Patent Application
20200306133
In certain types of medical emergencies a patient's heart stops working. This stops the blood flow, without which the patient may die. Cardio Pulmonary Resuscitation (CPR) can forestall the risk of death. CPR includes performing repeated chest compressions to the chest of the patient so as to cause their blood to circulate some. CPR also includes delivering rescue breaths to the patient. CPR is intended to merely maintain the patient until a more definite therapy is made available, such as defibrillation. Defibrillation is an electrical shock deliberately delivered to a person in the hope of correcting their heart rhythm.
The repeated chest compressions of CPR are actually compressions alternating with releases. They cause the blood to circulate some, which can prevent damage to organs like the brain. For making this blood circulation effective, guidelines by medical experts such as the American Heart Association dictate suggested parameters for chest compressions, such as the frequency, the depth reached, fully releasing after a compression, and so on. The releases are also called decompressions.
Traditionally, CPR has been performed manually. A number of people have been trained in CPR, including some who are not in the medical professions just in case. However, manual CPR might be ineffective, and being ineffective it may lead to irreversible damage to the patient's vital organs, such as the brain and the heart. The rescuer at the moment might not be able to recall their training, especially under the stress of the moment. And even the best trained rescuer can become quickly fatigued from performing chest compressions, at which point their performance might be degraded. Indeed, chest compressions that are not frequent enough, not deep enough, or not followed by a full decompression may fail to maintain blood circulation.
The risk of ineffective chest compressions has been addressed with CPR chest compression machines. Such machines have been known by a number of names, for example CPR chest compression machines, mechanical CPR devices, cardiac compressors and so on.
CPR chest compression machines repeatedly compress and release the chest of the patient. Such machines can be programmed so that they will automatically compress and release at the recommended rate or frequency, and can reach a specific depth within the recommended range. Some of these machines can even exert force upwards during decompressions. Sometimes the feature can even pull the chest higher than it would be while at rest—a feature that is called active decompression.
At present, most CPR chest compression machines repeat the same type of compressions over and over, pressing each time at the same location of the patient chest. This precise consistency is non-physiologic and may miss an opportunity to better move blood through each part of the patient's circulatory systems.
The present description gives instances of CPR chest compression machines, software and methods, the use of which may help overcome problems and limitations of the prior art.
In embodiments a CPR chest compression machine includes a retention structure that is configured to retain a body of the patient, and a compression mechanism. The compression mechanism is coupled to the retention structure and configured to perform successive compressions to the patient's chest. Various types of chest compressions may be performed on a patient during a single resuscitation event.
Some embodiments also include a driver configured to drive the compression mechanism. The compression mechanism may thus perform chest compressions that differ from each other in a number of aspects, for example the depth of the compressions or the height of the active decompressions between the compressions.
Some embodiments also include an adjustment mechanism. The adjustment mechanism may shift the compression mechanism with respect to the patient so that the chest compressions are performed at different locations of the patient's chest.
An advantage over the prior art can be improved blood flow and thus improved CPR patient outcomes. For example, blood flow may be optimized for one side of the patient's heart, then the other.
These and other features and advantages of this description will become more readily apparent from the Detailed Description, which proceeds with reference to the associated drawings in which:
As has been mentioned, the present description is about CPR chest compression machines, methods and software that can perform automatically a series of Cardio-Pulmonary Resuscitation (“CPR”) chest compressions on a patient. Embodiments are now described in more detail.
Components 100 also include a compression mechanism 148 configured to perform successive compressions to a chest of the patient, and a driver 141 configured to drive compression mechanism 148 so as to cause compression mechanism 148 to perform successive compressions to the patient's chest. Compression mechanism 148 and driver 141 may be implemented in combination with retention structure 140 in any number of ways. In the above mentioned example of U.S. Pat. No. 7,569,021 compression mechanism 148 includes a piston, and driver 141 includes a rack-and-pinion mechanism. In embodiments where retention structure 140 includes a belt, compression mechanism 148 may include a spool for collecting and releasing the belt so as to squeeze and release the patient's chest, and driver 141 can include a motor for driving the spool.
Driver 141 may be controlled by a controller 110 according to embodiments. Controller 110 may be coupled with a User Interface 114, for receiving user instructions, and for outputting data.
Controller 110 may include a processor 120. Processor 120 can be implemented in any number of ways, such as with a microprocessor, Application Specific Integration Circuits (ASICs), programmable logic circuits, general processors, etc. While a specific use is described for processor 120, it will be understood that processor 120 can either be standalone for this specific use, or also perform other acts.
In some embodiments controller 110 additionally includes a memory 130 coupled with processor 120. Memory 130 can be implemented by one or more memory chips. Memory 130 can be a non-transitory storage medium that stores instructions 132 in the form of programs. Instructions 132 can be configured to be read by processor 120, and executed upon reading. Executing is performed by physical manipulations of physical quantities, and may result in functions, processes, actions and/or methods to be performed, and/or processor 120 to cause other devices or components to perform such functions, processes, actions and/or methods. Often, for the sake of convenience only, it is preferred to implement and describe a program as various interconnected distinct software modules or features, individually and collectively also known as software. This is not necessary, however, and there may be cases where modules are equivalently aggregated into a single program, even with unclear boundaries. In some instances, software is combined with hardware in a mix called firmware.
While one or more specific uses are described for memory 130, it will be understood that memory 130 can further hold additional data, such as event data, patient data, and so on. For example, data gathered according to embodiments could be aggregated in a database over a period of months or years and used to search for evidence that one pattern or another of CPR is consistently better (in terms of a measured parameter) than the others, of course correlating with the patient. If so, this could be used to adapt the devices to use that pattern either continuously or at least as one of their operating modes.
Controller 110 can be configured to control driver 141 according to embodiments. Controlling is indicated by arrow 118, and can be implemented by wired or wireless signals and so on. Accordingly, compressions can be performed on the chest of patient 182 as controlled by controller 110. In embodiments, the compressions are performed automatically in one or more series, and perhaps with pauses between them as described below, as controlled by controller 110. A single resuscitation event can be a single series of compressions for the same patient, or a number of series thus performed sequentially.
Controller 110 may be implemented together with retention structure 140, in a single CPR chest compression machine. In such embodiments, arrow 118 is internal to such a CPR chest compression machine. Alternately, controller 110 may be hosted by a different machine, which communicates with the CPR chest compression machine that uses retention structure 140. Such communication can be wired or wireless. The different machine can be any kind of device, such as a medical device. One such example is described in U.S. Pat. No. 7,308,304, titled “COOPERATING DEFIBRILLATORS AND EXTERNAL CHEST COMPRESSION MACHINES”, only the description of which is incorporated by reference. Similarly, User Interface 114 may be implemented on the CPR chest compression machine, or on a host device.
So, according to state machine 200, operations of a CPR chest compression machine according to embodiments can include one or more compressions according to mode M1, then one or more compressions according to mode M2, then one or more compressions according to mode M3 and so on. In some embodiments where there are only two states 210, 220, execution may alternate between them. When there are three or more states, execution may or may not return to state 210. When execution alternates or transitions between two modes, it can do so with or without a pause.
In many embodiments, one or more of the modes can be adjusted for optimizing blood flow into one or more of the different parts of the patient's circulatory system. More particularly, the patient's circulatory system has two main parts, namely the pulmonary vasculature 296 and the systemic arterial circulatory system 297. The heart 285 of a patient is shown with a dot-dash line dividing it into the right side 286 (“right heart 286”) and the left side 287 (“left heart 287”). Right heart 286 pumps blood into pulmonary vasculature 296, where it becomes oxygenated by the lungs while carbon dioxide is removed. The oxygenated blood is then received back in heart 285. Left heart 287 then pumps the oxygenated blood into systemic arterial circulatory system 297 via the arteries. The blood is then received back in the heart via the veins. The two parts of the patient's circulatory system are mechanically different, and therefore have different hemodynamics for the purpose of pumping. For example, pulmonary vasculature 296 is more distensible than systemic arterial circulatory system 297. Moreover, the operations of each part of the patient's circulatory system are different.
In these embodiments, as further indicated by large arrows in
The invention addresses the fact that, for CPR to successfully sustain a patient in arrest and ultimately lead to return of the patient to neuro-intact life, we believe that CPR must provide at least some minimal amount of blood flow to the brain and also to the heart itself (via the coronary arteries). The properties of the vasculatures in those two organs differ, and there is no particular reason to think that the same CPR pattern would lead to optimal flow to both organs. Therefore, embodiments alternate between modes, which may result in each organ receiving a burst of good blood flow periodically.
As mentioned above, modes M1, M2, . . . can be different in that one or more of the chest compressions performed during these modes can be different. The chest compressions can be different in one or more ways that include chest compression depth, the height of active decompression, the chest compressions being performed at different locations of the body, ventilation related parameters, time parameters such as the frequency or rate and the duty ratio as described in co-pending U.S. patent application Ser. No. 14/271,660, which is hereby incorporated by reference. Examples are now given.
In embodiments, the driver is configured to drive the compression mechanism so as to cause the compression mechanism to perform to the patient's chest various chest compressions. A first one of the compressions can be at a first depth, then a second one of the compressions can be at a second depth at least 10% deeper than the first depth, and then a third one of the compressions can be at a third depth at least 10% shallower than the second depth. An example is now described.
In time range 310 compressions 315 can include the first compression mentioned above and are performed at a first depth D1, measured downwards from the normal vertical level. In time range 320 compressions 325 can include the second compression mentioned above and are performed at a second depth D2. In time range 330 compressions 335 can include the third compression mentioned above and are performed at a third depth D3.
It will be appreciated that second depth D2 is at least 10% deeper than first depth D1, and it could be even deeper, for example 15% or more than first depth D1. Additionally, third depth D3 is at least 10% shallower than second depth D2, and it could be even shallower, for example 15% or more than second depth D2. In this case third depth D3 is not the same as first depth D1, which corresponds to having at least three states in a state machine, and thus at least three modes. Alternately, if the third depth were the same as the first depth, that could correspond to having only two states in the state machine and thus only two modes.
In one embodiment, the compression depth could alternate between a standard depth (for example 2 inches) and a greater depth (say 2.5 inches). In a series of compressions, after a run of standard depth compressions, the depth would be increased for a period of time, for example for 10 seconds, and then returned to the standard depth for a period of time, for example 10 seconds. In a similar embodiment, the depth could alternate between periods of a lesser depth (for example, 1.5 inches) and a greater depth (for example 2.5 inches). Experiments would be needed to figure out the optimal timing and depths.
The diagram of
The devices and/or systems made according to embodiments perform functions, processes and/or methods, as described in this document. These functions, processes and/or methods may be implemented by one or more devices that include logic circuitry, such as was described for controller 110.
Moreover, methods and algorithms are described below. This detailed description also includes flowcharts, display images, algorithms, and symbolic representations of program operations within at least one computer readable medium. An economy is achieved in that a single set of flowcharts is used to describe both programs, and also methods. So, while flowcharts describe methods in terms of boxes, they also concurrently describe programs. A method is now described.
According to an operation 410, a first one of the compressions in the series is performed at a first depth.
According to another operation 420, a second one of the compressions in the series is performed at a second depth that is at least 10% deeper than the first depth.
According to another operation 430, a third one of the compressions in the series is performed at a third depth at least 10% shallower than the second depth. The relationships between the depths can be as described above.
Referring back to
In some embodiments, therefore, the driver is configured to drive the compression mechanism so as to cause the compression mechanism to perform decompressions reaching different heights above the normal vertical level. The height reached is directly related to the decompression force applied, so different heights are reached by applying different decompression forces. A first one of the decompressions can reach a first height above the normal vertical level, then a second one of the decompressions can reach a second height that is less than 80% of the first height above the normal vertical level, and then a third one of the decompressions can reach a third height that is at least as high as the first height above the normal vertical level.
In time range 510 decompressions 515 can include the first compression mentioned above and are performed at a first height H1, measured upwards from the normal vertical level. In time range 520 decompressions 525 can include the second compression mentioned above and are performed at a second height H2. In time range 530 decompressions 535 can include the third compression mentioned above and are performed at a third height H3.
It will be appreciated that second height H2 is less than 80% of first height H1, as measured above the normal vertical level. Moreover, second height H2 can be less than 30% of first height H1. In fact, second height H2 can be substantially zero above the normal vertical level, meaning that the decompression is not an active decompression at all.
Additionally, third height H3 is at least as high as first height H1 above the normal vertical level. In this case third height H3 is not the same as first height H1, which corresponds to having at least three states in a state machine, and thus at least three modes. Alternately, if the third height H3 were the same as the first height, that could correspond to having only two states in the state machine and thus only two modes.
Accordingly, the compressions could change between the modes in the amount of decompression force applied. In embodiments, the compressions could be delivered while alternating between applying decompression force to the chest between compressions, and not applying decompression force to the chest between compressions. Experiments would be needed to figure out the optimal force, resulting in optimal heights.
The diagram of
According to an operation 610, a first one of the decompressions in the series is performed to reach a first height above the normal vertical level.
According to another operation 620, a second one of the decompressions in the series is performed to reach a second height, which is less than 80% of the first height above the normal vertical level.
According to another operation 630, a third one of the compressions in the series is performed to reach a third height that is at least as high as the first height above the normal vertical level. The relationships between the heights can be further as described above.
Referring back to
Embodiments of a CPR machine also include an adjustment mechanism, which is coupled to the retention structure of the CPR machine that was described above. In
The different positions of the body with respect to the compression mechanism can advantageously result in the compressions being performed at different locations of the body. To depict the shifting most economically, in the example of
The body can be shifted with respect to the compression mechanism for implementing the different modes of
Accordingly, shifting the body with respect to the compression mechanism among the different positions can result in the compressions being performed at different locations 791, 792, 793. Of course, a compression mechanism of the CPR machine of the final implementation such as a piston may have a footprint larger than the circles shown, and such footprints can overlap for the different locations 791, 792, 793. Of course, such overlapping footprints do not eviscerate the notion of shifting to a different point if the overlapping is not exact. For example, in embodiments the compression mechanism can include a contact member configured to make contact with the chest, the contact member can define a footprint of how it contacts the chest, and the footprint can have a center of gravity along substantially two dimensions. In such embodiments, the center of gravity of the footprint by the contact member due to the first compression is at least 0.5″ (12 mm) away from the center of gravity of the footprint by the contact member due to the second compression. In fact, that distance can be larger, such as 1″ (25 mm), or even farther. The adjustment mechanism is included to effectuate the shifting, so that the locations of the compressions are different.
In one embodiment, the first type of compressions would be similar to those in the prior art, with a force exerted on the lower sternum in the center of the chest. The second type of compressions would exert force at a different position, perhaps 2-3 centimeters to the patient's left of center. This would more likely provide more direct compression of the left ventricle. The system would switch types of compressions every, say, 6 compressions.
Shifting can be performed in any number of ways. In some embodiments shifting is automatic. For example, a controller such as controller 110 can be configured to generate a control signal, and the shifting from one of the first and the second position to the other is performed responsive to the control signal being generated. In other embodiments, instructions such as instructions 132 for individual or a series of compressions are implemented in a memory such as memory 130, and they are read and executed.
In some embodiments shifting is performed by an operator of the CPR machine. For example, a user interface such as user interface 114 can be configured to receive a shift input from an operator, and the shifting from one of the first and the second position to the other is performed in response to the shift input being received.
The shifting by adjustment mechanism 770 can be implemented in any number of ways, by moving different parts with respect to each other. Examples are now described.
In some embodiments the adjustment mechanism is configured to shift where the body is retained with respect to the retention structure. This can be performed in a number of ways. In one example, the retention structure can include a solid portion while the adjustment mechanism includes one or more flexible belts. The belts can shift the patient's body with respect to the solid portion.
Components 800 include an abstracted retention structure 840, which can be implemented as was written above for retention structure 140. Components 800 also include a compression mechanism 848, which can be implemented as was written above for compression mechanism 148. Components 800 further include a driver 841, which can be implemented as was written above for driver 141.
Patient 882 is retained in retention structure 840. As seen,
In components 800 the adjustment mechanism includes a pump 870, inflatable bladders 871, 872, a switch system 874 and a valve system 875. Air pumped by pump 870 can be steered by switch system 874 to inflate either one of bladders 871, 872, while bladder deflation can be helped by valve system 875. In embodiments, valve system 875 can further steer some of the air from the deflating bladder into the other bladder for a little while, so as to help inflate it. While this is an example of pumping air, another fluid can also be used, for example with the pump operating reversibly.
Operation in two modes could be implemented by alternating between what is shown in
The operation of
Additional embodiments are now described. For simplicity, the patient is not depicted. Moreover, compression mechanisms are not shown with the suction cup recommended for performing active decompression.
In some embodiments the compression mechanism includes a piston coupled to the retention structure, and a contact member coupled to the piston. In these embodiments, the adjustment mechanism is coupled between the piston and the contact member, and shifting is performed by shifting the contact member with respect to the piston. An example is now described.
Components 900 further include a driver 941, which can be implemented as was written above for driver 141 to drive piston 942 up and down. For example, driver 941 could be implemented by a rack and pinion mechanism.
In components 900, adjustment mechanism 970 includes a disk-shaped portion that is rotatable around an axis parallel to the drawing so as to move protrusion 949 to various positions. As between
In the above implementation there can be a small motor for the rotation of the disk of adjustment mechanism 970. Rotation would be performed preferably when not compressing. Wires could reach the motor by traveling through a cavity in piston 942.
If it is known that the position needs to be shifted after every compression, the above described implementation can be performed mechanically instead, without needing a motor. Contact member 947 can instead have just the protrusion, and a switching mechanism can toggle the location of the protrusion as a result of each compression.
The implementation of
In some embodiments the adjustment mechanism is configured to shift the compression mechanism with respect to the retention structure. An example is now described.
Components 1000 further include a driver 1041, which can be implemented as was written above for driver 141 to drive piston 1042 up and down. For example, driver 1041 could be implemented by a rack and pinion mechanism.
Driver 1041 and thus also piston 1042 are suspended on a short axle 1045 that has an axis vertical to the drawing. Driver 1041 is thus rotatable around axle 1045, and therefore piston 1042 can compress the chest at different locations. An adjustment mechanism 1070 controls the rotation of driver 1041 around axle 1045. More particularly, adjustment mechanism 1070 includes a base 1071 coupled to retention structure 1040, and a disk 1072 on base 1071 that is rotatable around an axis perpendicular to the drawing. An elongate member 1074 is coupled to disk 1072 and to driver 1041 via joints. As between
The implementation of
According to an operation 1110, a body of the patient is retained at a first position with respect to a compression mechanism.
According to another operation 1120, at least a first one of the compressions is performed while the body is maintained at the first position.
According to another operation 1130, the body is then shifted so that it is retained at a second position with respect to the compression mechanism.
According to another operation 1140, at least a second one of the compressions is performed while the body is maintained at the second position.
According to another operation 1150, the body is then shifted so that it is retained at the first position with respect to the compression mechanism.
According to another operation 1160, at least a third one of the compressions is performed while the body is maintained at the first position.
The above mentioned modes could also vary in terms of ventilation. For instance, the mode of ventilating could be changed back and forth between two modes. So for example, a period with no ventilations could be alternated with a period of multiple relatively quick breaths. This could work with standard airway, such as an endotracheal tube. For special situations, such as using a Boussignac tube and continuous oxygen insufflation through that tube, the flow of oxygen through the tube could be turned on and off for the two different modes. Likewise, if applying jet ventilation through a tube, that jet ventilation could be turned on and off to get the two different modes to alternate between.
In embodiments, a change in ventilation could be made at the time of (or a time offset be a known amount from) the change from one mode of compressions to another. For example, a positive pressure breath would be administered just as the compressions switch from type 1 to type 2; this would help squeeze blood volume out of the pulmonary vasculature into the left heart. The device could prompt for delivery of the breath at that time or, if it was a combined Chest Compression device/ventilator, it could automatically deliver the breath then. Alternatively, the breath could be delivered 1-3 compressions before changing to type 2 compressions. To summarize, possible ventilation related variables include the mode of ventilation, the ventilatory flow of gases, the operation of valves that regulate the flow of gases, and the amount of resistance added to the airway (to inhibit inflow or outflow of gases) (for example, for an impedance threshold device, turn on and off its ability to resist inflow during chest release).
In the methods described above, each operation can be performed as an affirmative step of doing, or causing to happen, what is written that can take place. Such doing or causing to happen can be by the whole system or device, or just one or more components of it. In addition, the order of operations is not constrained to what is shown, and different orders may be possible according to different embodiments. Moreover, in certain embodiments, new operations may be added, or individual operations may be modified or deleted. The added operations can be, for example, from what is mentioned while primarily describing a different system, apparatus, device or method.
Returning to
Upon sensing the physiological parameter, a value of it can be transmitted to controller 110, as is suggested via arrow 119. Transmission can be wired or wireless.
Controller 110 may further optionally aggregate resuscitation data, for transmission to a post processing module 190. The resuscitation data can include what is learned via arrow 119, time data, etc. Transmission can be performed in many ways, as will be known to a person skilled in the art. In addition, controller 110 can transmit status data of the CPR chest compression machine that includes retention structure 140.
A person skilled in the art will be able to practice the present invention in view of this description, which is to be taken as a whole. Details have been included to provide a thorough understanding. In other instances, well-known aspects have not been described, in order to not obscure unnecessarily the present invention. Plus, any reference to any prior art in this description is not, and should not be taken as, an acknowledgement or any form of suggestion that this prior art forms parts of the common general knowledge in any country.
This description includes one or more examples, but that does not limit how the invention may be practiced. Indeed, examples or embodiments of the invention may be practiced according to what is described, or yet differently, and also in conjunction with other present or future technologies. Other embodiments include combinations and subcombinations of features described herein, including for example, embodiments that are equivalent to: providing or applying a feature in a different order than in a described embodiment; extracting an individual feature from one embodiment and inserting such feature into another embodiment; removing one or more features from an embodiment; or both removing a feature from an embodiment and adding a feature extracted from another embodiment, while providing the features incorporated in such combinations and subcombinations.
In this document, the phrases “constructed to” and/or “configured to” denote one or more actual states of construction and/or configuration that is fundamentally tied to physical characteristics of the element or feature preceding these phrases. This element or feature can be implemented in any number of ways, as will be apparent to a person skilled in the art after reviewing the present disclosure, beyond any examples shown in this example.
The following claims define certain combinations and subcombinations of elements, features and steps or operations, which are regarded as novel and non-obvious. Additional claims for other such combinations and subcombinations may be presented in this or a related document. When used in the claims, the phrases “constructed to” and/or “configured to” reach well beyond merely describing an intended use, since such claims actively recite an actual state of construction and/or configuration based upon described and claimed structure.
This patent application is a continuation of U.S. patent application Ser. No. 15/892,374 filed on Feb. 8, 2018, which is a divisional of U.S. patent application Ser. No. 14/273,593 filed on May 9, 2014, which claims priority from U.S. Provisional Patent Application Ser. No. 61/822,234, filed on May 10, 2013, the disclosures of which are hereby incorporated by reference for all purposes.
| Number | Date | Country | |
|---|---|---|---|
| 61822234 | May 2013 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 14273593 | May 2014 | US |
| Child | 15892374 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15892374 | Feb 2018 | US |
| Child | 16902027 | US |
