THINKING OUTSIDE THE BOX

Ben Best wrote:

In 2004 CI Member Paul Michaels helped us obtain some Ambu Cardio Pumps from England. We are running short again, but Paul is no longer in a position to help us obtain them. What we require is someone in England who has a business and a VAT registration number who will agree to help us buy these pumps and send them to the US. Any suggestions? For more background on what the Ambu CardioPump is all about, I quote from my website:

Somewhat better than manual CPR -- and more effective is AC/DC (Active Compression/DeCompression) CPR with an plumber's helper type Ambu Cardio pump which is applied to the patient's chest and provides cardio-action on both the upstroke and downstroke. But this too can be tiring, if manual mechanical units can be purchased, if they can be afforded.

AC/DC units are highly politicized in the United States because the FDA has created bureaucratic barriers.

From Jordan Sparks:

I'm sorry, I know this sounds very irreverent, but has anyone tried an actual modified toilet plunger? I bet there are some fancy ones out there that don't look typical, so nobody would notice. I'm going to begin searching.

I just tried one on the washroom floor of the CI Facility,, and I think that it could work reasonably well for someone who could straddle a patient and wear gloves to keep splinters out of their hands. The rubber on the CardioPumps is a bit softer, but I think you’re right that a toilet plunger would make a handy and often readily-available alternative. It embarrasses me that I have not thought of suggesting this before. I do think that the CardioPump is a bit better, if available.

John K. Strickland, Jr. wrote:

The more brains working on a problem, the faster it gets solved! Why would you get splinters? Are the handles on some brands that rough? You might want to lightly sand a very smooth handle for a better grip Speaking of handles, would it be useful to modify the handle of a plunger with a shovel's D-shaped handle, to make pulling easier, and also perhaps shorten the handle. This is basic human factors design stuff. Also, certain brands of plungers may be softer or harder and thus better or worse for this use. Is there a resuscitation dummy available to test these ideas on?

I have just washed the toilet plunger from our washroom and tried it out on our resuscitation dummy as John suggested, straddling the dummy. It works fine! Remember, the whole idea of ACDC resuscitation devices began with a physician using a toilet plunger to do CPR, with resounding success. I would highly recommend this to anyone -- any of our Members -- who is in a situation where they have a cryonics patient whom they want to give CPR while cooling.

Photo Debbie Fleming: $2.79 plunger vs $250 Cardio pump

As one of our Members recently noted, CPR with ice packed under the armpits is a good way to get colder blood going to the brain and thereby cooling the patient more rapidly. Of course slush ice gives much better cooling than ice cubes, but can be very messy.

Admittedly, a cryonicist in a hospital administering cryonics rescue procedures on a dearly beloved deanimated loved-one on a bed covered with water ice slush using a toilet plunger is not likely to inspire a high professional regard among some of the hospital staff. The regard of hospital staff is often critical in gaining co-operation.

I do think John's suggestion of a shovel-like D-shaped handle on the plunger stick bears investigation. I also think that if CPR can be given with this device in a standing position, it can probably be done for a longer time, with better force and with less fatigue and strain than the method of an Ambu-CardioPump, which requires gripping the device with both hands and applying force through the base of the palms. But experimentation is called-for.

Jordan Sparks wrote:

I have to disagree. I can't generate 110 lbs (50 Kg, 489 N) of Downward force repeatedly without tiring unless I'm in the standard CPR position with my elbows locked and really leaning into it. The vertical handle is a distraction and an impediment to doing proper CPR. The compression stroke will remain the most important and people need to focus on that part of it. For instance, the pictures on the CI website of Andy demonstrating the Ambu are very wrong. I would estimate from his angle of attack that he's putting maybe 20 lbs of force into it, far short of what would be necessary. Unless the person doing CPR is a very heavy and strong man, they will essentially need to put their entire body weight into each compression. Not going to happen for very long at 90 cycles/min using a vertical wooden handle.

You might have been able to get some extra efficiency out of it, but I don't think a typical person will be able to. And yes, an unmodified toilet plunger is ludicrous enough that I would never dream of recommending it. The one advantage it might have, however, is that you could do it while the patient was in an ice bath without having to sit in water.

You are right, Jordan, that the CardioPump demonstration by Andy shown on the CI website would not generate much force for CPR. My intention at the time was simply to demonstrate the ACDC phenomenon -- which I hope was visible from the pictures -- ie, that the CardioPump is able to suction the chest as well as compress the chest. This is not relevant to the question of whether adequate pressure could be generated with a toilet plunger.

You are right about the amount of force that can be generated by the toilet plunger, however. I just tried the toilet plunger on our scale and it was quite hard to consistently generate a 100 pound force. Much effort needs to be put into maintaining the stick in the vertical position and it is simply hard to push effectively. The Ambu CardioPump works fine, however. The CardioPump has a scale on top allowing the user to read how much pressure is being generated.

The CPR standard is one to one-and-a-half inches compression. I think this would require different amounts of pressure depending on the frame of the person -- a light elderly woman would be different from a portly man. A portly man would probably require the one-and-a-half whereas the light elderly woman might be better with one inch (and might do better if a toilet plunger was being used in an emergency).

Do let me know how your T-bar construction works-out. Would you make one by simply cutting a toilet plunger a few inches above the cup and drilling a hole through the stick for the T-bar?

Ben

Jordan Sparks

A T-bar would be simpler to build than a D handle. But I'm still certain that two parallel handles gives you more control because you have four support points instead of two. The Ambu essentially uses two parallel handles. But I haven't used it, and you seem to indicate that it's awkward. Maybe they just should have gone with two cylindrical parallel handles instead of making you use your palms which puts stress on your wrists. I'm personally probably going to go with a T-bar because it's so easy to build. And I also don't intend to use a manual device like this unless there is a malfunction in the rescue cart or unless it hasn't arrived yet. So it's really only a backup.

Jordan Sparks

From Jordan:

Here's a link to suction cups I found in less than 5 minutes using google:

http://www.anver.com/document/vacuum%20components/vacuum%20cups/cups-b1.5.htm

They look absolutely identical to the Ambu CarioPump, but very likely without the high price tag.

Editor’s note: Reminds us of the story about NASA spending millions for a pen that would write in zero gravity. The Russians use a pencil.

Coincidentally, FLORIDA TODAY ran this item in early December: A plumber's friend, or plunger, Can be an even better buddy than you might think. If you've ever had a drawer that is stuck closed or the drawer pull has come off, you can. push the plunger on the front of the drawer and, once stuck, it can. be used to pull the drawer out. If you have a tile that needs to be pulled out of the. floor but you. can't get hold of the edges to do so, a plunger could be used for this as well. It can even be used to pull small dents out of your car. Looks like CPR could be added to this list!