Apparatus For Sealing The Oesophagus And Providing Artificial Respiration

Abstract

Apparatus for use in artificial respiration comprising an elongated member designed to be inserted into the oesophagus and having an expandable inflatable element which can be operated externally after insertion in order to close the oesophagus to prevent inflation or aspiration of the stomach. The apparatus preferably includes a tubular airway in combination with the elongated member, with discharge openings to allow air to be introduced into the patient's respiratory passages and lungs. The expandible element may be mechanically operated.

Description

This invention is concerned primarily with artificial respiration or resuscitation. The older techniques of artificial respiration have now been largely replaced by "mouth-to-mouth" respiration, using either the direct method or "kiss of life" in which the medical attendant exhales directly into the mouth of the person to be revived, or the indirect method in which air is exhaled into an airway usually in the form of a short plastics tube inserted into the mouth of the patient.

Resuscitation by expired air has certain advantages over the older techniques but also has a number of draw-backs. It is to some extent aesthetically unpleasant, a substantial part of the respirator effort is wasted in inflating the stomach, and there is a serious risk that the stomach contents will be aspirated through the oesophagus into the mouth and throat passages, with consequent gastric spillage into the respiratory passages. If the latter occurs complete failure of the procedure may follow.

The only alternative method available at the present time is to insert an endotracheal tube, but this requires an anaesthetist with hospital facilities. Obviously resuscitation is needed for persons who drown, are asphyxiated, or have sudden heart arrest, and these events may occur at any time or place, often where a hospital is quite inaccessible.

Accordingly it is one object of the invention to provide an improved apparatus, primarily for resuscitation which will overcome some of the disadvantages of existing equipment.

Broadly, from one aspect, the invention consists in apparatus for use in resuscitation, and/or for other medical purposes, comprising an elongated member or tube designed to be inserted into an internal passage in the body, for example the oesophagus, an expandable element carried by the member or tube or attached thereto, at a point displaced from its outer end, means for causing the element to expand so as to form an effective seal with the walls of the passage, and a duct, which may be the elongated member or tube itself, providing communication between an inlet adjacent the outer end of the tube, and a discharge port, on the side of the expandable element adjacent to or remote from the outer end of the elongated member.

Preferably the expandable element comprises an inflatable member, and conveniently the expandable element is operated in response to the supply of fluid through an auxiliary conduit extending along the tube. The inflatable member may be connected via an auxiliary conduit within the tube to an external inflator unit, and preferably the inflator unit includes an expandable pressure indicator member.

According to a preferred feature of the invention the duct extends from the outer end of the tube to one or more discharge ports between this outer end and the expandable element. In this case the duct can be used as an air resuscitation tube to supply air to the respiratory passages of the patient.

Alternatively or in addition the apparatus may include a duct extending along the length of the tube, through the expandable element, to a discharge port on the remote side thereof. Thus when the expandable element is inserted into and seals the oesophagus, this duct can be used to wash out or void the stomach contents, without risk of gastric spillage into the respiratory passages.

In some forms of the apparatus there may be provided both a resuscitation tube terminating in ports on one side of the expandable element, and a stomach washing tube, or guide, terminating on the opposite side of this element.

In any case the tube is preferably curved, to facilitate insertion through the mouth into the oesophagus, and the outer end of the tube may be connected or connectable to a mouthpiece or tube. The apparatus may also include a mouth shield, and/or bite tube, at the outer end of the tube.

The invention also consists in a method of applying artificial respiration in which an expandable element attached to an elongated member is introduced into the patient's oesophagus, and caused to expand therein by means of an externally operated remote actuator, to close the oesophagus passage, and air for resuscitation is supplied through the patient's mouth to the respiratory passages.

From yet another aspect the invention consists in a method of washing out, dosing or voiding the stomach, in which an expandable blocking element is introduced into the oesophagus, and caused to expand therein to form a seal, by means of a remotely operated actuator, and fluids are passed into or out of the stomach by means of a tube extending through the blocking element.

The invention may be performed in various ways and two specific embodiments, with some possible modifications, will now be described by way of example, with reference to the accompanying drawings, in which:

FIG. 1 is a somewhat diagrammatic perspective view, partly in section, of one form of apparatus according to the invention, designed for artificial respiration only,

FIG. 2 is a similar illustration of another embodiment having facilities both for artificial respiration and for stomach washing or evacuation,

FIG. 3 is a fragmentary sectional view on an enlarged scale through an alternative form of mechanically operated expander,

FIG. 4 is a diagrammatic illustration of another form of the invention, designed to act as an oesophogal block, and

FIG. 5 is a side elevation, on an enlarged scale, of a simple form of mouth-to-mouth airway.

The apparatus illustrated in FIG. 1 consists of a main tube 10, formed for example of a synthetic plastics material have some rigidity, but also a degree of flexibility. The tube is somewhat curved as shown to facilitate insertion through the mouth of a patient, over the tongue into the oesophagus. To assist this insertion the inner leading end of the tube is provided with a guide tip 11 having a rounded blunt nose. The outer end of this tube 10 is connected via a coupling 12, which may be relatively more flexible, to a tube 13 which forms a mouth piece by which the medical attendant can apply exhaled air for resuscitation. At the junction between the tube 10 and the coupling 12 there is provided a cup-shaped flange or mouth shield 14 to fit over the mouth of the patient, and adjacent this part of the tube a rigid inner tube may be fitted, for example of steel, to act as a bite tube to prevent the tube being closed or damaged by the patient's teeth. The tube 10 is provided with a transverse wall or seal at 15, and above this point, i.e., on the side adjacent to the inlet, the wall of the tube is formed with a considerable number of discharge apertures 16 spaced along the length of the tube, and also preferably spaced around its peripheral wall. When the leading end of the tube is inserted through the patient's mouth into the oesophagus, these apertures 16 provide satisfactory communication with the respiratory passages, even if some of the apertures are closed.

Adjacent the leading inner end of the tube there is provided an inflatable sealing element comprising an expandable resilient tubular wall 20, formed for example of a synthetic rubber or like material. This resilient wall may be in the form of a tubular sheath positioned around and outside the wall of the main tube 10, and sealed thereto at both ends, or it may itself constitute part of the wall of the tube, in which case it will be of reduced thickness, or of a different material, to provide the necessary flexibility and resilience. In the illustrated embodiment the inflatable wall 20 is a separate sheath element surrounding the main tube wall 10. In order to expand this element 20 a small bore tube 21, also preferably formed of a flexible synthetic plastics material, extends within the main tube 10 and is connected at its outer end via a branch 22 to an inflater unit comprising a manual pressure bulb 23 connected via an on-off valve 24 and a balloon type inflatable pressure indicator 25 to the branch. It will be seen when the valve 24 is open, pressure is applied to the bulb 23 will force air down the tube 21 into the inner inflatable element 20 causing this to expand against the walls of the oesophagus to form a seal therein. The pressure indicator balloon 25 is so formed that when the inner inflatable element 20 expands, the pressure indicator will also expand to show that the oesophagus is closed. If there is any leak in this air system the balloon pressure indicator will deflate to warn the operator. When the inflatable element is expanded the valve 24 can be closed to hold it in this condition.

In using the apparatus to resuscitate a patient the main tube 10 can be inserted without difficulty through the mouth into the oesophagus, with the inflatable element 20 collapsed. This is a non-traumatic procedure and can be used by a trained ambulance man or nurse. Pressure is then applied to the bulb 23 to cause the element 20 to expand within the oesophagus so as to close off the stomach from the respiratory passages, and artificial respiration can then be performed by breathing into the mouth tube 13 in the normal manner without risk of inflating the stomach, or of gastric spillage into the respiratory passages.

The apparatus illustrated in FIG. 2 is in many respects identical with that illustrated in FIG. 1, and similar parts are indicated by the same reference numerals. In this case the guide tip 11 at the leading end of the main tube 10 is provided with a longitudinal passage provided with a seal 30 through which projects a small bore stomach washing tube 28. This tube 28 extends within a guide tube 31 passing through the inflatable element 20, along the length of the main tube 10, through the wall 15, and having an external entrance branch 32. The outer end 29 of the tube 28 is connected to apparatus (not shown) for supplying washing water or other dosing fluids, or to a pump for evacuating the stomach contents.

In this form of the apparatus the stomach tube 28 is slidable within the tube 10 and may be partly withdrawn initially into the guide tip 11 as the apparatus is inserted into the oesophagus, and then extended as necessary through the passage in the guide tip into the stomach.

In a further possible alternative, not illustrated, the apparatus is designed solely for stomach washing or the like, and no air inlet 13 and air outlets 16 are provided. In this case the main tube 10 may itself form part of the stomach washing tube.

It will be understood that a variety of modifications are possible. For example the apparatus may be used in conjunction with any oxygen mask, and instead of exhaled air the inlet to the tube 10 may be connected to a bellows, or to a compressed air supply or pump. The expandable element may take various different forms, and may be fluid-operated as illustrated or may be operated mechanically, or electrically. For example, as illustrated in FIG. 3 the expandable element may be in the form of a flexible rubber sleeve 35 which is contracted axially between a fixed abutment 36 and a movable abutment 37, so as to expand radially as shown in dotted lines at 40, the axial movement being effected by a flexible tension member such as a cord 38 passing within the tube 10, and opposed by a tension spring 39. An electro-mechanical transducer such as a solenoid may also be used to operate the expander. The main air tube 10 is preferably of oral external cross-section to reduce the risk of the tube entering accidentally the patient's respiratory passages or lungs.

As illustrated in FIG. 4, the apparatus may also take the form of an elongated flexible tube 45, connected at its outer end to an inflator unit similar to that described in the previous examples, incorporating an inflator bulb 46 and an expansion indicator 47, and having at its inner end an inflatable element 48, designed to close off the oesophagus passage. The tube 45 may be of relatively small transverse dimensions, similar to that of a conventional trans-nasal stomach tube, so that it can be introduced through the patient's nasal passages into the oesophagus. When inflated to close the oesophagus air for resuscitation can then be introduced into the respiratory passages through the patient's mouth by any convenient method. For example air may be introduced by direct mouth-to-mouth exhalation, without any further special equipment, or using a simple form of tubular mouth-to-lung airway, as illustrated in FIG. 5, having a mouthpiece 50, a lip flange 51, and a bend 52 to pass over the back of the tongue.

In yet another form of the invention, a single common tube is used both to introduce air into the respiratory passages, and also to inflate the expandable element, so that the expandable element is inflated simultaneously when air under pressure is delivered to the respiratory passages. For example in the case of the apparatus illustrated in FIG. 1 the tube 21 would be connected to the main air tube 10, and the inflator unit 23, 25, omitted.

Claims

We claim:

1. Apparatus for medical purposes comprising an elongated tubular member constructed and arranged to be inserted into the oesophagus and having an outer end and an inner end, an expandable element carried by the member at a point displaced from its outer end, means for causing the element to expand so as to form an effective seal with the walls of the oesophagus, an inlet adjacent the outer end of the member and a discharge port in the member located between said outer end and said expandable element, and a duct within the elongated tubular member providing fluid communication between the inlet and discharge port, "said duct terminating at a point between the discharge port and said inner end so that the fluids directed down the duct to the discharge port will not discharge out of the inner end and no fluid may flow into the inner end to the discharge port".

2. Apparatus as claimed in claim 1, in which the expandable element comprises an inflatable member.

3. Apparatus as claimed in claim 2 further characterized by an auxiliary conduit extending along the member and connected to the expandable element and through which the expandable element is operated in response to the supply of fluid fed through said auxiliary conduit.

4. Apparatus as claimed in claim 3 further characterized by an external inflator unit connected to the outer end of the auxiliary conduit.

5. Apparatus as claimed in claim 4, in which the inflator unit includes an expandible pressure indicator member.

6. Apparatus as claimed in claim 1, in which the member is curved, to facilitate insertion through the mouth into the oesophagus.

7. Apparatus as claimed in claim 1, in which the outer end of the member is connected to a mouthpiece.

8. Apparatus as claimed in claim 1, including a mouth shield and bite tube, at the outer end of the member.

9. Apparatus as claimed in claim 1 further characterized by said duct being an integral part of the member and said discharge port comprising a plurality of openings designed to communicate with the respiratory passages of the patient.

10. Apparatus as claimed in claim 9 further characterized by

an auxiliary conduit extending along the member and connected to the expandable element and through which the expandable element is operated in response to the supply of fluid fed through said auxiliary conduit.

11. Apparatus as claimed in claim 10, including a mouth shield and bite tube, at the outer end of the member.

12. Apparatus as claimed in claim 10 further characterized by an external inflator unit connected to the outer end of the auxiliary conduit.

13. Apparatus as claimed in claim 12, including a mouth shield and bite tube, at the outer end of the member.