Source: https://patents.google.com/patent/US20150231027A1/en
Timestamp: 2019-07-20 16:03:31
Document Index: 773891334

Matched Legal Cases: ['Application No. 61', 'Application No. 62', 'Application No. 62', 'art 600', 'art 600', 'art 600', 'art 400', 'art 400', 'art 400', 'arts 1900', 'arts 2100']

US20150231027A1 - Systems and methods for gravity-assisted cardiopulmonary resuscitation - Google Patents
US20150231027A1
US20150231027A1 US14/677,562 US201514677562A US2015231027A1 US 20150231027 A1 US20150231027 A1 US 20150231027A1 US 201514677562 A US201514677562 A US 201514677562A US 2015231027 A1 US2015231027 A1 US 2015231027A1
US14/677,562
US10092481B2 (en
2014-02-19 Priority to US201414090836A priority
2015-04-02 Application filed by Keith G. Lurie filed Critical Keith G. Lurie
2015-08-20 Publication of US20150231027A1 publication Critical patent/US20150231027A1/en
2016-05-20 Priority claimed from US15/160,492 external-priority patent/US20190175444A9/en
2018-10-09 Publication of US10092481B2 publication Critical patent/US10092481B2/en
This application is a continuation of U.S. patent application Ser. No. 14/626,770, filed Feb. 19, 2015, which claims the benefit of U.S. Provisional Application No. 61/941,670, filed Feb. 19, 2015, U.S. Provisional Application No. 62/0090,836, filed Feb. 19, 2014 and U.S. Provisional Application No. 62/087,717, filed Dec. 4, 2014, the complete disclosure of which is hereby incorporated by reference for all intents and purposes.
It is contemplated that any of a number of various procedures, techniques, and devices are applicable to the systems and methods of the present disclosure, such as those described in, for example, U.S. Pat. Nos. 5,551,420; 5,692,498; 5,730,122; 6,029,667; 6,062,219; 6,155,257; 6,234,1816; 6,224,562; 6,526,973; 6,604,523; 6,986,349; 7,082,945, 7,185,649, 7,195,012, 7,195,013, 7,766,011, 7,204,251 7,836,881, and 8,108,204, 8,702, 633, and U.S. patent application Ser. Nos. 12/819,959; 13/175,670; 13/554,986; 61/509,994; 61/577,565; 61/816,064; 61/829,176; and 61/907,202, the complete disclosures of which are herein incorporated by reference for all intents and purposes.
It is contemplated that adjustment and positioning of the surfaces of the cart 600 and/or the chest compression device 624 may be manually set or via a control mechanism. For example, a controller 626 may be hardwired and/or wirelessly coupled to the cart 600 to allow a user to set via interaction with interface 628 one or more of the particular angle θ and the particular angle φ, along with the particular location or positioning of the articulating arm 622 along the axis X and the axis Y. Additionally, or alternatively, the controller 626 may be communicatively coupled to the chest compression device 624 and any of a number of other sensors or devices so as to allow a physician or technician to control and monitor the same For example, the controller 626 may be communicatively coupled to various physiological sensors, a ventilator, an intrathoracic pressure regulator, one or more drug delivery systems, and/or any other device or mechanism typically used in a medical setting, trauma or otherwise. It is contemplated that the sensors could be for basic blood pressure, intrathoracic pressure regulation, oxygen saturation, and many others, such as sensors configured to acquire the data or tracings shown in respective ones of the figures. The sensor-derived data would be used to help treat the patient and could be used to modify the elevation angle of the head and shoulders or head and torso or modify the manner in which the CPR is delivered either manually or by the automated CPR device. Many other examples are possible.
For example, a computing system 630 may be hardwired and/or wirelessly coupled to the cart 600 to allow a user to set via interaction with interface 628 one or more of the particular angle θ and the particular angle φ, along with the particular location or positioning of the articulating arm 622 along the axis X and the axis Y. Further, the computing system 630 may display other parameters, such as various patient vitals for observation by a technician or physician. In either or both scenarios, it is contemplated that information may be displayed on a screen associated with the controller 626 and/or computing system 630 to guide a rescuer, such as how to manually perform CPR, adjust the cart 400, and etc. The information displayed on the screen may be done so in view of feedback provided by various sensors coupled to the cart 400 and/or a patient lying on the cart 400. Still other examples are possible.
Studies in pigs support the benefit of the CPR wedge to elevate the head and shoulders to about 30 degrees. A wedge device 1402, based upon a hinge mechanism, is shown under a porcine subject in FIG. 14A, and was used in pigs in cardiac arrest to demonstrate the benefit of elevation of the head and shoulders. In these studies, CPR was performed with an automated ACD CPR device such as is described in, for example, U.S. Pat. Nos. 5,454,779; 5,645,522; 8,702,633, all incorporated herein by reference) and an impedance threshold device such as is described in, for example, U.S. Pat. Nos. 5,551,420; 5,692,498; 5,730,122; 6,029,667; 6,062,219; 6,155,257; 6,234,1816; 6,224,562; 6,526,973; 6,604,523; 6,986,349; and 7,204,251, all of which are hereby incorporated by reference, attached to an endotracheal tube and a manual resuscitator bag.
One example way to perform CPR is by using the combination of ACD+ITD and a circumferential band. For example, a band 1404 may generally be wrapped around a subject's chest, as shown in FIG. 14B. The band remains loose, however, when the patient is in the supine or 0 degree position relative to the floor, patient's head is flat. In the horizontal plane CPR can be delivered manually or with a compression device as long as the band remains loose such that there is no significant circumferential pressure applied to the thorax. However, when the head is elevated, then the devices and methods of the present disclosure allow for the band to tighten with each compression of the chest with the ACD CPR device: the combination of compressions with the ACD CPR device and the band tightening increases the intrathoracic pressure resulting in a higher aortic pressure. However, with the head-up the ICP does not rise as much, thus the there is a net rise in CerPP. With each active decompression, with or without the ITD, ICP falls further and the heart is refilled, especially with the ITD in place. Thus, in the head-up position the combination of ACD+ITD plus the tight circumferential band is used to optimize circulation to the heart and brain. When this device is used when the head is in the horizontal plane relative to the floor, the band should be loosened or the brain risks getting damaged with each compression.
Under aseptic surgical conditions, initial sedation was achieved with intramuscular ketamine (10 mL of 100 mg/mL) followed by inhaled isoflurane at a dose of 0.8-1.2%. Pigs were intubated with a 7.0 French endotracheal tube. The animal's temperature was maintained between 36.5 C to 37.5 C with a warming blanket (Bair Hugger, Augustine Medical, Eden Prairie, Minn.). Central aortic blood pressure was recorded continuously with an electronic-tipped catheter (Mikro-Tip Transducer, Millar Instruments, Houston, Tex.) placed in the descending thoracic aorta. A second Millar catheter was inserted in the right atrium via the right external jugular vein. An ultrasound flow probe (Transonic 420 series multichannel, Transonic Systems, Ithaca, N.Y.) was placed in the left common carotid artery to measure carotid blood flow (ml/min). After creating a burr hole, a Millar catheter was then inserted into the parietal lobe to measure intracranial pressure, ICP. In pigs used for the microsphere studies (see below), a second femoral artery cannulation was performed and a 7F pigtail catheter was positioned in the left ventricle under fluoroscopic guidance. All animals received an intravenous heparin bolus (100 units/kg). Animals were fasted overnight and received normal saline solution to maintain the mean right atrial pressure between 3-5 mmHg. The animals were ventilated with room air, using an anesthesia machine (Narkomed, Telford, Pa.), with a tidal volume of 10 mL/kg and a respiratory rate adjusted to continually maintain an end tidal CO2 (ETCO2) of 40 mmHg and O2 saturation of >92%. Arterial blood gases (Gem 3000, Instrumentation Laboratory) were obtained at baseline, and 3 minutes after each change of CPR position. Surface electrocardiographic tracings were continuously recorded. All hemodynamic data including aortic pressure, right atrial pressure, ETCO2, ICP, and carotid blood flow were continuously monitored and recorded with a digital recording system (BIOPAC MP 150, BIOPAC Systems, Inc., CA, USA). Coronary perfusion pressure (CPP) was calculated as the difference between aortic pressure and right atrial pressure during the CPR decompression phase.8 Cerebral perfusion pressure (CerPP) was calculated as the difference between mean aortic pressure and mean ICP. Ultrasound derived carotid blood flow velocity was reported in ml/min. ETCO2, tidal volume, minute ventilation, and blood oxygen saturation were continuously measured with a respiratory monitor (COSMO Plus, Novametrix Medical Systems, Wallingford, Conn.).
μ = 1.2 · 10 6 + ( ( 1.9 · 10 5 ) · ω ) μ = Required   number   of   microspheres ω = pig   weight Baseline   injection   volume = μ ( 5 · 10 8 ) 20 Baseline   injection   volume = μ ( ( 5 · 10 8 ) 20 ) · 5 3
In Table 5 ITP: Intrathoracic pressure during chest compression, PIP: Peak inspiratory pressure during positive pressure ventilation. Pressures are in mmHg. *p<0.05 compare to 0 degrees CPR.
Further experiments were also performed to support the claims presented herein. In one study, a porcine model experiment was performed with 8 pigs receiving ACD+ITD when positioned supine as shown in FIG. 18A and receiving ACD+ITD when positioned in a head-shoulders-elevated (HSE) position, as shown in FIG. 18B. FIG. 19 and FIG. 20 show charts 1900 and 2000, respectively, that demonstrate the difference between 30 degrees head-down CPR (e.g., feet-up) and 30 degrees head-up CPR. FIG. 21 and FIG. 22 show charts 2100 and 2200, respectively, of coronary perfusion pressures (mmHg) in pigs in head-up and supine positions after 8 minutes of VF.
It is contemplated that it may be easier to implement CPR in the HSE position as shown in FIG. 18B versus whole body tilt as shown in FIG. 10. Additionally, as shown in FIG. 18B, at least one support member 1802 is contemplated that which may be selectively deployed to stably hold a rest member 1804 in or at a particular inclined angle, e.g., 30 degrees with respect to a level surface 1806. It is further contemplated that the least one support member 1802 may be integrated with or to rest member 1804, similar to a “kickstand” on a bicycle. For instance, a pivotal arm or other support member may be pivoted down from a storage position and locked into place to incline the bed. It will be appreciated though that the least one support member 1802 may take many different forms, each of which may be a function of type of bed or cart a subject, patient, or individual is positioned thereto. Additionally, it is contemplated that the least one support member 1802 may be configured and/or arranged to extend or telescope to different lengths, possibly in particular increments, such as ¼inch or ½ inch, etc., so that the at least one support member 1802 be selectively deployed to stably hold a rest member 1804 in or at any particular inclined angle between about 0 degrees and about 90 degrees with respect to the level surface 1806. For example, the least one support member 1802 may be configured and/or arranged to extend or telescope to a particular length so that the rest member 1804 is positioned to an inclined angle of about 30 degrees, or about 30.5 degrees, or about 30.55 degrees, etc., with respect to level surface 1806, based upon the granularity of the above-mentioned particular increments. In practice, this may be implemented via a wrench-like mechanism that is integral to the support member 1802 and comprises incrementally-spaced teeth and a stop member that fits into a space between and engages particular surfaces of the teeth. Other examples are tough possible.
elevating one or both of the torso and head of an individual to an angle greater than zero degrees relative to horizontal;
performing CPR by repeatedly compressing the chest, whereby elevation of the one or both of the torso and head assists to lower intracranial pressure and increase cerebral perfusion pressure during the performance of CPR, and
regulating the intrathoracic pressure of the individual while performing CPR using an impedance threshold device positioned to the airway of the individual to create a negative pressure within the chest during a relaxation phase of CPR.
2. The method of claim 1, further comprising elevating the torso or the head of the individual to an angle less than or equal to about ninety degrees relative to horizontal.
3. The method of claim 1, further comprising elevating the torso or the head of the individual to an angle selected from a range between about fifteen degrees to about thirty degrees relative to horizontal.
4. The method of claim 1, further comprising elevating the torso or the head of the individual by manual adjustment of a surface that supports the torso or the head.
5. The method of claim 1, further comprising elevating the torso or the head of the individual by automated adjustment of a surface that supports the torso or the head.
6. The method of claim 1, further comprising performing at least one of: standard CPR, stutter CPR, an active compression decompression CPR; a thoracic band with phased CPR; an automated CPR using a device that performs CPR according to a pre-determined algorithm.
activating the mechanical CPR device to repeatedly compress the individual's chest.
8. A method for performing cardiopulmonary resuscitation (CPR), comprising:
elevating one or both of the torso and head of an individual to an angle greater than zero degrees relative to horizontal to lower intracranial pressure;
9. The method of claim 8, further comprising interfacing an impedance threshold device with the airway of the individual to create a negative pressure within the chest during a relaxation phase of CPR.
10. The method of claim 8, wherein the elevating step comprises placing the head or shoulders on a wedge, wherein the wedge has a surface coating that allows it to easily slip under the head and shoulders while placing it in position but prevents slippage due to gravity once the head and shoulders are in the intended position.
11. The method of claim 8, wherein the elevating step comprises placing the head or shoulders on a wedge, wherein the wedge includes at least one small cup shaped cut-out space to allow for the occipital portion of the patient's head to reach backward, helping to both secure the head-elevation position and provide for a way to more easily ventilate the patient when using a face mask.
12. The method of claim 8, further comprising varying the angle of at least one of the head and torso relative to horizontal while performing CPR.
assessing heart rhythm or another measured physiologic parameter of the patient to determine whether defibrillation is needed.
14. The method of claim 8, wherein the chest compression device comprises a band that is positioned around the thorax;
wherein the band around the thorax tightens with each compression and relaxes with each decompression.
15. The method of claim 14, further comprising varying the tension on the band depending on the position of the head.
16. The method of claim 14, wherein the band includes a mechanism to actively decompress the chest.
17. A method for performing cardiopulmonary resuscitation (CPR) that involves a chest compression phase and a relaxation phase, comprising:
elevating one or both of the torso and head of an individual to an angle greater than zero degrees as measured relative to horizontal to lower intracranial pressure;
interfacing an impedance threshold device with the airway of the individual to create a negative pressure within the chest during the relaxation phase of CPR;
repeatedly compressing the chest while interfacing the impedance threshold device with the airway and while one or both of the torso and head is elevated to increase the individual's perfusion pressure while reducing or lowering intercranial pressure.
18. The method of claim 17, wherein the chest is compressed using an automated chest compression device.
19. The method of claim 18, further comprising varying the angle of elevation based on a measured physiological parameter.
US14/677,562 2014-02-19 2015-04-02 Systems and methods for gravity-assisted cardiopulmonary resuscitation Active US10092481B2 (en)
US201414090836A true 2014-02-19 2014-02-19
US14/935,262 Continuation-In-Part US9707152B2 (en) 2014-02-19 2015-11-06 Systems and methods for head up cardiopulmonary resuscitation
US20150231027A1 true US20150231027A1 (en) 2015-08-20
US10092481B2 US10092481B2 (en) 2018-10-09
US20120260428A1 (en) * 2011-04-14 2012-10-18 Damon Franklin Cardiopulmonary resuscitation support pillow
DE19947329B4 (en) 1999-10-01 2005-04-28 D E Pfaff Ingenieurbuero Gmbh An apparatus for forming vertical stacks of printed products part
FR2949321B1 (en) 2009-08-31 2011-09-16 Hill Rom Ind Sa A support device comprising a mattress with adjustable dimensions with the aid of inflatable cells
US20190159962A9 (en) 2014-02-19 2019-05-30 Keith G. Lurie Elevation timing systems and methods for head up cpr
US20190175444A9 (en) 2014-02-19 2019-06-13 Keith G. Lurie Active compression decompression and upper body elevation system
US10245209B2 (en) 2019-04-02
Niemann et al. 1985 Mechanical “cough” cardiopulmonary resuscitation during cardiac arrest in dogs