Mechanical cardiopulmonary resuscitation combining circumferential constriction and anteroposterior compression of the chest

Abstract

The present invention is a method for improving hemodynamics and clinical outcome of patients suffering cardiac arrest and other low-flow states by combination of circumferential constriction and anteroposterior compression decompression of the chest cardiopulmonary resuscitation. Anteroposterior compression decompression may be provided by a piston mechanism attached to a gantry above the patient. Circumferential constriction may be achieved by inflation of pneumatic bladders or shortening of a band. The on-off sequence and relative force of circumferential constriction and anteroposterior compression decompression may be adjusted so as to improve efficacy.

Claims

1. A method to improve hemodynamics and clinical outcome of patients suffering cardiac arrest, or other low-flow states, the method comprising: providing cardiopulmonary resuscitation that is a combination of providing circumferential constriction and providing anteroposterior compression decompression of a chest of a patient, and incorporating feedback from a feedback mechanism to automatically control the timing of the circumferential constriction and the anteroposterior compression decompression of the chest, and wherein the anteroposterior compression and the circumferential constriction occur together, then the circumferential constriction reaches its full constriction before the anteroposterior compression decompression reaches its full compression, then the anteroposterior compression reaches its full compression after the circumferential constriction has reached its full constriction, said anteroposterior compression ultimately being closer to the center of the patient's chest.

2. The method according to claim 1 wherein providing anteroposterior compression decompression includes attaching an anteroposterior compression decompression mechanism to the chest and providing forceful decompression of the chest.

3. The method according to claim 1 further comprising temporary full or partial obstruction of an airway during a portion of a chest compression cycle.

4. The method according to claim 2 further comprising temporary full or partial obstruction of an airway during a portion of a chest compression cycle.

5. The method according to claim 2 wherein forces applied to the chest by the anteroposterior compression decompression mechanism, a circumferential constriction mechanism, and an active decompression mechanism are in a ratio of 1:2:1.

6. The method according to claim 1 wherein the circumferential constriction and anteroposterior compression decompressions are simultaneous.

7. The method according to claim 1 wherein the circumferential constriction and anteroposterior compression decompression are mechanisms having a fixed phasic relationship that is not simultaneous, wherein the fixed phasic relationship is in phase with indicators of residual cardiac mechanical or electrical activity.

8. The method according to claim 1 wherein circumferential constriction is provided by a mechanism selected from the group consisting of: inflation of a pneumatic device, inflation of pneumatic chamber, inflation of a series of pneumatic chambers, and a band that has inflatable pneumatic chambers on all or portion of its inner circumference.

9. The method according to claim 1 further comprising phasic abdominal compression and decompression in phase with the anteroposterior compression decompression.

10. The method according to claim 1 wherein a portion of a circumferential constriction mechanism is applied to vertical posts on both sides of the patient.

11. The method according to claim 1 further comprising incorporating feedback from the feedback mechanism to automatically control individual force contributions of the circumferential constriction and anteroposterior compression decompression.

12. The method according to claim 1 wherein one or more pneumatic bladders are enclosed within a three sided gantry, the bladder or bladders being an accordion mechanism of expandable volume, and the sidewalls of the gantry adjustable with respect to the patient's chest.

13. The method according to claim 2 wherein a flexible diaphragm within a hardened bell structure is on a patient side of an anteroposterior compression mechanism, and application of positive pressure above said diaphragm by a motor operatively connected to the hardened bell structure augments compression and circumferential constriction and application of negative pressure augments sternal decompression.

14. The method according to claim 1 further comprising adjusting a pattern of the circumferential constriction such that it is not uniform and provides greater constriction to one area of the chest than another.

15. The method according to claim 1 wherein compression and constriction mechanisms are contained within a gantry over the patient and wherein said gantry opens such that the patient may be placed on a backboard, and closing the gantry applies and engages the compression and constriction mechanisms.

16. The method according to claim 2 wherein an attachment capability of active decompression mechanism is a flexible diaphragm within a hardened hemispheric structure, and application of negative pressure above the diaphragm engages the attachment capability during active decompression.

17. The method according to claim 1 wherein portions of a pneumatic bladder that are between a backboard and the patient inflate under the patient simultaneously with the anteroposterior compression, thereby pushing the patient upwards into an anteroposterior compression mechanism, and wherein the pneumatic bladder is not located between the patient and the anteroposterior compression mechanism.

18. A method to improve hemodynamics and clinical outcome of patients suffering cardiac arrest, or other low-flow states, the method comprising: providing cardiopulmonary resuscitation that is a combination of providing circumferential constriction and providing anteroposterior compression decompression of a chest of a patient, wherein the anteroposterior compression and the circumferential constriction occur together, then the circumferential constriction mechanism reaches its full constriction before the anteroposterior compression decompression reaches its full compression, then the anteroposterior compression reaches its full compression after the circumferential constriction mechanism has reached its full constriction, said anteroposterior compression ultimately being closer to the center of the patient's chest.

19. A method to improve hemodynamics and clinical outcome of patients suffering cardiac arrest, or other low-flow states, the method comprising: providing cardiopulmonary resuscitation that is a combination of providing circumferential constriction and providing anteroposterior compression decompression of a chest of a patient, and incorporating feedback from a feedback mechanism to automatically control the timing of the circumferential constriction and the anteroposterior compression decompression of the chest, and wherein portions of a pneumatic bladder that are between a backboard and the patient inflate under the patient simultaneously with the anteroposterior compression, thereby pushing the patient upwards into an anteroposterior compression mechanism, and wherein the pneumatic bladder is not located between the patient and the anteroposterior compression mechanism.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1: Cross section of patient, gantry, anteroposterior compression mechanism, multi-bladder pneumatic circumferential constriction mechanism and backboard.

(2) FIG. 2: Cross section of patient, gantry, anteroposterior compression mechanism, belt-band circumferential constriction mechanism, roller motors, and backboard.

DETAILED DESCRIPTION

(3) The present disclosure is for a system, method, or device intended generally to improve hemodynamics and clinical outcome of patients suffering cardiac arrest, or other low-flow states, by providing CPR that is a combination of circumferential constriction and anteroposterior compression.

(4) It is anticipated that the system would be comprised of multiple components.

(5) A practitioner of ordinary skill in the art, once taught the invention, would appreciate that a preferred, but not limiting, implementation of the method might include: 1. A backboard of sorts 8 to maintain the patient's chest 9 in the optimal configuration with respect to the other components. 2. A piston like device 1, 2, 3 for provision of anteroposterior compression of the patient's chest. 3. A mechanism to attach the piston 3 to the patient's chest 9 for provision of forceful decompression 3, 4. This may be a suction cup or similar device. 4. A structural gantry or arch 5 anterior to or above the patient for holding the piston in position. 5. A circumferential, or semi-circumferential band 12 or pneumatic bladder or bladders 7, 10 for provision of circumferential constriction. 6. A method or methods to provide force or energy to the components that provide anteroposterior compression and circumferential constriction, both for the piston mechanism 2 and the circumferential mechanism 13.

(6) There are components of the invention that, while sufficient, are interchangeable within the context of the invention. A practitioner skilled in the art would know which specific embodiments of these components to utilize in optimizing performance of the invention.

(7) For purposes of illustration and not limitation, a practitioner of ordinary skill in the art would, once taught the invention, be able to construct a particular preferred embodiment composed additionally of:

(8) A hinged backboard 8 capable of changing the geometric relationship or relationships between the head, patient's chest 9, abdomen and extremities.

(9) A section of circumferential pneumatic constrictor may be applied to a portion of the backboard next to the posterior aspect of the patient's chest 10.

(10) The gantry may be adjustable as to shape, so as to maximize the application and effectiveness of the pneumatic constrictor function with respect to the patient's chest. The gantry may be adjustable as to location over the patient such that the location and vector of the anteroposterior compression mechanism.

(11) Adjustable vertical lateral struts on either side of the patient's chest, each with a section of circumferential pneumatic constrictor between the strut and the patient's lateral chest. This may be adjustable as to shape and location, so as to maximize the application and effectiveness of the pneumatic constrictor function chamber to the patient's chest.

(12) A band device 12 capable of wrapping around the patient's anterior and lateral chest and contributing to both anteroposterior compression and circumferential constriction. A section of circumferential pneumatic constrictor system might be applied to a portion of the band so as to further enhance efficacy. This may be adjustable as to shape, so as to maximize the application and effectiveness of the pneumatic constrictor function chamber to the patient's chest. The band itself 12 may be attached to a motor 13 or mechanical device, such that it's length may be forcibly shortened to create chest constriction.

(13) A piston component 3 capable of anteroposterior compression of the chest. This would be attached a motor 2, mechanical or pneumatic device at a point sagittal and centrifugal to the patient, most likely above the mid-anterior chest. The attachment to the gantry 5 and the gantry itself may be adjustable so as to allow change in the vector force of the piston. The patient side of the piston would be capable of attachment to the patient's chest such that the piston could apply upward decompressive force, so called active decompression. This could be accomplished by a suction cup or adhesive component 3, 4.

(14) A mechanical system capable of sending force to the constricting band 12, 13 and piston 1, 3.

(15) A pneumatic system capable of sending inflation-deflation to the chambers of the pneumatic circumferential constricting system 7.

(16) A feedback control component capable of utilizing indicators of tissue perfusion and varying the parameters of the compression and constricting systems so as to improve tissue perfusion and the probability of successful resuscitation.

(17) A control component capable of varying the force or timing of chest compression or constriction so as to increase the likelihood that electrical defibrillation will result in return of spontaneous circulation.

(18) A component capable of providing electrical defibrillation without stopping chest compression or constriction, and at a specific time in the chest compression or constriction cycle.

(19) A particular refinement to improve the efficacy of the system would be enclosure of the pneumatic bladder or bladders within a three sided gantry. The bladder or bladders would incorporate an accordion like mechanism such that the volume has significant capacity to expand. The sidewalls of the gantry would be adjusted to minimize the open space between the gantry and the patient's chest. A practitioner with ordinary skill wound know that the volume and stiffness of the pneumatic bladder, characteristics of the accordion sides and the degree of friction between the sides of the bladder and the adjustable sides of the gantry 5 would determine the force and speed of the circumferential constriction mechanism.

(20) An additional particular refinement would be integration of the anteroposterior compression-decompression piston 3 and the gantry portions 7 of the circumferential constriction mechanism. This integration may be within the gantry structure.

(21) The construction of the attachment capability of active decompression mechanism may be by means of a flexible diaphragm 4 within a hardened hemisphere or bell-like structure 3. This would allow it to be a component of, and functionally contribute to, both the active decompression and the circumferential constriction mechanisms. Application of negative pressure above the diaphragm would engage the attachment-adhesive capability for active decompression. Application of positive pressure above the diaphragm would engage additional compression to the mid-anterior chest, contributing to anteroposterior compression.

(22) Further, a practitioner of ordinary skill in the art would, once taught the invention, further understand that: 1. It is a combination of circumferential constriction and anteroposterior compression of the chest, with or without active decompression of the chest. And that the efficacy of the method may be further enhanced by providing full or partial obstruction 14 of the airway during a fixed portion of the chest compression cycle. 2. In certain embodiments, the component performing anteroposterior compression of the chest is attached to the component providing circumferential constriction. 3. In certain embodiments, the mechanism providing force to the circumferential constricting band may altered and adjusted such that the force is applied unevenly with respect to the chest. Portions of the chest whose constriction is associated with greater positive impact on blood flow would receive greater force and constriction. In specific embodiments this can be achieved by and independent mechanism between the band and the patient. 4. In certain embodiments, the circumferential constriction and anteroposterior compression of the chest are in a fixed phasic relationship with indicators of residual cardiac mechanical or electrical activity. 5. In certain embodiments, the on-off sequence of circumferential constriction and anteroposterior compression may be adjusted to additionally improve efficacy. In one embodiment the circumferential constriction occurs before the anteroposterior compression while in another the reverse occurs. 6. In certain embodiments, the efficacy of circumferential constriction and anteroposterior compression of the chest are augmented by administration of pressor drugs. 7. In certain embodiments, the efficacy of circumferential constriction and anteroposterior compression of the chest are augmented by simultaneous or phasic abdominal binding or abdominal compression. 8. In certain embodiments, the mechanical or pneumatic force for circumferential constriction or anteroposterior compression of the chest may be provided by electrical, mechanical or pneumatic subsystems alone or in combination. 9. In certain embodiments, the circumferential constriction is provided by a band that has inflatable pneumatic chambers on all, or portion, of its inner circumference. 10. In certain embodiments, a portion of the circumferential constriction mechanism is applied to the backboard. Portions of the pneumatic bladder between the backboard and the patient may inflate simultaneously with the anteroposterior compression piston mechanism so as to enhance its efficacy. 11. In certain embodiments, a portion of the circumferential constriction is provided by inflation of pneumatic chambers applied to adjustable vertical side posts 16 connected to the backboard on either side of the patient. These may inflate before the anteroposterior compression is initiated so as to stabilize the chest. 12. In certain embodiments, the component providing anteroposterior compression of the chest also provides force to the anterior portion of a circumferential band. 13. In certain embodiments, the system includes a component capable of sensing a biomarker indicative of system efficacy. Said biomarker may control the on-off sequencing of the other mechanisms. 14. In certain embodiments, the efficacy of the system is augmented by use of a feedback mechanism to control the timing and force of the circumferential constriction and anteroposterior compression of the chest. 15. In certain embodiments, the anteroposterior compression or circumferential constriction mechanism are adjustable in shape or configuration such that they match the shape of the chest more accurately. 16. In certain embodiments, the efficacy of the system is augmented by use of a feedback mechanism that adjusts the location or vector of the anteroposterior compressive mechanism. 17. In certain embodiments, the mechanism providing anteroposterior compression applies greater force and displacement to the compression of the mid-anterior chest compared to the force and distance applied to the remainder of the chest by the circumferential constriction mechanism. 18. In certain embodiments, the system includes a component capable of providing electrical defibrillation without stopping chest compression or constriction. The positive and negative leads for this component may be applied to the patient side of the piston or circumferential constriction band. Multiple leads allows simultaneous defibrillation in multiple vectors. 19. In certain embodiments, the system includes a component capable of providing electrical defibrillation at a specific time in the chest compression or constriction cycle. 20. In certain embodiments, the system includes a component capable of varying the force or timing of chest compression or constriction so as to increase the likelihood that electrical defibrillation will result in return of spontaneous circulation. 21. In certain embodiments, the system includes a hinged backboard capable of changing the geometric relationship or relationships between the head, chest, abdomen and extremities. 22. In certain embodiments, the system includes adjustable lateral struts on either side of the patient's chest, each with a section of the circumferential pneumatic constrictor between the strut and the patient's lateral chest. This is moldable as to shape and adjustable as to location. 23. In certain embodiments, the mechanism providing anteroposterior compression is attached to a gantry over the patient. Said gantry opens such that the patient may be placed on the backboard. Closing the gantry also applies, and mechanically engages, the circumferential constriction mechanism. 24. In certain embodiments, the pneumatic bladder or bladders are enclosed within a hollow three sided gantry. The bladder or bladders are within the gantry and are accordion-like mechanism such that the volume has significant capacity to expand and compress the patient's chest. The sidewalls of the gantry would be adjustable so as to minimize the open space between their ends and the patient's chest. 25. In certain embodiments, the anteroposterior compression-decompression piston and the gantry portions of the circumferential constriction mechanism are integrated within the gantry. 26. In certain embodiments, there are force sensors applied to the patient side surfaces of the anteroposterior compression-decompression piston and the circumferential constriction mechanism. Signals from these sensors are used to adjust the force of the mechanisms. 27. In certain embodiments, the attachment capability of the active decompression mechanism is achieved by means of a flexible diaphragm within a hardened hemispheric structure. Application of negative pressure above the diaphragm would engage the attachment capability for active decompression. Application of positive pressure above the diaphragm would create additional compression to the mid-anterior chest. 28. In certain embodiments, there is an additional mechanism for phasic compression 15 of the abdomen. 29. In certain embodiments, the structure holding the anteroposterior compression mechanism can be moved with respect to the patient's chest such that the location and vector of force is changed. 30. In certain embodiments, an additional component may provide electrical defibrillation at a specific and optimal time in the chest compression constriction cycle without stopping chest compression or constriction. 31. In certain embodiments, the mechanism providing anteroposterior compression applies greater force and distance to the compression of the mid-anterior chest compared to the force and distance applied to the remainder of the chest circumference by the circumferential constriction mechanism. 32. In certain embodiments, the anteroposterior compression or circumferential constriction mechanism are adjustable in shape or configuration such that the match the shape of the chest more accurately. 33. In certain embodiments, the anteroposterior compression-decompression piston and the gantry portions of the circumferential constriction mechanism are integrated within the gantry. 34. In certain embodiments, the circumferential constriction mechanism is a belt. Said belt is attached at one end to the side of the anteroposterior compression mechanism and at the other end to motors on either side of the patient and incorporated in the backboard.

(23) Usefulness of the Disclosed Invention

(24) Once it is understood and appreciated that the invention disclosed herein is for a method to improve CPR hemodynamics and the clinical outcome of patients suffering cardiac arrest, the usefulness will be manifest to anyone with ordinary skill in the art.

(25) Non-Obviousness

(26) The non-obviousness of the invention herein disclose is clear from the complete absence of its appreciation or discussion in the medical literature. Additionally, a number of large commercial enterprises produce devices for mechanical CPR; despite extensive research and development enterprises, none of these companies have disclosed or developed methods or systems such as disclosed herein.

(27) Modifications

(28) It will be understood that many changes in the details, materials, steps and arrangements of elements, which have been herein described and illustrated in order to explain the nature of the invention, may be made by those skilled in the art without departing from the scope of the present invention. Since many modifications, variations and changes in detail can be made to the described embodiments of the invention, it is intended that all matters in the foregoing description and shown in the accompanying drawings be interpreted as illustrative and not in a limiting sense. Thus, the scope of the invention should be determined by the appended claims and their legal equivalents.

(29) Now that the invention has been described,

Other Publications Incorporated in the Current Application by Reference

REFERENCE LIST

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