US 3425409 A
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RESUSCITATOR Sheet Filed Nov. 8, 1965 mm N k m QM EN vi W\ \m 8 0m ww 9 1m mw I .t mm Q Q Q mm TQE INVENTORS MAX lsnncso/v BENJAMIN SM/LG mfw W Feb 4, 1969 M. ISAACSON ET AL 3,425,409
RESUSCITATOR Filed Nov. 8, 1965 Sheet 2 0f 2 0o 2) V1 for \fll m m s 8. Q \Q qr% N l INVENTORS 0 r MAX ISHHCSON N BY BENJAMIN SM/LG United States Patent 3,425,409 RESUSCITATOR Max Isaacson, 420 W. Nottingham Road, and Benjamin 3876 Dorset Drive, both of Dayton, Ohio 4 Filed Nov. 8, 1965, Ser. No. 506,639 US. Cl. 128--28 Int. Cl. A61h 31/00, 23/04; A62b 7/00 Claims ABSTRACT OF THE DISCLOSURE of air and number of pulses of air delivered to the patient as well as the exhalation period may be controlled by a manipulatable relief valve in the accumulator chamber or a separate double acting valve may be provided which is actuated by pressure from the resuscitation device to deliver and remove air to the lungs of a patient and is actuated into another position by the patient to permit exhalation.
This invention relates to a process and a device for resuscitating a person or animal in a respiratory emergency by producing pressure impulses on the sternum portion of the chest so as to cause a circulation of blood similar to that normally resulting from the action of the heart.
Medical research in resuscitation has shown that in many cases the probability of successful revival of a nonbreathing patient is increased if pressure impulses are applied at the sternum at a rate of approximately sixty times per minute. The pressure impulses must be large enough to produce chest deflections of one to two inches. The art has taught that those impulses should be applied by the rescuers hands pressed directly upon the sternum. Cases have been reported where damage to the patients ribs and other organs have been caused by such manual methods.
It is an object of this invention to provide a process and a device for producing the necessary impulses for resuscitation purposes, while providing auxiliary support to the victims body so as to minimize the probability of damage to the ribs and other organs. This is accomplished not only by providing external mechanical support to the patients back and ribs, but also by providing internal support as well as additional constraint of the heart; utilizing, for example, air pressure applied to the lungs, etc.
Another object of this invention is to provide a cardiac massage and resuscitation device providing means to limit the force applied to the victim to a predetermined value depending on the age, size and sex of the victim.
A further object of this invention is to provide a cardiac massage and resuscitation device capable of minimizing the effort used by the rescuer so that he can continue to produce the pressure impulses for long periods of time, as may be required.
A still further object of this invention is to provide a cardiac massage and resuscitation device which permits the rescuer to apply pressure impulses to the victims chest under conditions where it would be inconvenient or impossible to apply the impulses by placing his hands directly on the victims chest. Such conditions would include a victim who is trapped in a cave-in, or one who is in an ambulance where there is insuflicient head room for the rescuer to bend over the victim in order to apply substantially large pressure impulses to his chest.
3,425,409 Patented Feb. 4, 1969 ICC Other objects of this invention will become readily apparent upon a reading of the following specification and upon references to the accompanying drawings, in which:
FIGURE 1 is a side view partially in cross-section showing one arrangement of the device of the invention;
FIGURE 2 is a side view, similar to FIGURE 1, showing another embodiment of the invention;
FIGURE 3 is a side elevational view showing a means for automating the exhalation cycling of the embodiment of FIGURE 1; and
FIGURE 4 is a cross-sectional view showing a modification of the device of the invention.
In one embodiment of the invention, as shown in FIG- URE 1, there is provided a flexible belt 1 which can be adapted to encircle the chest so as to offer support to the ribs and back of said victim. Mounted on the belt is a cylinder 2 so arranged that it can be positioned over the sternum of the victim.
The cylinder 2 is provided with ears 3, 3 and pins 4, 4, so that the belt 1 can be attached to the cylinder by loops around the pins. Cylinder 2 contains a piston 5 which is supported by piston rods 6 and 7 that extend above and below the piston, respectively. Piston 5 is also provided with a flexible skirt 8 which forms a pressure seal between the piston and the internal wall of the cylinder. This skirt is made with a large convolution to permit large displacements of piston 5 while providing a pressure seal with negligible friction force. The skirt 8 is riveted or otherwise afiixed to the piston 5, as shown, and is held between the upper and lower portions 2a and 2b of the housing. A bushing 9 with suitable packing 10 is used at the point where the upper piston rod 6 passes through the top of the cylinder. A bushing 11 with a suitable packing 12 is used at the point where the lower piston rod 7 passes through the bottom of the cylinder.
A hand-lever 13 is used to produce axial motion of piston 5 in the cylinder. In the preferred arrangement an ear 14 is extended laterally from the top of the cylinder 2. A movable link 15 is extended vertically from and pinned to ear 14 as by the fixed pin 16. At the too of link 15 there is a pin 17 which passes through both link 15 and lever 13 and acts as the effective pivot for the hand-lever 13. The upper piston rod 6 is attached to the hand lever 13 by pin 18. Consequently, as the end 19 of the hand lever 13 is forced to move up and down by the operator, the piston 5 is caused to move up and down in cylinder 2. It is understood that movement of the piston may also be produced by electric or fluid power means using methods well known to those skilled in the art.
At the lower end of piston rod 7 there is provided a plate 20, to-the bottom of which a rubber pad 21 is cemented. A buckle 22 is provided on one end of the belt 1 so that it can be adjusted on the victim to fit snugly around his ribs when the rubber pad 21 is at its uppermost position of travel and is resting lightly against the victims sternum. Consequently, upon the downward displacement of piston 5 and pad 21, a pressure impulse will be applied to the sternum of the patient; and this pressure impulse will be removed upon the upward displacement of piston 5 and pad 21. Thus, pad 21, when suitably actuated, will intermittently apply a series of pressure impulses to the sternum of the patient so as to compress the heart and induce a circulation of the blood.
The displacement of piston 5 can also be used to cause compression of air or other suitable gas for delivery to the patient. On the downward motion of piston 5, air or other gas is drawn into chamber 23 through inlet check valve 24. On the upward motion of piston 5, the air is compressed and forced into accumulator chamber 25 through check valve 26. Chamber 25 is connected to fiacepiece 27 by means of the hose 28 so that if the facepiece is pressed tightly against the patients face to produce a seal around his mouth and nose, the pressure present in chamber 25 will be exerted on the patients trachea, lungs and internal organs. Not only can this pressure be used to ventilate the patients lungs, but by its action in inflating the lungs, etc., it provides internal support to the ribs and constrains the heart so that a given displacement of the sternum will become more effective in producing circulation of the blood. Chamber 25 is provided 'With an automatic relief valve 29 which vents excess pressure through openings 30, in order to protect the patient. Chamber 25 is also provided with a manually operated exhaust valve 31 with protruding stem 31 so that the operator, by pressing downward on stem 31, can cause the pressure in chamber 25 to drop rapidly to atmospheric pressure and thus permit the patient to exhale at suitable time intervals as determined by the operator.
These intervals for exhalation may correspond to one or more strokes of the lever 13 and may be timed so that exhalation occurs as the pad 21 moves away from the patients chest, or at some other desired time relationship. For example, lever 13 may be manually cycled at a rate of once per second, while the valve stem 31' is depressed on each downstroke; or, if preferred, once every 3 downstrokes. It may then be held in a depressed position for exhalation during as long a time as desired. The action of the exhaust valve 31 may also be produced automatically by lever, cam or pawl devices operated by the motion of lever 13 or piston 5, to produce the desired time/phase relationships. Such a construction is shown in FIGURE 3. In the piston rod 6 are formed a series of holes 32, into one of which a bent pin 34 may be inserted. As the bent pin 34 moves up and down, its lower end contacts one end of lever arm 35 causing the opposite end of lever 35 to turn pawl 36 through one-fourth of a turn. Both the lever 35 and pawl 36 are pivotally mounted on the cylinder 2. Attached to pawl 36 is a cam 37 having a lobe 38 to depress stem 31 of exhalation valve 31. Return spring 39 reposition s lever 35 to its original position against a stop 40 mounted on cylinder 2. Consequently, on each fourth stroke of lever 13 the exhalation valve 31 will be depressed and the patient will exhale, since a four-toothed pawl 36 is employed. Obviously any other desired relationship of the strokes of lever 13 to the actuation of valve 31 may be obtained by employing different pawls.
The force being applied to the patient may be indicated by means of markings on the rod 6 extending above piston 5, or more positively limited by making a series of holes 32 in rod 6 for the insertion of a heavy pin 33 to act as a limiting stop with respect to the displacement of piston and pad 21 (see FIG. 1). This will permit the travel of the piston to be adjusted to suit the size, age and sex of the victim.
The belt may be made extendable and adjustable by various means, including elastic materials, slip-joints, buckles, etc. The belt may be of hollow construction so as to be inflatable by the gas supplied by the pump or other means. A rigid back plate 47 and adjustable cushions 48 can be provided to support the patients back and sides. The exhaust valve 31 may also consist of a slide valve mechanism operated by the action of lever 13, either directly or through a system of levers or cams. Further, the air pump chamber need not be placed directly above the pressure pad, but it may be offset so that the axial stroke of the piston 5 may be substantially different than the axial stroke of pad 21.
Where it is desired to cause the patient to exhale once per stroke of the piston, the device of the invention may be modified to incorporate features as indicated in FIG- URE 2. 1
As shown in FIGURE 2, the air pressure generated by the upward motion of piston 50 is transmitted through the tube 51 to the valve assembly 52. This pressure forces the diaphragm 53 to be pressed against valve seat 54, so that the compressed air passes through the holes 55' in the phr g 5 and thence through opening 56 into a facepiece (110 shown) and into the trachea and lungs of the patient. As the piston 50 is next caused to move downward, a partial vacuum is produced in the tube 51, which causes diaphragm 53 to move away from seat 54 and to be pressed against seat 55. The pressure in the facepiece aids this motion of diaphragm 53 and the patients inflated lungs are now suddenly caused to exhale against diaphragm 53 and out to atmosphere through opening 56. Further, as the piston 50 moves downward in the cylinder 57, the air inlet valves 58 Open automatically permitting air to flow into the cylinder until piston 50 starts its upward motion to compress the air, whereupon the air inlet valve 58 closes automatically. An auxiliary air inlet valve 58' is located at the top of cylinder 57 to ensure that suflicient air is drawn into the chamber 23', to prevent excessive suction that might lead to the collapse of the piston skirt 8. The air compressed by the upward motion of piston 50 is again caused to flow to the patients lungs, as has already been previously described, and the cycle is repeated. Thus, for each downward stroke of the lever a pressure impulse is applied externally on the patients sternum while the patient is caused to exhale; and for each upward stroke of the lever, the external pressure impulse is removed from the patients sternum and the patients lungs are inflated.
In order to reduce the initial impact of applying pressure loads on the sternum, the mounting of the pressure plate of the device of FIGURE 2 may be modified as shown in FIGURE 4.
The piston 50' has a lower piston rod formed by tele scoping elements 61 and 62. A spring 59 is housed within the tubular element 61 to bias the lower rod element 62. The pressure plate 60 is aflixed to the rod element 62. The rod 62 is provided with an elongated slot 63 through which a pin 64 protrudes. The pin 64 is pressed through a hole or othenwise aflixed in tubular element 61. The pin-slot arrangement prevents unwanted rotation of the plate 60. Thus, the piston 50' can be caused to travel through a stroke different from the stroke of pressure plate 60 because of the lost motion connection described.
Since plate 60 is significantly restrained against downward motion by the structural resistance of the patients sternum to downward displacement, the result therefore of a downward displacement of the hand lever is initially to move the piston 50' against the restraint of spring 59. The displacement of the sternum will normally be negligible until the lower piston rod element 61 completes its downward travel with respect to rod 62 to contact plate 60.
In order to make the device of this invention less cumbersome; to remove the weight of the resuscitator mechanism from the patients chest; and to permit the use of the device as a lung ventilator only, without applying the pressure pulses to the sternum, the resuscitator mechanism of FIGURE 2 is shown with a different support structure than is illustrated in FIGURE 1. Thus, a backplate 65 is employed which has a belt 78 riveted or other- 'wise affixed thereto at 79. A leaf spring element 77 is also clamped to belt 78 by the rivet 79, in order to hold belt 78 extended horizontally when it is not in use. A buckle or other fastener is provided at the opposite extremity of belt 78 to permit engagement of the free end of belt 78 when he patient is in position beneath the pressure pad 21.
The backplate 65 is provided at one end with a boss 66 having an opening '67 into which a rod 68 is mounted. The rod 68 is retained in position by the set screw 69. Slidably mounted upon rod 68 is a support arm 73 for the resuscitator cylinder 57. The arm 73 has a horizontally extending portion 74 to which the cylinder 57 is aflixed as by the rivets 75, 75. The arm 73 is provided with a sleeve 70 having the opening 71 through which the rod 67 extends. A clamp screw 72 is threaded into sleeve 70 for locking the arm 73 at any desired vertical or angular position.
Although specific embodiments of this invention have been shown and described, it will be readily apparent to those skilled in the art that various modifications and rearrangements of the parts may be made without departing from the spirit and scope of the invention as set forth in the appended claims.
What we claim is:
1. A device for resuscitation and cardiac massage comprising chest-encircling means, means for intermittently applying a mechanical force primarily at the sternum area of a patients chest, actuating means mounted upon said chest-encircling means and mechanically interconnected in a force and motion transmitting relationship 'with said intermittent force applying means, fluid pump means for creating positive pressure fluid, said actuating means being further mechanically interconnected to positively operate said fluid pump means, and means for transmitting said positive pressure fluid to the lungs and trachea of a patient at times other than when the mechanical force is applied to the sternum area.
2. The device of claim 1 wherein the fluid pump means includes an element from which said intermittent force applying means depends.
3. The device of claim 1 wherein an accumulator chamber is associated with said fluid pump means for receiving the pressurized fluid therefrom, means leading from said accumulator chamber to -a facemask, whereby the pressurized fluid is transmitted to and from the lungs of a patient, said accumulator being provided with means for intermittently venting fluid to atmosphere to thereby cause exhalation at a desired relationship to the force application.
4. The device of claim 1 wherein said fluid pump means comprises a piston and cylinder, and said fluid pressure transmitting means is connected to communicate with the cylinder at a position above that of the piston within said cylinder.
5. The device of claim 1 including means providing a lost motion interconnection between said actuating means and mechanical force applying means.
References Cited UNITED STATES PATENTS 2,071,215 2/1937 Petersen 128-53 2,486,667 11/ 1949 Meister 128-28 3,219,031 11/1965 Rentsch l2851 3,242,921 3/1966 Seeler 128--14S.5 3,254,645 6/ 1966 Rand et al. 12852 3,336,920 8/1967 Thomas 128-53 3,348,536 10/1967 Tambascia 128-53 3,351,052 11/ 1967 Henson 128-145.8
FOREIGN PATENTS 1,310,617 10/1962 France.
CHARLES F. ROSENBAUM, Primary Examiner.
US. Cl. X.R.