EP3651716B1 - Device for a cardiopulmonary massaging and/or resuscitation - Google Patents

Description

The invention relates to a device for cardiopulmonary massage and/or resuscitation with the features of independent patent claim 1.

A cardiac arrest poses a serious threat to a patient's life. Only if it is possible to initiate and maintain an "emergency circuit" for cardiopulmonary resuscitation within a very short time does the patient have a real chance of survival without permanent damage. In addition to ventilation, a central component of cardiopulmonary resuscitation is the performance of cardiac massage to establish a replacement blood circulation so that vital organs, especially the brain, are supplied with oxygen. The classic chest compression is carried out manually, i.e. for example by a paramedic who compresses and releases the patient's thorax in the sternum area at frequencies of the order of 80-140 per minute, thereby allowing the blood to circulate through the patient's body so that the oxygen supply to the organs occurs.

From the WO 94/03142 A1 a device for direct manual cardiac massage is known, which can be applied directly to the patient's heart through a comparatively small incision in the chest of a patient for cardiac massage during cardiac arrest. The known device has a pressure surface which is connected to a lower pipe section, in which an upper inner pipe provided with a handle is telescopically received and locked in a working position by means of a locking element. If a triggering force of the locking element is exceeded, the locking connection opens and the inner tube pushes into the lower tube section, which signals to the surgeon handling the device that he should not put any more force on the pressure surface in order to avoid damage to the heart muscle.

Manual chest compression for resuscitation is very strenuous for the assistant performing it and can only be carried out with the required frequency for a limited time. Since it is often intended to continue even when the patient is transferred to the hospital, for example, US 2014/0088467 A1 , mechanical devices for cardiopulmonary massage have been proposed, which complement the technical equipment of rescue vehicles, helicopters or the like and with the help of which the chest compressions on patients can be carried out mechanically over practically any length of time without the rescuers becoming tired. Rather, you can initiate additional life-saving measures while the mechanical device performs chest compressions to maintain emergency circulation. For this purpose, such a device has a massage stamp that can be moved by a drive and which is moved up and down at the desired frequency, i.e. approx. 80-140 per minute. The pressure surface arranged at the bottom of the massage stamp transfers the force required to carry out the cardiac massage to the contact area on the patient's chest and compresses it to the desired depth.

When carrying out cardiac massage, it is not only important that the correct pressure point, namely directly above the patient's breastbone, is used and that it is maintained during the massage, as shown in the DE 10 2013 100 943 A1 is described in detail. Efforts are also made to avoid injuries to the patient caused by chest compression, which can be the result of excessive compression force or depth during cardiac massage. Even if, for example, rib fractures cannot be avoided with certainty due to a patient's lack of thoracic strength, such injuries should, if possible, not occur due to errors in cardiac massage, i.e. excessive compression force applied or the wrong starting point of compression. The risk of injury as a result of excessive pressure is comparatively high when massaging (small) children and adolescents.

The object of the invention is to provide a device for cardiopulmonary massage and/or resuscitation with a massage stamp that can be driven reversibly in an actuation direction by a drive device, whose pressure surface attacks the patient's chest, so that injuries to the patient as a result of excessive compression force during cardiac massage of the chest can be reliably avoided. This problem is solved with the invention by combining the features of independent patent claim 1.

According to the invention, with the two-part arrangement of the massage stamp consisting of the upper stamp part and the lower stamp part and the locking mechanism provided between these two stamp parts, an automatic termination/interruption of the massage process is ensured when the specified, maximum permissible compression force is reached/exceeded during the treatment of the respective patient. The locking mechanism is triggered when the predetermined compression force is reached/exceeded and cancels the locking, which results in an at least essentially force-free adjustment of the lower part of the stamp relative to the upper part of the stamp into a length that is shortened relative to the working length. The two stamp parts are adjusted relative to one another, for example pushed into one another, so that the then effective (shortened) length of the massage stamp is significantly smaller compared to the working length, so that even when the drive device continues to run and the massage stamp moves up and down with it with the pressure surface either no longer touches the patient's chest at all or at least only performs a significantly smaller compression path and thus also transmits a lower compression force than is the case with the full working length of the massage stamp. In this way it is ensured that injuries, such as rib fractures, do not occur to the patient being treated as a result of excessive compression forces.

According to the invention, the locking mechanism is essentially formed by a magnetic holding device acting between the upper part of the stamp and the lower part of the stamp, the magnetic holding force of which corresponds to the predetermined compression force. When the specified, maximum permitted compression force is reached in the direction of movement of the massage stamp, the magnetic holding force of the magnetic holding device is overcome, so that the The magnetic holding device forming the locking mechanism opens and the previously existing, non-positive connection between the upper part of the stamp and the lower part of the stamp is removed. The lower part of the stamp then no longer follows the movement of the upper part of the stamp, which is coupled to the drive device and is moved up and down by it, but is rather displaced relative to the upper part of the stamp in the sense of shortening the effective length of the massage stamp.

It has proven to be advantageous if the upper stamp part and the lower stamp part are aligned coaxially to one another and telescopically guided into one another. This arrangement is particularly space-saving. In addition, it is particularly suitable for transmitting the compression force, which essentially only acts in the Z direction (vertical direction). The Z direction should be defined as the direction in which the chest compressions are carried out, i.e. the direction in which the stamp is moved up and down in order to compress the chest of the patient (usually lying on his back) during the downward movement and at the opposite upward movement.

The upper part of the stamp can have an upper part base and the lower part of the stamp can have a lower part cover, which is located in the massage stamp above the upper part base, the locking mechanism engaging between the upper part base and the lower part cover and/or being formed by them. This configuration has proven effective when using the magnetic holding device as a locking mechanism. It is then particularly preferably provided that the locking mechanism comprises at least one holding magnet arranged on or formed by the upper part base and/or on the lower part cover, which then interacts with a ferromagnetic surface on the opposite part and/or a magnetic pole provided there with opposite polarity.

If the magnet holding device has at least one replaceable holding magnet, it is particularly easy to change the compression force that can be transmitted with the magnet holding device, namely simply by pressing the holding magnet in question against another with lower or higher holding force is replaced. It is also possible to change the holding force of a magnetic holding device acting between the upper part of the stamp and the lower part of the stamp by changing the distance between the two mutually attractive magnetic poles or a magnet and a ferromagnetic counterpart that interacts with it.

From a constructive point of view, an embodiment of the invention has proven successful, in which the upper part of the stamp and the lower part of the stamp are provided with complementary recesses arranged in their peripheral walls and extending essentially over their entire height, for the passage of the bottom of the upper part in the lower part of the stamp and of the lower part cover in the upper part of the stamp. The recesses and the longitudinal webs on the lower and upper parts of the stamp that remain between them then fit into one another like claws, whereby a stable, rotation-proof arrangement of the two stamp parts is achieved, which are guided in a form-fitting manner in the longitudinal direction of the massage stamp when the locking mechanism is triggered and the stamp parts are then pushed together. In this embodiment, it is preferably provided that the upper stamp part and the lower stamp part each have at least two recesses (and a number of longitudinal webs adapted in number and dimensions).

In order to quickly and easily couple the massage stamp with the drive device and, if necessary, to be able to exchange it for another stamp with different dimensions, an advantageous development of the invention provides a connection adapter arranged at the upper end of the upper part of the stamp for quick connection to the drive device. In addition, it is advantageous if the pressure surface is arranged to be replaceable at the lower end of the lower part of the stamp; it can then be replaced with an element with a smaller or larger, effective compression surface and/or with a different geometric design, for example round, elliptical, spherical, etc become.

It is also particularly advantageous in the invention if a preferably between the upper part of the stamp and the lower part of the stamp is more effective after the locking mechanism has been triggered and the lower part of the stamp has been adjusted relative to the upper part of the stamp, the position of which is held in the second position by a securing mechanism. Such a securing mechanism can advantageously be essentially formed by a securing retaining magnet and/or a preferably spring-loaded snap hook connection, which preferably acts between the top of the lower part cover and a counter surface formed at the upper end of the upper part of the stamp or on the drive device. The safety mechanism ensures that after the holding mechanism has been triggered once and the lower part of the stamp is then moved relative to the upper part of the stamp into the second (shortened) position, the massage stamp cannot give up this shortened length again on its own, because the safety mechanism holds the lower part of the stamp in the second position until the user of the device consciously releases the connection again, for example after the parameters for carrying out the chest compressions on the patient in question have been re-established in order to prevent the locking mechanism from being triggered again. It is also possible to use a spring or other suitable actuating element to ensure that after the locking mechanism is triggered, the lower part of the stamp is actively retracted until it reaches the second position and is then locked in this position by means of the safety mechanism.

Fig. 1

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

Fig. 2a,b

eine bevorzugte Ausführungsform des bei der Vorrichtung nach Fig.1 zum Einsatz kommenden Massagestempels in einer ersten Position, in zwei unterschiedlichen Seitenansichten, teilweise im Schnitt;

Fig. 3a,b

den Gegenstand der Fig. 2 in einer zweiten Position, die gegenüber der ersten Position verkürzt ist;

Fig. 4a-c

das Stempeloberteil des Massagestempels nach Fig. 2 und 3, in drei verschieden Darstellungen; und

Fig. 5

das Stempelunterteil des Massagestempels nach Fig. 2 und 3, ebenfalls in drei verschiedenen Darstellungen.

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

Fig. 1

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

Fig. 2a,b

a preferred embodiment of the device according to Fig.1 The massage stamp used in a first position, in two different side views, partly in section;

Fig. 3a,b

the subject of the Fig. 2 in a second position shortened from the first position;

Fig. 4a-c

the upper part of the massage stamp Fig. 2 and 3 , in three different representations; and

Fig. 5

the lower part of the massage stamp Fig. 2 and 3 , also in three different representations.

In the Fig. 1 a device for cardiopulmonary massage and/or resuscitation of a patient 11, designated in its entirety as 10, is shown in its position applied to the patient's thorax 12. The device 10 has an abutment board 14 placed under the back 13 of the patient 11, in the corner area of which an upwardly projecting portal support 15 is arranged. The portal support 15 is arranged to be pivotable about a vertical axis relative to the abutment board 14 and to be displaceable in height. It can be locked - preferably continuously - at different heights. At its upper end it carries a boom 16, which is also articulated about a vertical axis on the portal support 15. The boom 16 in turn is provided at its outer, free end with a massage stamp 17, which is driven reversibly up and down in a substantially vertical actuation direction 18 by a drive device arranged inside the boom housing. The massage stamp 17, which compresses the patient's thorax during its downward movement and thereby exerts a compression force K and relieves the chest again with the upward movement, is in the Fig. 2 to 5 presented in more detail.

The massage stamp 17 has an upper stamp part 19 and a lower stamp part 20, which is operatively connected to the upper stamp part 19. The two stamp parts 19 and 20 are coaxially aligned with one another and telescopically guided into one another, so that they can be adjusted relative to one another in the actuation direction 18 at least between a first position defining a working length L and a second position in which an effective length 1 of the massage stamp 17 is shortened compared to the working length L. In the first position in which the massage stamp 17 has the (larger) working length L, the upper stamp part 19 and the lower stamp part 20 are locked together with a locking mechanism 21. When a predetermined, maximum permitted compression force K _max is reached, which is exerted by the massage stamp on the patient's chest, the locking mechanism 21 is triggered and thus cancels the operative connection of the two stamp parts 19, 20 in the first position. The arrangement is such that when the locking mechanism is triggered, the lower part of the stamp 20 and the upper part of the stamp 19 push together, so that at the end of this process the massage stamp 17 only has the shortened length 1 corresponding to the second position. This pushing together can be supported by an actuating element acting between the upper part of the stamp and the lower part of the stamp, for example a prestressed tension spring (not shown) which acts at the bottom of the lower part of the stamp and at the top of the upper part of the stamp, which actively pulls or pushes the two stamp parts together into the short effective length 1 as soon as the locking mechanism has triggered.

In the invention, the locking mechanism 21 is essentially formed by a magnetic holding device 22 acting between the upper stamp part 19 and the lower stamp part 20, the magnet holding force M of which corresponds to the predetermined compression force K _max . In the present case, the arrangement is such that the upper stamp part 19 has an upper part base 23 and the lower stamp part 20 has a lower part cover 24. This is located in the massage stamp 17 above the upper part base 23. The magnet holding device 22 has two holding magnets 25, 26, one of which is embedded on the upper side 27 of the upper part base 23 and the other coaxially on the underside 28 of the lower part cover 24 so that they are in contact with each other put on. The locking mechanism 21 in the form of the magnet holding device 22 therefore engages between the upper part bottom 23 and the lower part cover 24 and pulls the two stamp parts 19, 20 firmly in the first position, i.e. the extended working length L, with the magnetic holding force M effective between the holding magnets 25, 26. against each other.

In the drawing ( Fig.4 and 5 ) you can clearly see that the upper stamp part 19 and the lower stamp part 20 are provided with mutually complementary recesses 29, 30 in their peripheral walls 31, 32, which extend essentially over the entire height of the stamp parts 19, 20 extend. These recesses 29, 30 form, on the one hand, a passage for radially outer holding sections 33 of the upper part base 23 in the lower part of the stamp 20 and, on the other hand, for corresponding holding sections 34 of the lower part cover 24 in the upper part of the stamp 19. In this way, the two stamp parts 19, 20 can fit into one another in the direction 18 move when the maximum compression force, which corresponds to the magnet holding force in the first working position, is reached during chest compressions and then the locking mechanism is triggered. The lower stamp part 20, which is provided with a pressure surface D at the bottom, with which it rests on the patient's chest 12 ( Fig.1 ), when the locking mechanism 21 is triggered, loses its firm connection to the upper punch 19 caused by the holding magnets and, without exerting any further significant force on the patient's thorax 12, pushes itself into the upper punch 19 when it is pushed further by the drive device is moved down. The wall webs 35 of the upper stamp part 19 standing between the two recesses 29 slide in a form-fitting manner into the recesses 30 in the lower stamp part 19, while the wall webs 36 of the lower stamp part 20 slide fittingly into the corresponding recesses 29 on the upper stamp part 19 until the two stamp parts 19, 20 are pushed together into the second, shortened position with the shorter length 1. The massage stamp 17 can then no longer exert any compression force on the patient's thorax 12, so the cardiac massage is automatically interrupted as soon as the compression force, which in the exemplary embodiment must be transmitted by the magnetic holding device, is reached or exceeded.

In order to hold the two stamp parts in the second position relative to one another after the locking mechanism 21 has been triggered and the lower stamp part 20 has then retracted relative to the upper stamp part 19, a securing mechanism 37 which is effective between the upper stamp part 19 and the lower stamp part 20 is provided. In the exemplary embodiment, the securing mechanism 37 is essentially formed by the holding magnet 26 arranged in the lower part cover 24, which also generates a sufficiently large magnetic holding force on the top side 38 of the lower part cover in cooperation with a counter surface 41 formed at the upper end 40 of the upper part of the stamp 19 in order to achieve this Lower part of the stamp in the shortened length 1 of the massage stamp hold when the lower part of the stamp 20 retracts and its lower part cover 24 abuts the upper end 40 of the upper part of the stamp 19. The holding force exerted by the holding magnet 26 on the ferromagnetic counter surface 41 then ensures that the two stamp parts 19, 20 do not move apart again by themselves when the upper stamp part 19 of the massage stamp 17 is raised again by the drive device in the decompression stroke. Rather, the lower stamp part 20 then follows this upward movement of the upper stamp part 19, since it is sufficiently firmly connected to the upper stamp part 19 by the holding magnet 39 acting on the counter surface 41.

The invention ensures that the cardiac massage is immediately interrupted when the predetermined compression force is reached, because this causes the locking mechanism to be triggered and the two stamp parts to be brought into the second position with a shortened effective length l. It is possible to detect the triggering of the locking mechanism and/or pushing the stamp parts together using a sensor, which then stops the drive device for the massage stamp 17, expediently when it has reached its highest position again before the start of a subsequent compression stroke (downward movement). .

The invention is not limited to the exemplary embodiment shown and described, but various changes and additions are conceivable without departing from the scope of the invention. For example, it is conceivable that at least one of the holding magnets of the magnet holding device 22 is interchangeable and can be exchanged for a magnet with a larger or smaller holding force. In this way, the compression force at which the locking mechanism is triggered can be adjusted. This goal can also be achieved by making the distance between the two holding magnets in the first position of the stamp parts variable, for example with the help of an adjustable depth stop. The greater the distance between the two holding magnets, the lower the holding force acting between them.

A preferably spring-loaded snap connection can also be used as a securing mechanism, for example a ring snap connection or a hook-snap connection that holds the two stamp parts in the second position with the massage stamp shortened in relation to each other.

The printing surface, which is formed at the bottom of the lower part of the stamp, can be designed to be interchangeable, so that printing surfaces of different shapes and sizes, possibly also with different soft/hard coatings, can be used.

Reference symbol list

10

contraption

11

patient

12

thorax

13

Back

14

abutment board

15

Portal support

16

boom

17

Massage stamp

18

Direction of operation

19

Stamp top

20

Stamp base

21

Locking mechanism

22

Magnetic holding device

23

Top bottom

24

Base cover

25

first holding magnet

26

second holding magnet

27

Top of 23

28

Bottom of 24

29

Recesses in 19th

30

Cutouts in 20

31

Perimeter walls of 19

32

Circumferential walls of 20

33

Stop sections at 23

34

Stop sections at 24

35

Wall walkways from 19th century

36

Wall walkways of 20

37

Security mechanism

38

Top of 24

39

Fuse holding magnet

40

top end of 19

41

Counter surface

L

Length of 17 in the first position (long)

L

Length of 17 in the second position (short)

K

Compression force

M

Magnet holding force

D

printing area

Claims (11)

1. Device for cardiopulmonary massage and/or resuscitation, having a massage stamp (17) which can be reversibly driven by a drive apparatus in an actuation direction (18) and which has a pressure surface (31) that can be positioned on the chest (12) of a patient (11), having the following features:

   - the massage stamp (17) has a stamp upper part (19) and a stamp lower part (20) which is operatively connected to the stamp upper part;

   - the stamp upper part (19) and the stamp lower part (20) can be adjusted relative to one another in the actuation direction (18) at least between a first position which defines a working length (L) and a second position in which an effective length (1) of the massage stamp (17) is shortened compared to the working length (L);

   - in the first position, the stamp upper part (19) is locked to the stamp lower part (20) by means of a releasable locking mechanism (21); and

   - the locking mechanism (21) is released upon reaching/exceeding a predetermined compression force (K_max) transmitted by the massage stamp (17), characterised in that the locking mechanism (21) is substantially formed by a magnetic holding device (22) effective between the stamp upper part (19) and the stamp lower part (20), the magnetic holding force (M) of which corresponds to the predetermined compression force (K_max).
2. Device according to claim 1, characterised in that the stamp upper part (19) and the stamp lower part (20) are aligned coaxially with one another and are guided telescopically into one another.
3. Device according to claim 1 or 2, characterised in that the stamp upper part (19) has an upper part bottom (23) and the stamp lower part (20) has a lower part cover (34) which is located in the massage stamp (17) above the upper part bottom (23), and in that the locking mechanism (21) engages between and/or is formed by the upper part bottom (23) and the lower part cover (24).
4. Device according to claim 3, characterised in that the locking mechanism (21) comprises at least one holding magnet (25, 26) arranged on or formed by the upper part bottom (23) and/or the lower part cover (24).
5. Device according to any one of claims 1 to 4, characterised in that the magnet holding device (22) comprises at least one exchangeable holding magnet (25, 26).
6. Device according to any one of claims 2 to 5, characterised in that the stamp upper part (19) and the stamp lower part (20) are provided with complementary recesses (29, 30) arranged in their circumferential walls (31, 32) and extending substantially over the entire height of said walls, for the passage of the upper part bottom (23) in the stamp lower part (20) and of the lower part cover (24) in the stamp upper part (19).
7. Device according to claim 6, characterised in that the stamp upper part (19) and the stamp lower part (20) each have at least two recesses (29, 30).
8. Device according to any one of claims 1 to 7, characterised by a connection adapter arranged on the stamp upper part (19) at its upper end (40) for quick connection to the drive apparatus.
9. Device according to any one of claims 1 to 8, characterised in that the pressure surface (31) is arranged at the lower end of the stamp lower part (20) in an exchangeable manner.
10. Device according to any one of claims 1 to 9, characterised by a securing mechanism (37) which is effective between the stamp upper part (19) and the stamp lower part (20) and, after the locking mechanism (21) has been released and the stamp lower part (20) has been adjusted relative to the stamp upper part (19), holds their position in the second position relative to one another.
11. Device according to claim 10, characterised in that the securing mechanism (37) is substantially formed by a securing holding magnet (29) preferably effective between the upper side (38) of the lower part cover (24) and a counter surface (41) formed on the upper end (40) of the stamp upper part (19) or on the drive apparatus and/or a preferably spring-loaded snap-hook connection.

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