Head Up CPR System with Integrated and Optimized Mechanical Active Compression Decompression for Improving Survival after Cardiac Arrest

摘要 这项应用的总体目标是提高心脏骤停后神经功能完整的存活率。 (SCA)，这是美国成年人死亡的主要原因。尽管有传统的(C)心肺复苏术，但30万人中的10% 在美国，每年30万住院SCA患者中，30%的人在神经功能良好的情况下存活下来 功能。我们建议开发和评估一种新的综合平视体位(HUP)的心肺 复苏(CPR)系统主要设计为允许基本生活服务(BLS)提供者(消防队没有 护理人员)，以快速提供全自动心肺复苏，包括第一次自动呼吸输送和 自动和优化的全抬起主动按压减压，以增加神经学上的可能性 SCA后的完整生存和增加船员的安全。该提案的重点是进一步开发和交付 基于我们最新突破的创新一体式HUP复苏系统(HRS)，用于BLS团队 头胸联合控制序贯抬高在SCA中优化脑血流灌注的研究 使用主动压缩减压(ACD)CPR和阻抗阈值装置(ITD)。AS 在一个被广泛接受的猪SCA模型中显示，HUP CPR结合全举ACD CPR和ITD 独一无二地利用重力来加强从头部和颈部、低颅内的静脉血液的排出 血压，并显著增加全身和脑血流量，以及神经完好的可能性 生死存亡。这一应用程序的总体目标也得到了来自HUP CPR的新临床数据的支持 注册表展示了这种神经保护方法，当通过以下方式快速部署时，提供了显著的好处 紧急医疗服务(EMS)第一反应人员。此外，在全国范围内资源紧张的EMS系统中 人们越来越需要开发技术，以最大限度地减少交付高性能所需的资源 高质量的心肺复苏，对患者的预后最好，对救援人员也更安全。我们建议实现这些目标 通过展示纳入1)自动化和集成的ACD CPR和2)实现集体目标 将自动呼气输送到易于部署的全自动HUP CPR系统中，对于 BLS提供商，将减少CPR人员资源需求，最重要的是将优化机会 用于SCA术后神经学上的完整存活。因此，具体目标是：1)确定最佳波形 在HUP期间使用全ACD CPR优化脑和心脏血流，并将优化的波形与 猪存活研究中的Lucas 3.1波形和2)设计和原型一体式功能性HRS 具有集成的、优化的和自动化的全ACD CPR和自动呼吸输送的设备。

Abstract The overall goal of this application is to improve neurologically-intact survival rates after sudden cardiac arrest (SCA), the leading cause of death in adults in the US. Despite conventional (C) CPR, <10% of 300,000 pre- hospital and <30% of 300,000 in-hospital SCA patients in the US each year survive with favorable neurological function. We propose to develop and evaluate a novel comprehensive Head Up Position (HUP) cardiopulmonary resuscitation (CPR) System designed primarily to allow Basic Life Services (BLS) providers (a fire crew without paramedics) to rapidly deliver fully automated CPR, including for the first time, automated breath delivery and automated and optimized full lift active compression decompression, to increase the likelihood of neurologically intact survival after SCA and increase crew safety. The proposal focuses on further developing and delivering an innovative all-in-one HUP resuscitation system (HRS) for BLS teams based on our most recent breakthroughs in optimizing brain perfusion during SCA using controlled sequential elevation of the head and thorax combined with Active Compression Decompression (ACD) CPR and an impedance threshold device (ITD). As demonstrated in a well-accepted porcine SCA model, HUP CPR combined with full lift ACD CPR and an ITD uniquely harnesses gravity to enhance drainage of venous blood from the head and neck, lower intracranial pressure, and markedly increase systemic and cerebral blood flow and likelihood for neurologically-intact survival. The overall objectives of this application are also supported by new clinical data from a HUP CPR Registry demonstrating this neuroprotective approach provides a striking benefit when deployed rapidly by Emergency Medical Services (EMS) first responders. Moreover, in resource-strapped EMS systems countrywide there is a growing need to develop technology that minimizes the number of resources required to deliver high quality CPR that is best for patient outcomes and safer for rescue personnel. We propose to achieve these collective objectives by demonstrating that incorporation of 1) automated and integrated ACD CPR and 2) automated breath delivery into an easy to deploy and fully automated HUP CPR system, is feasible and safe for BLS providers, will reduce CPR personnel resource requirements, and most importantly, will optimize chances for neurologically intact survival after SCA. As such, the Specific Aims are: 1) Determine the optimal waveform during HUP with full ACD CPR to optimize brain and heart blood flow and compare the optimized waveform with a LUCAS 3.1 waveform in a porcine survival study and 2) Design and prototype a functional HRS, an all-in-one device with integrated, optimized, and automated full ACD CPR and automated breath delivery.