U.S. patent number 3,610,233 [Application Number 04/105,786] was granted by the patent office on 1971-10-05 for massage apparatus.
This patent grant is currently assigned to Michigan Instruments Incorporated. Invention is credited to Clare E. Barkalow.
United States Patent |
3,610,233 |
Barkalow |
October 5, 1971 |
**Please see images for:
( Certificate of Correction ) ** |
MASSAGE APPARATUS
Abstract
Apparatus for use exteriorly of the human body for massaging and
reactivating a heart by rhythmic depression of the breastbone,
comprising: rigid support means including a base member having a
platform for placing beneath the back of patient's body; a
vertically reciprocable, breastbone-engaging, pressure application
means spaced from said platform and oriented toward said platform
to reciprocate toward and away from it; said base member including
portions adjacent one end of said platform; upright means securely
mounted to said portions of said base, and extending over said
platform at a spacing therefrom to enable a patient to be
positioned therebetween, said upright means mounting said pressure
application means on said base and over said platform;
pressure-supplying means operably connected to said pressure
application means to move it repeatedly toward said platform for
depressing the breastbone and heart of a patient on said platform
and then release to allow the rib cage of the patient to
elastically expand again for expansion and filling of the heart to
provide a massaging action on the heart; control means operably
connected with said pressure application means for causing rhythmic
cyclic movement of the pressure application means alternately
toward and away from the heart at approximately the normal rate of
heartbeat; and an augmentation control device for cyclically
supplying output signals in response to heartbeat detection signals
comprising a first electrical circuit adapted to transmit
electrical power, a first switch means and a second switch means in
said first electrical circuit, a second electrical circuit having a
first relay means adapted to actuate said first switch means and a
second relay means adapted to actuate said second switch means, a
signal-receiving means adapted to receive electrical signals
corresponding to said heartbeat detection signals and having a
first signal input means and a first output means, a signal delay
means, having a second input means and a second output means, said
first output means connected to said second input means and to said
first relay means whereby said first relay means is activated by an
output of said signal-receiving means to thereby activate said
first switch means, said second output means being connected to
said second relay means whereby said second relay means is
activated by an output of said signal delay means to thereby
actuate said second switch means, and a feedback means connecting
said second output means to said signal-receiving means,
wherethrough an output of said signal delay means is fed back to
said signal-receiving means to terminate the output of said
signal-receiving means, at a period of time after the initiation
thereof substantially equivalent to the physiological delay in the
systolic cardiac contraction.
Inventors: |
Barkalow; Clare E. (Comstock
Park, MI) |
Assignee: |
Michigan Instruments
Incorporated (Comstock Park, MI)
|
Family
ID: |
22307766 |
Appl.
No.: |
04/105,786 |
Filed: |
April 26, 1961 |
Current U.S.
Class: |
601/106; 601/107;
601/41 |
Current CPC
Class: |
A61H
31/008 (20130101); A61H 31/006 (20130101); A61H
2201/1246 (20130101) |
Current International
Class: |
A61H
31/00 (20060101); A61h 007/00 () |
Field of
Search: |
;128/38,39,51,52,44,27,28,60,54,55 ;317/135 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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|
|
|
|
|
673,551 |
|
Mar 1939 |
|
DT |
|
673,551 |
|
Mar 1939 |
|
DT |
|
Primary Examiner: Trapp; L. W.
Claims
I claim:
1. Apparatus for use exteriorly of the human body for massaging and
reactivating a heart by rhythmic depression of the breastbone,
comprising:
rigid support means including a base member having a platform for
placing beneath the back of patient's body;
a vertically reciprocable, breastbone-engaging, pressure
application means spaced from said platform and oriented toward
said platform to reciprocate toward and away from it;
said base member including portions adjacent one end of said
platform;
upright means securely mounted to said portions of said base, and
extending over said platform at a spacing therefrom to enable a
patient to be positioned therebetween, said upright means mounting
said pressure application means on said base and over said
platform;
pressure-supplying means operably connected to said pressure
application means to move it repeatedly toward said platform for
depressing the breastbone and heart of a patient on said platform
and then release to allow the rib cage of the patient to
elastically expand again for expansion and filling of the heart to
provide a massaging action on the heart;
control means operably connected with said pressure application
means for causing rhythmic cyclic movement of the pressure
application means alternately toward and away from the heart at
approximately the normal rate of heartbeat; and
an augmentation control device for cyclically supplying output
signals in response to heartbeat detection signals comprising a
first electrical circuit adapted to transmit electrical power, a
first switch means and a second switch means in said first
electrical circuit, a second electrical circuit having a first
relay means adapted to actuate said first switch means and a second
relay means adapted to actuate said second switch means, a
signal-receiving means adapted to receive electrical signals
corresponding to said heartbeat detection signals and having a
first signal input means and a first output means, a signal delay
means, having a second input means and a second output means, said
first output means connected to said second input means and to said
first relay means whereby said first relay means is activated by an
output of said signal-receiving means to thereby activate said
first switch means, said second output means being connected to
said second relay means whereby said second relay means is
activated by an output of said signal delay means to thereby
actuate said second switch means, and a feedback means connecting
said second output means to said signal-receiving means,
wherethrough an output of said signal delay means is fed back to
said signal-receiving means to terminate the output of said
signal-receiving means, at a period of time after the initiation
thereof substantially equivalent to the physiological delay in the
systolic cardiac contraction.
2. Apparatus for use exteriorly of the human body for massaging and
reactivating a heart by rhythmic depression of the breastbone,
comprising:
rigid support means including a base member having a platform for
placing beneath the back of a patient's body;
a vertically reciprocable, breastbone-engaging, pressure
application means spaced from said platform and oriented toward
said platform to reciprocate toward and away from it, said pressure
application means comprising a telescoping cylinder and
fluid-responsive means, said cylinder comprising an outer member
closed at one end and a fluid-responsive member which is closed at
the end nearest said body and disposed oppositely to said one end,
comprising in addition a fluid inlet means to the interior of said
telescoping cylinder means through which a fluid is admitted and
removed to provide for actuation of said fluid-responsive member, a
source of pressurized fluid, and conduit means connecting said
source to said inlet means, said conduit means having valve means
therein adapted to permit flow of fluid from said source to said
telescoping cylinder means and to vent fluid from said telescoping
cylinder means;
said base member including portions adjacent one end of said
platform;
upright means securely mounted to said portions of said base, and
extending over aid platform at a spacing therefrom to enable a
patient to be positioned therebetween, said upright means mounting
said pressure application means on said base and over said
platform;
pressure-supplying means operably connected to said pressure
application means to move it repeatedly toward said platform for
depressing the breastbone and heart of a patient on said platform
and then release to allow the rib cage of the patient to
elastically expand again for expansion and filling of the heart to
provide a massaging action on the heart;
control means operably connected with said pressure application
means for causing rhythmic cyclic movement of the pressure
application means alternately toward and away from the heart at
approximately the normal rate of heartbeat; and
an augmentation control device comprising a first electrical
circuit adapted to transmit electrical power from a power source to
said valve means, a first switch means and a second switch means in
said first electrical circuit, a second electrical circuit having a
first relay means adapted to actuate said first switch means and a
second relay means adapted to actuate said second switch means, a
signal receiving means adapted to receive electrical signals, and
having a first signal input means and a first output means, a
signal delay means, having a second input means and a second output
means, said first output means connected to said second input means
and to said first relay means whereby said first relay means is
activated by an output of said signal-receiving means to thereby
activate said first switch means, said second output means being
connected to said second relay means whereby said second relay
means is activated by an output of said signal delay means to
thereby actuate said second switch means, and a feedback means
connecting said second output means to said signal-receiving means,
wherethrough an output of said signal delay means is fed back to
said signal-receiving means to terminate the output of said signal
receiving means.
3. Apparatus for use exteriorly of the human body for massaging and
reactivating a heart by rhythmic depression of the breastbone,
comprising:
rigid support means including a base member having a platform for
placing beneath the back of a patient's body;
a vertically reciprocable, breastbone-engaging, pressure
application means spaced from said platform and oriented toward
said platform to reciprocate toward and away from it;
said base member including portions adjacent one end of said
platform;
upright means securely mounted to said portions of said base, and
extending over said platform at a spacing therefrom to enable a
patient to be positioned therebetween, said upright means mounting
said pressure application means on said base and over said
platform;
pressure-supplying means operably connected to said pressure
application means to move it repeatedly toward said platform for
depressing the breastbone and heart of a patient on said platform
and then release to allow the rib cage of the patient to
elastically expand again for expansion and filling of the heart to
provide a massaging action on the heart;
control means operably connected with said pressure application
means for causing rhythmic cyclic movement of the pressure
application means alternately toward and away from the heart at
approximately the normal rate of heartbeat; and
means for detecting a heartbeat and providing a detecting signal,
and means for adjusting said control means responsive to said
detective signal to synchronize the rhythmic, cyclic movement of
the pressure application means with said detected heartbeat.
Description
This invention relates to a cardiac massage apparatus. More
particularly this invention relates to an apparatus for
closed-chest cardiac massage and to a method for performing such
massage.
In the medical history of animals, including the human species,
events often occur which result in cardiac arrest. To prevent
irreversible damage, the blood circulation of the subject must be
promptly restored. One method of aiding the restoration of
circulation is to open the chest and massage the exposed heart.
Another is the closed-chest method of heart massage as described by
Kouwenhoven et al. in a publication appearing in J.A.M.A., Vol.
173, No. 10, page 1,064, July 9, 1960. The external massage method
described consists of compressing the heart between the sternum and
the spine of the subject by a manual application of force. The
amount of force required may be up to about 100 lbs. or more
depending on the size, age and bone structure of the thorax region.
The massage may sometimes be required for a comparatively long
period of time as when the subject is being transported to a
surgical place of treatment for additional medical care. Such
manual massage may be difficult for a person to apply over a
comparatively extended period of time especially when it is
considered that artificial respiration should accompany the heart
massage treatment. Hence it would be helpful to have available an
apparatus which could be manipulated to provide external cardiac
massage.
It is, therefore, an object of this invention to provide a cardiac
massage apparatus to be used not only in cardiac arrest cases, but
also to augment a weak heartbeat. It is also an object to provide
an apparatus which may be operated with the aid of pressurized
fluid, such as oxygen which is readily available in ambulances and
other medical aid facilities. Another object is to provide a method
for external heart massage employing a mechanical apparatus. Still
other objects will become apparent from the discussion which
follows.
The above and other objects of this invention are accomplished by
an apparatus comprising a base member, a cylinder disposed opposite
said base member and having its axis substantially perpendicular to
the base member, a supporting member connecting the cylinder to the
base member, and a piston slidably mounted for reciprocal motion
within the cylinder.
The apparatus and method of this invention will be more fully
described with the aid of the accompanying drawings in which:
FIG. 1 is a perspective view of the apparatus with the position of
the subject in relation thereto shown by means of a dotted outline
of the subject's form.
FIG. 2 is a side view of the apparatus as viewed from a point on an
extension of a line joining the feet to the head of the subject
shown in FIG. 1, with the piston partially retracted within the
cylinder.
FIG. 3 is a view of the apparatus of FIG. 2 rotated 90.degree. with
the piston fully retracted within the cylinder.
FIG. 4 is a cross-sectional view taken along line 4--4 of FIG.
3.
FIG. 5 is a view similar to that of FIG. 4 but with the piston in
extended position.
FIG. 6 is a view of an alternate embodiment of this invention.
FIG. 7 shows a schematic diagram of an automatic cycling unit.
FIG. 8 shows a schematic diagram of an augmentation control unit
that is employed with the heart resuscitator.
FIG. 1 provides a perspective view of the cardiac resuscitator 11
with the base of the piston 16 resting on the rib cage of subject
111.
In FIG. 2 is shown a side view of the cardiac resuscitator 11, the
components of which are made of metal or other structural material
except as otherwise indicated in this writing. The conduits are
made of metal, rubber, plastic, or reinforced rubber or plastic and
other materials well known in the art. The cardiac resuscitator has
a base member 12 and a cylinder means 13 having its axis
substantially normal to the plane of the base member surface on
which the subject 111 is positioned. The end of the cylinder
farthest removed from the base member is closed by a cylinder cap
14, which is mounted or fastened onto the cylinder 13 by means of
bolts 35. Supporting member 15 fixedly connects the cylinder 13
with the base member 12 and rigidly mounts the cylinder above the
base member. Piston 16 is slidably mounted in cylinder 13, one end
of the piston being external of the cylinder. End plate 17 closed
the terminal of the piston at the one end which extends beyond the
confines of the cylinder during reciprocal motion. A resilient
member 18, made of a flexible material such as rubber, is mounted
on the lower surface of the end plate 17. It serves to cushion the
force with which the piston 16 depresses the rib cage during
cardiac massage operation. A fluid inlet port 19 in cap 14 connects
the interior of the cylinder 13 with a source of actuating fluid
such as a cylinder of oxygen or nitrogen, or hydraulic fluid under
pressure. A pressure release safety valve 20 is connected to cap 14
and communicates with the chamber inside cylinder 13. The pressure
relief valve functions to prevent too great a pressure being
exerted on the rib cage of the subject by the piston 16. The
pressure release valve can be set to function at any predetermined
pressure. For human beings, the force employed to depress a rib
cage during a heart resuscitation operation falls within the range
of from about 20 to above 100 pounds. Conduit 50 leading from a
pressure fluid source is connected to conduit 46 through a solenoid
valve 44 having outlet port 45. The solenoid valve can be
electrically time controlled by means of an automatic cycling
control 53 through an electrical connecting cable 54 which leads to
the coil 69 in the solenoid valve. Alternatively, the solenoid
valve can be controlled by an augmentation control 55 through
electrical cable 75 and 54.
When an augmentation control unit is employed, an electrical signal
representing a faint heartbeat is detected by electrocardiogram
(EKG) electrodes. This signal is fed through terminals 56 to the
augmentation control which in turn operates the solenoid valve 44
thereby timing the reciprocal motion of the piston 16 so that the
external massage by the cardiac resuscitator coincides with the
detected faint heartbeat. In this way the cardiac resuscitator aids
the heart function. The augmentation control is connected to a
source of power through terminal 58.
The autocycle control unit 53 is connected to a source of line
power through terminals 59 which may be a 110-volt, 60-cycle
source, or, alternatively, it may be connected through terminals 60
to a direct current source through a vibrator inverter (not shown).
A 12-volt direct current source may be used as a power supply, for
example.
The construction of the cylinder and piston are shown in FIGS. 4, 5
and 6. The cylinder 13 is shown mounted on support members 15 above
the base member 12. The upper end of the cylinder, that is, the end
farthest removed from the base member 12, is closed by a cylinder
cap 14 having a cavity 61 which communicates with the chamber 62
within the cylinder 13. A port 19 communicates between conduit 46
and cavity 61. The cylinder cap 14 is mounted either on cap 14 as
shown in FIG. 6, and communicates with cavity 61, or it is mounted
on conduit line 46 or some other convenient location so long as it
communicates with chamber 62 on the inside of the cylinder. Mounted
within the first end portion of the cylinder, that is the end
portion of the cylinder nearest base member 12, is an annular guide
sleeve 23. Sleeve 23 has an outwardly or radially extending flange
26 at its first end nearest the base member 12. A plurality of
bolts 40 are used to secure the sleeve to flange 27, which extends
radially outward from the cylinder 13 at its first or lower end.
The sleeve or sleeve bushing 23 may be made of metal, or, metal
lined with nylon or Teflon, or other suitable material not
shown.
A piston 16 of tubular construction having an outer surface 24 and
an inner surface 25 is slidably mounted for reciprocal motion
within cylinder 13 and sleeve bushing 23. The piston 16 has a
radially outward extending flange 21 at its first end which is
farthest removed from base member 12. The second end, which is the
end nearest base member 12, is closed off by end plate 17. End
plate 17 is mounted on the second end of the piston 16 by means of
the upstanding cylindrical member 29 which is threadedly engaged
with the inner surface of piston 16 at the second end. The
cylindrical member 29 is fixed onto the end plate 17. It is seen
from FIGS. 4 and 5 that the piston 16 is slidingly mounted for
reciprocal motion within the cylinder 13, the length of the stroke
being limited by the flange 21 and the end plate 17 coming in
contact with the sleeve bushing 23 at the extreme limits of travel
of the piston. The bushing 23 serves as a sealing member which
cooperates with the outer surface 24 of the piston 16 to inhibit
leadage of the pressurized fluid which actuates the piston to its
extended position. When the sleeve bushing 23 has a lining on the
inner surface of Teflon or other suitable material, the lining
serves to protect the piston surface from galling, and also serves
as a seal around the outer surface of the piston 16.
A stud member 30 having a head 31, is fixedly mounted on the lower
or first surface 32 of the end plate 17. The stud member can be
mounted on the end plate by means of welding. Alternatively, the
neck 67 of the stud member is passed through opening 64 in the end
plate 17, and nut 65 threadedly engaged with the end 66 of the stud
member opposite the head 30.
The resilient member 18 has a cavity 33 in its base 34. The cavity
has an internal diameter or cross section which is smaller that
that of the head 31 of stud member 30. The depth of cavity 33 is
great enough to accommodate stud member 30 when the base 34 of the
resilient member 18 lies in contact with the surface 32 of the end
plate 17.
Fluid under pressure admitted through port 19 to the chamber 62
causes the piston 16 to move downward toward the base member 12,
contacting the rib cage of the subject positioned between the
piston 16 and the base member 12. The permissible travel distance
of the piston 16 is a distance sufficient to cause a compression of
the rib cage of the subject. The amount of compression or the
distance that the piston travels after contacting the rib cage is a
function of the pressure of the activating fluid within the
cylinder chamber 62 and of the reacting pressure of the rib cage of
the subject. Activating fluid is applied having a pressure of a
magnitude capable of compressing the rib cage sufficiently to cause
pressure to be exerted on the heart, and thereby causing blood to
be expelled therefrom. A release of the pressure on the activating
fluid, as by permitting the fluid to escape through port 45 in a
solenoid valve 44 as shown in FIG. 2, or by venting the fluid to
the atmosphere by means of a manually controlled valve, not shown,
allows the spring action of the rib cage to cause the piston 16 to
be retracted with in the cylinder 13. This releases the pressure on
the heart, allowing it to fill with blood. Repeated cyclic
application of the pressure by means of the activating fluid to the
piston 16, followed by a release of that pressure, results in a
compression and decompression of the heart and serves as a massage
to provide blood circulation or to enhance the circulation in an
arrested heart, without the necessity of opening the chest.
FIG. 6 shows another embodiment of the cardiac resuscitator of this
invention. The structure of the cylinder and piston assembly 13 and
16 is the same as that shown in FIGS. 1-5. The solenoid valve 44 is
equipped with a manual override control 68 so that the apparatus
may be satisfactorily used without electrical power as may be
required for certain emergencies away from a source of power, or in
the event of electrical power failure. The solenoid valve terminals
lead either to an automatic cycling control or to an augmentation
control as hereinabove described. In FIG. 6, the cylinder assembly
is fixedly connected to arm member 70 which, in turn, is slidably
mounted on upright member 71. The upright member 71 is fixedly
mounted on the base member 12. In FIG. 6, the upright member is of
tubular or hollow member construction. Its upper end is closed by
cap member 76. The lower end of the tubular member is closed by a
portion of the base member 12. An inlet port 74 at the base of the
hollow member 71 communicates with the chamber within member 71 and
pressurized fluid inlet conduit 77, and also with solenoid valve
44. The arm 70 may be located at any predetermined height on
upright member 71, above base member 12, and held in position by
means of clamping means 72 which can be of a split-cylinder type,
with a screw clamp, similar to the construction commonly used for
drill presses. The height to which the arm 70 and, therefore, the
cylinder 13 is clamped above the base member 12, is a function of
the chest thickness of the subject that is to receive artificial
cardiac massage. This embodiment of the invention permits the
positioning of the cylinder and piston at a height above the chest
cage of the subject such that when the piston is fully extended the
chest cage of the subject will be compressed to just the required
amount for heart massage, regardless of the pressure exerted by the
pressure fluid within the cylinder chamber. This provides a safety
feature which is in addition to the pressure release valve
connected to the cylinder. Also, this embodiment of the invention
reduces the total volume of gas needed to effectively apply cyclic
massage pressure.
The chamber in member 71 serves as a buffer tank for the pressure
fluid which activates the reciprocating piston 16. When the
solenoid valve 44 admits pressurized fluid to the cylinder 13,
causing the piston 16 to extend outwardly from the cylinder and
exert pressure on the rib cage of the subject, the pressurized
fluid is supplied from the buffer tank 71 which is fed by a
pressurized fluid source such as a cylinder 128 (FIG. 6) of
compressed gas. This serves to minimize pressure fluctuations
associated with fluid flow restraints in the regulator valve, and
in the line leading to the apparatus.
An alternate embodiment of this invention is a modification of the
cylinder-piston assembly wherein the piston is powered by
pressurized fluid during both the upward and downward strokes. This
is accomplished by incorporating a reciprocating piston in the
cylinder 13. A pressurized fluid inlet port is provided at the base
of the cylinder in addition to the one present at the top of
cylinder. The piston is then moved either up or down by the
application of pressure by means of the pressurized fluid on either
the lower or the upper face of the piston respectively. The piston
in this embodiment has an arm member which extends through a
close-fitting opening in an end plate covering the base of the
cylinder, that is, the end of the cylinder nearest the base member
12. An end member equivalent to the end plate 17 is attached to the
extended end of the piston arm member. The end member has a
resilient member 18 mounted on its lower surface as illustrated in
the drawings. The advantage inherent in this embodiment is that the
upward stroke of the piston is not dependent on the elastic or
resilient force of the rib cage of the subject undergoing
artificial cardiac massage.
Still another embodiment of this invention is the substitution of
an electric motor activating a cam or linkages in place of the
cylinder-piston assembly. Another embodiment of this invention is
the substitution of an electrically excited coil, moving in a
magnetic field, for the cylinder-piston assembly. Either of the
above embodiments could be used as prime motivation for the
external cardiac massage technique.
In FIG. 7 is illustrated a schematic of the automatic cycling
control unit shown in FIG. 2. A pair of terminal leads 80 lead to a
source of power such as 110-volt, 60-cycle AC line source, or to a
vibrator inverter (not shown) for DC use with a 12-volt DC battery,
for example. A second pair of terminals 81 lead to a solenoid valve
44 in the pressurized fluid line which leads to the cylinder
chamber. A power switch 82 controls the admission of power from an
outside source to the automatic cycling control unit. The automatic
cycling unit can be bypassed by closing the manual switch 83 and
thus sending the current from the power source directly to the
solenoid valve. However, if the manual switch is not depressed, and
the automatic cycling switch 84 is closed, the automatic cycling
unit is put into operation. Current flows through the motor 85
which rotates a shaft 86, shown here by means of dotted lines, at
the end of which is located a cam 87. As the cam 87 rotates, the
raised portion 88 comes in contact with switching member 89,
causing it to contact a point 90 and thereby closing the circuit to
the solenoid valve. When the cam wheel has been rotated so that the
raised portion no longer contacts the switching member 89, the
switch 91 is opened and no current flows to the solenoid valve.
Thus, a rotation of cam 87 produces a cyclic opening and closing of
the solenoid valve 44.
FIG. 8 shows a diagram of the components of the augmentation
control unit. A pair of terminals 92 lead to an outside power
source, while terminals 93 lead to the solenoid valve. Terminals 94
lead from electrocardiogram electrodes to an electrical circuit
connected to a power supply (not shown). The pulse from the EKG
electrodes is fed to a preamplifier 95, the output from which is
fed to a squaring and pulse generator 96. The output from the
squaring and pulse generator is fed to a pulse delay unit 97 which
can be adjusted by first control means 98 for the desired delay
time between the EKG signal and the application of pressure, in
accordance with the similar, normal, physiological delay in the
systolic cardiac contraction.
The output from the pulse start delay unit is maintained until a
"reset" input pulse is received. It is fed to a first relay means
99 which closes first switching means 100, and also to pulse
duration delay unit 101 which can be adjusted by second control
means 102 in order to control the duration of the application of
pressure, which adjustment would be made nominally to coincide with
the normal systolic period. The output from the pulse duration
delay unit 101 is fed to second relay means 103 which, when
activated, serves to open second switching means 104, and also
supplies the "reset" signal to the pulse start delay unit, thus
returning it to the condition whereby it can respond to the next
incoming pulse. When the switching means 100 is closed, current
flows through terminals 93, leading to solenoid valve 44, admitting
pressurized fluid to the cylinder chamber 62. When second relay
means 103 is activated by the pulse after having passed through the
pulse duration delay unit 101, switching means 104 is opened.
Concurrently, first relay means 99 is no longer activated and first
switching means 100 opens. The solenoid valve is then deactivated
and cutting off the flow of pressurized fluid, and the cylinder
chamber is vented through the vent part 45.
The drawings illustrating the cardiac resuscitator of this
invention show a solenoid valve in the pressure fluid conduit
system leading to the cylinder for the purpose of controlling the
time period during which the fluid exerts pressure on the inside of
the cylinder and on the piston to cause the latter to be propelled
towards or extended from the lower end of the cylinder, followed by
the time period during which the pressure on the inside of the
cylinder is released permitting the retraction of the piston into
the cylinder. However, other means may be substituted for the
solenoid valve. For example, a three-way valve may be employed in
the repressurized fluid conduit system which can be manually
controlled to permit fluid to flow into the cylinder for the
downward stroke of the piston. Then, the valve is turned in order
to connect cylinder with an exhaust port thus relieving the
pressure on the inside of the cylinder. As a result, the chest cage
of the subject can expand and cause the piston to be retracted into
the cylinder, or moved away from the base member.
The pressurized fluid employed for the operation of the
resuscitator can be a hydraulic fluid or a gaseous substance such
as air, nitrogen, helium, oxygen, etc. It is preferably to use
compressed gases since the conduit lines and apparatus
specifications need not be kept to excessively closed tolerances.
For example, if a pressurized gas is used, some leakage between the
piston and cylinder can be tolerated. Also, the pressurized gas can
be vented to the atmosphere whereas a hydraulic fluid would require
the use of an exhaust reservoir. The pressurized gas can be
supplied by a compressor or used out of a compressed gas storage
vessel. The pressurized fluid is supplied through a pressure
control means 130 on cylinder 128 (FIG. 6), including a tank
pressure gauge 132 and a line pressure gauge 134, to the apparatus
conduit system. In the case of a pressurized gas such as oxygen or
nitrogen, it can be supplied through a pressure reduction valve of
the diaphragm, or like type. Examples of the valve are those
commonly used with compressed gas cylinders for applications such
as gas welding, and the like. In the case of resuscitator apparatus
having a fixed distance between the base member and the bottom of
the cylinder as in FIG. 2, so that the piston during the chest
compressor stroke, is extended through a length sufficient to
compress the chest cage in an amount which will cause the heart to
contract and expel blood therefrom, the pressure of the fluid fed
to the cylinder is adjusted to provide sufficient piston force to
accomplish this.
With an apparatus such as illustrated in FIG. 6, in which the
cylinder and piston assembly can be raised or lowered relative to
the base member, and the height of the cylinder above the base
member is adjusted so that a full extension of the piston below the
cylinder is just sufficient to provide for a contraction of the
heart and expulsion of the blood therefrom, the pressure of the
fluid supplied to the cylinder need not be controlled within as
close a range of pressure values as in the case of the apparatus
shown in FIG. 2. It will be recalled that in the operation of the
apparatus of FIG. 2, the downward travel of the piston is halted by
a reaction pressure of the rib cage of the subject, when such
reaction pressure is equal and opposite to the pressure exerted
downwardly on the piston. The range of pressures that can be
applied for use of various subjects, is medically available. The
rib cage of the average male adult compresses approximately 1 inch
for 40 pounds of applied force. In general, good perfusion may be
maintained with cyclic compression of approximately 2 inches,
requiring, accordingly, approximately 80 pounds of force. As stated
hereinabove the apparatus is equipped with a pressure relief valve
which can be of an adjustable type so that a variety of
predetermined pressure conditions can be achieved within the
cylinder. The apparatus of FIG. 6 has a further advantage in that
the height of the cylinder above the subject can be adjusted so
that a full extension of the piston, regardless of pressure, is
just sufficient to provide the desired heart contraction.
An example of one embodiment of the apparatus of this invention is
a cardiac massage apparatus having a geometry such that 2 pounds of
force correspond to 1 p.s.i.g. The equipment can be designed, for
example, for a maximum of 100 pounds force (50 p.s.i.g.). The force
is reduced to zero (except for weight of piston per se) by venting
the cylinder to the atmosphere.
For effective perfusion of blood, as stated hereinabove, the
application and removal of pressure must be cyclically repeated at
intervals of about 1 second. The application of pressure
corresponds to the systole of the heart and the release of pressure
corresponds to the diastole. Preferably, diastole should hold for a
longer period than systole, to permit the heart to adequately fill.
An example is to permit one complete cycle time period to consist
of 60 percent diastole and 40 percent systole. Adequate control
with manual massage would, of course, be difficult, and thus, the
advantages of a mechanized method, making use of an automatic
cycling control with the apparatus of this invention, is
self-evident.
In certain cases it is highly desirable to use massage to augment a
natural but weak heartbeat. This has been done with some success
manually with the operator monitoring the patient's
electrocardiogram wave, as with the use of an oscilloscope, and
synchronizing his application of pressure with the detected
heartbeat. This, of course, is more effectively accomplished by a
fully automatic control of the mechanical massager in response to
the EKG electrical impulse. This mode of operation is termed as
augmentation and is another distinct advantage of the use of the
cardiac resuscitator of this invention employed in conjunction with
the augmentation control illustrated in FIG. 8.
The cardiac resuscitator of this invention can be employed in a
variety of tactical situations. In the case of a field emergency
where a source of pressurized gas is present but in the absence of
electrical power, the mechanical gas valve in the pressurized fluid
conduit system leading to the cylinder of the resuscitator can be
manually controlled for resuscitation operation. In an ambulance,
the cardiac resuscitator can be employed with a solenoid gas valve
in the fluid supply line controlled by an automatic cycling control
unit as shown in FIG. 7, powered by a 12-volt DC motor connected to
the ambulance power.
In a hospital or a doctor's or dentist's office the heart
resuscitator can be operated with an automatic cycling control unit
powered by 110-volt, 60-cycle line current. In the hospital the
resuscitator can be employed with an augmentation control unit as
shown in FIG. 8 powered either by 110-volt, 60-cycle line current
or by an auxiliary power unit. In case of power failure the unit
can always be operated manually insofar as the control of the flow
of pressure exerting fluid to and from the cylinder is
concerned.
This invention also provides a method for providing reciprocal
motion to the piston of the apparatus of FIG. 2. This method
comprises admitting a fluid under pressure into said cylinder
through the inlet means for a first period of time, thereby causing
said piston to move toward the base, and thereafter releasing the
pressure on the fluid in the cylinder for a second period of
time.
The following examples illustrate the use of the
heart-resuscitating apparatus of this invention.
EXAMPLE I
The apparatus of this invention was employed in external cardiac
massage of an animal. An anesthetized dog was put into cardiac
fibrillation by application of an electric shock. The animal had
been previously cannulated at the abdominal aorta and the arterial
pressure, as well as the animal's electrocardiogram, were recorded
prior to and after fibrillation, and during massage. The animal was
placed on its side on the base member 12 of the apparatus shown in
FIG. 2, so that its rib cage was positioned between the base member
and the piston 16. The cardiac massaging apparatus was then
operated with oxygen supplied from a pressurized storage vessel.
The pressure of oxygen supplied was approximately 40 p.s.i.g. The
pressure was applied to the chamber of the cylinder for a first
cyclic period of 0.4 seconds corresponding to systole. The oxygen
in the cylinder was next vented to the atmosphere for a second
cyclic period of 0.6 seconds, corresponding to diastole. At
intervals during this time, external manual massage was applied to
obtain a comparison between the manual and automatic techniques. It
was found that the apparatus of this invention was capable of
maintaining adequate blood pressure to sustain the life of the dog,
and in all cases was at least as good as the manual technique.
Pressure of 65/25, referring to systolic and diastolic pressures
respectively, in mm. of Hg, were recorded with mechanical massage.
With manual massage, pressures of 55/12 were recorded. In both
cases, perfusion was adequate to support the dog's life. In both
cases, perfusion was sufficient to support the dog's life for a
duration of time to permit ancillary treatment to restore normal
cardiac function.
EXAMPLE II
The apparatus of this invention was again employed in the
artificial heart massage of another dog. An anesthetized dog was
put into fibrillation by applying electric shock across the
animal's chest. The animal had been previously cannulated at the
abdominal aorta and the arterial pressure as well as the animal's
electrocardiogram, were recorded prior to, and after fibrillation
and during massage. The animal was placed, in this example, on its
back in a supine position on the base member 12 of the apparatus
shown in FIG. 2 so that its rib cage was positioned between the
base member and the piston 16. The cardiac-massaging apparatus was
then operated with oxygen supplied from a pressurized storage
vessel. The pressure of the oxygen supplied to the cylinder was
approximately 40 p.s.i.g. The pressure was applied to the chamber
of the cylinder for a first cyclic period in this example of 0.2
seconds corresponding to systole. The oxygen in the cylinder was
next vented to the atmosphere for a second cyclic period of 0.3
seconds corresponding to diastole. The resulting pulse rate of 120
pulse beats per minute, twice that of the first example, more
closely approximates the normal canine function. The external
massage technique was carried out for approximately 1 hour with the
apparatus of this invention employed for this purpose approximately
one-half of the time, with manual massage technique applied for the
remainder of the time. During this total period the dog did not
develop any measurable normal arterial pressure despite the
application of defibrillation shock and medication. Vitality of the
dog, however, during the period, was satisfactorily maintained, as
judged by breathing, blood color, and general physiological
observation, and it can be positively stated that, during this
time, the dog's life was maintained by external cardiac massage.
During approximately one-half of this period the dog's life was
maintained by the action solely of the apparatus of this
invention.
EXAMPLE III
An unconscious male adult with heart in ventricular fibrillation,
having a chest depth of approximately 10 inches, is placed on the
base member of the cardiac resuscitator of FIG. 2. Pressure is
adjusted to 40 p.s.i.g. The resilient pad 18 is placed on the
patient's sternum, approximately centered at a point 2 inches from
the xiphoid region, as indicated in FIG. 1. The autocycle control
is switched on, and the resuscitator starts its periodic
compression of the rib cage. Upon application of this technique, a
definite peripheral pulse is detectable. This pulse is monitored in
the carotid arteries, supplying the brain.
Along with cardiac resuscitation, the patient is ventilated using a
positive pressure apparatus. After approximately 5 minutes of
combined cardiac resuscitation and ventilation, sufficient
oxygenated blood perfusion is accomplished to restore body tone, as
evidenced by reduced pupil dilation, general color and return of
respiratory movements. When cardiac resuscitation is stopped
momentarily and ventricular fibrillation still persists, as is
evidenced by EKG signal, and lack of normal pulse, the
resuscitation is again started, and an external electric
defibrillator, similar to that described by Kouwenhoven, Jude, and
Knickerbocker, in the Journal of the American Medical Assn.,
173:1064, 1960, is readied. After approximately 3 more minutes, the
resuscitator is stopped again. The defibrillator electrodes are
placed on the patient's chest and a defibrillating impulse is
applied. Immediately following this, the EKG trace indicates the
cessation of fibrillation, and complete cardiac arrest. The
resuscitator is again energized. Immediately the EKG indicates the
resumption of a normal heartbeat. The resuscitator is stopped, and
normal cardiac function is indicated by EKG, peripheral pulse, body
tone, and finally the return of the patient to a conscious
condition. In this example, the external cardiac resuscitator
maintains adequate blood perfusion to sustain life, external
defibrillation is accomplished, and the patient is restored to
normalcy without performing a thoracotomy with its attendant
disadvantages.
EXAMPLE IV
In this example, an average-size female adult suffers a rapidly
diminishing level of cardiac function known medically as
hypotension, brachycardia, with poor peripheral circulation, during
the administration of anesthesia in preparation for a surgical
operation. The patient, as part of the surgical procedure, is
previously cannulated, for the monitoring of arterial pressures,
electrocardiographic electrodes are applied and EKG is monitored.
The diminishing level of cardiac function is demonstrated by these
monitoring systems.
Immediately, the external cardiac resuscitator of FIG. 2 is
employed connected to the output 93 of the augmentation control of
FIG. 8. The EKG signal is connected to the input 94 of the
augmentation control unit. Pressure, in this case, is set at 35
p.s.i.g., and the external resuscitator system is turned on.
Immediately, the resuscitator augments the normal, weak cardiac
perfusion, in synchronism with the normal cardiac pulses, and body
tone begins to improve. After approximately 5 minutes of this
treatment, and with the administration of proper medicinals, the
external resuscitator is stopped and the monitoring devices
indicate the return of normal, adequate cardiac function. the
cardiac resuscitator is removed, and the surgical process is
resumed.
EXAMPLE V
A 6-year-old made chile is found to be in ventricular fibrillation
after suffering an accidental electrical shock in his home. The
emergency ambulance crew arrives on the scene within 4 minutes of
the accident. Immediately the apparatus of FIG. 6 is applied. The
apparatus is adjusted such that with the piston fully extended
against its stop, rib cage compression will be limited to 1 inch.
Pressure, not being critical under these conditions, is set at 30
p.s.i.g. Because an electrical supply is not immediately available,
the apparatus is cyclically controlled using the manual override
control. Simultaneously, oxygen is supplied with a positive
pressure breathing apparatus. Almost immediately, body tone is
observed to improve. Next, electrical power is made available, and
operation is switched to autocycle control. After 5 minutes of this
technique, body tone is restored, and the resuscitator is stopped
and removed temporarily, and the patient is quickly moved to the
ambulance. The external cardiac resuscitator is again immediately
applied, in the autocycle mode, this time powered from the DC
ambulance power through a vibrator inverter. Upon arrival at the
hospital, the patient is transferred to emergency where external
defibrillation methods and proper medication are administered,
along with continuing use of the external resuscitator. These
administrations successfully restore normal cardiac function.
Although the apparatus and method of this invention have been
illustrated and described in detail, the same is by way of
illustration nd example only and is not to be taken by way of
limitation, the spirit and scope of this invention being limited
only by the appended claims.
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