VASODILATOR-ENHANCED CARDIOPULMONARY RESUSCITATION

• US 20120203147A1
• Filed: 07/01/2011
• Published: 08/09/2012
• Est. Priority Date: 07/02/2010
• Status: Abandoned Application

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Resqsystems Inc.
• Inventors: Lurie, Keith, Yannopoulos, Demetris
• Application Number:
  US13/175,670
• Publication Number:
  US 20120203147A1
• Time in Patent Office: Days
• US Class Current: 601/41
• CPC Class Codes: A61H 31/004 Heart stimulation
• CPC Class Codes: A61K 31/21 Esters, e.g. nitroglycerine, selenocyanates
• CPC Class Codes: A61K 31/34 having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide
• CPC Class Codes: A61K 31/4985 Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
• CPC Class Codes: A61K 31/519 ortho- or peri-condensed with heterocyclic rings
• CPC Class Codes: A61K 31/522 having oxo groups directly attached to the heterocyclic ring, e.g. hypoxanthine, guanine, acyclovir
• CPC Class Codes: A61K 31/7076 containing purines, e.g. adenosine, adenylic acid
• CPC Class Codes: A61K 33/26 Iron; Compounds thereof
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61P 9/04 Inotropic agents, i.e. stimulants of cardiac contraction; Drugs for heart failure

Abstract

A method for increasing blood flow to vital organs during cardiopulmonary resuscitation of a person experiencing a cardiac arrest may include performing standard or active compression decompression cardiopulmonary resuscitation on a person to create artificial circulation by repetitively compressing the person'"'"'s chest such that the person'"'"'s chest is subject to a compression phase and a relaxation or decompression phase. The method may also include administering one or more vasodilator drugs to the person to improve the artificial circulation created by the cardiopulmonary resuscitation. The method may also include binding at least a portion of the person'"'"'s abdomen, either manually or with an abdominal compression device. Performing cardiopulmonary resuscitation on a person may include ventilating the person with either an impedance threshold device or a intrathoracic pressure regulator.

Claims

1. A kit for increasing blood flow to vital organs during cardiopulmonary resuscitation of a person experiencing a cardiac arrest, wherein the kit comprises:

one or more vasodilator drugs in an amount effective to improve artificial circulation during cardiopulmonary resuscitation when administered to the person; and

instructions for performing cardiopulmonary resuscitation and for administering the one or more vasodilator drugs in the effective amount.

2. The kit for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 1, wherein one or more vasodilator agents is selected from a group consisting of:

sodium nitroprusside;

glycerol trinitrate;

isosorbide mononitrate;

isosorbide dinitrate;

pentaerythritol tetranitrate;

sildenafil;

tadalafil;

vardenafil.

adenosine

an adenosine analog and

a methylxanthine.

3. The kit for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 1, further comprising a mechanical device to increase the blood pressure of the person, wherein the mechanical device is selected from a group consisting of:

an abdominal binding;

an impedance threshold device;

an intrathoracic pressure regulator;

an automated chest compression device; and

an active compression decompression chest compression device.

4. The kit for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 3, wherein the kit further comprises a support surface, wherein:

the support surface is configured to support the person experiencing the cardiac arrest; and

the support surface is coupled with the mechanical device.

5. The kit for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 1, wherein the kit further comprises at least one device to assist in inducing therapeutic hypothermia in the person.

6. The kit for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 5, wherein inducing therapeutic hypothermia in the person comprises lowering the person'"'"'s body temperature to between about 32°

C. and about 34°

C.

7. A method for increasing blood flow to vital organs during cardiopulmonary resuscitation of a person experiencing a cardiac arrest, wherein the method comprises:

administering one or more vasodilator agents to the person; and

mechanically increasing blood pressure in addition to providing cardiopulmonary resuscitation to the person.

8. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 7, wherein the method further comprises inducing therapeutic hypothermia in the person.

9. A method for increasing blood flow to vital organs during cardiopulmonary resuscitation of a person experiencing a cardiac arrest, wherein the method comprises:

performing cardiopulmonary resuscitation on a person to create artificial circulation by repetitively compressing the person'"'"'s chest such that the person'"'"'s chest is subject to a compression phase and a relaxation or decompression phase; and

administering sodium nitroprusside by itself or in combination with adenosine to the person to improve the artificial circulation created by the cardiopulmonary resuscitation.

10. A method for increasing blood flow to vital organs during cardiopulmonary resuscitation of a person experiencing a cardiac arrest, wherein the method comprises:

performing cardiopulmonary resuscitation on a person to create artificial circulation by repetitively compressing the person'"'"'s chest such that the person'"'"'s chest is subject to a compression phase and a relaxation or decompression phase; and

administering sodium nitroprusside by itself or in combination with adenosine in part of a cocktail of compounds designed to preserve brain function, to the person to improve the artificial circulation created by the cardiopulmonary resuscitation.

11. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein performing cardiopulmonary resuscitation comprises:

performing standard cardiopulmonary resuscitation;

or

performing active compression decompression cardiopulmonary resuscitation.

12. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein the method further comprises:

binding at least a portion of the person'"'"'s abdomen.

13. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 12, wherein the binding at least a portion of the person'"'"'s abdomen comprises:

binding, manually, at least a portion of the person'"'"'s abdomen;

or

binding, with an abdominal compression device, at least a portion of the person'"'"'s abdomen.

14. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein the method further comprises:

binding, manually, at least a portion of the person'"'"'s abdomen;

or

binding, with an abdominal compression device, at least a portion of the person'"'"'s abdomen.

15. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 12, further comprising:

at least temporarily preventing or impeding airflow to the person'"'"'s lungs during at least a portion of the relaxation or decompression phase using an impedance threshold device that is coupled with the person'"'"'s airway.

16. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 11, further comprising:

at least temporarily preventing or impeding airflow to the person'"'"'s lungs during at least a portion of the relaxation or decompression phase using an impedance threshold device that is coupled with the person'"'"'s airway.

17. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, further comprising:

at least temporarily preventing or impeding airflow to the person'"'"'s lungs during at least a portion of the relaxation or decompression phase using an impedance threshold device that is coupled with the person'"'"'s airway.

18. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 12, further comprising:

regulating the airflow to or from the person'"'"'s lungs using an intrathoracic pressure regulator.

19. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, further comprising:

regulating the airflow to or from the person'"'"'s lungs using an intrathoracic pressure regulator.

20. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, further comprising measuring a blood pressure of the person, and further:

altering the administration of sodium nitroprusside based on the blood pressure;

or

altering a manner of chest compressions based on the blood pressure.

21. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, further comprising:

ventilating the person, at least periodically.

22. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 21, further comprising:

measuring a blood pressure of the person; and

altering the ventilating of the person based on the blood pressure.

23. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein the method further comprises inducing hypothermia in the person.

24. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein the method further comprises delivery of a defibrillatory shock to the person.

25. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein administering sodium nitroprusside to the person comprises:

administering sodium nitroprusside in amounts of at least substantially 1 milligram per 30 kilograms of mass of the person (1 milligram per 66 pounds of weight of the person).

26. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein administering sodium nitroprusside to the person comprises:

administering at least two doses of sodium nitroprusside with at least a 3 to 5 minute interval between at least two doses.

27. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein improving the artificial circulation created by the cardiopulmonary resuscitation comprises:

increasing carotid blood flow.

28. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein improving the artificial circulation created by the cardiopulmonary resuscitation comprises:

increasing systolic and diastolic blood pressures.

29. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein administering sodium nitroprusside further improves a favorable characteristic of a ventricular fibrillation waveform of the person at a point in time after an onset of the cardiac arrest.

30. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 10, wherein the method further comprises inducing therapeutic hypothermia in the person.

31. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 12, wherein the method further comprises inducing therapeutic hypothermia in the person.

32. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 15, wherein the method further comprises inducing therapeutic hypothermia in the person.

33. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 17, wherein the method further comprises inducing therapeutic hypothermia in the person.

34. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 18, wherein the method further comprises inducing therapeutic hypothermia in the person.

35. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation of claim 19, wherein the method further comprises inducing therapeutic hypothermia in the person.

36. A method for increasing blood flow to vital organs during cardiopulmonary resuscitation using an at least partially invasive circulatory assist procedure, wherein the method comprises:

performing cardiopulmonary resuscitation on a person by repetitively compressing the person'"'"'s chest such that the person'"'"'s chest is subject to a compression phase and a relaxation or decompression phase;

performing an at least partially invasive circulatory assist procedure on the person; and

administering sodium nitroprusside to the person.

37. The method for increasing blood flow to vital organs during cardiopulmonary resuscitation using an at least partially invasive circulatory assist procedure of claim 36, wherein the at least partially invasive circulatory assist procedure comprises:

inserting a percutaneous left ventricular assist device into the person;

inserting an intra-aortic balloon pump into the person;

or

performing a cardiopulmonary bypass on the person.

38. A method for increasing blood flow to vital organs of a person experiencing a cardiac arrest, wherein the method comprises:

alternatively compressing and decompressing a chest of the person at a rate of about 60 cycles to about 120 cycles per minute to create artificial circulation;

administering sodium nitroprusside in an amount of about 0.01 milligrams to about 5.0 milligrams to the person to improve the artificial circulation created by the alternative compressing and lifting of the chest;

regulating inflow of respiratory gases into the person'"'"'s lungs during decompressing of the chest to maintain a negative intrathoracic pressure at least below about −

4.0 millimeters of Mercury (mmHg) for a time of at least about 1.0 seconds.

39. The method for increasing blood flow to vital organs of a person experiencing a cardiac arrest of claim 38, wherein the method further comprises:

binding at least a portion of the person'"'"'s abdomen.

40. The method for increasing blood flow to vital organs of a person experiencing a cardiac arrest of claim 38, wherein regulating inflow of respiratory gases into the person'"'"'s lungs during decompressing of the chest comprises:

disposing a threshold valve in communication with the person'"'"'s airway, wherein the threshold valve is set to open in a range from about −

2.0 centimeters water (cmH20) to about −

20 cmH20.

41. The method for increasing blood flow to vital organs of a person experiencing a cardiac arrest of claim 38, wherein regulating inflow of respiratory gases into the person'"'"'s lungs during decompressing of the chest comprises:

extracting gases from the lungs using a vacuum source.

42. The method for increasing blood flow to vital organs of a person experiencing a cardiac arrest of claim 41, wherein the person'"'"'s lungs experience a vacuum having a pressure of less than about −

4.0 millimeters of mercury (mmHg).

43. The method for increasing blood flow to vital organs of a person experiencing a cardiac arrest of claim 41, wherein:

a start time of the vacuum is substantially coincident with a start of the decompressing of the chest; and

an end time of the vacuum is substantially coincident with an end of the compression of the chest.

44. The method for increasing blood flow to vital organs of a person experiencing a cardiac arrest of claim 38, further comprising measuring a blood pressure of the person, and further:

altering the administration of sodium nitroprusside based on the blood pressure;

or

altering a manner of chest compressions based on the blood pressure.

45. A method of inducing therapeutic hypothermia in a person, wherein the method comprises:

administering a vasodilator to the person; and

lowering the temperature of the person.

46. The method of inducing therapeutic hypothermia in a person of claim 45, wherein administering the vasodilator to the person comprises administering sodium nitroprusside to the person.

47. The method of inducing therapeutic hypothermia in a person of claim 45, wherein lowering the temperature of the person comprises lowering the temperature of the heart or the brain of the person to between about 32°

C. and about 34°

C.