EP3253355B1 - Apparatus for cardiopulmonary massaging and/or resuscitation - Google Patents

Description

The invention relates to a device for cardiopulmonary massage and / or resuscitation, with a massage device which has a pressure stamp which is reversible in an actuating direction, can be actuated by a drive and can be positioned on a patient's chest at a desired contact area. The invention further relates to a locking mechanism for blocking a mobility between two translationally and / or rotationally interconnected gear elements, in particular for locking a joint mechanism of the inventive device for cardiopulmonary massage and / or resuscitation.

A respiratory or circulatory arrest means the greatest danger to life for a patient. Only if it is possible to start and maintain an "emergency circulation" within a very short period of time through a cardiopulmonary resuscitation, is there a real chance of survival for the patient without permanent damage. In addition to ventilation, a key component of cardiopulmonary resuscitation is performing a cardiac massage to build up a replacement blood circulation, so that vital organs such as the brain in particular are supplied with oxygen. The classic cardiac massage is carried out manually, i.e. For example, by a paramedic who compresses and releases the thorax of the patient in the sternum at frequencies of the order of 80-140 per minute and thereby causes the blood to circulate through the patient's body and thus the oxygen supply to the organs.

Manual chest compression for resuscitation is very exhausting for the person performing the work and can only be carried out at the required frequency for a limited time. Since they are often also at Transfer of the patient to the hospital is to be continued, mechanical devices for cardiopulmonary massage have been proposed, which complement the technical equipment of ambulances, helicopters or the like and with the help of which the cardiac massage can be performed mechanically on patients over practically any time without the Fatigue rescuers. Rather, you can take complementary life-saving measures while the mechanical device performs chest compression to maintain the emergency circulation. For this purpose, such a device has a massage device with a pressure stamp, which is driven by a drive with the desired frequency, that is to say reversing about 80-140 per minute, that is to say up and down. The pressure stamp is positioned on the patient's chest by the doctor or paramedic at the location provided for the cardiac massage and can thus carry out the massage.

It is important for the cardiac massage to be carried out correctly that the correct pressure point is used and that it is maintained during the massage. The pressure point is located directly above the sternum (sternum), more precisely at the upper end of the lower third of the sternum. The sternum is the best area for performing the chest compressions because the heart is directly underneath, i.e. the organ that is to be compressed. In addition, the breastbone is a solid bone, which is connected to the ribs with cartilage connections and can thus be moved. A deviation from the correct pressure point can not only lead to a reduction in the effectiveness of the cardiac massage, but also to serious injuries to the patient, of which broken ribs are usually the least problematic. If the pressure point in the chest compressions moves towards the upper abdomen, serious injuries to the internal organs can occur. It is therefore necessary both in manual cardiopulmonary resuscitation and when performing it using a mechanical device to maintain the correct pressure point during the massage.

DE 197 04 032 A1 discloses a portable device for performing cardiopulmonary resuscitation, the force being transmitted from the helper to the patient by means of a lever arm.

DE 10 2011 014304 A1 discloses a device for resuscitation consisting of a pressure stamp which is driven by a drive device, a position measuring device and a holding device for the drive device and the pressure stamp.

WO 97/18789 A1 discloses a device for transmitting an outward force to the patient's chest, i.e. a negative pressure, in order to support the ventilation of the patient (especially of premature babies) and to prevent the lung from collapsing, consisting of a Velcro fastener and a tension band.

From the DE 10 2013 100 943 A1 A device of the generic type is known in which deviations of the actual position of the pressure stamp in the XY direction, that is to say the plane transverse to the direction of actuation of the massage device, are determined from a desired pressure point on the patient's chest by providing a position sensor device with which Changes in the position of the massage device and / or its pressure stamp relative to the desired contact area on the patient's chest can be determined in a plane normal to the direction of actuation of the massage device. If the actual position of the pressure stamp deviates from a target position and a previously defined limit value is exceeded, the cardiac pressure massage device is automatically stopped, for example, or an alarm signal is issued which indicates to the paramedics that readjustment is necessary. Alternatively, the known device can also be used to actively position the massage device transversely to its direction of actuation, for which purpose an actuator which adjusts the massage device or its pressure stamp in the plane normal to the direction of actuation is provided, with the aid of which the determined actual position of the pressure stamp on the Target position is adjusted.

The known device has proven to be very successful and reliable, but in particular the realization of the active tracking of the pressure stamp with an actuator to be provided for this purpose is comparatively complex and accordingly expensive. The object of the invention is therefore to provide a device of the type mentioned in the introduction, in which the correct position of the pressure stamp is reliably achieved with less effort.

This object is achieved with the invention in that the pressure stamp on the patient's chest can be fixed to the desired contact area and between at least during a state of relief two massage strokes are freely movable in a plane transverse to the direction of actuation.

The subject of the present invention is defined by claim 1.

With this solution, a passive, quasi-automatic positioning of the pressure stamp in the XY plane is possible fixing the pressure stamp to the desired contact area on the patient's chest, an actuator is no longer required. Rather, the fixation ensures that the pressure stamp always takes the correct position relative to the patient's chest. As a result of the free movement of the pressure stamp transversely to the direction of actuation, i.e. in the XY plane, the stamp is passively adjusted between two massage strokes, so it immediately compensates for any changes in position of the patient during the ongoing massage and is located at the beginning of each subsequent one Massage strokes due to the fixation during the massage always in the correct position, i.e. above the patient's sternum.

In an advantageous development of the invention, it is provided that the pressure stamp can be locked in its position relative to the patient's chest in a load state during a massage stroke in the plane transverse to the direction of actuation. This can ensure that the position of the pressure stamp in the plane transverse to the actuation direction (X-Y plane) does not change during the massage stroke, that is to say the movement of the stamp downward compressing the patient's chest. The stamp cannot therefore unintentionally change its position laterally during this downward movement, for example as a result of thrust forces acting between the chest and the pressure surface of the stamp, which could be dangerous for the patient during the printing process.

The function according to the invention can advantageously be implemented in that the massage device has at least one articulated mechanism that can be locked and unlocked about an axis that runs parallel to the direction of actuation. It is particularly advantageous if a locking mechanism, preferably acted upon by a force and / or displacement sensor, is provided to prevent transverse movement of the pressure plunger during a massage stroke, in particular to lock the at least one joint mechanism.

According to the invention, the pressure stamp is fixed or can be fixed on a holding means which can be fixed on the patient's chest, the holding means is designed as a holding pad that can be glued to the chest by means of an adhesive layer. It has proven to be particularly advantageous if the fixation between the pressure stamp and the holding means is created by a Velcro connection that is effective between these two. The holding pad is thus provided on its upper side with a Velcro fastener element, preferably the mesh fabric, on which the other Velcro fastener element formed on the pressure stamp on its pressure surface, in the constellation of the hook fastener preferably used, can be detachably fixed. The doctor or paramedic then first sticks the holding means, which preferably has a contact area that is larger than the pressure area formed by the pressure stamp, to the patient's chest over his breastbone and can then align the pressure stamp over the holding pad exactly in the correct position and through Bring (preferably manual) lowering into contact with the holding means, so that the Velcro connection closes and thereby fixes the pressure stamp. A correction of the position is possible at any time, whereby the enlarged contact area of the holding means in comparison to the pressure area of the stamp ensures that it protrudes laterally over an area in an area, for example if the adhesive pad is not applied to the patient's chest, and then not over it its entire printing area is connected to the pad.

In addition, an abutment board that can be positioned under the patient's body and on which the massage device is arranged can be provided. The height of the massage device can be adjustable relative to the abutment board, so that the device can easily be individually adapted to the respective patient.

It has also proven to be advantageous if the pressure stamp is arranged so that it can rotate freely on the massage device, so that the massage device or its joint mechanism can be adjusted as desired, even if the pressure surface of the pressure stamp has already been fixed on the patient's chest.

In a further development of the invention it can be provided that the pressure stamp on the massage device has a play of approximately 10-15 mm in the actuating direction. This ensures that when the plunger is lifted, i.e. in the ventilation phase, the pressure plunger does not exert any tensile force on the thorax in the relief phase. This allows the thorax to lower and raise freely during the ventilation phase.

Alternatively, however, it is also possible to implement negative compression by using an arrangement with little or no play in the pressure stamp in the actuating direction. In this way, a firm coupling of the pressure stamp to the thorax can be brought about both under pressure and tension and the chest can be actively raised with the drive of the massage device if the pressure stamp is also fixed in a tensile manner to the thorax, for example by means of a Velcro connection. In this case, the stamp is actively used for relief.

So that the pressure stamp can optimally fit the shape of the patient's thorax, it is preferably connected to the massage device with a ball joint.

Fig. 1

eine am Thorax eines Patienten applizierte Vorrichtung zur kardiopulmonalen Massage nach der Erfindung in einer perspektivischen Darstellung von schräg oben;

Fig. 2

den Gegenstand der Fig. 1 in perspektivischer Darstellung von schräg unten;

Fig. 3

die am Thorax des Patienten angesetzte Massagevorrichtung der erfindungsgemäßen Vorrichtung in einer Ansicht;

Fig. 4

eine Einzelheit IV nach Fig.3 in einem Vertikalschnitt;

Fig. 5

eine schematische Schnittdarstellung eines bei der Vorrichtung eingesetzten Verriegelungsmechnismus; und

Fig.6

eine abgewandelte Version eines Verriegelungsmechanismus in einer schematischen Seitenansicht.

Further features and advantages of the invention will become apparent from the following description and the drawing, in which a preferred embodiment of the invention is illustrated and explained in more detail using an example. It shows:

Fig. 1

a device applied to the thorax of a patient for cardiopulmonary massage according to the invention in a perspective view obliquely from above;

Fig. 2

the subject of Fig. 1 in perspective from obliquely below;

Fig. 3

the massage device of the device according to the invention applied to the thorax of the patient in a view;

Fig. 4

a detail IV after Fig. 3 in a vertical section;

Fig. 5

is a schematic sectional view of a locking mechanism used in the device; and

Fig. 6

a modified version of a locking mechanism in a schematic side view.

In the Fig. 1 and 2nd shows a device, designated in its entirety by 10, for cardiopulmonary massage and / or resuscitation of a patient 11 in its position applied to his thorax 12. The device 10 has an abutment board 14 placed under the back 13 of the patient 11, in the corner region of which a massage device, designated in its entirety by 15, is arranged.

The massage device 15 has an articulation mechanism 16 connected to the abutment board 14, which essentially consists of a portal support 16 a projecting upwards from the abutment board 14 and an extension arm 16 b articulated to its upper, projecting end, with a pressure stamp unit 17 at its free, outer end a drive 18 is provided. With the aid of the drive, a pressure stamp 19 of the stamp unit 17 can be driven up and down in a substantially vertical direction 23, for example by means of a drive spindle (not shown). The arrangement is such that the portal support 16a can be pivoted about vertical axes relative to the abutment board 14 and the boom 16b relative to the portal support 16a. With the aid of a locking mechanism (not shown) in the interior of the joint mechanism 16, the pivoting mobility between the parts of the joint mechanism can be prevented or released in the manner described below.

The height of the portal support is arranged on the abutment board 14 so that it can be adjusted, preferably steplessly, into different positions Altitudes can be set and locked in the set positions.

If you now turn to the Fig. 3 and 4th , it can be seen that the pressure stamp 19 of the pressure stamp unit 17 has a lower pressure surface 20 which, when the device is used as intended, is positioned on the chest 12 of the patient 11 at a desired contact area 21 - namely normally at the upper end of the lower third of the sternum - and in Operation of the massage device carries out the cardiopulmonary massage on the patient by the pressure plunger 19 moving up and down compressing the chest 12 at a set frequency and relieving it again.

So that during this cardiopulmonary massage the target contact area 21 or pressure point at which the pressure surface 20 of the pressure stamp 19 engages does not change, for example, during the transport of the patient, the pressure stamp 19 can be fixed to the target contact area 21 according to the invention. In the preferred embodiment of the invention shown, this is achieved with the aid of a holding means 22 which can be fixed on the chest 12 of the patient 11 in the form of an adhesive holding pad 24 which is provided on its upper contact surface 25 with a mesh fabric 26 of a Velcro connection 27. The counterpart for this Velcro connection 27, namely a hook mesh 28 which interacts with the mesh fabric 26, is arranged on the pressure surface 20 of the pressure stamp 19. Thus, after its alignment, the pressure stamp on the patient's thorax 12 can be fixed by appropriately pivoting the joint mechanism 16 above the desired contact area 21 and lowering the pressure stamp 19 until the pressure surface 20 comes into contact with the holding means 22, because then the Velcro connection 27 closes and opens only again when an upward pull force exceeds the loosening force of the Velcro fastener. So that the doctor or paramedic can optimally align the pressure stamp 19 even when the holding pad is not initially placed 100% when glued to the patient's chest, the holding means 22 is larger than the pressure surface 20 of the stamp 19, so that sufficient adjustment possibility is created on the side.

As already mentioned, the articulation mechanism 16, on which the pressure stamp is arranged, can be locked and unlocked with the aid of the locking mechanism, of which in Fig. 3 the part effective between the portal support 16a and the boom 16b pivotally connected thereto is shown schematically at 29. The entire locking mechanism has a plurality of bolt locks 30, preferably at least one such bolt lock 30 being provided on each locking mechanism part 29 for each of the articulated connections or linear guides of the articulated mechanism to be locked during a massage stroke. How Fig. 5 shows, the bolt lock 30 (or the bolt locks) is actuated electromagnetically in the preferred exemplary embodiment, for which purpose it has an electromagnet 31 which is subjected to a switching current and a locking plunger 33 which is biased in the locking direction by a helical compression spring 32 and which is supported by the spring 32 against one with a plurality of latching plates 35 provided closely adjacent to one another is pressed. The locking plunger 33 is provided on its front end facing the locking plate 35 with a locking lug 36, with which it can optionally engage in one of the various locking positions defining locking openings 34, thereby mechanically blocking the mobility of the joint in question or a linear guide. When the electromagnet 31 is acted upon by the switching current, which occurs between two successive massage strokes during the unloaded state, the plunger 33 is pulled back by the electromagnet 31 against the action of the helical compression spring 32, so that the latching nose no longer fits into one of the latching openings 34 and thus the locking given during the loaded movement phase of the pressure stamp (massage stroke) is then released in the relieved or load-free movement phase. It is then possible to readjust the position of the pressure stamp in the XY direction. Fig. 5 further reveals that the latching openings 34 are arranged at the smallest possible, discrete distances from one another in order to enable locking in correspondingly small steps. The locking openings 34 are also provided on their side facing the locking plunger 33 with conical guide cones 37, the guide cones 37 of adjacent locking openings 34 tanging or intersecting with one another. This ensures that the latch 36 of the Closing plunger always securely in one of the locking openings 34 when the electromagnet is switched off.

In any case, according to the invention, the locking is released between two massage strokes, i.e. the part of the movement of the pressure stamp in which it is relieved and does not compress the chest 12 of the patient 11 with force, which leads to the pressure stamp in this relief state between two massage strokes in the plane is freely movable transversely to the direction of actuation 23 (xY plane). This compensates for any changes in the relative position between the patient and the massage device, i.e. the pressure stamp, which is fixed to the patient's chest, follows the changes in position that the chest undergoes, for example, as a result of external influences. The pressure stamp is thus forced in the X-Y plane between two massage strokes by the holding pad glued to the patient's body and its pressure surface is always exactly above the desired pressure point on the patient's thorax at the start of a subsequent massage stroke.

During the massage stroke, the articulation mechanism of the massage device is then blocked with the aid of the locking mechanism, so that the pressure stamp only moves in the vertical direction (Z axis) during the massage stroke, but is locked in the directions perpendicular to it. This ensures that a lateral running of the pressure stamp is prevented during the printing phase, which could otherwise occur as a result of thrust forces that occur more or less strongly due to an inhomogeneous thorax.

In order to also be able to easily compensate for twists between the patient and the massage device, the pressure stamp 19 is mounted in the stamp unit 17 so as to be freely rotatable about the vertical axis. In order to ensure the best possible contact between the pressure surface 20 and the holding means 22 glued to the thorax during the chest compression, the pressure stamp 19 or its lower stamp head 38 forming the pressure surface 20 can be provided with a ball joint 39 ( Fig. 4 ) must be connected so that the pressure surface can incline as required and thus optimally adapt to the shape of the thorax.

The fixation of the pressure stamp 19 to the thorax 12 of the patient 11, which is used in the preferred exemplary embodiment described, by means of a Velcro connection also has the effect that the pressure stamp is attached to the adhesive pad in a tensile manner until the release force is reached in order to open the Velcro fastener. Since it is also held in the stamp unit of the massage device - preferably with slight play (for example 5 to 15 mm) - and is thus lifted upwards again by the stamp unit after the end of a compression phase, it exercises the patient's chest during this withdrawal movement a pulling force results in additional decompression (negative compression) and thus a further improvement in the effectiveness of the massage.

The locking mechanism of the device can be actively controlled. Advantageously, the locking is automatically activated or released depending on the detection of a counter pressure on the stamp unit. As soon as the pressure stamp comes into the pressure phase during a massage stroke and exerts a massage force on the chest, this leads to a correspondingly large counterforce in the Z direction in the massage device, which immediately ensures that the mobility of the massage device, in the preferred embodiment by means of the electromagnetically operated bolt locks (30) are blocked in the X and Y directions.

genügt. Dabei ist k eine ganzzahlige Konstante oder Null. Das Teilungsverhältnis T kann somit dem einer Noniusskala entsprechen, wenn neun Verschlusselemente 33 vorgesehen werden. Um eine besonders platzsparende Anordnung zu schaffen, können wie gezeigt mehrere Rastleisten 40 a,b,c parallel nebeneinander angeordnet sein, deren Rastöffnungen 34 phasenverschoben zu den Rastöffnungen 34 einer benachbarten Rastleiste angeordnet sind, wobei jeder Rastleiste mindestens ein Verschlusselement 33 zugeordnet ist, wie dies in Fig. 6 schematisch dargestellt ist.A particularly advantageous development of the locking mechanism, which can be used in the device of the type according to the invention, but which has its own inventive significance, is shown in Fig. 6 outlined. It results when at least one locking bar 40 is arranged on one of the gear elements, for example on the portal support 16a, for locking the articulated mechanism 16 of the device 10, the locking bar 40 having a large number of locking openings 34 arranged at a constant first distance A from one another . In the case of this particularly advantageous design, a plurality n, in the exemplary embodiment shown three, of actuatable closure elements 33, each with one into the other, on the other gear element, in this case the arm 16b Latching openings 34 snap-in latch 36 provided. The arrangement is such that the latching lugs of the plurality n (in the exemplary embodiment n = 3) closure elements 33 are arranged at a constant second distance a from one another, which divides the first distance A between the latching openings 34 in a division ratio T, which is the condition $$T=\frac{a}{A}=\frac{1}{n}+k$$

enough. K is an integer constant or zero. The division ratio T can thus correspond to that of a vernier scale if nine closure elements 33 are provided. In order to create a particularly space-saving arrangement, as shown, a plurality of locking bars 40 a, b, c can be arranged side by side in parallel, the locking openings 34 of which are arranged out of phase with the locking openings 34 of an adjacent locking bar, with each locking bar being assigned at least one closure element 33, as is the case here in Fig. 6 is shown schematically.

Claims (15)

1. Device for cardiopulmonary massaging and/or resuscitation, having a massaging device which has a pressing stamp (19), reversably movable in an operating direction (23), able to be operated (15) by a drive and able to be positioned on the rib cage (12) of a patient (11) on a target contact region (21), wherein the pressing stamp (19) can be fixed on the rib cage (12) of the patient (11) on the target contact region (21) and at least during a rest-state between two massage strokes is mounted freely movably in a plane perpendicular to the operating direction (23), characterised in that the pressing stamp (19) is fixed or can be fixed on a holding means (22) which can be fastened on the rib cage (12) of the patient (11), wherein the holding means (22) is formed as a holding pad (24) which can be adhesively bonded by means of an adhesive layer on the rib cage (12).
2. Device according to claim 1, characterised in that the pressing stamp (19) in a load state during a massage stroke in the plane perpendicular to the operation direction (23) can be locked in its position relatively to the rib cage of the patient (11).
3. Device according to claim 1 or 2, characterised in that the massaging device (15) has at least one lockable and un-lockable joint mechanism (16) which can be adjusted about an axis extending parallel to the operating direction (23).
4. Device according to any of claims 1 to 3, characterised by a locking mechanism (29) preferably acted upon by a force-sensor and/or displacement sensor to prevent the lateral movability of the pressing stamp (19) during a massage stroke, in particular to lock the at least one joint mechanism (16).
5. Device according to any of claims 1 to 4, characterised by a Velcro connection (27) active between the pressing stamp (19) and the holding means (22).
6. Device according to any of claims 1 to 5, characterised in that the holding means (22) has a contact surface (25) which is greater than a pressing surface (20) formed by the pressing stamp (19).
7. Device according to any of claims 1 to 6, characterised by a counter-support board (14), which can be positioned below the body of the patient (11), on which is disposed the massaging device (15).
8. Device according to claim 7, characterised in that the massaging device (15) is adjustable in its height position relatively to the counter-support board (14).
9. Device according to claim 8, characterised in that the pressing stamp (19) is disposed mounted freely rotatable on the massaging device (15).
10. Device according to any of claims 1 to 9, characterised in that the pressing stamp (19) is disposed in a tension-resistant manner in operating direction (23) on the massaging Device (19), preferably with play.
11. Device according to any of claims 1 to 10, characterised in that the pressing stamp (19) is connected in a ball-and-socket manner with the massaging device (15).
12. Device according to any of claims 4 to 11, characterised in that the locking mechanism (29) has at least one preferably electromotively actuatable bolt lock (30) which can snap-in in a plurality of detent positions at a joint or a linear guide of the joint mechanism (16).
13. Device according to any of claims 4 to 12, characterised in that the locking mechanism has at least one detent strip (40), disposed at a gear element (16a) of the joint mechanism (16), having a has a plurality of detent openings (34) disposed at a first distance A from one another which remains the same and a multiplicity n, provided on another gear element (16b) of the joint mechanism (16), of actuatable locking elements (33) having in each case one detent lug (36) which can snap-in to the detent openings (34), wherein the detent lugs of the multiplicity n locking elements (33) are disposed at a second distance a from one another which remains the same, which divides the first distance A between the detent openings (34) in a division ratio (T) of $$T=\frac{a}{A}=\frac{1}{n}+k\left(k\in {\mathbb{N}}_0\right)$$

    
14. Device according to claim 13, characterised in that the division ratio (T) corresponds to that of a vernier scale.
15. Device according to claim 13 or 14, characterised in that several detent strips (40 a, b, c) are disposed parallel next to one another, the detent openings (34) of which are disposed in a phase-shifted manner, preferably by the division ratio (T), to the detent openings of an adjacent detent strip, wherein to each detent strip (40) is assigned at least one locking element (33).

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