Abstract
A device for cardiopulmonary resuscitation, a pad for assisting with cardiopulmonary resuscitation, and a method for controlling such a device, wherein the parameters of compression depth and frequency of the heart massage, and at least one vital parameter, are continuously monitored, and the parameters of the heart massage within the context of the position of the action of force on the patient's thorax, the direction of the action of force on the patient's thorax, the compression depth and/or the frequency of the heart massage are optimized on the basis of the individual anatomy of the patient.
Claims
1-18. (canceled)
19. An apparatus for cardiopulmonary resuscitation, comprising: at least one computing unit; at least one sensor interface for establishing a connection to at least one sensor; and a memory, wherein at least one vital parameter of a patient is rendered acquirable by the at least one sensor, wherein the acquired measured values of the at least one vital parameter are storable in the memory, wherein the computing unit is configured to ascertain success of a cardiac massage, and wherein a measure for adjusting at least one parameter of the cardiac massage is derivable from the ascertained success.
20. The apparatus for cardiopulmonary resuscitation according to claim 19, further comprising a ventilation apparatus for ventilating the patient and a control device for controlling the ventilation.
21. The apparatus for cardiopulmonary resuscitation according to claim 19, further comprising an output unit for the optical and/or acoustic output of instructions for a human aider.
22. The apparatus for cardiopulmonary resuscitation according to claim 19, further comprising a thorax compression device for compressing the thorax of the patient and a control device for controlling the thorax compression device.
23. The apparatus for cardiopulmonary resuscitation according to claim 19, further comprising a thorax compression device and an output device for outputting instructions to a human aider.
24. The apparatus for cardiopulmonary resuscitation according to claim 22, wherein the thorax compression device is configured so that a position of an action of force on the thorax of the patient and/or a direction of the action of force on the thorax of the patient is modifiable based on a measure that is determinable by the computing unit.
25. A pad for use with an apparatus for cardiopulmonary resuscitation apparatus according to claim 19, comprising a guide device that defines a search path, a thorax of a patient being compressed along the search path within the scope of a cardiopulmonary resuscitation.
26. The pad according to claim 25, wherein the guide device is realized by an optical marking on the pad or a haptic design of a surface of the pad.
27. The pad according to claim 25, wherein the guide device is a guide rail that extends along the search path and in which a handle is displaceably mounted so that an action of force on the handle at a respective position along the search path is transferred to the thorax of the patient.
28. A method for controlling an apparatus for cardiopulmonary resuscitation, comprising the steps of: outputting an instruction to a human aider and/or controlling a thorax compression device for purposes of starting a cardiac massage with starting parameters including a starting position, a starting angle, a starting compression depth, and a starting frequency; acquiring at least one vital parameter of a patient and the compression depth and the frequency of the cardiac massage; ascertaining success of the cardiac massage using the starting parameters; determining a measure that corresponds to an adjustment of at least one of the parameters of a position of an action of force, direction of the action of force, compression depth and frequency of the cardiac massage; and outputting a previously determined measure as an instruction to the human aider controlling the thorax compression device.
29. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 28, wherein the outputting of the previously determined measure to a human aider and/or the controlling of a thorax compression device is followed by an acquisition of at least one vital parameter of the patient, and a success of the measure is ascertained in a further method step, and a determination of a subsequent measure is implemented in a further method step.
30. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 29, including implementing the determination of the subsequent measure based on the success of the preceding measure.
31. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 28, including optimizing at least one of the parameters of the position of the action of force on the thorax of the patient, the direction of the action of force on the thorax of the patient, the compression depth, and the frequency of the cardiac massage by determining the measures and ascertaining the success of the respective measure.
32. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 31, including implementing the optimization of the position of the action of force on the thorax of the patient and/or the optimization of the direction of the action of force on the thorax of the patient is implemented along a search path, with a traversal of the search path being followed by ascertainment of the position and/or direction of the action of force on the thorax of the patient where success was greatest.
33. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 32, wherein the search path is specified and loaded from a memory at a start of the method, with the subsequent measure being given by a next point on the search path, at least during the optimization of the parameters of the position of the action of force on the thorax of the patient or a joint optimization of the position and direction of the action of force on the thorax of the patient.
34. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 32, including optimizing the direction of the action of force on the thorax of the patient at each point along the search path based on an optimization process and ascertaining an interaction of position and direction of the action of force on the thorax of the patient with the greatest success following the traversal of the search path.
35. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 31, including a component-by-component optimization of the parameters of position and direction of the action of force on the thorax of a patient.
36. The method for controlling an apparatus for cardiopulmonary resuscitation according to claim 28, including using an apparatus for cardiopulmonary resuscitation that comprises: at least one computing unit; at least one sensor interface for establishing a connection to at least one sensor; and a memory, wherein at least one vital parameter of a patient is rendered acquirable by the at least one sensor, wherein the acquired measured values of the at least one vital parameter are storable in the memory, wherein the computing unit is configured to ascertain success of a cardiac massage, and wherein a measure for adjusting at least one parameter of the cardiac massage is derivable from the ascertained success and/or using a pad that comprises a guide device that defines a search path, a thorax of a patient being compressed along the search path within the scope of a cardiopulmonary resuscitation.
Description
[0102] The drawings illustrate exemplary embodiments of an apparatus according to the invention and a method according to the invention. In detail:
[0103] FIG. 1: shows a schematic representation of a block diagram of an embodiment of an apparatus according to the invention for cardiopulmonary resuscitation without a thorax compression device,
[0104] FIG. 2: shows a schematic representation of a block diagram of an embodiment of an apparatus according to the invention for cardiopulmonary resuscitation with a thorax compression device,
[0105] FIG. 3: shows a schematic representation of the torso of a patient in a frontal view,
[0106] FIG. 4: shows a schematic representation of a section through the torso and head of a patient in the sagittal plane,
[0107] FIG. 5: shows a schematic representation of a section through the torso of a patient in the transverse plane,
[0108] FIG. 6: shows an abstracted schematic representation of the progress of an embodiment of a method according to the invention for controlling an apparatus for cardiopulmonary resuscitation,
[0109] FIGS. 7 & 8: show a schematic representation of the progress of a component-by-component optimization of the position of the action of force on the thorax of a patient in an embodiment of a method according to the invention,
[0110] FIGS. 9 & 10: show a schematic representation of the progress of a component-by-component optimization of the direction of the action of force on the thorax of a patient in an embodiment of a method according to the invention,
[0111] FIG. 11: shows a schematic representation of the progress of a continuous component-by-component fine alignment following the actual optimization of the parameters using the example of the transverse component of the position of the action of force on the thorax of a patient,
[0112] FIG. 12: shows a schematic representation of a search path in an embodiment of the method according to the invention,
[0113] FIG. 13: shows a further schematic representation of a search path in an embodiment of the method according to the invention,
[0114] FIG. 14: shows a schematic representation of the progress of an optimization along a search path in an embodiment of a method according to the invention,
[0115] FIG. 15: shows a schematic representation of the progress of a vector optimization in an embodiment of a method according to the invention,
[0116] FIG. 16: shows a schematic representation of the progress of a combination of search path and vector optimization in an embodiment of a method according to the invention,
[0117] FIG. 17: shows a schematic representation of the progress of a frequency optimization in an embodiment of a method according to the invention, and
[0118] FIG. 18: shows a schematic representation of the progress of a compression depth optimization in an embodiment of a method according to the invention.
[0119] FIG. 1 schematically represents the block diagram of an embodiment according to the invention of an apparatus for cardiopulmonary resuscitation (1) without a thorax compression device (11).
[0120] The apparatus for cardiopulmonary resuscitation (1) comprises a computing unit (2), a sensor interface (3), a pad (4) for application or placement on the chest of a patient (100), at least one sensor (5) for acquiring at least one vital parameter, at least one memory (6), and an output device (7). An optional embodiment of an apparatus according to the invention for cardiopulmonary resuscitation (1) additionally comprising a control device for controlling the ventilation (8) and further optionally comprising a ventilator (9) is illustrated using dashed lines. The pad (4) comprises, either integrated therein or connected thereto in any other way, at least one acceleration sensor and/or gyroscope sensor. The sensors are connected to the sensor interface (3) such that the measured data acquirable with the aid of the sensors are transmittable to the computing unit (2) and/or the memory (6). Optical and/or acoustic instructions for a human aider with regard to carrying out a cardiac massage are able to be output with the aid of the output device (7).
[0121] With the aid of the illustrated embodiment of an apparatus according to the invention for cardiopulmonary resuscitation (1), at least one vital parameter corresponding to the implementation of a cardiac massage is rendered monitorable and the success of the cardiac massage over time is ascertainable therefrom with the aid of the computing unit (2). Instructions for adjusting at least one parameter of the cardiac massage are able to be output to a human aider with the aid of the output device (7) and the success of this measure is ascertainable by monitoring the at least one vital parameter with the aid of the computing unit (2).
[0122] FIG. 2 shows the block diagram of an embodiment according to the invention of an apparatus for cardiopulmonary resuscitation (1) comprising a thorax compression device (11). The thorax compression device (11) is designed so that the thorax (101) of a patient (100) is rendered compressible for the purpose of carrying out a cardiac massage. For the purpose of controlling the thorax compression device (11), the depicted embodiment of an apparatus for cardiopulmonary resuscitation (1) comprises a control unit (10). With the aid of the control unit (10), it is possible to generate control signals for controlling the thorax compression with the aid of the thorax compression device (11) and the said control signals are transmittable to the thorax compression device (11). In this embodiment of the invention, the output device (7) for outputting instructions to a human aider is optional. In an embodiment of the invention, the thorax compression device (11) is designed for the automated adjustment of all parameters of the cardiac massage. In another embodiment of the invention, the thorax compression device (11) relies on the operation by a human aider for the purpose of adjusting at least one parameter of the cardiac massage, for example the position of the action of force on the thorax (101) of a patient (100), with the output device (7) in this embodiment of the invention being designed to appropriately instruct the human aider. Moreover, the use of the pad (4) with the at least one integrated acceleration and/or gyroscope sensor for monitoring the compression depth and frequency parameters of the cardiac massage is optional in this embodiment of the invention. In embodiments of the invention where no pad (4) is used, the monitoring means for the compression depth and/or compression frequency of the cardiac massage is arranged in the region of the thorax compression device (11) or integrated in the latter.
[0123] FIG. 3 schematically illustrates the torso of a patient (100) in a frontal view. Depicted on the torso or the thorax (101) is the position (103) of the action of force on the thorax (101) of a patient (100) according to the guidelines, which is located in the lower region of the sternum (102), and the search region (104) according to the invention located around this position (103) for the purpose of ascertaining the optimal position of the action of force on the thorax (101) of a patient (100). Furthermore, the direction components of the position of the action of force on the thorax (101) of a patient (100) are depicted using right/left and superior/inferior. For instance, the search region (104) is delimited by the costal margin (110) in the inferior direction.
[0124] FIG. 4 shows a schematic representation of a section of the torso (101) and head of a patient (100) in the sagittal plane. The plotted coordinate axes define the superior direction in the direction of the head of the patient (100), inferior direction in the direction of the lower abdomen of the patient (100), anterior direction away from the chest of the patient (100) and posterior direction away from the back of the patient (100). A pad (4) has been placed on the upper side of the thorax (101) of the patient (100). A force is exerted onto the pad (4) for the purposes of carrying out a cardiac massage. The direction of the action of force on the pad (4) is given by the direction vector (105) of the action of force on the thorax (101) of the patient (100). According to the guidelines, the action of force is approximately perpendicular onto the pad (4). Within the scope of optimizing the direction of the action of force on the thorax (101) of the patient (100), the direction of the action of force on the thorax (101) is varied over a given first angular range (106) in the sagittal plane in an embodiment of a method according to the invention. In this case, the angle describes the degree of the tilt of the direction vector (105) of the action of force on the thorax (101) from the perpendicular direction according to the guidelines. In this case, the tilt of the direction vector (105) of the action of force can be implemented both in the inferior direction and in the superior direction. In the depicted embodiment of the invention, the first angular range (106) is realized by an angular range encompassing 20°, with the latter being divided symmetrically into a tilt of the direction vector (105) of 10° in the inferior direction or superior direction. In other embodiments of the invention, it is conceivable to have both different angular dimensions of the first angular range (106) and a non-symmetric division of the first angular range (106) in the inferior and superior directions.
[0125] FIG. 5 shows a schematic representation of a section of the torso (101) of a patient (100) in the transverse plane. The anterior direction, posterior direction and left and right directions are noted on the plotted coordinate axes. In accordance with the explanations regarding the variation of the direction vector (105) of the action of force on the thorax (101) in the sagittal plane, the direction vector (105) is tilted out of the perpendicular guideline-conform position within the scope of the optimization of the direction of the action of force on the thorax (101) of a patient (100) in an embodiment of a method according to the invention. In the transverse plane, the direction vector (105) is varied within a second angular range (107) which encompasses an angular range of 20° in the right or left directions. A symmetric distribution of the second angular range (107) of in each case 10° in the right and left direction is depicted. In other embodiments of the invention, other angular ranges of the second angular range (107) and/or non-symmetric distribution of the second angular range (107) among the left and right directions are conceivable.
[0126] FIG. 6 shows an abstracted schematic representation of the progress of an embodiment of a method according to the invention for controlling an apparatus for cardiopulmonary resuscitation (1). The depicted schematic progress comprises five method steps, with the individual method steps depicted in this figure each being able to be subdivided into further method steps. In the first method step, an instruction is output to a human aider and/or a thorax compression device (11) is controlled for the purpose of starting a cardiac massage at a starting point or a specific position of the action of force on the thorax (101) of a patient (100), a starting angle or direction vector (105) of the action of force on the thorax (101) which describes the direction of the action of force on the thorax (101), a starting compression depth, and a starting frequency of the cardiac massage.
[0127] At least one vital parameter of the patient (100) and the CPR data within the meaning of compression depth and the frequency of the cardiac massage of a cardiopulmonary resuscitation are acquired in the second method step.
[0128] Implemented abstractly in the third method step is the ascertainment of the success of the cardiac massage using the current parameters. If this method step is applied anew during the course of the method according to the invention, the success of the preceding measure is ascertained at this point.
[0129] In preferred embodiments of the invention, the method step of “ascertaining the success of the measure” comprises the readout of at least some of the stored previous measured data of the at least one vital parameter from a memory and the comparison of at least one measured value from a preceding measurement with at least one measured value of the current measurement.
[0130] The subsequent measure is determined in the fourth method step, with a measure being given by an adjustment of the instructions output to a human aider and/or of the control of a thorax compression device (11) in respect of the position of the action of force on the thorax (101), the direction of the action of force on the thorax (101), the compression depth and/or the frequency of the cardiac massage. The determination of the subsequent measure can in this case be based in embodiments of the method according to the invention on the ascertained success of a previous measure or on a specified sequence of measures.
[0131] In the fifth method step, the output of the determined measure is implemented as instructions for a human aider and/or by the corresponding control of a thorax compression device (11).
[0132] Subsequently, at least one vital parameter of the patient (100) and the CPR data are acquired anew in accordance with the second method step in the depicted embodiment of a method according to the invention, with a loop comprising method steps 2-5 being run through.
[0133] At least one termination criterion, the fulfillment of which terminates the loop, is defined in embodiments of the method according to the invention.
[0134] FIGS. 7 and 8 show a schematic representation of the progress of a component-by-component optimization of the position of the action of force on the thorax (101) of a patient (100) in an embodiment of a method according to the invention, with FIG. 7 representing the optimization of the right/left component of the position of the action of force and FIG. 8 representing the optimization of the position in the superior/inferior direction.
[0135] The following nomenclature is used in the figures relating to the optimization of individual parameters: if the term is preceded by a “/”, then this relates to the determination of a quantity; if the term is placed between square brackets (e.g., [better]), then this relates to an evaluation; and if the term is placed between curly brackets (e.g., {displace left}), then this relates to an action.
[0136] In both direction components, the optimization is implemented starting from an initial position, from which a displacement is carried out in one direction and the success of the measure provided by this displacement is subsequently determined. If an improvement has occurred in the process, then there is another displacement in the same direction, but if there is a deterioration or the state remains unchanged, then the position is displaced in the opposite direction. The success of the further measure provided by this displacement is subsequently determined. If an improvement in the state has occurred, then there is a renewed displacement in the same direction, but if the state has deteriorated, then there is a displacement in the opposite direction within the meaning of a measure. If the success of the measure is determined as unchanged, then there is no further displacement of the position in the respectively optimized direction and the optimization of the direction component has been completed.
[0137] Analogously, FIGS. 9 and 10 show a schematic representation of the progress of a component-by-component optimization of the direction of the action of force on the thorax (101) of a patient (100) in an embodiment of a method according to the invention. In accordance with the displacement of the position of the action of force in the various directions, the measure here is however a tilt of the direction vector (105) of the action of force on the thorax (101) in the respective direction.
[0138] FIG. 11 represents the progress of a local optimization or re-optimization/readjustment of the position of the action of force on the thorax (101) using the example of the right/left direction component. Such a local optimization or readjustment follows an initial optimization of at least one parameter of the cardiac massage in embodiments of a method according to the invention. In this case, there is a displacement of the position of the action of force in a direction of the direction component, the determination of the success of this measure, and, as a determination of the subsequent measure, a definition of the new position provided an improvement has occurred or a displacement of the position in the opposite direction if a deterioration or no change has occurred. The flowcharts for optional local optimizations or re-optimizations of the superior/inferior direction component of the position and/or of the angular ranges in the sagittal or transverse plane may be designed analogously in embodiments of the invention.
[0139] FIG. 12 represents the optimization of at least the position of the action of force on the thorax (101) of a patient (100) on the basis of a search path optimization. In this case, the optimization of the position of the action of force is implemented along a predetermined search path (108). The optimization starts at a starting point (108a) of the search path (108). In this case, the search path (108) extends within a predefined search region (104). The displacement of the position of the action of force on the thorax (101) is in this case implemented incrementally along the search path (108), with the success of the measure given by the displacement along the search path (108) being ascertained continuously by acquiring and evaluating at least one vital parameter of the patient (100). Once the endpoint of the search path (108) has been reached, the said endpoint also corresponding to the starting point (108a) in the depicted embodiment of the method according to the invention, the position of the action of force on the thorax (101) where the greatest success was ascertained is determined.
[0140] This optimized position is output as an instruction to a human aider and/or used to control a thorax compression device (11).
[0141] FIG. 13 shows a schematic representation of the projection of the search vector (109) in a frontal view of the thorax (101). From the starting point (108a), there is in this case a displacement of the position of the action of force on the thorax (101) in a range of +/−5 cm, both in the right/left direction component and in the superior/inferior direction component. The search vector (109) specifies the direction of the positional change along a search path (108).
[0142] FIG. 14 schematically represents the progress of a vector path optimization of an embodiment of a method according to the invention. There is within the scope of vector path optimization a displacement along a search path (108) of the position of the action of force on the thorax (101), with the direction vector of the direction of the action of force on the thorax (101) being aligned in such a way at each position on the search path (108) that the said direction vector is directed at the position of the heart of the patient (100). In accordance with the progresses of the optimization illustrated in the previous figures, the vector path optimization also includes a displacement of the position along the search path (108) and additionally an adjustment of the direction vector (105) of the action of force within the meaning of a measure of a method according to the invention. Once the search path (108) has been traversed, there is a comparison of the successes determined for the different positions and the corresponding direction vectors and the selection of the position with the greatest success.
[0143] FIG. 15 shows a flowchart for the combined optimization of vector and position in the individual direction components of the position of the action of force on the thorax (101).
[0144] FIG. 16 illustrates the path/vector optimization with predefined search path (108) and search vector (109).
[0145] FIG. 17 shows the frequency optimization and FIG. 18 shows the compression depth optimization of an embodiment according to the invention of a method for controlling an apparatus for cardiopulmonary resuscitation (1).
