WO2006000006A2

WO2006000006A2 - Device for cooling a patient and device for giving off cold to said patient

Info

Publication number: WO2006000006A2
Application number: PCT/AT2005/000223
Authority: WO
Inventors: Fritz Sterz; Wilhelm Behringer; Claus Hinterecker
Original assignee: Emcools-Emergency Medical Cooling Systems Ag
Priority date: 2004-06-23
Filing date: 2005-06-23
Publication date: 2006-01-05
Also published as: ATA10662004A; WO2006000006A3; AT413480B

Abstract

The invention relates to a device (1) for cooling a patient (2), particularly a patient suffering from cardiac arrest, comprising a device (3) for producing or providing a cooling medium and a device (4) through which the cooling medium flows and which is used to discharge cold transported by the cooling medium to the patient (2). The discharge device (4) sealingly envelops the patient (2) and is provided with distancing elements used to distance the patient (2) and with cavities (10) which are located between the distancing elements (9) and which are used to guide the cooling medium. In order to create a cooling device (1) which enables the patient (2) to be cooled in a particularly rapid manner, the cooling medium is formed by liquid air and the discharge device (4) is configured for essentially airtight envelopment of the patient (2) and at least one line (7) is provided for guiding the liquid air, said line comprising at least one opening (8) which leads into the discharge device (4) and which is used to vaporize the liquid air for correspondingly rapid cooling of the patient (2).

Description

A device for cooling a patient and means for delivering the cold to a patient

The invention relates to a device for cooling a Pati¬ ducks, in particular with cardiac arrest, with a device for generating or providing a cooling medium and a device flowed through by the cooling medium for delivering the transported coolant from the cooling medium to the patient, which dispensing device for tight wrapping of the patient ¬ is formed and spacer elements for spacing the patient and between the spacer elements has cavities for guiding the cooling medium.

Furthermore, the invention relates to a device for delivering the transported by a cooling medium cold to a patient, in particular with cardiac arrest, which dispensing device is designed for tight enclosure of the patient and Abstand¬ elements for spacing the patient and between the Ab¬ stand elements cavities for guiding the cooling medium has ,

Studies have shown that the chance of survival of patients with cardiac arrest can be substantially increased by reducing the body temperature after successful resuscitation. The application of hypothermia not only reduces the oxygen consumption in the brain of the patient, but also slows down various cellular decay processes which cause irreparable neurological damage even after successful restoration of the circuit. Despite progressive outpatient and emergency care and the use of the latest medical technologies in intensive care medicine, the chances of a patient surviving a cardiac arrest outside of a hospital are still very low. The incidence of sudden cardiac arrest outside the hospital is between 36 and 128 per 100,000 inhabitants per year in industrialized countries. If the victims of cardiac arrest receive no treatment within the first 4-6 minutes, irreversible brain damage may already occur. The chances of survival decrease by 7 to 10% with each minute without treatment. After 10 minutes, only a few resuscitation attempts are successful. Current cardiac arrest therapy focuses on resuscitation measures. The use of life-supporting medical devices and sophisticated surgical techniques allows physicians to restore the victim's circulation even after prolonged periods of inactivity, with the problem of irreversible damage to the brain. Even after the restoration of spontaneous circulation, the fatal damage process of brain and organs progresses due to chemical and physical changes of the blood during cardiac arrest (post-resuscitation syndrome). The pathophysiological mechanisms responsible for damage to the brain before, during and after resuscitation are manifold. So far there is no specific therapy to protect the brain after the restoration of spontaneous circulation. Biomedical pharmaceuticals, which can hinder the mechanisms of cellular destruction, represent a promising field of research that is still in its infancy. Research groups around the world are therefore exploring other ways to overcome these fatal mechanisms.

At present, hypothermia is the most advanced medical concept for the prevention or alleviation of post-reunification syndrome. Many studies show a pronounced positive effect of hypothermia on specific ischemic conditions, especially after cardiac arrest. In contrast to uncontrolled hypothermia, therapeutic hypothermia, as used for cardiac and neuro-surgery or for resuscitation after a cardiac arrest, requires controlled conditions. In therapeutic hypothermia different degrees of cooling are defined:

Mild hypothermia: 3β-33 ° C Moderate hypothermia: 32-28 ⁰ C Hypothermia depth: 27-ll ° C Profound hypothermia: 10-6 ° C Ultra-profound hypothermia: 5-0 ⁰ C

Studies investigating the use of mild hypothermia in to study normothermia in comatose cardiological cardiac arrest survivors, show that lowering body temperature improves survival and neurological recovery in these patients. In July 2003, the American Heart Association recommended that victims of cardiac arrest outside a hospital should be treated with mild hypothermia. This recommendation was adopted in Europe in October 2002 by the ILOR (International Liaison Committee of Resuscitation), which includes the ERC (European Resuscitation Council), the AHA (American Heart Association) and many other global associations the development of standardized guidelines for Cardiopulmonary Resuscitation (CPR).

In mild hypothermia, the timing of the onset of cooling and its duration is crucial. The currently available cooling methods are not suitable for early induction of hypothermia. Although immersion in ice water leads to relatively faster cooling, it is practically impracticable. When removing clothing and attaching ice packs to the head and torso, cooling will be slow. Although extracorporeal cooling of blood is the fastest method of reducing temperature, it involves logistical difficulties. Although the use of a cardiopulmonary bypass and a heat exchanger results in a rapid reduction in temperature, cooling is delayed by the time required to obtain vascular access and prepare the devices. The intravenous infusion of large volumes of ice-cold liquid also only leads to a slow cooling of the patient.

Mild hypothermia should be initiated as soon as possible after successful resuscitation. In contrast to mild hypothermia after successful resuscitation, another use of hypothermia appears to be promising in animal experiments, namely the very rapid induction of deep hypothermia already in cardiac arrest in order then to transport the patient to the hospital under the protection of cooling, and first to revive in hospital under controlled conditions ("suspended animation"). But this concept must first - A -

be proven in animal experiments.

Rapidly induced hypothermic cooling, which prevents the mechanism of cellular destruction, is not limited to cardiac arrest victims. Other possible indications in which the lowering of the body temperature has proven favorable are, for example, myocardial infarction, apoplexy, brain trauma, spinal cord injuries or septic shock.

Currently available, non-invasive cooling devices are not able to cool the patient rapidly since the low temperature must be transported through skin and muscle and these systems only partially and not over the entire Kör¬ peroberfläche act. In addition, existing devices are very large, difficult and complicated to handle and require a relatively long preparation time. In addition, the available devices usually require a permanent electrical supply, which is not available, for example, in an emergency vehicle.

A cooling device of the subject type is described in US 2002/0193852 Al. This is a lightweight portable system for heating or cooling patients, comprising a device for providing a liquid cooling medium and a device through which the cooling medium flows to deliver the cold conveyed by the cooling medium to the patient. The dispenser is placed around the patient leaving the patient's face blank. The sackför¬ mige delivery device includes spacer elements, between wel¬ che cavities are formed for guiding the cooling medium. At the end of the bag, the cooled or heated liquid is flowed in and discharged on the opposite side. Apart from the leakage problems that occur, the device described is very voluminous and heavy due to the high quantities of liquid required. In addition, only relatively low cooling rates can be achieved with this method.

Based on this prior art, the present invention has the object to provide a device for cooling a patient, in particular with cardiac arrest, can be achieved with the fastest possible cooling rates, which is as small and light as possible, so that use outside of the hospital, for example in rescue vehicles but also outside of this is possible and also can be applied by non-trained personnel. Furthermore, the cooling device should be as independent as possible of exter¬ ner electrical supply applicable.

A further object of the present invention is to provide a device for delivering the cold transported by a cooling medium to a patient, in particular with cardiac arrest, with which the fastest possible cooling rates can be achieved and which is as small and lightweight as possible. In addition, the dispensing device should be able to be produced as inexpensively as possible, so that it can also be used as a disposable product.

Disadvantages of known systems should be avoided or reduced.

The first object according to the invention is achieved in that the cooling medium is formed by liquid air and the dispensing device is designed to substantially airtight envelope the patient and that at least one conduit is provided for guiding the liquid air, with at least one opening in the dispensing device Opening for vaporization of the liquid air for correspondingly rapid cooling of the patient. By using liquid air, the patient can be cooled down particularly quickly, which can increase the chances of survival. Furthermore, the necessary weight of liquid air as cooling medium for efficient cooling is relatively low, which contributes to making the cooling device very small and simple to construct. As a result, an insert is also used in ambulance vehicles or the like. allows. Liquid air has a boiling point of -195.8 ⁰ C. One liter of liquid air evaporated to approximately 700 liters of air with a temperature of -195.8 ° C. After the vaporized liquid air represents a breathable cold atmosphere, the patient may also be completely by the dispensing device are wrapped. A complete Umhül¬ ment facilitates the one hand, the application, as not - as in State of the art - the face of the patient must be recessed and sealed against the environment. Furthermore, any escaping cooling medium must not be collected in a complex manner and discharged or recycled. To ensure sufficient evaporation of the liquid air in the casing, it is discharged via at least one correspondingly designed opening in the at least one line for guiding the liquid air. The patient is surrounded by cavities with the exception of those points at which the spacers are arranged, which are all filled with vaporized liquid air and thus lead to a particularly rapid cooling of the body. The cooling device according to the invention is re¬ relatively small and easy to manufacture and thus guarantees a wide application even outside a hospital or outside of ambulances. To ensure rapid deployment, a portable design is advantageous.

Advantageously, the device for producing or providing the cooling medium is formed by a pressure vessel containing the liquid air. Such containers for liquid air are relatively simple and, depending on the structure of the insulation capable of keeping the liquid air over appropriate time to the required low temperatures. In the simplest form, such a container will manage without electrical energy. For the purpose of cooling a patient, pressure vessels with about 10 to 15 kilograms of liquid air will suffice. Such pressure vessels provided without their own cooling device would be sufficient, for example, for the supply in an emergency vehicle. Upon arrival of the rescue vehicle in the rescue station of Druckbehäl¬ ter could be replaced or refilled. Advantageously, the pressure vessel for the liquid air is a low-pressure vessel, since the safety-related conditions for such containers are lower and thus the manufacturing costs are lower. For example, a pressure vessel up to 3.9 bar can be very simple.

To ensure a rapid inflow of the liquid air into the dispensing device, it may be necessary for an additional device to increase the pressure with the pressure vessel connected is. Such a pressure increasing device, for example, the pressure in the low-pressure vessel from 0 bar to, for example, 3, 9 bar increase, so that a rapid flow of liquid air through the line to the opening and a local evaporation is possible.

The device for producing or providing the cooling medium advantageously has a device for pressure regulation. As a result, the pressure with which the liquid air flows into the delivery device can be adapted to the respective requirements. As a result, additional devices, such as a cold-air respirator or a device for mechanical cardiac massage, can also be operated by the liquid air as cooling medium in order to further increase the patient's chances of survival.

The device for producing or providing the cooling medium advantageously has a device for regulating the flow rate of the cooling medium. After the envelope of the patient is filled with vaporized liquid air, the supply of further liquid air can be reduced in order to prevent an overloading of the envelope of the patient. Also, the temperature at which the patient is to be cooled can be set so accurately. These temperatures thus generated may advantageously be between -40 and -110 ° C.

In order to prevent heating of the cooling medium by incidence of heat in the device for producing or providing the cooling medium, the device for generating or providing the cooling medium can have a cooling device. This Küh¬ leinrichtung, which may be formed for example by a Peltier element, by a Stirling engine, by a sound tube compressor or a combination of these components, for example, supplied by the on-board power supply of the ambulance with electrical energy or at rescue stations or in hospitals to the appropriate power supply ange¬ plugged.

In order to be able to easily transport the cooling device to the patient, at least the device for producing or providing the cooling medium is preferably designed to be mobile or arranged on a transport device.

According to a further feature of the invention, it is provided that the dispensing device is formed by an air-tight film with at least one substantially airtight seal. By using a particularly lightweight, thin and resistant film, on the one hand the dispensing device can be made particularly small and light and, on the other hand, the requisite tear strength can be achieved. The substantially airtight closure ensures easier insertion of the patient. Several air-tight closures may be provided in the delivery device, through which, for example, the patient's head or hand may be inserted in order to gain access to a blood vessel or to the patient's face for breathing activities. Similarly, openings can be provided, through which, for example, the doctor's hands can be inserted in order to be able to perform a cardiac massage during cooling.

In order to prevent too much cold escaping to the outside, the film may include at least one heat-insulating film. As a result, the formation of an ice layer on the outside of the dispensing device is prevented or reduced.

In order to prevent the film from tearing, the latter can comprise at least one reinforcing layer, for example made of glass fiber fabric. Glass fiber fabric is characterized by particularly high resistance but also particularly low weight and is therefore frequently used in the aerospace industry. A disadvantage is the relatively high price of such multilayer film.

Good results are also achieved with a film made of siliconized paper. The silicone impregnation ensures the sealing of the delivery device. The use of airtight, coated tent fabrics is also possible.

The substantially airtight closure may be formed, for example, by a substantially airtight zipper. It is important that the wrapping after inserting the patient can be closed very quickly and easily. Of course, it is also possible to form the dispenser in the form of a bag and to close by constricting the open end. However, the larger the opening of the dispensing device, the simpler and faster the introduction of the patient is possible. Some permeability of the closure may be desired whereby a small proportion of the vaporized liquid air may escape to protect the envelope from excessive pressure.

The spacer elements can be arranged on a separate mat, which is arranged in the dispenser under the patient.

Advantageously, a device for inflating the dispenser is provided. This inflator may be formed by an electrically operated impeller which initially pumps outside air into the dispenser at the start of cooling and thus ensures very rapid inflation of the dispenser to a stable mold, for example similar to a cylinder. The Aufblas¬ formed, for example, as an impeller device can serve for the swirling of the liquid air in the dispenser after the inflation.

The at least one conduit for guiding the liquid air into the dispensing device may be arranged on a rod, preferably with a handle, which is inserted into the closure of the dispensing device, where the liquid air evaporates and the patient is rapidly cooled. As a result, no constructive measures are required for the delivery of the liquid air in the delivery device, so that it can be produced relatively simply and inexpensively and formed as a disposable product.

In order to ensure optimum vaporization of the liquid air and high convection in the dispensing device, the at least one opening is advantageously formed by a nozzle. At the opening or nozzle, the liquid air should completely evaporate. In order to ensure optimal mixing and thus high convection of the evaporated liquid air in the delivery device, and on the other hand to prevent spraying of the liquid air, a device for swirling the vaporized liquid air in the delivery device, preferably in the form of a Impellers, be provided. This impeller is designed so that it optimally atomizes the liquid air in the dispenser and by high convection, which is generated, the internal air well mixed and thus ensures a rapid and uniform cooling of the patient. Such an impeller is preferably arranged above the patient and can be driven, for example, by compressed air from liquid air or electrical energy.

The impeller or the swirling device is preferably arranged on the rod in front of the opening, via which the liquid air flows. This brings an optimal turbulence of the liquid air.

In order to achieve optimum mixing of the evaporated, liquid air in the dispensing device, the impeller may be connected to a device for reversing in particular the direction of rotation of the impeller, in particular cyclically. In this case, the reversal of the direction of rotation can take place automatically or manually, for example via the handle of the rod.

In order to be able to monitor the temperature in the interior of the delivery device and / or on the patient, sensors for measuring the temperature are advantageously provided. These can be mounted, for example, at the outlet opening of the impeller, in order to determine exact temperature data of the gasified liquid air which connects to the internal air of the delivery device. In addition to temperature sensors, of course, other sensors may be provided in the dispenser.

In order to be able to observe the patient during the treatment, viewing windows made of transparent plastic are preferably arranged in the dispensing device. It is important to ensure that the material for the transparent plastic can withstand the low temperatures. For example, Hostaphan assigns that a film of polyethylene terephthalate (PET) in this respect outstanding physical properties.

In order to achieve sufficient light inside the dispenser, a lamp in the dispenser may preferably be arranged on the rod. At the handle of the rod, an operating element for activating the lamp can be provided.

In order to protect sensitive areas of the patient, in particular the fingers, toes, ears and so on, from the low temperatures, devices such as pockets or the like may be arranged in the dispensing device to protect these sites. Eben¬ so it is of course possible to use these protective devices in the form of gloves, headbands or the like. Independently of the dispensing device.

For easy handling of the cooling device, a device is provided for controlling the delivery of the cooling medium from the device for producing or providing the cooling medium.

To enable automatic control of the cooling, this control device can be connected to a sensor for measuring the temperature inside the dispensing device.

The second object according to the invention is achieved by an above-mentioned dispensing device, which is designed for the substantially air-tight envelope of the patient and is formed by an air-tight foil with at least one substantially airtight closure.

For further inventive features in connection with the dispensing device, reference is made to the above description of the cooling device.

The present invention will be explained in more detail with reference to the accompanying drawings.

Show: Fig. 1 is a schematic block diagram of a cooling device according to the invention;

FIG. 2 shows a further schematic block diagram of a cooling device according to the invention; FIG.

3 shows a sectional view through the delivery device according to FIG. 1 along the section line III - III;

4 shows the film for forming the dispenser in an enlarged cutaway view; and

5 shows a detailed view of a sectional view of the dispensing device.

1 shows a schematic block diagram of a device 1 for cooling a patient 2, in particular with cardiac arrest according to the present invention. The device 1 contains a device 3 for producing or providing a cooling medium and a device 4, which is flowed through by the cooling medium and delivers the cold conveyed by the cooling medium to the patient 2. The delivery device 4 encloses the patient 2 and discharges the cold discharged from the cooling medium to the patient 2. In the illustrated example, the head and the hand of the patient 2 protrude from the dispenser 4. As shown in FIG. 2, a complete enclosure of the patient 2 can also take place. According to the invention, liquid air is used as the cooling medium, which is generated or stored in the device 3 for producing or providing the cooling medium. In a simple manner, the device 3 for generating or providing the cooling medium by a pressure vessel containing the liquid air. Advantageously, this pressure vessel is formed by a low-pressure vessel from which a corresponding line 5 leads to the dispenser 4. To increase the pressure if necessary, a device 6 can be provided to increase the pressure. This pressure increasing device 6 may be integrated in the device 3 for generating or providing the cooling medium or formed separately. Furthermore, a device for regulating the flow rate of the cooling medium can be provided, which is also provided in the device 3 integrated or separately formed for the production or provision of the cooling medium (not shown). Via the line 5, the liquid air enters at least one line 7 in the dispensing device 4. The line 7 contains at least one opening 8, through which the liquid air in the interior of the dispensing device 4 evaporates. The line 7 may be arranged on a rod 23, preferably with a handle 24, which is inserted into a closure 14, for example a zipper, the dispensing device 4. So that the patient 2 is flowed through by the cold air uniformly from all sides, this is preferably on spacer elements 9, between which cavities 10 are formed. In this case, the spacer elements 9 can be integrated in the dispenser 4 or formed as a separate mat 25. Thus, the corresponding cold is provided for rapid cooling of the patient 2. Of course, instead of a rod 23 with a handle 24, a corresponding frame or the like can also be provided, via which the liquid air is conveyed in a suitable manner into the dispensing device 4 and vaporized there (not shown).

As can be better seen in FIG. 3, the patient 2 rests on spacer elements 9, so that cavities 10 are formed between the delivery device 4 and the patient 2 and the spacer elements 9, through which the evaporated liquid air flows. The spacer elements 9 may be formed for example of foam rubber, a dimpled mat or inflatable elements. The dispenser 4 and the possible mat 25 with the Distanzelemeten 9 can be easily folded or rolled up. The dispenser 4 is formed from a film 11, which may include at least one heat-insulating layer 12 and / or at least one reinforcing layer 13 (see Fig. 4).

In order to be able to place the patient 2 more easily in the dispensing device 4, at least one substantially airtight closure 14, for example a zipper, is provided. A certain permeability of the closure 14 may also be desirable, whereby a small proportion of the evaporated liquid air can aus¬ occur to protect the dispenser 14 against excessive pressure. The device 3 for production or provision The cooling medium may also include its own cooling device 15, for example a Peltier element, a Stirling engine, a sound tube compressor or a combination of such components, by which the maintenance of the low temperature of the liquid air of the cooling medium is ensured or the temperature of the cooling medium deeper , can be lowered to near the freezing point of the liquid air. To protect sensitive areas of the patient 2, for example the fingers, toes or ears, protective devices can be applied to patients 2, which can also be integrated into the dispensing device 4. For example, bag-shaped inserts may be disposed in the dispenser 4 to protect the fingers and toes. Headbands or hood-shaped protective devices can be used to protect the ears and nose.

The means 3 for producing or providing the cooling medium may also include its own air compression, air drying and condensation countercurrent heat exchanger means to allow actual refilling with liquid air (not shown).

In order to improve the flow through the interior of the delivery device 4, a device 16 for swirling the vaporized liquid air, preferably in the form of an impeller or the like, may be provided. For optimum turbulence, an arrangement of the vortex device 16 in front of the opening 8 above the patient 2 is advantageous. The rod 23 is thereby positioned substantially horizontally, so that the air flow passes over the patient 2 and an undesired direct flow of the patient 2 is avoided. In order to avoid a direct flow of the patient 2 safely, for example, a tilt sensor can be arranged on the rod 23, over which an excessive deviation from the horizontal position detected and then the shutdown of the coolant supply can be initiated (not shown).

Fig. 2 shows a comparison with FIG. 1 slightly modified form in which the patient 2 is completely enveloped by the dispenser 4. Inside the dispenser 4, a sensor 17 for Measurement of the temperature to be provided. This sensor 17 may be connected to a control device 18, with which the discharge of the cooling medium from the means 3 for the production or provision of the cooling medium can be controlled. Preferably, the temperature sensor 17 is also arranged on the rod 23. To protect the dispenser 4 against overpressure, a safety valve 19 may be arranged. If a sufficient amount of the evaporated liquid air can escape via the closure 14, such a safety valve need not necessarily be provided. For observing the completely enveloped patient, a viewing window 26 made of transparent plastic can be sewn or glued in the film 11 of the dispensing device 4. To create optimal lighting conditions even within the dispenser 4, a lamp 28 may preferably be arranged on the rod 23. As indicated schematically, the device 3 for generating or providing the liquid air and possibly the control device 18 may be arranged on a transport device 27 or may be designed to be mobile.

5 shows a sectional view of the delivery device 4 in an enlarged representation, wherein a passage 20 is provided for substantially airtight passage of lines, sensors or the like. In this way, on the one hand the tightness of the dispenser 4 is ensured and on the other hand, the implementation of sensors for measuring physiological parameters or the like. Enables. Alternatively or in addition to such passages 20, it is also possible to arrange plug-in connections 21 via which a connection can be established, for example, to sensors 22 for measuring physiological parameters or the like. For example, a temperature sensor provided permanently in the dispensing device 4 can be connected to such a plug connection 21 to which a corresponding display device can be connected from the outside.

The delivery device 4 should be as simple and inexpensive to produce as possible, so that it can be designed as a disposable product. The connection between the delivery device 4 and the device 3 designed as a pressure vessel for the production or provision of the liquid air can be carried out with fast handling. Baren plug connections of any kind done. The cooling device 1 according to the invention as well as the dispensing device 4 according to the invention enables a particularly rapid cooling of patients, in particular with cardiac arrest also away from hospitals or similar devices, whereby the chance of survival can be increased and the risk of cerebral damage can be reduced. The device may also be used in other cases where mild or higher hypothermia is beneficial.

Claims

claims:

1. A device (1) for cooling a patient (2), in particular with cardiac arrest, with a device (3) for generating or providing a cooling medium, and a device flowed through by the cooling medium (4) for delivering the transported from the cooling medium cold to the patient (2) which dispensing device (4) is designed to seal the patient (2) tightly and has spacer elements (9) for spacing the patient (2) and between the spacer elements (9) cavities (10) for guiding the cooling medium, characterized in that the Kühl¬ medium is formed by liquid air, that the Ausgabeinrich¬ device (4) for substantially airtight enclosure of the patient (2) is formed, and that at least one conduit (7) is provided for guiding the liquid air , with at least one in the discharge device (4) opening out opening (8) for Verdamp¬ tion of the liquid air for correspondingly rapid cooling of Pa¬ tients (2).

2. Cooling device according to claim 1, characterized in that the device (3) for generating or providing the cooling medium is formed by a pressure vessel containing the liquid air, in particular a low pressure vessel.

3. Cooling device according to claim 2, characterized in that the pressure vessel is connected to a device (6) for increasing the pressure.

4. Cooling device according to claim 2 or 3, characterized gekennzeich¬ net, that the means (3) for generating or providing the cooling medium comprises means for pressure control.

5. Cooling device according to one of claims 2 to 4, characterized ge indicates that the means (3) for generating or Be¬ provision of the cooling medium comprises means for controlling the flow rate of the cooling medium.

6. Cooling device according to one of claims 1 to 5, characterized ge indicates that the device (3) for generating or Be¬ provision of the cooling medium comprises a cooling device (15).

7. Cooling device according to claim 6, characterized in that the cooling device (15) is formed by a Peltier element.

8. Cooling device according to claim 6, characterized in that the cooling device (15) is formed by a Stirling engine.

9. Cooling device according to claim 6, characterized in that the cooling device (15) is formed by a sound tube compressor ge.

10. Cooling device according to one of claims 1 to 9, characterized in that the device (3) for generating or Be¬ provision of the cooling medium is designed to be mobile or on a transport device (27).

11. Cooling device according to one of claims 1 to 10, characterized in that the dispensing device (4) by an air-tight film (11) with at least one substantially luftdich¬ th closure (14) is formed.

12. Cooling device according to claim 11, characterized in that the film (11) includes at least one heat-insulating layer (12).

13. Cooling device according to claim 11 or 12, characterized gekenn¬ characterized in that the film (11) comprises at least one reinforcing layer (13), for example of glass fiber fabric.

14. Cooling device according to one of claims 11 to 13, characterized in that the film (11) consists of siliconized paper.

15. Cooling device according to one of claims 11 to 14, characterized in that the closure (14) is formed by a substantially airtight airtight zipper.

16. Cooling device according to one of claims 1 to 15, characterized in that the spacer elements (9) on a mat (25) are arranged, which under the patient (2) can be arranged is.

17. Cooling device according to one of Ansprüuche 1 to 16, characterized in that a device for inflating the dispensing device (4) is provided.

18. Cooling device according to one of claims 1 to 17, characterized in that the at least one line (7) on a rod (23), preferably with a handle (24) is arranged.

19. Cooling device according to one of claims 1 to 18, characterized in that the at least one opening (8) is formed by a nozzle.

20. Cooling device according to one of claims 1 to 19, characterized in that means (16) for swirling the vaporized liquid air in the dispensing device (4), preferably in the form of an impeller is provided.

21. Cooling device according to claim 20, characterized in that the impeller (16) on the rod (23) in front of the opening (8) is angeord¬ net.

22. Cooling device according to claim 21, characterized in that the impeller (16) with a device for particular cyclical reversal of the direction of rotation of the impeller (16) is connected ver¬.

23. Cooling device according to one of claims 1 to 22, characterized in that sensors (17) for measuring the temperature in the interior of the dispensing device (4) are provided.

24. Cooling device according to one of claims 1 to 23, characterized in that in the dispensing device (4) viewing window (26) are arranged made of transparent plastic.

25. Cooling device according to one of claims 1 to 24, characterized in that in the dispensing device (4) a lamp (28) is arranged.

26. Cooling device according to one of claims 1 to 25, characterized in that in the dispensing device (4) devices, such as pockets od. Like. For the protection of sensitive areas of Pati¬ ducks, in particular the fingers, toes or ears, are arranged.

27. Cooling device according to one of claims 1 to 26, characterized in that a device (18) for controlling the delivery of the cooling medium from the means (3) for generating or providing the cooling medium is provided.

28. Cooling device according to claim 27, characterized in that the control device (18) is connected to a sensor (17) for measuring the temperature in the interior of the delivery device (4).

29 device (4) for delivering the transported by a cooling medium cold to a patient (2), in particular with cardiac arrest, which dispensing device (4) for dense Umhül¬ treatment of the patient (2) is formed and spacer elements (9) for spacing the Patients (2) and between the Abstand¬ elements (9) has cavities (10) for guiding the Külmediums auf¬, characterized in that the dispensing device (4) for substantially airtight envelope of the patient (2) aus¬ formed and by a airtight film (11) is formed with at least one substantially airtight closure (14).

30. Device according to claim 29, characterized in that the film (11) includes at least one heat-insulating layer (12).

31. Device according to claim 29 or 30, characterized gekennzeich¬ net, that the film (11) at least one reinforcing layer (13), for example of glass fiber fabric includes.

32. Device according to one of claims 29 to 31, characterized ge indicates that the film (11) is made of siliconized paper be¬.

33. Device according to one of claims 29 to 32, characterized ge indicates that the closure (14) is formed by a substantially chen-airtight zipper.

34. Device according to one of claims 29 to 33, characterized ge indicates that the spacer elements (9) on a mat (25) are arranged, which under the patient (2) can be arranged.

35. Device according to one of claims 29 to 34, characterized ge indicates that in the film (11) viewing window (26) are arranged made of transparent plastic.

36. Device according to one of claims 29 to 35, characterized ge indicates that devices such as pockets od. Like. For the protection of sensitive areas of the patient, especially the fingers, toes or ears, are arranged.