Institute of Critical Care Medicine

Nihon Kohden Corporation

Cardio Pulminary Laboratory Research Foundation

Jose Bisera

Max Harry Weil

Wanchun Tang

James H Carrington

Victor E Kimball

Methods, formulations and kits are described for resuscitating a patient suffering from cardiac arrest, for enhancing the efficacy of cardiopulmonary resuscitation, for treating post-resuscitation hypotension, and for reducing the incidence of ventricular arrhythmias and myocardial dysfunction in a patient following cardiopulmonary resuscitation. Prior methods and agents often cause inotropic or chronotropic effects, which can lead to undesirable post-resuscitation myocardial dysfunction. The invention comprises administering a therapeutically effective amount of an &agr; -receptor agonist that does not cross the blood-brain barrier, such as &agr;-methylnorepinephrine, to enhance cardiopulmonary resuscitation.

Administration of an &agr;2-adrenergic receptor agonist to enhance cardiopulmonary resuscitation

Methods and devices are provided for assessing impairment of blood circulation in a patient, such as that in perfusion failure, by measurement of blood flow in the gastrointestinal tract or upper respiratory/digestive tract of the patient. The method comprises introducing a blood-flow sensor into the gastrointestinal tract or the upper respiratory/digestive tract of a patient, placing the sensor adjacent a mucosal surface therein, and measuring blood flow in adjacent tissue to determine blood flow in that tissue. The method may also involve measurement of PCO,and/or pH in combination with the blood flow determination. The invention affords rapid measurement and detection of perfusion failure.

Method and device for assessing perfusion failure in a patient by measurement of blood flow

Methods and devices are provided for assessing impairment of blood circulation in a patient, such as that in perfusion failure, by measurement of pCO,(partial pressure of carbon dioxide) in the upper digestive and/or respiratory tract of the patient. The method comprises introducing a carbon dioxide sensor into the upper digestive and/or respiratory tract of a patient, without passing the sensor down through or beyond the patient's epiglottis. Specifically, a carbon dioxide sensor is placed adjacent a mucosal surface within the upper digestive and/or respiratory tract, preferably within the patient's mouth or inside the patient's nose. By avoiding passage through the mouth into the throat and esophagus, discomfort is substantially avoided and the potential for injury minimized. Previously, the belief in the art was that increased partial pressure of carbon dioxide was a localized phenomenon during perfusion failure; however, applicants have now discovered that increases in tissue CO,occur throughout the body during perfusion failure, and the method and device of the invention are premised on this discovery.

Method and device for assessing perfusion failure in a patient

A device and method are provided for assessing impairment of blood circulation in a patient, such as that in perfusion failure, wherein the patient requires mechanical ventilatory support. The invention involves measurement of PCO.sub.2 (partial pressure of carbon dioxide) within the lower respiratory tract of the patient, using a device that includes an endotracheal breathing tube for introducing air from an air supply pump into a patient's lungs, wherein a carbon dioxide sensor is provided as an integral part of that device, i.e., is physically connected to the endotracheal breathing tube in a manner that allows for PCO.sub.2 measurement along the sidewall of the patient's trachea.

Device and method for assessing perfusion failure in a patient during

A method and apparatus are provided for assessing impairment of blood circulation of a patient by measurement of PCO.sub.2 (partial pressure of carbon dioxide) in the upper digestive/respiratory tract of the patient. The method includes introducing a CO.sub.2 sensor into the mouth-nose area and against a mucosal surface. In one example, the sensor is placed under the tongue, in the manner of an oral thermometer, and sublingual (under the tongue) measurements of CO.sub.2 are taken. This allows for the triage of patients or victims in emergency of disaster settings. The measurement involves minimal invasion while avoiding false readings. For monitoring of more than about one or two minutes, holders are used to hold the CO.sub.2 sensor instrument stabily in the mouth or nose, and to isolate the mucosal area immediately around the CO.sub.2 sensor from air flow that could carry away CO.sub.2, while maintaining high humidity.

Patient CO.sub.2  Measurement

A method is described for assessing perfusion failure of a patient by measurement pCO.sub.2 (partial pressure of carbon dioxide) in the digestive system of the patient. The method includes introducing a catheter (10, FIG. 1) through the nasal passage until a sensor (12) on the catheter lies in the esophagus, and taking measurements of CO.sub.2 in the esophagus. The measurements can be taken at the wall of the esophagus without inflating a balloon, by instead allowing the walls of the esophagus to contract about the catheter and the sensor thereof. The measurement involves minimal invasion while avoiding false readings such as those arising from CO.sub.2 produced in the stomach during digestion.

Measurement of systemic perfusion

A method and apparatus are described for resuscitating a person who has suffered cardiac arrest. The method includes threading a balloon through the aorta until it lies along the ascending aorta, and then inflating the balloon (40, FIG. 1) to block the ascending aorta to thereby increase blood flow into the coronary arteries (30, 32). A tube (42) extends through the balloon, and blood-compatible fluid which is preferable oxygen rich, is injected past the balloon to provide additional oxygen-carrying fluid to flow through the coronary arteries when the balloon is inflated. The balloon is repeatedly deflated and inflated, so after a period of perhaps 30 seconds during which blood flows only to the coronary arteries, the balloon is deflated to allow some blood flow to the brain. During the entire procedure, pressure is repeatedly applied to the chest and therefore to the heart to sustain blood circulation.

Cardiac arrest treatment

Apparatus for facilitating the performance of medical procedures involving the vascular system of a patient, especially in a critical care environment, such as withdrawal of blood for analysis and infusion of medication. In the taking of a blood sample, blood flows through an arterial catheter connected to an artery of the patient, past a sample station, and then through a venous catheter that brings the blood back to the patient, the various mechanisms being connected by transparent plastic tubes. After a sample is taken, the tubes are flushed through the sample station, arterial catheter, and the venous catheter. Calibration of all pressure transducers requires application of high and low pressures to them, the high pressure being obtained by applying a high pressure (e.g. 200 mm Hg) to a bottle of saline solution which is also utilized to flush the tubes and which is connected to all of the transducers.

Vascular interface

A monitor is described for use with an intravenous injection system of the type that includes an accumulator (18) located between the pump (14) and the needle (28) that connects to the patient's vein. The monitor generates an alarm when there is infiltration (no resistance to outflow, as when the needle withdraws from a vein) or occlusion (the needle is blocked). The monitor includes a pressure sensor (32) coupled to the accumulator, and a circuit (34) which responds to the rate of change of the pressure to operate an alarm when the rate of change exceeds a predetermined amount such as 5 mm Hg, but only when it exceeds that value over a particular time period such as 10 seconds or one minute.

Monitor for intravenous injection system for detecting occlusion and/or

High frequency medical breathing apparatus is provided, which delivers efficiently controlled high frequency air pulses to a catheter, and which is of relatively low cost and is energized by pressured air that is commonly available in a hospital environment. The apparatus includes a large flexible bag with entrance and exit openings, walls forming a sealed chamber around the bag, and a source that applies pressure pulses to the chamber to partially compress the bag at each pulse so as to deliver air through the exit end of the bag and a check valve, and into a catheter that leads to a patient's lungs.

High frequency ventillator

An apparatus is provided for injecting fluid into a patient over an extended period of time, such as in intravenous feeding of a patient. The apparatus enables close control of injection quantity and rate while assuring an even flow into the patient. The apparatus utilizes relatively simple disposable parts. The apparatus includes an air-operated peristaltic pump which pumps a controlled amount of fluid in each cycle of operation, and a pressure moderator which receives the liquid pulses and supplies an even flow to the patient. The moderator includes a closed chamber, and a resilient tube connected to the pump and having slits that permit the escape of pumped liquid into the chamber. The peristaltic pump includes a flexible but nonresilient tube connected to the container, the nonelasticity assuring that the tube does not expand beyond a predetermined dimension when a vacuum is applied to it.

Closely controllable intravenous injection system

A method and apparatus for assessing the condition of a patient in circulatory shock by measuring the peripheral or skin temperature of the patient, as by measuring the difference between the patient's toe temperature and ambient temperature, which is more accurate than heretofore. The gradient of the toe-minus-ambient temperature difference is calculated, and an indication of poor condition is given if the toe-minus-ambient temperature difference does not rise by at least a predetermined amount such as 3.degree. C. within a predetermined period such as ten hours. Instead of taking only the difference between the temperature at one toe and ambient, the temperatures at both large toes of the patient are taken and the difference between the higher of the two toe temperatures minus ambient is utilized in the calculations that provide an indication of patient condition.

Apparatus and method for assessing the condition of critically ill

An osmotic sensing head for measuring the osmotic pressure of protein molecules in blood, which is of the type that includes a reference chamber for holding saline solution, a sample chamber for holding blood, an osmotic membrane between the chambers, and a pressure sensor coupled to the reference chamber to measure the pressure therein. The sample chamber has a small volume and is provided with an inlet and outlet so that a storage saline solution can be removed and a blood sample introduced by merely flowing the blood sample in through the inlet while allowing the storage solution to pass out through the outlet. The inlet is directed at the membrane at an angle to help wash away material lying on the membrane. The osmotic membrane is held in slight tension by an elastomeric O-ring which presses the membrane against a conical surface.

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Camarillo, CA, United States of America

Jose Bisera