US 2826193 A
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March 11,1958 A. VINEBERG CARDIAC RESUSCITATION DEVICE Filed Aug. 1, 195 s s Sheets-Sheet 1 @Q MM A. VINEBIERG CARDIAC RESUSCITATION DEVICE March 11, 1958 3 Sheets-Sheet 2 Filed Aug. 1, 1956 QM 5. i=5 i l- A??? 12%;? .o o No. g flww oi li'l a lo M v m 0 v Q N m m u m Mm $8 QM m f 6% March 11, 1958 I A. VINEBERG 2,826,193
CARDIAC RESUSCITATIdN DEVICE Filed Aug. 1, 1956 3 Sheets-Sheet 3.
United States Patent CARDIAC RESUSCITATION DEVICE Arthur Vineberg, Montreal, Quebec, Canada, assignor to Vineberg Heart Foundation, Montreal, Quebec, Canada Application August 1, 1956, Serial No. 601,499 9 Claims. (Cl. 128-38) The present invention is concerned with the development of a mechanical apparatus adapted to apply resuscitati-ng and massaging action to a human heart.
It is known in medical practice that at times, for example during an operation, and at other times, the heart stops and an attempt is made to restore its action by applying a direct massaging action.
While the technique is broadly known, this massaging action is performed manually by a doctor or doctors and to be effective must develop sufiiciently high blood pressure to keep the patient alive and may have to be maintained for a considerable length of time. This manual massaging action is very fatiguing and, furthermore, requires a fair'amount of skill to apply the correct amount ofpressure and maintain an eflicient and steady blood pressure.
The present apparatus is designed to accomplish this effect by mechanical means through the use of a hollow shell adapted to surround a major portion of a human heart and which is provided internally with flexible membranes which will come in direct contact with the heart and are actuated by a pulsing beat of fluid pressure so as to squeeze and release the heart as is necessary.
Accordingly, the invention in its broadest aspects comprises a cardiac resuscitation apparatus consisting essentially of a hollow shell adapted to surround a major portion of a human heart, opposed flexible diaphragms mounted within the shell, and means for supplying a pulsating fluid pressure to the interior of the diaphragms.
More specifically, a preferred construction of a cardiac resuscitation apparatus in accordance with the invention embodies the use of a flexiblepouch or sac having one open side and an open top with closure means provided on the open side and about the top so that the sac can be placed about the heart, closed along the open side, and the open top adjusted so as to fit snugly about the upper portion of the heart. This flexible sac or pouch is surrounded by a two-piece hollow shell, preferably of fairly rigid material, so as to provide a resistance against the pressure of a pair of opposed flexible membranes provided within the flexible pouch. The shell is preferably shaped to corre spon d with the external conformation of the heart.
The membranes are provided with suitable outlets adapted for connection to a source of pulsating fluid pressure and are located within the flexible pouch so that the pressure is direc fill inwardly and downwardly against the sides of the heart to produce the squeezing action necessary.
It will be appreciated that the combination of a flexible sac and a separate outer shell is illustrative only and represents one form, which the apparatus may take.
It is also contemplated that the flexible pouch and shell might be combined with the flexible membranes placed directly on the interior of the hollow shell for the purpose described.
The method of restricting'the open top can also. be
2,826,193 Patented Mar. 11, 1958 varied. For example, in a preferred construction where the separate flexible pouch is utilized the open top is gathered about the upper portion of the heart by means of a flexible draw-string. This, of course, could easily be replaced by a resilient sponge rubber ring or the like in the case where the interior pouch and shell were combined. The main purpose of the means for restricting the open top of the apparatus is to prevent the heart from being forced up through the top when the necessary relaxation of the heart in its normal function. The speed of operation of the pump can be varied from case to case to obtain the required satisfactory pumping action,
Having thus generally described the nature of the invention, particular reference will be made to the accompanying drawings, wherein there is shown by way of illustration a preferred embodiment thereof, and in which:
Figure l is a diagrammatic view in front elevation of the heart encasing portion of a cardiac resuscitation apparatus in accord nqe with the invention.
Figures 2 is a crosssectional view of the construction shown in Figure 1 along the line 2-2.
Figure 3 is a complete section of the apparatus shown in Figure 1 to illustrate more clearly the relative position of the flexible diaphragms in relation to a human heart surrounded by the apparatus. 1
Figure 4 is a diagrammatic view in, plan elevation, of an interior flexible sac or pouch, as shown in the constructions of Figures 1, 2 and 3 as it would appear when spread open prior to its engagement with the human heart.
Figure 5 is a somewhat diagrammatic View of the ap paratus shown in Figures 1, 2 and 3 as attached to and actuated by a double-acting air pump.
Figure 6 is an enlarged view partially in. section of the piston portion of the pump construction shown in Figure 5..
Figure 7 is a cross sectional view of Figure 6 along the line 7-7.
Figure 8 is an end view of the pump iston shown in Figures 5 and 6. t
Figures 9 is a plan view of the cam portion and adjustable cam engaging portion of the pump construction,
With particular reference to Figures 1,. 2, 3. and 4 of the drawings, the main element of the form of the: apparatus shown comprises a flexible pouch or sac 10 which is provided along. one open side with a zipper closure 12 and along the open top with a drawing-string 14. A pair of flexible diaphragms. 16a, 16b. are secured to the interior walls of the. flexible pouch 10 so as to constitute air-tight flexible membranes which can be expanded or contracted by the application and release of fluid pressure, for example air. The material used for the pouch or sac 10 is preferably strong and flexible, for example nylon or the like, while the flexible membranes 16a, 16b are preferably of a high quality rubber or the like.
The membranes 16a, 16b are provided with flexible conduit portions 17a, 17b permitting an attachment to the source of fluid pressure. In use, the sac or pouch T0 is placed beneath the heart, that is one side is placed beneath the heart, the other side folded over, and by the zipper closure 12 the sac is caused to envelop the heart, as shown in Figure 3. The open top is constricted through the use of the drawing-string 14 so as to prevent a portion of the heart being forced out through this top when the pressure is supplied.
In order to exert the pressure applied by the flexible membranes 16a, 1617 against the Walls of the heart the flexible pouch is surrounded by a hollow shell 20 of rigid material. This is shaped to follow heart contour and preferably is made from a cast of a heart. The shell 20, as shown, is preferably made in two identical sections hinged at 22 so that it can be placed around the pouch-enveloped heart and retained in this position by suitable means, for example a catch or clamps. The ends of the conduit 17a, 17b protrude through suitable openings provided in the walls of the shell 20.
When pulsations of fluid pressure are applied through the membranes 16a, 16b, due to the rigid nature of the outer shell 20, the pressure of the membranes is directed against the walls of the heart (ventricles), preferably inwardly and downwardly so as to achieve the desired massaging action.
With particular reference to Figures 5 through 9, a preferred means of supplying the desired pulsating fluid pressure is illustrated as comprising of a double-acting pump arrangement including a main cylinder 30, a piston assembly 32, a piston rod 34, an adjustable cam engaging arrangement 36, and a contoured cam 38 driven by a suitable motor 40.
These elements are mounted on a supporting stand 42 in the following manner. The cylinder is mounted for restricted pivotal movement on a standard 31, the piston rod 34 is supported and guided by a supporting frame 29 extending from the cylinder 30 and on which is provided opposed guiding rollers 50, 52. The piston assembly 32 comprises of a piston head to which there is attached a flexible cylinder wall lining 62 secured at the other end to the cylinder head 35, so that movement of the piston head 60 in one direction, towards the cylinder head 35, causes air to be delivered under pressure, while movement of the piston head 60 in the opposite direction produces a suction or aspirating eflect.
The desired stroke is imparted to the piston head 60 through the piston rod 34 by means of a predetermined contoured cam 38, as mentioned above. The cam 38 is mounted on a support on a common axis with a friction drive wheel 72 which is in contact with and is frictionally driven by a further friction contact wheel 74 connected directly to the motor 40. The diameters of the friction drive wheels 74, 72 are selected proportionately to the speed of the motor 40 so as to achieve the desired rate of pulsation.
The contour surface of the cam 38 is predetermined to produce the required one-third pressure stroke and two-thirds suction stroke per revolution to correspond with the one-third systolic contraction and two-thirds diastolic relaxation of the heart cycle. In order to transmit the exact motion of the cam to the piston 34, the end of the piston rod is connected to the guide member of the arrangement 36. As shown best in Figure 9, the member 80 is mounted on a slide guide 92 pivotally mounted on a supporting frame 42. The slide guide 92 in turn is resiliently biased towards the cam 38 by means of a coil spring 94. The support 80 is threadably engaged with a rotary screw 96 also mounted on the slide bar 92. An extension 81 is mounted on the bar 92 and supports a cam engaging Wheel 83. With this arrangement, rotation of the threaded rod 96 permits adjustment of the relative position of the support 80 relative to the cam wheel 83. A locking screw is provided so that the member 80 can be locked in the desired position to produce the required stroke.
A flexible conduit 100 is connected from the outlet 37 of the cylinder head 35. The conduit 100 terminates 75 in Y-shaped end fittings 102a, 102b connected to the flexible conduit 17a, 17b of the resuscitating element.
It will be appreciated that the double-acting pump arrangernent described and illustrated may be replaced by other equipment and apparatus for the purpose of providing the necessary pulsating fluid pressure to the flexible diaphragms in a. timed cycle of /3 pressure and suctron.
it will also be appreciated that the construction shown with respect to the main element of the apparatus may be also varied without departing from the scope of the invention. For example, the two-piece arrangement of flexible pouch and rigid outer shell might be replaced by a semi-rigid shell having a lining, incorporating the flexible diaphragms, of flexible material. Also, the drawstring arrangement of the flexible pouch shown might be replaced by an annular rim or head of sponge rubber or the like to act as a grommet or sleeve about the upper portion of the heart-surrounding shell. Still further, the shell itself might be replaced by a metallic chain link type of bag with a plastic material interlining embodying the necessary flexible diaphragms.
The main requirements are that the heart be fully encased by a shell or the equivalent with heart contours and that the flexible diaphragms be disposed within the shell and arranged so as to act, under fluctuating pressure, to squeeze and release the heart so enclosed. It is also essential that this pressure be applied inwardly and downwardly as opposed to inwardly and upwardly, which would tend to force the heart towards the upper port on of the enclosure rather than producing the massaging action required to the lower and main portion of the heart.
1. A cardiac resuscitation apparatus comprising, a container conforming to the external contour of a human heart and adapted to surround a major portion thereof, opposed flexible diaphragms mounted Within sa d container, and means for supplying a pulsating fluid pressure to the interior of said diaphragms which are adapted to compress the ventricles of the heart and force blood through the circulation.
2. A cardiac resuscitation device, as claimed in claim 1, wherein said container is in two interconnectable sections and one of said flexible diaphragms is mounted within each section.
3. A cardiac resuscitation apparatus comprising, a hollow shell conforming to the external contour of a human heart and adapted to surround a major portion thereof, opposed flexible diaphragms mounted within said shell, and means for supplying a pulsating fluid pressure to the interior of said diaphragms.
4. A cardiac resuscitation device, as claimed in claim 3. wherein said hollow shell is in two hingedly interconnected sections and one of said flexible diaphragms is mounted within each section.
5. A cardiac resuscitation device, as claimed in claim 3, wherein said hollow shell is substantially rigid, and a flexible pouch, adapted to accommodate a human heart, is located within said rigid shell, said flexible diaphragms being mounted in opposed relationship within said flexible pouch.
6. A cardiac resuscitation device, as claimed in claim 3, wherein said means for supplying said pulsating fluid pressure comprises a cam controlled double-acting pressure pump.
7. A cardiac resuscitation apparatus comprising, a pouch of flexible material having one open side and an open top, closure means provided on said pouch open side and adjustable restricting means provided in said open top whereby said pouch is adapted to be placed about a human heart, said open side closed and said 'open top contracted about the upper portion of said heart, a pair of flexible diaphragms mounted on opposite sides of said flexible pouch, means connected to said flexible 2,826,193 5 6 diaphragms adapted to deliver a pulsating fluid pressure 9. A cardiac resuscitation device, as claimed in claim thereto, and a hollow outer shell having a formation 7, wherein said means for supplying a pulsating fluid corresponding to the external contours of a heart adapted pressure to said diaphragms includes a cam controlled to surround said flexible pouch whereby pressure caused d b1 i pump, d id cam i predetermined i y the movement of said flexible diaphragm is adapted 5 contour to cause timed pressure fluctuations. to be directed inwardly against a human heart contained therein.
8. A cardiac resuscitation device, as claimed in claim References Cited in the file of this Patent 7, wherein said hollow shell is in two hingedly inter- UNITED STATES PATENTS connected sections and one of said flexible diaphragms 10 is disposed within each section. 2,694,395 Brown Nov. 16, 1954