US 3371662 A
Description (OCR text may contain errors)
March 5, 1968 J. HEID ETAL DEVICE FOR AUTOMATICALLY EFFECTING CARDIAC MASSAGE Filed Jan. 17, 1966 2 Shets-Shee t 1 6 J4 y 7,147 r fl rys.
March 5, 1968 J, ET AL.
DEVICE FOR AUTOMATICALLY EFFECTING CARDIAC MASSAGE Filed Jan. 17, 1966 2 Sheets-Sheet 2 Fig. 5
INVENTORS (/6255: 142-70 M0255: bmxas Jo'zsn' 55/9567 United States Patent DEVICE FOR AUTOMATICALLY EFFECTIN G CARDIAC MASSAGE Jzsef Heid, Jzsef Hajs and Jzsef Seregi, Budapest, Hungary, assignors to Villamos Automatika Intezet, Budapest, Hungary Filed Jan. 17, 1966, Ser. No. 521,006 6 Claims. (Cl. 12824.5)
ABSTRACT OF THE DISCLOSURE A device for automatically effecting cardiac massage, comprises a two-Walled flexible chamber adapted to be secured on the heart in such a manner as to surround the heart. The device is elastic and is provided between the walls with closed cavities adapted to communicate with apparatus for supplying to and withdrawing from the cavities a fluid pressure medium at the desired heart rhythm. The device also has stimulating defibrillating electrodes arranged in a wall of the device to conduct the action potentials of the heart into the apparatus.
This invention relates to a device for automatic cardiac massage whereby the hearts activity can be regulated by the vital functions automatically, by mechanical means, and in the way most beneficial to the affected heart, so as to resuscitate the patient from the condition of clinical death. I
Conditions being favorable, modern medicine is able to restore a patient to life from the condition of clinical death. Revival from the state of clinical death involves the use of a whole complex of revival factors (artificial respiration, high pressure intra-arterial transfusion, cardiac massage, electrical stimulation of the heart, defibrillation, and treatment with drugs).
One of the most important factors in this complex therapy is regulation of the blood circulation, i.e., by maintenance of the circulation or by restarting the stopped heart.
Cardiac massage, carried out in practice directly by hand, with the assistance of chemical and electrical factors, has been confirmed and attested by experience as a successful means of restoring the activity of the heart.
Direct heart massage as carried out manually has a number of drawbacks which militate against its success.
Manual massage is unable to ensure the proper pressure ratio in imitation of natural cardiac activity acting alternately on the auricles and ventricles of the heart, and unable to provide the optimum dual-action rhythm.
It is a dimcult matter to synchronize the rhythm of manual massage with the beat of the reviving heart, and for this reason manual massage can be carried out successfully only by a highly experienced doctor.
In the case of cardiac massage extending over a long period of perhaps several hours, the doctor is bound to succumb to physical exhaustion, so that he will be unable to continue with the work quite evenly, and this must inevitably diminish the effectiveness of the treatment, Hand massage possibly carried out with the wrong technique, or excessively prolonged, may do serious damage to the muscular system of the heart (various suggillations of the hearts musculature, tearing of the papillary muscle, perforation of the cardiac muscle, and so on).
Manual cardiac massage also excludes the possibility of simultaneously applying electrical stimulus or defibrillation, or of deriving the direct action potential of the heart on the return of its spontaneous activity.
It is an object of the present invention to provide a mechanical device for automatically effecting cardiac massage by the aid of which there can be exerted upon 3,371,662 Patented Mar. 5, 1968 individual parts of the heart a pressure which is of the appropriate magnitude, phase and rhythm and best corresponds to the given condition of the heart. The device may permit the course of the massage to continue uniform and unaltered even after prolonged treatment over several hours, and does no damage to the heart. Moreover, the device may permit the employment simultaneously with massage of electrical stimulation or defibrillation, and also make it possible to derive the direct action potential of the heart, on the return of the spontaneous heartbeat.
According to the present invention there is provided a device for automatically effecting cardiac massage, comprising a two walled flexible member which is adapted to be secured on the heart in such a manner as to surround the heart, the member being made of elastic material, and being equipped between the walls with closed cavities adapted to be brought into communication with apparatus for feeding into and out of the cavities a gaseous or liquid pressure medium; at a rhythm corresponding to that desired to be imparted to the heart, the member being provided with stimulating defibrillating electrodes arranged in the wall of the member and being arranged to conduct the action potentials of the heart into said apparatus.
The invention also resides in the combination of the device with the apparatus for operating it.
In order to enable the invention to be more readily understood, reference will now be made to the accompanying drawings, which illustrate diagrammatically and by way of example an embodiment thereof, and in which:
FIGURE 1 is a view of a device for automatically effecting cardiac massage shown in an opened-up position;
FIGURE 2 is a view of the inside of the device;
FIGURE 3 is a perspective view of the device, folded up and fastened;
FIGURE 4 is a block diagram of the mechanical parts of the assembled device, and
FIGURE 5 is a wiring diagram for the electrical control part of the device.
The device 1 illustrated in the drawings is in essence a double-walled flexible tube, the inner wall being made of elastic flexible rubber or plastic material with a soft surface, and the outer wall being likewise relatively readily flexible but containing also an insert, for example of metal or plastic material, preventing expansion. A closure device 2a,2b serves for connecting the two ends of the device, after the device has been folded around the heart, the closure device being adjustable to allow the device to embrace with equal firmness small or large hearts.
The device 1 is divided into cavities by means of partitions, in the manner shown in FIGURE 2. Cavities 6a and 6b are intended to lie adjacent the auricles of the heart, and cavities 7a and 7b are intended to lie adjacent theventricles of the heart. A gaseous or liquid pressure medium can be passed through connections 8, 8a, 9 and 9a, incorporated in the cavities of the device 1, or the pressure medium can flow out of these spaces.
Electrodes 10 mounted in the inner wall of the cavities serve the purpose of stimulating the heart during the cardiac massage, the electrodes 14] can be connected through leads with a conventional stimulator.
On the parts of the inner wall of the device 1 intended to lie against the cardiac ventricles are mounted defibrillating electrodes 10a, 10b, which serve for defibrillation and for derivation of the action potential of the reviving heart. The electrodes 10, 10a and 10b may be made of metal and/or conductive rubber and/ or conductive plastics.
A depression 11 which can be seen in FIGURE 3 on the upper part of the device 1 in its assembled condition ensures that the device 1 cannot touch the arteries at the point where they branch off from the heart, so that there is no risk of injury to the arteries, which are able to perform their proper task without hindrance.
The gaseous or liquid pressure medium is intended to flow from a pressure reservoir 12 to the device 1 surrounding the heart at a pressure exceeding atmospheric pressure through pressure reducers 13 and 14, three-way electropneumatic valves 15 and 16 and ducts 17 and 18. The high pressure medium is conducted into the pressure reservoir 12 through a connection 19.
The removal of the pressure medium from the device 1 is effected by operating the electropneumatic valves 15 and 16, the pressure medium then flowing from the corresponding cavity in the device 1 through a pressure reducer 20 into a vacuum tank 21 or to waste.
The operation of the electropneumatic valves 15 and 16 is effected by the control device illustrated in FIG- URE 5. A rhythm generator 22 of the control device part ensures within wide limits the rhythm of the valve operation, which corresponds to the rhythm of the massage. Impulses actuating the valves (for example, on the average say 50-90 times a minute) are allotted or started up by the control device within a period by counting the frequency of the rhythm generator 22. The duration of the impulses is adjusted by impulsing means 23 and signal formers 24 and 25. The control impulses are brought by output amplifiers 26 and 27, respectively, to the output level necessary for operating the electropneumatic valves.
The action potentials of the spontaneous cardiac activity started during the massage are utilized by the device in substitution for its own control rhythm, in that the device derives them from the electrodes 10a, 10b also used for defibrillation, and amplifies them in a signal former 28. The rhythm of the further massage is in this way ensured through the action potential of the heart itself.
When the frequency of the otherwise regular spontaneous action potential exceeds the upper limit of the massage frequency, which still has a corresponding effect at its disposal, the impulses, subdivided by two or three, of the action current rhythm then serve to control the device.
The time constant of the structural elements of the mechanical device is taken account of by the frequency dependence of the retardation used in the electronic control system, namely in that this ensures such a storage for the action potential signal as exactly corresponds to one period.
The operation of a conventional stimulator 29 connected onto the device is likewise effected by the rhythm generator 22 or impulsing means 23, a commutator 30 serving for selecting the most effectually stimulating pair of electrodes 10.
The action potentials of the fibrillating heart cannot be used for the control. The electrodes 10a, 10b used for defibrillation have to be switched over to the source of current for the conventional defibrillizer 33 having'a defibrillating button 31 for the duration of the impulse to be emitted, by means of a hand switch 32. After the hand switch 32 has been released, the electrodes 10a, 1011 are again suited to receive the action currents.
With the present device for automatically effecting cardiac massage, cardiac massage can be carried out for an indefinite period of time at a uniform rhythm and under constant conditions of pressure, or in a rhythm corresponding to the spontaneous action potentials of the reviving heart. The massage can be carried out in such a way as to spare any injury to the surface or muscular system of the heart. Simultaneously with the massage and without interrupting the same, drugs can be introduced into the ventricles to stimulate the heart, fibrillation can be observed and the heart defibrillated. The rhythm of the massage and the degree of pressure can be adjusted in conformity with the respective condition of the heart, determined as the result of observation or automatically. Because of the adjustable closure device the present device can beplaced on hearts of differing shape and size. The device surrounds the heart concentrically and without any gaps, distributing the pressure exerted on the heart over a wide area of the heart.
The line of that part of the device which lies against the base of the heart accommodates the pericardial folds lying thereabove and thus leaves free the arteries leading to and from the heart.
The invention is not restricted to the components in the form of construction here described and illustrated by way of example, which components may be replaced by other components of similar function and effect but of different construction. Thus, for example, the electrodes may be located elsewhere, or may be considerably more numerous than as here described, or the vessel 21 may be connected to a vacuum pump or the like, and so forth.
What we claim is:
1. A device for automatically effecting cardiac massages, comprising a two walled flexible member which is adapted to be secured on the heart in such a manner as to surround the heart, the member being made of elastic material, and being equipped between the walls with closed cavities adapted to be brought into communication with apparatus for feeding into and out of the cavities a gaseous or liquid pressure medium; at a rhythm corresponding to that desired to be imparted to the heart, the member being provided with stimulating defibrillating electrodes arranged in the wall of the member and being arranged to conduct the action potentials of the heart into said apparatus.
2. A device as claimed in claim 1, wherein an inelastic material for preventing expansion is arranged in the outer wall of the member.
3. A device as claimed in claim 1, in combination with said apparatus, wherein the latter includes valves for feeding the pressure medium to the cavities and for discharging it therefrom, and an electronic device comprising output amplifiers, signal formers, impulsing means and a rhythm generator for controlling said valves.
4. A combination as claimed in claim 3, wherein the apparatus is provided with a commutator for connecting the electrodes.
5. A combination as claimed in claim 3, wherein current circuits for counting and distributing the action current impulses of the heart are provided in the control device.
6. A combination as claimed in claim 3, wherein the electrodes are made of a material selected from the class consisting of metal, conductive rubber, and conductive plastic.
References Cited UNITED STATES PATENTS 2,826,193 3/1958 Vineberg 128-64 3,034,501 5/1962 Hewson 128-64 3,053,249 9/1962 Smith 128-64 3,254,645 6/1966 Rand et al. 128-52 L. W. TRAPP, Primary Examiner.