EP4231982A1

EP4231982A1 - Device for cardiopulmonary resuscitation, pad, and method for controlling a device for cardiopulmonary resuscitation

Info

Publication number: EP4231982A1
Application number: EP21801415.7A
Authority: EP
Inventors: Christian Neuhaus; Tobias KALWA
Original assignee: Weinmann Emergency Medical Technology GmbH and Co KG
Current assignee: Anamed GmbH and Co KG
Priority date: 2020-10-23
Filing date: 2021-10-15
Publication date: 2023-08-30
Also published as: WO2022083824A1; DE102020127948A1; US20230381062A1; CN116507307A

Abstract

The invention relates to a device for cardiopulmonary resuscitation, a pad for assisting with cardiopulmonary resuscitation, and a method for controlling such a device, wherein the parameters of compression depth and frequency of the heart massage, and at least one vital parameter, are continuously monitored, and the parameters of the heart massage within the context of the position of the action of force on the patient's thorax, the direction of the action of force on the patient's thorax, the compression depth and/or the frequency of the heart massage are optimised on the basis of the individual anatomy of the patient.

Description

Device for cardiopulmonary resuscitation, pad and method for controlling a device for cardiopulmonary resuscitation

The invention relates to a device for cardiopulmonary resuscitation.

Furthermore, the invention relates to a pad for use in cardiopulmonary resuscitation.

The invention also relates to a method for controlling a device for cardiopulmonary resuscitation, in which an assistant is instructed to carry out cardiopulmonary resuscitation and/or a thoracic compression device for mechanically assisting cardiopulmonary resuscitation is controlled.

Cardiopulmonary resuscitation, also CPR (cardiopulmonary resuscitation), is a resuscitation measure used in respiratory and circulatory arrest, which serves to maintain the supply of oxygen to the organs, especially the brain and heart.

Various factors are important when performing appropriate resuscitation. In particular, these are the frequency and the pressure depth of the cardiac massage. In addition, periods of activity and periods of rest can be important. In combination with the use of defibrillators, there are also different variants regarding the duration of the defibrillation, the number of defibrillations and the length of the pauses between such actions. Basic rules for performing appropriate resuscitations are gleaned from statistical information on large populations. Experimental studies and calculations were used to derive how a cardiac massage should be carried out in the course of cardiopulmonary resuscitation for an optimal result on average. For example, guidelines were drawn up that stipulate that a cardiac massage should be performed vertically from above, onto the lower half of the breastbone, with a pressure frequency of 100 - 120 1/min and a pressure depth of 5 - 6 cm.

It has been shown in the past that the appropriate resuscitation measures are carried out for the individual patients with very different success rates. This is due to the fact that every individual person has an individual anatomy to a certain extent, so that the specifications for a heart pressure massage or cardiopulmonary resuscitation that work optimally on average cannot achieve the same good results for every individual patient.

In principle, in addition to manual cardiac massage by a human helper, technically supported cardiac massage or cardiopulmonary resuscitation is also possible.

Devices are known from the prior art which can be used for automated cardiopulmonary resuscitation. Devices of this type have a thoracic compression device which automatically exerts an alternating force on the thorax of a patient so that a cardiac massage can be carried out.

In addition, aids for manual compression of a thorax, for example in the form of pads, are also known.

Devices are also known which support a human helper, for example a paramedic, in carrying out cardiopulmonary resuscitation by providing information about the cardiopulmonary resuscitation carried out.

Both with the technical support of a human helper and with a fully or partially automated cardiac massage or cardiopulmonary resuscitation, the acquisition and processing of measurement data for cardiac massage as such and/or from the vital parameters of the patient is the necessary basis for a functioning control or regulation of the cardiac massage. The measurement of the parameters of pressure frequency and pressure depth of the cardiac massage is possible, for example, based on the data that can be recorded using acceleration sensors and/or gyroscope sensors.

The measurement of a patient's vital parameters, which can be given for example by the blood pressure and/or the oxygen saturation of the blood, can be carried out using known methods such as cerebral oximetry, pulse oximetry and the known methods for measuring blood pressure.

The generation of instructions or feedback for a human helper or the control of an automated cardiac massage or cardiopulmonary resuscitation based on the data on the pressure depth and pressure frequency recorded using suitable measuring means is already known in principle.

An object of the invention is to provide a cardiopulmonary resuscitation device that increases the likelihood of achieving better outcomes for an individual patient.

According to the invention, this object is achieved by a device for cardiopulmonary resuscitation according to patent claim 1 .

Another object of the invention is to provide a pad for use in cardiopulmonary resuscitation that increases the likelihood of achieving better outcomes for an individual patient.

According to the invention, this object is achieved by a pad according to patent claim 7 .

A further object of the invention is to provide a method for controlling a device for cardiopulmonary resuscitation which increases the probability of achieving better results for an individual patient.

According to the invention, this object is achieved by a method for controlling a device for cardiopulmonary resuscitation according to patent claim 10 .

Advantageous embodiments of the invention are specified in the dependent claims. The teaching according to the invention is based on the approach that the optimal position and direction of the force acting on the thorax of a patient during a cardiac massage in the course of cardiopulmonary resuscitation varies due to the individual human anatomy to a certain extent.

In order to achieve the best possible effect of the cardiac massage, the device according to the invention and the method according to the invention for controlling the device are designed in such a way that during the performance of the cardiac massage, by varying the position and/or the direction of the force acting on the patient's thorax and by continuously monitoring at least of a vital parameter of the patient, conclusions can be drawn about the optimal position and direction of the force on the patient's thorax for the individual patient, so that these can be used for the further cardiac massage of the patient.

In a further aspect of the invention, the pressure depth and the frequency of the cardiac massage can be reduced starting from the reference values to relieve a helper performing the cardiac massage, among other things, so that there is just no corresponding deterioration in the patient's vital parameters.

The features of a device for cardiopulmonary resuscitation disclosed below are part of the invention both individually and in all executable combinations.

A device according to the invention for cardiopulmonary resuscitation is designed at least to support cardiopulmonary resuscitation on a patient.

For this purpose, a device according to the invention for cardiopulmonary resuscitation has at least one computing unit, at least one sensor interface and at least one memory.

The at least one sensor interface is designed for connection to at least one sensor for recording the data of a cardiac massage in terms of pressure depth and pressure frequency and at least one sensor for recording at least one vital parameter of a patient.

In one embodiment of the invention, the at least one sensor interface is designed for connection to at least one sensor to record the blood pressure and/or the oxygen saturation in the patient's blood and at least one sensor to record the pressure depth and/or the pressure frequency of the cardiac massage. In one embodiment of the invention, this has a pad that has at least one sensor for determining the pressure depth and/or the frequency of the cardiac massage. The pad can be positioned on the patient's chest and connected to the sensor interface.

In one embodiment of the invention, the pad has at least one acceleration sensor and/or a gyroscope sensor and/or a magnetic field sensor with a total of 3, 6 or 9 axes (e.g. 3-axis acceleration sensor and 3-axis gyroscope sensor and 3-axis magnetic field sensor).

In one embodiment of the invention, the pad includes a multi-axis accelerometer.

In a preferred embodiment of the invention, the pad has a 6-axis acceleration/yaw rate sensor.

In one embodiment of the invention, the pad is designed as a flexible mat that can be positioned on the patient's chest.

In a preferred embodiment of the invention, the pad can be glued to the patient's chest.

In a further embodiment of the invention, the pad has a fixed housing in which the at least one sensor for detecting the pressure depth and/or the frequency of the cardiac massage is integrated.

In one embodiment of the invention, the pad has a force sensor for detecting a force acting on the pad.

In a further embodiment of the invention, the at least one sensor interface is designed for connection to at least one sensor for monitoring an at least partially automated ventilation of a patient, in addition to the aforementioned sensors.

The data transmitted via the sensor interface to the at least one computing unit of the device for cardiopulmonary resuscitation according to the invention can be evaluated using the computing unit. In one embodiment of the invention, the device for cardiopulmonary resuscitation has at least one output device with which information can be output for a human helper.

The at least one output device can preferably be embodied as a display, as an individual light source or a plurality of light sources and/or as an acoustic output device.

In one embodiment of the invention, the device for cardiopulmonary resuscitation is also designed in such a way that the cardiac massage on a patient can be carried out automatically.

For this purpose, the device has a thoracic compression device with which the thorax of the patient can be compressed in order to carry out a cardiac massage.

In these embodiments of the invention, the device for cardiopulmonary resuscitation has at least one control unit that is designed to control the automatic cardiac massage using the thoracic compression device.

The control signals that can be generated using the control unit are designed to control the pressure frequency, the pressure depth, the pressure direction and/or the position of the force acting on the patient's thorax by the thoracic compression device.

A chest compression device, in one embodiment of the invention, includes a compression head that is movable back and forth along an axis. From a resting position, the compression head can be moved according to a preset and/or adjustable length value from the top of the thorax of a patient in the area of the sternum approximately in the direction of the spine.

In one embodiment of the invention, the axis along which the compression head can be moved can be tilted, so that the compression of the thorax is not only made possible by a force exerted approximately perpendicularly on the thorax, but also in an angular range around the vertically aligned axis.

In one embodiment of the invention, the axis of movement of the compression head can be inclined in an angular range of −15° to 15° about the axis of movement aligned perpendicularly to the thorax. In a further embodiment of the invention, the axis of movement of the compression head can be inclined in an angular range of −10° to 10° about the axis of movement aligned perpendicularly to the thorax.

In one embodiment of the invention, the position of the compression head on a patient's thorax can be changed manually by a human assistant.

In another embodiment of the invention, the position of the compression head on a patient's thorax can be changed in addition to manual change or only automatically.

For this purpose, a device according to the invention for cardiopulmonary resuscitation has actuators with which the position of the compression head on the thorax of a patient can be changed at least in two dimensions.

In a preferred embodiment of the invention with an at least partially automated thoracic compression device for performing a cardiac massage, the axis of movement of the compression head can be tilted in an angular range around a movement axis aligned perpendicular to the thorax and the position of the compression head on the thorax of a patient can be changed manually or exclusively automatically changeable.

In one embodiment of the invention, the at least one output device is designed to output instructions to a human helper.

In the case of a manual cardiac massage by the human helper, the at least one output device is used to provide visual and/or acoustic instructions for adjusting the pressure frequency, the pressure depth, the position and/or the direction of the force applied to the patient's thorax by the helper's hand or a pad can be printed on the patient's thorax.

A visual output of the instructions using arrows and/or pictograms is advantageous for a quick grasp of the instructions by a human helper. In one embodiment of the invention, the output unit is designed to output instructions for positioning the ball of the hand of the human helper used for the cardiac massage or a possibly used pad to a human helper.

In one embodiment of the invention, the instructions for positioning the ball of the thumb of the human helper used for cardiac massage or a possibly used pad can be output to a human helper optically and/or acoustically with the aid of the output unit.

In a further embodiment of the invention, the device for cardiopulmonary resuscitation is also designed in such a way that instructions for adjusting the pressure depth and/or frequency can be issued to a human helper with the aid of the output unit in such a way that these can be reduced from the guideline values to such an extent that When the human helper is relieved, the patient's vital parameters do not deteriorate.

In one embodiment of the invention with a thoracic compression device, the control unit is designed in such a way that it can be used to transmit control signals to the thoracic compression device to change the position of the compression head on a patient's chest and/or to change the axis of movement of the pressure head and/or to adjust the pressure depth and/or or the frequency of the cardiac massage are transferrable.

In one embodiment of the invention, the processing unit is designed in such a way that the data from the sensors on the vital parameters of the patient that can be recorded using the sensor interface can be evaluated to determine whether the condition of the patient with regard to the recorded vital parameters changes in the course of chest compressions or cardiopulmonary resuscitation improved or worsened over time.

In a preferred embodiment of the invention, the device for cardiopulmonary resuscitation is designed to monitor the oxygen saturation in the patient's blood and/or the patient's blood pressure and/or the volume flow of the blood in at least one vein of the patient, for example in a carotid .

In one embodiment of the invention, the sensor interface, the computing unit and the output unit and/or the control unit for controlling a chest compression device are integrated into a defibrillator. The features of a method for controlling a device for cardiopulmonary resuscitation disclosed below are part of the invention both individually and in all executable combinations.

In a method according to the invention for controlling a device for cardiopulmonary resuscitation, at least one vital parameter of a patient is recorded in at least one method step, the pressure depth and/or the frequency of the cardiac massage applied to the patient is recorded in at least one method step, the recorded data of the at least a vital parameter and the pressure depth and/or the frequency of the cardiac massage are stored in a memory, the stored measurement data of the at least one vital parameter from previous measurement points are compared in at least one method step with the measurement data of the at least one vital parameter recorded in a current method step, in at least one Method step based on the comparison of the stored measurement data of the at least one vital parameter from previous measurement points with the measurement data of the at least one vital parameter recorded in a current method step, whether si ch has resulted in an improvement or deterioration or no change in the at least one vital parameter and in a further method step a measure to adjust the position of the force on the patient's thorax and/or the angle of the force on the patient's thorax and/or the Pressure depth and / or the frequency of the cardiac massage is determined, the adjustment may be 0 if necessary. In a further method step of a method according to the invention for controlling a device for cardiopulmonary resuscitation, the specific measure is output to a human helper visually and/or acoustically as an instruction using an output unit and/or converted into corresponding control signals for controlling a thoracic compression device using a control unit.

In one embodiment of the method according to the invention, the chest compression device is controlled using the control signals in such a way that, depending on the specific measure, the position of the force acting on the patient's thorax and/or the angle of the force acting on the patient's thorax and/or the pressure depth and/or the Frequency of chest compressions is adjusted.

In a method according to the invention, the at least one vital parameter is continuously recorded at least after the implementation of a previously determined measure and compared with the stored measurement data of the at least one vital parameter. According to the method steps disclosed above, the success of the previously determined measure, in terms of the comparison of the current with the stored measurement data Influencing the at least one recorded vital parameter, determined and, if necessary, another measure to adjust the position of the force on the patient's thorax and / or the angle of the force on the patient's thorax and / or the pressure depth and / or the frequency of the cardiac massage determined .

In embodiments of the invention, the following value ranges/threshold values are used to determine the success of a measure in relation to a particular vital parameter. For blood pressure, +/- 3 mmHg is considered unchanged, lower is worse, higher is better. For oxygenation, +/- 1 vol% is considered unchanged, lower is worse, higher is better. This applies to both RSO2 (regional cerebral oxygenation) and PAO2 (arterial partial pressure of oxygen) values.

A more differentiated assessment is preferably made for breath CO2: Here, a rapid increase (+1 vol.%) is good, an equal decrease is bad. However, a slow decrease has no meaning (relative change).

In one embodiment of a method according to the invention, the measure to be output and/or implemented in at least one subsequent method step is determined on the basis of a defined optimization process.

In one embodiment of the invention, the optimization process is implemented as a component-by-component optimization of the individual parameters of a cardiac massage.

In one embodiment of the method according to the invention, the directional components of the position of the force acting on the patient's thorax are each the subject of a separate optimization.

Starting from a starting point, the left/right directional component is used to shift the position of the force on the patient's thorax from a starting point in a direction approximately perpendicular to the longitudinal direction of the sternum on the patient's thorax, and the superior/inferior directional component is used to shift the position the force applied to the patient's thorax approximately in the longitudinal direction of the sternum, with inferior meaning a displacement in the direction of the abdomen and superior a displacement in the direction of the patient's head. In an embodiment of the method according to the invention, the starting point of the optimization corresponds to the area defined by the guidelines on the lower half of the patient's breastbone.

The term "point" or "starting point" is used in this context in the sense of the midpoint of the area on which the force for carrying out the cardiac massage acts on the patient's thorax.

In one embodiment of the method according to the invention, the components of the direction of the force acting on the patient's thorax are each the subject of a separate optimization.

Starting from a starting angle, the direction vector of the force acting on the patient's thorax is varied as a specific measure.

In one embodiment of the invention, the starting angle of the direction vector of the force acting on the patient's thorax is defined as 0° within the meaning of this document, which means an approximately vertical force acting on the patient's thorax within the meaning of the guidelines.

In one embodiment of the invention, the directional vector of the force acting on the patient's thorax is divided into a sagittal and a transverse component. The peak of the directional vector lies approximately at the midpoint of the area of application of the force, with a change in the sagittal component of an inclination of the directional vector approximately in the direction of the head (superior) or the abdomen (inferior) of the patient and the change in the transverse component directed perpendicular to the sagittal component of a inclination of the directional vector corresponds approximately in the direction of the patient's left or right arm.

A method according to the invention is started by the output of predetermined starting parameters as instructions to a human helper and/or a corresponding activation of a thoracic compression device.

The starting parameters, which are given by the position of the force on the patient's thorax and/or the direction of the force on the patient's thorax and/or the pressure depth of the chest compressions and/or the frequency of the chest compressions, are in of a preferred embodiment of the invention as the values specified by the applicable guidelines.

For the currently valid guidelines, the starting parameters are, as already described above, given by the lower half of the sternum as the starting position of the force on the patient's thorax, approximately perpendicular to the sternum as the starting direction of the force on the patient's thorax, about 5 to 6 cm as Starting pressure depth of the cardiac massage and about 100 to 120 1/min as the starting frequency of the cardiac massage.

In a preferred embodiment of a method according to the invention, after each output of a change in a parameter in the course of a specific measure as an instruction to a human helper and/or the corresponding activation of the chest compression device, a comparison of the at least one vital parameter then recorded with the stored previous measurement data takes place Determination of the success of the previously determined measure.

In a particularly preferred embodiment, the determination of a possibly subsequent measure takes place taking into account the success of the previous measure.

In one embodiment of the method according to the invention, at least the position of the force acting on the patient's thorax is optimized along a search path.

The search path initially has at least one starting point in terms of the position of the force acting on the patient's thorax and at least one defined first measure in terms of changing the position of the force acting on the patient's thorax.

In a preferred embodiment of the method according to the invention with an optimization of at least the position of the force acting on the patient's thorax along a search path, the search path is completely predetermined and is at least partially read from the memory of the device used for cardiopulmonary resuscitation to determine the following measures .

In one embodiment of the invention, the search path has a plurality of points, each corresponding to a position on the patient's thorax. At these points on the search path, the position of the effect of the force is successively determined in order to optimize at least the position of the effect of the force on the thorax of the patient in the sense of a measure shifted, the respective success of the measure is determined and, after walking the search path, the point is determined which corresponds to the position with the greatest determined success.

In one embodiment of the method according to the invention, the search path is continuously adjusted during the optimization of the position of the force acting on the patient's thorax based on the success of the previous measure determined using the recorded vital parameters.

In one embodiment of the invention, there is an additional optimization along the search path with regard to the direction of the force acting on the patient's thorax.

A pad according to the invention for use in cardiopulmonary resuscitation has a guide device that defines a search path, with cardiopulmonary resuscitation compressing the thorax of a patient along the search path.

In one embodiment of the invention, the guide device of the pad is realized by an optical marking on the pad and/or by a haptic design of the surface of the pad.

As a result, a human helper can safely follow the search path with his hand or an aid and, if necessary, safely implement the instructions issued with the aid of the cardiopulmonary resuscitation device.

In one embodiment of the invention, the haptic design of the surface of the pad as a guide device is designed such that the search path has a smooth surface and the remaining part of the surface of the pad is rough. A reverse design can also achieve the desired effect.

In another embodiment of the invention, the surface of the pad is set off from the rest of the surface along the search path in such a way that it protrudes from the rest of the surface along the search path or has a lower height than the rest of the surface.

In further embodiments of the invention, the guide device is realized by a guide rail that extends along the search path and in which a handle is slidably mounted, with a vertical force acting on the handle being transmitted to the patient's thorax at the respective position along the search path. In advantageous embodiments of the invention, the pad has one or more sensors for detecting at least one parameter of cardiopulmonary resuscitation according to the above description of the pad in connection with the device for cardiopulmonary resuscitation according to the invention.

In embodiments of a device for cardiopulmonary resuscitation according to the invention, it has a pad with such a guide device.

In embodiments of the method according to the invention for controlling a device for cardiopulmonary resuscitation, a pad according to the invention as described above is used.

In preferred embodiments of the invention, a human helper is informed in which direction and/or how far he should shift the position of the force along the search path to optimize the position of the force acting on the thorax of a patient during a cardiac massage.

The figures show exemplary embodiments of a device according to the invention and a method according to the invention. Show it:

Figure 1: A schematic representation of a block diagram of an inventive

Embodiment of a device for cardiopulmonary resuscitation without thoracic compression device,

Figure 2: A schematic representation of a block diagram of an inventive

Embodiment of a device for cardiopulmonary resuscitation with a thoracic compression device,

Figure 3: A schematic representation of the torso of a patient in front view,

Figure 4: A schematic representation of a section of the trunk and head of a

patients in the sagittal plane,

Figure 5: A schematic representation of a section of the torso of a patient in the transverse plane, FIG. 6: An abstracted schematic representation of the sequence of an embodiment of a method according to the invention for controlling a device for cardiopulmonary resuscitation,

Figures 7 & 8: A schematic representation of the sequence of a component-by-component optimization of the position of the force acting on the thorax of a patient in an embodiment of a method according to the invention,

Figures 9 & 10: A schematic representation of the process of a component-by-component

Optimizing the direction of the force acting on the thorax of a patient in one embodiment of a method according to the invention,

Figure 11: A schematic representation of the process of a continuous component-by-component fine alignment after the actual optimization of the parameters using the example of the transversal component of the position of the force acting on the thorax of a patient,

Figure 12: A schematic representation of a search path of an embodiment of the method according to the invention,

Figure 13: Another schematic representation of a search path of an embodiment of the method according to the invention,

Figure 14: A schematic representation of the sequence of an optimization along a

Search path in one embodiment of a method according to the invention,

Figure 15: A schematic representation of the sequence of a vector optimization in a

embodiment of a method according to the invention,

Figure 16: A schematic representation of the sequence of a combination of search path and

Vector optimization in one embodiment of a method according to the invention,

Figure 17: A schematic representation of the sequence of a frequency optimization in a

Embodiment of a method according to the invention and FIG. 18: A schematic representation of the process of a printing depth optimization in a

Embodiment of a method according to the invention.

FIG. 1 shows the block diagram of an embodiment according to the invention of a device for cardiopulmonary resuscitation (1) without a thoracic compression device (11).

The device for cardiopulmonary resuscitation (1) has a computing unit (2), a sensor interface (3), a pad (4) for application or placement on the chest of a patient (100), at least one sensor (5) for recording at least a vital parameter, at least one memory (6), an output device (7). An optional embodiment of a device for cardiopulmonary resuscitation (1) according to the invention is shown in dashed lines, additionally having a control device for controlling ventilation (8) and further optionally a device for ventilation (9). The pad (4) has at least one acceleration sensor and/or a gyroscope sensor integrated or otherwise connected to it. The sensors are connected to the sensor interface (3), so that the measurement data that can be recorded using the sensors can be transmitted to the computing unit (2) and/or the memory (2). The output device (7) can be used to output optical and/or acoustic instructions to a human helper for carrying out a cardiac massage.

With the aid of the illustrated embodiment of an inventive device for cardiopulmonary resuscitation (1), at least one vital parameter corresponding to the performance of a cardiac massage can be monitored and the success of the cardiac massage over time can be determined therefrom with the aid of the computing unit (2). Using the output device (7), instructions for adjusting at least one parameter of the cardiac massage can be output to a human helper and the success of this measure can be determined by monitoring the at least one vital parameter using the computing unit (2).

FIG. 2 shows the block diagram of an embodiment according to the invention of a device for cardiopulmonary resuscitation (1) with a thoracic compression device (11). The thoracic compression device (11) is designed in such a way that the thorax (101) of a patient (100) can be compressed in order to carry out a cardiac massage. The illustrated embodiment of a device for cardiopulmonary resuscitation (1) has a control unit (10) for controlling the thoracic compression device (11). The control unit (10) can be used to generate control signals for controlling the chest compression using the chest compression device (11) and to send them to the chest compression device (11). transferable. In this embodiment of the invention, the output device (7) for issuing instructions to a human helper is optional. In one embodiment of the invention, the thoracic compression device (11) is designed for the automated adjustment of all parameters of the cardiac massage. In another embodiment of the invention, the thoracic compression device (11) is dependent on the operation of a human helper to adjust at least one parameter of the cardiac massage, such as the position of the force acting on the thorax (101) of a patient (100), the output device ( 7) in this embodiment of the invention is adapted to instruct the human helper accordingly. Furthermore, in this embodiment of the invention, the use of the pad (4) with the at least one integrated acceleration and/or gyroscope sensor for monitoring the parameters pressure depth and frequency of the cardiac massage is optional. In embodiments of the invention in which no pad (4) is used, the monitoring of the pressure depth and/or the pressure frequency of the cardiac massage is arranged in the area of the thoracic compression device (11) or is integrated into it.

The torso of a patient (100) is shown schematically in a front view in FIG. On the torso or the thorax (101) is the position (103) according to the guidelines of the force acting on the thorax (101) of a patient (100), who lies in the lower area of the sternum (102), and who, according to the invention, is about this position (103 ) lying search area (104) for determining the optimal position of the force acting on the thorax (101) of a patient (100). Furthermore, the directional components of the position of the force acting on the thorax (101) of a patient (100) are shown with right/left and superior/inferior. In the inferior direction, the search area (104) is limited approximately by the costal arch (110).

FIG. 4 shows a schematic representation of a section of the torso (101) and the head of a patient (100) in the sagittal plane. The drawn coordinate system defines the directions superior in the direction of the patient's head (100), inferior in the direction of the patient's abdomen (100), anterior away from the patient's chest (100) and posterior away from the patient's back (100). A pad (4) is placed on the upper side of the thorax (101) of the patient (100). A force is exerted on the pad (4) to carry out a cardiac massage. The direction of the force acting on the pad (4) is given by the direction vector (105) of the force acting on the thorax (101) of the patient (100). According to the guidelines, the force is applied approximately perpendicularly to the pad (4). In the course of optimizing the direction of the force acting on the thorax (101) of the patient (100), in one embodiment of a method according to the invention, the direction of the force acting on the thorax (101) in the sagittal plane is varied in a predetermined first angular range (106). The angle describes the degree of tilting of the directional vector (105) of the force acting on the thorax (101) away from the guideline-compliant vertical direction. The tilting of the direction vector (105) of the force action can take place both in the inferior direction and in the superior direction. In the illustrated embodiment of the invention, the first angular range (106) is realized by an angular range encompassing 20°, this being divided symmetrically by a tilting of the directional vector (105) of 10° in the inferior or superior direction. In other embodiments of the invention, both other angular dimensions of the first angular range (106) and a non-symmetrical division of the first angular range (106) in the inferior and superior directions are conceivable.

FIG. 5 shows a schematic representation of a section of the torso (101) of a patient (100) in the transverse plane. The directions anterior, posterior as well as left and right are noted on the inserted coordinate system. In accordance with the explanations regarding the variation of the directional vector (105) of the force acting on the thorax (101) in the sagittal plane, in one embodiment of a method according to the invention, the direction of the force acting on the thorax (101) of a patient (100) is tilted direction vector (105) out of the vertical policy position. In the transversal plane, the directional vector (105) varies in a second angular range (107), which comprises an angular range of 20° in the right or left direction. A symmetrical distribution of the second angular range (107) of 10° each in the right and left directions is shown. In other embodiments of the invention, other angular ranges for the second angular range (107) and/or an asymmetrical distribution of the second angular range (107) to the left and right directions are conceivable.

FIG. 6 shows an abstracted schematic representation of the sequence of an embodiment of a method according to the invention for controlling a device for cardiopulmonary resuscitation (1). The schematic sequence shown comprises five method steps, it being possible for the individual method steps shown in this figure to be subdivided into further method steps. In the first method step, an instruction is issued to a human helper and/or a thoracic compression device (11) is activated to start a cardiac massage with a starting point or a specific position of the force acting on the thorax (101) of a patient (100), a starting angle or a directional vector (105) of the force acting on the thorax (101) describing the direction of the force acting on the thorax (101), a starting pressure depth and a starting frequency of the cardiac massage. In the second method step, at least one vital parameter of the patient (100) and the CPR data are recorded in terms of the pressure depth and the frequency of the cardiac massage of a cardiopulmonary resuscitation.

In the third method step, the success of the cardiac massage is determined abstractly with the current parameters. If this method step is used again in the course of the method according to the invention, the success of the previous measure is determined at this point.

In preferred embodiments of the invention, the method step “determining the success of the measure” includes reading out at least part of the stored previous measurement data of the at least one vital parameter from a memory and comparing at least one measurement value from a previous measurement with at least one measurement value from the current measurement.

In the fourth step of the method, the following measure is determined, with a measure by adapting the instructions issued to a human helper and/or the activation of a thoracic compression device (11) with regard to the position of the force acting on the thorax (101), the direction of the force acting on the thorax (101), the pressure depth and/or the frequency of the cardiac massage. In embodiments of the method according to the invention, the following measure can be determined based on the ascertained success of a previous measure or based on a predefined sequence of measures.

In the fifth step of the method, the specific measure is output as an instruction to a human helper and/or through the corresponding activation of a thoracic compression device (11).

In the illustrated embodiment of a method according to the second method step, at least one vital parameter of the patient (100) and the CPR data are then recorded again, with a loop comprising method steps 2-5 being run through.

In embodiments of the method according to the invention, at least one termination criterion is defined, and when this criterion is met, the loop is interrupted. Figures 7 and 8 show a schematic representation of the sequence of a component-by-component optimization of the position of the force acting on the thorax (101) of a patient (100) in an embodiment of a method according to the invention, with the optimization of the right/left component of the position of the Effect of force and in Figure 8, the optimization of the position is shown in the superior/inferior direction.

The following nomenclature is used in the figures for the optimization of individual parameters: If the term is preceded by a "/", then it is a matter of determining a variable, if the term is enclosed in square brackets (e.g. [better]), it is a matter of a Evaluation and if the term is enclosed in curly brackets (e.g. {move jinks}) then it is an action.

In both directional components, the optimization takes place from a starting position, from which it is shifted in one direction and the success of the measure given by this shift is then determined. If there is an improvement, it is shifted again in the same direction; if it deteriorates or the situation remains unchanged, the position is shifted in the opposite direction. The success of the further action given by this postponement is then determined. If there is an improvement in the condition, there is a shift in the same direction again; if the condition has deteriorated, there is a shift in the opposite direction in the sense of a measure. If the success of the measure is determined to be unchanged, then there is no further displacement of the position in the respectively optimized direction and the optimization of the directional component is complete.

Similarly, FIGS. 9 and 10 show a schematic representation of the sequence of a component-by-component optimization of the direction of the force acting on the thorax (101) of a patient (100) in an embodiment of a method according to the invention. Corresponding to the shift in the position of the force effect in the different directions, the measure here is a tilting of the directional sector (105) of the force effect on the thorax (101) in the respective direction.

FIG. 11 shows the process of local optimization or post-optimization/post-adjustment of the position of the force acting on the thorax (101) using the example of the right/left directional component. In embodiments of a method according to the invention, such a local optimization or readjustment follows an initial optimization of at least one parameter of the cardiac massage. There is a shift in the position of the force in a direction of the directional component that Determination of the success of this measure and as a determination of the following measure, a determination of the new position if an improvement has occurred or a shift of the position in the opposite direction if there has been a deterioration or no change. The flow charts for optional local optimizations or post-optimizations of the superior/inferior directional component of the position and/or of the angular ranges in the sagittal or transverse plane can be designed analogously in embodiments of the invention.

FIG. 12 shows the optimization of at least the position of the force acting on the thorax (101) of a patient (100) using a search path optimization. The position of the force action is optimized along a predetermined search path (108). Optimization begins at a starting point (108a) of the search path (108). The search path (108) runs within a predefined search area (104). The position of the force acting on the thorax (101) is shifted step by step along the search path (108), with the success of the measure given by the shift along the search path (108) being continuously determined by the recording and evaluation of at least one vital parameter of the patient (100) is determined. As soon as the end point of the search path (108), which in the illustrated embodiment of the method according to the invention also corresponds to the starting point (108a), that position of the force acting on the thorax (101) is determined at which the greatest success was determined.

This optimized position is issued as an instruction to a human helper and/or used to control a chest compression device (11).

FIG. 13 shows a schematic representation of the projection of the search vector (109) in a front view of the thorax (101). From the starting point (108a), the position of the force acting on the thorax (101) is shifted in a range of +/-5 cm both in the right/left directional component and in the superior/inferior directional component. The search vector (109) indicates the direction of the change in position along a search path (108).

FIG. 14 shows the sequence of a vector path optimization of an embodiment of a method according to the invention. In vector path optimization, the position of the force acting on the thorax (101) is shifted along a search path (108), with the direction vector of the direction of the force acting on the thorax (101) being aligned at each position on the search path (108) in such a way that this aims at the position of the patient's heart (100). Corresponding to the optimization processes shown in the previous figures, the position on the path is also shifted during vector path optimization Search path (108) and, in addition, an adjustment of the direction vector (105) of the force effect in the sense of a measure of a method according to the invention. After the search path (108) has been traversed, a comparison is made of the successes determined for the various positions and the corresponding directional vectors and the selection of the position with the highest success achieved.

FIG. 15 shows a flow chart for the combined optimization of vector and position in the individual directional components of the position of the force acting on the thorax (101).

FIG. 16 shows the path/vector optimization with a predefined search path (108) and search vector (109).

FIG. 17 shows the frequency optimization and FIG. 18 the pressure depth optimization of an embodiment according to the invention of a method for controlling a device for cardiopulmonary resuscitation (1).

Claims

Device for cardiopulmonary resuscitation (1) having at least one computing unit (2), at least one sensor interface (3) for connection to at least one sensor and a memory (6), characterized in that at least one vital parameter is measured using at least one sensor of a patient (100) can be recorded, that the measured values recorded for the at least one vital parameter can be stored in the memory (6), that the success of a cardiac massage can be determined using the computing unit (2), and that a measure for adapting at least one Parameters of cardiac massage can be derived. Device for cardiopulmonary resuscitation (1) according to claim 1, characterized in that it has a ventilation device (9) for ventilation of the patient (100) and a control device for controlling ventilation (8). Cardiopulmonary resuscitation device (1) according to one of Claims 1 and 2, characterized in that it has an output unit (7) for optically and/or acoustically outputting instructions to a human helper. Device for cardiopulmonary resuscitation (1) according to at least one of Claims 1 to 3, characterized in that it has a thoracic compression device (11) for compressing the thorax (101) of the patient (100) and a control device (10) for controlling the Thoracic compression device (11). Cardiopulmonary resuscitation device (1) according to at least one of the preceding claims, characterized in that it has an output device (7) for outputting instructions to a human helper and a thoracic compression device (11). Device for cardiopulmonary resuscitation (1) according to one of Claims 4 and 5, characterized in that the position of the force acting on the thorax (101) of the patient (100) and/or the direction of the force acting on the thorax (101) of the patient (100) can be changed using the thoracic compression device (11) based on a measure that can be determined using the computing unit (2). Pad (4) for use with a device for cardiopulmonary resuscitation (1) according to any one of claims 1 to 6, characterized in that the pad (4) has a guide device by which a search path (108) is defined, wherein during cardiopulmonary resuscitation along the search path (108) the thorax (101) of a patient (100) is compressed. Pad (4) according to Claim 7, characterized in that the guide device is implemented by an optical marking on the pad (4) or by a haptic design of the surface of the pad (4). Pad (4) according to Claim 7, characterized in that the guide device is implemented by a guide rail which extends along the search path (108) and in which a handle is movably mounted, with a force acting on the handle at the respective position along the Search path (108) is transferred to the thorax (101) of the patient (100). Method for controlling a device for cardiopulmonary resuscitation (1), characterized in that in a method step an instruction is issued to a human helper and/or a control of a chest compression device (11) to start a cardiac massage with a starting position, a starting angle , a starting pressure depth and a starting frequency, that at least one vital parameter of the patient (100) and the pressure depth and the frequency of the cardiac massage are recorded in at least one further method step, that the success of the cardiac massage is determined with the starting parameters in at least one further method step that in a further method step a measure is determined which adapts at least one of the parameters position of the force, Corresponds to the direction of the force, pressure depth and frequency of the cardiac massage, and that in a further method step the previously determined measure is output as an instruction to a human helper and/or a corresponding control of a thoracic compression device (11) takes place. Method for controlling a device for cardiopulmonary resuscitation (1) according to Claim 10, characterized in that after the previously determined measure has been output to a human helper and/or the corresponding activation of a thoracic compression device (11), at least one vital parameter is detected of the patient (100) and that the success of the measure is determined in a further method step and that the following measure is determined in a further method step. Method for controlling a device for cardiopulmonary resuscitation (1) according to claim 11, characterized in that the determination of the following measure is based on the success of the previous measure. Method for controlling a device for cardiopulmonary resuscitation (1) according to one of Claims 10 to 12, characterized in that by determining the measures and determining the success of the respective measure, an optimization of at least one of the parameters position of the force acting on the Thorax (101) of the patient (100), direction of the force acting on the thorax (101) of the patient (100), pressure depth and frequency of the cardiac massage. Method for controlling a device for cardiopulmonary resuscitation (1) according to claim 13, characterized in that the optimization of the position of the force on the thorax (101) of the patient (100) and / or the optimization of the direction of the force on the Thorax (101) of the patient (100) along a search path (108), after walking the search path (108) that position and / or direction of the force on the thorax (101) of the patient (100) is determined at which success was greatest. Method for controlling a device for cardiopulmonary resuscitation (1) according to Claim 14, characterized in that the search path (108) is predetermined and is loaded from a memory (6) at the start of the method, the following measure being taken at least during the Optimization of the parameters of the position of the force applied to the thorax (101) of the patient (100) or joint optimization of the position and Direction of the force acting on the thorax (101) of the patient (100) is given by a next point on the search path. Method for controlling a device for cardiopulmonary resuscitation (1) according to one of Claims 14 and 15, characterized in that at each point on the search path (108) the direction of the force acting on the thorax (101) of the patient (100) is determined using an optimization process is optimized and that after walking the search path (108) the interaction of position and direction of the force acting on the thorax (101) of the patient (100) is determined with the greatest success. Method for controlling a device for cardiopulmonary resuscitation (1) according to Claim 13, characterized in that the parameters position and direction of the force acting on the thorax (101) of a patient (100) are optimized component by component. Method for controlling a device for cardiopulmonary resuscitation (1) according to one of Claims 10 to 17, characterized in that a device for cardiopulmonary resuscitation (1) according to one of claims 1 to 6 and/or a pad ( ) according to any one of claims 7 to 9 is used.

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