Abstract:
The Chest-positioner/pad Cardio Pulmonary Resuscitation System (CCPRS) provides improved resuscitation during one-person or two-person CPR. The simple, compact, portable and cost-effective system provides for manual, mechanical or electrical driven external chest compressions via a socket connection to a chest-positioner/pad unit. The chest-positioner/pad unit provides greater control of compression positioning providing adequate and reproducible chest compressions while preventing rib fractures and damage to vital internal organs. A module gives providers feedback to enable a provider to apply an appropriate compressive force in an appropriate direction, recurringly under emergency conditions. The present invention also provides improved blood circulation, oxygenation and gas exchange by expanding the chest past its normal relaxation point during diastole. Providers are able to administer adequate CPR for longer periods of time with reduced or minimal effort while improving survivability of cardiac arrest victims.

Description:
This application claims the benefit of and is a divisional of prior U.S. application Ser. No. 09/173,622 filed Oct. 16, 1998 now U.S. Pat. No. 6,174,295 which is based in part on U.S. Provisional Application No. 60/062,299 filed Oct. 17, 1997. 
    
    
     The heart and lungs work together to circulate oxygenated blood. However, the heart may stop due to heart attack, drowning, suffocation and electric shock. Consequently, oxygenated blood may not flow to vital organs, particularly the brain. Brain cells begin to suffer and die within six minutes after the heart stops circulating blood. In the event of heart pumping failure, Cardio Pulmonary Resuscitation (CPR) is often administered to temporarily sustain blood circulation to the brain and other organs during efforts to re-start the heart pumping. This effort is directed toward reducing hypoxic damage to the victim. 
     Generally, CPR is administered by a series of chest compressions to simulate systole and relaxations to simulate diastole, thereby providing artificial circulatory support. Ventilation of the lungs is usually provided by mouth-to-mouth breathing or by means of an externally activated ventilator. Successful resuscitation is determined primarily by three factors: 1. the time delay in starting treatment, 2. the effectiveness of a provider&#39;s technique, and 3. prior or inherent damage to the heart and vital organs. Considering these factors, the present techniques of resuscitation have shortcomings. 
     Manual CPR as taught in training courses worldwide can be easily started without delay in most cases. When properly administered, basic CPR can provide some limited circulatory support. Unfortunately, there is considerable variability in provider skill, endurance and strength. Furthermore, a person who does not perform CPR very often may not maintain those skills. Even in trained persons there is considerable variation in application of force, timing, and dwell time of the duty cycle. The American Heart Association recommends a 50% dwell time in compression. The position of the hands on the victim&#39;s chest may vary or shift during CPR, thereby risking damage to ribs or internal organs and lessening the effectiveness of CPR. With prolonged CPR, provider fatigue may limit effectiveness and indeed, is an indication to terminate rescue efforts. 
     Various mechanical, electrical, pneumatic, and hydraulic devices have been devised to address these problems and to improve resuscitation efforts. Devices have included chest squeezers, chest thumpers, and sternal depressors in various configurations. Some systems include means for ventilatory support, abdominal counter-pulsation or binding, defibrillation, chest decompression, and electrical monitoring of cardiac electrical activity. A timer device has also been developed which can monitor manually applied CPR forces. 
     None of the devices reported to date has the capacity to provide all the beneficial functions of CPR; including adequate compressions/decompressions, ventilation, abdominal support, and data logging in a configuration which is compact, portable, mobile, simple, and cost-effective. None of these devices can effectively provide circulatory support in a variety of adverse conditions such as moving ambulances, flying airliners, sports arenas, remote or irregular terrain or woodlands, victims trapped in limited space, or victims in a soft bed. 
     SUMMARY 
     The chest-positioner/pad cardio pulmonary resuscitation system (CCPRS) provides improved resuscitation during one-person or two-person CPR. The simple, compact, portable and cost-effective system provides for manual, mechanical or electrical driven external chest compressions via a socket connection to a chest-positioner/pad unit. The chest-positioner/pad unit provides greater control of compression positioning providing adequate and reproducible chest compressions while preventing rib fractures and damage to vial internal organs. The present invention also provides improved blood circulation, oxygenation and gas exchange by expanding the chest past its normal relaxation point during diastole. Providers are able to administer adequate CPR for longer periods of time with reduced or minimal effort while improving survivability of cardiac arrest victims. 
     Certain embodiments of this invention are not limited to any particular individual features disclosed, but include combinations of features distinguished from the prior art in their structures and functions. Features of the invention have been broadly described so that the detailed descriptions that follow may be better understood, and in order that the contributions of this invention to the arts may be better appreciated. There are, of course, additional aspects of the invention described below. These may be included in the subject matter of the claims to this invention. Those skilled in the art who have the benefit of this invention, its teachings, and suggestions will appreciate that the conceptions of this disclosure may be used as a creative basis for designing other structures, methods and systems for carrying out and practicing the present invention. The claims of this invention are to be read to include any legally equivalent devices or methods which do not depart from the spirit and scope of the present invention. 
     The present invention recognizes, addresses and meets the previously-mentioned preferences or objectives in its various possible embodiments and equivalents thereof. To one of skill in this art who has the benefit of this invention&#39;s realizations, teachings, disclosures, and suggestions, other purposes and advantages will be appreciated from the following description and the accompanying drawings. The detail in the description is not intended to thwart this patent&#39;s object to claim this invention no matter how others may later disguise it by variations in form or additions of further improvements. These descriptions illustrate certain preferred embodiments and are not to be used to improperly limit the scope of the invention which may have other equally effective or legally equivalent embodiments. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a view of a Chest-positioner/pad CPR System (CCPRS) attached to a victim, showing also an endotracheal tube in place for ventilation support, and an adjustable abdominal binding strap. 
     FIG. 2 is a front view of an electrical CCPRS driven by a strap winding shaft, secured to a victim&#39;s chest. 
     FIG. 3 is a top view of the “chest-positioner/pad” chest positioner/pad. 
     FIG. 4 is a cross-sectional view of the chest-positioner/pad chest positioner/pad taken along line  4 — 4  of FIG.  3 . 
     FIG. 5 is a top view of the back strap with the stiffeners removed from the pocket. 
     FIG. 6 is a top view of an uncoiled recoil spring. 
     FIG. 7 is an exploded view of a tensioning buckle-hook. 
     FIG. 8 is a cutaway top view of the compression device shown in FIG.  2 . 
     FIG. 9 is a cutaway side view of the compression device shown in FIG.  2 . 
     FIG. 10 is a cutaway end view of the compression device shown in FIG.  2 . 
     FIG. 11 is a block diagram of the electronic control system. 
     FIG. 12 is a perspective view of a mechanical compression device with a compression augmentation lever apparatus. 
     FIG. 13 is a perspective view of another embodiment of a compression device. 
     FIG. 14 is a top, sectional view of the compression device shown in FIG.  13 . 
     FIG. 15 is an exploded view of another embodiment of the invention. 
     FIG. 16 is an exploded elevational of view of the embodiment shown in FIG.  15 . 
     FIG. 17 is an elevational view of the grip base. 
     FIG. 18 is a top view of the grip base. 
     FIG. 19 is an elevational view of the sensor cover. 
     FIG. 20 is a top view of the chestpiece socket. 
    
    
     DETAILED DESCRIPTION 
     Referring to FIGS. 1 and 2, the present invention is for use with a victim  10  in need of CPR and generally comprises a chest-positioner/pad  20  (referred to below as chest-positioner/pad unit  20 ), compression device  40 , control system  50 , an assembly  60  for securing the compression device  40  to victim  10 , dorsal strap  70 , connector  80  and recoil spring  90  for exerting an upward recoil force to lift the compression device  40  and victim&#39;s anterior chest wall  12 . A pressure sensor  52  is located in the base of the compression device  40 . 
     Referring to FIGS. 3 and 4, chest-positioner/pad unit  20  generally comprises a rim  21 , elastic sheet  22 , sternal pad  23 , and socket  27 . The primary functions of the chest-positioner/pad unit  20  are: (1) to protect the thorax  13  including the ribs  15 , costal cartilages  16 , sternum  14 , and internal organs (not shown), and (2) to provide a stable platform for the compression device  40 . Other designs for a chest-positioner/pad unit which achieve these same functional features may be incorporated into the invention. 
     The rim  21  is shaped like a rectangular ring. The outer boundary of the rim  21  may be 7″×5.75″. The inner boundary of the rim  21  may be 5.5″×4.25″. The rim  21  is preferably semi-rigid on the lateral bands  33   a,b  and flexible on the end bands  33   c,d . The rim  21  may be fabricated from various materials including plastic, rubber and aluminum. A rubber gasket  31  may be attached to underside of rim  21 . The rubber gasket  31  may be {fraction (1/16)} inch thick and provide additional padding and electrical insulation for the victim  10  as providers of medical assistance may use CCPRS concurrently with electrocardiographic monitoring (ECM) and electrical defibrillation (shocking the heart). Adhesive strips  32   a,b  are bonded to the underside of rim  21  along the two lateral bands  33   a,b  of rim  21 . The chest-positioner/pad unit  20  may be formed from a single piece of plastic, and adhesive strips  32   a,b  attach to the underside of lateral rim  21 /gasket  31  and adhesive strip  26  attaches to the underside of sternal pad  23 . X-ray lucent materials should be used where possible. Markings on rim  21  will indicate proper positioning of the chest-positioner/pad unit  20  on the anterior chest wall  12 . The sternal pad  23  is positioned on the lower half of the sternum  14 . The rim  21  of chest-positioner/pad unit  20  attaches to the anterior chest wall  12  by adhesive strips  32   a,b.    
     An elastic (rubber or plastic) sheet  22  stretches across top of rim  21 . The chest-positioner/pad unit  20  is radiolucent and disposable. Sternal pad  23  attaches to the under side of the center of chest-positioner/pad unit  20 . 
     Sternal pad  23  is composed of Neoprene rubber or biocompatible plastic, and will meet FDA standards. The top portion  24  of sternal pad  23  is flat and affixed to the elastic sheet  22 . The base  25  of sternal pad  23  is 0.5″ thick, 2.5″ wide and 3.5″ in length. Base  25  of sternal pad  23  has convex margins  25   a  and contains adhesive strip  26  which attaches to the anterior chest wall  12 . 
     The socket  27  attaches to the top of the elastic sheet  22 . Socket  27  may be fabricated from plastic, metal or hardwood material. Socket  27  is 0.5″ tall, 2.5″ wide and 3.5″ in length. Socket  27  has walls  28  which define a cavity which may be 0.25″ deep, 2″ wide and 3″ in length. Electrical, mechanical or manual compression devices  40  may snap into the socket  27 . 
     Referring to FIGS. 2 and 5 dorsal/backstrap  70  secures via connector  80  to compression device  40 . Compression device  40  is snapped into socket  27  of the chest-positioner/pad unit  20  on the chest  12  of victim  10 . The dorsal strap  70  is a fabric or plastic band which may be up to 42″ in length. Fabric is preferred because it is durable, flexible, disposable, and economical. The middle section  71  of dorsal strap  70  may be 10″ in length and 8″ wide. Dorsal strap  70  tapers from a 6″ wide middle section  71  to a 2″ wide end section. The 2″ wide strap section  72  may 10″ in length, attaching to the connector  80 . Middle section  71  of strap  70  includes a first  74  and second  75  piece defining a pocket (See FIG.  2 ). 
     Two stiff plastic pieces  76  and  77  are hinged together at their ends and inserted into the pocket. First plastic piece  76  is rectangular and may have dimensions of 6″ wide and 10″ in length. Second plastic piece  77  is rectangular and may have dimensions of 5″ wide and 12″ in length. Second plastic piece  77  is thinner and longer than first plastic piece  76 . First plastic piece  76  rests on top of second plastic piece  77  and is positioned closest to the victim&#39;s body  10 . Flap  79  folds over first and second plastic pieces  76  and  77 . Plastic pieces  76  and  77  are connected by hinge  78  at the ends and provide a simple support or stiffener whereby the recoil spring  90  may be quickly inserted into the pocket of dorsal strap  70 . Dorsal strap  70  connects to the compression device  40  via connector  80 . 
     Referring to FIG. 6, an uncoiled view of the recoil spring  90  is shown (FIGS. 1 and 2 show installed views). The recoil spring  90  is a tapered or semi-triangulated sheet of spring steel or flexible composite plastic. Base portion  92  is 6″×10″. Upper end  94  is approximately 3″ long and up to 2″ wide. Referring to FIG. 2, upper end  94  is bent to form a hook  96 . The recoil spring  90  tapers from 6″ wide at the base portion  92  to ½-2 inches wide at the upper end  94 . Other types of recoil devices may also be used. 
     As illustrated in FIG. 2, base portion  92  slips into the dorsal strap  70  pocket between the plastic pieces  76 ,  77 . The recoil spring  90  curves around the right side of the thorax  16  upward to upper end  94 . Upper end  94  hooks under bail  98  of compression device  40 . The tapered design of spring  90  allows greater rigidity at lower end  92 , flexibility at upper end  94  and stability for the whole system. 
     Recoil spring  90  lifts the compression device  40  away from the anterior chest wall  12 . Lifting the compression device  40  likewise exerts an upward force on chest-positioner/pad unit  20 . Chest-positioner/pad unit  20  is adhered to anterior chest wall  12  of victim  10  by adhesive strips  26 ,  32   a,b . The result is that an upward force is exerted on the anterior chest wall  12  of the victim  10 . The preferred force exerted on the anterior chest wall  12  is from two to ten pounds. If the compression device  40  weighs six lbs., then a recoil spring  90  which creates an up lift of approximately eight to sixteen lbs. may be used. 
     Recoil spring  90  lifts compression device  40  and anterior chest wall  12  during relaxation (diastole) phase of CPR. This “passive” decompression enhances blood return to the chest and heart and likewise enhances air/oxygen influx. The recoil spring  90  provides a passive means to expand the chest wall  12  beyond normal diastole relaxation position. Recent studies have shown that expanding the chest beyond the normal diastole relaxation position increases blood circulation, oxygenation and gas exchange. Such studies are referred to in  Active Compression - Decompression; A New Method of Cardiopulmonary Resuscitation,  Todd J. Cohen, et. al.,  JAMA,  Jun. 3, 1992-Vol. 267, No. 21, pp. 2916-2923;  Effects of Active Compression - Decompression Resuscitation on Myocardial and Cerebral Blood Flow in Pigs,  Karl H. Linder, et. al.,  Circulation,  (88), 1993, No. 3, pp. 1254-1263;  A Comparison of Active Compression - Decompression Cardiopulmonary Resuscitation with Standard Cardiopulmonary Resuscitation for Cardiac Arrests Occurring in the Hospital,  Todd J. Cohen, et. al.,  The New England Journal of Medicine,  Dec. 23, 1993-Vol. 329, pp. 1918-1921;  Abdominal Compressions During CPR: Hemodynamic Effects of Altering Timing and Force,  J. M. Christenson, et. al.,  The Journal of Emergency Medicine,  1992, Vol. 10, pp. 257-266; and  Effects of Various Degrees of Compression and Active Decompression on Haemodynamics, End - Tidal CO   2   , and Ventilation During Cardiopulmonary Resuscitation of Pigs,  Lars Wik, et. al.,  Resuscitation,  1996-Vol. 31, pp. 45-47, which are intended to be incorporated herein by reference. 
     Referring to FIGS. 2 and 7, one embodiment of a connector  80  is shown. This connector  80  is a quick-release tension-indicator buckle/hook  80   a  and includes a casing  81 , hook  82 , friction-grip crossbars  83   a,b , two spring shafts  84   a,b , two springs  85   a,b , and spring plate  86 . A slot  87  cut into the casing  81  allows an operator to see the spring plate  86  which becomes a tension indicator. Springs  85   a,b  and spring plate  86  are enclosed inside casing  81 . Springs  85   a,b  are placed around spring shafts  84   a,b . The preferred spring load is from one to two pounds. The ends of springs  85   a,b  contact interior wall of casing  81  and spring plate  86 . 
     The spring plate  86  is secured to both shafts  84   a,b . Spring plate  86  moves concurrently with the shafts  84   a,b  when tension changes. The other end of shafts  84   a,b  pass through holes in the end of casing  81  and attach to hook  82 . As tension increases, springs  85   a,b  compress against the interior of the casing  81  and the spring plate  86  moves towards the hook end of casing  81 . As tension decreases, springs  85   a,b  decompress and spring plate  86  moves toward rest position. Spring plate  86  also serves as tension indicator when viewed through slot  87 . System tension must be adequate to eliminate slack in dorsal strap  70  and to secure and stabilize compression device  40 . Connector  80  may be capable of supporting tensions up to one hundred pounds. Other connectors  80  having similar functional features may be implemented into the system. 
     Referring to FIG. 11, the block diagram indicates the control system  50  which operates on a twelve Volt source. Control system  50  preferably provides audio and visual (LED) indicators and a display panel to control and monitor chest pressure, motor  56  performance, and ventilation parameters. The control system  50  may also log the time and sequence of events during its use. Either a 110/220 AC source with AC/14V DC converter or a fourteen Volt DC source may be used to power the Electrical Compression Devices  40 . The design and construction of a control system  50  to be implemented into the invention is within the level of skill of one ordinary skill in the art. 
     Referring to FIGS. 1,  2 ,  8 ,  9  and  10 , one embodiment of a compression device  40  is shown. This compression device  40  is capable of producing “hands-off” electrically driven chest compressions and generally comprises a motor box  120 , gear box  130 , motor  56 , worm gears  141 ,  142 , strap winding shaft  150 , vertical drive shaft  143 , bearings  122   a-h , hinges  160   a,b , torsion springs  161   a,b , hinge arms  162   a,b , angular sensor  164  and winding strap  42 . 
     Compression device  40  is approximately 4″ in height, 6″ in length and 4″ wide and is divided into motor box  120  and split gear box  130   a,b  sections. Motor box  120  contains motor  56 , bearings  122   d,h  for strap winding shaft  150  and bearing  122   a  for motor shaft  58 , and pressure sensor  52  in base of motor box  120 . A stepper or servo motor may be used as motor  56 . 
     Gear box  130  contains upper  130   a  and lower  130   b  sections. Upper section  130   a  of gear box  130  contains bearings  122   d,e  for strap winding shaft  150 , strap shaft drive gear  144 , a worm gear shaft  143  with worm gear  141  and bearings  122   c,f . Lower section of gear box  130   b  contains bearings  122   a,b  for motor shaft  58 , worm gear  142  and bearings  122   c,g  for shaft  143 . 
     When motor  56  is activated and motor shaft  58  rotates, motor worm gear  142  likewise rotates. The worm gear  142  drives the lower gear  59  in lower section of gear box  130   b.    
     A portion of the vertical drive shaft  143  in upper gear box section  130   a  is threaded to form a worm gear  141 . As drive shaft  143  rotates, worm gear  141  drives winding shaft gear  144 . The winding shaft gear  144  is fixed to the horizontal winding shaft  150 . The winding shaft  150  likewise rotates when winding shaft gear  144  rotates. 
     Strap winding shaft  150  extends through motor box  120 . Strap winding shaft  150  freely rotates between bearings  122   d,e,h . A portion of the winding shaft  150  in motor box section  120  is trimmed away to form flat face  152 . Strap  42  attaches to flat face  152  via anchor screws  154  which secure to flat face  152  of strap winding shaft  150 . When strap  42  is wound, strap  42  passes though slots  112   a,b  in adjacent sides of motor box  120 . Slots  112   a,b  are wider than the thickness of strap  42  and located near the top of motor box  120 . Strap glides or rollers  118   a,b  are attached to motor box  120  to form the lower edge of slots  112   a,b . Strap glides  118   a,b  decrease friction and provide smooth movement of strap  42  through slots  112   a,b  of motor box  120 . Ends of strap  42  pass through slots  112   a,b  and secure themselves to the back side of the hinge arms  162   a,b . Hinge arms  162   a,b  are attached to hinges  160   a,b . Hinges  160   a,b  are attached to side walls of motor box  120 . Hinges  160   a,b  provide system stability, redirect and concentrate opposing forces and help define the angles of hinge arms  162   a,b  with respect to the motor box  120 . Sensor  164  and the hinges  160   a,b  can detect angular changes and report these to the control system  50 . The angular displacement of hinge arms  162   a,b  is set by control system  50  by motor  56  rotational drive. Other devices may be implemented to limit such displacement. Tension springs  161   a,b  initially set hinge arms  162   a,b  to rest/zero position. Zero position is approximately ten degrees above horizontal. Tension springs  161   a,b  hold hinge arms  162   a,b  open during rest position. Tension springs  161   a,b  also provide stability during operation when hinge arms  162   a,b  rotate downward to rest and overshoot positions. Hinge arms  162   a,b  also contain hook catch rods  163   a,b . Hooks  82  of quick-release tension buckles  80   a  attach to hook catch rods  163   a,b . Dorsal strap  70  which is placed around body of the victim  10  is attached to quick-release tension buckle  80   a . With the above configuration, the compression device  40  may be activated. 
     Quick-release tension buckles  80   a  attach to dorsal strap  70  and hook over hook catch rods  163   a,b  to secure the system to victim  10 . Dorsal strap  70  passes around victim  10  and slack in dorsal strap  70  is removed via quick-release tension buckles  80   a . The display  87  in quick-release tension buckles  80   a  allows the provider to achieve proper tension prior to starting motor  56 . 
     Motor  56  weighs approximately one pound. When motor  56  is activated, motor shaft  58  rotates a predetermined amount as determined by control system  50 . 
     Strap  42  is taken-up into the motor box as it wraps around strap winding shaft  150 . The strap  42  may be replaced by chains, wire components or other materials including plastics and various reinforced strap materials. Decreased strap  42  length causes hinge arms  162   a,b  to rotate in unison upward towards bail  98  from rest position, but not more than sixty degrees from rest position. The sixty degree limitation is set by the control system  50  and the configuration of the motor box  120  and hinge arms  162   a,b.    
     Consequently, an upward displacement of hinge arms  162   a,b  produces a small compressive force on the body/ribs  15  of victim  10 , but a relatively large (fifty to one hundred pounds) downward force on chest wall  12  of victim  10  by sternal pad  23  for the systole phase of CPR since forces are directed by hinge arms  162   a,b  and strap glides  118   a,b  to motor housing  120 . 
     The motor  56  reverses after hinge arms  162   a,b  reach their electronically/mechanically limited peak and/or the sternal pad  23  is driven to compress chest  12  a preferred distance ranging from 1.5″ to 2″ or pressure sensor  52  detects a preset pressure of up to 100 lbs. Hinge arms  162   a,b  then rotate downward away from bail  98  and overshoot past rest (zero) position. The overshoot is assisted by recoil spring  90  lifting the compression device  40  and anterior chest wall  12  (spring  90  is capable of lifting fifteen to twenty pounds). The overshoot will not be greater than negative twenty degrees past rest position. This downward overshoot of hinge arms  162   a,b  is set by control system  50  and the unwound length of strap  42 . Recoil spring  90  attached to compression device  40  via bail  98  helps take up slack in strap  42  and keep it taught. The result is that chest wall  12  is passively expanded beyond normal chest relaxation position during diastole. 
     An optional dust boot cover (not shown) may be applied around or over hinges  160   a,b  and hinge arms  162   a,b . A suitable dust boot cover is flexible (made of rubber or the like) and prevents dust or other particles and foreign bodies from interfering with hinge function. 
     Referring to the FIG. 12, mechanically driven chest compressions may be administered in one embodiment by inserting compression augmentation device (CAD)  300  into socket  27  of chest-positioner/pad unit  20 . CAD  300  may replace or provide backup to compression device  40 . CAD  300  generally comprises a box  310 , strap  320 , pump handle system  330  and plunger  331 . Box  310  is approximately three inches wide, four inches in length and four inches in height. Strap  320  is two inches wide, and passes through horizontal slots  312   a,b  (with or without rollers) in box  310 . Slots  312   a,b  are on two parallel faces of box  310  approximately one-half inch from the top of box  310 . Hinges  313   a,b  and hinge arms  314   a,b  attach to respective sides of box  310  similarly to configuration of the motor box/hinges on the compression device  40 . Cross bars  315   a,b  are attached to hooks  82  of connector  80  on dorsal strap  70  to secure CAD  300  to victim  10 . The foot plate  316  of box  310  sits in socket  27 . 
     In operation, CAD  300  is snapped into socket  27 . Connector hooks  82   a,b  are attached to crossbars  315   a,b  and cinched down to a predetermined resting tension as indicated by slot  87 . In this resting position, the strap  320  passes straight through slots  312   a,b  so that footpad  332  rests on the middle of strap  320 . Footpad  332  may be anchored to strap  320  by glue or screw(s) (not shown). The plunger arm  331  is attached via a hinge pin  333  to the middle part of lower lever arm  334 . Lower lever arm  334  is attached by hinge  335  to upper lever arm  336 . Hand grip  337  is attached to the upper end of upper lever arm  336 . Also attached to the upper end of upper lever arm  336  by hinge pin  342  are stabilizer arms  340   a,b . Hinge pin  343  attaches upper stabilizer arms  340   a,b  to lower stabilizer arms  341   a,b . Lower stabilizer arms  341   a,b  pass downward toward guide rails  350   a,b . Hinge pin  333  is attached, at midpoint of the lower stabilizer arms  341   a,b  and at the lower end is pin  344  which slides in slots  351   a,b . The guide rails  350   a,b , are firmly affixed to the upper rim of box  310 . The lower end of lever arm  334  is attached to guide rails  350   a,b  by hinge pin  345 . 
     At the rest (diastole) position the pump handle system  330  is fully extended upward a distance predetermined by the position of pin  344  in slots  351   a,b . During the power stroke (systole) the handgrip  337  is pushed downward toward the victim&#39;s sternum  14  until it is stopped by the pin  344  being moved to the opposite ends of slots  351   a,b . Plunger  331  is forced downward into the box  310  cavity, thereby drawing strap  320  into the box  310  through slots  312   a,b . This motion raises hinge arms  314   a,b  thereby lifting connectors  80 . This tightens dorsal strap  70  and forces the foot plate  316  downward toward the sternum  14 , increasing the downward force of sternal pad  23 . The mechanical advantage of handgrip  337  motion to plunger  331  motion is approximately three to one. This serves to amplify the operator&#39;s applied force, so that a sternal force of approximately sixty pounds requires only about twenty pounds of force on the handgrip  337 . 
     An alternate manual backup system for CCPRS is realized by snapping a simple palm pad (not shown) into socket  27 . Palm pad may be of various materials including wood, plastic, ceramic, etc. Palm pad may be round or dome-shaped to comfortably fit the contour(s) of the hand. 
     Referring to FIGS. 13 and 14, an alternative compression device  40   a  generally includes a motor  56   a , gear system  148  and rocker arms  168   a  and  b.  In operation, motor  56   a  drives gear system  148  which drives rocker arms  168   a,b . In many other ways, compression device  40   a  is similar to compression device  40 . 
     Chest-positioner/pad unit  20  provides proper positioning over sternum  14  and distributes forces over anterior chest wall  12  to protect ribs  15  and costal cartilage  16  from fracture during CPR. 
     Referring to FIG. 1, an adjustable abdomen compression/binder device  500  may be applied to victim  10  after CPR has been initiated and after endo-tracheal intubation has been performed. Abdomen compression  500  is an extended Disposa-Cuff 2505 made by CRITIKON. Other abdominal binder or compression devices may also be utilized. The effect of applying abdominal compression device  500  is an increase in abdominal pressure forcing blood from abdomen into chest during diastole. Increased blood return to the chest increases cardiac output and improves CPR. Abdomen compression device  500  comprises a wrap containing a blood pressure cuff (cuff/wrap  502 ), pressure gauge  510 , bulb pump  520  and Velcro type attachments (not shown). Velcro attachments are on ends of cuff/wrap  502 . Cuff/wrap  502  is of sufficient length to wrap around victim  10  of various sizes. The length of cuff/wrap  502  may be adjusted to accommodate a waist of up to fifty inches girth. Cuff/wrap  502  is wrapped around victim  10  snugly and secured with Velcro attachments. Bulb pump  520  is repetitively squeezed until a desired pressure is attained. Pressures of approximately 50-100 Torr may be provided. 
     Referring to FIGS. 1 and 11, an optional respirator system (not shown) such as those known to one of ordinary skill in the art of rescue and resuscitation may be used with the CCPRS. A bag-valve-respirator (not shown) or other available respirator may be employed to provide breathing in concert with chest compressions. 
     The above disclosed invention enables providers to administer effective CPR with less effort. Besides overcoming weaknesses in the prior art, other novel and unique capabilities are realized with the CCPRS. 
     First the CCPRS may be used in hospitals, homes or mobile units where space is often limited. Providers are able to administer CPR with the CCPRS in an airplane, ambulance or other mobile unit. Typically space is very limited in mobile units considering space occupied by providers, seats and equipment. Many of the prior devices lack mobility. They further lack adaptability for positioning the patient in limited space. With the small size and adaptability of the CCPRS, victims may be positioned supine, upright or at various angles to accommodate mobility and space limitations. A stable platform or firm back board is not required for the electrical compression device  40 . 
     Second, a significant benefit of positioning the victim at varionus angles is that the head of the victim is not required to be at the same horizontal level as the heart. The head may now be elevated above the heart, thereby enhancing blood return from the head. Since CPR elevates intra cranial pressure, as reported in the publications identified above which are intended to be incorporated herein by reference, elevation of the head may help reduce this undesired effect. 
     Third, the CCPRS could also be used to transport donor organs. Typically donor organs are removed from the donor body after death and placed in a cooler, then transported. With the CCPRS, the whole body could be transported while the organs continue to be perfused as occurs in vivo. When the body reaches its destination, the CCPRS is disengaged and organ(s) are removed from the body for transplantation. This allows for preservation of organs in a more natural state until just prior to transplant. 
     Fourth, the CCPRS may provide short-term left ventricular assistance during electro mechanical dissociation. The EKG can be employed to trigger chest compressions. Thus, the CCPRS may be employed to augment contractions of a failing heart. 
     Fifth, the gentle application of CPR via CCPRS may allow thrombolytic drugs to be given during CPR. 
     Certain changes can be made to the invention to address issues such as proper chest positioning; applying proper force at the proper time in a proper downward direction; and in maintaining such proper forces at the proper time in the proper direction. Referring to FIGS. 15 and 16 another embodiment of the invention is shown. This embodiment generally includes a grip  600 , an electronic display module  640  and a position assurance device  680 . 
     The grip  600  is made to fit the palm of the hand and includes a palm grip or grip cover  602 , a gasket  604  and a grip base  606 . The grip  600  also includes snaps  608  and  609 , battery pack  610  and a hinge  612 . The palm grip  602  is a rounded disk for fitting the palm of the hand and may be made of pour molded polyurethane. The grip base  606  may be made of A.B.S. and cut from a lathe. Generally, it may have a top diameter of 3½ inches, a bottom diameter of 2 inches and a height of 2⅛ inches. The sidewall  607  may be angled at 27 degrees from the vertical (see FIGS.  17  and  18 ). The grip base  606  includes a battery compartment  605 . 
     The electronic display module  640  allows one to determine and measure the force applied during a chest compression, to display the force so that one can determine whether they are applying a proper barehand force, feed back on whether the force is being applied at the proper rate and a way to measure and display whether the force is applied in the proper direction, all under emergency conditions. The circuit design for same is within the range of one of ordinary skill in the art. 
     The display module  640  generally includes a display face  642 , an array of sensors  670 , a foot piece  682 , and a sensor cover  684 . 
     Electronic display module  640 : 
     (a) functions as a metronome to report the pace selected by a user (such as, for example, 60, 80, or 100 communications per minute). The report may be by light  646  and/or sound. 
     (b) displays stroke or compression force with running light display  650 . This gives the user feedback as to whether they are applying an appropriate barehand force. 
     (C) counts strokes up to, for example, 15 strokes and reports at counter display  654 , then gives a report, for example, by a double beep to remind single rescuer to give two breaths; (it may reset to zero if for example there is no stroke for three seconds). One may turn the counter off for two rescuers. 
     (d) monitors force and angle of applied force, and alarms if force from grip is applied with a “TILT” condition and reports direction of tilting with LED array  658  (four directional display shown). 
     (e) has data output  662  to allow interface with PC computer or laptop. This is useful when it is desired to be in a teaching mode. 
     (F) may be set to turn itself off if no strokes are detected, for example, in five minutes. 
     The array of sensors  670  includes a pressure sensor  672  to determine/measure the pressure to be transduced to a force signal. The pressure sensor  672  is preferably a Motorola MX200 and can be set to start reading or displaying at various levels, such as for example, twenty pounds at running light display  650 . The array  670  also includes multiple micro switches  674  (in this case four are shown). The amount and direction of force applied is used to determine the triggering of each micro switch  674 . In this case, the four micro switches  674  transduce a signal to the four LED&#39;s  658  mounted on the display face  642  to indicate whether and in which direction the tilt limits have been violated. The array of sensors  670  may be buffered by bumpers  678 . The bumpers  678  may be made of cylindrical neoprene rubber to provide support and stability to the array  670 . The display face may be made of A.B.S. or other suitable materials. The array of sensors  670  may be adhered to the underside of the electronic display module  640 . 
     The foot piece  682  has a foot plate  690  which contacts pressure sensor  672  and four, for example, Neoprene bumpers  678 . Each of the four top edges  691  of the foot plate  690  should not contact one of the four micro switches  674  unless excessive downward force is applied to the grip  600  or device such as in a “tilt” condition. This configuration enables each micro switch  674  to determine a “tilt” condition in its corresponding direction. Whether or not a “tilt” condition exists is a variable dependent on the applied force vector which includes the quantum of force and the angle of force. One of ordinary skill can determine the appropriate conditions. 
     The sensor cover  684  has a base  694  and four sidewalls  696 . Four holes (e.g. {fraction (9/16)}″ diameter) are made through the base  694  proximate each of the corners  697 . The legs  692  in the foot piece  682  correspond with and when assembled protrude through the holes in the sensor cover  684  leaving a {fraction (1/32)} inch gap between each hole and each leg  692  allowing a pressure relief while maintaining alignment of the foot piece  682 . The legs  692  then rest on the base  685  of the chestpiece socket  686 . This allows the foot piece  682  to wobble during CPR operations so that edges  691  move for potential interaction with microswitches  674  for determining whether the force is applied in a correct direction or whether a “tilt” condition exists. The foot piece  682  and sensor cover  684  may be made of A.B.S. or metal or some other suitable material. 
     The position assurance device  680  generally includes a chestpiece socket  686  and a chestplate  688 . 
     The chestplate  688  may be made of PVC, polyethylene or a similar semirigid but flexible plastic and may be 5 inches by 6 inches by ⅛ inch thick. The chestplate  688  may be releasably adhered to the chest of the patient, protects the thorax including the ribs of the patient, does not interfere with defibrillator pads, and is transparent to x-rays. 
     The chestpiece socket  686  may be made of a rigid plastic such as PVC or A.B.S. and attaches to the chestplate  688 . Socket  686  (FIG. 20) has a base  685  and four sidewalls  687  defining inner dimensions of 3{fraction (1/16)}″ by 2{fraction (1/16)}″ by ⅜″ deep to receive sensor cover  684  with a loose fit. Sensor cover  684  fits within socket  686  and legs  692  rest on the base  685  of the socket  686 . 
     In conclusion, therefore, it is seen that the present invention and the embodiments disclosed herein and those covered by the claims are well adapted to carry out the objectives and obtain the ends set forth. Certain additional changes can be made in the subject matter without departing from the spirit and the scope of this invention. It is realized that changes are possible within the scope of this invention and it is further intended that each element or step recited in any claims is to be understood as referring to all equivalent elements or steps. The claims are intended to cover the invention as broadly as legally possible in whatever form it may be utilized.