System for performing remote ischemic preconditioning

• US 7,717,855 B2
• Filed: 12/06/2006
• Issued: 05/18/2010
• Est. Priority Date: 12/06/2006
• Status: Active Grant

• Current Assignee: Hospital For SICK Children
• Original Assignee: Hospital For SICK Children
• Inventors: Redington, Andrew, Caldarone, Christopher
• Primary Examiner(s): Marmor, II; Charles A
• Assistant Examiner(s): Natnithithadha; Navin
• Application Number:
  US11/634,749
• Publication Number:
  US 20080139949A1
• Time in Patent Office: 1,259 Days
• Field of Search: 600/481, 600/483, 600/485, 600490-504, 606201-203
• US Class Current: 600/496
• CPC Class Codes: A61B 17/132 Tourniquets sphygmomanometer A61B5/022
• CPC Class Codes: A61B 17/135 inflatable for measuring blood pressure A61B5/022; inflatable pressure pads A61F5/34
• CPC Class Codes: A61B 17/1355 Automated control means therefor
• CPC Class Codes: A61B 5/022 by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers
• CPC Class Codes: A61B 5/02225 using the oscillometric method
• CPC Class Codes: A61B 5/02233 Occluders specially adapted therefor tourniquets A61B17/132
• CPC Class Codes: A61H 2201/165 Wearable interfaces
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/5071 Pressure sensors
• CPC Class Codes: A61H 2201/5082 Temperature sensors
• CPC Class Codes: A61H 2230/30 Blood pressure A61H2230/04 takes precedence
• 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: A61H 9/0092 Cuffs therefor

Abstract

A system for remote ischemic preconditioning that includes a cuff, and actuator, and a controller that operates the actuator according to a treatment protocol. The treatment protocol includes a plurality of treatment cycles that each comprise cuff actuation, an ischemic duration, cuff release, and a reperfusion duration.

Claims

1. A system for remote ischemic preconditioning, the system comprising:

a cuff configured to retract about a limb of a subject;

an actuator connected to the cuff and that, when actuated, causes the cuff to contract about the limb of the subject to reduce blood flow there through; and

a controller that controls the actuator to operate according to a treatment protocol that includes a plurality of sequentially actuated treatment cycles, each treatment cycle comprising;

cuff actuation, during which the actuator contracts the cuff about the limb of the subject to a pressure above systolic pressure to occlude blood flow through the limb;

an ischemic duration, during which the actuator maintains the cuff contracted about the limb at a set point above systolic pressure to occlude blood flow through the limb, the ischemic duration lasting for at least about a minute;

cuff release, during which the actuator releases the cuff to allow blood flow through the limb; and

a reperfusion duration, during which the cuff is maintained in an at least partially relaxed state to allow blood flow through the limb, the reperfusion duration lasting for at least one minute.

2. The system according to claim 1, wherein the treatment protocol further comprises:

systolic pressure identification.

3. The system according to 2, wherein systolic pressure identification is performed prior to an initial treatment cycle.

4. The system according to claim 2, wherein systolic pressure identification occurs during each of the plurality of treatment cycles.

5. The system according to claim 1, wherein the ischemic duration comprises further actuation by the actuator to maintain pressure applied by the cuff at the set point.

6. The system according to claim 5, wherein the set point is approximately 10 mm Hg above systolic pressure of the subject.

7. The system according to claim 5, wherein the set point of the ischemic phase is approximately 20 mm Hg above systolic pressure of the subject.

8. The system according to claim 5, wherein the set point is approximately 30 mm Hg above systolic pressure of the subject.

9. The system according to claim 1, further comprising:

a transducer that identifies reperfusion through the limb, wherein the controller receives a signal from the transducer during the ischemic phase to confirm a lack of reperfusion.

10. The system according to claim 9, wherein the controller receives a signal from the transducer during the reperfusion phase to confirm reperfusion through the limb.

11. The system according to claim 9, wherein the transducer is selected from a group consisting of:

a photoplethysmographic transducer, an ultrasonic flow transducer, a temperature transducer, an infrared detector, and a near infrared transducer.

12. The system according to claim 1, further comprising:

a safety release configured to allow blood flow through the limb when a safety criteria is met.

13. The system according to claim 12, wherein the safety criteria includes one or more criteria selected from the group consisting of:

a power outage of the system, a power spike in the system, activation of a manual release switch.

14. The system according to claim 1, wherein the treatment protocol is configured to be reprogrammable.

15. The system according to claim 1, further comprising:

an interface to be accessed by the subject, the user interface providing controls that allow the subject to initiate the treatment protocol and to terminate the treatment protocol.

16. The system according to claim 14, wherein the controller includes safeguards to prevent the subject from altering the treatment protocol.

17. The system according to claim 1, further comprising:

a data logger to record use of the system by the subject.

18. The system according to claim 1, wherein the treatment cycle is repeated five times during the treatment protocol.

19. The system according to claim 1, wherein the ischemic duration is less than 1 minute during an initial treatment cycle of the treatment protocol, and wherein the ischemic duration is greater than 1 minute in a treatment cycle that occurs subsequently during the treatment protocol.

20. The system according to claim 1, wherein the cuff is a pneumatically inflatable cuff and wherein the actuator is an air pump.

21. The system according to claim 1, further comprising:

a bleed valve that continuously releases pressure from the cuff.

22. The system according to claim 1, configured to be portable.

23. The system according to claim 1, further comprising:

a computer readable medium that includes the treatment protocol, and that when executed by the controller, executes the treatment protocol.

24. The system according to claim 1, wherein the treatment protocol includes three or more treatment cycles.

25. A method of performing remote ischemic preconditioning comprising:

providing a device that includes;

a cuff configured to retract about a limb of a subject;

an actuator connected to the cuff and that, when actuated, causes the cuff to contract about the limb of the subject to reduce blood flow there through; and

a controller that controls the actuator according to a treatment protocol that includes a plurality of sequentially actuated treatment cycles;

initiating operation of the device to effect remote ischemic preconditioning of the subject by actuating the actuator according to the treatment protocol, wherein the treatment protocol comprises;

contracting the cuff about the limb of the subject to a pressure above systolic pressure to occlude all blood flow through the limb;

maintaining the cuff in a contracted state about the limb at a set point above systolic pressure to occlude all blood flow through the limb for at least about a minute;

releasing the cuff to allow blood flow through the limb;

maintaining the cuff in at least a partially relaxed state to allow blood flow through the limb for at lest one minute; and

repeating the treatment protocol.

26. The method according to claim 25, further comprising:

identifying a systolic pressure level of the subject prior to initiating operation of the device.

27. The method according to claim 25, further comprising:

monitoring for safety criteria; and

allowing reperfusion through the limb of the subject when the safety criteria is met.

28. The method according to claim 27, wherein monitoring for safety criteria includes monitoring for a power outage to the device, a power spike to the device, and/or activation of a manual release switch.

29. The method according to claim 25, wherein initiating operation of the device includes initiation of the device by the subject.

30. The method according to claim 25, wherein initiating operation of the device to effect remote ischemic preconditioning includes initiating operation of the device according to a treatment protocol that includes five or more treatment cycles.

31. The method according to claim 25, wherein initiating operation of the device to effect remote ischemic preconditioning includes initiating operation of the device according to a treatment protocol that includes treatment cycles that each have different ischemic durations.

32. The method according to claim 31, wherein initiating operation of the device to effect remote ischemic preconditioning includes initiating operation of the device according to a treatment protocol that includes treatment cycles that each have ischemic durations greater than 30 seconds.

33. A method of performing remote ischemic preconditioning, the method comprising:

providing a system that includes;

a cuff configured to retract about a limb of a subject;

an actuator connected to the cuff and that, when actuated, causes the cuff to contract about the limb of the subject to reduce blood flow there through; and

a controller that controls the actuator to operate according to a treatment protocol that includes a plurality of sequentially actuated treatment cycles, each treatment cycle comprising;

cuff actuation, during which the actuator contracts the cuff about the limb of the subject to a pressure above systolic pressure to occlude all blood flow through the limb;

an ischemic duration, during which the actuator maintains the cuff contracted about the limb at a set point above systolic pressure to occlude all blood flow through the limb, the ischemic duration lasting for at least about a minute;

cuff release, during which the actuator releases the cuff to allow blood flow through the limb; and

a reperfusion duration, during which the cuff is maintained in an at least partially relaxed state to allow blood flow through the limb, the reperfusion duration lasting for at least one minute;

positioning the cuff about the limb of the subject; and

initiating operation of the device to effect remote ischemic preconditioning of the subject by actuating the actuator according to the treatment protocol.