneumatic device comprises pad, plate, the disk that use can be set, so that attach to patient's chest, and wherein be used to provide the electric device of electricity irritation to comprise two electrodes: a preceding electrode, be used in patient's chest, be adjacent to pad, plate or the disk setting of reciprocating pneumatic device or be integrated in wherein, make it be connected to chest towards patient's chest and with described pad, plate or disk combination; A rear electrode is arranged to be connected to patients back.
4. device as claimed in claim 3 is characterized in that, is used to provide the electric device of electricity irritation to comprise the device that is used to analyze by the ECG signal of described electrode collection and importing ECG analytical equipment.
5. device as claimed in claim 4 is characterized in that pacing frequency is controlled as the frequency of deferring to mechanical compression/decompression.
6. device as claimed in claim 5 is characterized in that, the breathing gas that offers the patient respiration road has been used to drive pneumatic repeat system.
7. reciprocal compression/decompression device, be used for the recovery patient, drive by the compression breathing gas, it is characterized in that, it comprises: detachable apparatus is used in 1 minute or above time period the part of the breathing gas that drive compression/decompression device consumed being provided to malleation patient's respiratory tract.
8. device as claimed in claim 7 is characterized in that, the described time period be 5 minutes or more than.
9. device as claimed in claim 7 is characterized in that breathing gas comprises the oxygen of at least 50 volume %.
10. device as claimed in claim 7 is characterized in that, described detachable apparatus is selected from face shield, endotracheal tube or trachea outer tube.
11. a system that is used for managing each step of patient's cardio-pulmonary resuscitation process comprises:
The breast compressions device is used for implementing mechanical stimulus to patient's heart;
Be used for implementing the module of electricity irritation to described heart;
Be used for during the cardio-pulmonary resuscitation process, providing the device of pressure breathing gas to patient's pulmonary;
Control unit is used for coordinating in the cardio-pulmonary resuscitation process described heart to be implemented machinery and electricity irritation; And
Analytic unit is used for the state of evaluating patient heart during the cardio-pulmonary resuscitation process,
Wherein, described control unit comprises and is used for assessing in response to described analytic unit and automatically changes the program of each step in the cardio-pulmonary resuscitation process,
Wherein, described breast compressions device is the pneumatic means with gas-operated, and is used to provide the gas of the described pneumatic means of the recycling operation of device of pressure breathing gas.
12. system as claimed in claim 11 is characterized in that, described analytic unit is electrocardiographic recorder/analyzer.
13. system as claimed in claim 11 is characterized in that, is used for providing the device of pressure breathing gas to comprise to patient pulmonary and is used for adding medicament with the device to patient's administration at breathing gas.
14. the device that the patient who is used for cardiac arrest recovers, described device comprises:
The reciprocating apparatus that is used for the mechanical stimulus heart;
The device that is used for the electricity irritation heart;
Be used to control the device that machinery and electricity irritation are provided in time, when taking place, provide electricity irritation in following situation: the right ventricle inner blood when asystole or ventricular fibrillation all measure reduced 50% or more than, and/or in people's all the year round left ventricle, accumulated 20 milliliters or above blood, and/or obtained the coronary perfusion malleation;
Airway or face shield or be used for pressure breathing gas is introduced other device of described patient's respiratory tract, and
Be used for to the compression respiratory gas source that breathing gas just is provided the patient of resuscitation therapy that is connected to airway or other breathing gas introducing device, and
Be used to control the device of the pressure of the breathing gas that offers patient,
Be used for the medicament that alleviates the cardiac arrest effect being provided and/or helping the doser of the medicament of sanguimotor reconstruction to patient, described doser link to each other with airway or other breathing gas introducing device or integrated, and can produce aqueous mist or the spraying that comprises medicament.
15. the device as claim 14 is characterized in that, described coronary perfusion malleation be 10 millimetress of mercury or more than
16. the device as claim 14 is characterized in that, described coronary perfusion malleation be 15 millimetress of mercury or more than
17. the device as claim 14 is characterized in that, described coronary perfusion malleation be 25 millimetress of mercury or more than.
18. the device as claim 14 is characterized in that, described compression respiratory gas source is designed to be provided for driving the gas of reciprocating apparatus.
19. the device as claim 14 or 18 is characterized in that, the device that provides that is used to control mechanical stimulus and electricity irritation comprises the device of the pressure that is used to control the breathing gas that offers patient.
Applications Claiming Priority (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US47022903P | 2003-05-12 | 2003-05-12 | |
| US60/470,229 | 2003-05-12 | ||
| US10/456,088 | 2003-06-06 | ||
| US10/456,088 US7226427B2 (en) | 2003-05-12 | 2003-06-06 | Systems and procedures for treating cardiac arrest |
| PCT/SE2004/000712 WO2004112683A1 (en) | 2003-05-12 | 2004-05-11 | Systems and procedures for treating cardiac arrest |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN1787796A CN1787796A (en) | 2006-06-14 |
| CN1787796B true CN1787796B (en) | 2010-08-18 |
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ID=36784992
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN200480012890.2A Expired - Fee Related CN1787796B (en) | 2003-05-12 | 2004-05-11 | Systems and procedures for treating cardiac arrest |
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| Country | Link |
|---|---|
| CN (1) | CN1787796B (en) |
| ZA (1) | ZA200509157B (en) |
Families Citing this family (14)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| KR100776627B1 (en) * | 2006-10-24 | 2007-11-15 | 주식회사 아이원이노텍 | Buried type hinge apparatus having automatic return function |
| US20110041852A1 (en) * | 2009-08-21 | 2011-02-24 | Bergman Robert T | Ambu-bag automation system and method |
| TWI386199B (en) * | 2009-12-08 | 2013-02-21 | 私立中原大學 | Heart massage device |
| CN102090973B (en) * | 2009-12-11 | 2014-11-19 | 私立中原大学 | Heart massaging device |
| CN103040602A (en) * | 2011-10-12 | 2013-04-17 | 广州蓝仕威克医疗科技有限公司 | Electric control pneumatic cardio-pulmonary resuscitation machine |
| US9149412B2 (en) * | 2012-06-14 | 2015-10-06 | Zoll Medical Corporation | Human powered mechanical CPR device with optimized waveform characteristics |
| US8920348B2 (en) * | 2012-09-28 | 2014-12-30 | Zoll Medical Corporation | Method and device for performing alternating chest compression and decompression |
| CN104368069A (en) * | 2014-10-15 | 2015-02-25 | 南阳市行知专利技术服务有限公司 | Cardio-pulmonary resuscitation system combining breathing with precise compression |
| CN105727406B (en) * | 2016-02-29 | 2018-01-02 | 朱明龙 | Eccentric wheel ditch control artificial respiration and cardiac compression simultaneously operating device |
| CN108852713B (en) * | 2018-05-19 | 2021-01-26 | 济南市儿童医院（山东大学齐鲁儿童医院） | Internet of things auxiliary AED (automatic guided Equipment) box and method based on remote control simple respirator |
| CN109223505B (en) * | 2018-11-14 | 2020-07-28 | 王云文 | Internal medicine cardiovascular disease treatment auxiliary device |
| CN110123616B (en) * | 2019-06-27 | 2021-04-30 | 茅荣鑫 | Medical rescue cardiopulmonary resuscitation machine |
| EP3766411A1 (en) * | 2019-07-18 | 2021-01-20 | Koninklijke Philips N.V. | Device, system, and method to control activation and configuration of pulse detection and pulse oximetry measurements during cpr |
| CN115670902B (en) * | 2022-10-10 | 2024-07-12 | 山东大学 | Intelligent decision-making system and method for cardiopulmonary resuscitation |
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| US4273114A (en) * | 1978-10-19 | 1981-06-16 | Michigan Instruments, Inc. | Cardiopulmonary resuscitator, defibrillator and monitor |
| CN2076418U (en) * | 1990-10-17 | 1991-05-08 | 中国人民解放军第一四八医院 | Portable heart and lung resuscitator for field operations |
| US5618287A (en) * | 1994-01-28 | 1997-04-08 | Thomas J. Fogarty | Methods of surgically implanting a defibrillator electrode within a patient |
| WO2002002185A2 (en) * | 2000-06-30 | 2002-01-10 | Medtronic, Inc. | Implantable medical device having flat eletrolytic capacitor with porous gas vent within electrolyte fill tube |
-
2004
- 2004-05-11 CN CN200480012890.2A patent/CN1787796B/en not_active Expired - Fee Related
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Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4273114A (en) * | 1978-10-19 | 1981-06-16 | Michigan Instruments, Inc. | Cardiopulmonary resuscitator, defibrillator and monitor |
| CN2076418U (en) * | 1990-10-17 | 1991-05-08 | 中国人民解放军第一四八医院 | Portable heart and lung resuscitator for field operations |
| US5618287A (en) * | 1994-01-28 | 1997-04-08 | Thomas J. Fogarty | Methods of surgically implanting a defibrillator electrode within a patient |
| WO2002002185A2 (en) * | 2000-06-30 | 2002-01-10 | Medtronic, Inc. | Implantable medical device having flat eletrolytic capacitor with porous gas vent within electrolyte fill tube |
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| Publication number | Publication date |
|---|---|
| CN1787796A (en) | 2006-06-14 |
| ZA200509157B (en) | 2007-04-25 |
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