Method for defibrillation of cardiac ventricles

FIELD: medicine, cardio-pulmonary resuscitation.

SUBSTANCE: one should strike a blow for the 2nd intercostal area right-hand against patient's sternum. The present innovation enables to restore rhythmic contractions of cardiac muscle due to inducing mechanical energy with a pacemaker followed by transforming it into electric energy.

EFFECT: higher efficiency.

2 ex

 

The invention relates to medicine, namely to cardiopulmonary resuscitation, and can be used for ventricular fibrillation, as well as in cases of ventricular tachycardia, AV block, asystole.

Electrical defibrillation (ED) is an effective means of terminating ventricular fibrillation (FG) of the heart during cardiopulmonary resuscitation (CPR). According to Greer K., Cavallaro D. (1996) FJ occurs in 90% of cases, Electromechanical dissociation heart with asistoliei about 10% with cardiac arrest. Despite the high efficiency of the ED in the intensive care unit affected, it is not always possible to apply it. The main reason is the inability to use the ED at the moment the heart stops to medical care in the prehospital and in hospitals due to the lack of electric defibrillator.

To compensate for this disadvantage world health organization (Collector who, 1976, p.93-94, Safar and Ngige in kN.: "Cardiopulmonary and cerebral resuscitation", 1997, s-358) proposed to fill this large gap in the CPR by defibrillation without the use of electric current. The essence of this method is the following: "In the area of the middle part of the sternum in the 1st minute after cardiac arrest fist generate reactive (not g is oxycoccos) the heart of a small electrical impulse. The kick is able to restore the contractions of the heart in cases of asystole ventricular fibrillation caused by heart block, as well as the commencement of ventricular tachycardia (VT) or ventricular fibrillation. For heart blockages kick can play the role of an artificial pacemaker" (Collector who, 1976, p.93). A significant disadvantage of defibrillation is the low efficiency of the method in the return of life compared with ED. In addition, "... under anoxic asystole and with a massive unmet blood loss kick ineffective. Don't need the kick and adipose tissue, providing normal circulation" (ibid, s).

Safar and Ngigi (in kN.: "Cardiopulmonary and cerebral resuscitation", 1997, s, RES) for defibrillation recommend "a Sharp blow in the region of the heart. From a distance of 20-30 cm on the chest in the region of the middle part of the sternum to strike as fast as a single fist (the lower soft part). ... electric current that occur in the heart as the result of a sharp blow in the region of the heart, is powerful enough to stop Fi... there are some experimental and clinical evidence suggesting that a sharp blow in the region of the heart, adipose tissue, and sometimes even when Fi you can install sinus rhythm. In severe bradycardia or asystole due to heart block (syndrome, Morgagni-Adams-Stokes equations) to repeat rye tapping in the heart, started within 30 s after cardiac arrest, often restore normal heart activity and serve as external mechanical pacemaker ("fist pacemaker"). Because tapping can begin immediately any person, they are recommended for use by any rescuer as the first phase of CPR when the prescribed cardiac arrest: 1) without ECG monitoring when the defibrillator at this time is unavailable and 2) in terms of ECG monitoring during ventricular tachycardia, accompanied by the absence of pulse or ventricular fibrillation. Tapping does not stop the fibrillation and do not restore the reduction in anoxic hearts, so they cannot replace CPR. However, a sharp blow may cause ventricular fibrillation" (ibid, s-358). This method is used for the prototype. However, according to Appelbee (in kN.: Clinical physiology, 1984, p. 166) successful results outside of the hospital did not exceed 15%. The prototype, precardiac punch (PU), a fist on the sternum, contributes mainly mechanical stress on the muscles of the ventricles, is able to decrease after conversion of mechanical energy into electrical energy, equal to 2-5 J.

Safar and Ngige recommend the use of PU in the area of the middle part of the sternum at VT full of atroven regularnog blockade and asystole (in kN.: "Clinical cases in anesthesia", pp.96), but unfortunately, they do not celebrate the efficacy of defibrillation.

The low efficiency of this technique we explain the fact that when struck his fist on the middle part of the sternum mechanical energy is dissipated on the surface of the sternum and rib cage with exposure to weak mechanical energy to the pacemaker. Thus, according to Greer K., Cavallaro energy precardiac impact does not exceed 2-5 j (in kN.: "Cardiopulmonary resuscitation", 1966, p.28). Although it is well known that the cardioversion with low energy (20 j) is effective in the treatment of adipose tissue, and in unstable hemodynamics required discharge in 100 j. When relatively stable hemodynamics, it is advisable to apply 50 J.

Electrical defibrillation is performed with the energy 200-300-360 j with high efficiency.

The proposed method solves the problem of increasing the effectiveness of resuscitation in the absence of an electric defibrillator.

The technical result when using the invention - improving the efficiency of the normalization of the heart muscle due to excitation pacemaker greater mechanical energy and converting it into electricity, which is enough to reduce heart muscle.

This technical result is achieved by the fact that in the 2nd intercostal space to the right of the sternum put a single sharp blow with a fist.

Obseive the IDT, in normal conditions, the heart muscle is functioning thanks to the influence of the conduction system of the heart. In the sinoatrial node, located in the right atrium between the hollow veins at the level of the second intercostal space to the right of the sternum, are special cells - cells of the Pacemaker capable of getting turned on to transfer the energy conducting system of the heart for the normal functioning of the muscular system of the Atria and ventricles.

In numerous experiments and in the clinic proved that "the impact of under - and above-threshold defibrillation pulses FG does not cause the contractile response of the myocardium. When effective defibrillation first contraction of the heart muscle is a response to a stimulus pacemaker". (Amernic et al., in W-Les "Anesthesiology and reanimatology", 1985, No. 5, p.65).

On the basis of the foregoing that normalizerbase effect discharge the high voltage capacitor is instantaneously transmitted to the conducting system, starting from the sinoatrial node pacemaker to the heart muscle. If not applied energy defibrillation in experiments and clinic get the opposite effect. For example, if a VT after defibrillation subthreshold energy instead of sinus rhythm get ventricular fibrillation, which can result in death.

The proposed method is SL is blowing. The victim from a distance of 20-30 cm on the chest in the 2nd intercostal space to the right of the sternum causing a sharp quick single blow (the lower soft part). The impact with impact directly on sinus node reproducing electrical impulses and transmits them via the conduction paths contributes to sinus rhythm of the heart.

The authors in scientific medical and patent literature not found information about celebrity blow in the 2nd intercostal space to the right of the sternum for defibrillation of ventricular fibrillation. Thus, the claimed invention meets the criterion of "novelty".

The authors were first established that a kick in the 2nd intercostal space to the right of the sternum causes the transformation of the greater part of the mechanical energy into electrical energy, which is enough to reduce heart muscle. Thus, the claimed invention meets the criterion of "inventive step".

Prehospital precardiac blow to the prototype, not having electric defibrillator was used in 9 cases. Of them positive effect was observed only in two cases.

The proposed method is illustrated by the following examples.

Example 1. In the receiving Department when hemodynamic using ECG in 11 cases was diagnosed with ventricular fibrillation. In 4 cases used a shot of the prototype effect is Lucile only in one case. In 3 patients used a repeated impact by the proposed method with a positive effect in all three patients. In 6 cases the remaining 7 patients, which was immediately used a blow to the proposed method, it has been effective. One patient with extensive infarction and unstable hemodynamics kick proved to be ineffective.

Example 2. In intensive care units in 9 patients with ventricular fibrillation resuscitation was performed according to the proposed method. A positive effect was obtained in 6 patients, in three ineffective cases used electrical defibrillator discharge 200-260 and 360 joules. Only in one case have an effective defibrillation. In 2 cases, ED was also ineffective.

In all cases, ineffective defibrillation used CPR in full.

High positive effect in use of the invention is achieved by:

1) PU is applied immediately when the diagnosis of cardiac arrest in the first minute;

2) PU is applied in the second intercostal space to the right of the sternum, i.e. directly on the pacemaker sinoauricular site;

3) PU allows you to initiate a pacemaker with higher mechanical energy;

4) pacemaker cells sinoauricular site with high mechanical energy converted into electrical sufficient value, causing the normalization with technol muscles;

5) PU can be applied not only physicians, but also trained paramedics in all situations, wasting no time in preparing for ED;

6) PU can be applied in the absence of an electric defibrillator.

The proposed method is easily reproducible, when it achieved the specified technical result. Thus, the claimed invention meets the criterion of "industrial applicability".

The way defibrillation of the heart ventricles by means of a single sharp blow with a fist in the chest, characterized in that the shock is applied to the second intercostal space to the right of the sternum.



 

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