Cardiopulmonary resuscitation and assisted circulation system

• US 4,928,674 A
• Filed: 11/21/1988
• Issued: 05/29/1990
• Est. Priority Date: 11/21/1988
• Status: Expired due to Term

• Current Assignee: Zoll Circulation Incorporated (Asahi Kasei Corporation), Johns Hopkins University
• Original Assignee: Johns Hopkins University
• Inventors: Gelfand, Mark, Tsitlik, Joshua, Weisfeldt, Myron, Halperin, Henry
• Primary Examiner(s): Jaworski, Francis
• Assistant Examiner(s): Manuel, George
• Application Number:
  US07/273,810
• Time in Patent Office: 554 Days
• Field of Search: 128/28, 128/679, 128/30.2, 128/327, 128/681-683, 128/685, 128/419 D, 128/697, 600/16
• US Class Current: 601/44
• CPC Class Codes: A61H 2031/003 with alternated thorax decompression due to lateral compression
• CPC Class Codes: A61H 2201/0103 inflatable
• CPC Class Codes: A61H 2201/0173 Means for preventing injuries
• CPC Class Codes: A61H 2201/0176 By stopping operation
• CPC Class Codes: A61H 2201/10 with further special therapeutic means, e.g. electrotherapy, magneto therapy or radiation therapy, chromo therapy, infrared or ultraviolet therapy
• CPC Class Codes: A61H 2201/1238 with hydraulic or pneumatic drive
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/5043 Displays
• CPC Class Codes: A61H 2201/5071 Pressure sensors
• CPC Class Codes: A61H 2230/04 Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
• CPC Class Codes: A61H 31/005 with feedback for the user
• CPC Class Codes: A61H 31/006 Power driven
• CPC Class Codes: A61H 31/008 Supine patient supports or bases, e.g. improving air-way access to the lungs
• CPC Class Codes: A61H 9/0078 with intermittent or alternately inflated bladders or cuffs mattresses for preventing bed-sores with alternated pressurized chambers A61G7/05776
• CPC Class Codes: A61N 1/046 Specially adapted for shock therapy, e.g. defibrillation
• CPC Class Codes: A61N 1/0472 Structure-related aspects
• CPC Class Codes: A61N 1/0492 Patch electrodes A61N1/0412, A61N1/0428 take precedence
• CPC Class Codes: A61N 1/39044 in combination with cardiopulmonary resuscitation [CPR] therapy

Abstract

A vest system for generating cyclic fluctuations in intrathoracic pressure for use in cardiopulmonary resuscitation and non-invasive circulatory assistance. The vest is preferably provided with a two bladder inflation system. A high pressure bladder contacts the chest wall while a bias bladder is disposed between the high pressure bladder and the vest material. The bias bladder is pressurized to press the high-pressure bladder tightly against the chest wall so that cyclic inflation of the high-pressure bladder can generate large changes in intrathoracic pressure. The bias bladder is released periodically to allow the chest to expand for adequate ventilation. Air flow into and out of each bladder is controlled by sequencing large bore 3-way and 2-way solenoid valves and the rate of air flow into the high-pressure bladder is controlled by a variable resistor.

Claims

1. A system for generating cyclic fluctuations in intrathoracic pressure for use in cardiopulmonary resuscitation of a patient comprising:

a first inflatable bladder means;

means for cyclically inflating and deflating said inflatable bladder means;

means for mounting said inflatable bladder means adjacent the chest wall of a patient so that cyclic inflation of deflation of the bladder means will produce pressure on the chest wall thus generating changes in intrathoracic pressure;

means for (a) urging said inflatable bladder means against the chest wall of the patient to generate an initial pressure on the chest wall, (b) cyclically inflating said bladder means to generate large changes in intrathoracic pressure and, (c) periodically interrupting said urging to release said initial pressure and allow the chest to expand for adequate ventilation of the patient.

2. A system as in claim 1, wherein said means for urging the bladder means against the chest wall comprises means for clamping the pressure in the bladder means above atmospheric pressure such that said bladder means is cyclically inflated and deflated with the minimum pressure during an inflation and deflation cycle being above atmospheric pressure.

3. A system as in claim 1, wherein said means for cyclically urging comprises a second inflatable bladder means mounted so that said first inflatable bladder means is disposed intermediate the chest wall of the patient and the second bladder means and means for cyclically inflating and deflating said second bladder means whereby cyclic inflation of said second bladder means cyclically urges said first bladder means tightly against the chest wall and deflation of said second bladder means permits patient ventilation.

4. A system as in claim 3, wherein said means for cyclically inflating and deflating said second bladder means comprises a plurality of valve means and means for sequencing said valve means to inflate and deflate said second bladder means.

5. A system as in claim 3, wherein said means for mounting includes a vest-like garment having said first bladder means and said second bladder means mounted thereto and being adapted to be mounted in surrounding relation to the thorax of the patient.

6. A system as in claim 5, wherein said means for mounting further includes a rigid base member, said vest like garment having first and second opposite edges, a first edge of said vest-like garment being fixedly coupled to said rigid base member, said second edge of said vest-like garment including means for releasably coupling to a corresponding means for a coupling defined in said rigid base so that a thorax receiving cylindrical chamber is defined by said rigid base and said vest-like garment and further including means for varying the cross-sectional size of said cylindrical chamber.

7. A system as in claim 6, wherein said means for varying the cross-sectional size of said cylindrical chamber includes a channel defined within said rigid base member and a rod extending through said chamber and coupled to said means for coupling defined in said rigid base so that movement of said rod within said channel moves said means for coupling so as to move said second longitudinal edge toward and away from said rigid base member to thereby vary said cross-section of said cylindrical chamber.

8. A system as in claim 5 wherein said first and second bladder means of said vest-like garment are positioned so that different bladders cover different portions of the thorax or abdomen when applied to the patient and wherein the relative positions of the bladder means can be varied so as to vary the pressure distribution on the thoracic surface.

9. A system as in claim 5, wherein at least one of said bladder means has at least one edge formed of a material having properties distinct from the remainder of the bladder means so that said at least one edge bulges an amount different than the remainder of the bladder when inflated.

10. A system as in claim 5, wherein at least one edge of at least one of said bladder means is formed from a pleated material so that said edge will bulge more than the remainder of the bladder means so as to vary the amount of compression at the end of the bladder means.

11. A system as in claim 3 including primary means for monitoring pressure within said first bladder means, primary means for monitoring pressure within said second bladder means, and further, backup, monitoring means for monitoring pressure within said first and second bladder means, and means for actuating release of pressure from said bladder means if the pressure monitored by said backup monitoring means at least one of exceeds a predetermined maximum, exceeds a predetermined duration, or is different from the pressure monitored by either of the primary means for monitoring pressure.

12. A system as in claim 1, further comprising defibrillator means for delivering a defibrillating pulse to the chest wall of the patient.

13. A system as in claim 1, further comprising electrocardiogram processor means for receiving electrical signals from the chest wall of the patient and for synchronizing inflation and deflation of said first bladder means to the beating heart.

14. A system as in claim 1, further comprising means for conducting oxygen-enriched air to the patient.

15. A system as in claim 14, wherein said means for conducting includes a face mask and a source of oxygen-enriched air.

16. A system as in claim 1, wherein said means for mounting includes a vest-like garment having said first bladder means mounted thereto and being adapted to be mounted in surrounding relation to the thorax of the patient.

17. A system as in claim 16, wherein said means for mounting further includes a rigid base member, said vest like garment having first and second longitudinal side edges, a first longitudinal side edge of said vest-like garment being fixedly coupled to said rigid base member, said second longitudinal side edge of said vest-like garment including means for releasably coupling to a corresponding means for a coupling defined in said rigid base so that a thorax receiving cylindrical chamber is defined by said rigid base and said vest-like garment and further including means for varying the cross-sectional size of said cylindrical chamber.

18. A system as in claim 17, wherein said means for varying the size of said cylindrical chamber includes a channel defined within said rigid base member and a rod extending through said chamber and coupled to said means for coupling defined in said rigid base so that movement of said rod within said channel moves said means for coupling so as to move said second longitudinal edge toward and away from said rigid base member to thereby vary said cross-section of said cylindrical chamber.

19. A system as in claim 16, wherein said bladder means has at least one edge formed of a material having properties distinct from the remainder of the bladder means so that said edge bulges an amount different than the remainder of the bladder means when inflated.

20. A system as in claim 16, wherein at least one edge of said bladder means is formed from a pleated material so that said at least one edge will bulge more than the remainder of the bladder means so as to vary the amount of compression at the end of the bladder means.

21. A system as in claim 1, wherein said means for cyclically inflating and deflating said first bladder means comprises a plurality of valve means and means for sequencing said valves to inflate and deflate said first bladder means.

22. A system as in claim 21, further comprising means for monitoring pressure within said first bladder means, said means for monitoring pressure monitoring the rise in pressure during bladder inflation, at least one of said valves being actuated to clamp pressure in the bladder means at a predetermined level.

23. A system as in claim 22, wherein said means for actuating said valve applies an electrical signal to the valve at a time prior to the rise of bladder pressure to said predetermined level so that the time required for mechanical closure of the valve will be just sufficient for the pressure to rise to the desired level.

24. A system as in claim 23, including means for determining the time required for mechanical closure of the valve sufficient for pressure to rise to the desired level.

25. A system as in claim 21, wherein said valve means comprise solenoid valves.

26. A system as in claim 1, further comprising means for monitoring pressure within said first bladder means.

27. A system as in claim 1, further including means for varying the rate of flow of inflating air to said first bladder means.

28. A system as in claim 27, wherein said means for varying includes a variable resistor.

29. A system as in claim 1, wherein said means for cyclically inflating and deflating said bladder means includes an air-hose element coupled to said inflatable bladder means, the coupling of said hose to said bladder means including a substantially rigid coupling element having a first end coupled to said air hose and a second open end defined within said bladder means and further including at least one aperture defined transversely to said second open end.

30. A system for generating cyclic fluctuations in intrathoracic pressure for use in cardiopulmonary resuscitation of a patient comprising:

a first inflatable bladder means covering the front of the chest and extending laterally to cover the sides;

means for cyclically inflating and deflating said inflatable bladder means;

means for mounting said inflatable bladder means adjacent the chest wall of a patient so that cyclic inflation of deflation of the bladder means will produce pressure on the chest wall thus generating changes in intrathoracic pressure;

means for urging said inflatable bladder means against the chest wall of the patient so that cyclic inflation of the bladder means generates large changes in intrathoracic pressure and for periodically interrupting said urging so that the chest can expand for adequate ventilation of the patient.