EP3431069B1 - Automatisierte brustkompressionsvorrichtung zur erhöhung der effizienz der kardiopulmonalen wiederbelebung mittels alternierender phasen, bei denen die physikalischen eigenschaften der brustkompression zur erhöhung des gesamten vorwärtsblutflusses variiert werden - Google Patents

Automatisierte brustkompressionsvorrichtung zur erhöhung der effizienz der kardiopulmonalen wiederbelebung mittels alternierender phasen, bei denen die physikalischen eigenschaften der brustkompression zur erhöhung des gesamten vorwärtsblutflusses variiert werden Download PDF

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EP3431069B1
EP3431069B1 EP18000048.1A EP18000048A EP3431069B1 EP 3431069 B1 EP3431069 B1 EP 3431069B1 EP 18000048 A EP18000048 A EP 18000048A EP 3431069 B1 EP3431069 B1 EP 3431069B1
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ccdcs
optimized
chest compression
compression device
cardiac output
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French (fr)
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EP3431069A1 (de
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Norman Paradis
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H31/00—Artificial respiration or heart stimulation, e.g. heart massage
    • A61H31/004—Heart stimulation
    • A61H31/006—Power driven
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H11/00—Belts, strips or combs for massage purposes
    • A61H2011/005—Belts, strips or combs for massage purposes with belt or strap expanding and contracting around an encircled body part
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5005—Control means thereof for controlling frequency distribution, modulation or interference of a driving signal

Definitions

  • the present invention relates to automated chest compression.
  • Devices performing automated mechanical cardiopulmonary resuscitation (CPR) have been developed for inducing blood flow by application of external force to the thorax.
  • CPR cardiopulmonary resuscitation
  • Circumferential and partial circumferential constrictions may incorporate a band around the front and sides of the patient, or a pneumatic bladder with a constricting outer circumference.
  • a circumferential device for applying chest compressions using a bladder is described, for instance, in US2007/0010765 A1 .
  • anteroposterior compression decompression may be provided by a piston mechanism attached to a gantry above the patient.
  • Circumferential constriction may be achieved by inflation pneumatic bladders or shortening of a band.
  • the mechanical devices may perform chest compressions under control of a processer.
  • the processor controls operation of the mechanical application of force to the patient.
  • Hemodynamics is the forward movement of blood. As such, it is required for the maintenance of life in any organism with a separate vascular system.
  • the vascular system is composed of a pumping mechanism - the heart - and a closed circuit of arteries and veins. Arteries deliver freshly oxygenated blood to the tissues and veins return blood to the heart and lungs for replenishment of oxygen.
  • the circulatory system is considered to have four components: 1) a pump, 2) an arterial compartment, 3) an organ and tissue compartment, and 4) a venous compartment. Forward blood flow is achieved through a combination of cardiac output and venous return. Additionally:
  • each heart beat is similar to any other and incorporates components intended to achieve cardiac output and venous return.
  • mammals respond to the need for greater cardiac output by means of increasing stroke volume and heart rate.
  • CPR cardiopulmonary resuscitation
  • Normal cardiac output in a healthy adult is in the range of 4.7 liters per minute. This output maintains a mean arterial compartment blood pressure of approximately 90 mm Hg.
  • the human heart responds to greater needs for blood flow by increasing rate and the force of contraction.
  • cardiac outputs, ventricular stroke volumes, tissue flows, and venous return are generally in equilibrium.
  • one of the vascular compartments does not expand significantly with respect to the other compartments over time frames of minutes. This may not be the case under the extreme low-flow of cardiac arrest and CPR.
  • the relative expansion of the venous compartment may result in inadequate volume on the arterial side of the circulation. This, in turn, may result in impaired cardiac output.
  • CCDCs CPR chest compression decompression cycles
  • cardiopulmonary resuscitation based on manipulation of the external chest and/or abdomen may be considered to fall into two broad categories: 1) those that directly create or enhance arterial forward flow (cardiac output), and 2)those that create or enhance venous return.
  • components/devices of the CPR cycle that create or enhance cardiac output act to pressurize the arterial compartment. This will increase flow from the arterial compartment into the tissue compartment. Subsequent increased flow in the tissue compartment will result in increased flow into the venous compartment. The expansion and increased pressure of the venous compartment will enhance flow back to the heart, which is venous return. And finally, enhanced venous return may prime the CPR pump for increased cardiac output and forward-flow on the next cycle.
  • CPR hemodynamics The mechanistic understanding of CPR hemodynamics is limited by a general lack of agreement as to the actual pump. (Haas et al. 2003) Some authorities believe that the heart continues to function as a pump mechanism, (Bircher, Safar, and Stezoski 1982) while others believe that the thorax becomes functionally the pump during CPR. (Niemann et al. 1980; Weisfeldt, Chandra, and Tsitlik 1981) It is possible that the mechanism of CPR is a combination of cardiac and thoracic pumps, and that the proportional contribution of each mechanism is variable patient to patient. Alteration of device CCDC s between arterial optimized and venous optimized is independent of the CPR pump mechanism.
  • Devices applying methods intended to increase arterial cardiac output during CPR include, but are not limited to ( Figure 3 ):
  • Devices applying methods intended to increase venous return during cardiopulmonary resuscitation include, but are not limited to ( Figure 4 ):
  • Examples of forward flow cardiac output enhancing techniques include, but are not limited to, standard anteroposterior chest compression and circumferential constriction.(Kouwenhoven, Jude, and Knickerbocker 1960; Halperin et al. 1993)
  • Examples of techniques that may enhance venous return include, but are not limited to, active decompression of the chest (Cohen, Tucker, Lurie, et al. 1992), abdominal counterpulsation (Voorhees, Niebauer, and Babbs 1983), and partial airway obstruction during inhalation - the so called impedance threshold device. (Wolcke et al. 2003)
  • the improvement in hemodynamics associated with active decompression may be mechanistically mediated by creation of increased negative intrathoracic pressure during the decompression phase of CPR 10,3 , with resulting enhancement of venous return. Additional enhancement of negative intrathoracic pressure and venous return may be achieved by briefly obstructing the airway during the decompression release phase.(Plaisance et al. 1999) Typically, this is achieved through utilization of a cracking valve mechanism called an impedance threshold device.
  • the invention disclosed here relates in general to the field of cardiopulmonary resuscitation (CPR), and more particularly, to an automated chest compression or constriction device for improving hemodynamics and clinical outcome.
  • CPR cardiopulmonary resuscitation
  • US 2017/035650 A1 discloses an example of a chest compression system.
  • an automated chest compression device according to claim 1.
  • each CCDC will have a duration of 600ms and standard compression and relaxation phases durations of 300ms.
  • the major compartments of the circulatory system may not be in continuous equilibrium. Rather, during the phase of the cycle in which the device CCDCs are optimized for cardiac output, the arterial compartment may become pressurized relative to the tissue and venous compartments. If this pressure differential moves blood from the arterial compartment to the tissue compartment and then into the venous compartment, the venous compartment may then become relatively pressurized. Subsequently, during the phase in which the CCDCs are optimized for venous return, the venous compartment would be drained with increased returned blood flow to the heart.
  • a pattern may be established in which there is sequential volume expansion and pressurization of first the arterial compartment, then the tissue compartment and finally the venous compartment.
  • the arterial and venous compartments may be considered components of a systemic pumping mechanism rather than simply conduits. Flow within the tissues may take on a more sinusoidal pattern.
  • the overall hemodynamic efficacy for example the minute-volume of blood flow through an organ of interest, is improved relative to what could be achieved by either of the two types of CCDCs alone.
  • CCDCs optimized for cardiac output would include, but are not limited to CCDCs of:
  • alterations in the abdomen and/or ventilations may adjunctively augment overall hemodynamics during CCDCs optimized for cardiac output. These alterations may be synchronized with specific alterations in the cardiac output or venous return optimized CCDCs.
  • CCDCs optimized for venous return would include, but are not limited to CCDCs of:
  • alterations in the abdomen and/or ventilations may adjunctively augment overall hemodynamics during CCDCs optimized for venous return. These alterations may be synchronized with specific alterations in the venous return optimized CCDCs.
  • a practitioner of ordinary skill would produce a method for controlling an automated chest compression device in which there are alternating pairs of CCDCs, one cycle optimized for cardiac output, a second cycle optimized for venous return ( Figure 5 ).
  • a practitioner of ordinary skill would produce a method for controlling an automated chest compression device in which there are alternating time intervals composed of multiple CCDCs, one interval composed of multiple cycles optimized for cardiac output, a second phase composed of multiple cycles optimized for venous return ( Figures 6 , 7 ).
  • a practitioner of ordinary skill would produce a method for controlling an automated chest compression device in which there are repeating time intervals composed of multiple CCDCs, each repeating interval composed of CCDCs that transition from cycles optimized for cardiac output to cycles optimized for venous return.
  • a practitioner of ordinary skill would produce a method for controlling an automated chest compression device in which there are repeating intervals composed of multiple CCDCs, each repeating interval composed of multiple CCDCs cycles that transition from cycles optimized for venous return to cycles optimized for cardiac output.
  • a practitioner of ordinary skill would produce a method for controlling an automated chest compression device in which the CCDCs are optimized for cardiac output through incorporation of one or more selected from the group consisting of: greater compressive force, greater compressive speed, greater depth of compression, more frequent compressions, prolonged compression phase relative to relaxation, lessened active decompression, decreased force of decompression, decreased speed of decompression, shortened decompression phase.
  • a practitioner of ordinary skill would produce a method for controlling an automated chest compression device in which the CCDCs are optimized for venous return through incorporation of one or more selected from the group consisting of: greater active decompression, increased force of decompression, increased speed of decompression, lengthened decompression phase, lessened compressive force, lessened compressive speed, lessened depth of compression, prolonged decompression phase.
  • CCDCs may be provided that transition incrementally from ones that are solely intended to enhance venous return through CCDCs that blend venous return and cardiac output enhancing characteristics to CCDCs that are solely intended to enhance cardiac output.
  • the oscillation through this cycle would be alternated with a time period that is itself optimized empirically or through feedback to enhance overall system forward flow.

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  • Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Emergency Medicine (AREA)
  • Pulmonology (AREA)
  • Epidemiology (AREA)
  • Pain & Pain Management (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Rehabilitation Therapy (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Percussion Or Vibration Massage (AREA)

Claims (14)

  1. Automatische Thoraxkompressionsvorrichtung zum Durchführen von Thoraxkompressionen während einer kardiopulmonalen Reanimation an einem Patienten, wobei die Vorrichtung dazu konfiguriert ist, zwei oder mehr unterschiedliche Thoraxkompressions-/- dekompressionszyklen CCDC auf den Patienten anzuwenden, wobei die zwei oder mehr CCDC einen ersten Satz von CCDC, die für das Herzminutenvolumen optimiert sind, und einen zweiten Satz von CCDC, die für den venösen Rückfluss optimiert sind, beinhalten; dadurch gekennzeichnet, dass
    der Satz von CDCC, die für das Herzminutenvolumen optimiert sind, durch eine Entspannungsphase von 1 bis 300 Millisekunden gekennzeichnet ist und
    der Satz von CDCC, die für den venösen Rückfluss optimiert sind, durch eine aktive kraftvolle Dekompression und/oder eine Entspannungsphase von 400 bis 1500 Millisekunden gekennzeichnet ist; und
    wobei der Satz von CCDC, die für das Herzminutenvolumen optimiert sind, abwechselnd mit dem Satz von CDCC, die für den venösen Rückfluss optimiert sind, durchgeführt wird, um die hämodynamische Gesamteffizienz zu verbessern.
  2. Automatische Thoraxkompressionsvorrichtung nach Anspruch 1, wobei mindestens einer von dem ersten und dem zweiten Satz von CDCC CCDC umfasst, die alle dieselben Parameter aufweisen.
  3. Automatische Thoraxkompressionsvorrichtung nach Anspruch 1 oder 2, wobei mindestens einer von dem ersten und dem zweiten Satz von CDCC mindestens fünf CDCC-Zyklen umfasst.
  4. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 2, wobei mindestens einer von dem ersten und dem zweiten Satz von CDCC eine Dauer von mindestens 5 Sekunden umfasst.
  5. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 4, wobei ein Verhältnis von Zeitintervallen des ersten und des zweiten Satzes von CDCC eins zu eins beträgt.
  6. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 4, wobei ein Verhältnis von Zeitintervallen des ersten und des zweiten Satzes von CDCC nicht eins zu eins beträgt.
  7. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 6, wobei der erste Satz von CDCC, die für das Herzminutenvolumen optimiert sind, ein erstes Intervall von mehreren CDCC umfasst und der zweite Satz von CDCC, die für den venösen Rückfluss optimiert sind, ein zweites Intervall von mehreren CDCC umfasst.
  8. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 7, wobei ein inkrementeller Übergang von dem ersten Satz von CDCC, die für das Herzminutenvolumen optimiert sind, zu dem zweiten Satz von CDCC, die für den venösen Rückfluss optimiert sind, stattfindet.
  9. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 8, wobei das Anwenden des ersten Satzes von CDCC, die für das Herzminutenvolumen optimiert sind, und das Anwenden des zweiten Satzes von CDCC, die für den venösen Rückfluss optimiert sind, ein Anwenden des ersten und des zweiten Satzes von CDCC in einem sich wiederholenden Intervall und Muster umfasst.
  10. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 9, wobei eine Dauer oder ein Verhältnis von Mustern mindestens eines von dem ersten und dem zweiten Satz von CDCC auf der Basis eines Biomarkermesswerts, der von dem Patienten erhalten wird, justiert wird.
  11. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 10, wobei ein Muster des Übergangs von dem ersten Satz von CDCC, die für das Herzminutenvolumen optimiert sind, zu dem zweiten Satz von CDCC, die für den venösen Rückfluss optimiert sind, auf der Basis eines Biomarkermesswerts, der von dem Patienten erhalten wird, justiert wird.
  12. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 11, wobei die kardiopulmonale Reanimation durch zirkumferentielle oder partielle zirkumferentielle Verengung und Entspannung des Thorax bereitgestellt wird.
  13. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 12, wobei ein Verhältnis von Zeitintervallen des ersten und des zweiten Satzes von CDCC 3 zu 2 beträgt.
  14. Automatische Thoraxkompressionsvorrichtung nach einem der Ansprüche 1 bis 13, wobei ein Signal von der Vorrichtung zum Ermöglichen einer Synchronisierung ausgegeben wird, um CCDC oder ihre jeweiligen Phasen durch phasische automatische Manipulation des Abdomens oder Veränderung von Beatmungsmuster oder -drücken weiter zu verbessern.
EP18000048.1A 2017-07-21 2018-01-19 Automatisierte brustkompressionsvorrichtung zur erhöhung der effizienz der kardiopulmonalen wiederbelebung mittels alternierender phasen, bei denen die physikalischen eigenschaften der brustkompression zur erhöhung des gesamten vorwärtsblutflusses variiert werden Active EP3431069B1 (de)

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US15/657,078 US11684542B2 (en) 2016-07-22 2017-07-21 Method to increase the efficacy of cardiopulmonary resuscitation by means of alternating phases during which the physical characteristics of chest compression are varied so as to increase overall forward blood flow

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Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060094991A1 (en) * 2004-11-03 2006-05-04 Rob Walker Mechanical CPR device with variable resuscitation protocol

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US5769800A (en) 1995-03-15 1998-06-23 The Johns Hopkins University Inc. Vest design for a cardiopulmonary resuscitation system
US7645247B2 (en) * 2004-10-25 2010-01-12 Norman A. Paradis Non-invasive device for synchronizing chest compression and ventilation parameters to residual myocardial activity during cardiopulmonary resuscitation
US20140155792A1 (en) * 2011-05-15 2014-06-05 All India Institute Of Medical Sciences A cardio pulmonary resuscitation device and an integrated resuscitation system thereof
US10143619B2 (en) * 2013-05-10 2018-12-04 Physio-Control, Inc. CPR chest compression machine performing prolonged chest compression
US10596064B2 (en) * 2014-03-18 2020-03-24 Zoll Medical Corporation CPR chest compression system with tonometric input and feedback
US10695264B2 (en) * 2014-05-07 2020-06-30 Jolife Ab CPR chest compression system with rate-based patient tranquility mode
US10772793B2 (en) 2015-06-12 2020-09-15 Norman A. Paradis Mechanical cardiopulmonary resuscitation combining circumferential constriction and anteroposterior compression of the chest

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060094991A1 (en) * 2004-11-03 2006-05-04 Rob Walker Mechanical CPR device with variable resuscitation protocol

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