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Oxylator® Product Series
Overview
Oxylator® EM-100
Introduction
Brochure (PDF)
Operating Manual (PDF)
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Disassembly for Cleaning



Comparison of Features among Ventilation Devices


How to Use Effectively
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Case Studies



St. Gallen Cantonal Hospital, Switzerland (PDF)



Hospital Princeps d'Espanya Bellvitge, Barcelona, Spain



Royal Victoria Hospital and McGill University, Montreal, QC, Canada



Montérégie's EMS System, Longueil, QC, Canada



NTV a Nederlands Tijdschrift Voor Anesthesi- medewerkers, Netherlands



Helicopter Emergency Medical Services, University Hospital Rotterdam, Netherlands



University of Massachussetts Medical Center, Worcester, MA, U.S.A.



Emergency Scientific Medical Center, Yerevan, Armenia


CPR Medical Devices Inc., Toronto, ON, Canada
Testimonials


Carter County Emergency & Rescue Squad, Inc., Elizabethton, TN, U.S.A.


University of Massachusetts Medical Center, Worcester, MA, U.S.A.


U.S. Department of Veteran Affairs, Dublin, GA, U.S.A.


Croft Rescue Squad, Spartanburg, SC, U.S.A.


Lenoir Memorial Hospital, Kinston, NC, U.S.A.


Dunn Rescue Squad, Inc., Dunn, NC, U.S.A.

Jefferson County EMS, Dandridge, TN, U.S.A.
Oxylator® FR-300
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Brochure (PDF)
Operating Manual (PDF)
Usage Guide
Photographs
Publications


Patents, Approvals, and Clearances
Case Studies


St. Elisabeth Hospital, Tilburg, NL (PDF)

University of Massachussetts Medical School, Worcester, MA, U.S.A. (PDF)
Oxylator® EMX
Introduction
Brochure (PDF)
Operating Manual (PDF)
Usage Guide
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Patents, Approvals, and Clearances
Oxylator® HD
Introduction
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St. Michael's Hospital, Toronto, ON, Canada (PDF)

Patents, Approvals, and Clearances
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Oxylator® EM-100 (PDF)
Oxylator® FR-300 (PDF)
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Oxylator® EM-100 (PDF)
Oxylator® FR-300 (PDF)
Oxylator® EMX (PDF)
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Oxylator® FR-300 (PDF)
Oxylator® EMX (PDF)
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Oxylator® EM-100
Oxylator® FR-300
Oxylator® EMX
Oxylator® HD
Case Studies
Oxylator® EM-100


St. Gallen Cantonal Hospital, Switzerland (PDF)


Hospital Princeps d'Espanya Bellvitge, Barcelona, Spain


Royal Victoria Hospital and McGill University, Montreal, QC, Canada


Montérégie's EMS System, Longueil, QC, Canada


NTV a Nederlands Tijdschrift Voor Anesthesi- medewerkers, Netherlands


Helicopter Emergency Medical Services, University Hospital Rotterdam, Netherlands


University of Massachussetts Medical Center, Worcester, MA, U.S.A.


Emergency Scientific Medical Center, Yerevan, Armenia

CPR Medical Devices, Inc., Toronto, ON, Canada
Oxylator® FR-300


St. Elisabeth Hospital, Tilburg, NL (PDF)

University of Massachussetts Medical School, Worcester, MA, U.S.A. (PDF)
Oxylator® HD
St. Michael's Hospital, Toronto, ON, Canada (PDF)
Testimonials
Oxylator® EM-100

Carter County Emergency & Rescue Squad, Inc., Elizabethton, TN, U.S.A.

University of Massachusetts Medical Center, Worcester, MA, U.S.A.

U.S. Department of Veteran Affairs, Dublin, GA, U.S.A.

Croft Rescue Squad, Spartanburg, SC, U.S.A.

Lenoir Memorial Hospital, Kinston, NC, U.S.A.

Dunn Rescue Squad, Inc., Dunn, NC, U.S.A.
Jefferson County EMS, Dandridge, TN, U.S.A.
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Helicopter Emergency Medical Services, University Hospital Rotterdam, Netherlands
REA 2000, Ostschweizer Bildungsaustellung, St. Gallen, Switzerland
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Features
Oxylator® outperforms bag-valve, in the European Journal of Anaesthesiology Oxylators® reviewed in the Journal of Emergency Medical Services
Oxylator® bests bag-valve in peer-review studies Oxylators® reviewed in JEMS magazine
Internal study, 1995

Studies of the Oxylator® EM-100 Resuscitation System


CPR Medical Devices, Inc.
161 Don Park Road, Markham, Ontario, Canada


Introduction | Protocol | Methods | Results | Discussion | Conclusions


Introduction

The EM-100 Oxylator® is a compact, hand-held resuscitator/inhalator intended for use by emergency response personnel whenever a patient's ventilatory ability has been compromised. The EM-100 may be used as a resuscitator or, for a patient who is breathing spontaneously but is in need of supplemental oxygen enrichment, as an inhalator. It is a stand-alone unit, requires a source of appropriately-regulated oxygen to function (pressure of 50 psi), and offers the care-giver great flexibility in responding to the patient's needs.

The Oxylator® contains a valve that delivers compressed 100% oxygen at a maximum flow rate of 40 litres per minute from a pressure source of 50 psi. The system also permits the adjustment of it's maximum inspiratory pressures from a value of 25 cmH2O to 50 cmH2O.

The system has four different operation modes:

1. Manual mode
2. Manual mode with the addition of a baseline pressure (PEEP)
3. Automatic cycling mode with a baseline pressure (PEEP)
4. Inhalation mode which provides oxygen enriched air

The third mode, automatic cycling, was used in our investigations. This mode was used in order to study the efficacy of the EM-100 in delivering adequate ventilation simultaneously with continuous chest compressions.

The EM-100 Oxylator® system meets all of the standard recommendations and guidelines for oxygen powered resuscitation devices published in JAMA 268, 2199-2241, 1992.

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Protocol

Investigation 1: using the Oxylator® EM-100 resuscitation device (automatic cycling mode) and a simulated human mannequin.

A modified 'foam-filled' human simulated mannequin (Adam) was used in these experiments. A cavity was formed inside of the mannequin by removing some of the underlying foam material. The cavity was later filled with 2 (2 litres) 'Penlon' anaesthesia test lungs. Their expansion limit was controlled by covering the open end cavity with a thick card board.

The mannequin's endotraceal tube was connected to the respirometer first and then to the Oxylator® EM-100. The mannequin is equipped with a one way valve that is capable of creating an airway blockage, if the head of the mannequin is not appropriately tilted. The Oxylator® was set at the automatic cycling mode, at a pressure of 50 cmH2O. The EM-100 gives both a visual an audible indication of such an obstruction by 'clicking' rapidly.

Investigation 2: using the Oxylator® EM-100 resuscitation device (automatic cycling mode), a simulated human mannequin and a Thumper™ (cardiopulmonary resuscitator system) set at 5:1 ratio (5 compressions to 1 ventilation cycle).

Same as for Investigation 1, but with the addition of the Thumper™. The Thumper™ is a cardiopulmonary resuscitator system that is placed on the patient's sternum and compressions occur at a rate of 80 compressions per minute. Between each 5 continuous chest compressions, the Thumper™ stops and delivers 1 complete cycle of ventilation. The Thumper™ is also capable of delivering continuous chest compressions with no interruptions.

The Thumper™ was also set to deliver 80 chest compressions per minute, at a vertical displacement of the chest, of about 1.5-2 inches. (The contact surface area of the Thumper™ pad, was 3 cm x 2 cm.)

Investigation 3: using the Oxylator® EM-100 resuscitation device (automatic cycling mode), a simulated human mannequin and a Thumper™ (cardiopulmonary resuscitator system) in continuous chest compressions mode.

Same conditions as in Investigation 2, except in this case the Thumper™ was allowed to deliver continuous chest compressions at a rate of 80 compressions per minute in conjunction with the automatic cycling of the Oxylator®.

The three investigations were designed to determine the efficacy of the Oxylator® EM-100 in delivering adequate oxygenation in cardiopulmonary resuscitation attempts, in three different settings:

1. By itself
2. With the Thumper™ set at 5:1 ratio (five chest compressions to one breath)
3. With the Thumper™ set at continuous chest compression mode

In evaluating the Oxylator's functional characteristics, the following parameters were measured and recorded:

1. Rate (breaths per minute)
2. Vt tidal volume (litres)
3. Vmin minute volume (litres)

Also, in order to obtain reliable and consistent results, each one of the three investigations was performed five separate times, each time using a different Oxylator® EM-100. Equipment used in these investigations were:

Five Oxylators® (EM-100 resuscitation device), serial numbers 019, 080, 228, 246, 251, manufactured by CPR Medical Devices, Inc., Canada
The Thumper™ (cardiopulmonary resuscitator system), model number 1004, serial number 0118, manufactured by Michigan Instruments, U.S.A.
Simulated human mannequin (Adam), foam-filled and containing 2 (2 litres) 'penlon' anesthesia test lungs, manufactured by Simulaids Woodstock, U.S.A.
Wright respirometer, serial number H 155, manufactured by Haloscale Infanta, England
Stop watch, manufactured by Bulova, Switzerland

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Methods

The tidal volumes and the minute volumes generated by the Oxylator® (EM-100 resuscitation device) and delivered into the 2 (2 litres) test lungs inside the mannequin, were observed and recorded with the Wright respirometer; a stop watch was used, in order to count the respiratory rate (breaths per minute).

Each one of the five EM-100 Oxylators® were allowed to cycle automatically in the 3 different investigations.

In each case the data was collected and entered into the same spreadsheet.

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Results

By comparing the results of each investigation, it was noticed that all of the five Oxylators® (EM-100) were delivering approximately the same amounts of tidal volumes and minute volumes into the test lungs.

In the first set of investigations, only the efficacy of the Oxylator® EM-100 was being tested. The Oxylator® was capable of delivering tidal volumes between (0.78-0.89 litres) and minute volumes between (12.2-13.5 litres). Both were within the acceptable range of what is considered to be adequate ventilation.

In the second set of investigations, the Thumper™ was activated, in order to simulate a real cardiopulmonary resuscitation attempt. The standard in such attempts is five 5 chest compressions followed by a two second pause for ventilation.

The Thumper™ was preset to deliver chest compressions at a rate of 80 compressions per minute, with a 5:1 ratio (5 compressions to each breath).

At lower inspiratory pressures (25 cmH2O) the Oxylator® cycled in synchrony with each chest compression cycle, delivering 100% oxygen to the patient during each decompression phase. At higher inspiratory pressures (45-50 cmH2O), the Oxylator® cycled asynchronously with the delivered chest compressions.

Two complete chest compression cycles were needed before the lung pressure reached the preselected pressure of 50 cmH2O, which triggered the Oxylator® to switch to the expiratory phase.

Complete exhalation was observed during two subsequent chest compression cycles before a new cycle of inspiration started (see plots
Oxylator® EM-100 in 'automatic cycling' mode with baseline pressure set to 50 cmH2O. The three plots show the Oxylator® EM-100 in 'automatic' mode with the pressure set between 40 and 42 cmH2O. The top plot is without chest compressions. The middle plot is with chest compressions for two-man cpr according to the JAMA guidelines (one full inspiration-to-five compressions). The Oxylator® EM-100 synchronizes automatically with every chest compression; the '5-to-1' method can be done safely in 'automatic' mode. The bottom plot is with continuous chest compressions. The three plots represent the same three actions as in 25 cmH2O
Oxylator® EM-100 in 'automatic cycling' mode with baseline pressure set to 25 cmH2O. The three plots show the Oxylator® EM-100 in 'automatic' mode with the pressure set at 25 cmH2O. The top plot is without chest compressions. The middle plot is with chest compressions for two-man cpr according to the JAMA guidelines (one full inspiration-to-five compressions). The Oxylator® EM-100 synchronizes automatically with every chest compression. The bottom plot is with continuous chest compressions. Of note: The pressure setting selected is never exceeded. The tidal volume is too low to be meaningful. Our analysis indicates that continuous chest compressions should not be performed with a pressure setting of 25 cmH2O.
at the higher setting. However, the results are vastly different. Tidal volume in the continuous chest compression is now adequate to ventilate a non-breathing patient. To be sure that proper CO2 removal occurs, clinical studies (blood gases etc.) must be done.
). The Oxylator®, was capable of delivering tidal volumes between (0.65-0.75 litres)and minute volumes between (13.6-15.2 litres) at an approximate rate of 19 breaths per minute.

In the third set of investigation, the Thumper™ was set to deliver chest compressions continuously. The Oxylator® was capable of delivering tidal volumes between (0.69-0.77 litres) and minute volumes between (13.9-15.5 litres) at a rate of approximately 22 breaths per minute.

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Discussion

The following points were observed:

1. Adequate tidal and minute volumes were being delivered into the lungs of the mannequin during continuous chest compressions, approximate of 730 mls per breath and 14.7 litres per minute. hence stopping chest compressions for the delivery of a breath may not be necessary.
2. The EM-100 set at lower inspiratory pressures
Oxylator® EM-100 in 'automatic cycling' mode with baseline pressure set to 25 cmH2O. The three plots show the Oxylator® EM-100 in 'automatic' mode with the pressure set at 25 cmH2O. The top plot is without chest compressions. The middle plot is with chest compressions for two-man cpr according to the JAMA guidelines (one full inspiration-to-five compressions). The Oxylator® EM-100 synchronizes automatically with every chest compression. The bottom plot is with continuous chest compressions. Of note: The pressure setting selected is never exceeded. The tidal volume is too low to be meaningful. Our analysis indicates that continuous chest compressions should not be performed with a pressure setting of 25 cmH2O.
(25 cmH2O) was only capable of delivering ventilation between chest compressions (during the decompression phase), but when the Oxylator® was set at higher inspiratory pressures
Oxylator® EM-100 in 'automatic cycling' mode with baseline pressure set to 50 cmH2O. The three plots show the Oxylator® EM-100 in 'automatic' mode with the pressure set between 40 and 42 cmH2O. The top plot is without chest compressions. The middle plot is with chest compressions for two-man cpr according to the JAMA guidelines (one full inspiration-to-five compressions). The Oxylator® EM-100 synchronizes automatically with every chest compression; the '5-to-1' method can be done safely in 'automatic' mode. The bottom plot is with continuous chest compressions. The three plots represent the same three actions as in 25 cmH2O
Oxylator® EM-100 in 'automatic cycling' mode with baseline pressure set to 25 cmH2O. The three plots show the Oxylator® EM-100 in 'automatic' mode with the pressure set at 25 cmH2O. The top plot is without chest compressions. The middle plot is with chest compressions for two-man cpr according to the JAMA guidelines (one full inspiration-to-five compressions). The Oxylator® EM-100 synchronizes automatically with every chest compression. The bottom plot is with continuous chest compressions. Of note: The pressure setting selected is never exceeded. The tidal volume is too low to be meaningful. Our analysis indicates that continuous chest compressions should not be performed with a pressure setting of 25 cmH2O.
at the higher setting. However, the results are vastly different. Tidal volume in the continuous chest compression is now adequate to ventilate a non-breathing patient. To be sure that proper CO2 removal occurs, clinical studies (blood gases etc.) must be done.
(45-50 cmH2O), the system allowed for oxygen delivery into the lungs during, and between chest compressions.
3. When using the Oxylator®, the preset maximum pressure of 45-50 cmH2O was not reached during the first chest compression applied, but was built up over a period of two complete chest compression cycles. once the pressure reached the preselected value, the system immediately switched to the passive exhalation mode, which took the next two chest compressions to complete.
4. A new inspiratory phase was initiated only when exhalation was completed. although continuous chest compressions were being applied to the mannequin, exhalation of the lungs was not impaired.
5. Unlike pressure cycled resuscitators that switch immediately to the expiratory mode once a chest compression is applied, the Oxylator® allows for ventilation to occur simultaneously during chest compressions. This is due to the EM-100 ability to be set at higher pressure limits.
6. These results were obtained by using a Thumper™, which was delivering a specific and consistent amount of force, on the sternum of the mannequin (vertical displacement of 1.5-2.0 inches).
7. Although the frequency and sequence of delivery of chest compressions (5:1 or continuous) varied between the second and third investigations, the cycling of the EM-100 and the Thumper™ were independent of each other. The application of compressions during the expiratory phase assisted in exhalation, thereby reducing the expiratory time, i.e. allowing the baseline pressure to be reached sooner, resulting in an increased ventilatory frequency.
8. Minute volumes delivered to the lungs increased (14.8%) by using the Thumper™ at a preset ratio of 5:1 and they increased even more, (18.1%), when the Thumper™ was used to deliver continuous chest compressions.

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Conclusions

From the above experiments that were conducted with specific equipment and under controlled conditions, it was observed that there was no need to stop chest compressions in order to deliver adequate ventilation, when using the EM-100.

This system is capable of providing adequate ventilatory volumes even when the patient has poor lung compliance, which is often the case during a cardiac arrest. This is possible due to the Oxylator's patented feature, which allows the user to increase the maximum inspiratory pressure limit.

The EM-100 Oxylator®, with it's functional characteristics, was capable of delivering adequate tidal and minute volumes during continuous chest compressions (average of 730 mls per breath and 14.7 litres per minute were observed). Delivered minute volumes were increased when chest compressions were applied — 14%, on average, when 5:1 ratio was maintained and 18%, on average, when continuous compressions were applied. This could potentially increase both blood circulation and ventilation, and therefore, may improve the outcome of cardiopulmonary resuscitation.

Due to the limitations of these experiments in simulating real-life situations, future clinical studies are needed to verify and compare these findings in human subjects.

The use of the Oxylator ® EM-100 could be a revolutionary step in improving the outcome of cpr.

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