CPR volume exchanger valve system with safety feature and methods

• US 9,675,770 B2
• Filed: 03/02/2015
• Issued: 06/13/2017
• Est. Priority Date: 04/19/2007
• Status: Active Grant

• Current Assignee: Zoll Medical Corporation (Asahi Kasei Corporation)
• Original Assignee: Advanced Circulatory Systems, Inc. (Asahi Kasei Corporation)
• Inventors: Lurie, Keith G., Metzger, Anja, Homuth, Jim
• Primary Examiner(s): DOUGLAS, STEVEN O
• Application Number:
  US14/635,525
• Publication Number:
  US 20150202393A1
• Time in Patent Office: 834 Days
• Field of Search: 12820524, 12820716, 12820418, 12820423, 12820715, 12820024
• CPC Class Codes: A61H 2201/107 Respiratory gas
• 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 2230/40 Respiratory characteristics
• CPC Class Codes: A61H 2230/65 Impedance, e.g. skin conductivity; capacitance, e.g. galvanic skin response [GSR]
• CPC Class Codes: A61H 31/004 Heart stimulation
• CPC Class Codes: A61H 31/005 with feedback for the user
• CPC Class Codes: A61H 31/02 "Iron-lungs" , i.e. involving chest expansion by applying underpressure thereon, whether or not combined with gas breathing means
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0048 Mouth-to-mouth respiration teaching or training models G09B23/288
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/0084 self-reinflatable by elasticity, e.g. resuscitation squeeze bags
• CPC Class Codes: A61M 16/10 Preparation of respiratory gases or vapours
• CPC Class Codes: A61M 16/1005 with O2 features or with parameter measurement
• CPC Class Codes: A61M 16/202 electrically actuated
• CPC Class Codes: A61M 16/208 Non-controlled one-way valves, e.g. exhalation, check, pop-off non-rebreathing valves
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/103 the CO2 concentration
• CPC Class Codes: A61M 2202/0208 Oxygen
• CPC Class Codes: A61M 2205/3331 Pressure; Flow
• CPC Class Codes: A61M 2205/52 : with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2205/583 : by visual feedback
• CPC Class Codes: A61M 2230/04 : Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/432 : partial CO2 pressure (P-CO2)

Abstract

A method for regulating gas flows into and out of a patient includes repetitively forcing respiratory gases out of the lungs. Respiratory gases are prevented from entering back into the lungs during a time between when respiratory gases are forced out of the lungs. Periodically, an oxygen-containing gas is supplied to the lungs.

Claims

1. A method to perform cardiopulmonary resuscitation in a patient in cardiac arrest, the method comprising:

repetitively compressing the chest and permitting the chest to recoil a rate of about 60 to about 120 times/min;

wherein with each compression a volume of respiratory gas is expelled from the lungs;

wherein for a plurality of chest recoils, preventing respiratory gases from returning to the lungs by configuring a valve to remain closed during multiple successive chest decompressions such that there is a successive decrease in respiratory gases within the lungs thereby allowing more blood to enter the thoracic space; and

periodically actively expanding the lungs with an oxygen-containing gas.

2. A method as in claim 1, wherein the step of permitting the chest to recoil comprises permitting the chest to recoil by its own resilience or by actively pulling upward on the chest to achieve complete chest wall recoil.

3. A method as in claim 1, wherein during the chest recoil, intracranial pressures are decreased more rapidly and to a lower value thereby further increasing the duration and magnitude of cerebral perfusion pressure, and wherein the valve opens to permit air to flow into the lungs through the valve if the patient begins to breathe.

4. A method as in claim 1, wherein the volume of respiratory gas expelled over a series of chest compression/recoil cycles is in the range from about 1 to about 15 cc/kg.

5. A method as in claim 1, further comprising expelling the volume of respiratory gas from the chest against a low level of fixed or variable resistance that is in the range from about 0 to about 10 cm H₂O.

6. A method as in claim 1, further comprising providing visual or audible instructions to a rescuer as to a desired compression or ventilation rate.

7. A method as in claim 1, further comprising measuring patient gas volumes or airway pressures, and using a controller having a memory and a computer processor to estimate the rate and depth of chest compressions by evaluating variations in the amount of gasses delivered or airway pressure produced by positive-pressure ventilations to the amount of gasses expelled or airway pressures produced during chest compressions or chest recoil.

8. A device to augment circulation during the performance of cardiopulmonary resuscitation in a patient in cardiac arrest, the device comprising:

a housing having a rescuer port and a patient port, an exhalation one way valve and an inhalation one way valve which is biased in a closed position;

wherein the housing and one way valves are configured such that a volume of respiratory gas expelled from the lungs during each chest compression enters the housing through the patient port, passes through the exhalation one way valve and exits the rescuer port, and wherein, when the chest wall recoils, oxygen containing gasses are prevented from entering the lungs through the rescuer port by both of the one way valves;

a ventilation source to inject an oxygen-containing gas into the housing, to open the inhalation one way valve, and to pass through the rescuer port and to the patient to periodically expand the lungs with the oxygen-containing gases;

wherein the inhalation one way valve is configured to remain closed during multiple, successive chest decompressions so that respiratory gasses are prevented from reaching the lungs through the inhalation one way valve over successive chest compression/chest recoil cycles to successively decrease the volume of respiratory gasses in the lungs thereby allowing more blood to enter the thoracic space;

wherein the inhalation one way valve is configured to open when a pressure in the intrathoracic space is about −

10 cm H₂O; and

when the patient gasps or begins spontaneous breathing, the inhalation one way valve is configured to open and allow air to enter the patient'"'"'s lungs.

9. A device to augment circulation during the performance of cardiopulmonary resuscitation in a patient in cardiac arrest, the device comprising:

a housing having a rescuer port and a patient port;

a valve system disposed in the housing;

wherein the housing and the valve system are configured such that a volume of respiratory gas expelled from the lungs during each chest compression enters the housing through the patient port, passes through the valve system and exits the rescuer port, and wherein, when the chest wall recoils, oxygen containing gases are prevented from entering the lungs through the patient port by the valve system;

a ventilation source to inject an oxygen-containing gas into the housing, to pass through the valve system, and to pass through the patient port and to the patient to periodically expand the lungs with the oxygen-containing gases;

at least one physiological sensor that is selected from a group consisting of airway pressure sensors, carbon dioxide sensors, electrocardiogram signal sensors, and impedance sensors; and

a communication system to permit signals from the physiological sensor to be transmitted to a CPR device or to the person performing CPR and used during resuscitation to provide feedback for at least one of how to perform CPR, an optimal time to actively inflate the lungs with respiratory gases and an optimal time to defibrillate, and further comprising at least one indicator that is configured to assist a rescuer in performing CPR.

10. A device as in claim 9, wherein the valve system includes at least one valve selected from a group consisting of a check valve, a spring valve, a duck valve and an electronically-controlled valve.

11. A device as in claim 9, wherein the ventilation source is selected from a group consisting of mouth-to-mouth ventilation, a mouth-mask, a resuscitator bag, an automatic ventilator, a semi-automatic ventilator, a body cuirass and an iron-lung device.

12. A device as in claim 9, wherein the valve system includes a means to impede the exodus of respiratory gases from the lungs with a fixed or variable resistance that is in the range from about 0 to about 10 cm H₂O.

13. A device as in claim 9, further comprising a supply system to deliver a low flow and volume of continuous oxygen into the lungs which is less than the volume of respiratory gases expelled with successive chest compressions so that the number of times that the lungs are expanded with oxygen-containing gases is reduced by the low level of continuous oxygen insufflation.

14. A device as in claim 9, wherein the valve system comprises a pair of one way valves that are separately configured to open with opposite gas flows through the housing.

15. A device as in claim 9, further comprising a monitoring system to measure the total volume expelled from the lungs while performing CPR.

16. A device to augment circulation during the performance of cardiopulmonary resuscitation in a patient in cardiac arrest, the device comprising:

a housing having a rescuer port and a patient port, an exhalation one way valve and an inhalation one way valve which is biased in a closed position;

wherein the housing and one way valves are configured such that a volume of respiratory gas expelled from the lungs during each chest compression enters the housing through the patient port, passes through the exhalation one way valve and exits the rescuer port;

a ventilation source to inject an oxygen-containing gas into the housing, to open the inhalation one way valve, and to pass through the rescuer port and to the patient to periodically expand the lungs with the oxygen-containing gases;

a sensor that is associated with the housing to measure gas volumes or airway pressure; and

a controller that is configured to receive measurements from the sensor and to estimate the rate and depth of chest compressions by evaluating variations in the amount of gasses delivered or airway pressure produced by positive-pressure ventilations to the amount of gasses expelled or airway pressures produced during chest compressions.

17. A device as in claim 16, wherein the controller is configured to send instructions to produce visual instructions as to a desired compression and/or ventilation rate.

18. A device as in claim 16, wherein, when the chest wall recoils, oxygen containing gasses are prevented from entering the lungs through the rescuer port by both of the one way valves, and wherein the inhalation one way valve is configured to remain closed during multiple, successive chest decompressions so that respiratory gasses are prevented from reaching the lungs through the inhalation one way valve over successive chest compression/chest recoil cycles to successively decrease the volume of respiratory gasses in the lungs thereby allowing more blood to enter the thoracic space.

19. A system to augment circulation during the performance of cardiopulmonary resuscitation in a patient in cardiac arrest, the device comprising:

a housing having;

a rescuer port; and

a patient port; and

a valve system disposed in the housing;

wherein the housing and the valve system are configured such that respiratory gas expelled from a patient'"'"'s lungs during a chest compression enters the housing through the patient port, passes through the valve system, and exits the rescuer port, and wherein, when the chest wall recoils, oxygen containing gasses are prevented from entering the patient'"'"'s lungs through the patient port by the valve system;

wherein the valve system is configured to remain closed during multiple, successive chest decompressions so that respiratory gasses are prevented from reaching the patient'"'"'s lungs over successive chest compression/chest recoil cycles to successively decrease the volume of respiratory gasses in the lungs thereby allowing more blood to enter the thoracic space; and

wherein the valve system is configured to open and allow air to enter the patient'"'"'s lungs if the patient gasps or begins spontaneous breathing;

at least one of an airway pressure sensor, carbon dioxide sensor, electrocardiogram signal sensor, and an impedance sensor;

at least one indicator that is configured to assist a rescuer in performing CPR; and

a communication system to permit signals from the at least one of an airway pressure sensor, carbon dioxide sensor, electrocardiogram signal sensor, and an impedance sensor to be transmitted to a CPR device or to the rescuer performing CPR to provide feedback for at least one of how to perform CPR, an optimal time to actively inflate the lungs with respiratory gases and an optimal time to defibrillate.

20. The system of claim 19, wherein the indicator is a timing light.

21. The system of claim 19, further comprising a ventilation source to inject an oxygen-containing gas into the housing and through the valve system to pass oxygen-containing gas through the patient port and to the patient to periodically expand the lungs with the oxygen-containing gas.

22. The system of claim 21, wherein the device comprises a carbon dioxide sensor configured to provide an indication of a proper seal between the patient'"'"'s trachea and the ventilation source.

23. A system to augment circulation during the performance of cardiopulmonary resuscitation in a patient in cardiac arrest, the device comprising:

a housing having;

a rescuer port; and

a patient port; and

a first valve and a second valve disposed in the housing; and

at least one of an airway pressure sensor, carbon dioxide sensor, electrocardiogram signal sensor, and an impedance sensor disposed in at least one of the patient port, rescuer port, first valve, or second valve,

wherein the housing and the valve system are configured such that respiratory gas expelled from a patient'"'"'s lungs during a chest compression enters the housing through the patient port, passes through the first valve, and exits the rescuer port, and wherein, when the chest wall recoils, oxygen containing gasses are prevented from entering the patient'"'"'s lungs through the patient port by both of the first valve and the second valve;

wherein the first valve and second valve are biased in a closed position such that respiratory gasses are prevented from reaching the patient'"'"'s lungs over successive chest compression/chest recoil cycles to successively decrease the volume of respiratory gasses in the lungs; and

wherein the second valve is configured to open and allow air to enter the patient'"'"'s lungs through the patient port if;

the patient gasps or begins spontaneous breathing;

or

an oxygen-containing gas is injected into the housing through the rescuer port.

24. The device of claim 23, wherein the first valve and the second valve are one-way valves, such that the first valve only permits airflow from the patient port to the rescuer port, and the second valve only permits airflow from the rescuer port to the patient port.

25. The device of claim 24, wherein the first valve and the second valve are check valves, and wherein the first valve is biased in a closed position unless and until gas exiting the patient'"'"'s lungs through the patient port exert a pressure on the valve that is less than about 20 cm H₂O, and wherein the second valve is biased in a closed position unless and until a pressure of from about −

5 to about −

10 mmHg is reached in the patient'"'"'s thorax.

26. The device of claim 23, wherein the device comprises a carbon dioxide sensor configured to provide an indication of a proper seal between the patient'"'"'s trachea and a ventilation source in fluid communication with the rescuer port.

27. A device to augment circulation during the performance of cardiopulmonary resuscitation in a patient in cardiac arrest, the device comprising:

a housing having a rescuer port and a patient port;

an exhalation one way valve biased in a closed position; and

an inhalation one way valve biased in a closed position;

wherein the housing and one way valves are configured such that a volume of respiratory gas expelled from the lungs during each chest compression enters the housing through the patient port, passes through the exhalation one way valve and exits the rescuer port;

a sensor that is associated with the housing configured to provide an indication of a proper seal between the patient'"'"'s trachea and a ventilation source in fluid communication with the rescuer port; and

a controller that is configured to receive measurements from the sensor and to estimate the rate and depth of chest compressions by evaluating variations in the amount of gasses delivered or airway pressure produced by positive-pressure ventilations to the amount of gasses expelled or airway pressures produced during chest compressions.

28. The device of claim 27, wherein the device comprises a carbon dioxide sensor configured to provide an indication of a proper seal between the patient'"'"'s trachea and a ventilation source in fluid communication with the rescuer port.

29. The device of claim 27, wherein the inhalation and exhalation one way valves include impede the exodus of respiratory gases from the lungs with a fixed or variable resistance that is in the range of from about 0 to about 10 cm H₂O.

30. The device of claim 27, wherein the sensor is a carbon dioxide sensor.

31. The device of claim 27, wherein the sensor measures gas volumes and/or airway pressure.