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Sample records for cardiopulmonary support device

  1. Automated cardiopulmonary resuscitation using a load-distributing band external cardiac support device for in-hospital cardiac arrest: a single centre experience of AutoPulse-CPR.

    Science.gov (United States)

    Spiro, J R; White, S; Quinn, N; Gubran, C J; Ludman, P F; Townend, J N; Doshi, S N

    2015-02-01

    Poor quality cardiopulmonary resuscitation (CPR) predicts adverse outcome. During invasive cardiac procedures automated-CPR (A-CPR) may help maintain effective resuscitation. The use of A-CPR following in-hospital cardiac arrest (IHCA) remains poorly described. Firstly, we aimed to assess the efficiency of healthcare staff using A-CPR in a cardiac arrest scenario at baseline, following re-training and over time (Scenario-based training). Secondly, we studied our clinical experience of A-CPR at our institution over a 2-year period, with particular emphasis on the details of invasive cardiac procedures performed, problems encountered, resuscitation rates and in-hospital outcome (AutoPulse-CPR Registry). Scenario-based training: Forty healthcare professionals were assessed. At baseline, time-to-position device was slow (mean 59 (±24) s (range 15-96s)), with the majority (57%) unable to mode-switch. Following re-training time-to-position reduced (28 (±9) s, pCPR Registry: 285 patients suffered IHCA, 25 received A-CPR. Survival to hospital discharge following conventional CPR was 28/260 (11%) and 7/25 (28%) following A-CPR. A-CPR supported invasive procedures in 9 patients, 2 of whom had A-CPR dependant circulation during transfer to the catheter lab. A-CPR may provide excellent haemodynamic support and facilitate simultaneous invasive cardiac procedures. A significant learning curve exists when integrating A-CPR into clinical practice. Further studies are required to better define the role and effectiveness of A-CPR following IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Ventricular Assist Device Support

    Science.gov (United States)

    Fasseas, Panayotis; Kutalek, Steven P.; Samuels, Fania L.; Holmes, Elena C.; Samuels, Louis E.

    2002-01-01

    We describe herein the cases of 2 patients who had ventricular arrhythmias. In one, a short-term biventricular assist device, the ABIOMED BVS 5000, was placed because the patient had sustained ventricular tachycardia and could not be weaned from cardiopulmonary bypass. Excellent hemodynamic support was maintained for several days while the antiarrhythmic therapy was maximized. Sinus rhythm was restored, and the patient was successfully weaned from the ventricular assist device. However, the substrate for the arrhythmia persisted, and a recurrence, 1 week later, resulted in the patient's death. In the 2nd patient, the use of an implantable left ventricular assist device was successful in temporarily alleviating the ventricular tachycardia associated with ischemic cardiomyopathy. However, after 2 days of device assistance, the patient experienced a recurrence of the tachycardia, which degenerated into ventricular fibrillation with a marked deterioration in the patient's hemodynamics. The arrhythmia persisted despite multiple attempts at external cardioversion, and internal cardioversion and placement of an automatic implantable cardioverter-defibrillator were necessary. This treatment, along with repeated boluses of amiodarone, led to successful suppression of the arrhythmias, and the patient eventually underwent transplantation. The mechanical hemodynamic support of the circulation by ventricular assist devices was effective in supporting these 2 patients who had sustained ventricular arrhythmias. (Tex Heart Inst J 2002;29:33–6) PMID:11995847

  3. Cardiopulmonary support and extracorporeal membrane oxygenation for cardiac assist.

    Science.gov (United States)

    von Segesser, L K

    1999-08-01

    Use of cardiopulmonary bypass for emergency resuscitation is not new. In fact, John Gibbon proposed this concept for the treatment of severe pulmonary embolism in 1937. Significant progress has been made since, and two main concepts for cardiac assist based on cardiopulmonary bypass have emerged: cardiopulmonary support (CPS) and extracorporeal membrane oxygenation (ECMO). The objective of this review is to summarize the state of the art in these two technologies. Configuration of CPS is now fairly standard. A mobile cart with relatively large wheels allowing for easy transportation carries a centrifugal pump, a back-up battery with a charger, an oxygen cylinder, and a small heating system. Percutaneous cannulation, pump-driven venous return, rapid availability, and transportability are the main characteristics of a CPS system. Cardiocirculatory arrest is a major predictor of mortality despite the use of CPS. In contrast, CPS appears to be a powerful tool for patients in cardiogenic shock before cardiocirculatory arrest, requiring some type of therapeutic procedures, especially repair of anatomically correctable problems or bridging to other mechanical circulatory support systems such as ventricular assist devices. CPS is in general not suitable for long-term applications because of the small-bore cannulas, resulting in significant pressure gradients and eventually hemolysis. In contrast, ECMO can be designed for longer-term circulatory support. This requires large-bore cannulas and specifically designed oxygenators. The latter are either plasma leakage resistent (true membranes) or relatively thrombo-resistant (heparin coated). Both technologies require oxygenator changeovers although the main reason for this is different (clotting for the former, plasma leakage for the latter). Likewise, the tubing within a roller pump has to be displaced and centrifugal pump heads have to be replaced over time. ECMO is certainly the first choice for a circulatory support system

  4. Earlier application of percutaneous cardiopulmonary support rescues patients from severe cardiopulmonary failure using the APACHE III scoring system.

    Science.gov (United States)

    Song, Suk-Won; Yang, Hong-Suk; Lee, Sak; Youn, Young-Nam; Yoo, Kyung-Jong

    2009-12-01

    Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score >or=50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores >or=50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

  5. Performance of a wearable artificial cardiopulmonary support device in a sheep model%便携式人工心肺辅助装置动物实验研究

    Institute of Scientific and Technical Information of China (English)

    刘洋; 金振晓; 董小超; 魏旭峰; 杨剑; 程亮; 俞世强

    2015-01-01

    Objective To evaluate the performance of a wearable artificial cardiopulmonary support device in vivo . Methods Heparin-coating hollow fiber and axial pump were used to setup a wearable artificial cardiopulmonary support device. Six 40-kg sheepwere used in the study. The left anterolateral thoracotomy were performed after general anesthesia. Then the veno-arterial connectionswere setup with cannulation in the right atrium and descending aorta. The saturation, partial oxygen pressure and partial carbon dioxidepressure of the inlet and outlet were measured, and oxygen transfer rate was calculated before operating devices and then every 2 hoursat 4.0L/ min for 12 hours. The plasma free hemoglobin and platelet activation were evaluated every 2 hours as well. Results The satu⁃ration of outlet was stable at over 98% during the study. The plasma free hemoglobin was lower than 20mg/ dL and the platelet activationwas lower than 8% over 12 hours. Conclusions The wearable artificial cardiopulmonary support device with heparin-coating hollow fi⁃ber and axial pump conducted the reliable performance in vivo.%目的:初步考察便携式人工心肺辅助装置的在体性能。方法应用肝素涂层中空纤维氧合技术与磁悬浮离心泵装置整合构建小型化、便携式心肺辅助装置。40 kg实验羊( n=6)在全麻下第五肋间左前外侧切口,分别置入右心房插管连接至人工心肺辅助装置流入道,降主动脉插管连接至装置流出道开始转流,4.0 L/min运转12 h,于转流前和转流后每2 h检测装置流入道及流出道血氧饱和度,氧分压,二氧化碳分压等,计算装置氧合效率。取静脉血检测游离血红蛋白检含量评价装置溶血性能并检测血小板激活率。结果12 h中,装置流出道氧饱和度保持98%以上,氧合效率稳定。4.0 L/min流量运行12 h,游离血红蛋白含量均在20 g/L以下,血小板激活均小于8%。结论应用肝素

  6. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis.

    Science.gov (United States)

    Soeda, Rie; Taniguchi, Fumika; Sawada, Maiko; Hamaoka, Saeko; Shibasaki, Masayuki; Nakajima, Yasufumi; Hashimoto, Satoru; Sawa, Teiji; Nakayama, Yoshinobu

    2016-01-01

    A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  7. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis

    Directory of Open Access Journals (Sweden)

    Rie Soeda

    2016-01-01

    Full Text Available A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  8. Extracorporeal membrane oxygenation support in post-traumatic cardiopulmonary failure

    Science.gov (United States)

    Lin, Chun-Yu; Tsai, Feng-Chun; Lee, Hsiu-An; Tseng, Yuan-His

    2017-01-01

    Abstract Patients with multiple traumas associated with cardiopulmonary failure have a high mortality rate; however, such patients can be temporarily stabilized using extracorporeal membrane oxygenation (ECMO), providing a bridge to rescue therapy. Using a retrospective study design, we aimed to clarify the prognostic factors of post-traumatic ECMO support. From March 2006 to July 2016, 43 adult patients (mean age, 37.3 ± 15.2 years; 7 females [16.3%]) underwent ECMO because of post-traumatic cardiopulmonary failure. Pre-ECMO demographics, peri-ECMO events, and post-ECMO recoveries were compared between survivors and nonsurvivors. The most common traumatic insult was traffic collision (n = 30, 69.8%), and involved injury areas included the chest (n = 33, 76.7%), head (n = 14, 32.6%), abdomen (n = 21, 48.8%), and fractures (n = 21, 48.8%). Fifteen patients (34.9%) underwent cardiopulmonary resuscitation and 22 (51.2%) received rescue interventions before ECMO deployment. The mean time interval between trauma and ECMO was 90.6 ± 130.1 hours, and the mode of support was venovenous in 26 patients (60.5%). A total of 26 patients (60.5%) were weaned off of ECMO and 22 (51.6%) survived to discharge, with an overall mean support time of 162.9 ± 182.7 hours. A multivariate regression analysis identified 2 significant predictors for in-hospital mortality: an injury severity score (ISS) >30 (odds ratio [OR], 9.48; 95% confidence interval [CI], 1.04–18.47; P = 0.042), and the requirement of renal replacement therapy (RRT) during ECMO (OR, 8.64; 95% CI, 1.73–26.09; P = 0.020). These two factors were also significant for the 1-year survival (ISS >30: 12.5%; ISS ≤30, 48.1%, P = 0.001) (RRT required, 15.0%; RRT not required, 52.2%, P = 0.006). Using ECMO in selected traumatized patients with cardiopulmonary failure can be a salvage therapy. Prompt intervention before shock-impaired systemic organ perfusion and acute

  9. Certified Basic Life Support Instructors Assess Cardiopulmonary Resuscitation Skills Poorly

    DEFF Research Database (Denmark)

    Hansen, Camilla; Rasmussen, Stinne E; Kristensen, Mette Amalie

    2016-01-01

    Introduction: High-quality cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest. During basic life support (BLS) training, instructors assess CPR skills to enhance learning outcome. Emergency department staff and senior residents have been shown to assess chest compression...... quality poorly. Currently no studies have evaluated CPR assessment among certified BLS instructors. The aim of this study was to investigate certified BLS instructors’ assessment of chest compressions and rescue breathing.Methods: Data were collected at BLS courses for medical students at Aarhus...... University, Denmark. In pairs, BLS instructors, certified by the European Resuscitation Council, evaluated each learner in an end-of-course cardiac arrest test. Instructors’ assessments were compared with CPR quality data collected from the resuscitation manikin. Correct chest compressions were defined as ≥2...

  10. Cardiopulmonary resuscitation support application on a smartphone - randomized controlled trial.

    Science.gov (United States)

    Sakai, Tomohiko; Kitamura, Tetsuhisa; Nishiyama, Chika; Murakami, Yukiko; Ando, Masahiko; Kawamura, Takashi; Tasaki, Osamu; Kuwagata, Yasuyuki; Shimazu, Takeshi; Iwami, Taku

    2015-01-01

    This simulation trial aimed to compare the quality of cardiopulmonary resuscitation (CPR) with and without the newly-developed CPR support application on smartphones. In this trial, participants were randomly assigned to either the CPR support application group or the control group, stratified by sex and previous CPR training. Participants' CPR skills were evaluated by a 2-min case-based scenario test using the Leardal Resusci Anne PC Skill reporting Manikin System(®). The outcome measures were the proportion of chest compressions performed in each group and the number of total chest compressions and appropriate chest compressions performed during the 2-min test period. A total of 84 participants were enrolled and completed the protocol. All participants in the CPR support application group performed chest compressions, compared with only 31 (75.6%) in the control group (Psmartphones contributed to increasing the implementation rate and the number of total chest compressions performed and may assist in improving the survival rate for out-of-hospital cardiac arrests (UMIN000004740).

  11. Recommendations on ambulance cardiopulmonary resuscitation in basic life support systems.

    Science.gov (United States)

    Hock Ong, Marcus Eng; Shin, Sang Do; Sung, Soon Swee; Tanaka, Hideharu; Huei-Ming, Matthew; Song, Kyoung Jun; Nishiuchi, Tatsuya; Leong, Benjamin Sieu-Hon; Karim, Sarah Abdul; Lin, Chih-Hao; Ryoo, Hyun Wook; Ryu, Hyun Ho; Iwami, Taku; Kajino, Kentaro; Ko, Patrick Chow-In; Lee, Kyung Won; Sumetchotimaytha, Nathida; Swor, Robert; Myers, Brent; Mackey, Kevin; McNally, Bryan

    2013-01-01

    Cardiopulmonary resuscitation (CPR) during ambulance transport can be a safety risk for providers and can affect CPR quality. In many Asian countries with basic life support (BLS) systems, patients experiencing out-of-hospital cardiac arrest (OHCA) are routinely transported in ambulances in which CPR is performed. This paper aims to make recommendations on best practices for CPR during ambulance transport in BLS systems. A panel consisting of 20 experts (including 4 North Americans) in emergency medical services (EMS) and resuscitation science was selected, and met over two days. We performed a literature review and selected 33 candidate issues in five core areas. Using Delphi methodology, the issues were classified into dichotomous (yes/no), multiple choice, and ranking questions. Primary consensus between experts was reached when there was more than 70% agreement. Questions with 60-69% agreement were made more specific and were submitted for a second round of voting. The panel agreed upon 24 consensus statements with more than 70% agreement (2 rounds of voting). The recommendations cover the following: length of time on the scene; advanced airway at the scene; CPR prior to transport; rhythm analysis and defibrillation during transport; prehospital interventions; field termination of resuscitation (TOR); consent for TOR; destination hospital; transport protocol; number of staff members; restraint systems; mechanical CPR; turning off of the engine for rhythm analysis; alternative CPR; and feedback for CPR quality. Recommendations for CPR during ambulance transport were developed using the Delphi method. These recommendations should be validated in clinical settings.

  12. Ventricular Assist Device Support: for Management of Sustained Ventricular Arrhythmias

    OpenAIRE

    2002-01-01

    We describe herein the cases of 2 patients who had ventricular arrhythmias. In one, a short-term biventricular assist device, the ABIOMED BVS 5000, was placed because the patient had sustained ventricular tachycardia and could not be weaned from cardiopulmonary bypass. Excellent hemodynamic support was maintained for several days while the antiarrhythmic therapy was maximized. Sinus rhythm was restored, and the patient was successfully weaned from the ventricular assist device. However, the s...

  13. Dobutamine for inotropic support during emergence from cardiopulmonary bypass.

    Science.gov (United States)

    Tinker, J H; Tarhan, S; White, R D; Pluth, J R; Barnhorst, D A

    1976-04-01

    Dobutamine, a recently introduced derivative of dopamine, is reported to retain inotropic properties with less pronounced chronotropic and arrhythmogenic effects than isoproterenol. The drug was evaluated in two doses, 5 mug/kg/min and 10 mug/kg/min, in two groups of ten patients each, during emergence from cardiopulmonary bypass. A third group of five patients was studied similarly with isoproterenol, 0.02 mug/kg/min. Cardiac index increased 16 and 28 per cent eith the two doses of dobutamine, respectively, and 9 per cent with isoproterenol. Heart rate, in contrast, increased 6 and 15 per cent with dobutamine (not significant) and 44 per cent with isoproterenol (significant). Dobutamine seemed to associated with fewer arrhythmias than isoproterenol. It is concluded that dobutamine, 5-10 mug/kg/min, is suitable for use during emergence from cardiopulmonary bypass and may possess advantages over isoproterenol.

  14. Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support

    OpenAIRE

    Kalz, Marco

    2013-01-01

    Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.

  15. Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support

    NARCIS (Netherlands)

    Kalz, Marco

    2013-01-01

    Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.

  16. 海藻酸钠交联肝素涂层在体外循环及人工心肺支持装置管路中的应用%Cross-linked alginate/heparin coated cardiopulmonary bypass support device

    Institute of Scientific and Technical Information of China (English)

    刘东; 李彤; 于美丽; 胡晓旻; 段大为; 李鑫

    2011-01-01

    BACKGROUND: Currently, non-heparin-coated pipe and tube have a great impact on internal cardiopulmonary bypass (CPB) cardiac surgery, which can cause blood damage, heavy inflammatory response, and influence the postoperative recovery and survival of patients.OBJECTIVE: To develop a new heparin-coated CPB pipe by using the bomedical polymer materials, and to study its stability and performance of anticoagulant.METHODS: CaCl2 was used to form Ca2+ membrane for modifying the inner surface of medical polyvinyl chloride (PVC) pipe cross-linking with sodium alginate and heparin. The Ca2+ reacted with Na+ which was in the sodium alginate and heparin, so that the linear polymer cross-linking molecules were to form chemical cross-linked sodium alginate-heparin complex network structure,a type of biomaterial heparin coating.RESULTS AND CONCLUSION: CaCl2 modified activated medical PVC cardiopulmonary bypass pipe reacting with heparin and sodium alginate to bring out the cross-linking reaction and form biological polymers heparin-coating pipe. The heparin-coated pipe has been proved that it has good blood compatibility, stability, anti-coagulation performance to meet short-term extracorporeal circulation bypass.%背景:目前国内体外循环心脏手术使用的非肝素涂层管路和插管对血液破坏大、炎性反应重,影响心脏手术后患者的恢复和生存.目的:采用生物医用高分子材料研制新型体外循环管道肝素涂层技术,并对其稳定性及抗凝血性能进行研究.方法:利用CaCl2将活化医用聚氯乙烯体外循环管道内表面修饰形成Ca2+膜,并与海藻酸钠和肝素交联;其中Ca2+与海藻酸钠、肝素钠中的Na+反应,从而使线型聚合物分子发生交联,形成化学交联海藻酸钠-肝素复合物的网状结构,实现生物型材料肝素化涂层.结果与结论:CaCl2修饰活化医用聚氯乙烯体外循环管道并与海藻酸钠和肝素交联反应,形成生物型高分子材料肝素化涂层

  17. Basic life support knowledge of secondary school students in cardiopulmonary resuscitation training using a song.

    Science.gov (United States)

    Fonseca Del Pozo, Francisco Javier; Valle Alonso, Joaquin; Canales Velis, Nancy Beatriz; Andrade Barahona, Mario Miguel; Siggers, Aidan; Lopera, Elisa

    2016-07-20

    To examine the effectiveness of a "cardiopulmonary resuscitation song" in improving the basic life support skills of secondary school students. This pre-test/post-test control design study enrolled secondary school students from two middle schools randomly chosen in Córdoba, Andalucia, Spain. The study included 608 teenagers. A random sample of 87 students in the intervention group and 35 in the control group, aged 12-14 years were selected. The intervention included a cardiopulmonary resuscitation song and video. A questionnaire was conducted at three-time points: pre-intervention, one month and eight months post-intervention. On global knowledge of cardiopulmonary resuscitation, there were no significant differences between the intervention group and the control group in the trial pre-intervention and at the month post-intervention. However, at 8 months there were significant differences with a p-value = 0.000 (intervention group, 95% CI: 6.39 to 7.13 vs. control group, 95% CI: 4.75 to 5.92), F(1,120)=16.644, p=0.000). In addition, significant differences about students' basic life support knowledge about chest compressions at eight months post-intervention (F(1,120)=15.561, p=0.000) were found. Our study showed that incorporating the song component in the cardiopulmonary resuscitation teaching increased its effectiveness and the ability to remember the cardiopulmonary resuscitation algorithm. Our study highlights the need for different methods in the cardiopulmonary resuscitation teaching to facilitate knowledge retention and increase the number of positive outcomes after sudden cardiac arrest.

  18. Long-term outcome of complete cardiovascular implantable electronic device removal with cardiopulmonary bypass.

    Science.gov (United States)

    Okada, Masaho; Narita, Yuji; Araki, Yoshimori; Oshima, Hideki; Usui, Akihiko; Ueda, Yuichi

    2013-06-01

    Definitive endovascular techniques have been developed for pacemaker lead extraction; however, a few patients require immediate secondary open heart surgery because of incomplete transvenous lead extraction. This study examined the safety, effectiveness, and long-term outcome of the removal of cardiovascular implantable electronic device (CIED) via median sternotomy under cardiopulmonary bypass. The removal of CIED was performed in 6 patients (mean age 57 ± 16 years, 5 males and 1 female), from September 2000 to April 2011. The reasons for removal included eradication of an infection in 5 patients and elimination of pacemaker component allergy in 1. Positive culture results, including methicillin-sensitive Staphylococcus aureus (MSSA, n = 2), methicillin-resistant S. aureus (MRSA, n = 1), coagulase-negative staphylococci (CNS, n = 1), and methicillin-resistant S. epidermidis (MRSE, n = 1) were observed in all 5 infected patients. Mitral annuloplasty (n = 1), mitral valvuloplasty (n = 1), tricuspid annuloplasty (n = 3). Implantation of myocardial pacing leads (n = 5) were performed concomitantly (n = 4), or secondarily (n = 1). All 6 patients were alive in good condition at 72 ± 55 months following CIED removal. New device infection occurred in 1 patient during long-term follow up. Complete surgical removal of pacing systems via median sternotomy with cardiopulmonary bypass is, therefore, considered to be safe and feasible with acceptable long term results.

  19. Emergent cardiopulmonary bypass for a 180 kilogram patient: support with a single oxygenator.

    Science.gov (United States)

    Hunter, Kyler T; Lopez, Angela R; Yun, Kwok L

    2013-09-01

    As obesity increases in prevalence, so will cases in which patients present at the boundaries of care. We report the support of a class III obese man, having a body mass index of 60.8 kg/m2 and in acute renal failure, with a single Trillium-coated Affinity NT Hollow Fiber oxygenator in cardiopulmonary bypass for an emergent aortic valve replacement secondary to infective endocarditis. A maximum oxygen delivery of 807.51 mL of oxygen per minute is reported for this oxygenator in this case report.

  20. Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies

    NARCIS (Netherlands)

    Bonnes, J.L.; Brouwer, M.A.; Navarese, E.P.; Verhaert, D.V.; Verheugt, F.W.; Smeets, J.L.; Boer, M.J. de

    2016-01-01

    STUDY OBJECTIVE: Mechanical chest compression devices have been developed to facilitate continuous delivery of high-quality cardiopulmonary resuscitation (CPR). Despite promising hemodynamic data, evidence on clinical outcomes remains inconclusive. With the completion of 3 randomized controlled

  1. Using an automated emboli detection device in a porcine cardiopulmonary bypass (CPB) model: feasibility and considerations.

    Science.gov (United States)

    Schnürer, Christian; Gyoeri, Georg; Hager, Martina; Jeller, Anton; Moser, Patrizia L; Velik-Salchner, Corinna; Laufer, Guenther; Lorenz, Ingo H; Kolbitsch, Christian

    2007-12-01

    The significant risk of cerebral embolism during cardiopulmonary bypass (CPB) makes monitoring of embolic events advisable already when developing new operation and coagulation management strategies for example in CPB animal models. The present study therefore evaluated in a porcine CPB model the feasibility of bilateral epicarotid Doppler signal recording and the quality of manual or automatic emboli detection. A total of 42 recordings (e.g. right carotid artery (n = 20), left carotid artery (n = 22)) were evaluated. The frequency of emboli counts was comparable for both carotid arteries. Automatic emboli detection, however, found significantly more embolic events per pig than did post-hoc manual off-line analysis of the recordings (172 +/- 217 vs. 13 +/-10). None of the brains, however, showed any emboli or infarction area either in cross-examination or in histological evaluation. In conclusion, the present study showed the feasibility of using an epicarotid Doppler device for bilateral emboli detection in a porcine CPB model. Automatic on-line emboli detection, however, reported more embolic events than did post hoc, off-line manual analysis. Possible reasons for this discrepancy are discussed.

  2. Experimental Study of a Novel Method of Cardiopulmonary Resuscitation Using a Combination of Percutaneous Cardiopulmonary Support and Liposome-encapsulated Hemoglobin (TRM645

    Directory of Open Access Journals (Sweden)

    Ogata,Yoshitaka

    2008-08-01

    Full Text Available Percutaneous cardiopulmonary support (PCPS has been applied for cardiopulmonary arrest (CPA. We have developed a novel method of cardiopulmonary resuscitation using PCPS combined with liposome-encapsulated hemoglobin (TRM645 to improve oxygen delivery to vital organs. Ventricular fibrillation was electrically induced to an adult goat for 10 min. Next, PCPS (30 ml/kg/min, V/Q: 1 was performed for 20 min. Then, external defibrillation was attempted and observed for 120 min. The TRM group (n5 was filled with 300 mL of TRM645 for the PCPS circuit. The control group (n5 was filled with the same volume of saline. The delivery of oxygen (DO2 and oxygen consumption (VO2 decreased markedly by PCPS after CPA, compared to the preoperative values. DO2 was kept at a constant level during PCPS in both groups, but VO2 slowly decreased at 5, 10, and 15 min of PCPS in the control groups, demonstrating that systemic oxygen metabolism decreased with time. In contrast, the decreases in VO2 were small in the TRM group at 5, 10, and 15 min of PCPS, demonstrating that TRM645 continuously maintained systemic oxygen consumption even at a low flow rate. AST and LDH in the TRM group were lower than the control. There were significant differences at 120 min after the restoration of spontaneous circulation (p<0.05.

  3. Ventricular assist device support for management of sustained ventricular arrhythmias.

    Science.gov (United States)

    Fasseas, Panayotis; Kutalek, Steven P; Samuels, Fania L; Holmes, Elena C; Samuels, Louis E

    2002-01-01

    We describe herein the cases of 2 patients who had ventricular arrhythmias. In one, a short-term biventricular assist device, the ABIOMED BVS 5000, was placed because the patient had sustained ventricular tachycardia and could not be weaned from cardiopulmonary bypass. Excellent hemodynamic support was maintained for several days while the antiarrhythmic therapy was maximized. Sinus rhythm was restored, and the patient was successfully weaned from the ventricular assist device. However, the substrate for the arrhythmia persisted, and a recurrence, 1 week later, resulted in the patient's death. In the 2nd patient, the use of an implantable left ventricular assist device was successful in temporarily alleviating the ventricular tachycardia associated with ischemic cardiomyopathy. However, after 2 days of device assistance, the patient experienced a recurrence of the tachycardia, which degenerated into ventricular fibrillation with a marked deterioration in the patient's hemodynamics. The arrhythmia persisted despite multiple attempts at external cardioversion, and internal cardioversion and placement of an automatic implantable cardioverter-defibrillator were necessary. This treatment, along with repeated boluses of amiodarone, led to successful suppression of the arrhythmias, and the patient eventually underwent transplantation. The mechanical hemodynamic support of the circulation by ventricular assist devices was effective in supporting these 2 patients who had sustained ventricular arrhythmias.

  4. Evaluation of nurses' perceptions on providing patient decision support with cardiopulmonary resuscitation.

    Science.gov (United States)

    Pyl, Nicole; Menard, Prudy

    2012-01-01

    The decision whether to receive cardiopulmonary resuscitation (CPR) is a decision in which the personal values of the patient must be considered along with information about the risks and benefits of the treatment. A decision aid can be used to provide patient decision support to a patient who is seriously ill and needs to consider CPR options. The goal of this project was to identify the barriers and facilitators to using a CPR decision aid, through evaluating nursing perceptions on providing patient decision support. Using a needs assessment, it was determined that implementing a patient decision aid for CPR status in the Acute Monitor Area (AMA) of The Ottawa Hospital would be an excellent quality improvement project. The nurses who chose to participate were given an education session regarding patient decision support. Questionnaires were distributed to evaluate their views of patient decision support and decision aids before and after the education session and implementation of the CPR decision aid. Questionnaire results did not indicate a significant change between before or after education session and decision aid implementation. Qualitative reports did indicate that nurses generally have positive attitudes toward patient decision support and decision aids. The nurses identified specific barriers and facilitators in their commentaries. This clinically relevant data supports the idea that patient decision support should be integrated into daily nursing practice.

  5. Supporting Multiple Pointing Devices in Microsoft Windows

    DEFF Research Database (Denmark)

    Westergaard, Michael

    2002-01-01

    In this paper the implementation of a Microsoft Windows driver including APIs supporting multiple pointing devices is presented. Microsoft Windows does not natively support multiple pointing devices controlling independent cursors, and a number of solutions to this have been implemented by us...

  6. Supporting Multiple Pointing Devices in Microsoft Windows

    DEFF Research Database (Denmark)

    Westergaard, Michael

    2002-01-01

    In this paper the implementation of a Microsoft Windows driver including APIs supporting multiple pointing devices is presented. Microsoft Windows does not natively support multiple pointing devices controlling independent cursors, and a number of solutions to this have been implemented by us...

  7. Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) with pulmonary embolism in surgical patients - a case series.

    Science.gov (United States)

    Swol, J; Buchwald, D; Strauch, J; Schildhauer, T A

    2016-01-01

    Extracorporeal life support (ECLS) devices maintain the circulation and oxygenation of organs during acute right ventricular failure and cardiogenic shock, bypassing the lungs. A pulmonary embolism can cause this life-threatening condition. ECLS is a considerably less invasive treatment than surgical embolectomy. Whether to bridge embolectomy or for a therapeutic purpose, ECLS is used almost exclusively following failure of all other therapeutic options. From January 1, 2008 to June 30, 2014, five patients in cardiac arrest and with diagnosed pulmonary embolism (PE) were cannulated with the ECLS system. PE was diagnosed using computer tomography scanning or echocardiography. Cardiac arrest was witnessed in the hospital in all cases and CPR (cardiopulmonary resuscitation) was initiated immediately. Cannulation of the femoral vein and femoral artery was always performed under CPR conditions. Right heart failure regressed during the ECLS therapy, usually under a blood flow of 4-5 L/min after 48 hours. Three patients were weaned from ECLS and one patient became an organ donor. Finally, two of the five PE patients treated with ECLS were discharged from inpatient treatment without neurological dysfunction. The duration of ECLS therapy depends on the patient's condition. Irreversible damage to the organs after hypoxemia limits ECLS treatment and leads to futile multiorgan failure. Hemorrhages after thrombolysis and cerebral dysfunction were further complications. Veno-arterial cannulation for ECLS can be feasibly achieved and should be established during active CPR for cardiac arrest. In the case of PE, the immediate diagnosis and rapid implantation of the system are decisive for therapeutic success. © The Author(s) 2015.

  8. Keratometry device for surgical support

    Directory of Open Access Journals (Sweden)

    Saia Paula

    2009-12-01

    Full Text Available Abstract Background High astigmatisms are usually induced during corneal suturing subsequent to tissue transplantation or any other surgery which involves corneal suturing. One of the reasons is that the procedure is intimately dependent on the surgeon's skill for suturing identical stitches. In order to evaluate the influence of the irregularity on suturing for the residual astigmatism, a prototype for ophthalmic surgical support has been developed. The final intention of this prototype is to be an evaluation tool for guided suture and as an outcome diminish the postoperative astigmatism. Methods The system consists of hand held ring with 36 infrared LEDs, that is to be projected onto the lachrymal film of the cornea. The image is reflected back through the optics of the ocular microscope and its distortion from the original circular shape is evaluated by developed software. It provides keratometric and circularity measurements during surgery in order to guide the surgeon for uniformity in suturing. Results The system is able to provide up to 23D of astigmatism (32D - 55D range and is ± 0.25D accurate. It has been tested in 14 volunteer patients intraoperative and has been compared to a commercial keratometer Nidek Oculus Hand-held corneal topographer. The correlation factors are 0.92 for the astigmatism and 0.97 for the associated axis. Conclusion The system is potentially efficient for guiding the surgeon on uniformity of suturing, presenting preliminary data indicating an important decrease on the residual astigmatism, from an average of 8D - for patients not submitted to the prototype guidance - to 1.4D - for patients who have actually been submitted to the prototype guidance - after the first 24 hours post-surgery and in the subsequent weeks. It also indicates that the surgeon should achieve circularity greater or equal to 98% in order to avoid postoperative astigmatisms over 1D. Trial Registration Trial registration number: CAAE - 0212.0.004.000-09.

  9. CPR PRO® device reduces rescuer fatigue during continuous chest compression cardiopulmonary resuscitation: a randomized crossover trial using a manikin model.

    Science.gov (United States)

    Kovic, Ivor; Lulic, Dinka; Lulic, Ileana

    2013-10-01

    The performance of high-quality chest compressions with minimal interruptions is one of the most important elements of the "Chain of Survival." To evaluate the impact of a novel CPR PRO(®) (CPRO) device for manual chest compression on rescuer fatigue, pain, and cardiopulmonary resuscitation (CPR) quality. Randomized crossover trial of 24 health care professionals performing continuous chest compression CPR for 10 min with a CPRO device and conventional manual CPR (MCPR). Data about chest compressions were recorded using a manikin. Rescuers' physiologic signs were recorded before and after each session, and heart rate (HR) data were tracked continuously. Fatigue was assessed with ratings of perceived exertion, and pain questionnaire. All subjects completed 10 min of CPR with both methods. Significantly more rest breaks were taken during MCPR sessions (1.7 ± 2 vs. 0.21 ± 0.72). Subjects' perceived exertion was higher after MCPR, as well as the average (120.7 ± 16.8 vs. 110.8 ± 17.6) and maximal HR (134.3 ± 18.5 vs. 123.42 ± 16.5) during testing. Subjects reported more pain in the hands, especially the wrist, after performing MCPR. Average depth of compressions was higher with the CPRO device (4.6 ± 7.0 vs. 4.3 ± 7.9) and declined more slowly over time. Other CPR quality parameters, such as the correct position and complete release of pressure, were also better for CPRO CPR. CPRO device reduces rescuer fatigue and pain during continuous chest compression CPR, which results in a higher quality of CPR in a simulation setting. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems.

    Science.gov (United States)

    Gholami, Behnood; Bailey, James M; Haddad, Wassim M; Tannenbaum, Allen R

    2012-03-01

    Patients in the intensive care unit (ICU) who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations.

  11. Newly graduated doctors' competence in managing cardiopulmonary arrests assessed using a standardized Advanced Life Support (ALS) assessment

    DEFF Research Database (Denmark)

    Jensen, Marianne Lidang; Hesselfeldt, R.; Rasmussen, M.B.

    2008-01-01

    and to study whether teaching site affects their resuscitation competence. Materials and methods: The entire cohort of medical students from Copenhagen University expected to graduate in June 2006 was invited to participate in the study. Participants’ ALS- competence was assessed using the Advanced Life...... Support Provider (ALS) examination standards as issued by the European Resuscitation Council (ERC). The emergency medicine course is con- ducted at three different university hospital teaching sites and teaching and assessment might vary across sites, despite the common end objectives regarding...... resuscitation teaching issued by the university. Results: Participation was accepted by 154/240 (64%) graduates. Only 23% of the participants met the ALS pass criteria. They primarily lacked skills in managing cardiopulmonary arrest. There were significant differences in ALS-competence between teaching sites....

  12. Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure.

    Science.gov (United States)

    Schmitt, Katharina Rose Luise; Fedarava, Katsiaryna; Justus, Georgia; Redlin, Mathias; Böttcher, Wolfgang; Delmo Walter, Eva Maria; Hetzer, Roland; Berger, Felix; Miera, Oliver

    2016-05-01

    Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4.9 months, range 2.3-38 months; median weight 7.2 kg, range 5.2-11.7 kg) were randomized to a perfusion temperature of either 32°C (Group 1, n = 10) or 36°C (Group 2, n = 10). The clinical data and blood samples were collected before cardiopulmonary bypass, directly after aortic cross-clamp release, and 4 and 24 h after weaning from cardiopulmonary bypass. Time on ventilation as primary outcome did not differ between the two groups. Other clinical outcome parameters like fluid balance or length of stay in the intensive care were also similar in the two groups. Compared with Group 2, Group 1 needed significantly higher and longer inotropic support (P bypass temperature does not influence time on ventilation or inflammatory marker release. However, in the present study, with a small patient cohort, patients operated under hypothermic bypass needed higher and longer inotropic support. The use of hypothermic cardiopulmonary bypass in infants and children should be approached with care.

  13. 21 CFR 868.6175 - Cardiopulmonary emergency cart.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary emergency cart. 868.6175 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6175 Cardiopulmonary emergency cart. (a) Identification. A cardiopulmonary emergency cart is a device intended to store and...

  14. Conditions and procedures for in-hospital extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR) of adult patients.

    Science.gov (United States)

    Swol, Justyna; Belohlávek, Jan; Haft, Jonathan W; Ichiba, Shingo; Lorusso, Roberto; Peek, Giles J

    2016-04-01

    The use of extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR; ECPR) has been repeatedly published as non-randomized studies, mainly case series and case reports. The aim of this article is to support physicians, perfusionists, nurses and extracorporeal membrane oxygenation (ECMO) specialists who regularly perform ECPR or are willing to start an ECPR program by establishing standards for safe and efficient ECPR procedures. This article represents the experience and recommendations of physicians who provide ECPR routinely. Based on its survival and outcome rates, ECPR can be considered when determining the optimal treatment of patients who require CPR. The successful performance of ECLS cannulation during CPR is a life-saving measure and has been associated with improved outcome (including neurological outcome) after CPR. We summarize the general structure of an ECLS team and describe the cannulation procedure and the approaches for post-resuscitation care. The differences in hospital organizations and their regulations may result in variations of this model. © The Author(s) 2015.

  15. A stabilization device that promotes the efficiency of cardiopulmonary resuscitation during ambulance transportation to the level as under non-moving conditions.

    Science.gov (United States)

    Foo, Ning-Ping; Chang, Jer-Hao; Su, Shih-Bin; Chen, Kow-Tong; Cheng, Ching-Fa; Chen, Pei-Chung; Lin, Tsung-Yi; Guo, How-Ran

    2014-01-01

    The survival rate of patients with out-of-hospital cardiac arrest is low, and measures to improve the quality of cardiopulmonary resuscitation (CPR) during ambulance transportation are desirable. We designed a stabilization device, and in a randomized crossover trial we found performing CPR in a moving ambulance with the device (MD) could achieve better efficiency than that without the device (MND), but the efficiency was lower than that in a non-moving ambulance (NM). To evaluate whether a modified version of the stabilization device, can promote further the quality of CPR during ambulance transportation. Participants of the previous study were recruited, and they performed CPR for 10 minutes in a moving ambulance with the modified version of the stabilization device (MVSD). The primary outcomes were effective chest compressions and no-flow fraction recorded by a skill-reporter manikin. The secondary outcomes included back pain, physiological parameters, and the participants' rating about the device after performing CPR. The overall effective compressions in 10 minutes were 86.4±17.5% for NM, 60.9±14.6% for MND, 69.7±22.4% for MD, and 86.6%±13.2% for MVSD (pambulance to a level similar to that in a non-moving condition without increasing the severity of back pain.

  16. The Effect of the Duration of Basic Life Support Training on the Learners’ Cardiopulmonary and Automated External Defibrillator Skills

    Directory of Open Access Journals (Sweden)

    Jin Hyuck Lee

    2016-01-01

    Full Text Available Background. Basic life support (BLS training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR and automated external defibrillator (AED skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min, level 2 (80 min, level 3 (120 min, and level 4 (180 min. Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p<0.001 and average chest compression depth (p=0.003. All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p<0.001. Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs.

  17. Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study

    NARCIS (Netherlands)

    Kalz, Marco; Lenssen, Niklas; Felzen, Marco; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max

    2014-01-01

    Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the persp

  18. Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study

    NARCIS (Netherlands)

    Kalz, Marco; Lenssen, Niklas; Felzen, Marco; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max

    2014-01-01

    Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the

  19. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kanwalpreet Sodhi

    2011-01-01

    Full Text Available Background: Guidelines on performing cardiopulmonary resuscitation (CPR have been published from time to time, and formal training programs are conducted based on these guidelines. Very few data are available in world literature highlighting the impact of these trainings on CPR outcome. Aim: The aim of our study was to evaluate the impact of the American Heart Association (AHA-certified basic life support (BLS and advanced cardiac life support (ACLS provider course on the outcomes of CPR in our hospital. Materials and Methods : An AHA-certified BLS and ACLS provider training programme was conducted in our hospital in the first week of October 2009, in which all doctors in the code blue team and intensive care units were given training. The retrospective study was performed over an 18-month period. All in-hospital adult cardiac arrest victims in the pre-BLS/ACLS training period (January 2009 to September 2009 and the post-BLS/ACLS training period (October 2009 to June 2010 were included in the study. We compared the outcomes of CPR between these two study periods. Results: There were a total of 627 in-hospital cardiac arrests, 284 during the pre-BLS/ACLS training period and 343 during the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 52 patients (18.3% had return of spontaneous circulation, compared with 97 patients (28.3% in the post-BLS/ACLS training period (P < 0.005. Survival to hospital discharge was also significantly higher in the post-BLS/ACLS training period (67 patients, 69.1% than in the pre-BLS/ACLS training period (12 patients, 23.1% (P < 0.0001. Conclusion : Formal certified BLS and ACLS training of healthcare professionals leads to definitive improvement in the outcome of CPR.

  20. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Science.gov (United States)

    2010-04-01

    ... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass vascular catheter,...

  1. Energy conversion device with support member having pore channels

    Science.gov (United States)

    Routkevitch, Dmitri [Longmont, CO; Wind, Rikard A [Johnstown, CO

    2014-01-07

    Energy devices such as energy conversion devices and energy storage devices and methods for the manufacture of such devices. The devices include a support member having an array of pore channels having a small average pore channel diameter and having a pore channel length. Material layers that may include energy conversion materials and conductive materials are coaxially disposed within the pore channels to form material rods having a relatively small cross-section and a relatively long length. By varying the structure of the materials in the pore channels, various energy devices can be fabricated, such as photovoltaic (PV) devices, radiation detectors, capacitors, batteries and the like.

  2. 21 CFR 870.4430 - Cardiopulmonary bypass intracardiac suction control.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass intracardiac suction....4430 Cardiopulmonary bypass intracardiac suction control. (a) Identification. A cardiopulmonary bypass intracardiac suction control is a device which provides the vacuum and control for a cardiotomy return sucker...

  3. Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial.

    Science.gov (United States)

    Cheng, Adam; Brown, Linda L; Duff, Jonathan P; Davidson, Jennifer; Overly, Frank; Tofil, Nancy M; Peterson, Dawn T; White, Marjorie L; Bhanji, Farhan; Bank, Ilana; Gottesman, Ronald; Adler, Mark; Zhong, John; Grant, Vincent; Grant, David J; Sudikoff, Stephanie N; Marohn, Kimberly; Charnovich, Alex; Hunt, Elizabeth A; Kessler, David O; Wong, Hubert; Robertson, Nicola; Lin, Yiqun; Doan, Quynh; Duval-Arnould, Jordan M; Nadkarni, Vinay M

    2015-02-01

    The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA. Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams). Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA. The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA. The quality of CPR was poor in the control group, with 12.7% (95% CI, 5.2%-20.1%) mean depth compliance and 27.1% (95% CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9% (95% CI, 11.1%-28.7%; P 89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines but was not significantly better than either intervention in isolation. The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes. clinicaltrials.gov Identifier: NCT02075450.

  4. Changing guidelines of cardiopulmonary resuscitation and basic life support for general dental practitioners and oral and maxillofacial surgeons.

    Science.gov (United States)

    Gadipelly, Srinivas; Neshangi, Srisha

    2015-06-01

    Every general dental practitioner and oral and maxillofacial surgeon needs a thorough knowledge of the diagnosis and management of medical emergencies. Cardiopulmonary arrest is the most urgent of emergencies and diagnosis must be done as soon as possible. This paper discusses the importance of the International Liaison Committee on Resuscitation which forms the guidelines for cardiopulmonary resuscitation (CPR), highlighting the important changes in the guidelines of CPR from the year 2000 to 2010, the basic sequence of performing CPR and also the role of defibrillation and the use of automated external defibrillators. Finally the five part chain of survival which is of utmost importance to dental health care professionals and oral and maxillofacial surgeons. All dental health care personnel and oral & maxillofacial surgeons should recognize the importance of the changes in the guidelines of CPR, be trained and allowed to use a properly maintained defibrillator, to respond to cardiac arrest victims.

  5. Effect of an interactive cardiopulmonary resuscitation assist device with an automated external defibrillator synchronised with a ventilator on the CPR performance of emergency medical service staff: a randomised simulation study.

    Science.gov (United States)

    Nitzschke, Rainer; Doehn, Christoph; Kersten, Jan F; Blanz, Julian; Kalwa, Tobias J; Scotti, Norman A; Kubitz, Jens C

    2017-04-04

    The present study evaluates whether the quality of advanced cardiac life support (ALS) is improved with an interactive prototype assist device. This device consists of an automated external defibrillator linked to a ventilator and provides synchronised visual and acoustic instructions for guidance through the ALS algorithm and assistance for face-mask ventilations. We compared the cardiopulmonary resuscitation (CPR) quality of emergency medical system (EMS) staff members using the study device or standard equipment in a mannequin simulation study with a prospective, controlled, randomised cross-over study design. Main outcome was the effect of the study device compared to the standard equipment and the effect of the number of prior ALS trainings of the EMS staff on the CPR quality. Data were analysed using analyses of covariance (ANCOVA) and binary logistic regression, accounting for the study design. In 106 simulations of 56 two-person rescuer teams, the mean hands-off time was 24.5% with study equipment and 23.5% with standard equipment (Difference 1.0% (95% CI: -0.4 to 2.5%); p = 0.156). With both types of equipment, the hands-off time decreased with an increasing cumulative number of previous CPR trainings (p = 0.042). The study equipment reduced the mean time until administration of adrenaline (epinephrine) by 23 s (p = 0.003) and that of amiodarone by 17 s (p = 0.016). It also increased the mean number of changes in the person doing chest compressions (0.6 per simulation; p trainings, the time intervals in the ALS algorithm until the defibrillations decreased with standard equipment but increased with the study device. EMS staff with limited training in CPR profit from guidance through the ALS algorithm by the study device. However, the study device somehow reduced the ALS quality of well-trained rescuers and thus can only be recommended for ALS provider with limited experience.

  6. Impedance Threshold Device Combined With High-Quality Cardiopulmonary Resuscitation Improves Survival With Favorable Neurological Function After Witnessed Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Sugiyama, Atsushi; Duval, Sue; Nakamura, Yuji; Yoshihara, Katsunori; Yannopoulos, Demetris

    2016-09-23

    The quality of cardiopulmonary resuscitation (CPR) has been recently shown to affect clinical outcome. The Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (PRIMED) trial showed no differences in outcomes with an active vs. sham impedance threshold device (ITD), a CPR adjunct that enhances circulation. It was hypothesized the active ITD would improve survival with favorable neurological outcomes in witnessed out-of-hospital cardiac arrest patients when used with high-quality CPR. Using the publicly accessible ROC PRIMED database, a post-hoc analysis was performed on all witnessed subjects with both compression rate and depth data (n=1,808) who received CPR within the study protocol definition of adequate CPR quality (compression rate 80-120/min and depth 4-6 cm; n=929). Demographics were similar between sham and active ITD groups. In witnessed subjects who received quality CPR, survival with favorable neurological function was 11.9% for the active ITD subjects (56/470) vs. 7.4% for the sham (34/459) (odds ratio 1.69 [95% confidence interval 1.08, 2.64]). There were no statistically significant differences for this primary outcome when CPR was performed outside the boundaries of the definition of adequate CPR quality. Multivariable models did not change these associations. An active ITD combined with adequate-quality conventional CPR has the potential to significantly improve survival after witnessed cardiac arrest. (Circ J 2016; 80: 2124-2132).

  7. Internal Models Support Specific Gaits in Orthotic Devices

    DEFF Research Database (Denmark)

    Matthias Braun, Jan; Wörgötter, Florentin; Manoonpong, Poramate

    2014-01-01

    Patients use orthoses and prosthesis for the lower limbs to support and enable movements, they can not or only with difficulties perform themselves. Because traditional devices support only a limited set of movements, patients are restricted in their mobility. A possible approach to overcome...

  8. Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies.

    Science.gov (United States)

    Bonnes, Judith L; Brouwer, Marc A; Navarese, Eliano P; Verhaert, Dominique V M; Verheugt, Freek W A; Smeets, Joep L R M; de Boer, Menko-Jan

    2016-03-01

    Mechanical chest compression devices have been developed to facilitate continuous delivery of high-quality cardiopulmonary resuscitation (CPR). Despite promising hemodynamic data, evidence on clinical outcomes remains inconclusive. With the completion of 3 randomized controlled trials, we conduct a meta-analysis on the effect of in-field mechanical versus manual CPR on clinical outcomes after out-of-hospital cardiac arrest. With a systematic search (PubMed, Web of Science, EMBASE, and the Cochrane Libraries), we identified all eligible studies (randomized controlled trials and nonrandomized studies) that compared a CPR strategy including an automated mechanical chest compression device with a strategy of manual CPR only. Outcome variables were survival to hospital admission, survival to discharge, and favorable neurologic outcome. Twenty studies (n=21,363) were analyzed: 5 randomized controlled trials and 15 nonrandomized studies, pooled separately. For survival to admission, the pooled estimate of the randomized controlled trials did not indicate a difference (odds ratio 0.94; 95% confidence interval 0.84 to 1.05; P=.24) between mechanical and manual CPR. In contrast, meta-analysis of nonrandomized studies demonstrated a benefit in favor of mechanical CPR (odds ratio 1.42; 95% confidence interval 1.21 to 1.67; PCPR guidelines (2000 versus 2005) and the CPR strategy (P=.27). Survival to discharge and neurologic outcome did not differ between strategies. Although there are lower-quality, observational data that suggest that mechanical CPR used at the rescuer's discretion could improve survival to hospital admission, the cumulative high-quality randomized evidence does not support a routine strategy of mechanical CPR to improve survival or neurologic outcome. These findings are irrespective of the endorsed CPR guidelines during the study periods. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  9. Personal view: current role of artificial liver support devices.

    Science.gov (United States)

    O'Grady, J

    2006-06-01

    Enthusiasm for liver support devices, particularly cell-based biological systems and albumin dialysis, increased over the last decade and there has been considerable clinical activity both within and without the construct of clinical trials. Most data have been generated on patients with acute liver failure or in patients with decompensation of chronic liver disease, often referred to as acute-on-chronic liver failure. In acute liver failure liver, liver support devices are more realistically being used as a 'bridge' to liver transplantation rather than to transplant-free survival. In acute-on-chronic liver failure the clinical objective of attaining clinical stability with treatment appears more achievable. The so-called bioartificial liver device, based on porcine hepatocytes, is the most extensively evaluated biological device. A sizeable clinical trial failed to demonstrate efficacy, but secondary analyses suggest it would be unwise to assume futility had been established with this device. Molecular adsorbent recirculating system leads the way in the non-biological category in terms of the number of patients treated, but data from large clinical trials are not yet available. One of the strongest conclusions of this review is that the amount of high-quality data available on liver support devices dramatically understates the effort and money that have been expended in their assessment. It is very clear that randomized controlled trials are mandatory to establish clinical efficacy, but it is less clear how the ideal trial should be constructed.

  10. Successful Management of a Patient with Refractory Ventricular Fibrillation (VF) due to Acute Myocardial Infarction (AMI) and Lung Injury by Transition from Percutaneous Cardiopulmonary Support (PCPS) to Veno-Venous Extracorporeal Membrane Oxygenation (ECMO).

    Science.gov (United States)

    Sato, Atsushi; Isoda, Kikuo; Gatate, Yodo; Akita, Koji; Daida, Hiroyuki

    2016-01-01

    A 69-year-old man was admitted to our hospital with cardiopulmonary arrest. Percutaneous cardio-pulmonary support (PCPS) using the right femoral artery and vein was initiated, because ventricular fibrillation continued. Although we succeeded in defibrillation after percutaneous coronary intervention (PCI), a chest radiograph indicated a pneumothorax in the right lung and a pulmonic contusion in the left lung caused by cardiopulmonary resuscitation. Two days after PCI, partial pressure of arterial oxygen (PaO2) from the right radial artery suddenly decreased, and his cardiac function showed improvement on an echocardiogram. To avoid additional brain damage, we converted the treatment to veno-venous extracorporeal membrane oxygenation by changing the blood returning site of PCPS from the right femoral artery to the right jugular vein. Thereafter, the patient's PaO2 level gradually improved.

  11. 78 FR 61383 - Certain Thermal Support Devices For Infants, Infant Incubators, Infant Warmers, and Components...

    Science.gov (United States)

    2013-10-03

    ... COMMISSION Certain Thermal Support Devices For Infants, Infant Incubators, Infant Warmers, and Components... United States after importation of certain thermal support devices for infants, infant incubators, infant... certain thermal support devices for infants, infant incubators, infant warmers, and components thereof...

  12. 21 CFR 870.4270 - Cardiopulmonary bypass cardiotomy suction line blood filter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass cardiotomy suction line... Devices § 870.4270 Cardiopulmonary bypass cardiotomy suction line blood filter. (a) Identification. A cardiopulmonary bypass cardiotomy suction line blood filter is a device used as part of a gas exchange (oxygenator...

  13. 体外膜肺氧合在心肺辅助循环中的应用%Application of ECMO in cardiopulmonary failure support

    Institute of Scientific and Technical Information of China (English)

    陈娅; 唐令凤; 刘才仟; 杨康

    2011-01-01

    目的 总结7例体外膜肺氧合(ECMO)在心肺辅助循环中的临床应用.方法 自2007年12月至2010年10月,对7例重症心肺功能衰竭患者进行ECMO支持治疗,所有患者均采用静脉-动脉插管行ECMO支持治疗,期间维持血流动力学和呼吸指标稳定.结果 ECMO支持时间20~48 h,平均32 h,患者建立ECMO后血流动力学及气体交换均有明显好转.其中5例患者顺利脱机,不能脱机的2例中1例在血管活性药物用量较大,ECMO流量较大的情况下仅能维持较低血压,而后心跳停止不能恢复.1例因患者肺受损严重,ECMO治疗效果不佳,肾功能衰竭,最后放弃治疗.结论 ECMO是救治心功能衰竭、呼吸功能衰竭的重要心肺辅助循环的有效手段.正确掌握其适应证、选择转流方式、良好的管理才能提高ECMO的成功率.%Objective observe the application of ECMO(extracorporeal membrane oxygenation)in cardiopulmonary failure support and summarize clinical experience. Methods gave ECMO treatment to 7 patients suffering from severe cardiopulmonary failure from December 2007 to October 2010. All the 7 patients received intravenous arterial cannula ECMO support treatment and main rained stable hemodynamic and respiratory indexes. Results ECMO support time:20~48h,32h on average. With ECMO support,hemodynamics and respiration were significantly improved. 5 patients needed no longer to receive equipment treatment. One of the remained two patients used great amount of vasoactive drugs so that low blood pressure could be maintained with large ECMO flow. After that, cardiac arrest occurred and can not be restored. Poor effect was achieved for I patient due to severe lung damage.In addition, the patient also suffered from renal failure. Finally, the treatment was abandoned. Conclusion ECMO is an effective means for heart failure and respiratory failure treatment for cardiopulmonary circulatory support. With proper understanding of its indication and

  14. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial

    Science.gov (United States)

    Combescure, Christophe; Lacroix, Laurence; Haddad, Kevin; Sanchez, Oliver; Gervaix, Alain; Lovis, Christian; Manzano, Sergio

    2017-01-01

    Background During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. Objective The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. Methods The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. Results A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean

  15. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240... bypass heat exchanger. (a) Identification. A cardiopulmonary bypass heat exchanger is a device, consisting of a heat exchange system used in extracorporeal circulation to warm or cool the blood...

  16. A hydraulic distribution device of a powered support section

    Energy Technology Data Exchange (ETDEWEB)

    Zhuravlev, R.P.; Barinov, V.S.; Demidovich, Z.A.; Fedorov, L.I.; Kozhukhov, L.F.; Mosunov, Yu.Ya.

    1981-01-30

    The goal of this invention is to reduce the working time for manual control in the process of bracing a hydraulic prop and complete use of the working pressure of the support's hydraulic system to perform initial bracing of the hydraulic prop. To achieve this goal, the device has a reflux valve with a locking element and a choke, the latter situated between the piston and rod chambers; the floating piston is made with a stop which interacts with the motion limiter, while the rod of the floating piston has a pusher which interacts with the locking element of the reflux valve. Use of the hydraulic device of this design in powered supports during their operation under various mining conditions significantly raises the operating life of hydraulic supports and hydraulic distributors, while lowering the total complex's down time. Automatic positioning of the predetermined amount of initial spacing shortens the time in which the operator handles the support sections. The operator uses the time available to perform succeeding operations (transition to the next control panel, unloading, and transfer).

  17. Effects of Mini-Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low-Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support.

    Science.gov (United States)

    Kim, Sang Yoon; Cho, Sungkyu; Choi, Eunseok; Kim, Woong-Han

    2016-01-01

    Mixing of autologous blood with priming volume has relatively significant effects on blood composition, especially in low-bodyweight neonates. In an effort to reduce these effects, mini-volume priming (MP) has been applied in cardiopulmonary bypass (CPB). The present study was designed to examine the effect of MP on clinical outcomes of low-bodyweight neonates undergoing open heart surgery.We retrospectively reviewed medical records of low-bodyweight (2.5 kg or less) neonates who underwent open heart surgery in our center from January 2000 to December 2014. A total of 64 patients were included. MP was introduced in 2007, and became a routine protocol in 2009. Preoperative and intraoperative characteristics included age, bodyweight, RACHS-1, priming volume, CPB time, and aortic cross-clamp time, transfusion, and hematocrit during CPB. Clinical outcomes included 30-day mortality, postoperative extracorporeal membrane oxygenation (ECMO) support, open sternum status, prolonged mechanical ventilation care (>7 days), and acute renal failure. MP was utilized in 39 patients and conventional priming (CP) was used in 25 patients. The priming volume decreased to 126.0 mL in the MP group compared with 321.6 mL in the CP group. Transfusion volume during CPB was 87.3 mL in the MP group versus 226.8 mL in the CP group, and the difference was statistically significant (P priming volume and higher RACHS-1 were significant risk factors of postoperative ECMO support in univariate and multivariate analysis. The results of the present study suggest that MP may be beneficial in avoiding transfusion without having a significant effect on the hematocrit. Clinical outcomes did not differ between the two groups. However, larger priming volume was a significant risk factor for postoperative ECMO support with RACHS-1 category. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals Inc.

  18. Impact of Extracorporeal Membrane Oxygenation Support on Clinical Outcome of Pediatric Patients with Acute Cardiopulmonary Failure: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Ying-Jui Lin

    2013-02-01

    Full Text Available Background: Conventional therapy against acute pediatric cardiopulmonary failure (APCPF caused by a variety of disease entities remains unsatisfactory with extremely high morbidity and mortality. For refractory APCPF, extracorporeal membrane oxygenation (ECMO is one of the last resorts. Methods: In this study, the in-hospital outcomes of pediatric patients with refractory APCPF receiving ECMO support were reviewed. Results: Between August 2006 and May 2011, a single-center cohort study was performed in pediatric patients who required ECMO support due to cardiogenic shock or severe hypoxemia. A total of 22 patients with mean age of 7.0 ± 6.3 years received ECMO (male = 11; female = 11. The indications included acute fulminant myocarditis (AFM (n = 6, congenital diaphragmatic hernia (CDH (n = 3, acute respiratory distress syndrome (ARDS (n = 6, enterovirus 71 (n = 3, viral sepsis (n = 2, refractory ventricular fibrillation due to long QT syndrome (n = 1, and pulmonary edema with brain herniation (n = 1. Eighteen patients received veno-arterial (VA mode ECMO, while another four patients undertook the veno-venous (VV mode. The duration of ECMO use and hospitalization were 6.1 ± 3.1 and 24.4 ± 19.4 days, respectively. The survival rate in patients with AFM was 100% (n = 6. Successful ECMO weaning with uneventful discharge from hospital was noted in 14 (63.6% patients, whereas in-hospital mortality despite successful ECMO weaning occurred in 5 patients (22.7%. Failure in ECMO weaning and in-hospital death was noted in 3 patients (13.6%. Conclusions: ECMO resuscitation is an effective strategy in the clinical setting of APCPF.

  19. Construction of devices in bioartificial liver support system.

    Science.gov (United States)

    Liu, Jianfeng; Li, Ming; Yang, Wei; Lou, Hanfen

    2005-01-01

    An automatic control device in Bioartificial Liver Support System is designed and implemented. Details of the hardware structure, design of the control system and the applied software in the device are described. Main controller uses the WS-843AW industrial control computer; precision electromagnetic valves are selected as implements to control the flux of three-gases (oxygen, carbon dioxide and nitrogen). The interconnected rule of controlled parameters in the system is analysed, and then matched by the mass balance equation. By a series of logic judgements of signals from sensors and direct digital calculations (DDC), a simple proportional plus integral (PI) controller can firstly manipulate the operations of electromagnetic valves, and then the on-line and off-line predictive control algorithm is used in accordance with practical experience to meet the requirements of the parameters in the culture and metabolism of hepatocytes. Software based on Visual C++ is implemented. All these serve to ensure high operational reliability, expansibility and better maneuverability of the whole system. Experiments show that this method can achieve sound performances in practice although there exist very strong coupling, dead-delay and lots of non-linear factors in the bioreactor. The controlling range is: Dissolved Oxygen 0-200±5%; pH 6-8±0.05pH; Temperature 20-45±0.1°C. The device can work in a steady state, and the control precision is high. It can meet the needs in the Bioartificial Liver Support System, and hopefully improve clinical therapeutic effect.

  20. 78 FR 54911 - Certain Thermal Support Devices for Infants, Infant Incubators, Infant Warmers and Components...

    Science.gov (United States)

    2013-09-06

    ... COMMISSION Certain Thermal Support Devices for Infants, Infant Incubators, Infant Warmers and Components.... International Trade Commission has received a complaint entitled Certain Thermal Support Devices for Infants, Infant Incubators, Infant Warmers and Components Thereof, DN 2976; the Commission is soliciting...

  1. Development of an interprofessional pediatric ventricular assist device support team.

    Science.gov (United States)

    Furness, Sarah; Hyslop-St George, Cecilia; Pound, Barbara; Earle, Misty; Maurich, Andrea; Rice, Danika; Humpl, Tilman

    2008-01-01

    Caring for pediatric patients with a ventricular assist device (VAD) requires a collaborative approach from an interprofessional team to ensure maximum patient safety and optimal outcomes. Initiating a VAD program is challenging, due to the complex medical and technical nature of this device and associated learning needs. At our institution, the development of the interprofessional VAD support team was established in four phases. Initial Education, Core Team Formation, Expansion, and Evaluation. A "core VAD team" was created after the initial education at an established VAD center. In a third step, all efforts were directed toward increasing the number of health care professionals caring for the VAD patients in the Cardiac Critical Care setting and on the Cardiac ward. The last phase consists of ongoing evaluation. Several key areas imperative to the care of a patient on a VAD were identified and further elaborated. The complex care of a patient on a VAD needs a specialized team approach to cover all patient care needs. Ongoing interprofessional education continues to improve competency of care. Continuity of care was assured on all levels of service to ensure the best possible outcomes.

  2. Stery-hand: A new device to support hand disinfection.

    Science.gov (United States)

    Szilagyi, Laszlo; Lehotsky, Akos; Nagy, Melinda; Haidegger, Tamas; Benyo, Balazs; Benyo, Zoltan

    2010-01-01

    Incomplete disinfection can cause serious complications in surgical care. The teaching of effective hand washing is crucial in modern medical training. To support the objective evaluation of hand disinfection, we developed a compact, mobile device, relying on digital imaging and image processing. The hardware consists of a metal case with matte black interior, ultra-violet lighting and a digital camera. Image segmentation and clustering are performed on a regular notebook. The hand washing procedures performed with a soap mixed with UV-reflective powder. This results the skin showing bright under UV light only on the treated (sterile) surfaces. When the surgeon inserts its hands into the box, the camera placed on the top takes an image of the hand for evaluation. The software performs the segmentation and clustering automatically. First, the hand contour is determined from the green intensity channel of the recorded RGB image. Then, the pixels of the green channel belonging to the hand are partitioned to three clusters using a quick, histogram based fuzzy c-means algorithm. The optimal threshold between the intensities of clean and dirty areas is extracted using these clusters, while the final approximated percentage of the clean area is computed using a weighting formula. The main advantage of our device is the ability to obtain objective and comparable result on the quality of hand disinfection. It may find its best use in the clinical education and training.

  3. Device-Related Thrombosis in Continuous-Flow Left Ventricular Assist Device Support.

    Science.gov (United States)

    Doligalski, Christina Teeter; Jennings, Douglas L

    2016-02-01

    Advanced heart failure therapy has been revolutionized with the advent of continuous-flow ventricular assist devices (CF-LVADs) which have improved both survival and quality of life. Despite this, support with CF-LVADs is frequently complicated, with 70% of recipients experiencing a major complication in the first year of durable support. The most concerning of these complications to emerge is device-related thrombosis, which is associated with increased morbidity and mortality. Pathophysiology and diagnosis are multifaceted and complex, with pump-specific and patient-specific factors to be considered. Incidence estimates are evolving with increases seen in the past 2 years compared with earlier implant data. Evidence for treatment is limited to case series and reports, which are subject to significant publication bias. Finally, appropriate primary and secondary prophylaxis is imprecise with multiple antiplatelet and antithrombotic strategies described. This review seeks to summarize the current literature surrounding the pathophysiology, diagnosis, and management of thrombosis in CF-LVAD recipients.

  4. Factors Affecting Ankle Support Device Usage in Young Basketball Players

    Directory of Open Access Journals (Sweden)

    Michael D. Cusimano

    2013-05-01

    Full Text Available This cross-sectional study explores factors affecting the decision of basketball players to wear ankle support devices (ASDs. A questionnaire regarding attitudes towards ASD usage was developed based on the Health Belief Model (HBM. The questionnaire assessed HBM perceptions (susceptibility, severity, benefits, and barriers and modifying factors (demographic, personal history of ankle injury, influence of coach to preventive action that may affect an athlete’s decision to wear ASDs. One hundred forty basketball players competing at the recreational, high school, or university levels completed the questionnaire, with the questionnaires being completed at the basketball gymnasium or at home. It was found that athletes whose coaches enforced ASD use were significantly more likely to wear them (OR: 35.71; 95% CI: 10.01, 127.36, as were athletes who perceived ankle injuries to be severe (OR: 2.77; 95% CI: 1.04, 7.37. Previous injury did not significantly increase the odds of using an ASD. The combined influence of coach enforcement and previous injury had the greatest effect on increasing ASD use. The largest barrier to ASD use was a lack of aesthetic appeal. Strategies aimed at increasing players’ willingness to wear ankle protection should be emphasized among coaches and parents as this may increase use of ASDs.

  5. Supporting Multi-hop Device-to-Device Networks Through WiFi Direct Multi-group Networking

    OpenAIRE

    Funai, Colin; Tapparello, Cristiano; Heinzelman, Wendi

    2015-01-01

    With the increasing availability of mobile devices that natively support Device-to-Device (D2D) communication protocols, we are presented with a unique opportunity to realize large scale ad hoc wireless networks. Recently, a novel D2D protocol named WiFi Direct has been proposed and standardized by the WiFi Alliance with the objective of facilitating the interconnection of nearby devices. However, WiFi Direct has been designed following a client-server hierarchical architecture, where a singl...

  6. 21 CFR 860.93 - Classification of implants, life-supporting or life-sustaining devices.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Classification of implants, life-supporting or life-sustaining devices. 860.93 Section 860.93 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE CLASSIFICATION...

  7. Usefulness of a device for body support during operations performed while standing.

    Science.gov (United States)

    Ito, Kiyoshi; Horiuchi, Tetsuyoshi; Seguchi, Tatsuya; Hongo, Kazuhiro

    2015-10-01

    During microsurgical procedures, manipulations are often performed using a foot switch while the surgeon stands on one foot. This position can easily result in body axis instability and greater musculoskeletal loading. To support the surgeon's posture, we have developed a tool called the "Surgeon's Body Support Device." The objective of this study was to determine the efficacy of this device by analyzing surgeons' kinematics and musculoskeletal loading during simulated operations undertaken while standing. Fourteen surgeons volunteered to perform simulations of surgery while standing. To analyze motion kinetics and musculoskeletal loading with and without this device, a three-axis accelerometer and surface electromyography (SEMG) sensors were attached to the subjects. Compared with not using the supportive device, the axis of the surgeon's body was significantly more stable when the support device was used (P = .001). The evenness of motion also tended to be superior when the device was utilized (P = .009). Simulations performed using the device significantly reduced the musculoskeletal loading on the ventral side of the left foot by 70 % compared with simulations performed not using the device (P = .001). Data from SEMG sensor placed on the right hand, which performs the surgical manipulations, indicated that simulations performed using the device generated approximately 10 % of the musculoskeletal load generated when the device was not used (P = .001). The Surgeon's Body Support Device appears to improve maneuverability and reduce musculoskeletal loading during simulated surgical procedures undertaken while standing.

  8. Cardiovascular implanted electronic devices in people towards the end of life, during cardiopulmonary resuscitation and after death: guidance from the Resuscitation Council (UK), British Cardiovascular Society and National Council for Palliative Care.

    Science.gov (United States)

    Pitcher, David; Soar, Jasmeet; Hogg, Karen; Linker, Nicholas; Chapman, Simon; Beattie, James M; Jones, Sue; George, Robert; McComb, Janet; Glancy, James; Patterson, Gordon; Turner, Sheila; Hampshire, Susan; Lockey, Andrew; Baker, Tracey; Mitchell, Sarah

    2016-06-01

    The Resuscitation Council (UK), the British Cardiovascular Society (including the British Heart Rhythm Society and the British Society for Heart Failure) and the National Council for Palliative Care recognise the importance of providing clear and consistent guidance on management of cardiovascular implanted electronic devices (CIEDs) towards the end of life, during cardiorespiratory arrest and after death. This document has been developed to provide guidance for the full range of healthcare professionals who may encounter people with CIEDs in the situations described and for healthcare managers and commissioners. The authors recognise that some patients and people close to patients may also wish to refer to this document. It is intended as an initial step to help to ensure that people who have CIEDs, or are considering implantation of one, receive explanation of and understand the practical implications and decisions that this entails; to promote a good standard of care and service provision for people in the UK with CIEDs in the circumstances described; to offer relevant ethical and legal guidance on this topic; to offer guidance on the delivery of services in relation to deactivation of CIEDs where appropriate; to offer guidance on whether any special measures are needed when a person with a CIED receives cardiopulmonary resuscitation; and to offer guidance on the actions needed when a person with a CIED dies.

  9. Effective Use of Human Computer Interaction in Digital Academic Supportive Devices

    OpenAIRE

    Thuseethan, S.; Kuhanesan, S.

    2015-01-01

    In this research, a literature in human-computer interaction is reviewed and the technology aspect of human computer interaction related with digital academic supportive devices is also analyzed. According to all these concerns, recommendations to design good human-computer digital academic supportive devices are analyzed and proposed. Due to improvements in both hardware and software, digital devices have unveiled continuous advances in efficiency and processing capacity. However, many of th...

  10. Designing Mixed Media Devices for support of healthcare professionals

    DEFF Research Database (Denmark)

    Kramp, Gunnar

    2008-01-01

    at tilføje en lokation til et fotografi. I denne afhandling betegnes denne type objekter som Mixed-Media-Devices på grund af deres heterogene natur.   For at Mixed-Media-Devices kan forbinde sig til hinanden, er det nødvendigt med en software arkitektur, som understøtter denne heterogenitet. Ydermere, må......”. Med andre ord, at udvikle den nødvendige software til at kunne orkestrere de fremspirende Mixed-Media-Devices i vores omgivelser. Arbejdet, der ligger til grund for denne afhandling er, blevet til indenfor Palcom projektets rammer.   Palcom projektet koordineres af Datalogi på Århus Universitet...... virkelighedens brugere har Palcom projektet arbejdet med en række indsatsområder som katastrofeindsats, graviditet og barsel, hånd-kirurgi og en neonatal afdeling. Sammen med brugerne fra disse områder er der udviklet en række Mixed-Media-Devices med henblik på at informere om og afprøve den udviklede software...

  11. Utilizing an eye tracker device for operator support

    NARCIS (Netherlands)

    Greef, T.E. de; Lafeber, H.

    2007-01-01

    At present a number of studies have attempted to embed eye-tracking devices into closed-loop systems to augment the cognitive state of the human operator. It has been demonstrated that the pupil diameter and blinking frequency serve as such indicators. Although these two factors serve cognitive

  12. Supporting Place Sensemaking with Multidimensional Information Representation on Mobile Devices

    Science.gov (United States)

    Wu, Anna

    2012-01-01

    Knowing the living environments is an intrinsic part of human development for building self-confidence and meeting social requirements. Proliferation of mobile devices has greatly changed our interaction with the physical environments. The problem for existing mobile navigation tools is that it only emphasizes the spatial factor by offering…

  13. Outline of the International Organization for Standardization Standard for Circulatory Support Devices (ISO 14708-5).

    Science.gov (United States)

    Imachi, Kou; Mussivand, Tofy

    2010-09-01

    The rapid progress of artificial heart and circulatory support devices enables us to apply them to severe heart failure patients. Many types of circulatory support devices have been developed in the United States, Europe, and Japan. This situation urged the establishment of an International Organization for Standardization (ISO) Standard for the circulatory support devices. A new work, "Cardiac Ventricular Assist Devices," was proposed to the ISO/TC150/SC6 (TC150: Technical Committee of Implants for Surgery, SC6: Sub-committee of Active Implants) in 2000, and the work was finalized for publication at a 2009 meeting of the ISO/TC150 in Kyoto. In this article, the authors would like to introduce the ISO system and the outline of the ISO Standard for Circulatory Support Devices.

  14. Capillary electrophoresis-electrochemical detection microchip device and supporting circuits

    Science.gov (United States)

    Jackson, Douglas J.; Roussel, Jr., Thomas J.; Crain, Mark M.; Baldwin, Richard P.; Keynton, Robert S.; Naber, John F.; Walsh, Kevin M.; Edelen, John. G.

    2008-03-18

    The present invention is a capillary electrophoresis device, comprising a substrate; a first channel in the substrate, and having a buffer arm and a detection arm; a second channel in the substrate intersecting the first channel, and having a sample arm and a waste arm; a buffer reservoir in fluid communication with the buffer arm; a waste reservoir in fluid communication with the waste arm; a sample reservoir in fluid communication with the sample arm; and a detection reservoir in fluid communication with the detection arm. The detection arm and the buffer arm are of substantially equal length.

  15. Omnidirectional wireless power transfer system supporting mobile devices

    Science.gov (United States)

    Che, Bang-Jun; Meng, Fan-Yi; Lyu, Yue-Long; Zhu, Wen-Liang; Zhang, Kuang; Yang, Guo-Hui; Fu, Jia-Hui; Zhu, Lei; Wu, Qun; Sun, Li

    2016-02-01

    An efficient method for the challenge design of an omnidirectional wireless power transfer system (OWPT) is proposed. The OWPT is realized utilizing the rotating magnetic field, which is generated by the proposed 2-D transmitter. The transmitter is composed by two mutually perpendicular loops fed by two excitation sources with the same magnitude and 90° phase difference. An OWPT system prototype is fabricated and measured. Experimental results demonstrate that the system can deliver power to receivers moving around the transmitter with a steady transfer efficiency. Furthermore, the magnitude distribution of the rotating magnetic field can be controlled by the feeding phase difference between the two loops. This capability enables the OWPT system to focus energy for device moving in a limited receiving angle range.

  16. Airway management during cardiopulmonary resuscitation.

    Science.gov (United States)

    Bernhard, Michael; Benger, Jonathan R

    2015-06-01

    This article evaluates the latest scientific evidence regarding airway management during in-hospital and out-of-hospital cardiopulmonary resuscitation (CPR). In the in-hospital setting, observational research suggested that the quality of CPR using 'no flow ratio' as a surrogate marker was improved when advanced airway techniques were used. A registry study demonstrated that an initial failed intubation attempt was associated with an average delay of 3 min in time to return of spontaneous circulation. A prospective observational study showed that the Glide Scope videolaryngoscope was associated with a first-pass success rate of 93%, with no differences between less and more experienced physicians. In the out-of-hospital setting, a registry study suggested that intubation leads to a better outcome compared with supraglottic airway devices. However, no advanced airway devices showed a better outcome than basic airway techniques. An observational study reported that the i-gel supraglottic airway device offers a first-pass insertion success rate of 90%, and was easier to establish than the Portex Soft Seal laryngeal mask airway. Other out-of-hospital observational studies showed that the laryngeal tube offers a lower first-pass insertion success rate than expected, and complications of this device may influence later definitive airway management and the outcome as a whole. Recent studies of airway management during CPR rely mostly on registry and observational designs. Prospective randomized trials are needed to determine the optimal approach to airway management during cardiac arrest, but have not yet been completed.

  17. Dynamic Generation of Reduced Ontologies to Support Resource Constraints of Mobile Devices

    Science.gov (United States)

    Schrimpsher, Dan

    2011-01-01

    As Web Services and the Semantic Web become more important, enabling technologies such as web service ontologies will grow larger. At the same time, use of mobile devices to access web services has doubled in the last year. The ability of these resource constrained devices to download and reason across these ontologies to support service discovery…

  18. Use of a design challenge to develop postural support devices for intermediate wheelchair users

    Science.gov (United States)

    Tanuku, Deepti; Moller, Nathaniel C.

    2017-01-01

    The provision of an appropriate wheelchair, one that provides proper fit and postural support, promotes wheelchair users’ physical health and quality of life. Many wheelchair users have postural difficulties, requiring supplemental postural support devices for added trunk support. However, in many low- and middle-income settings, postural support devices are inaccessible, inappropriate or unaffordable. This article describes the use of the design challenge model, informed by a design thinking approach, to catalyse the development of an affordable, simple and robust postural support device for low- and middle-income countries. The article also illustrates how not-for-profit organisations can utilise design thinking and, in particular, the design challenge model to successfully support the development of innovative solutions to product or process challenges. PMID:28936418

  19. Development of irradiation support devices for production of brachytherapy seeds

    Energy Technology Data Exchange (ETDEWEB)

    Mattos, Fabio R.; Rostelato, Maria Elisa C.M.; Zeituni, Carlos A.; Souza, Carla D.; Moura, Joao A.; Peleias Junior, Fernando S.; Karan Junior, Dib; Feher, Anselmo; Oliveira, Tiago B.; Benega, Marcos A.G., E-mail: tiagooliveira298@gmail.com, E-mail: mattos.fr@gmail.com, E-mail: elisaros@ipen.br, E-mail: czeituni@ipen.br, E-mail: carladdsouza@yahoo.com.br, E-mail: jamoura@ipen.br, E-mail: ernandopeleias@gmail.com, E-mail: s, E-mail: dib.karan@usp.br, E-mail: afeher@ipen.br, E-mail: marcosagbenega@gmail.com [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2013-07-01

    Ophthalmic tumors treatment with brachytherapy sources has been widely used as a primary or secondary therapy for non-malignant or malignant tumors, for example, choroid melanoma, and retinoblastoma. Ruthenium-106, Iodine-125, Palladium -103, Gold-198 and Iridium-192, are some radionuclides that can be applied for treatment of ocular tumors. These sources are in small sizes (a few millimeters) and different shapes (rods, wires, disks). To ensure high accuracy during treatment, they are positioned in eye applicators, specially designed to fit on the surface of tumor. The Nuclear and Energy Research Institute (IPEN/CNEN) in a partnership with Paulista Medicine School (UNIFESP) created a project that aims to develop a prototype of Iridium-192 seeds for treatment of eye cancer. This seed consists in a core of Ir -Pt alloy (20%-80%) with a length of 3 mm, to be activated in IPEN's IEA-R1 Reactor, and a titanium capsule sealing the core. It was imperative to develop a sustainer device for irradiation. This piece is used to avoid overlapping of one cores and, therefore, avoiding the 'shadow effect' that does not allow full activation of each core due to the high density. (author)

  20. Automated cardiopulmonary resuscitation: a case study.

    Science.gov (United States)

    Spiro, Jon; Theodosiou, Maria; Doshi, Sagar

    2014-02-01

    Rates of survival after cardiac arrest are low and correlate with the quality of cardiopulmonary resuscitation (CPR). Devices that deliver automated CPR (A-CPR) can provide sustained and effective chest compressions, which are especially useful during patient transfer and while simultaneous invasive procedures are being performed. The use of such devices can also release members of resuscitation teams for other work. This article presents a case study involving a man with acute myocardial infarction complicated by cardiogenic shock and pulmonary oedema. It describes how ED nursing and medical teams worked together to deliver A-CPR, discusses the use of A-CPR devices in a tertiary cardiac centre, and highlights the advantages of using such devices.

  1. Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

    Science.gov (United States)

    Noje, Corina; Fishe, Jennifer N; Costabile, Philomena M; Klein, Bruce L; Hunt, Elizabeth A; Pronovost, Peter J

    2017-10-01

    To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Narrative review. Not applicable. Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

  2. Circulatory support devices: fundamental aspects and clinical management of bleeding and thrombosis.

    Science.gov (United States)

    Susen, S; Rauch, A; Van Belle, E; Vincentelli, A; Lenting, P J

    2015-10-01

    Circulatory support devices are increasingly being used to overcome cardiac or respiratory failure. Long-term devices are used either as a 'bridge to transplant' to support patients who are unable to wait any longer for a heart transplant, or, more recently, as 'destination therapy' for older patients suffering from end-stage heart failure and who have contraindications to heart transplantation. Short-term support devices for high-risk percutaneous coronary intervention, or as a 'bridge for decision' for patients suffering from refractory cardiogenic shock, have also been developed. The clinical benefit of such assist devices has been demonstrated in several important studies, but, unfortunately, thrombotic and bleeding complications are two major clinical issues in patients requiring these devices. Overcoming these issues is of major importance to allow the safe and broad use of these devices, and to consider them as true alternatives to heart transplantation. The present review focuses on thrombotic and bleeding complications, and describes how the risk of thrombosis and bleeding may vary according to the clinical indication, but also according to the type of device. We describe the current knowledge of the mechanisms underlying the occurrence of these complications, provide some guidance for choosing the most appropriate anticoagulation regimen to prevent their occurrence for each type of device and indication, and provide some recommendations for the management of patients when the complication occurs.

  3. Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease.

    Science.gov (United States)

    Chopski, Steven G; Moskowitz, William B; Stevens, Randy M; Throckmorton, Amy L

    2017-01-01

    The use of mechanical circulatory support (MCS) devices is a viable therapeutic treatment option for patients with congestive heart failure. Ventricular assist devices, cavopulmonary assist devices, and total artificial heart pumps continue to gain acceptance as viable treatment strategies for both adults and pediatric patients as bridge-to-transplant, bridge-to-recovery, and longer-term circulatory support alternatives. We present a review of the current and future MCS devices for patients having congenital heart disease (CHD) with biventricular or univentricular circulations. Several devices that are specifically designed for patients with complex CHD are in the development pipeline undergoing rigorous animal testing as readiness experiments in preparation for future clinical trials. These advances in the development of new blood pumps for patients with CHD will address a significant unmet clinical need, as well as generally improve innovation of the current state of the art in MCS technology.

  4. RIO EPICS device support application case study on an ion source control system (ISHP)

    Energy Technology Data Exchange (ETDEWEB)

    Sanz, Diego [UPM – Universidad Politécnica de Madrid, Madrid (Spain); Ruiz, Mariano, E-mail: mariano.ruiz@upm.es [UPM – Universidad Politécnica de Madrid, Madrid (Spain); Eguiraun, Mikel [Department of Electricity and Electronic, Faculty of Science and Technology, University of Basque Country, Bilbao (Spain); Arredondo, Iñigo [ESS Bilbao Consortium, Zamudio (Spain); Badillo, Inari; Jugo, Josu [Department of Electricity and Electronic, Faculty of Science and Technology, University of Basque Country, Bilbao (Spain); Vega, Jesús; Castro, Rodrigo [Asociación EURATOM/CIEMAT, Madrid (Spain)

    2015-10-15

    Highlights: • A use case example of RIO/FlexRIO design methodology is described. • Ion source device is controlled and monitored by means EPICS IOCs. • NIRIO EPICS device support demonstrates that is able to manage RIO devices. • Easy and fast deployment is possible using RIO/FlexRIO design methodology using NIRIO-EDS. • RIO/FlexRIO technology and EPICS are a good combination for support large scale experiments in fusion environments. - Abstract: Experimental Physics and Industrial Control System (EPICS) is a software tool that during last years has become relevant as a main framework to deploy distributed control systems in large scientific environments. At the moment, ESS Bilbao uses this middleware to perform the control of their Ion Source Hydrogen Positive (ISHP) project. The implementation of the control system was based on: PXI Real Time controllers using the LabVIEW-RT and LabVIEW-EPICS tools; and RIO devices based on Field-Programmable Gate Array (FPGA) technology. Intended to provide a full compliant EPICS IOCs for RIO devices and to avoid additional efforts on the system maintainability, a migration of the current system to a derivative Red Hat Linux (CentOS) environment has been conducted. This paper presents a real application case study for using the NIRIO EPICS device support (NIRIO-EDS) to give support to the ISHP. Although RIO FPGA configurations are particular solutions for ISHP performance, the NIRIO-EDS has permitted the control and monitoring of devices by applying a well-defined design methodology into the previous FPGA configuration for RIO/FlexRIO devices. This methodology has permitted a fast and easy deployment for the new robust, scalable and maintainable software to support RIO devices into the ISHP control architecture.

  5. Emergent cardiopulmonary bypass during pectus excavatum repair

    Directory of Open Access Journals (Sweden)

    Ryan Craner

    2013-01-01

    Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

  6. Cardiopulmonary bypass in pregnancy

    Directory of Open Access Journals (Sweden)

    Mukul Chandra Kapoor

    2014-01-01

    Full Text Available Cardiac surgery carried out on cardiopulmonary bypass (CPB in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

  7. Biometric gait recognition for mobile devices using wavelet transform and support vector machines

    DEFF Research Database (Denmark)

    Hestbek, Martin Reese; Nickel, C.; Busch, C.

    2012-01-01

    The ever growing number of mobile devices has turned the attention to security and usability. If a mobile device is lost or stolen this can lead to loss of personal information and the possibility of identity theft. People often tend not to use passwords which leads to lack of personal security...... obtained from mobile devices. Gait templates were constructed of Bark-frequency cepstral coefficients (BFCC) from the wavelet coefficients and these were arranged to train a support vector machine (SVM). A cross-day scenario demonstrates that the proposed approach shows competitive recognition performance...

  8. Improving car passengers' comfort and experience by supporting the use of handheld devices.

    Science.gov (United States)

    van Veen, S A T; Hiemstra-van Mastrigt, S; Kamp, I; Vink, P

    2014-01-01

    There is a demand for interiors to support other activities in a car than controlling the vehicle. Currently, this is the case for the car passengers and--in the future--autonomous driving cars will also facilitate drivers to perform other activities. One of these activities is working with handheld devices. Previous research shows that people experience problems when using handheld devices in a moving vehicle and the use of handheld devices generally causes unwanted neck flexion [Young et al. 2012; Sin and Zu 2011; Gold et al.2011]. In this study, armrests are designed to support the arms when using handheld devices in a driving car in order to decrease neck flexion. Neck flexion was measured by attaching markers on the C7 and tragus. Discomfort was indicated on a body map on a scale 1-10. User experience was evaluated in a semi-structured interview. Neck flexion is significantly decreased by the support of the armrests and approaches a neutral position. Furthermore, overall comfort and comfort in the neck region specifically are significantly increased. Subjects appreciate the body posture facilitated by the armrests and 9 out of 10 prefer using handheld devices with the armrests compared to using handheld devices without the armrests. More efforts are needed to develop the mock-up into an established product, but the angles and dimensions presented in this study could serve as guidelines.

  9. A Distributed Management Scheme for supporting energy-harvested I/O devices

    NARCIS (Netherlands)

    Zand, P.; Das, Kallol; Mathews, E.; Havinga, Paul J.M.

    Current wireless technologies for industrial application, such as WirelessHART and ISA100.11a, are not designed to support harvester-powered input/output (I/O) devices, where energy availability varies in a non-deterministic manner. The centralized management approach of these standards makes it

  10. Mobile Device Intervention for Student Support Services in Distance Education Context--FRAME Model Perspective

    Science.gov (United States)

    Kumar, Lalita S.; Jamatia, Biplab; Aggarwal, A. K.; Kannan, S.

    2011-01-01

    This paper reports the findings of a study conducted to analyse the effect of mobile device intervention for student support services and to gauge its use for enhancing teaching--learning process as a future study in the context of offer of Distance Education programmes. The study was conducted with the learners of the coveted Post Graduate…

  11. Effects of Cues and Real Objects on Learning in a Mobile Device Supported Environment

    Science.gov (United States)

    Liu, Tzu-Chien; Lin, Yi-Chun; Paas, Fred

    2013-01-01

    This study investigated whether arrow-line cues can improve the effectiveness and efficiency of learning in a mobile device supported learning environment on leaf morphology of plants, either with or without the use of real plants. A cued and un-cued condition, in which primary school students used text and pictures on a tablet PC, were compared…

  12. Effects of a Physical Education Supportive Curriculum and Technological Devices on Physical Activity

    Science.gov (United States)

    Clapham, Emily Dean; Sullivan, Eileen C.; Ciccomascolo, Lori E.

    2015-01-01

    The purpose of this study was to examine the effects of a physical education supportive curriculum and technological devices, heart rate monitor (HRM) and pedometer (PED), on physical activity. A single-subject ABAB research design was used to examine amount and level of participation in physical activity among 106 suburban fourth and fifth…

  13. Effects of a Physical Education Supportive Curriculum and Technological Devices on Physical Activity

    Science.gov (United States)

    Clapham, Emily Dean; Sullivan, Eileen C.; Ciccomascolo, Lori E.

    2015-01-01

    The purpose of this study was to examine the effects of a physical education supportive curriculum and technological devices, heart rate monitor (HRM) and pedometer (PED), on physical activity. A single-subject ABAB research design was used to examine amount and level of participation in physical activity among 106 suburban fourth and fifth…

  14. Extracorporeal cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Steven A. Conrad

    2016-04-01

    Full Text Available ECPR is defined as the rapidly-deployed application of venoarterial extracorporeal membrane oxygenation, in patients with cardiac arrest, during cardiopulmonary resuscitation before the return of ROSC. ECPR is one of the most rapidly growing segments of ECLS, and is becoming more widespread. Consideration for institution of ECPR is given to patients with witnessed arrest, good quality CPR instituted within 5 min of arrest, in whom ROSC does not occur within 15 min, and who can complete cannulation within 30–60 min. Patients from both inpatient and out-of-hospital settings are candidates if they meet these criteria. Deep hypothermic cardiac arrest, such as cold-water drowning, should receive consideration for ECPR even after considerable duration of arrest. Available outcome data are based on retrospective observation studies, some with propensity matching, and suggests a higher chance for survival with ECPR. Published outcomes from ECPR, however, are difficult to interpret, since many centers classify their use of ECLS after ROSC, in addition to ECLS before ROSC, as ECPR. Both children and adults are candidates for ECPR, but the experience in children is weighted heavily toward those with a diagnosis of cardiac disease and arrest occurring within closely monitored units.

  15. Functional status of United States children supported with a left ventricular assist device at heart transplantation.

    Science.gov (United States)

    Bulic, Anica; Maeda, Katsuhide; Zhang, Yulin; Chen, Sharon; McElhinney, Doff B; Dykes, John C; Hollander, Amanda M; Hollander, Seth A; Murray, Jenna; Reinhartz, Olaf; Gowan, Mary Alice; Rosenthal, David N; Almond, Christopher S

    2017-08-01

    As survival with pediatric left ventricular assist devices (LVADs) has improved, decisions regarding the optimal support strategy may depend more on quality of life and functional status (FS) rather than mortality alone. Limited data are available regarding the FS of children supported with LVADs. We sought to compare the FS of children supported with LVADs vs vasoactive infusions to inform decision making around support strategies. Organ Procurement and Transplant Network data were used to identify all United States children aged between 1 and 21 years at heart transplant (HT) between 2006 and 2015 for dilated cardiomyopathy and supported with an LVAD or vasoactive infusions alone at HT. FS was measured using the 10-point Karnofsky and Lansky scale. Of 701 children who met the inclusion criteria, 430 (61%) were supported with vasoactive infusions, and 271 (39%) were supported with an LVAD at HT. Children in the LVAD group had higher median FS scores at HT than children in the vasoactive infusion group (6 vs 5, p < 0.001) but lower FS scores at listing (4 vs 6, p < 0.001). The effect persisted regardless of patient location at HT (home, hospital, intensive care) or device type. Discharge by HT occurred in 46% of children in the LVAD group compared with 26% of children in the vasoactive infusion cohort (p = 0.001). Stroke was reported at HT in 3% of children in the LVAD cohort and in 1% in the vasoactive infusion cohort (p = 0.04). Among children with dilated cardiomyopathy undergoing HT, children supported with LVADs at HT have higher FS than children supported with vasoactive infusions at HT, regardless of device type or hospitalization status. Children supported with LVADs at HT were more likely to be discharged from the hospital but had a higher prevalence of stroke at HT. Copyright © 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  16. Self-Supporting Ion Gels for Electrochemiluminescent Sticker-Type Optoelectronic Devices

    Science.gov (United States)

    Hong, Kihyon; Kwon, Yeong Kwan; Ryu, Jungho; Lee, Joo Yul; Kim, Se Hyun; Lee, Keun Hyung

    2016-07-01

    Nowadays, there has been an increasing demand to develop low-cost, disposable or reusable display devices to meet and maximize short-term user convenience. However, the disposable device has unfortunately not materialized yet due to the light-emitting materials and fabrication process issues. Here, we report sticker-type electrochemiluminescent (ECL) device using self-supporting, light-emitting gel electrolytes. The self-supporting ion gels were formulated by mixing a network-forming polymer, ionic liquid, and metal complex luminophore. The resulting ion gels exhibit excellent mechanical strength to form free-standing rubbery light-emitting electrolyte films, which enables the fabrication of sticker-type display by simple transfer and lamination processes on various substrates. The sticker-type ECL devices can be operated under an AC bias and exhibit a low operating voltage of 4 V (peak-to-peak voltage) with a maximum luminance of 90 cd/m2. It is notable that the result is the first work to realize sticker displays based on electrochemical light emitting devices and can open up new possibilities for flexible or disposal display.

  17. Supporting Local Mobility in Healthcare by Application Roaming among Heterogeneous Devices

    DEFF Research Database (Denmark)

    Bardram, Jacob Eyvind; Kjær, Thomas A.K.; Nielsen, Christina

    2003-01-01

    fieldwork has emphasised the differences between remote mobility, where users travel over long distances, and local mobility, where users walk around within a fixed set of buildings and/or places. Based on our field studies and our design work, we conclude that local mobility puts up three requirements......This paper presents results from a research project aiming at developing an architecture supporting local mobility within hospitals. The architecture is based on fieldwork and design workshops within a large Danish hospital and it has been implemented and evaluated after a pilot phase. Our...... for computer support; (i) it should integrate into the existing infrastructure, (ii) it should support the use of various heterogeneous devices, and (iii) it should enable seamless application roaming between these devices. The paper describes how these requirements were realized in an architecture for local...

  18. 78 FR 1158 - Anesthesiology Devices; Reclassification of Membrane Lung for Long-Term Pulmonary Support...

    Science.gov (United States)

    2013-01-08

    ... From 1987 to 2006,'' Pediatric Critical Care Medicine Journal, vol. 10, pp. 439-444, July 2009. 2. Cook... separate from cardiopulmonary bypass following cardiac surgery. A membrane lung for long-term pulmonary... following cardiac surgery. FDA believes that the identified special controls, in addition to general...

  19. A new principle and device for large aircraft components gaining accurate support by ball joint

    Institute of Scientific and Technical Information of China (English)

    Bao-gui QIU; Jun-xia JIANG; Ying-lin KE

    2011-01-01

    How to obtain an accurate support for large components by ball joint is a key process in aircraft digital assembly. A novel principle and device is developed to solve the problem. Firstly, the working principle of the device is introduced. When three or four displacement sensors installed in the localizer are touched by the ball-head, the spatial relation is calculated between the large aircraft component's ball-head and the localizer's ball-socket. The localizer is driven to achieve a new position by compensation. Relatively, a support revising algorithm is proposed. The localizer's ball-socket approaches the ball-head based on the displacement sensors. According to the points selected from its spherical surface, the coordinates of ball-head spherical center are computed by geometry. Finally, as a typical application, the device is used to conduct a test-fuselage's ball-head into a localizer's ball-socket. Positional deviations of the spherical centers between the ball-head and the ball-socket in the x, y, and z directions are all controlled within ±0.05 mm under various working conditions. The results of the experiments show that the device has the characteristics of high precision, excellent stability, strong operability, and great potential to be applied widely in the modern aircraft industry.

  20. Multiple Dissipative Devices for Blast-Resisting Cable-Supported Glazing Façades

    Directory of Open Access Journals (Sweden)

    Claudio Amadio

    2013-01-01

    Full Text Available The paper analyzes the structural response of a high-level air blast loaded cable-supported façade. Since the glass panels and the cables present a typical brittle behavior and are subjected to elevated tensile stresses when a high-level explosion occurs, multiple dissipative devices are simultaneously introduced in the conventional glazing system to mitigate the maximum effects of the design blast wave. Dynamic analyses are performed using a sophisticated FE-model to describe accurately the response of the façade equipped by dissipative devices. Based on numerical results of previous contributions, viscoelastic spider connectors (VESCs are introduced in the points of connection between glass panels and pretensioned cables, to replace “rigid” spider connectors commonly used in practice. At the same time, rigid-plastic frictional devices (RPDs are installed at the top of the bearing cables to mitigate furthermore the bracing system. As a result, due to the combined use of VESCs and RPDs opportunely calibrated, the maximum tensile stresses in the glass panels and in the cables appear strongly reduced. In addition, the proposed devices do not trouble the aesthetics of such transparent structural systems. At last, simple design rules are presented to predict the response of cable-supported façades subjected to high-level dynamic loads and to preliminary estimate the mechanical parameters of combined VESCs and RPDs.

  1. Exercise in heart failure patients supported with a left ventricular assist device

    DEFF Research Database (Denmark)

    Jung, Mette Holme; Gustafsson, Finn

    2015-01-01

    After implantation of a continuous-flow left ventricular assist device (CF-LVAD), exercise capacity in heart failure patients remains reduced with peak oxygen uptake (peak VO2) values averaging from 11 to 20 ml/kg/min. Total cardiac output in CF-LVAD patients during exercise is predominantly...... determined by pump speed, the pressure difference across the pump, and in some cases ejection through the aortic valve. Fixed pump speed utilized in CF-LVADs may provide insufficient support, resulting in a moderate cardiac output increase during increased physical strain. Ongoing studies are evaluating...... whether pump speed changes in response to varied loading conditions may enable LVADs to provide sufficient support even during strenuous exercise. In the currently used devices, evidence suggests that focus on optimizing non-cardiac peripheral parameters is vital. Extra-cardiac potentially reversible...

  2. The Evolution of Devices and Systems Supporting Rehabilitation of Lower Limbs

    Directory of Open Access Journals (Sweden)

    Olinski M.

    2015-02-01

    Full Text Available This paper presents the process of development, as well as examples of devices and systems supporting rehabilitation of the human lower extremities, developed independently over the years in many parts of the world. Particular emphasis was placed on indicating, which major groups of devices supporting kinesitherapy of the lower limbs can be distinguished, what are the important advantages and disadvantages of particular types of solutions, as well as what directions currently dominating in development of rehabilitation systems may be specified. A deeper analysis and comparison of several selected systems was also conducted, resulting in gathering the outcomes in two tables. They focused on a few features of mechanical design, especially the devices’ kinematic structures, and devices’ additional functions associated with, among others, interaction, as well as diagnosis of the limb's state and the progress of rehabilitation.

  3. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi

    2014-01-01

    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  4. In Vivo Evaluation of a Pneumatic Extracorporeal Ventricular Assist Device for up to 90 Day Support.

    Science.gov (United States)

    Conger, Jeff L; Grace, Brian W; Van Noy, Kelsey L; Handy, Kelly M; Costas, Gil G; Rodriguez-Sierra, Carlos A; Trejo, Alejandro; Pinzon, Javier; Cohn, William E

    In a previous study, we showed that the Vitalmex Extracorporeal Ventricular Assist Device-Pneumatic (EVAD-P)-a low-cost, pneumatically actuated, pulsatile blood pump-is easy to implant and safe for short-term in vivo support (30 ± 5 days). In the current study, we included additional 30 day experiments and assessed the safety and durability of the EVAD-P for up to 90 days of support. Using the same surgical procedure as in the previous study, we implanted the device into 14 healthy sheep. Group I subjects (n = 7) were evaluated for up to 30 days, and group II (n = 2) and group III (n = 5) subjects were evaluated for up to 49 and 93 days, respectively. After a system redesign, two of the five sheep in group III reached the scheduled end-point without device-related problems at a fixed beat rate of 56 bpm, a stroke volume (SV) of 58.0 ± 2.3 ml, and a flow of 3.5 ± 0.2 L/min. This study shows that the EVAD-P can provide safe pulsatile mechanical circulatory support (MCS) for up to 93 days. To further confirm that the system can consistently provide MCS for this duration, additional studies are recommended.

  5. Extracorporeal Life Support Bridge to Ventricular Assist Device: The Double Bridge Strategy.

    Science.gov (United States)

    Marasco, Silvana F; Lo, Casey; Murphy, Deirdre; Summerhayes, Robyn; Quayle, Margaret; Zimmet, Adam; Bailey, Michael

    2016-01-01

    In patients requiring left ventricular assist device (LVAD) support, it can be difficult to ascertain suitability for long-term mechanical support with LVAD and eventual transplantation. LVAD implantation in a shocked patient is associated with increased morbidity and mortality. Interest is growing in the utilization of extracorporeal life support (ECLS) as a bridge-to-bridge support for these critically unwell patients. Here, we reviewed our experience with ECLS double bridging. We hypothesized that ECLS double bridging would stabilize end-organ dysfunction and reduce ventricular assist device (VAD) implant perioperative mortality. We conducted a retrospective review of prospectively collected data for 58 consecutive patients implanted with a continuous-flow LVAD between January 2010 and December 2013 at The Alfred Hospital, Melbourne, Victoria, Australia. Twenty-three patients required ECLS support pre-LVAD while 35 patients underwent LVAD implantation without an ECLS bridge. Preoperative morbidity in the ECLS bridge group was reflected by increased postoperative intensive care duration, blood loss, blood product use, and postoperative renal failure, but without negative impact upon survival when compared with the no ECLS group. ECLS stabilization improved end-organ function pre-VAD implant with significant improvements in hepatic and renal dysfunction. This series demonstrates that the use of ECLS bridge to VAD stabilizes end-organ dysfunction and reduces VAD implant perioperative mortality from that traditionally reported in these "crash and burn" patients.

  6. Optimization of Centrifugal Pump Characteristic Dimensions for Mechanical Circulatory Support Devices.

    Science.gov (United States)

    Korakianitis, Theodosios; Rezaienia, Mohammad A; Paul, Gordon M; Rahideh, Akbar; Rothman, Martin T; Mozafari, Sahand

    2016-01-01

    The application of artificial mechanical pumps as heart assist devices impose power and size limitations on the pumping mechanism, and therefore requires careful optimization of pump characteristics. Typically new pumps are designed by relying on the performance of other previously designed pumps of known performance using concepts of fluid dynamic similarity. Such data are readily available for industrial pumps, which operate in Reynolds numbers region of 10. Heart assist pumps operate in Reynolds numbers of 10. There are few data available for the design of centrifugal pumps in this characteristic range. This article develops specific speed versus specific diameter graphs suitable for the design and optimization of these smaller centrifugal pumps concentrating in dimensions suitable for ventricular assist devices (VADs) and mechanical circulatory support (MCS) devices. A combination of experimental and numerical techniques was used to measure and analyze the performance of 100 optimized pumps designed for this application. The data are presented in the traditional Cordier diagram of nondimensional specific speed versus specific diameter. Using these data, nine efficient designs were selected to be manufactured and tested in different operating conditions of flow, pressure, and rotational speed. The nondimensional results presented in this article enable preliminary design of centrifugal pumps for VADs and MCS devices.

  7. Hemocompatibility of Axial Versus Centrifugal Pump Technology in Mechanical Circulatory Support Devices.

    Science.gov (United States)

    Schibilsky, David; Lenglinger, Matthias; Avci-Adali, Meltem; Haller, Christoph; Walker, Tobias; Wendel, Hans Peter; Schlensak, Christian

    2015-08-01

    The hemocompatible properties of rotary blood pumps commonly used in mechanical circulatory support (MCS) are widely unknown regarding specific biocompatibility profiles of different pump technologies. Therefore, we analyzed the hemocompatibility indicating markers of an axial flow and a magnetically levitated centrifugal device within an in vitro mock loop. The HeartMate II (HM II; n = 3) device and a CentriMag (CM; n = 3) adult pump were investigated in a human whole blood mock loop for 360 min using the MCS devices as a driving component. Blood samples were analyzed by enzyme-linked immunosorbent assay for markers of coagulation, complement system, and inflammatory response. There was a time-dependent activation of the coagulation (thrombin-antithrombin complexes [TAT]), complement (SC5b-9), and inflammation system (polymorphonuclear [PMN] elastase) in both groups. The mean value of TAT (CM: 4.0 μg/L vs. 29.4 μg/L, P centrifugal CM device showed significantly lower activation of coagulation and inflammation than that of the HM II axial flow pump. Both HM II and CM have demonstrated an acceptable hemocompatibility profile in patients. However, there is a great opportunity to gain a clinical benefit by developing techniques to lower the blood surface interaction within both pump technologies and a magnetically levitated centrifugal pump design might be superior.

  8. Laryngeal support device enhances the learning of laryngeal anatomy and voice physiology.

    Science.gov (United States)

    Curcio, Daniella Franco; Behlau, Mara; Barros, Mirna Duarte; Smith, Ricardo Luiz

    2012-01-01

    Multidisciplinary cooperation in health care requires a solid knowledge in the basic sciences for a common ground of communication. In speech pathology, these fundamentals improve the accuracy of descriptive diagnoses and support the development of new therapeutic techniques and strategies. The aim of this study is to briefly discuss the benefits of hands-on education on laryngeal anatomy and voice physiology in Brazilian graduate programs in speech pathology, as well as to describe a simple prototype that can be used as a useful educational tool for this purpose. The laryngeal anatomic support device was designed to provide a vertical frame to hold human or mammalian larynges with no preservation treatment, with the goal of allowing good visualization of the vocal folds during artificial phonation. The device was designed to provide the user the ability to manipulate the soft and cartilaginous structures of the larynx with near-natural biomechanical properties. The description of the project is detailed to allow the reproduction of this simple and inexpensive device. It may be used as an experimental feature in a variety of settings, from high-school programs to experimental research methods, and may suit a wide array of different educational models.

  9. Wearable devices and mobile technologies for supporting behavioral weight loss among people with serious mental illness.

    Science.gov (United States)

    Naslund, John A; Aschbrenner, Kelly A; Scherer, Emily A; McHugo, Gregory J; Marsch, Lisa A; Bartels, Stephen J

    2016-10-30

    Promoting physical activity is essential for addressing elevated cardiovascular risk and high obesity rates affecting people with serious mental illness. Numerous challenges interfere with exercise participation in this high-risk group including mental health symptoms, low motivation, and limited access to safe and affordable options for physical activity. Wearable devices and mobile health technologies may afford new opportunities for promoting physical activity and supporting behavioral weight loss efforts. This exploratory study examined whether daily step count measured using Fitbit wearable devices was associated with weight loss and improved fitness among individuals with serious mental illness enrolled in a 6-month lifestyle program. Participants (n=34) had a schizophrenia spectrum disorder (23.5%), major depression (50.0%), or bipolar disorder (26.5%), and wore Fitbits most of the days (M=86.2%; SD=18.4%) they were enrolled in the study. At 6-months, higher average daily step count was associated with greater weight loss (F=5.07; df=1,32; p=0.0314), but not improved fitness (F=1.92; df=1,31; p=0.176). These findings demonstrate that encouraging participants with serious mental illness enrolled in lifestyle interventions to collect more steps may contribute to greater weight loss. This suggests that wearable devices may offer a feasible and potentially effective strategy for supporting behavioral weight loss in community mental health settings.

  10. Molecular changes after left ventricular assist device support for heart failure.

    Science.gov (United States)

    Birks, Emma J

    2013-08-30

    Heart failure is associated with remodeling that consists of adverse cellular, structural, and functional changes in the myocardium. Until recently, this was thought to be unidirectional, progressive, and irreversible. However, irreversibility has been shown to be incorrect because complete or partial reversal can occur that can be marked after myocardial unloading with a left ventricular assist device (LVAD). Patients with chronic advanced heart failure can show near-normalization of nearly all structural abnormalities of the myocardium or reverse remodeling after LVAD support. However, reverse remodeling does not always equate with clinical recovery. The molecular changes occurring after LVAD support are reviewed, both those demonstrated with LVAD unloading alone in patients bridged to transplantation and those occurring in the myocardium of patients who have recovered enough myocardial function to have the device removed. Reverse remodeling may be attributable to a reversal of the pathological mechanisms that occur in remodeling or the generation of new pathways. A reduction in cell size occurs after LVAD unloading, which does not necessarily correlate with improved cardiac function. However, some of the changes in both the cardiac myocyte and the matrix after LVAD support are specific to myocardial recovery. In the myocyte, increases in the cytoskeletal proteins and improvements in the Ca²⁺ handling pathway seem to be specifically associated with myocardial recovery. Changes in the matrix are complex, but excessive scarring appears to limit the ability for recovery, and the degree of fibrosis in the myocardium at the time of implantation may predict the ability to recover.

  11. Exercise physiology, testing, and training in patients supported by a left ventricular assist device.

    Science.gov (United States)

    Loyaga-Rendon, Renzo Y; Plaisance, Eric P; Arena, Ross; Shah, Keyur

    2015-08-01

    The left ventricular assist device (LVAD) is an accepted treatment alternative for the management of end-stage heart failure. As we move toward implantation of LVADs in less severe cases of HF, scrutiny of functional capacity and quality of life becomes more important. Patients demonstrate improvements in exercise capacity after LVAD implantation, but the effect is less than predicted. Exercise training produces multiple beneficial effects in heart failure patients, which would be expected to improve quality of life. In this review, we describe factors that are thought to participate in the persistent exercise impairment in LVAD-supported patients, summarize current knowledge about the effect of exercise training in LVAD-supported patients, and suggest areas for future research.

  12. A reusable device for electrochemical applications of hydrogel supported black lipid membranes.

    Science.gov (United States)

    Mech-Dorosz, Agnieszka; Heiskanen, Arto; Bäckström, Sania; Perry, Mark; Muhammad, Haseena B; Hélix-Nielsen, Claus; Emnéus, Jenny

    2015-02-01

    Black lipid membranes (BLMs) are significant in studies of membrane transport, incorporated proteins/ion transporters, and hence in construction of biosensor devices. Although BLMs provide an accepted mimic of cellular membranes, they are inherently fragile. Techniques are developed to stabilize them, such as hydrogel supports. In this paper, we present a reusable device for studies on hydrogel supported (hs) BLMs. These are formed across an ethylene tetrafluoroethylene (ETFE) aperture array supported by the hydrogel, which is during in situ polymerization covalently "sandwiched" between the ETFE substrate and a gold electrode microchip, thus allowing direct electrochemical studies with the integrated working electrodes. Using electrochemical impedance spectroscopy (EIS), X-ray photoelectron spectroscopy and contact angle measurements, we demonstrate the optimized chemical modifications of the gold electrode microchips and plasma modification of the ETFE aperture arrays facilitating covalent "sandwiching" of the hydrogel. Both fluorescence microscopy and EIS were used to demonstrate the induced spontaneous thinning of a deposited lipid solution, leading to formation of stabilized hsBLMs on average in 10 min. The determined specific membrane capacitance and resistance were shown to vary in the range 0.31-0.49 μF/cm(2) and 45-65 kΩ cm(2), respectively, corresponding to partially solvent containing BLMs with an average life time of 60-80 min. The characterized hsBLM formation and devised equivalent circuit models lead to a schematic model to illustrate lipid molecule distribution in hydrogel-supported apertures. The functionality of stabilized hsBLMs and detection sensitivity of the platform were verified by monitoring the effect of the ion transporter valinomycin.

  13. History of the evolution of cardiopulmonary resuscitation

    OpenAIRE

    2013-01-01

    Cardiopulmonary resuscitation (CPR) is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, hist...

  14. Effective gas exchange in paralyzed juvenile rabbits using simple, inexpensive respiratory support devices.

    Science.gov (United States)

    Diblasi, Robert M; Zignego, Jay C; Smith, Charles V; Hansen, Thomas N; Richardson, C Peter

    2010-12-01

    We have developed two devices: a high-amplitude bubble continuous positive airway pressure (HAB-CPAP) and an inexpensive bubble intermittent mandatory ventilator (B-IMV) to test the hypotheses that simple, inexpensive devices can provide gas exchange similar to that of bubble CPAP (B-CPAP) and conventional mechanical ventilation (CMV). Twelve paralyzed juvenile rabbits were intubated, stabilized on CMV, and then switched to CPAP. On identical mean airway pressures (MAPs), animals were unable to maintain pulse oximeter oxygen saturation (SpO2) >80% on conventional B-CPAP, but all animals oxygenated well (97.3 ± 2.1%) on HAB-CPAP. In fact, arterial partial pressures of O2 (Pao2) were higher during HAB-CPAP than during CMV (p = 0.01). After repeated lung lavages, arterial partial pressures of CO2 (Paco2) were lower with B-IMV than with CMV (p < 0.0001), despite identical ventilator settings. In lavaged animals, when HAB-CPAP was compared with CMV at the same MAP and 100% O2, no differences were observed in Pao2, but Paco2 levels were higher with HAB-CPAP (70 ± 7 versus 50 ± 5 mm Hg; p < 0.05). Arterial blood pressures were not impaired by HAB-CPAP or B-IMV. The results confirm that simple inexpensive devices can provide respiratory support in the face of severe lung disease and could extend the use of respiratory support for preterm infants into severely resource-limited settings.

  15. Factor V Leiden and Cardiopulmonary Bypass.

    Science.gov (United States)

    Uppal, Victor; Rosin, Mark; Marcoux, Jo-Anne; Olson, Marnie; Bezaire, Jennifer; Dalshaug, Gregory

    2015-12-01

    We present a case of a patient with factor V Leiden with an antithrombin III activity of 67% who received a successful aortic valve replacement supported by cardiopulmonary bypass (CPB). A safe level of anticoagulation was achieved by monitoring activated clotting time (ACT) and heparin concentration ensuring adequate anticoagulation throughout the procedure. Results from ACT, heparin dose response, heparin protamine titration, and thrombelastography are given. Factor V Leiden patients can be safely anti-coagulated using heparin for CPB procedures when monitored with ACT, heparin protamine titration, and thrombelastography. Postoperative chest tube losses were 360 mL, less than half our institutional average. Anticoagulation for the pre-and post-operative phase is also discussed.

  16. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass coronary pressure gauge... Cardiopulmonary bypass coronary pressure gauge. (a) Identification. A cardiopulmonary bypass coronary pressure... the coronary arteries. (b) Classification. Class II (performance standards). ...

  17. Touching for attention: How flight instructors support a pilot wearing a view-limiting device

    DEFF Research Database (Denmark)

    Nevile, Maurice Richard; Tuccio, William A.

    2017-01-01

    demonstrates a technique for controlling descent. The data examples are taken from a corpus of almost 100 hours of video recordings of actual in-flight instruction. We consider how our analyses can inform flight instructor training and improve instructor effectiveness, for example by revealing possible......We use video recordings from pilot training flights to show how instructors support attention of a student wearing ‘foggles’, a view-limiting device designed to train pilots to fly by reference only to the cockpit flight instruments. The instructors touch cockpit displays with a pointing finger......, what we call ‘touch-pointing’, in close collaboration with their emerging talk, and so make visibly salient relevant parts of the instrument panel for the flight activities being instructed. We examine two examples. In the first, instructor assigns student a navigational task. In the second, instructor...

  18. A MOBILE-DEVICE-SUPPORTED PEER-ASSISTED LEARNING SYSTEM FOR COLLABORATIVE EARLY EFL READING

    Directory of Open Access Journals (Sweden)

    Yu-Ju Lan

    2007-02-01

    Full Text Available Collaborative learning methods which emphasize peer interaction have been widely applied to increase the intensity and effectiveness of EFL reading programs. However, simply grouping students heterogeneously and assigning them group goals does not guarantee that effective collaborative learning will ensue. The present research includes two studies. In Study One, the weaknesses of collaborative learning in a traditional EFL setting were observed. Then, in Study Two, a mobile-device-supported peer-assisted learning (MPAL system was developed for the purpose of addressing the identified weaknesses. Two classes of twenty-six third grade students participated in the present research to examine the unique contribution of MPAL to collaborative EFL reading activities. The collaborative behavior of elementary EFL learners was videotaped and analyzed. Detailed analysis of the videotaped behavior indicated that MPAL helped improve collaboration in elementary school level EFL learners and promotes their reading motivation.

  19. Multiple dimensions of cardiopulmonary dyspnea

    Institute of Scientific and Technical Information of China (English)

    HAN Jiang-na; XIONG Chang-ming; YAO Wei; FANG Qiu-hong; ZHU Yuan-jue; CHENG Xian-sheng; Karel P Van de Woestijne

    2011-01-01

    Background The current theory of dyspnea perception presumes a multidimensional conception of dyspnea.However,its validity in patients with cardiopulmonary dyspnea has not been investigated.Methods A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort,affective aspects,and behavioral items was administered to 396 patients with asthma,chronic obstructive pulmonary disease (COPD),diffuse parenchymal lung disease,pulmonary vascular disease,chronic heart failure,and medically unexplained dyspnea.Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis.The separation of patient groups was achieved by a variance analysis on symptom factors.Results Seven factors appeared to measure three dimensions of dyspnea:sensory (difficulty breathing and phase of respiration,depth and frequency of breathing,urge to breathe,wheeze),affective (chest tightness,anxiety),and behavioral (refraining from physical activity) dimensions.Difficulty breathing and phase of respiration occurred more often in COPD,followed by asthma (R2=0.12).Urge to breathe was unique for patients with medically unexplained dyspnea (R2=0.12).Wheeze occurred most frequently in asthma,followed by COPD and heart failure (R2=0.17).Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R2=0.04).Anxiety characterized medically unexplained dyspnea (R2=0.08).Refraining from physical activity appeared more often in heart failure,pulmonary vascular disease,and COPD (R2=0.15).Conclusions Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups.These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

  20. History of cardiopulmonary bypass (CPB).

    Science.gov (United States)

    Hessel, Eugene A

    2015-06-01

    The development of cardiopulmonary bypass (CPB), thereby permitting open-heart surgery, is one of the most important advances in medicine in the 20th century. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how recently it came into use (60 years) and how much the practice of CPB has changed during its short existence. In this paper, the development of CPB and the many changes and progress that has taken place over this brief period of time, making it a remarkably safe endeavor, are reviewed. The many as yet unresolved questions are also identified, which sets the stage for the other papers in this issue of this journal.

  1. Opportunistic mobility support for resource constrained sensor devices in smart cities.

    Science.gov (United States)

    Granlund, Daniel; Holmlund, Patrik; Åhlund, Christer

    2015-03-02

    A multitude of wireless sensor devices and technologies are being developed and deployed in cities all over the world. Sensor applications in city environments may include highly mobile installations that span large areas which necessitates sensor mobility support. This paper presents and validates two mechanisms for supporting sensor mobility between different administrative domains. Firstly, EAP-Swift, an Extensible Authentication Protocol (EAP)-based sensor authentication protocol is proposed that enables light-weight sensor authentication and key generation. Secondly, a mechanism for handoffs between wireless sensor gateways is proposed. We validate both mechanisms in a real-life study that was conducted in a smart city environment with several fixed sensors and moving gateways. We conduct similar experiments in an industry-based anechoic Long Term Evolution (LTE) chamber with an ideal radio environment. Further, we validate our results collected from the smart city environment against the results produced under ideal conditions to establish best and real-life case scenarios. Our results clearly validate that our proposed mechanisms can facilitate efficient sensor authentication and handoffs while sensors are roaming in a smart city environment.

  2. Analysis of baroreflex sensitivity during undulation pump ventricular assist device support.

    Science.gov (United States)

    Liu, Hongjian; Shiraishi, Yasuyuki; Zhang, Xiumin; Song, Hojin; Saijo, Yoshifumi; Baba, Atsushi; Yambe, Tomoyuki; Abe, Yusuke; Imachi, Kou

    2009-07-01

    The aim of this study was to examine the baroreflex sensitivity (BRS), which involves the autonomic nervous system, in a goat with a chronically implanted undulation pump ventricular assist device (UPVAD). The UPVAD involved transforming the rotation of a brushless DC motor into an undulating motion by a disc attached via a special linking mechanism, and a jellyfish valve in the outflow cannula to prevent diastolic backflow. The pump was implanted into the thoracic cavity of a goat by a left thoracotomy, and the inflow and outflow cannulae were sutured to the apex of the left ventricle and to the descending aorta, respectively. The driving cable was wired percutaneously to an external controller. Electrocardiogram and hemodynamic waveforms were recorded at a sampling frequency of 1 kHz. BRS was determined when awake by the slope of the linear regression of R-R interval against mean arterial pressure changes, which were induced by the administration of methoxamine hydrochloride, both with continuous driving of the UPVAD as well as without assistance. BRS values during the UPVAD support and without assistance were 1.60 +/- 0.30 msec/mm Hg and 0.98 +/- 0.22 msec/mm Hg (n = 5, P < 0.05), respectively. BRS was significantly improved during left ventricular assistance. Therefore, UPVAD support might decrease sympathetic nerve activity and increase parasympathetic nerve activity to improve both microcirculation and organ function.

  3. Pencil-drawn paper supported electrodes as simple electrochemical detectors for paper-based fluidic devices.

    Science.gov (United States)

    Dossi, Nicolò; Toniolo, Rosanna; Pizzariello, Andrea; Impellizzieri, Flavia; Piccin, Evandro; Bontempelli, Gino

    2013-07-01

    A simple procedure for preparing inexpensive paper-based three-electrode electrochemical cells is described here. They consist of small circular pads of hydrophilic paper defined by hydrophobic barriers printed on paper with wax-based ink. The back face of these pads is insulated by thermally laminating a polyethylene layer and working, reference and counter electrodes are drawn on paper by using commercial pencil leads. At last, a controlled volume of sample containing a supporting electrolyte was laid to soak in paper channels. Their performance was evaluated by assaying these devices as both simple cells suitable for recording voltammograms on static samples and low-cost detectors for flowing systems. Voltammetric tests, conducted by using potassium hexacyanoferrate(II) as model prototype, were also exploited for identifying the brand and softness of graphite sticks enabling paper to be marked with lines displaying the best conductivity. By taking advantage of the satisfactory information thus gained, pencil drawn electrodes were tested as amperometric detectors for the separation of ascorbic acid and sunset yellow, which were chosen as prototype electroactive analytes because they are frequently present concomitantly in several food matrices, such as soft drinks and fruit juices. This separation was performed by planar thin layer chromatography conducted on microfluidic paper-based devices prepared by patterning on filter paper two longitudinal hydrophobic barriers, once again printed with wax-based ink. Factors affecting both separation and electrochemical detection were examined and optimised, with best performance achieved by using a 20 mM acetate running buffer (pH 4.5) and by applying a detection potential of 0.9 V. Under these optimum conditions, the target analytes could be separated and detected within 6 min. The recorded peaks were well separated and characterized by good repeatability and fairly good sensitivity, thus proving that this approach is

  4. Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms

    Science.gov (United States)

    Gupta, Mihir; Cheung, Vincent J; Abraham, Peter; Wali, Arvin R; Gabel, Brandon C; Almansouri, Abdulrahman; Pannell, J. Scott; Khalessi, Alexander A

    2017-01-01

    Objective: Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries. Methods: We retrospectively reviewed records of patients treated with the LVIS Jr. device for intracranial aneurysms at a single center. A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25 mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology. Results: Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with stent-assisted coil embolization resulting in immediate complete occlusion in 94% of cases. Two fusiform aneurysms arising from the posterior circulation were further treated with elective clip ligation after delayed expansion and recurrence; no lesions required further endovascular treatment. Four aneurysms were treated by flow diversion with stand-alone LVIS Jr. stent, and complete occlusion was achieved in three cases. Small foci of delayed ischemic injury were noted in two patients in the setting of antiplatelet medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome based on the modified Rankin Scale score (mRS ≤ 2) was achieved in 100% of cases. Conclusion: Our midterm results suggest that the LVIS Jr. stent may be used for a variety of intracranial aneurysms involving small parent arteries (1.8-2.5 mm) with complete angiographic occlusion, parent vessel preservation, and functional clinical outcomes. This off

  5. Prolonged sustained ventricular fibrillation without loss of consciousness in patients supported by a left ventricular assist device.

    Science.gov (United States)

    Fasseas, Panayotis; Kutalek, Steven P; Kantharia, Bharat K

    2002-01-01

    Patients with cardiomyopathy of either ischemic or nonischemic origin are at increased risk for malignant ventricular arrhythmias. Normally sustained ventricular fibrillation (VF) leads to death very rapidly. We report two patients who remained in sustained VF, supported by a left ventricular assist device, for a prolonged period of time. Perfusion pressure through the device was sufficient to allow the patients to remain awake and responsive for several hours while in VF. The cases represent two of the longest reported episodes of sustained VF recorded in awake patients implanted with such devices.

  6. Accuracy of transcutaneous carbon dioxide tension measurements during cardiopulmonary exercise testing.

    NARCIS (Netherlands)

    Stege, G.; Elshout, F.J.J. van den; Heijdra, Y.F.; Ven, M.J.T. van de; Dekhuijzen, P.N.R.; Vos, P.J.E.

    2009-01-01

    BACKGROUND: Measurements of transcutaneous carbon dioxide tension (PtcCO(2)) with current devices are proven to provide clinically acceptable agreement with measurements of partial arterial carbon dioxide tension (PaCO(2)) in several settings but not during cardiopulmonary exercise testing (CPET). O

  7. Accuracy of transcutaneous carbon dioxide tension measurements during cardiopulmonary exercise testing.

    NARCIS (Netherlands)

    Stege, G.; Elshout, F.J.J. van den; Heijdra, Y.F.; Ven, M.J.T. van de; Dekhuijzen, P.N.R.; Vos, P.J.E.

    2009-01-01

    BACKGROUND: Measurements of transcutaneous carbon dioxide tension (PtcCO(2)) with current devices are proven to provide clinically acceptable agreement with measurements of partial arterial carbon dioxide tension (PaCO(2)) in several settings but not during cardiopulmonary exercise testing (CPET).

  8. A method of automatic control procedures cardiopulmonary resuscitation

    Science.gov (United States)

    Bureev, A. Sh.; Zhdanov, D. S.; Kiseleva, E. Yu.; Kutsov, M. S.; Trifonov, A. Yu.

    2015-11-01

    The study is to present the results of works on creation of methods of automatic control procedures of cardiopulmonary resuscitation (CPR). A method of automatic control procedure of CPR by evaluating the acoustic data of the dynamics of blood flow in the bifurcation of carotid arteries and the dynamics of air flow in a trachea according to the current guidelines for CPR is presented. Evaluation of the patient is carried out by analyzing the respiratory noise and blood flow in the interspaces between the chest compressions and artificial pulmonary ventilation. The device operation algorithm of automatic control procedures of CPR and its block diagram has been developed.

  9. Successful trans-Atlantic air ambulance transfer of a patient supported by a bi-ventricular assist device.

    Science.gov (United States)

    McLean, Neilson; Copeland, Ryan; Casey, Neil; Samoukovic, Gordon; Quigley, Robert

    2011-08-01

    The ventricular assist device (VAD) is a hemodynamic support device that augments cardiac output for patients with severe ventricular dysfunction. With improved reliability and technological advances, the use of VADs to support patients is increasing. Many VAD-dependent patients ultimately require heart transplants that are only available in specialized centers, necessitating an interhospital transfer. To date there are few reports of long-distance fixed wing aeromedical transport of patients dependent on a VAD. Here we describe the successful transfer of a patient supported by a biventricular assist device (BiVAD) from Cambridge, UK, to Durham, NC, via fixed-wing jet aircraft. During this transfer, we observed hemodynamic alterations secondary to gravitational forces, which should be anticipated and may be mitigated with simple maneuvers. With high-level logistical planning and appropriate medical oversight, patients dependant on BiVADs can be safely transported by fixed wing aircraft over long distances.

  10. Professional Rescuers' experiences of motivation for cardiopulmonary resuscitation: A qualitative study.

    Science.gov (United States)

    Assarroudi, Abdolghader; Heshmati Nabavi, Fatemeh; Ebadi, Abbas; Esmaily, Habibollah

    2017-06-01

    Rescuers' psychological competence, particularly their motivation, can improve the cardiopulmonary resuscitation outcomes. Data were collected using semistructured interviews with 24 cardiopulmonary resuscitation team members and analyzed through deductive content analysis based on Vroom's expectancy theory. Nine generic categories were developed: (i) estimation of the chance of survival; (ii) estimation of self-efficacy; (iii) looking for a sign of effectiveness; (iv) supportive organizational structure; (v) revival; (vi) acquisition of external incentives; (vii) individual drives; (viii) commitment to personal values; and (ix) avoiding undesirable social outcomes. When professional rescuers were called to perform cardiopulmonary resuscitation, they subjectively evaluated the patient's chance of survival, the likelihood of achieving of the desired outcome, and the ability to perform cardiopulmonary resuscitation interventions. If their evaluations were positive, and the consequences of cardiopulmonary resuscitation were considered favorable, they were strongly motivated to perform it. Beyond the scientific aspects, the motivation to perform cardiopulmonary resuscitation was influenced by intuitive, emotional, and spiritual aspects. © 2017 John Wiley & Sons Australia, Ltd.

  11. A systematic review of intensive cardiopulmonary management after spinal cord injury.

    Science.gov (United States)

    Casha, Steven; Christie, Sean

    2011-08-01

    Intensive cardiopulmonary management is frequently undertaken in patients with spinal cord injury (SCI), particularly due to the occurrence of neurogenic shock and ventilatory insufficiency and in an attempt to reduce secondary injury. We undertook a systematic review of the literature to examine the evidence that intensive care management improves outcome after SCI and to attempt to define key parameters for cardiopulmonary support/resuscitation. We review the literature in five areas: management of SCI patients in specialized centers, risk in SCI patients of cardiopulmonary complications, parameters for blood pressure and oxygenation/ventilation support following SCI, risk factors for cardiopulmonary insufficiency requiring ICU care after SCI, and preventative strategies to reduce the risks of cardiopulmonary complications in SCI patients. The literature supports that, in light of the significant incidence of cardiorespiratory complications, SCI patients should be managed in a monitored special care unit. There is weak evidence supporting the maintenance of MAP >85 mmHg for a period extending up to 1 week following SCI.

  12. ETSI-Standard Reconfigurable Mobile Device for Supporting the Licensed Shared Access

    Directory of Open Access Journals (Sweden)

    Kyunghoon Kim

    2016-01-01

    Full Text Available In order for a Mobile Device (MD to support the Licensed Shared Access (LSA, the MD should be reconfigurable, meaning that the configuration of a MD must be adaptively changed in accordance with the communication standard adopted in a given LSA system. Based on the standard architecture for reconfigurable MD defined in Working Group (WG 2 of the Technical Committee (TC Reconfigurable Radio System (RRS of the European Telecommunications Standards Institute (ETSI, this paper presents a procedure to transfer control signals among the software entities of a reconfigurable MD required for implementing the LSA. This paper also presents an implementation of a reconfigurable MD prototype that realizes the proposed procedure. The modem and Radio Frequency (RF part of the prototype MD are implemented with the NVIDIA GeForce GTX Titan Graphic Processing Unit (GPU and the Universal Software Radio Peripheral (USRP N210, respectively. With a preset scenario that consists of five time slots from different signal environments, we demonstrate superb performance of the reconfigurable MD in comparison to the conventional nonreconfigurable MD in terms of the data receiving rate available in the LSA band at 2.3–2.4 GHz.

  13. Online Maps and Cloud-Supported Location-Based Services across a Manifold of Devices

    Science.gov (United States)

    Kröpfl, M.; Buchmüller, D.; Leberl, F.

    2012-07-01

    Online mapping, miniaturization of computing devices, the "cloud", Global Navigation Satellite System (GNSS) and cell tower triangulation all coalesce into an entirely novel infrastructure for numerous innovative map applications. This impacts the planning of human activities, navigating and tracking these activities as they occur, and finally documenting their outcome for either a single user or a network of connected users in a larger context. In this paper, we provide an example of a simple geospatial application making use of this model, which we will use to explain the basic steps necessary to deploy an application involving a web service hosting geospatial information and a client software consuming the web service through an API. The application allows an insurance claim specialist to add claims to a cloud-based database including a claim location. A field agent then uses a smartphone application to query the database by proximity, and heads out to capture photographs as supporting documentation for the claim. Once the photos have been uploaded to the web service, a second web service for image matching is called in order to try and match the current photograph to previously submitted assets. Image matching is used as a pre-verification step to determine whether the coverage of the respective object is sufficient for the claim specialist to process the claim. The development of the application was based on Microsoft's® Bing Maps™, Windows Phone™, Silverlight™, Windows Azure™ and Visual Studio™, and was completed in approximately 30 labour hours split among two developers.

  14. Cardiopulmonary Bypass and Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Mustafa Zakkar

    2015-01-01

    Full Text Available The development of the cardiopulmonary bypass (CPB revolutionized cardiac surgery and contributed immensely to improved patients outcomes. CPB is associated with the activation of different coagulation, proinflammatory, survival cascades and altered redox state. Haemolysis, ischaemia, and perfusion injury and neutrophils activation during CPB play a pivotal role in oxidative stress and the associated activation of proinflammatory and proapoptotic signalling pathways which can affect the function and recovery of multiple organs such as the myocardium, lungs, and kidneys and influence clinical outcomes. The administration of agents with antioxidant properties during surgery either intravenously or in the cardioplegia solution may reduce ROS burst and oxidative stress during CPB. Alternatively, the use of modified circuits such as minibypass can modify both proinflammatory responses and oxidative stress.

  15. Cardiopulmonary loading in motocross riding.

    Science.gov (United States)

    Konttinen, Tomi; Häkkinen, Keijo; Kyröläinen, Heikki

    2007-07-01

    The present study was designed to examine physiological responses during motocross riding. Nine Finnish A-level motocross riders performed a 15-min ride at a motocross track and a test of maximal oxygen uptake (VO2max) in the laboratory. Cardiopulmonary strain was measured continuously during the ride as well as in the VO2max test. During the ride, mean VO2 was 32 ml x kg(-1) x min(-1) (s = 4), which was 71% (s = 12) of maximum, while ventilation (V(E)) was 73% (s = 15) of its maximum. The relative VO2 and V(E) values during the riding correlated with successful riding performance (r = 0.80, P motocross causes riders great physical stress. Both aerobic and anaerobic metabolism is required for the isometric and dynamic muscle actions experienced during a ride.

  16. Electromagnetic compatibility of WLAN adapters with life-supporting medical devices.

    Science.gov (United States)

    Calcagnini, G; Mattei, E; Censi, F; Triventi, M; Lo Sterzo, R; Marchetta, E; Bartolini, P

    2011-05-01

    This paper investigates the electromagnetic compatibility of 45 critical care medical devices (infusion pumps, defibrillators, monitors, lung ventilators, anesthesia machines and external pacemakers) with various types of wireless local area network (WLAN, IEEE 802.11 b/g, 2.45 GHz, 100 mW) adapters. Interference is evaluated by performing ad-hoc tests according to the ANSI C63.18 recommended practice. The behavior of the devices during the tests was monitored using patient simulators/device testers specific for each device class. Electromagnetic interference cases were observed in three of 45 devices at a maximum distance of 5 cm. In two cases the interference caused malfunctions that may have clinical consequences for the patient. The authors' findings show that the use of these wireless local area network adapters can be considered reasonably safe, although interference may occur if they are operated at very close distance (<10 cm) to the medical devices.

  17. Energy transmission and power sources for mechanical circulatory support devices to achieve total implantability.

    Science.gov (United States)

    Wang, Jake X; Smith, Joshua R; Bonde, Pramod

    2014-04-01

    Left ventricular assist device therapy has radically improved congestive heart failure survival with smaller rotary pumps. The driveline used to power today's left ventricular assist devices, however, continues to be a source of infection, traumatic damage, and rehospitalization. Previous attempts to wirelessly power left ventricular assist devices using transcutaneous energy transfer systems have been limited by restrictions on separation distance and alignment between the transmit and receive coils. Resonant electrical energy transfer allows power delivery at larger distances without compromising safety and efficiency. This review covers the efforts to wirelessly power mechanical circulatory assist devices and the progress made in enhancing their energy sources.

  18. Remission of chronic anthracycline-induced heart failure with support from a continuous-flow left ventricular assist device.

    Science.gov (United States)

    Khan, Nadeem; Husain, Syed Arman; Husain, Syed Iman; Khalaf, Natalia; George, Joggy; Raissi, Farshad; Segura, Ana Maria; Kar, Biswajit; Bogaev, Roberta C; Frazier, O H

    2012-01-01

    We report the case of a patient who had chronic anthracycline-induced cardiomyopathy that was reversed after treatment with a left ventricular assist device. A 29-year-old woman had undergone anthracycline-based chemotherapy as a teenager in 1991 and 1992 and received a diagnosis of dilated cardiomyopathy 10 years later. Optimal medical therapy had initially controlled the symptoms of heart failure. However, in June 2006, the symptoms worsened to New York Heart Association functional class IV status. We implanted a continuous-flow left ventricular assist device as a bridge to cardiac transplantation; of note, a left ventricular core biopsy at that time showed no replacement fibrosis. The patient's clinical status improved thereafter, enabling left ventricular assist device ex-plantation after 17 months. To our knowledge, this is the first report of the use of left ventricular assist device support to reverse chronic anthracycline-induced heart failure.

  19. A computerized data acquisition system for infusion devices--a clinical support tool, or a risk management tool?

    Science.gov (United States)

    Belal, S Y; Nevill, A J; Jeyaratnam, P

    2001-01-01

    A prototype computerized system for automatic data collection from multi-vendor infusion devices was constructed. The system was specifically designed around the needs of the critical care environment, and a survey of clinical staff was conducted to determine the functional requirements. Hardware, software and system configuration was based on the Medical Information Bus IEEE 1073 standard for medical device data communications. The infusion devices were configured into device communication controllers (DCC), which were polled at 0.25 Hz by a PC configured as a bedside communication controller (BCC). The system stores data samples after intervals of 1 ml of drug delivery and following any changes in the infusion rate. The system demonstrated significant opportunities for supporting clinical care and for the management of health care technology.

  20. Cardiopulmonary helminths in foxes from the Pyrenees.

    Science.gov (United States)

    Garrido-Castañé, Ignasi; Ortuño, Anna; Marco, Ignasi; Castellà, Joaquim

    2015-12-01

    The present survey was carried out to investigate the prevalence of cardiopulmonary helminths in red foxes in Pyrenees area and to evaluate the role of foxes in the eco-epidemiology of these nematodes. Hearts and entire respiratory tracts were obtained from 87 foxes from Vall d'Aran region, Pyrenees, Catalonia, north-eastern Spain. The cardiopulmonary tracts were dissected, flushed and examined for nematodes using sedimented flushing water. Of the 87 examined foxes, 53 (61%) were positive for cardiopulmonary helminths. The identified nematodes were Crenosoma vulpis (44.8%), Eucoleus aerophilus (29.9%) and Angiostrongylus vasorum (3.4%). Statistical differences were observed only on comparing age and C.vulpis prevalence, with young foxes being more infected than adults. The high prevalence of cardiopulmonary nematodes suggested that red foxes may play an important role in their transmission and maintenance in the studied area.

  1. Predictors of Death and Transplant in Patients With a Mechanical Circulatory Support Device : A Multi-institutional Study

    NARCIS (Netherlands)

    Holman, William L.; Kormos, Robert L.; Naftel, David C.; Miller, Marissa A.; Pagani, Frank D.; Blume, Elizabeth; Cleeton, Timothy; Koenig, Steven C.; Edwards, Leah; Kirklin, James K.

    2009-01-01

    Background: INTERMACS is a registry of FDA-approved durable mechanical circulatory support (MCS) devices used for the strategies of destination therapy (DT) and bridge to transplantation (BTT) or recovery. This study identifies predictors for death and transplantation based on initial results from I

  2. Mechanical Circulatory Support Devices Improve Tissue Perfusion in Patients With End-Stage Heart Failure or Cardiogenic Shock

    NARCIS (Netherlands)

    C.A. den Uil; A.P. Maat; W.K. Lagrand; M. van der Ent; L.S.D. Jewbali; R.J. van Thiel; P.E. Spronk; M.L. Simoons

    2009-01-01

    Objectives: This study evaluated the effects of mechanical circulatory support (MCS) on sub-lingual microcirculation as a surrogate for splanchnic microvascular perfusion. Methods: Between May 2008 and April 2009, 10 consecutive patients received an MCS device or extracorporeal membrane oxygenation

  3. Predictors of Death and Transplant in Patients With a Mechanical Circulatory Support Device : A Multi-institutional Study

    NARCIS (Netherlands)

    Holman, William L.; Kormos, Robert L.; Naftel, David C.; Miller, Marissa A.; Pagani, Frank D.; Blume, Elizabeth; Cleeton, Timothy; Koenig, Steven C.; Edwards, Leah; Kirklin, James K.

    Background: INTERMACS is a registry of FDA-approved durable mechanical circulatory support (MCS) devices used for the strategies of destination therapy (DT) and bridge to transplantation (BTT) or recovery. This study identifies predictors for death and transplantation based on initial results from

  4. Myocardial changes in patients with end-stage heart failure during continuous flow left ventricular assist device support

    NARCIS (Netherlands)

    Lok, S.I.|info:eu-repo/dai/nl/370140508

    2013-01-01

    With respect to the clinical outcome, cf-LVADs provide sufficient ventricular unloading and circulatory support. The post-operative mortality and morbidity in our centre are comparable with other recent experiences with this device. Based on these data, Heart Mate II (HM II) LVAD therapy can be cons

  5. ONLINE MAPS AND CLOUD-SUPPORTED LOCATION-BASED SERVICES ACROSS A MANIFOLD OF DEVICES

    Directory of Open Access Journals (Sweden)

    M. Kröpfl

    2012-07-01

    Full Text Available Online mapping, miniaturization of computing devices, the "cloud", Global Navigation Satellite System (GNSS and cell tower triangulation all coalesce into an entirely novel infrastructure for numerous innovative map applications. This impacts the planning of human activities, navigating and tracking these activities as they occur, and finally documenting their outcome for either a single user or a network of connected users in a larger context. In this paper, we provide an example of a simple geospatial application making use of this model, which we will use to explain the basic steps necessary to deploy an application involving a web service hosting geospatial information and a client software consuming the web service through an API. The application allows an insurance claim specialist to add claims to a cloud-based database including a claim location. A field agent then uses a smartphone application to query the database by proximity, and heads out to capture photographs as supporting documentation for the claim. Once the photos have been uploaded to the web service, a second web service for image matching is called in order to try and match the current photograph to previously submitted assets. Image matching is used as a pre-verification step to determine whether the coverage of the respective object is sufficient for the claim specialist to process the claim. The development of the application was based on Microsoft's® Bing Maps™, Windows Phone™, Silverlight™, Windows Azure™ and Visual Studio™, and was completed in approximately 30 labour hours split among two developers.

  6. A flexible unified architecture to support heterogeneous multi-device learning environments

    NARCIS (Netherlands)

    Giemza, Adam; Bollen, Lars; Jansen, Marc; Ulrich Hoppe, H.

    2013-01-01

    Since the personal ownership of mobile devices has increased steadily over the last decade, many students own personal mobile devices that can reasonably be integrated into mobile learning scenarios. Besides all the benefits this option brings, there are also drawbacks, such as the heterogeneity of

  7. Supportive techniques and devices for endoscopic submucosal dissection of gastric cancer

    National Research Council Canada - National Science Library

    Nobuyuki Sakurazawa Shunji Kato Itsuo Fujita Yoshikazu Kanazawa Hiroyuki Onodera Eiji Uchida

    2012-01-01

    ... improved.However,even with these innovations,ESD remains a potentially complex procedure.One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection.Recently,countertraction devices have been developed.In this paper,we introduce countertraction techniques and devices mainly for gastric cancer.

  8. Challenges and climate of business environment and resources to support pediatric device development.

    Science.gov (United States)

    Iqbal, Corey W; Wall, James; Harrison, Michael R

    2015-06-01

    The incidence of pediatric disease conditions pales in comparison to adult disease. Consequently, many pediatric disorders are considered orphan diseases. Resources for the development of devices targeting orphan diseases are scarce and this poses a unique challenge to the development of pediatric devices. This article outlines these challenges and offers solutions.

  9. Skeleton-supported stochastic networks of organic memristive devices: Adaptations and learning

    Energy Technology Data Exchange (ETDEWEB)

    Erokhina, Svetlana; Sorokin, Vladimir [IFMB, Kazan Federal University, Kremliovskaya str. 18, 420008, Kazan (Russian Federation); Erokhin, Victor, E-mail: victor.erokhin@fis.unipr.it [IFMB, Kazan Federal University, Kremliovskaya str. 18, 420008, Kazan (Russian Federation); CNR-IMEM, Parco delle Scienze 37/A, 43124, Parma Italy (Italy)

    2015-02-15

    Stochastic networks of memristive devices were fabricated using a sponge as a skeleton material. Cyclic voltage-current characteristics, measured on the network, revealed properties, similar to the organic memristive device with deterministic architecture. Application of the external training resulted in the adaptation of the network electrical properties. The system revealed an improved stability with respect to the networks, composed from polymer fibers.

  10. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  11. Towed Optical Assessment Device (TOAD) Data to Support Benthic Habitat Mapping since 2001

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Optical validation data were collected using a Tethered Optical Assessment Device (TOAD), an underwater sled equipped with an underwater digital video camera and...

  12. Ethical issues in cardiopulmonary resuscitation.

    Science.gov (United States)

    Holm, S; Jørgensen, E O

    2001-08-01

    If patients are to benefit from resuscitation, they must regain consciousness and their full faculties. In recent years, we have acquired important information about the natural history of neurological recovery from circulatory arrest. There are clinical tests that predict the outcome, both during ongoing cardiopulmonary resuscitation (CPR) and in the period after restoration of spontaneous circulation. The ability to predict neurological outcome at this stage offers a basis for certain ethical considerations, which are not exclusively centered on "do-not-attempt-resuscitation" (DNAR)- orders. Instead of being forced to make the decision that "I do not want CPR", the patient should be able to decide that "I want resuscitation to be discontinued, if you predict that I will not recover to a level of neurological function that is acceptable to me". Ideally, no competent patient should be given a DNAR-status without his or her consent. No CPR-attempt should be stopped, and no treatment decision for a patient recovering after CPR should be taken without knowing and assessing the available information. Good ethical decision-making requires reliable facts, which we now know are available.

  13. [Cardiopulmonary bypass in cardiac surgery].

    Science.gov (United States)

    Baehner, T; Boehm, O; Probst, C; Poetzsch, B; Hoeft, A; Baumgarten, G; Knuefermann, P

    2012-10-01

    Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery; however, apart from its therapeutic options a CPB might also initiate systemic and organ-specific complications, such as heart failure, renal and pulmonary dysfunction, impaired coagulation as well as neurological and cognitive dysfunction. The immunological response to the extracorporeal circulation generates systemic inflammation which often meets the definition of systemic inflammatory response syndrome (SIRS). The main inducers of SIRS are contact of blood with the artificial surfaces of the CPB, mechanical stress which affects the blood components and the extensive surgical trauma. Hence, a number of technical and surgical developments aim at reduction of the inflammatory response caused by the CPB. By reason of surgical demands, the majority of cardiothoracic procedures still depend on the use of CPB; however, there is an on-going development of new techniques trying to reduce the surgical trauma and the negative consequences of CPB. Here, minimized systems with biocompatible surfaces have been shown to be effective in attenuating the inflammatory response to CPB. Alternative procedures such as off-pump surgery may help to avoid CPB-associated complications but due to specific limitations will not replace conventional bypass surgery.

  14. Skeleton-supported stochastic networks of organic memristive devices: Adaptations and learning

    Directory of Open Access Journals (Sweden)

    Svetlana Erokhina

    2015-02-01

    Full Text Available Stochastic networks of memristive devices were fabricated using a sponge as a skeleton material. Cyclic voltage-current characteristics, measured on the network, revealed properties, similar to the organic memristive device with deterministic architecture. Application of the external training resulted in the adaptation of the network electrical properties. The system revealed an improved stability with respect to the networks, composed from polymer fibers.

  15. Longitudinal structural, functional, and cellular myocardial alterations with chronic centrifugal continuous-flow left ventricular assist device support.

    Science.gov (United States)

    Muthiah, Kavitha; Humphreys, David T; Robson, Desiree; Dhital, Kumud; Spratt, Phillip; Jansz, Paul; Macdonald, Peter S; Hayward, Christopher S

    2017-07-01

    Left ventricular assist device (LVAD) support triggers adaptations within failing hearts. The HeartWare (HeartWare International, Inc., Framingham, MA) LVAD exhibits different flow profiles and afterload dependence compared with previous-generation devices, which may alter remodelling patterns. We sought to characterize myocardial adaptation to third-generation centrifugal-flow LVADs at a functional, hemodynamic, and structural level in addition to profiling transcriptomal changes using next-generation sequencing platforms. We studied 37 patients supported with the HeartWare device with paired measurements of invasive hemodynamics, serial longitudinal left ventricular (LV) and right ventricular (RV) 3-dimensional echocardiography, and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) measurements. Paired samples for comparison of histologic myocardial cellular size and transcriptomal profiling were performed on specimens taken at pump implant and transplantation. The mean support duration was 280 ± 163 days. Mechanical unloading after HeartWare support resulted in reduced filling pressures (mean pulmonary capillary wedge pressure 27.1 ± 6.6 to 14.8 ± 5.1 mm Hg, p hypertrophy, and an improvement in LV and RV ejection fractions. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  16. Analysis on Supporting Stability for Track Subgrade Dynamic Response In-situ Test Device Based on NSGA-II

    Directory of Open Access Journals (Sweden)

    Feilong Zheng

    2013-07-01

    Full Text Available The dynamic response test to the subgrade plays a very important role in railway construction and a new in-situ test system is proposed. This paper presents the application of non-dominated sorting genetic algorithm-II (NSGA-II to analyze the stability of the supporting equipment for track subgrade dynamic response in-situ test device. Its stability is related with the extension length of the hydraulic cylinders and the backward condition of the supporting equipment - the hydraulic excavator. The problem is formulated as a multi-objective optimization problem with the objective of maximizing  the supporting force for the test device. An 85 tons excavator is picked as the case to study. The first optimal results show the excavator may not support the test system successfully. After redesigning the boom and adding its weight and length as new parameters, the second optimize results indicate the test device can work normally.

  17. Successful application of acute cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Derya ztrk; Erturul Altinbilek; Murat Koyuncu; Bedriye Mge Snmez; ilem altili; Ibrahim Ikzcel; Cemil Kavalci; Glsm Kavalci

    2015-01-01

    Objective: To compare the quality and correct the deficiencies of cardiopulmonary resuscitation (CPR) procedures performed in patients who developed cardiopulmonary cardiopulmonary arrest before or after Emergency Department admission. Methods: This study was conducted on patients who were applied CPR atŞŞişli Etfal Training and Research and Research Hospital, Emergency Department between 01 January 2012 and 31 December 2012. Chi-square and Mann-Whitney U test were used to compare the patients' data. The study data were analyzed in SPSS 18.0 software package. A P value less than 0.05 was considered statistically significant. Results: A total of 155 patients who were applied CPR were included in the analysis. Among the study patients, seventy eight (50.3%) were brought to Emergency Department after developing cardiopulmonary arrest while 77 (49.7%) developed cardiopulmonary arrest at Emergency Department. The mean age of the study population was (66 ± 16) years and 64%of the patients were male. The initial rhythms of the CPR-applied patients were different (P 0.05). The CPR response time was longer in ED (P Conclusions: The scientific data obtained in this study suggest that an early response and therapy improves outcomes in CPR procedure.

  18. Jogging support system with portable monitoring device and health manage software.

    Science.gov (United States)

    Makikawa, Masaki; Isaka, Tadao; Iida, Takeo; Asajima, Shuzo; Tsukise, Kanji; Shiozawa, Narihiro; Nishiyama, Kento; Wada, Sumio; Nakayama, Kyochiro; Horiguchi, Michiyuki; Torimoto, Hitoshi

    2004-01-01

    At MEDINFO 2001 we reported about an ambulatory biosignal memory device. As an application of this system, we have developed a portable jogging monitoring device and studied its application for health management here. This device is a micro processor based system with some sensors necessary to monitor condition of the user during jogging, that is, a heart rate sensor, a GPS sensor and a physical activity sensor. We also have developed PC based health management software that receives jogging data after jogging and stores it as a long term jogging trend data. From these long term data it feeds back the distance completion of jogging on the virtual course. Moreover it can show the trend of jogging time, distance, average heart rate and the user can know his/her own health condition.

  19. A new asymmetric directional microphone algorithm with automatic mode-switching ability for binaural hearing support devices.

    Science.gov (United States)

    Kim, Jinryoul; Nam, Kyoung Won; Yook, Sunhyun; Jang, Dong Pyo; Kim, In Young; Hong, Sung Hwa

    2015-06-01

    For hearing support devices, it is important to minimize the negative effect of ambient noises for speech recognition but also, at the same time, supply natural ambient sounds to the hearing-impaired person. However, conventional fixed bilateral asymmetric directional microphone (DM) algorithms cannot perform in such a way when the DM-mode device and a dominant noise (DN) source are placed on the same lateral hemisphere. In this study, a new binaural asymmetric DM algorithm that can overcome the defects of conventional algorithms is proposed. The proposed algorithm can estimate the position of a specific DN in the 90°-270° range and switch directional- and omnidirectional-mode devices automatically if the DM-mode device and the DN are placed in opposite lateral hemispheres. Computer simulation and KEMAR mannequin recording tests demonstrated that the performance of the conventional algorithm deteriorated when the DM-mode device and the DN were placed in the opposite hemisphere; in contrast, the performance of the proposed algorithm was consistently maintained regardless of directional variations in the DN. Based on these experimental results, the proposed algorithm may be able to improve speech quality and intelligibility for hearing-impaired persons who have similar degrees of hearing impairment in both ears.

  20. Analysis of mobile devices as a support tool for professional medical education in the university school

    OpenAIRE

    Briz Ponce, Laura; Juanes Méndez, Juan Antonio; García-Peñalvo, Francisco José

    2014-01-01

    [EN] According to the report of International Telecommunications Union (ITU), there are approximately 6.800 millions of users in the world with a mobile device. The fast evolution of these mobile devices for the last two decades has made the mobile phone become a minicomputer with a data connection. Because of the use of these mobile phones, the mobile applications appeared just one year later that the launching of the first iPhone and now the number of these applications reach more than 1 mi...

  1. "Orpheus" cardiopulmonary bypass simulation system.

    Science.gov (United States)

    Morris, Richard W; Pybus, David A

    2007-12-01

    In this paper we describe a high-fidelity perfusion simulation system intended for use in the training and continuing education of perfusionists. The system comprises a hydraulic simulator, an electronic interface unit and a controlling computer with associated real-time computer models. It is designed for use within an actual operating theatre, or within a specialized simulation facility. The hydraulic simulator can be positioned on an operating table and physically connected to the circuit of the institutional heart-lung machine. The institutional monitoring system is used to display the arterial and central venous pressures, the ECG and the nasopharyngeal temperature using appropriate connections. The simulator is able to reproduce the full spectrum of normal and abnormal events that may present during the course of cardiopulmonary bypass. The system incorporates a sophisticated blood gas model that accurately predicts the behavior of a modern, hollow-fiber oxygenator. Output from this model is displayed in the manner of an in-line blood gas electrode and is updated every 500 msecs. The perfusionist is able to administer a wide variety of drugs during a simulation session including: vasoconstrictors (metaraminol, epinephrine and phenylephrine), a vasodilator (sodium nitroprusside), chronotropes (epinephrine and atropine), an inotrope (epinephrine) and modifiers of coagulation (heparin and protamine). Each drug has a pharmacokinetic profile based on a three-compartment model plus an effect compartment. The simulation system has potential roles in the skill training of perfusionists, the development of crisis management protocols, the certification and accreditation of perfusionists and the evaluation of new perfusion equipment and/or techniques.

  2. Left heart bypass support with the Rotaflow Centrifugal Pump® as a bridge to decision and recovery in an adult.

    Science.gov (United States)

    Kashiwa, Koichi; Nishimura, Takashi; Saito, Aya; Kubo, Hitoshi; Fukaya, Aoi; Tamai, Hisayoshi; Yambe, Tomoyuki; Kyo, Shunei; Ono, Minoru

    2012-06-01

    Since left heart bypass or biventricular circulatory assist with an extracorporeal centrifugal pump as a bridge to decision or recovery sometimes requires long-time support, the long-term durability of extracorporeal centrifugal pumps is crucial. The Rotaflow Centrifugal Pump(®) (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) is one of the centrifugal pumps available for long-term use in Japan. However, there have been few reports of left heart bypass or biventricular circulatory support over the mid-term. This is a case report of left heart bypass support with the Rotaflow Centrifugal Pump(®) as a bridge to decision and recovery for an adult patient who could not be weaned from cardiopulmonary bypass and percutaneous cardiopulmonary support after cardiac surgery. We could confirm that the patient's consciousness level was normal; however, the patient could not be weaned from the left heart bypass support lasting 1 month. Therefore, the circulatory assist device was switched to the extracorporeal Nipro ventricular assist device (VAD). This time, left heart bypass support could be maintained for 30 days using a single Rotaflow Centrifugal Pump(®). There were no signs of hemolysis during left heart bypass support. The Rotaflow Centrifugal Pump(®) itself may be used as a device for a bridge to decision or recovery before using a VAD in cardiogenic shock patients.

  3. The Effects of Cigarette Smoking on Cardiopulmonary Function and Exercise Tolerance in Teenagers

    Directory of Open Access Journals (Sweden)

    Dianna Louie

    2001-01-01

    Full Text Available Teenagers who smoke are frequently warned that cigarette smoking will have detrimental effects on the function of their cardiopulmonary system and on their ability to perform exercise. However, there is little published evidence to support this statement. Therefore, in the present study, peak expiratory flow was measured as an indicator of lung function, expired carbon monoxide level was measured as an indicator of current smoking and the associated reduction in the oxygen carrying capacity of the blood, and blood pressure and heart rate were measured as indicators of cardiovascular hemodynamics before and after a one-mile run in 27 teenagers. The results show that, even at a young age, cigarette smoking is associated with significant detrimental effects on cardiopulmonary function and exercise tolerance. Objective evidence of an effect of smoking on cardiopulmonary function and exercise tolerance in this age group may assist educators and health care professionals in convincing teenagers to quit smoking.

  4. Tracking down a solution: exploring the acceptability and value of wearable GPS devices for older persons, individuals with a disability and their support persons.

    Science.gov (United States)

    Williamson, Brittany; Aplin, Tammy; de Jonge, Desleigh; Goyne, Matthew

    2017-11-01

    To explore the acceptability and value of three wearable GPS devices for older persons and individuals with a disability and safety concerns when accessing the community. This pilot study explored six wearers' and their support persons' experience of using three different wearable GPS devices (a pendant, watch, and mini GPS phone), each for a two-week period. Participants identified safety as the main value of using a wearable GPS device. The acceptability and value of these devices was strongly influenced by device features, ease of use, cost, appearance, the reliability of the GPS coordinates, the wearer's health condition and the users familiarity with technology. Overall, participants indicated that they preferred the pendant. Wearable GPS devices are potentially useful in providing individuals who have safety concerns with reassurance and access to assistance as required. To ensure successful utilization, future device design and device selection should consider the user's familiarity with technology and their health condition. This study also revealed that not all wearable GPS devices provide continuous location tracking. It is therefore critical to ensure that the device's location tracking functions address the wearer's requirements and reason for using the device. Implications for Rehabilitation The acceptability and usability of wearable GPS devices is strongly influenced by the device features, ease of use, cost, appearance, the reliability of the device to provide accurate and timely GPS coordinates, as well as the health condition of the wearer and their familiarity with technology. Wearable GPS devices need to be simple to use and support and training is essential to ensure they are successfully utilized. Not all wearable GPS devices provide continuous location tracking and accuracy of location is impacted by line of sight to satellites. Therefore, care needs to be taken when choosing a suitable device, to ensure that the device's location tracking

  5. The Effectiveness of Using Cloud-Based Cross-Device IRS to Support Classical Chinese Learning

    Science.gov (United States)

    Wang, Yi-Hsuan

    2017-01-01

    The purpose of the present study was to examine the effects of integrating a cloud-based cross-device interactive response system (CCIRS) on enhancing students' classical Chinese learning. The system is a cloud-based IRS system which provides instructors and learners with an environment in which to achieve immediate interactive learning and…

  6. Fabrication and Operation of Acoustofluidic Devices Supporting Bulk Acoustic Standing Waves for Sheathless Focusing of Particles

    Science.gov (United States)

    Shields, C. Wyatt; Cruz, Daniela F.; Ohiri, Korine A.; Yellen, Benjamin B.; Lopez, Gabriel P.

    2016-01-01

    Acoustophoresis refers to the displacement of suspended objects in response to directional forces from sound energy. Given that the suspended objects must be smaller than the incident wavelength of sound and the width of the fluidic channels are typically tens to hundreds of micrometers across, acoustofluidic devices typically use ultrasonic waves generated from a piezoelectric transducer pulsating at high frequencies (in the megahertz range). At characteristic frequencies that depend on the geometry of the device, it is possible to induce the formation of standing waves that can focus particles along desired fluidic streamlines within a bulk flow. Here, we describe a method for the fabrication of acoustophoretic devices from common materials and clean room equipment. We show representative results for the focusing of particles with positive or negative acoustic contrast factors, which move towards the pressure nodes or antinodes of the standing waves, respectively. These devices offer enormous practical utility for precisely positioning large numbers of microscopic entities (e.g., cells) in stationary or flowing fluids for applications ranging from cytometry to assembly. PMID:27022681

  7. Impact of Obesity on Cardiopulmonary Disease.

    Science.gov (United States)

    Chandler, Marjorie L

    2016-09-01

    Although there are known detrimental effects of obesity on the heart and lungs, few data exist showing obesity as risk factor for cardiopulmonary disorders in dogs and cats. It is probable that increased abdominal fat is detrimental as it is in humans, and there is evidence of negative effects of increased intrathoracic fat. As well as physical effects of fat, increased inflammatory mediators and neurohormonal effects of obesity likely contribute to cardiopulmonary disorders. Weight loss in overweight individuals improves cardiac parameters and exercise tolerance. Obesity in patients with obstructive airway disorders is recognized to increase disease severity.

  8. Teamwork and leadership in cardiopulmonary resuscitation.

    Science.gov (United States)

    Hunziker, Sabina; Johansson, Anna C; Tschan, Franziska; Semmer, Norbert K; Rock, Laura; Howell, Michael D; Marsch, Stephan

    2011-06-14

    Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.

  9. Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices

    Institute of Scientific and Technical Information of China (English)

    Athanasios; Tsiouris; Gaetano; Paone; Hassan; W; Nemeh; Jamil; Borgi; Celeste; T; Williams; David; E; Lanfear; Jeffrey; A; Morgan

    2015-01-01

    AIM: To study the institutional experience over 8 years with 200 continuous-flow(CF)- left ventricular assist devices(LVAD).METHODS: We evaluated our institution’s LVAD database and analyzed all patients who received a CF LVAD as a bridge to transplant(BTT) or destination therapy from March 2006 until June 2014. We identified 200 patients, of which 179 were implanted with a Heart Mate II device(Thoratec Corp., Pleasanton, CA) and 21 received a Heartware HVAD(Heart Ware Inc., Framingham, MA).RESULTS: The mean age of our LVAD recipients was 59.3 years(range 17-81), 76%(152/200) were males, and 49% were implanted for the indication of BTT. The survival rate for our LVAD patients at 30 d, 6 mo, 12 mo, 2 years, 3 years, and 4 years was 94%, 86%, 78%, 71%, 62% and 45% respectively. The mean duration of LVAD support was 581 d(range 2-2595 d). Gastrointestinal bleeding(was the most common adverse event(43/200, 21%), followed by right ventricular failure(38/200, 19%), stroke(31/200, 15%), re exploration for bleeding(31/200, 15%),ventilator dependent respiratory failure(19/200, 9%) and pneumonia(15/200, 7%). Our driveline infection rate was 7%. Pump thrombosis occurred in 6% of patients. Device exchanged was needed in 6% of patients. On multivariate analysis, preoperative liver dysfunction, ventilator dependent respiratory failure, tracheostomy and right ventricular failure requiring right ventricular assist device support were significant predictors of post LVAD survival.CONCLUSION: Short and long term survival for patients on LVAD support are excellent, although outcomes still remain inferior compared to heart transplantation. The incidence of driveline infections, pump thrombosis and pump exchange have declined significantly in recent years.

  10. An Autoethnographic Study of the Use of Mobile Devices to Support Foreign Language Vocabulary Learning

    Directory of Open Access Journals (Sweden)

    Mark Osborne

    2013-12-01

    Full Text Available This autoethnographic study involved the author in the dual role of researcher and subject in a self-study language learning episode. The paper describes a foreign language learning experience of using a mobile phone (Apple iPhone word card application to learn Italian vocabulary. Data from diary entries were analysed and categorised, and the findings show that learning strategies, content, motivation and interface design are prominent themes. The significance of these themes is addressed in the discussion, and suggestions for further research are made. The findings are of value in order to inform the design, development and deployment of mobile device-based vocabulary learning resources for language learners, and are therefore of interest to language educators, mobile device materials designers, developers and publishers, as well as researchers.

  11. Hemodynamic stress echocardiography in patients supported with a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Andersen, Mads; Gustafsson, Finn; Madsen, Per Lav

    2010-01-01

    Functional assessment of continuous-flow left ventricular assist devices (LVADs) is usually performed with the patient at rest. This study compared echocardiographic indices of contraction and filling pressure with invasive measures in 12 ambulatory LVAD patients undergoing symptom-limited bicycl...... parallel with cardiac output) and diastolic E/e' ratio decreased (correlating inversely with diastolic pulmonary artery pressure). These findings emphasize the potential role of exercise echocardiography in studying exercise hemodynamics in LVAD patients....

  12. Fabrication and Operation of Acoustofluidic Devices Supporting Bulk Acoustic Standing Waves for Sheathless Focusing of Particles

    OpenAIRE

    Shields, C. Wyatt; Cruz, Daniela F.; Ohiri, Korine A.; Yellen, Benjamin B.; Lopez, Gabriel P.

    2016-01-01

    Acoustophoresis refers to the displacement of suspended objects in response to directional forces from sound energy. Given that the suspended objects must be smaller than the incident wavelength of sound and the width of the fluidic channels are typically tens to hundreds of micrometers across, acoustofluidic devices typically use ultrasonic waves generated from a piezoelectric transducer pulsating at high frequencies (in the megahertz range). At characteristic frequencies that depend on the ...

  13. Crossing the bends: Support-catheter based left ventricular lead placement in challenging cardiac resynchronization therapy device implantation

    Directory of Open Access Journals (Sweden)

    Amit Kumar Malik, MBBS, MD

    2012-08-01

    Full Text Available The combined use of an Amplatz guiding catheter and support catheter creates a progressively supportive rail to implant the left ventricular (LV lead in difficult cardiac resynchronization therapy device implantation. We describe the case of a 32-year-old male with non-ischaemic cardiomyopathy, left bundle-branch block, and an LV ejection fraction of 30%, who was referred to our centre for a repeat attempt at an LV lead implant. Previously, the implanter had been unable to advance different guide catheters over the wire to the desired tributary of the coronary sinus (CS. At our centre, the CS was cannulated with a 6-Fr AL2 coronary guiding catheter. A 135-cm support catheter (Spectranetics Quick-Cross was advanced via AL2 guiding over the 0.035 in. guide wire to the distal CS. The proximal luer fitting of the support catheter was cut and an inner sheath (Medtronic ATTAIN SELECT II advanced over the support catheter into the CS. A 4-Fr over-the-wire LV lead was advanced through the inner sheath over a 0.014 in. percutaneous transluminal coronary angioplasty wire after removal of the support catheter. The use of a support catheter serves as rail for the placement of the inner sheath deep in the CS and facilitates implantation of the LV pacing lead. This technique is safe and easily applied.

  14. Temporary Mechanical Circulatory Support in Cardiac Critical Care: A State of the Art Review and Algorithm for Device Selection.

    Science.gov (United States)

    Nagpal, A Dave; Singal, Rohit K; Arora, Rakesh C; Lamarche, Yoan

    2017-01-01

    With more than 60 years of continuous development and improvement, a variety of temporary mechanical circulatory support (MCS) devices and implantation strategies exist, each with unique advantages and disadvantages. A thorough understanding of each available device is essential for optimizing patient outcomes in a fiscally responsible manner. In this state of the art review we examine the entire range of commonly available peripheral and centrally cannulated temporary MCS devices, including intra-aortic balloon pumps, the Impella (Abiomed, Danvers, MA) family of microaxial pumps, the TandemHeart (CardiacAssist Inc, Pittsburg, PA) pump and percutaneous cannulas, centrally cannulated centrifugal pumps such as the CentriMag (Thoratec Corp, Pleasanton, CA/St Jude Medical, St Paul, MN/Abbott Laboratories, Abbott Park, IL) and Rotaflow (Maquet Holding BV & Co KG, Rastatt Germany), and extracorporeal membrane oxygenation. Several factors need detailed consideration when contemplating MCS in any given patient, mandating a balanced, algorithmic approach for these sick patients. In this review we describe our approach to MCS, and emphasize the need for multidisciplinary input to consider patient-related, logistical, and institutional factors. Evidence is summarized and referenced where available, but because of the lack of high-quality evidence, current best practice is described. Future directions for investigation are discussed, which will better define patient and device selection, and optimize MCS-specific patient care protocols. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  15. A Cross-Device Spatial Workspace Supporting Artifact-Mediated Collaboration in Interaction Design

    OpenAIRE

    Geyer, Florian; Reiterer, Harald

    2010-01-01

    In this paper we present our approach to support artifact-mediated collaboration in interaction design. We argue that the extensive number and the diversity of artifacts created and reflected upon during collaborative design activities as well as transitions between physical and digital representations impose both a challenge and opportunity for supporting interaction design practice. The design principles for our experimental tool that we introduce within this paper are based on a cross-devi...

  16. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    NARCIS (Netherlands)

    Bouwes, Aline; van Poppelen, Daniel; Koelman, Johannes H. T. M.; Kuiper, Michael A.; Zandstra, Durk F.; Weinstein, Henry C.; Tromp, Selma C.; Zandbergen, Eveline G. J.; Tijssen, Marina A. J.; Horn, Janneke

    2012-01-01

    Background: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of

  17. Physiological consequences : Cardiopulmonary, vestibular, and sensory aspects

    NARCIS (Netherlands)

    Welsch, H.; Albery, W.; Banks, R.D.; Bles, W.

    2000-01-01

    Discussing the physiological consequences of enhanced fighter manoeuvrability (EFM), aspects of cardiopulmonary reactions will be seen during high G manoeuvres, especially the combination of negative G-load followed by high G-onset manoeuvres ("push-pull"). The aircraft's capability to reach high al

  18. In vivo quantification of intraventricular flow during left ventricular assist device support

    Science.gov (United States)

    Vu, Vi; Wong, Kin; Del Alamo, Juan; Aguilo, Pablo M. L.; May-Newman, Karen; Department of Bioengineering, San Diego State University Collaboration; Department of Mechanical; Aerospace Engineering, University of California San Diego Collaboration; Mechanical Assist Device Program, Sharp Memorial Hospital Collaboration

    2014-11-01

    Left ventricular assist devices (LVADs) are mechanical pumps that are surgically connected to the left ventricle (LV) and aorta to increase aortic flow and end-organ perfusion. Clinical studies have demonstrated that LVADs improve patient health and quality of life and significantly reduce the mortality of cardiac failure. However, In the presence of left ventricular assisted devices (LVAD), abnormal flow patterns and stagnation regions are often linked to thrombosis. The aim of our study is to evaluate the flow patterns in the left ventricle of the LVAD-assisted heart, with a focus on alterations in vortex development and blood stasis. To this aim, we applied color Doppler echocardiography to measure 2D, time resolved velocity fields in patients before and after implantation of LVADs. In agreement with our previous in vitro studies (Wong et al., Journal of Biomechanics 47, 2014), LVAD implantation resulted in decreased flow velocities and increased blood residence time near the outflow tract. The variation of residence time changes with LVAD operational speed was characterized for each patient.

  19. Ventricular assist devices in heart failure: how to support the heart but prevent atrophy?

    Science.gov (United States)

    Pokorný, M; Cervenka, L; Netuka, I; Pirk, J; Koňařík, M; Malý, J

    2014-01-01

    Ventricular assist devices (VAD) have recently established themselves as an irreplaceable therapeutic modality of terminal heart failure. Because of the worldwide shortage of donors, ventricular assist devices play a key role in modern heart failure therapy. Some clinical data have revealed the possibility of cardiac recovery during VAD application. On the other hand, both clinical and experimental studies indicate the risk of the cardiac atrophy development, especially after prolonged mechanical unloading. Little is known about the specific mechanisms governing the unloading-induced cardiac atrophy and about the exact ultrastructural changes in cardiomyocytes, and even less is known about the ways in which possible therapeutical interventions may affect heart atrophy. One aim of this review was to present important aspects of the development of VAD-related cardiac atrophy in humans and we also review the most significant observations linking clinical data and those derived from studies using experimental models. The focus of this article was to review current methods applied to alleviate cardiac atrophy which follows mechanical unloading of the heart. Out of many pharmacological agents studied, only the selective beta2 agonist clenbuterol has been proved to have a significantly beneficial effect on unloading-induced atrophy. Mechanical means of atrophy alleviation also seem to be effective and promising.

  20. In vivo evaluation of centrifugal blood pump for cardiopulmonary bypass-Spiral Pump.

    Science.gov (United States)

    da Silva, Cibele; da Silva, Bruno Utiyama; Leme, Juliana; Uebelhart, Beatriz; Dinkhuysen, Jarbas; Biscegli, José F; Andrade, Aron; Zavaglia, Cecília

    2013-11-01

    The Spiral Pump (SP), a centrifugal blood pump for cardiopulmonary bypass (CPB), has been developed at the Dante Pazzanese Institute of Cardiology/Adib Jatene Foundation laboratories, with support from Sintegra Company (Pompeia, Brazil). The SP is a disposable pump with an internal rotor-a conically shaped fuse with double entrance threads. This rotor is supported by two ball bearings, attached to a stainless steel shaft fixed to the housing base. Worm gears provide axial motion to the blood column, and the rotational motion of the conically shaped impeller generates a centrifugal pumping effect, improving pump efficiency without increasing hemolysis. In vitro tests were performed to evaluate the SP's hydrodynamic performance, and in vivo experiments were performed to evaluate hemodynamic impact during usual CPB. A commercially available centrifugal blood pump was used as reference. In vivo experiments were conducted in six male pigs weighing between 60 and 90 kg, placed on CPB for 6 h each. Blood samples were collected just before CPB (T0) and after every hour of CPB (T1-T6) for hemolysis determination and laboratory tests (hematological and biochemical). Values of blood pressure, mean flow, pump rotational speed, and corporeal temperature were recorded. Also, ergonomic conditions were recorded: presence of noise, difficulty in removing air bubbles, trouble in installing the pump in the drive module (console), and difficulties in mounting the CPB circuit. Comparing the laboratory and hemolysis results for the SP with those of the reference pump, we can conclude that there is no significant difference between the two devices. In addition, reports made by medical staff and perfusionists described a close similarity between the two devices. During in vivo experiments, the SP maintained blood flow and pressure at physiological levels, consistent with those applied in cardiac surgery with CPB, without presenting any malfunction. Also, the SP needed lower rotational

  1. Evaluation of upper body muscle activity during cardiopulmonary resuscitation performance in simulated microgravity

    Science.gov (United States)

    Waye, A. B.; Krygiel, R. G.; Susin, T. B.; Baptista, R.; Rehnberg, L.; Heidner, G. S.; de Campos, F.; Falcão, F. P.; Russomano, T.

    2013-09-01

    Performance of efficient single-person cardiopulmonary resuscitation (CPR) is vital to maintain cardiac and cerebral perfusion during the 2-4 min it takes for deployment of advanced life support during a space mission. The aim of the present study was to investigate potential differences in upper body muscle activity during CPR performance at terrestrial gravity (+1Gz) and in simulated microgravity (μG). Muscle activity of the triceps brachii, erector spinae, rectus abdominis and pectoralis major was measured via superficial electromyography in 20 healthy male volunteers. Four sets of 30 external chest compressions (ECCs) were performed on a mannequin. Microgravity was simulated using a body suspension device and harness; the Evetts-Russomano (ER) method was adopted for CPR performance in simulated microgravity. Heart rate and perceived exertion via Borg scores were also measured. While a significantly lower depth of ECCs was observed in simulated microgravity, compared with +1Gz, it was still within the target range of 40-50 mm. There was a 7.7% decrease of the mean (±SEM) ECC depth from 48 ± 0.3 mm at +1Gz, to 44.3 ± 0.5 mm during microgravity simulation (p muscular and cardiovascular deconditioning that occurs during space travel.

  2. Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices.

    Science.gov (United States)

    Pal, Jay D; McCabe, James M; Dardas, Todd; Aldea, Gabriel S; Mokadam, Nahush A

    2016-10-01

    The development of new aortic insufficiency after a period of support with a left ventricular assist device can result in progressive heart failure symptoms. Transcatheter aortic valve repair can be an effective treatment in selected patients, but the lack of aortic valve calcification can result in unstable prostheses or paravalvular leak. We describe a technique of deploying a self-expanding CoreValve (Medtronic, Minneapolis, MN, USA) into the aortic annulus, followed by a balloon-expandable SAPIEN-3 (Edwards, Irvine, CA, USA).

  3. Implementation of a Low-Cost Mobile Devices to Support Medical Diagnosis

    Directory of Open Access Journals (Sweden)

    Carlos García Sánchez

    2013-01-01

    Full Text Available Medical imaging has become an absolutely essential diagnostic tool for clinical practices; at present, pathologies can be detected with an earliness never before known. Its use has not only been relegated to the field of radiology but also, increasingly, to computer-based imaging processes prior to surgery. Motion analysis, in particular, plays an important role in analyzing activities or behaviors of live objects in medicine. This short paper presents several low-cost hardware implementation approaches for the new generation of tablets and/or smartphones for estimating motion compensation and segmentation in medical images. These systems have been optimized for breast cancer diagnosis using magnetic resonance imaging technology with several advantages over traditional X-ray mammography, for example, obtaining patient information during a short period. This paper also addresses the challenge of offering a medical tool that runs on widespread portable devices, both on tablets and/or smartphones to aid in patient diagnostics.

  4. A reusable device for electrochemical applications of hydrogel supported black lipid membranes

    DEFF Research Database (Denmark)

    Mech-Dorosz, Agnieszka; Heiskanen, Arto; Bäckström, Sania

    2015-01-01

    Black lipid membranes (BLMs) are significant in studies of membrane transport, incorporated proteins/ion transporters, and hence in construction of biosensor devices. Although BLMs provide an accepted mimic of cellular membranes, they are inherently fragile. Techniques are developed to stabilize...... of the gold electrode microchips and plasma modification of the ETFE aperture arrays facilitating covalent "sandwiching" of the hydrogel. Both fluorescence microscopy and EIS were used to demonstrate the induced spontaneous thinning of a deposited lipid solution, leading to formation of stabilized hs......BLMs on average in 10 min. The determined specific membrane capacitance and resistance were shown to vary in the range 0.31-0.49 mu F/cm2 and 45-65 k Omega cm2, respectively, corresponding to partially solvent containing BLMs with an average life time of 60-80 min. The characterized hsBLM formation and devised...

  5. Laryngeal Support Device Enhances the Learning of Laryngeal Anatomy and Voice Physiology

    Science.gov (United States)

    Curcio, Daniella Franco; Behlau, Mara; Barros, Mirna Duarte; Smith, Ricardo Luiz

    2012-01-01

    Multidisciplinary cooperation in health care requires a solid knowledge in the basic sciences for a common ground of communication. In speech pathology, these fundamentals improve the accuracy of descriptive diagnoses and support the development of new therapeutic techniques and strategies. The aim of this study is to briefly discuss the benefits…

  6. Improving car passengers' comfort and experience by supporting the use of handheld devices

    NARCIS (Netherlands)

    Veen, S.A.T. van; Hiemstra-van Mastrigt, S.; Kamp, I.; Vink, P.

    2014-01-01

    Background: There is a demand for interiors to support other activities in a car than controlling the vehicle. Currently, this is the case for the car passengers and-in the future-autonomous driving cars will also facilitate drivers to perform other activities. One of these activities is working wit

  7. Improving car passengers' comfort and experience by supporting the use of handheld devices

    NARCIS (Netherlands)

    Van Veen, S.A.T.; Van Mastrigt, S.; Kamp, I.; Vink, P.

    2014-01-01

    BACKGROUND: There is a demand for interiors to support other activities in a car than controlling the vehicle. Currently, this is the case for the car passengers and – in the future – autonomous driving cars will also facilitate drivers to perform other activities. One of these activities is working

  8. Improving car passengers' comfort and experience by supporting the use of handheld devices

    NARCIS (Netherlands)

    Veen, S.A.T. van; Hiemstra-van Mastrigt, S.; Kamp, I.; Vink, P.

    2014-01-01

    Background: There is a demand for interiors to support other activities in a car than controlling the vehicle. Currently, this is the case for the car passengers and-in the future-autonomous driving cars will also facilitate drivers to perform other activities. One of these activities is working wit

  9. Improving car passengers' comfort and experience by supporting the use of handheld devices

    NARCIS (Netherlands)

    Van Veen, S.A.T.; Van Mastrigt, S.; Kamp, I.; Vink, P.

    2014-01-01

    BACKGROUND: There is a demand for interiors to support other activities in a car than controlling the vehicle. Currently, this is the case for the car passengers and – in the future – autonomous driving cars will also facilitate drivers to perform other activities. One of these activities is working

  10. An information model to support user-centered design of medical devices.

    Science.gov (United States)

    Hagedorn, Thomas J; Krishnamurty, Sundar; Grosse, Ian R

    2016-08-01

    The process of engineering design requires the product development team to balance the needs and limitations of many stakeholders, including those of the user, regulatory organizations, and the designing institution. This is particularly true in medical device design, where additional consideration must be given for a much more complex user-base that can only be accessed on a limited basis. Given this inherent challenge, few projects exist that consider design domain concepts, such as aspects of a detailed design, a detailed view of various stakeholders and their capabilities, along with the user-needs simultaneously. In this paper, we present a novel information model approach that combines a detailed model of design elements with a model of the design itself, customer requirements, and of the capabilities of the customer themselves. The information model is used to facilitate knowledge capture and automated reasoning across domains with a minimal set of rules by adopting a terminology that treats customer and design specific factors identically, thus enabling straightforward assessments. A uniqueness of this approach is that it systematically provides an integrated perspective on the key usability information that drive design decisions towards more universal or effective outcomes with the very design information impacted by the usability information. This can lead to cost-efficient optimal designs based on a direct inclusion of the needs of customers alongside those of business, marketing, and engineering requirements. Two case studies are presented to show the method's potential as a more effective knowledge management tool with built-in automated inferences that provide design insight, as well as its overall effectiveness as a platform to develop and execute medical device design from a holistic perspective.

  11. Postgraduate Education for Physical Therapists at Cardiopulmonary Area in Colombia

    Directory of Open Access Journals (Sweden)

    Diana Durán Palomino

    2007-09-01

    Full Text Available This paper presents the supply of postdegreeprograms in the cardiopulmonary area in Colombiain orden to show its state and sufficiency.Plans of formation, objectives, curricular approach,methodology and profile of performanceare analyzed in terms of costs, duration,supply, location and research capabilities.Our results show problems in regard to supplyas well as unanimous criteria and strategic alliances.There are no Gremial associations thatfavor both discussion and analysis about epidemiologistaspects of respiratory and cardiovasculardiseases in Colombia there is necessityof professionals in this area with experience.Knowledge and appropiated skills in management,administration, laws, agreements andpublic policies that cover the affected population.Also, it is exposed that the Universities whitthis programs require support and pursuit forprofessionals positioning both in national andinternational context.MethodologyA descriptive study was carried out with a datacollection made in a period between April-Decemberof 2006. Cards were done and they allowedto review different aspects such as costs,occupational profile, duration, modality, methodology,practical component and evaluation inthe offering universities of programs of postdegreein the cardiopulmonary area for physiotherapists.Later an analysis was made oncurriculum, profiles, objectives, contents, professionalcompetitions the areas of research.

  12. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

    Science.gov (United States)

    Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed

    2016-03-01

    "Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

  13. Left ventricular assist device support with a centrifugal pump for 2 months in a 5-kg child.

    Science.gov (United States)

    Inoue, Takafumi; Nishimura, Takashi; Murakami, Arata; Itatani, Keiichi; Takaoka, Tetsuhiro; Kitahori, Kazuo; Umeki, Akihide; Takezoe, Toshiko; Kashiwa, Koichi; Kyo, Shunei; Ono, Minoru

    2011-09-01

    The mid-term and long-term results of left ventricular assist device (LVAD) implantation for small children are still unsatisfactory. There have been few reports of LVAD implantation for more than a month in children weighing under 5 kg. We report the case of a 4-month-old female infant who survived for 2 months after being diagnosed with dilated cardiomyopathy (DCM) with extracorporeal centrifugal pump support. In recent years, although pumps designed for small children have been introduced and are used as a bridge to transplantation or recovery, mid-term or long-term mechanical support for small children with heart failure is still difficult. We managed to successfully provide support for a low-body-weight child with a centrifugal pump over a mid-term period. We achieved acceptable control of thrombosis, but eventually the infant died of sepsis. Autopsy revealed no prominent thrombosis in the perfusion cannula, drainage cannula, the pump, or the left ventricle. This is the first case report of LVAD support with the centrifugal pump, ROTAFLOW(®) (Maquet, Rastatt, Germany), for 2 months in a child weighing under 5 kg. Our method may potentially save severe heart failure children who need mid-term LVAD support.

  14. X-Learn: An XML-Based, Multi-agent System for Supporting "User-Device" Adaptive E-learning

    CERN Document Server

    De Meo, P; Terracina, G; Ursino, D

    2009-01-01

    In this paper we present X-Learn, an XML-based, multi-agent system for supporting "user-device" adaptive e-learning. X-Learn is characterized by the following features: (i) it is highly subjective, since it handles quite a rich and detailed user profile that plays a key role during the learning activities; (ii) it is dynamic and flexible, i.e., it is capable of reacting to variations of exigencies and objectives; (iii) it is device-adaptive, since it decides the learning objects to present to the user on the basis of the device she/he is currently exploiting; (iv) it is generic, i.e., it is capable of operating in a large variety of learning contexts; (v) it is XML based, since it exploits many facilities of XML technology for handling and exchanging information connected to e-learning activities. The paper reports also various experimental results as well as a comparison between X-Learn and other related e-learning management systems already presented in the literature.

  15. The Prometheus device for extracorporeal support of combined liver and renal failure.

    Science.gov (United States)

    Rifai, Kinan; Ernst, Thomas; Kretschmer, Ulrich; Hafer, Carsten; Haller, Hermann; Manns, Michael Peter; Fliser, Danilo

    2005-01-01

    Prometheus is a newly developed extracorporeal liver support system that combines removal of albumin-bound substances (adsorption on resin adsorbers) and water-soluble substances (diffusion during high-flux hemodialysis). Therefore, it is a promising treatment option for patients with hepatorenal syndrome (HRS). We studied 10 patients with HRS in a prospective clinical study. All patients underwent 2 consecutive Prometheus treatments. A variety of clinical and biochemical parameters were assessed. Prometheus treatment was uncomplicated and safe. A statistically significant improvement of serum creatinine and urea concentrations as well as blood pH was observed after Prometheus treatment. Furthermore, liver detoxification was supported by a significant decrease of serum levels of conjugated bilirubin, bile acids and ammonia. Prometheus is a safe treatment for patients with HRS. Both, albumin-bound and water-soluble substances were effectively removed. Controlled studies will evaluate the effect of this new treatment option on survival in patients with HRS. (c) 2005 S. Karger AG, Basel.

  16. A New Wireless VoIP Signaling Device Supporting SIP and H.323 Protocols

    Directory of Open Access Journals (Sweden)

    Salma Rattal

    2014-01-01

    Full Text Available Nowadays, VoIP is a technology with a great demand and wireless networks are increasingly deployed. Each of these has its own technology constraints. For VoIP, it is very important to take into consideration the need to provide a high quality service according to well-defined standard transmission (jitter, end-to-end delay, MOS, and packet loss. However, wireless networks (IEEE 802.11 are based on radio which undergoes a number of technical constraints to achieve theoretical transmission rates; among these constraints the number of users of the networks, the distance between the client and the access, and the amount of data transmitted point are included. In this term, a study is made by simulating wireless network in OPNET Modeler with a fairly large number of VoIPs (15 users whose signaling is handled via a new node that was created specifically to manage the signaling tasks under SIP and H.323 in order to minimize the number of nodes in the network and avoid the congestion. In this paper, two scenarios are compared; the first contains a number of VoIP users with SIP and H.323 signaling handled by the new created device; the second scenario is similar to the first except that the distance between the stations is remarkably lower.

  17. History of the evolution of cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    George Karlis

    2013-04-01

    Full Text Available Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.. Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references

  18. Mass cardiopulmonary resuscitation 99--survey results of a multi-organisational effort in public education in cardiopulmonary resuscitation.

    Science.gov (United States)

    Fong, Y T; Anantharaman, V; Lim, S H; Leong, K F; Pokkan, G

    2001-05-01

    Mass cardiopulmonary resuscitation (CPR) 99 in Singapore was a large-scale multi-organisational effort to increase awareness and impart basic cardiac life support skills to the lay public. Mass CPR demonstrations followed by small group manikin practice with instructor guidance was conducted simultaneously in three centres, four times a day. The exercise enlisted 15 community organisations and received the support of 19 other organisations. Three hundred and ninety-eight manikins and 500 instructors ('I's) were mobilised to teach an audience of 6000 participants ('P's). Two surveys, for 'I's and 'P's were conducted with respondent rates of 65.8% and 50%, respectively. 73.6% of the P-respondents ('P-R's) indicated that they attended the event to increase their knowledge. 66.9% were willing to attend a more comprehensive CPR course. Concerns and perceptions in performing bystander CPR were assessed.

  19. Probing Interaction Between Platinum Group Metal (PGM) and Non-PGM Support Through Surface Characterization and Device Performance

    Science.gov (United States)

    Saha, Shibely

    High cost and limited abundance of Platinum (Pt) have hindered effective commercialization of Proton Exchange Membrane Fuel Cell and Electrolyzer. Efforts have been undertaken to reduce precious group metal (PGM) requirement for these devices without compromising the activity of the catalyst by using transition metal carbides (TMC) as non-PGM support thanks to their similar electronic and geometric structures as Pt. In this work Mo2C was selected as non-PGM support and Pt was used as the PGM of interest. We hypothesize that the hollow nanotube morphology of Mo2C support combined with Pt nano particles deposited on it via atomic layer deposition (ALD) technique would allow increased interaction between them which may increase the activity of Pt and Mo2C as well as maximize the Pt active surface area. Specifically, a rotary ALD equipment was used to grow Pt particles from atomic level to 2--3 nanometers by simply adjusting number of ALD cycles in order to probe the interaction between the deposited Pt nanoparticles and Mo2C nanotube support. Interaction between the Pt and Mo2 C was analyzed via surface characterization and electrochemical characterization. Interaction between Pt and Mo2C arises due to the lattice mismatch between Pt and Mo2C as well as electron migration between them. Lattice spacing analysis using high resolution transmission electron microscopy (HRTEM) images, combined with Pt binding energy shift in XPS results, clearly showed strong bonding between Pt nanoparticles and the Mo2C nanotube support in all the resultant Pt/Mo2C samples. We postulate that this strong interaction is responsible for the significantly enhanced durability observed in our constant potential electrolysis (CPE) and accelerated degradation testing (ADT). Of the three samples from different ALD cycles (15, 50 and 100), Mo2C nanotubes modified by 50 (1.07 wt% Pt loading) and 100 cycles (4.4 wt% Pt) of Pt deposition, showed higher HER and HOR activity per Pt mass than commercial

  20. A failure mode effect analysis on extracorporeal circuits for cardiopulmonary bypass.

    Science.gov (United States)

    Wehrli-Veit, Michel; Riley, Jeffrey B; Austin, Jon W

    2004-12-01

    Although many refinements in perfusion methodology and devices have been made, extracorporeal circulation remains a contributor to neurological complications, bleeding coagulopathies, use of blood products, as well as systemic inflammatory response. With the exposure of these adverse effects of cardiopulmonary bypass, the necessity to re-examine the safety of extracorporeal circuits is vital. A failure mode effect analysis (FMEA) is a proven proactive technique developed to evaluate system effect or equipment failure. FMEA was used to evaluate the six different types of extracorporeal circuits based on feedback from five clinical experts. Cardiovascular device manufacturers, the Veteran's Administration National Center for Patient Safety, and the Joint Commission on Accreditation of Healthcare Organizations recommend the use of FMEA to assess and manage risks in current and developing technologies and therapies. This analysis investigates the safety of six types of extracorporeal circuits used in coronary revascularization, including the newer miniaturized extracorporeal circuits. The FMEA lists and ranks the hazards associated with the use of each cardiopulmonary bypass extracorporeal circuit type. To increase the safety of extracorporeal circuits and minimize the effects associated with cardiopulmonary bypass, perfusionists must incorporate FMEA into their clinical practice.

  1. The role of cardiopulmonary exercise test for individualized exercise training recommendation in young obese subjects

    Directory of Open Access Journals (Sweden)

    Lucian Hoble

    2010-06-01

    Full Text Available Obesity is affecting a growing segment of the population and should be considered a serious health problem which will lead to medical complications and decreased life span. Lifestyle changes by adopting healthy food and increase energy consumption through physical activity is the most important treatment for obesity. Cardiopulmonary exercise test (CPET is considered the gold standard for exercise capacity assessment. Purpose: This study is aiming to demonstrate that individualized exercise training programs, designed using CPET results, leads to increase of physical fitness, aerobic capacity, ventilatory and cardiac exercise performance in young obese subjects.Material and method:We performed a prospective research study of 6 months. 43 sedentary subjects without contraindications to exercise, 21.3±3.1 years old, 93% female were included in the study. Assessments were made at baseline and after six months of intervention and consists of cardiopulmonary exercise test on bicycle ergometer. After we recorded oxygen uptake at aerobic threshold (AT, anaerobic threshold (in the range of respiratory compensation point – RCP and maximal oxygen uptake (VO2max we designed the training program according to these parameters and individualized heart rate training zones of each subject. Exercise training (60 minutes/session, 3 sessions/week was performed taking in consideration the training zones and using a circuit on cardio devices. Each subject was supervised by a physiotherapist and using heart rate monitors. The number of subjects evaluated at the end of the study was 27 (dropout rate 37%.Results:After six months of intervention we noticed an improvement of maximum oxygen uptake (VO2max (from 22.7±3.69 to 27.44±5.55, aerobic threshold (VO2_AT (from 15.48±2.66 to 20.07±4.64 ml/min/kg, p<0.0001 and anaerobic threshold (VO2_RCP (from 20.3±3.66 to 25.11±5.84 ml/min/kg, p<0.0001, cardiac performance during exercise evaluated trough maximal oxygen

  2. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery

    2005-05-01

    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  3. Hardware for seizure prediction: towards wearable devices to support epileptic people.

    Science.gov (United States)

    Castellaro, Cipriano; Favaro, Gianpietro; Salemi, Giovanni; Sarto, Matteo; Rizzo, Nicola

    2011-01-01

    This paper presents the hardware developed for the EPILEPSIAE project (www.epilepsiae.eu), focused on epileptic seizure prediction. A portable low power acquisition system for EEG signals, called LTM-EU (Long Term Monitoring), with 64 channels and 2048 Hz sampling rate each and a safe (high isolation) PC interface on a PCIe bus specifically designed for this task, is described. The acquisition system, designed for a rapid commercialization, though used for research purposes, got the CE certification. The signal from the patient, on each channel, is amplified, converted in digital form and stored into a local flash memory (SD-MMC, 4 GB). Data are then formatted into a serial stream at 4 Mb/s and sent through a half-duplex RS485 link to the host where a specifically designed PCIe (BQPCIe) interface receive them and release the information to the OS (Windows or Linux). The amplifier runs with a couple of AA battery for more than 15 hours (300 mW). If a wireless link is established (Bluetooth), a bandwidth limited stream of data (or a subset of channels) is sent for monitoring purposes. The mission is to support the researchers of the consortium with a suitable hardware to have a real time seizure prediction system for algorithms tests. In the experimental phase all algorithms run on a portable PC, wire or wireless connected to the acquisition system.

  4. A marked increase in gastric fluid volume during cardiopulmonary bypass

    OpenAIRE

    2011-01-01

    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patie...

  5. An environment-adaptive management algorithm for hearing-support devices incorporating listening situation and noise type classifiers.

    Science.gov (United States)

    Yook, Sunhyun; Nam, Kyoung Won; Kim, Heepyung; Hong, Sung Hwa; Jang, Dong Pyo; Kim, In Young

    2015-04-01

    In order to provide more consistent sound intelligibility for the hearing-impaired person, regardless of environment, it is necessary to adjust the setting of the hearing-support (HS) device to accommodate various environmental circumstances. In this study, a fully automatic HS device management algorithm that can adapt to various environmental situations is proposed; it is composed of a listening-situation classifier, a noise-type classifier, an adaptive noise-reduction algorithm, and a management algorithm that can selectively turn on/off one or more of the three basic algorithms-beamforming, noise-reduction, and feedback cancellation-and can also adjust internal gains and parameters of the wide-dynamic-range compression (WDRC) and noise-reduction (NR) algorithms in accordance with variations in environmental situations. Experimental results demonstrated that the implemented algorithms can classify both listening situation and ambient noise type situations with high accuracies (92.8-96.4% and 90.9-99.4%, respectively), and the gains and parameters of the WDRC and NR algorithms were successfully adjusted according to variations in environmental situation. The average values of signal-to-noise ratio (SNR), frequency-weighted segmental SNR, Perceptual Evaluation of Speech Quality, and mean opinion test scores of 10 normal-hearing volunteers of the adaptive multiband spectral subtraction (MBSS) algorithm were improved by 1.74 dB, 2.11 dB, 0.49, and 0.68, respectively, compared to the conventional fixed-parameter MBSS algorithm. These results indicate that the proposed environment-adaptive management algorithm can be applied to HS devices to improve sound intelligibility for hearing-impaired individuals in various acoustic environments.

  6. The use of mobile devices for information sharing in a technology-supported model of care in A&E.

    Science.gov (United States)

    Baldwin, Lynne P; Low, Phuay Hui; Picton, Claire; Young, Terry

    2007-01-01

    Using a case study as an example, this paper illustrates the current model of care in Accident and Emergency (A & E); in particular, the 'cells' in which data/information is stored and how explicit and accessible it is (or is not) to healthcare professionals. It is a model of care which may be summed up as static information/dynamic clinicians. This paper then describes how mobile devices may be used to track patients through an A&E department. From there, a model of care is proposed that has at its core the notion of dynamic information/static clinicians which takes into account the potential and likelihood of such mobile technology being used to support healthcare professionals in the future. It is argued, however, that such 'disruptive technologies' are merely tools at our disposal and that it is human activity which must be foremost when considering how we might work differently ('better') in treating and/or dealing with patients.

  7. Peripheral arterial blood pressure versus central crterial blood pressure monitoring in critically ill patients after Cardio-pulmonary Bypass.

    Science.gov (United States)

    Ahmad, Rana Altaf; Ahmad, Suhail; Naveed, Anjum; Baig, Mirza Ahmad Raza

    2017-01-01

    To determine the accuracy of peripheral (radial) arterial access as compared to central (femoral) arterial access for measurement of invasive blood pressure (IBP) in critically ill patients after cardiopulmonary bypass. Sixty patients (60) who required high inotropic/vasopressor support on weaning from cardio-pulmonary bypass and weaned off in 2(nd) attempt were included in this study. The duration of this study was from June 2015 to August 2016. Radial and femoral arterial access was achieved in all patients for simultaneous measurement of blood pressure. Arterial pressures were noted after 5, 15 and 30 minutes of weaning from cardiopulmonary bypass for both radial and femoral artery simultaneously. Mean age of study patients was 56.48±11.17 years. 85% patients were male. There was significant difference in systolic blood pressure, diastolic blood pressure and mean arterial pressures between the radial artery and femoral artery cannulation. Mean arterial pressures were significantly high in femoral artery as compared to the radial artery. The mean arterial pressures after five minutes of weaning using central access were 76.28±10.21 mmHg versus 64.15±6.76 mmHg in peripheral arterial access (p-value arterial pressures after 15 minutes of weaning from cardiopulmonary bypass 78.70±10.12 mmHg in central access versus 72.03±6.76 mmHg using peripheral arterial access (p-value arterial pressures were less marked as compared to the previous differences after 30 minutes of weaning from cardiopulmonary bypass as compared to the earlier readings (p-value 0.001). Peripheral arterial pressures are unreliable in critically ill patients after cardiopulmonary bypass receiving high dose of inotropic drugs. Central arterial access should be used in these patients to get accurate estimates of patients' blood pressure in early periods after cardiopulmonary bypass.

  8. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Whitlock, Richard P; Devereaux, P J; Teoh, Kevin H; Lamy, Andre; Vincent, Jessica; Pogue, Janice; Paparella, Domenico; Sessler, Daniel I; Karthikeyan, Ganesan; Villar, Juan Carlos; Zuo, Yunxia; Avezum, Álvaro; Quantz, Mackenzie; Tagarakis, Georgios I; Shah, Pallav J; Abbasi, Seyed Hesameddin; Zheng, Hong; Pettit, Shirley; Chrolavicius, Susan; Yusuf, Salim

    2015-09-26

    with placebo, did not reduce the risk of death at 30 days (154 [4%] vs 177 [5%] patients; relative risk [RR] 0·87, 95% CI 0·70-1·07, p=0·19) or the risk of death or major morbidity (909 [24%] vs 885 [24%]; RR 1·03, 95% CI 0·95-1·11, p=0·52). The most common safety outcomes in the methylprednisolone and placebo group were infection (465 [12%] vs 493 [13%]), surgical site infection (151 [4%] vs 151 [4%]), and delirium (295 [8%] vs 289 [8%]). Methylprednisolone did not have a significant effect on mortality or major morbidity after cardiac surgery with cardiopulmonary bypass. The SIRS trial does not support the routine use of methylprednisolone for patients undergoing cardiopulmonary bypass. Canadian Institutes of Health Research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  10. Emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica Use of centrifugal pump and extracorporeal membrane oxygenation as cardiopulmonary support in pediatric cardiovascular surgery

    Directory of Open Access Journals (Sweden)

    Fernando A. Atik

    2008-04-01

    several aspects related to the use of extracorporeal membrane oxygenation in a pediatric heart center and determine its immediate and late outcomes. METHODS: Between October 2005 and January 2007, 10 patients who were submitted to pediatric cardiac surgery underwent extracorporeal membrane oxygenation implant. Median age was 58.5 days (40% neonates and median body weight was 3.9 kg. Circulatory assistance was initiated aiming at the recovery and the weaning protocols followed daily clinical and echocardiographic criteria. Support was discontinued when transplant was contraindicated, when the patient was unable to recover or when survival was considered to be limited by a multidisciplinary team. RESULTS: Extracorporeal membrane oxygenation was employed after corrective or palliative heart surgery in 80% and preoperatively in the remaining ones. It was most often indicated for irresponsive hemodynamic instability (40%, post-cardiotomy shock (20% and post-cardiac arrest (20%. The mean duration on support was 58 ± 37 hours. Weaning was successfully in 50% of the cases and 30% were discharged home. Actuarial survival was 40%, 30% and 20% at 30 days, 3 months and 24 months, respectively. CONCLUSION: Extracorporeal membrane oxygenation is an effective and useful tool for the resuscitation of patients presenting severe hemodynamic and/or respiratory failure in the perioperative period of pediatric cardiovascular surgery.

  11. Software for interpreting cardiopulmonary exercise tests

    Directory of Open Access Journals (Sweden)

    Corry David B

    2007-10-01

    Full Text Available Abstract Background Cardiopulmonary exercise testing (CPET has become an important modality for the evaluation and management of patients with a diverse array of medical problems. However, interpreting these tests is often difficult and time consuming, requiring significant expertise. Methods We created a computer software program (XINT that assists in CPET interpretation. The program uses an integrative approach as recommended in the Official Statement of the American Thoracic Society/American College of Chest Physicians (ATS/ACCP on Cardiopulmonary Exercise Testing. In this paper we discuss the principles behind the software. We also provide the detailed logic in an accompanying file (Additional File 1. The actual program and the open source code are also available free over the Internet at http://www.xint.org. For convenience, the required download files can also be accessed from this article. Additional file 1 XINTlogic. This file provides the detailed logic used by the XINT program. The variable names are described in Table 1. The actual source code may also be read directly simply by opening the source code with a text editor. Click here for file Results To test the clinical usefulness of XINT, we present the computer generated interpretations of the case studies discussed in the ATS/ACCP document in another accompanying file (Additional File 2. We believe the interpretations are consistent with the document's criteria and the interpretations given by the expert panel. Additional file 2 XINTinterpretations. These are the XINT generated reports based on the five examples provided in the ATS/ACCP statement on cardiopulmonary exercise testing 1. Click here for file Conclusion Computers have become an integral part of modern life. Peer-reviewed scientific journals are now able to present not just medical concepts and experimental studies, but actual functioning medical interpretive software. This has enormous potential to improve medical

  12. Asymptomatic cardiopulmonary changes caused by adenoid hypertrophy.

    Science.gov (United States)

    Abdel-Aziz, Mosaad

    2011-07-01

    Adenoid hypertrophy is the most common cause of pediatric upper airway obstruction, and it can lead to cardiopulmonary complications such as pulmonary hypertension, cor pulmonale, and even heart failure. The aim of this study was to detect the asymptomatic cardiopulmonary changes that could happen in children with adenoid hypertrophy.Eighty children with adenoid hypertrophy were included in this study. Chest x-ray was used to assess the cardiothoracic ratio, whereas echocardiography was used for measuring the pulmonary arterial pressures, right ventricular diastolic filling parameters, and right ventricular end-diastolic diameters. All patients underwent adenoidectomy with or without tonsillectomy, and they were subjected again to echocardiographic assessment 6 months after the operation. No patient showed an increase in the cardiothoracic ratio on x-ray. Preoperative echocardiography showed an increase in pulmonary artery pressure (22.7 [SD, 3.8] mm Hg), a decrease in right ventricular diastolic filling parameters (E/A = 1.03 [SD, 0.17]), and an increase in right ventricular end-diastolic diameters (1.89 [SD, 0.19] cm). Postoperatively, pulmonary artery pressure decreased to 17.2 [SD, 2.1] mm Hg, right ventricular diastolic filling (E/A) increased to 1.25 [SD, 0.11], and right ventricular end-diastolic diameters decreased to 1.68 [SD, 0.12] cm. The comparison between preoperative and postoperative results for each individual parameter was statistically significant. Clinically asymptomatic cardiopulmonary changes due to adenoid hypertrophy are not rare. Early diagnosis and treatment of upper airway obstruction can prevent these serious complications. Echocardiographic examination should be recommended for these patients as a part of preoperative preparation to avoid anesthetic complications.

  13. 微量晶体心肌保护灌注法在婴幼儿体外循环中的应用%The application of micro pump crystal solution perfusion device in infants' con-genital heart diseases with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    陈祥舟; 刘梅; 肖颖彬; 王学锋; 王咏

    2014-01-01

    目的:观察在婴幼儿体外循环( CPB)中采用自制微量晶体心肌保护灌注方法的临床效果。方法选择10 kg以下择期在CPB下行室间隔缺损修补术的患儿100例,随机分为试验组和对照组,每组各50例。心肌保护均采用顺行灌注高K+含血停搏液,试验组采用微量晶体灌注方法,对照组采用传统储血罐灌注方法。分别于麻醉诱导后( T1)、CPB 20 min( T2)、主动脉开放后( T3)、手术结束即刻( T4)检测动脉血气的K+离子浓度、红细胞比容( Hct)、乳酸( Lac)并进行比较,比较患儿术前和术后一般情况、左室射血分数( EF)、CPB时间、主动脉阻断时间、心脏复苏、术中超滤量、CPB预充总量、围术期用血量,肌酸激酶( CK)和肌酸激酶同工酶( CKMB)等数据。结果①两组患儿术前一般情况、术前和术后EF值、CPB时间、阻断时间、心脏复苏率、术中超滤量无统计学差异( P>0.05)。②T1、T2、T3、T4的动脉血气K+、Hct、Lac均无统计学差异( P>0.05)。③两组患儿CK、CKMB在术前、术后1天、术后3天各时间点组间比较均无统计学差异( P>0.05),但CK、CKMB在术后1天明显升高,与术前比较有显著差异( P<0.01),术后3天较术后1天明显下降( P<0.01),但仍高于术前水平( P<0.05)。④试验组较对照组CPB预充总量和围术期用血量均明显减少( P<0.05)。结论在婴幼儿CPB中的心肌保护使用微量晶体灌注方法能获得与储血罐灌注法相同的效果,但预充液总量和围术期用血量明显减少。%Objective To observe the clinical effect of myocardial protection using micro pump crystal solution perfusion de-vice in infants'congenital heart diseases with cardiopulmonary bypass ( CPB) . Methods Form Jun. 2010 to Oct. 2012, 100 infants ( body weight 0.05) . 2. There were no sig

  14. THE FIRST EXPERIENCE IN CLINICAL APPLICATION OF DOMESTIC CIRCULATORY SUPPORT DEVICE ON BASIS OF IMPLANTABLE AXIAL PUMP FOR TWO STAGE HEART TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2013-01-01

    Full Text Available The paper describes the first clinical experience in RF of successful application of domestic circulatory support device based on implantable axial pump for two stage heart transplantation. This case demonstrate the effec- tiveness and safety of our device (АВК-Н for a longtime (270 days left ventricular bypass and the ability to perform a successful transplantation of donor,s heart after application of this system. 

  15. THE FIRST EXPERIENCE IN CLINICAL APPLICATION OF DOMESTIC CIRCULATORY SUPPORT DEVICE ON BASIS OF IMPLANTABLE AXIAL PUMP FOR TWO STAGE HEART TRANSPLANTATION

    OpenAIRE

    S. V. Gautier; G. P. Itkin; S. Yu. Shemakin; R. Sh. Saitgareev; V. N. Poptsov; V. M. Zakharevich; G. A. Akopov; A. Ya. Kormer; T. A. Khalilulin; O. P. Shevchenko; А. М. Nevzorov; I. А. Filatov; S. V. Selishev

    2013-01-01

    The paper describes the first clinical experience in RF of successful application of domestic circulatory support device based on implantable axial pump for two stage heart transplantation. This case demonstrate the effec- tiveness and safety of our device (АВК-Н) for a longtime (270 days) left ventricular bypass and the ability to perform a successful transplantation of donor,s heart after application of this system. 

  16. [Clinical relevance of cardiopulmonary reflexes in anesthesiology].

    Science.gov (United States)

    Guerri-Guttenberg, R A; Siaba-Serrate, F; Cacheiro, F J

    2013-10-01

    The baroreflex, chemoreflex, pulmonary reflexes, Bezold-Jarisch and Bainbridge reflexes and their interaction with local mechanisms, are a demonstration of the richness of cardiovascular responses that occur in human beings. As well as these, the anesthesiologist must contend with other variables that interact by attenuating or accentuating cardiopulmonary reflexes such as, anesthetic drugs, surgical manipulation, and patient positioning. In the present article we review these reflexes and their clinical relevance in anesthesiology. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  17. Cardiopulmonary resuscitation: how far have we come?

    Science.gov (United States)

    Whitcomb, John J; Blackman, Virginia Schmied

    2007-01-01

    In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR.

  18. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. EACPR/AHA Joint Scientific Statement

    NARCIS (Netherlands)

    Martin Halle; Dalane Kitzman; Daniel Forman; Marco Guazzi; Prof. Dr. Luc L.E.M.J. Vanhees; Viviane Conraads; Carl Lavie; Gerald Fletcher; Volker Adams; Ross Arena; Alessandro Mezzani; Jonathan Meyers

    2012-01-01

    From an evidence-based perspective, cardiopulmonary exercise testing (CPX) is a well-supported assessment technique in both the United States (US) and Europe. The combination of standard exercise testing (ET) [i.e. progressive exercise provocation in association with serial electrocardiograms

  19. EACPR/AHA scientific statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations

    NARCIS (Netherlands)

    Ross Arena; Prof. Dr. Luc L.E.M.J. Vanhees; Daniel Forman; Volker Adams; Martin Halle; Carl Lavie; Gerald Fletcher; Alessandro Mezzani; Jonathan Myers; Marco Guazzi; Dalane Kitzman; Viviane Conraads

    2012-01-01

    From an evidence-based perspective, cardiopulmonary exercise testing (CPX) is a well-supported assessment technique in both the United States (US) and Europe. The combination of standard exercise testing (ET) (ie, progressive exercise provocation in association with serial electrocardiograms [ECG],

  20. Normal values for cardiopulmonary exercise testing in children

    NARCIS (Netherlands)

    ten Harkel, A.D.J.; Takken, T.; van Osch-Gevers, M.; Helbing, W.A.

    BACKGROUND: A reference set of data of normal values of newly developed cardiopulmonary parameters of exercise testing in an 8-18-year-old population is lacking. PATIENTS AND METHODS: Cardiopulmonary exercise testing was performed in 175 healthy school children (8-18 years old). Continuous

  1. [Choice of a method and a type of device for water decontamination and warming within physical-chemical life support systems].

    Science.gov (United States)

    Klimarev, S I; Il'in, V K; Starkova, L V

    2008-01-01

    The review has been undertaken within project Mars-500 supported by the Russian Academy of Sciences and aimed to make choice of a method and associated device for effective decontamination and warming potable water for humans during long confinement and isolation. Analysis of the literary data and patent specifications of chemical, physical and hybrid methods of water decontamination and warming guided the choice of energy of ultrahigh frequencies (UHF). Also, a waveguide-coaxial UHF-device implementing this method was proposed. Ease of the UHF energy transformation to heat, reliability, friendliness and impart attractiveness to the method in the eye of developers of long-operating physical-chemical life support systems.

  2. Assessing Exercise Limitation Using Cardiopulmonary Exercise Testing

    Directory of Open Access Journals (Sweden)

    Michael K. Stickland

    2012-01-01

    Full Text Available The cardiopulmonary exercise test (CPET is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption (V˙O2max is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation (V˙O2 = cardiac output × arterial-venous O2 content difference. In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O2 content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO2. Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O2 pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance.

  3. Telemonitoring and Medical Care of Heart Failure Patients Supported by Left Ventricular Assist Devices - The Medolution Project.

    Science.gov (United States)

    Reiss, Nils; Schmidt, Thomas; Müller-von Aschwege, Frerk; Thronicke, Wolfgang; Hoffmann, Jan-Dirk; Röbesaat, Jenny Inge; Deniz, Ezin; Hein, Andreas; Krumm, Heiko; Stewing, Franz-Josef; Willemsen, Detlev; Schmitto, Jan Dieter; Feldmann, Christina

    2017-01-01

    Long-term survival after left ventricular assist device (LVAD) implantation in heart failure patients is mainly determined by a sophisticated after-care. Ambulatory visits only take place every 12 weeks. In case of life-threatening complications (pump thrombosis, driveline infection) this might lead to delayed diagnosis and delayed intervention. It is the intention of the international project Medolution (Medical care evolution) to develop new approaches in order to create best structures for telemonitoring of LVAD patients. In the very early period of the project a questionnaire was sent to 180 LVAD patients to evaluate the need and acceptance of telemonitoring. Thereafter, a graphical user interface (GUI) mockup was developed as one of the first steps to improve the continuous contact between the LVAD patient and the physician. As a final goal the Medolution project aims to bundle all relevant informations from different data sources into one platform in order to provide the physician a comprehensive overview of a patient's situation. In the systems background a big data analysis should run permanently and should try to detect abnormalities and correlations as well. At crucial events, a notification system should inform the physician and should provide the causing data via a decision support system. With this new system we are expecting early detection and prevention of common and partially life-threatening complications, less readmissions to the hospital, an increase in quality of life for the patients and less costs for the health care system as well.

  4. Rhythm recognition is accountable for the majority of hands-off time during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Hansen, Lars Koch; Brabrand, Mikkel

    2014-01-01

    . Rhythms were presented to physicians who identified whether they were shockable and whether they would defibrillate. We measured time to stated decision. Thirty-five doctors participated, 32 had completed advanced life support training. The mean time to make a decision on whether to defibrillate......Cardiopulmonary resuscitation guidelines are constantly optimized to increase survival. Keeping hands-off time brief is vital. Our hypothesis is that rhythm recognition is time-consuming during cardiopulmonary resuscitation. A Laerdal Sim-Man simulated three shockable and four nonshockable rhythms...... or not was 3.4 s [95% confidence interval (CI): 2.8-3.9] for shockable and 4.4 s (95% CI: 3.6-5.3) for nonshockable rhythms (Ptime was 4.0 s (95% CI: 3.5-4.5). Of all shockable rhythms, 95.2 % were correctly diagnosed as shockable, compared with 88.6 % of nonshockable rhythms...

  5. Dosing antibiotic prophylaxis during cardiopulmonary bypass-a higher level of complexity? A structured review.

    Science.gov (United States)

    Paruk, Fathima; Sime, Fekade B; Lipman, Jeffrey; Roberts, Jason A

    2017-04-01

    In highly invasive procedures such as open heart surgery, the risk of post-operative infection is particularly high due to exposure of the surgical field to multiple foreign devices. Adequate antibiotic prophylaxis is an essential intervention to minimise post-operative morbidity and mortality. However, there is a lack of clear understanding on the adequacy of traditional prophylactic dosing regimens, which are rarely supported by data. The aim of this structured review is to describe the relevant pharmacokinetic/pharmacodynamic (PK/PD) considerations for optimal antibiotic prophylaxis for major cardiac surgery including cardiopulmonary bypass (CPB). A structured review of the relevant published literature was performed and 45 relevant studies describing antibiotic pharmacokinetics in patients receiving extracorporeal CPB as part of major cardiac surgery were identified. Some of the studies suggested marked PK alterations in the peri-operative period with increases in volume of distribution (Vd) by up to 58% and altered drug clearances of up to 20%. Mechanisms proposed as causing the PK changes included haemodilution, hypothermia, retention of the antibiotic within the extracorporeal circuit, altered physiology related to a systemic inflammatory response, and maldistribution of blood flow. Of note, some studies reported no or minimal impact of the CPB procedure on antibiotic pharmacokinetics. Given the inconsistent data, ongoing research should focus on clarifying the influence of CPB procedure and related clinical covariates on the pharmacokinetics of different antibiotics during cardiac surgery. Traditional prophylactic dosing regimens may need to be re-assessed to ensure sufficient drug exposures that will minimise the risk of surgical site infections. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  6. Life-Threatening and Suspicious Lesions Caused by Mechanical Cardiopulmonary Resuscitation

    DEFF Research Database (Denmark)

    Milling, Louise; Leth, Peter Mygind; Astrup, Birgitte Schmidt

    2017-01-01

    Chest compression devices for mechanical cardiopulmonary resuscitation (CPR) have become more common. Here, we report the case of a young woman who attempted resuscitated with LUCAS™2 after she was found unconscious at home. At autopsy, we found extensive intramuscular hemorrhages in posterior neck...... be attributed to automatic compression decompression CPR with LUCAS™2.The injuries may have been lethal had the patient survived. For the forensic pathologists, it is important to remain updated on developments in treatment techniques to avoid pitfalls when interpreting injury.Larger studies, prospective...... or retrospective, may be able to qualify the possible risks of automatic compression decompression CPR even further....

  7. Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review.

    Science.gov (United States)

    Olaussen, Alexander; Shepherd, Matthew; Nehme, Ziad; Smith, Karen; Bernard, Stephen; Mitra, Biswadev

    2015-01-01

    Cardio-pulmonary resuscitation (CPR) may generate sufficient cerebral perfusion pressure to make the patient conscious. The incidence and management of this phenomenon are not well described. This systematic review aims to identifying cases where CPR-induced consciousness is mentioned in the literature and explore its management options. The databases Medline, PubMed, EMBASE, Cinahl and the Cochrane Library were searched from their commencement to the 8th July 2014. We also searched Google (scholar) for grey literature. We combined MeSH terms and text words for consciousness and CPR, and included studies of all types. The search yielded 1997 unique records, of which 50 abstracts were reviewed. Nine reports, describing 10 patients, were relevant. Six of the patients had CPR performed by mechanical devices, three of these patients were sedated. Four patients arrested in the out-of-hospital setting and six arrested in hospital. There were four survivors. Varying levels of consciousness were described in all reports, including purposeful arm movements, verbal communication, and resuscitation interference. Management strategies directed at consciousness were offered to six patients and included both physical and chemical restraints. CPR-induced consciousness was infrequently reported in the medical literature, and varied in management. Given the increasing use of mechanical CPR, guidelines to identify and manage consciousness during CPR are required. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Percutaneous Ventricular Assist Devices: A Novel Approach in the Management of Patients With Acute Cardiogenic Shock.

    Science.gov (United States)

    Ergle, Kevin; Parto, Parham; Krim, Selim R

    2016-01-01

    Despite recent advances in the management of heart failure, cardiogenic shock remains a challenging and devastating condition with significant morbidity and mortality. We review currently available percutaneous mechanical circulatory support (MCS) devices and address each device's characteristics, mechanism of action, specific clinical indications, and contraindications. Four types of percutaneous MCS devices are currently available: the intraaortic balloon pump (IABP), Impella devices, the TandemHeart, and extracorporal membrane oxygenation (ECMO). IABPs provide less hemodynamic support compared to the Impella, TandemHeart, and ECMO devices. However, because of its ease of placement and relatively small access catheter size, the IABP remains the most commonly used MCS device for the treatment of cardiogenic shock. When full cardiopulmonary support is needed, ECMO is the best option. Temporary MCS has emerged as a therapeutic option in the management of patients with acute cardiogenic shock. However, clinician familiarity with the indications, limitations, and benefits of individual MCS devices and enhanced patient comfort with the placement are paramount to improve patient outcomes.

  9. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

    Directory of Open Access Journals (Sweden)

    Jennifer E. Flythe

    2014-01-01

    Full Text Available Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes. This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath and to use the lowest effective erythropoietin stimulating agent dose.

  10. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II)

    DEFF Research Database (Denmark)

    Andersen, Mads; Videbaek, Regitze; Boesgaard, Søren;

    2009-01-01

    The incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients supported with a continuous-flow left ventricular assist device (LVAD) has not been investigated in detail. In 23 consecutive recipients of a HeartMate II, we analyzed the incidence of VT/VF during a total...

  11. The Effects of Dual-Language Support on the Language Skills of Bilingual Children with Hearing Loss Who Use Listening Devices Relative to Their Monolingual Peers

    Science.gov (United States)

    Bunta, Ferenc; Douglas, Michael

    2013-01-01

    Purpose: The present study investigated the effects of supporting both English and Spanish on language outcomes in bilingual children with hearing loss (HL) who used listening devices (cochlear implants and hearing aids). The English language skills of bilingual children with HL were compared to those of their monolingual English-speaking peers'…

  12. The Effects of Dual-Language Support on the Language Skills of Bilingual Children with Hearing Loss Who Use Listening Devices Relative to Their Monolingual Peers

    Science.gov (United States)

    Bunta, Ferenc; Douglas, Michael

    2013-01-01

    Purpose: The present study investigated the effects of supporting both English and Spanish on language outcomes in bilingual children with hearing loss (HL) who used listening devices (cochlear implants and hearing aids). The English language skills of bilingual children with HL were compared to those of their monolingual English-speaking peers'…

  13. A marked increase in gastric fluid volume during cardiopulmonary bypass

    Science.gov (United States)

    Hirota, Kazuyoshi; Kudo, Mihoko; Hashimoto, Hiroshi; Kushikata, Tetsuya

    2011-01-01

    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patients undergoing cardiac surgery with cardiopulmonary bypass, and also compared in patients undergoing a off-pump coronary artery bypass graft surgery (off-pump cardiopulmonary bypass-H2 group, n = 15). Gastric pH (5.14 ± 0.61) and gastric fluid volume (13.2 ± 2.4 mL) at the end of surgery in off-pump cardiopulmonary bypass-H2 groups was significantly lower and higher than those in both cardiopulmonary bypass-H2 (6.25 ± 0.54, 51.3 ± 8.0 mL) and cardiopulmonary bypass-PPI (7.29 ± 0.13, 63.5 ± 14.8 mL) groups, respectively although those variables did not differ between groups after the induction of anesthesia. Plasma gastrin (142 ± 7 pg/mL) at the end of surgery and maximal blood lactate levels (1.50 ± 0.61 mM) in off-pump cardiopulmonary bypass-H2 group were also significantly lower than those in both cardiopulmonary bypass-H2 (455 ± 96 pg/mL, 3.97 ± 0.80 mM) and cardiopulmonary bypass-PPI (525 ± 27 pg/mL, 3.15 ± 0.44 mM) groups, respectively. In addition, there was a significant correlation between gastric fluid volume and maximal blood lactate (r = 0.596). In conclusion, cardiopulmonary bypass may cause an increase in gastric fluid volume which neither H2 antagonist nor PPI suppresses. A significant correlation between gastric fluid volume and maximal blood lactate suggests that gastric fluid volume may predict degree of gastrointestinal tract hypoperfusion. PMID:21765601

  14. Strategies for cardiopulmonary exercise testing of pectus excavatum patients

    Directory of Open Access Journals (Sweden)

    Moh H. Malek

    2008-01-01

    Full Text Available The purpose of this paper is to provide strategies for cardiopulmonary exercise testing of pectus excavatum patients. Currently, there are no standardized methods for assessing cardiovascular and pulmonary responses in this population; therefore, making comparisons across studies is difficult if not impossible. These strategies are intended for physicians, pulmonary technicians, exercise physiologists, and other healthcare professionals who conduct cardiopulmonary exercise testing on pectus excavatum patients. By using the strategies outlined in this report, comparisons across studies can be made, and the effects of pectus excavatum on cardiopulmonary function can be assessed with greater detail.

  15. Some Medicolegal Aspects of the Russian Cardiopulmonary Resuscitation Protocol

    Directory of Open Access Journals (Sweden)

    V. A. Kuksinsky

    2006-01-01

    Full Text Available The purpose of the study was to analyze the Russian legislation to identify the medicolegal aspects of cardiopulmonary resuscitation, which are most significant for an intensive care anesthesiologist. Statutory acts concerning human health care, including those pertinent to cardiopulmonary resuscitation and those providing for the responsibility of medical workers in some cases were analyzed. A number of discrepancies in various legal acts concerning human death verification and resuscitative measures were identified. The analysis has revealed the aspects of cardiopulmonary resuscitation, which are, from the point of view of legislation, most important for the physician.

  16. How Do Students Use Their Mobile Devices to Support Learning? A Case Study from an Australian Regional University

    Science.gov (United States)

    Farley, Helen; Murphy, Angela; Johnson, Chris; Carter, Brad; Lane, Michael; Midgley, Warren; Hafeez-Baig, Abdul; Dekeyser, Stijn; Koronios, Andy

    2015-01-01

    Though universities are eager to leverage the potential of mobile learning to provide learning flexibly, most balk at the cost of providing students with mobile hardware. The practice of "bring your own device" (BYOD) is often mooted as a cost-effective alternative. This paper provides a snapshot of student ownership of mobile devices at…

  17. An Exploration into How Physical Activity Data-Recording Devices Could Be Used in Computer-Supported Data Investigations

    Science.gov (United States)

    Lee, Victor R.; DuMont, Maneksha

    2010-01-01

    There is a great potential opportunity to use portable physical activity monitoring devices as data collection tools for educational purposes. Using one such device, we designed and implemented a weeklong workshop with high school students to test the utility of such technology. During that intervention, students performed data investigations of…

  18. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  19. Transient Diabetes Insipidus Following Cardiopulmonary Bypass.

    Science.gov (United States)

    Ekim, Meral; Ekim, Hasan; Yilmaz, Yunus Keser; Bolat, Ali

    2015-04-01

    Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

  20. Secondary pseudohypoaldosteronism causing cardiopulmonary arrest and cholelithiasis.

    Science.gov (United States)

    Kibe, Tetsuya; Sobajima, Takehiro; Yoshimura, Ayumi; Uno, Yuichi; Wada, Naohiro; Ueta, Ikuya

    2014-04-01

    A 4-month-old boy presented with cardiopulmonary arrest on arrival after a brief period of lethargy. Laboratory examination indicated severe hyperkalemia, hyponatremia, metabolic acidosis, and slightly elevated C-reactive protein. Whole body computed tomography identified left-dominant hydronephrosis, hydroureter and cholelithiasis. Despite cardiac arrest >30 min, he was successfully resuscitated and treated with therapeutic hypothermia. Escherichia coli was detected on urine culture. Renal ultrasound showed bilateral hydronephrosis, grade II in the right and grade IV in the left. Retrospective analysis of the blood sample at admission indicated a high level of aldosterone. The patient recovered almost fully with no electrolyte imbalance and normal plasma renin and aldosterone, leading to the diagnosis of secondary pseudohypoaldosteronism associated with bilateral infected hydronephrosis. In this case, cholelithiasis, which may account for chronic dehydration, was a diagnostic clue in the absence of information of pre-existing situations. © 2014 The Authors. Pediatrics International © 2014 Japan Pediatric Society.

  1. Cardiopulmonary resuscitation: a review for clinicians.

    Science.gov (United States)

    Varon, J; Marik, P E; Fromm, R E

    1998-02-01

    Attempts at cardiopulmonary resuscitation (CPR) date from antiquity, but it is only in the last 50 years that a scientifically-based methodology has been developed. External chest compressions is the standard method for managing circulatory arrest, however, numerous alterations of this technique have been proposed in attempts to improve outcome from CPR. Defibrillation is the single most important therapy for the management of ventricular fibrillation or pulseless ventricular tachycardia. Adrenergic agents used to improve myocardial and cerebral perfusion are also the subject of considerable investigation with new agents entering clinical study. This paper reviews the history, current techniques and pharmacotherapy as well as controversial issues in the management of patients with cardiac arrest.

  2. Neonatal extracorporeal membrane oxygenation devices, techniques and team roles: 2011 survey results of the United States' Extracorporeal Life Support Organization centers.

    Science.gov (United States)

    Lawson, Scott; Ellis, Cory; Butler, Katie; McRobb, Craig; Mejak, Brian

    2011-12-01

    In early 2011, surveys of active Extracorporeal Life Support Organization (ELSO) centers within the United States were conducted by electronic mail regarding neonatal Extracorporeal Membrane Oxygenation (ECMO) equipment and professional staff. Seventy-four of 111 (67%) U.S. centers listed in the ELSO directory as neonatal centers responded to the survey. Of the responding centers, 53% routinely used roller pumps for neonatal ECMO, 15% reported using centrifugal pumps and 32% reported using a combination of both. Of the centers using centrifugal pumps, 51% reported that they do not use a compliance bladder in the circuit. The majority (95%) of roller pump users reported using a compliance bladder and 97% reported using Tygon" S-97-E tubing in the raceway of their ECMO circuits. Silicone membrane oxygenators were reportedly used by 25% of the respondents, 5% reported using micro-porous hollow fiber oxygenators (MPHF), 70% reported using polymethylpentene (PMP) hollow fiber oxygenators and 5% reported using a combination of the different types. Some form of in-line blood monitoring was used by 88% of the responding centers and 63% of responding centers reported using a circuit surface coating. Anticoagulation monitoring via the activated clotting time (ACT) was reported by 100% of the reporting centers. The use of extracorporeal cardiopulmonary resuscitation (ECPR) was reported by 53% of the responding centers with 82% of those centers using a crystalloid primed circuit to initiate ECPR. A cooling protocol was used by 77% of the centers which have an ECPR program. When these data are compared with surveys from 2002 and 2008 it shows that the use of silicone membrane oxygenators continues to decline, the use of centrifugal pumps continues to increase and ECMO personnel continues to be comprised of multidisciplinary groups of dedicated allied health care professionals.

  3. Evaluation of coma patients after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    SU Ying-ying; YANG Qing-lin; PANG Ying; LV Xiang-ping

    2005-01-01

    Background Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR .Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS),brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG),brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD) .Results Twenty-four of 35 patients(68.57%)were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient.Twenty-four patients died within 1 month and 11 of them(45.83%)were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeⅠin 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients.Two patients(18.18%)regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively.Conclusion Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.

  4. Animation shows promise in initiating timely cardiopulmonary resuscitation: results of a pilot study.

    Science.gov (United States)

    Attin, Mina; Winslow, Katheryn; Smith, Tyler

    2014-04-01

    Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

  5. European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement.

    Science.gov (United States)

    Moons, Philip; Norekvål, Tone M

    2008-01-01

    Empirical evidence suggests that family presence during cardiopulmonary resuscitation (CPR) has beneficial effects. Although many American professional organizations have endorsed the idea of family presence, there is less formal support in Europe. In addition, the attitude of nurses from Anglo-Saxon countries, such as United Kingdom and Ireland, is more positive toward family presence than the attitude of nurses of mainland Europe. In order to support existing guidelines and to stimulate health care organizations to develop a formal policy with respect to family witnessed CPR, 3 important European nursing organizations have recently developed a joint position statement.

  6. Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions

    NARCIS (Netherlands)

    Dijkema, Marieke B A; van Strien, Robert T; van der Zee, Saskia C; Mallant, Sanne F; Fischer, Paul; Hoek, Gerard; Brunekreef, Bert; Gehring, Ulrike

    2016-01-01

    BACKGROUND: Air pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with cardi

  7. Rodent models of cardiopulmonary bypass: utility in improving perioperative outcomes

    NARCIS (Netherlands)

    de Lange, F.

    2008-01-01

    Despite advances in surgical and anesthesia techniques, subtle neurologic injury still remains an important complication after cardiac surgery. Because the causes are multifactorial and complex, research in an appropriate small animal model for cardiopulmonary bypass (CPB) is warranted. This thesis

  8. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    National Research Council Canada - National Science Library

    Ferreira, Cristiana Araújo G; Balbino, Flávia Simphronio; Balieiro, Maria Magda F. G; Mandetta, Myriam Aparecida

    2014-01-01

    Objective: To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units.Data sources...

  9. Predicting the need for blood during cardiopulmonary bypass

    African Journals Online (AJOL)

    Adele

    from the depot. Supply logistics of banked blood may be problematic during car- ... delivery that occurs on initiation of cardiopulmonary bypass (CPB). In spite of patient ... whole body oxygen consumption, there is a time lapse before stable.

  10. Induction and detection of disturbed homeostasis in cardiopulmonary bypass

    NARCIS (Netherlands)

    de Vroege, R; Meerman, FT; Eijsman, L; Wildevuur, WR; Wildevuur, CRH; van Oeveren, W

    2004-01-01

    During cardiopulmonary bypass (CPB) haemodynamic alterations, haemostasis and the inflammatory response are the main causes of homeostatic disruption. Even with CPB procedures of short duration, the homeostasis of a patient is disrupted and, in many cases, requires intensive postoperative treatment

  11. A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices

    Directory of Open Access Journals (Sweden)

    Sandra Benavides

    2011-03-01

    Conclusions Overall, general medicines information CDSTs performed better than paediatricspecific CDSTs in both scope and completeness. Results from this study may help guide CDST selection on mobile devices by healthcare professionalswhose patient populations include paediatrics.

  12. Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

    OpenAIRE

    Topjian, Alexis A.; Berg, Robert A; Nadkarni, Vinay M.

    2008-01-01

    More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenati...

  13. Effectiveness of Podcasts Delivered on Mobile Devices as a Support for Student Learning During General Chemistry Laboratories

    Science.gov (United States)

    Powell, Cynthia B.; Mason, Diana S.

    2013-04-01

    Chemistry instructors in teaching laboratories provide expert modeling of techniques and cognitive processes and provide assistance to enrolled students that may be described as scaffolding interaction. Such student support is particularly essential in laboratories taught with an inquiry-based curriculum. In a teaching laboratory with a high instructor-to-student ratio, mobile devices can provide a platform for expert modeling and scaffolding during the laboratory sessions. This research study provides data collected on the effectiveness of podcasts delivered as needed in a first-semester general chemistry laboratory setting. Podcasts with audio and visual tracks covering essential laboratory techniques and central concepts that aid in experimental design or data processing were prepared and made available for students to access on an as-needed basis on iPhones® or iPod touches®. Research focused in three areas: the extent of podcast usage, the numbers and types of interactions between instructors and student laboratory teams, and student performance on graded assignments. Data analysis indicates that on average the podcast treatment laboratory teams accessed a podcast 2.86 times during the laboratory period during each week that podcasts were available. Comparison of interaction data for the lecture treatment laboratory teams and podcast treatment laboratory teams reveals that scaffolding interactions with instructors were statistically significantly fewer for teams that had podcast access rather than a pre-laboratory lecture. The implication of the results is that student laboratory teams were able to gather laboratory information more effectively when it was presented in an on-demand podcast format than in a pre-laboratory lecture format. Finally, statistical analysis of data on student performance on graded assignments indicates no significant differences between outcome measures for the treatment groups when compared as cohorts. The only statistically

  14. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation1

    Science.gov (United States)

    Morais, Daniela Aparecida; Carvalho, Daclé Vilma; Correa, Allana dos Reis

    2014-01-01

    OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte. METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%. RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%). CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest. PMID:25296138

  15. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Daniela Aparecida Morais

    2014-08-01

    Full Text Available OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%, "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%, "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%, and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%.CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

  16. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    U. Ayala

    2014-01-01

    Full Text Available Interruptions in cardiopulmonary resuscitation (CPR compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

  17. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Science.gov (United States)

    Ayala, U.; Irusta, U.; Ruiz, J.; Eftestøl, T.; Kramer-Johansen, J.; Alonso-Atienza, F.; Alonso, E.; González-Otero, D.

    2014-01-01

    Interruptions in cardiopulmonary resuscitation (CPR) compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA) designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies. PMID:24895621

  18. Non-Contrast-Enhanced Silent Scan MR Angiography of Intracranial Anterior Circulation Aneurysms Treated with a Low-Profile Visualized Intraluminal Support Device.

    Science.gov (United States)

    Takano, N; Suzuki, M; Irie, R; Yamamoto, M; Teranishi, K; Yatomi, K; Hamasaki, N; Kumamaru, K K; Hori, M; Oishi, H; Aoki, S

    2017-08-01

    The Low-Profile Visualized Intraluminal Support Device comprises a small-cell nitinol structure and a single-wire braided stent that provides greater metal coverage than previously reported intracranial stents, as well as assumed strong susceptibility artifacts. This study aimed to assess the benefits of non-contrast-enhanced MRA by using a Silent Scan (Silent MRA) for intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents. Thirty-one aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents were assessed by using Silent MRA, 3D TOF-MRA, and x-ray DSA. The quality of MRA visualization of the reconstructed artery was graded on a 4-point scale from 1 (not visible) to 4 (excellent). Aneurysm occlusion status was evaluated by using a 2-grade scale (total occlusion/remnant [neck or aneurysm]). Weighted κ statistics were used to evaluate interobserver and intermodality agreement. The mean scores ± SDs for Silent MRA and 3D TOF-MRA were 3.16 ± 0.79 and 1.48 ± 0.67 (P < .05), respectively, with substantial interobserver agreement (κ = 0.66). The aneurysm occlusion rates of the 2-grade scale (total occlusion/remnant [neck or aneurysm]) were 69%/31% for DSA, 65%/35% for Silent MRA, and 92%/8% for 3D TOF-MRA, respectively. The intermodality agreements were 0.88 and 0.30 for DSA/Silent MRA and DSA/3D TOF-MRA, respectively. Silent MRA seems to be useful for visualizing intracranial anterior circulation aneurysms treated with Low-Profile Visualized Intraluminal Support Device stents. © 2017 by American Journal of Neuroradiology.

  19. Development of a bi-functional silica monolith for electro-osmotic pumping and DNA clean-up/extraction using gel-supported reagents in a microfluidic device.

    Science.gov (United States)

    Oakley, Jennifer A; Shaw, Kirsty J; Docker, Peter T; Dyer, Charlotte E; Greenman, John; Greenway, Gillian M; Haswell, Stephen J

    2009-06-07

    A silica monolith used to support both electro-osmotic pumping (EOP) and the extraction/elution of DNA coupled with gel-supported reagents is described. The benefits of the combined EOP extraction/elution system were illustrated by combining DNA extraction and gene amplification using the polymerase chain reaction (PCR) process. All the reagents necessary for both processes were supported within pre-loaded gels that allow the reagents to be stored at 4 degrees C for up to four weeks in the microfluidic device. When carrying out an analysis the crude sample only needed to be hydrodynamically introduced into the device which was connected to an external computer controlled power supply via platinum wire electrodes. DNA was extracted with 65% efficiency after loading lysed cells onto a silica monolith. Ethanol contained within an agarose gel matrix was then used to wash unwanted debris away from the sample by EOP (100 V cm(-1) for 5 min). The retained DNA was subsequently eluted from the monolith by water contained in a second agarose gel, again by EOP using an electric field of 100 V cm(-1) for 5 min, and transferred into the PCR reagent containing gel. The eluted DNA in solution was successfully amplified by PCR, confirming that the concept of a complete self-contained microfluidic device could be realised for DNA sample clean up and amplification, using a simple pumping and on-chip reagent storage methodology.

  20. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Siminelakis Stavros N

    2010-01-01

    Full Text Available Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB, hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.

  1. Possible SARS coronavirus transmission during cardiopulmonary resuscitation.

    Science.gov (United States)

    Christian, Michael D; Loutfy, Mona; McDonald, L Clifford; Martinez, Kennth F; Ofner, Mariana; Wong, Tom; Wallington, Tamara; Gold, Wayne L; Mederski, Barbara; Green, Karen; Low, Donald E

    2004-02-01

    Infection of healthcare workers with the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to occur primarily by either contact or large respiratory droplet transmission. However, infrequent healthcare worker infections occurred despite the use of contact and droplet precautions, particularly during certain aerosol-generating medical procedures. We investigated a possible cluster of SARS-CoV infections in healthcare workers who used contact and droplet precautions during attempted cardiopulmonary resuscitation of a SARS patient. Unlike previously reported instances of transmission during aerosol-generating procedures, the index case-patient was unresponsive, and the intubation procedure was performed quickly and without difficulty. However, before intubation, the patient was ventilated with a bag-valve-mask that may have contributed to aerosolization of SARS-CoV. On the basis of the results of this investigation and previous reports of SARS transmission during aerosol-generating procedures, a systematic approach to the problem is outlined, including the use of the following: 1) administrative controls, 2) environmental engineering controls, 3) personal protective equipment, and 4) quality control.

  2. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    LENUS (Irish Health Repository)

    Groarke, J

    2010-09-01

    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  3. The Cardiopulmonary effect of passive movement

    Directory of Open Access Journals (Sweden)

    L. Loram

    2002-02-01

    Full Text Available Eleven articles were reviewed on the cardiopulmonary effects of passive movements. These included two articles on theneurological effects of passive movements. Of the eleven articles, four were considered to have level II evidence in accordance with Sackett’s rules of evidence. There was little consensus regarding the rate or duration of passive movements. There were some suggestions that upper limb movement produces a greater ventilatory response than lower limb movement. There was a statistically significant increase (p< 0.05 in minute ventilation when the movement was done at a rate of 40 repetitions per minute or more, but this change may not be clinically significant. Passive movements were not detrimental to neurosurgical patients with a normal or slightly elevated intracranial pressure, although the values of the intracranial pressure were not stated.  The studies were limited in that eight of the eleven had small sample sizes and most studies were conducted using normal subjects. Further studies with higher levels of evidence need to be  conducted to verify any results reported to date in the literature. Studies that are relevant to clinical practice also need to be conducted in populations such as sedated intensive care patients.

  4. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation

    Science.gov (United States)

    Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; de Araújo, Claudio Gil Soares; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; de Almeida, Antonio Eduardo Monteiro; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel

    2016-01-01

    Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. PMID:27982272

  5. Cardiopulmonary exercise testing (CPET) in pulmonary emphysema.

    Science.gov (United States)

    Paoletti, Patrizia; De Filippis, Francesca; Fraioli, Francesco; Cinquanta, Alessandra; Valli, Gabriele; Laveneziana, Pierantonio; Vaccaro, Francesco; Martolini, Dario; Palange, Paolo

    2011-12-15

    In patients affected by chronic obstructive pulmonary disease (COPD), cardiopulmonary response to exercise was never related to the severity of emphysema (E) measured by high resolution computed tomography (HRCT). Sixteen patients (age=65±8 yrs; FEV(1)=54±18%pred; RV=160±28%pred) with moderate to severe E (quantified by lung HRCT as % voxels cycle-ergometer to exhaustion. Oxygen uptake (V˙(O2)), carbon dioxide output (V˙(CO2)), ventilation (V˙(E)), tidal volume (V(T)), and end-tidal P(CO2) (PET(CO2)) derived variables were measured breath-by-breath. The % of E correlated with: (1) the ratio V(Tpeak) (r=0.74; p=0.001); (2) the V˙(E)/V˙(CO2) slope (r=-0.77; p=0.0004); (3) PET(CO2) values at peak exercise (r=0.80; p=0.0001). Also, the %E was strongly predicted by the following exercise equation: %E(EST) = 58.1 + 11.9 × ΔV˙(E)/V˙(CO2) (r=0.94; p1 is typically observed in severe E patients; furthermore, the V˙(E)/V˙(CO2) slope and the PET(CO2peak) values decrease and increase respectively as more as the emphysema is severe.

  6. The Use of Mobile Devices as Means of Data Collection in Supporting Elementary School Students' Conceptual Understanding about Plants

    Science.gov (United States)

    Zacharia, Zacharias C.; Lazaridou, Charalambia; Avraamidou, Lucy

    2016-01-01

    The purpose of this study was to examine the impact of mobile learning among young learners. Specifically, we investigated whether the use of mobile devices for data collection during field trips outside the classroom could enhance fourth graders' learning about the parts of the flower and their functions, flower pollinators and the process of…

  7. The use of mobile devices as means of data collection in supporting elementary school students' conceptual understanding about plants

    NARCIS (Netherlands)

    Zacharia, Zacharias C.; Lazaridou, Charalambia; Avraamidou, Lucy

    2016-01-01

    The purpose of this study was to examine the impact of mobile learning among young learners. Specifically, we investigated whether the use of mobile devices for data collection during field trips outside the classroom could enhance fourth graders' learning about the parts of the flower and their fun

  8. Use of selective devices in trawls to support recovery of the Kattegat cod stock: a review of experiments and experience

    DEFF Research Database (Denmark)

    Madsen, Niels; Valentinsson, Daniel

    2010-01-01

    this provides a valuable management tool for reducing the bycatch of cod and reducing mortality, and thus helping to rebuild the depleted stock. Gear research in the area has been focused on devices that allow for continued exploitation of the Norway lobster (Nephrops norvegicus) and flatfish, but minimizing...

  9. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry

    DEFF Research Database (Denmark)

    Sjauw, Krischan D; Konorza, Thomas; Erbel, Raimund

    2009-01-01

    with poor LV function. The Impella 2.5, a percutaneous implantable LV assist device, might be a superior alternative to the traditionally used intra-aortic balloon pump. METHODS: The Europella registry included 144 consecutive patients who underwent a high-risk PCI. Safety and feasibility end points...

  10. The use of mobile devices as means of data collection in supporting elementary school students' conceptual understanding about plants

    NARCIS (Netherlands)

    Zacharia, Zacharias C.; Lazaridou, Charalambia; Avraamidou, Lucy

    2016-01-01

    The purpose of this study was to examine the impact of mobile learning among young learners. Specifically, we investigated whether the use of mobile devices for data collection during field trips outside the classroom could enhance fourth graders' learning about the parts of the flower and their

  11. Neurohormonal activation and exercise tolerance in patients supported with a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Jung, Mette Holme; Goetze, Jens Peter; Boesgaard, Soeren;

    2016-01-01

    BACKGROUND: Neurohormones play a key role in regulating hemodynamics in heart failure (HF) both at rest and during exercise. In contrast, little is known about the importance of neurohormonal regulation for exercise capacity in continuous-flow left ventricular assist device (CF-LVAD) patients...

  12. Supporting students' scientific explanations: A case study investigating the synergy focusing on a teacher's practices when providing instruction and using mobile devices

    Science.gov (United States)

    Delen, Ibrahim

    Engage students in constructing scientific practices is a critical component of science instruction. Therefore a number of researchers have developed software programs to help students and teachers in this hard task. The Zydeco group, designed a mobile application called Zydeco, which enables students to collect data inside and outside the classroom, and then use the data to create scientific explanations by using claim-evidence-reasoning framework. Previous technologies designed to support scientific explanations focused on how these programs improve students' scientific explanations, but these programs ignored how scientific explanation technologies can support teacher practices. Thus, to increase our knowledge how different scaffolds can work together, this study aimed to portray the synergy between a teacher's instructional practices (part 1) and using supports within a mobile devices (part 2) to support students in constructing explanations. Synergy can be thought of as generic and content-specific scaffolds working together to enable students to accomplish challenging tasks, such as creating explanations that they would not normally be able to do without the scaffolds working together. Providing instruction (part 1) focused on understanding how the teacher scaffolds students' initial understanding of the claim-evidence-reasoning (CER) framework. The second component of examining synergy (part 2: using mobile devices) investigated how this teacher used mobile devices to provide feedback when students created explanations. The synergy between providing instruction and using mobile devices was investigated by analyzing a middle school teacher's practices in two different units (plants and water quality). Next, this study focused on describing how the level of synergy influenced the quality of students' scientific explanations. Finally, I investigated the role of focused teaching intervention sessions to inform teacher in relation to students' performance. In

  13. An institutionwide approach to redesigning management of cardiopulmonary resuscitation.

    Science.gov (United States)

    Lighthall, Geoffrey K; Mayette, Michael; Harrison, T Kyle

    2013-04-01

    Despite widespread training in basic life support (BLS) and advanced cardiovascular life support (ACLS) among hospital personnel, the likelihood of survival from in-hospital cardiac arrests remains low. In 2006 a university-affiliated tertiary medical center initiated a cardiopulmonary (CPR) resuscitation redesign project. REDESIGNING THE HOSPITAL'S RESUSCITATION SYSTEM: The CPR Committee developed the interventions on the basis of a large-scale view of the process of delivering BLS and ACLS, identification of key decision nodes and actions, and compartmentalization of specific functions. It was proposed that arrest management follow a steady progression in a two-layer scheme from BLS to ACLS. Handouts describing team structure and specific roles were given to all code team providers and house staff at the start of their month-long rotations. To further increase role clarity and team organization, daily morning and evening meetings of the arrest team were instituted. Site-specific BLS training, on-site ACLS refresher training, and defibrillator training were initiated. Project elements also included use of unannounced mock codes to provide system oversight; preparation and distribution of cognitive aids (printed algorithms, dosing guides, and other checklists to ensure compliance with ACLS protocols), identification of patients who may be unstable or a source of concern, event review and analysis of arrests and other critical events, and a CPR website. A mature hospital-based resuscitation system should include definition of arrest trends and resuscitation needs, development of local methods for approaching the arresting patient, an emphasis on prevention, establishment of training programs tailored to meet specific hospital needs, system examination and oversight, and administrative processes that maximize interaction between all components.

  14. The use of cognitive AIDS during simulated pediatric cardiopulmonary arrests.

    Science.gov (United States)

    Nelson, Kristen L; Shilkofski, Nicole A; Haggerty, Jamie A; Saliski, Mary; Hunt, Elizabeth A

    2008-01-01

    Management of pediatric cardiopulmonary arrest (CPA) is challenging because of the low volume of experience of most pediatric health care providers. Use of cognitive aids may assist in making rapid decisions in these crises; however, there are no known published reports on whether these aids are actually used during arrest management and whether they impact quality of care. Sixty pediatric residents participated in individual simulated CPA scenarios, which involved pulseless ventricular tachycardia and pulseless electrical activity. Our primary outcome measure was the proportion of pediatric residents who used cognitive aids during simulated CPAs. Secondary outcome measures were to quantify 1) type of aids used, 2) category of use, and 3) human errors made during resuscitation efforts. Eighty-five percent of residents voluntarily used a cognitive aid to assist in managing simulated pediatric CPAs. The most commonly used aids were an American Heart Association Pediatric Advanced Life Support aid and an institutionally created aid. Forty-three of 51 (84.3%) and 23 of 46 (60.5%) residents used these aids for assistance with the pulseless ventricular tachycardia and pulseless electrical activity algorithm, respectively. Unfortunately, 13 of 51 (25.5%) residents chose the incorrect treatment algorithm, resulting in inappropriate management. CONCLUSION AND APPLICATION: Although the majority of residents chose to use cognitive aids for assistance, errors in management were common. Further study is required to determine whether these errors are associated with cognitive aid design flaws and whether improving their design through human factors research can help minimize errors in Basic and Advanced Life Support, ultimately improving patient outcomes.

  15. The use of mobile devices as means of data collection in supporting elementary school students' conceptual understanding about plants

    Science.gov (United States)

    Zacharia, Zacharias C.; Lazaridou, Charalambia; Avraamidou, Lucy

    2016-03-01

    The purpose of this study was to examine the impact of mobile learning among young learners. Specifically, we investigated whether the use of mobile devices for data collection during field trips outside the classroom could enhance fourth graders' learning about the parts of the flower and their functions, flower pollinators and the process of pollination/fertilization, and the interrelationship between animals and plants, more than students' use of traditional means of data collection. For this purpose, we designed a pre-post experimental design study with two conditions: one in which participants used a mobile device for data collection and another using traditional means (e.g. sketching and note-taking). The sample comprised 48 fourth graders (24 in each condition), who studied the flower, its parts, and their functions. A conceptual test was administered to assess students' understanding before and after instruction. Moreover, the students' science notebooks and accompanying artifacts were used as a data source for examining students' progress during the study's intervention. The conceptual test and notebook data were analyzed statistically, whereas we used open coding for the artifacts. Findings revealed that using mobile devices for data collection enhanced students' conceptual understanding more than using traditional means of data collection.

  16. Growth and Characterization of Polyimide-Supported AlN Films for Flexible Surface Acoustic Wave Devices

    Science.gov (United States)

    Li, Qi; Liu, Hongyan; Li, Gen; Zeng, Fei; Pan, Feng; Luo, Jingting; Qian, Lirong

    2016-06-01

    Highly c-axis oriented aluminum nitride (AlN) films, which can be used in flexible surface acoustic wave (SAW) devices, were successfully deposited on polyimide (PI) substrates by direct current reactive magnetron sputtering without heating. The sputtering power, film thickness, and deposition pressure were optimized. The characterization studies show that at the optimized conditions, the deposited AlN films are composed of columnar grains, which penetrate through the entire film thickness (~2 μm) and exhibit an excellent (0002) texture with a full width at half maximum value of the rocking curve equal to 2.96°. The film surface is smooth with a root mean square value of roughness of 3.79 nm. SAW prototype devices with a center frequency of about 520 MHz and a phase velocity of Rayleigh wave of about 4160 m/s were successfully fabricated using the AlN/PI composite structure. The obtained results demonstrate that the highly c-axis oriented AlN films with a smooth surface and low stress can be produced on relatively rough, flexible substrates, and this composite structure can be possibly used in flexible SAW devices.

  17. Gravity and Development of Cardiopulmonary Reflex

    Science.gov (United States)

    Nagaoka, Shunji; Eno, Yuko; Ohira, Yoshinobu

    Cardio-pulmonary reflex, which our cardiac activity is synchronized to the respiration by autonomic nervous system regulation, is called as "respiratory sinus arrhythmia" and commonly found in adult. The physiological function of the espiratory sinus arrhythmia is considered to maximize the gas exchange during respiration cycle. This respiration induced heart rate variability (RHRV) is only found in mammals and avian showing a remarkable postnatal development, whereas no RHRV in aquatic species such as fish or amphibian. To elucidate our hypothesis that gravity exposure may plays a key role in the postnatal development of RHRV as well as its evolutional origin in these ground animals, we have studied effects of hypergravity (2G) on the postnatal development of RHRV using rat. Pregnant Wister rats were kept in centrifugal cages system for 38 days from 6th days of pregnant mother to have neonates until 23 days old. Electrocardiograph was recorded from the neonates in 2 to 23 days old in 2G group with simultaneous control (1G) group. The RHRV analysis was performed by calculating a component of Fourier power spectral coincide with the respiration frequency. In both groups, averaged resting heart rate gradually increase from 2 to 23 days old. When comparing the heart rate between the two groups, the 2G group indicated significantly lower (240± 8 bpm) than 1G control (326±21 bpm, p¡0.001) in 2 days old, where as no significance in 23 days old. The RHRV of 2 days old neonates in both groups indicated very small magnitude but significantly lower in 2G group than 1G control (p¡0.01). The RHRV gradually increase during the first 2 weeks and then rapid increased to reached 45 fold of magnitude in 1G control, whereas 69 fold in 2G group. The results strongly suggested that the postnatal innervation from respiration to cardiovascular centers was gravity dependent.

  18. Managing the Inflammatory Response after Cardiopulmonary Bypass : Review of the Studies in Animal Models

    NARCIS (Netherlands)

    Liguori, Gabriel Romero; Kanas, Alexandre Fligelman; Moreira, Luiz Felipe Pinho

    2014-01-01

    OBJECTIVE: To review studies performed in animal models that evaluated therapeutic interventions to inflammatory response and microcirculatory changes after cardiopulmonary bypass. METHODS: It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and ("Microcirculation" (MeSH) or "Inflammat

  19. Complications of cardiopulmonary resuscitation in non-traumatic cases and factors affecting complications

    Directory of Open Access Journals (Sweden)

    Umit Kaldırım

    2016-09-01

    It has been shown that during cardiopulmonary resuscitation, severe injuries can occur due to thoracic compression. Only a positive correlation with the duration of cardiopulmonary resuscitation was found in our study.

  20. Applying a soft-robotic glove as assistive device and training tool with games to support hand function after stroke: Preliminary results on feasibility and potential clinical impact.

    Science.gov (United States)

    Prange-Lasonder, Gerdienke B; Radder, Bob; Kottink, Anke I R; Melendez-Calderon, Alejandro; Buurke, Jaap H; Rietman, Johan S

    2017-07-01

    Recent technological developments regarding wearable soft-robotic devices extend beyond the current application of rehabilitation robotics and enable unobtrusive support of the arms and hands during daily activities. In this light, the HandinMind (HiM) system was developed, comprising a soft-robotic, grip supporting glove with an added computer gaming environment. The present study aims to gain first insight into the feasibility of clinical application of the HiM system and its potential impact. In order to do so, both the direct influence of the HiM system on hand function as assistive device and its therapeutic potential, of either assistive or therapeutic use, were explored. A pilot randomized clinical trial was combined with a cross-sectional measurement (comparing performance with and without glove) at baseline in 5 chronic stroke patients, to investigate both the direct assistive and potential therapeutic effects of the HiM system. Extended use of the soft-robotic glove as assistive device at home or with dedicated gaming exercises in a clinical setting was applicable and feasible. A positive assistive effect of the soft-robotic glove was proposed for pinch strength and functional task performance 'lifting full cans' in most of the five participants. A potential therapeutic impact was suggested with predominantly improved hand strength in both participants with assistive use, and faster functional task performance in both participants with therapeutic application.

  1. 多次心肺复苏体外膜肺氧合支持后器官捐献供肾移植的临床疗效分析%Clinical outcomes of DCD renal transplantation after extracorporeal membrane oxygenation support with multiple cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    苏庆东; 董建辉; 李壮江; 孙煦勇; 曹嵩; 黄莹; 廖吉祥; 聂峰; 李海滨

    2016-01-01

    目的 比较多次心肺复苏后公民逝世后器官捐献(donation after citizen's death,DCD)供肾移植与无心肺复苏史DCD供肾移植的临床疗效.方法 回顾性分析了2012年7月至2014年12月完成的250例DCD供肾移植供、受者的临床资料.根据器官获取前是否发生多次心肺复苏(2次或2次以上)将其分为多次心肺复苏后DCD供肾移植组(观察组,17例)和无心肺复苏史供肾移植组(对照组,233例),多次心肺复苏供者均使用体外膜肺氧合(ECMO)技术支持.比较两组供者和受者的一般情况、受者术前血肌酐、术后不同时间点血肌酐水平、各种并发症的发生率及移植肾和受者的1年存活率.结果两组供者及受者一般情况、受者不同时间点血肌酐水平、住院时间相比较,差异均无统计学意义(P>0.05).观察组移植肾功能恢复延迟(DGF)发生率为17.6%(3/17),对照组DGF发生率为23.2%(54/233),差异无统计学意义(P>0.05).观察组术后急性排斥反应和肺部感染发生率均为11.8%;对照组分别为16.3%(38/233)及20.2%(47/233),两组间的差异均无统计学意义(P>0.05).Kaplan-Meier生存曲线结果显示,观察组受者和移植肾1年存活率均为94.1%,而对照组分别为92.7%和91.4%,但两组比较差异无统计学意义(P>0.05).结论 多次心肺复苏ECMO支持后DCD供肾移植近期临床效果与与无心肺复苏史DCD供肾移植相当.%Objective To compare the clinical outcomes of DCD renal transplantation from donors after extracorporeal membrane oxygenation (ECMO) support with multiple cardiopulmonary resuscitation (CPR) with donors showing no CPR history prior to organ procurement.Method A retrospective study was done on 17 cases of DCD renal transplantation from donors after (ECMO) support with multiple CPR (observation group) and 233 cases of DCD renal transplantation with no history of CPR (control group) from July 2012 to December 2014.Demographic and

  2. Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration

    Science.gov (United States)

    Bugedo, Guillermo; Florez, Jorge; Ferres, Marcela; Roessler, Eric; Bruhn, Alejandro

    2016-01-01

    Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation. PMID:27410413

  3. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...

  4. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

    2010-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...

  5. Continuous-flow left ventricular assist device support in patients with advanced heart failure: points of interest for the daily management.

    Science.gov (United States)

    Felix, S E A; Martina, J R; Kirkels, J H; Klöpping, C; Nathoe, H; Sukkel, E; Hulstein, N; Ramjankhan, F Z; Doevendans, P A F M; Lahpor, J R; de Jonge, Nicholaas

    2012-04-01

    Today, continuous-flow left ventricular assist devices (cf-LVADs) are implanted more often in patients with end-stage heart failure. Because of greater durability they can be implanted for an extended period of time. As a result of increased numbers of patients on cf-LVAD support, healthcare professionals should be aware of the potential complications inherent to this therapy. Both bleeding and thrombosis may occur, and also complications related either to the device itself or to the ensuing altered haemodynamics, valvular pathology, and rhythm disturbances such as ventricular tachycardias and fibrillation. Accurate clinical evaluation, together with an electrocardiogram and, if necessary, combined with an echocardiogram, is obligatory in these situations. This review summarizes common complications complemented by a few clinical cases.

  6. Pulsatile Support Mode of BJUT-II Ventricular Assist Device (VAD) has Better Hemodynamic Effects on the Aorta than Constant Speed Mode: A Primary Numerical Study.

    Science.gov (United States)

    Gu, Kaiyun; Gao, Bin; Chang, Yu; Zeng, Yi

    2016-07-01

    BACKGROUND BJUT-II VAD is a novel left ventricular assist device (LVADs), directly implanted into the ascending aorta. The pulsatile support mode is proposed to achieve better unloading performance than constant speed mode. However, the hemodynamic effects of this support mode on the aorta are still unclear. The aim of this study was to clarify the hemodynamic effects BJUT-II VAD under pulsatile support mode on the aorta. MATERIAL AND METHODS Computational fluid dynamics (CFD) studies, based on a patient-specific aortic geometric model, were conducted. Wall shear stress (WSS), averaged WSS (avWSS), oscillatory shear index (OSI), and averaged helicity density (Ha) were calculated to compare the differences in hemodynamic effects between pulsatile support mode and constant speed mode. RESULTS The results show that avWSS under pulsatile support mode is significantly higher than that under constant speed mode (0.955Pa vs. 0.675Pa). Similarly, the OSI value under pulsatile mode is higher than that under constant speed mode (0.104 vs. 0.057). In addition, Ha under pulsatile mode for all selected cross-sections is larger than that under constant mode. CONCLUSIONS BJUT-II VAD, under pulsatile control mode, may prevent atherosclerosis lesions and aortic remodeling. The precise effects of pulsatile support mode on atherosclerosis and aortic remodeling need to be further studied in animal experiments.

  7. 21 CFR 870.4410 - Cardiopulmonary bypass in-line blood gas sensor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass in-line blood gas sensor... Cardiopulmonary bypass in-line blood gas sensor. (a) Identification. A cardiopulmonary bypass in-line blood gas sensor is a transducer that measures the level of gases in the blood. (b) Classification. Class II...

  8. A Novel Idea to Improve Cardiac Output of Mechanical Circulatory Support Devices by Optimizing Kinetic Energy Transfer Available in Forward Moving Aortic Blood Flow.

    Science.gov (United States)

    Qureshi, Muhammad B; Glower, Jacob; Ewert, Daniel L; Koenig, Steven C

    2017-06-01

    Mechanical circulatory support devices (MCSDs) have gained widespread clinical acceptance as an effective heart failure (HF) therapy. The concept of harnessing the kinetic energy (KE) available in the forward aortic flow (AOF) is proposed as a novel control strategy to further increase the cardiac output (CO) provided by MCSDs. A complete mathematical development of the proposed theory and its application to an example MCSDs (two-segment extra-aortic cuff) are presented. To achieve improved device performance and physiologic benefit, the example MCSD timing is regulated to maximize the forward AOF KE and minimize retrograde flow. The proof-of-concept was tested to provide support with and without KE control in a computational HF model over a wide range of HF test conditions. The simulation predicted increased stroke volume (SV) by 20% (9 mL), CO by 23% (0.50 L/min), left ventricle ejection fraction (LVEF) by 23%, and diastolic coronary artery flow (CAF) by 55% (3 mL) in severe HF at a heart rate (HR) of 60 beats per minute (BPM) during counterpulsation (CP) support with KE control. The proposed KE control concept may improve performance of other MCSDs to further enhance their potential clinical benefits, which warrants further investigation. The next step is to investigate various assist technologies and determine where this concept is best applied. Then bench-test the combination of kinetic energy optimization and its associated technology choice and finally test the combination in animals.

  9. Noninvasive ultrasonic examination technology in support of counter-terrorism and drug interdiction activities: the acoustic inspection device (AID)

    Science.gov (United States)

    Diaz, Aaron A.; Burghard, Brion J.; Skorpik, James R.; Shepard, Chester L.; Samuel, Todd J.; Pappas, Richard A.

    2003-07-01

    The Pacific Northwest National Laboratory (PNNL) has developed a portable, battery-operated, handheld ultrasonic device that provides non-invasive container interrogation and material identification capabilities. The technique governing how the acoustic inspection device (AID) functions, involves measurements of ultrasonic pulses (0.1 to 5 MHz) that are launched into a container or material. The return echoes from these pulses are analyzed in terms of time-of-flight and frequency content to extract physical property measurements (the acoustic velocity and attenuation coefficient) of the material under test. The AID performs an automated analysis of the return echoes to identify the material, and detect contraband in the form of submerged packages and concealed compartments in liquid filled containers and solid-form commodities. An inspector can quickly interrogate outwardly innocuous commodity items such as shipping barrels, tanker trucks, and metal ingots. The AID can interrogate container sizes ranging from approximately 6 inches in diameter to over 96 inches in diameter and allows the inspector to sort liquid and material types into groups of like and unlike; a powerful method for discovering corrupted materials or miss-marked containers co-mingled in large shipments. This manuscript describes the functionality, capabilities and measurement methodology of the technology as it relates to homeland security applications.

  10. Effect of cardiopulmonary bypass on gastrointestinal perfusion and function.

    Science.gov (United States)

    Gaer, J A; Shaw, A D; Wild, R; Swift, R I; Munsch, C M; Smith, P L; Taylor, K M

    1994-02-01

    Gastric mucosal tonometry was used to determine the adequacy of gastrointestinal perfusion in 10 patients undergoing elective myocardial revascularization. Patients were prospectively randomized to receive either pulsatile or nonpulsatile flow during cardiopulmonary bypass. All patients showed a reduction in gastric mucosal perfusion during bypass, manifested by a reduction in the gastric mucosal pH, which occurred independently of variations in the arterial pH. In the group of patients receiving nonpulsatile flow, this reduction was significantly greater (p < 0.05). Cardiopulmonary bypass using nonpulsatile flow is associated with the development of a gastric mucosal acidosis, which may have implications for the development of postoperative complications.

  11. Complications of bystander cardiopulmonary resuscitation for unconscious patients without cardiopulmonary arrest

    Directory of Open Access Journals (Sweden)

    Yoshihiro Moriwaki

    2012-01-01

    Full Text Available Background: Insufficient knowledge of the risks and complications of cardiopulmonary resuscitation (CPR may be an obstructive factor for CPR, however, particularly for patients who are not clearly suffering out of hospital cardiopulmonary arrest (OH-CPA. The object of this study was to clarify the potential complication, the safety of bystander CPR in such cases. Materials and Methods: This study was a population-based observational case series. To be enrolled, patients had to have undergone CPR with chest compressions performed by lay persons, had to be confirmed not to have suffered OHCPA. Complications of bystander CPR were identified from the patients′ medical records and included rib fracture, lung injury, abdominal organ injury, and chest and/or abdominal pain requiring analgesics. In our emergency department, one doctor gathered information while others performed X-ray and blood examinations, electrocardiograms, and chest and abdominal ultrasonography. Results: A total of 26 cases were the subjects. The mean duration of bystander CPR was 6.5 minutes (ranging from 1 to 26. Nine patients died of a causative pathological condition and pneumonia, and the remaining 17 survived to discharge. Three patients suffered from complications (tracheal bleeding, minor gastric mucosal laceration, and chest pain, all of which were minimal and easily treated. No case required special examination or treatment for the complication itself. Conclusion: The risk and frequency of complications due to bystander CPR is thought to be very low. It is reasonable to perform immediate CPR for unconscious victims with inadequate respiration, and to help bystanders perform CPR using the T-CPR system.

  12. [Prevention of heel pressure sores with a foam body-support device. A randomized controlled trial in a medical intensive care unit].

    Science.gov (United States)

    Cadue, Jean-François; Karolewicz, Stéphane; Tardy, Catherine; Barrault, Claudie; Robert, René; Pourrat, Olivier

    2008-01-01

    To assess in a prospective controlled study the efficacy and safety of a specific foam body-support device designed as to prevent heel pressure ulcers. A randomization table was used to allocate 70 patients into 2 groups. The control group was treated with our standard pressure sore prevention protocol (half-seated position, water-mattress and preventive massages 6 times a day); the experimental group was treated with the same standard protocol as well as with the foam body-support device being evaluated. Patients were included if their Waterlow score was >10, indicating a high risk of developing pressure ulcers and if they had no skin lesion on the heels. Foam devices, covered with jersey, were constructed for the legs and allowed the heels to be free of any contact with the bed; another foam block was arranged perpendicularly to the first, in contact with the soles, to prevent ankles from assuming an equinus position (to prevent a dropfoot condition). The principal criterion for efficacy was the number of irreversible skin lesions on the heel (that is, beyond the stage of blanching hyperemia, reversible after finger pressure); these lesions were assessed every day until the end of the study (up to 30 days). The number of irreversible heel pressure ulcers was lower in the experimental (3 patients, 8.6%) than in the control group (19 patients, 55.4%) (ppressure ulcer was higher in the experimental group (5.6 days, compared with 2.8 days, p=0.01). The groups did not differ in the number of pressure sores on the sacrum and leg. An anatomical foam body-support is effective in preventing heel pressure ulcers in patients on a medical intensive care unit and is well tolerated.

  13. Specification of a VVER-1000 SFAT device prototype. Interim report on Task FIN A 1073 of the Finnish Support Programme to IAEA Safeguards

    Energy Technology Data Exchange (ETDEWEB)

    Nikkinen, M. [Radiation and Nuclear Safety Authority, Helsinki (Finland); Tiitta, A. [VTT Chemical Technology, Espoo (Finland); Iievlev, S.; Dvoeglazov, M.; Lopatin, S. [Ministry of Environmental Protection and Nuclear Safety, Kiev (Ukraine)

    1999-01-01

    The project to specify the optimal design of the Spent Fuel Attribute Tester (SFAT) for Ukrainian VVER-1000 facilities was run under Finnish Support Programme for IAEA Safeguards under the task FIN A1073. This document illustrates the optimum design and takes into account the special conditions at the Ukrainian facilities. The requirement presented here takes into account the needs of the user (IAEA), nuclear safety authority (NRA) and facilities. This document contains the views of these parties. According to this document, the work to design the optimal SFAT device can be started. This document contains also consideration for the operational procedures, maintenance and safety. (orig.) 5 refs.

  14. Effectiveness of Podcasts Delivered on Mobile Devices as a Support for Student Learning during General Chemistry Laboratories

    Science.gov (United States)

    Powell, Cynthia B.; Mason, Diana S.

    2013-01-01

    Chemistry instructors in teaching laboratories provide expert modeling of techniques and cognitive processes and provide assistance to enrolled students that may be described as scaffolding interaction. Such student support is particularly essential in laboratories taught with an inquiry-based curriculum. In a teaching laboratory with a high…

  15. Cardiopulmonary Resuscitation in Microgravity: Efficacy in the Swine During Parabolic Flight

    Science.gov (United States)

    Johnston, Smith L.; Campbell, Mark R.; Billica, Roger D.; Gilmore, Stevan M.

    2004-01-01

    INTRODUCTION: The International Space Station will need to be as capable as possible in providing Advanced Cardiac Life Support (ACLS) and cardiopulmonary resuscitation (CPR). Previous studies with manikins in parabolic microgravity (0 G) have shown that delivering CPR in microgravity is difficult. End tidal carbon dioxide (PetCO2) has been previously shown to be an effective non-invasive tool for estimating cardiac output during cardiopulmonary resuscitation. Animal models have shown that this diagnostic adjunct can be used as a predictor of survival when PetCO2 values are maintained above 25% of pre-arrest values. METHODS: Eleven anesthetized Yorkshire swine were flown in microgravity during parabolic flight. Physiologic parameters, including PetCO2, were monitored. Standard ACLS protocols were used to resuscitate these models after chemical induction of cardiac arrest. Chest compressions were administered using conventional body positioning with waist restraint and unconventional vertical-inverted body positioning. RESULTS: PetCO2 values were maintained above 25% of both 1-G and O-G pre-arrest values in the microgravity environment (33% +/- 3 and 41 +/- 3). No significant difference between 1-G CPR and O-G CPR was found in these animal models. Effective CPR was delivered in both body positions although conventional body positioning was found to be quickly fatiguing as compared with the vertical-inverted. CONCLUSIONS: Cardiopulmonary resuscitation can be effectively administered in microgravity (0 G). Validation of this model has demonstrated that PetCO2 levels were maintained above a level previously reported to be predictive of survival. The unconventional vertical-inverted position provided effective CPR and was less fatiguing as compared with the conventional body position with waist restraints.

  16. Off-pump exchange of short-term percutaneous ventricular assist device (VAD) to long-term implantable VAD in severe coagulopathy and multi-organ failure.

    Science.gov (United States)

    Busch, Jonas; Wojciechowski, Zbiguiew; Torre-Amione, Guillermo; Loebe, Matthias

    2008-05-01

    Ventricular support in patients with end-stage heart failure can be achieved using intracorporeal left ventricular assist device (LVAD) or percutaneous ventricular assist device (pVAD) systems. Multiple efforts have been made to minimize procedure-associated complications. We present a case report of an off-pump insertion of a MicroMed DeBakey VAD after Tandem Heart support using a previous sternotomy incision. A 47-year-old woman with end-stage heart failure after coronary artery bypass graft revascularization was admitted for pharmacologic treatment. She developed multi-organ failure and a severe coagulopathy with thromboembolic complications. Heparin-induced thrombocytopenia (HIT) was suspected. A percutaneous Tandem Heart was placed, the patient's condition stabilized, and finally a MicroMed DeBakey Child VAD was implanted off-pump, re-opening a previous sternotomy incision. To avoid the need for heparinization in the light of HIT and severe coagulopathy, the LVAD implantation was performed under Tandem Heart support without cardiopulmonary bypass. The patient has been anti-coagulated with angiomax ever since. Critically ill patients with end-stage heart disease, multi-organ failure, severe coagulopathy and a previous median sternotomy can be bridged from a Tandem Heart to MicroMed DeBakey VAD without cardiopulmonary bypass using the previous incision, provided there are few adhesions and stable hemodynamic conditions.

  17. Differences in displayed pump flow compared to measured flow under varying conditions during simulated cardiopulmonary bypass.

    LENUS (Irish Health Repository)

    Hargrove, M

    2008-07-01

    Errors in blood flow delivery due to shunting have been reported to reduce flow by, potentially, up to 40-83% during cardiopulmonary bypass. The standard roller-pump measures revolutions per minute and a calibration factor for different tubing sizes calculates and displays flow accordingly. We compared displayed roller-pump flow with ultrasonically measured flow to ascertain if measured flow correlated with the heart-lung pump flow reading. Comparison of flows was measured under varying conditions of pump run duration, temperature, viscosity, varying arterial\\/venous loops, occlusiveness, outlet pressure, use of silicone or polyvinyl chloride (PVC) in the roller race, different tubing diameters, and use of a venous vacuum-drainage device.

  18. The influence of biomaterials on inflammatory responses to cardiopulmonary bypass.

    Science.gov (United States)

    Courtney, J M; Matata, B M; Yin, H Q; Esposito, A; Mahiout, A; Taggart, D P; Lowe, G D

    1996-05-01

    The nature of cardiopulmonary bypass and the complexity of the inflammatory response make the detection and interpretation of a biomaterial influence difficult. However, if mediation of the inflammatory response is considered to be an appropriate clinical goal, alteration to the biomaterial influence merits further investigation.

  19. Cardiopulmonary resuscitation: biomedical and biophysical analysis (Chapter XXX)

    DEFF Research Database (Denmark)

    Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.

    2004-01-01

    The evolution of the human in caring for others is reflected in the development of cardiopulmonary resuscitation (CPR). Superstition, divine intervention and finally science have contributed to the development of a technique which may allow any person to save another’s life. Fully 50% of the firs...

  20. Gastrointestinal motility during cardiopulmonary bypass : A sonomicrometric study

    NARCIS (Netherlands)

    Gu, YJ; de Kroon, TL; Elstrodt, JM; Rakhorst, G

    2006-01-01

    Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using u

  1. Cardiopulmonary interactions during mechanical ventilation in critically ill patients

    NARCIS (Netherlands)

    T.G.V. Cherpanath (Thomas); W.K. Lagrand (Wim); M.J. Schultz (Marcus); A.B.J. Groeneveld (Johan)

    2013-01-01

    textabstractCardiopulmonary interactions induced by mechan-ical ventilation are complex and only partly understood. Ap-plied tidal volumes and/or airway pressures largely mediate changes in right ventricular preload and afterload. Effects on left ventricular function are mostly secondary to changes

  2. QUALITY-OF-LIFE AFTER CARDIOPULMONARY-RESUSCITATION

    NARCIS (Netherlands)

    MIRANDA, DR

    Objectives: This study evaluates the influence of Cardiopulmonary Resuscitation (CPR) on the components of quality of life (QOL) of patients after discharge from the hospital. Design: Extracted from a prospective national survey on Dutch intensive care units (ICUs). Setting: Thirty-six ICUs of both

  3. Cardiopulmonary Fitness and Endurance in Children with Developmental Coordination Disorder

    Science.gov (United States)

    Wu, Sheng K.; Lin, Hsiao-Hui; Li, Yao-Chuen; Tsai, Chia-Liang; Cairney, John

    2010-01-01

    The purpose of this study was to compare cardiopulmonary fitness and endurance in 9-11-year-old children with DCD against a group of typically developing children in Taiwan. The Movement ABC test was used to evaluate the motor abilities of children. Forty-one participants (20 children with DCD and 21 children without DCD) were recruited for this…

  4. Cardiopulmonary resuscitation: biomedical and biophysical analysis (Chapter XXX)

    DEFF Research Database (Denmark)

    Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.

    2004-01-01

    The evolution of the human in caring for others is reflected in the development of cardiopulmonary resuscitation (CPR). Superstition, divine intervention and finally science have contributed to the development of a technique which may allow any person to save another’s life. Fully 50% of the firs...

  5. Cardiopulmonary effects following endoscopic thoracic sympathectomy for primary hyperhidrosis.

    Science.gov (United States)

    Cruz, Jorge M; Fonseca, Manuel; Pinto, Fausto J; Oliveira, Antonio G; Carvalho, L Silva

    2009-09-01

    Endoscopic thoracic sympathectomy (ETS) is performed for the treatment of primary hyperhidrosis (PH). The second and third sympathetic thoracic ganglions excised in ETS also innervate the heart and lung. In the present work we studied the cardiopulmonary effects of ETS in a group of patients with PH. We performed a prospective study in 38 patients with severe PH. Pulmonary function, echocardiographic assessment of left ventricular function and myocardial contractility and maximal, symptom-limited, incremental exercise tests were evaluated 2 weeks before, and 6 months after ETS. Data were analysed with the paired t-test. Differences were considered significant when p<0.05. In pulmonary function tests, we found a statistically significant decrease forced expiratory flow in small airways and an increase of residual volume, a significant decrease in heart rate and ejection fraction, a significant decrease of 'rest' and 'peak' heart rate, and a significant increase of oxygen pulse (O2 pulse) and oxygen peak uptake (VO2 peak) after ETS (p<0.05). These cardiopulmonary effects observed 6 months after ETS in the treatment of patients with PH are all in normal ranges and are not relevant in cardiopulmonary function. We concluded that ETS in patients with PH is a safe procedure. Patients must be informed about these cardiopulmonary effects before the operation.

  6. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    Directory of Open Access Journals (Sweden)

    Cristiana Araujo G. Ferreira

    2014-03-01

    Full Text Available Objective: To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units. Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords "family", "invasive procedures", "cardiopulmonary resuscitation", "health staff", and "Pediatrics". Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed. Data synthesis : Most articles were published in the United States (80%, in Medicine and Nursing (46%, and were surveys (72% with healthcare team members (67% as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a to develop a sensitizing program for healthcare team; b to educate the healthcare team to include the family in these circumstances; c to develop a written institutional policy; d to ensure the attendance of family's needs. Conclusions: Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.

  7. 21 CFR 870.4350 - Cardiopulmonary bypass oxygenator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass oxygenator. 870.4350 Section 870.4350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during...

  8. Necessity of immediate cardiopulmonary resuscitation in trauma emergency

    Directory of Open Access Journals (Sweden)

    Luciano Baitello

    2010-08-01

    Full Text Available Abstract The ability to respond quickly and effectively to a cardiac arrest situation rests on nurses being competent in the emergency life-saving procedure of cardiopulmonary resuscitation. The objective of the current study was to evaluate the types of trauma and survival of patients that require immediate cardiopulmonary resuscitation in trauma emergencies. A total of 13301 patients treated as accident victims between July 2004 and December 2006 were evaluated in a prospective study. Patients requiring immediate cardiopulmonary resuscitation at admission were identified. The type of injury and the survival of these patients were evaluated. Of the 65 patients included in the study, 30% had suffered from gunshot wounds, 19% had been run over, 18% had been involved in car crashes, 13% in motor cycle accidents, 9% stabbings, 1% by cycle accidents and 10% other types of accidents including burns, hangings and falls. In only 12 of these patients, immediate resuscitation was successful and procedure such as chest drainage, exploratory laparotomy and interventions in the surgical center were performed. However all patients evolved to death; eight within 24 hours, two between 24 and 48 hours and the other 2 after 48 hours. Immediate cardiopulmonary resuscitation after accidents is a sign of high mortality requiring further studies to review indication and the ethical aspects involved.

  9. [Effects of airborne pollution on cardiopulmonary function of healthy person].

    Science.gov (United States)

    Liu, Xiaoli; Song, Xianqiang; Meng, Ziqiang

    2008-07-01

    To understand the effects of airborne pollution on cardiopulmonary function in healthy person. 15 healthy workers were selected from heavily polluted area as the experimental group (EG) and 15 healthy workers were selected from relatively clean area as control group (CG). The blood pressure were measured with sphygmomanometer and the vital capacity (VC) were detected with FHL-II type spirometer at rest status. Cardiopulmonary functions in different exercise states were measured by using the cardiopulmonary exercise testing (CPET). It showed that heart rate of EG was more higher than those of the CG at rest status (P VO2, VO2/kg, O2P and METS in CG were more higher than these indexes in EG (P VO2 max, the results of VO2 max, VO2 max/kg, O2P, METS and DT in CG were more higher than these indexes in EG (P < 0.01), and the recovery of heart rate in EG was slow in comparison with CG. Airborne pollution could have adverse effects on the cardiopulmonary function, reserve ability and function potential. The chronic adverse effects of airborne pollution on the health could be easy to reflect at static state. Therefore CPET could roundly evaluate the damage of airborne pollution to cardiorespiratory function.

  10. Cardiopulmonary fitness is related to disease severity in multiple sclerosis

    NARCIS (Netherlands)

    Heine, Martin; Wens, Inez; Langeskov-Christensen, Martin; Verschuren, Olaf|info:eu-repo/dai/nl/304819670; Eijnde, Bert O; Kwakkel, Gert; Dalgas, Ulrik

    2015-01-01

    BACKGROUND: In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life. OBJECTIVE: To investigate the association between disease severity and c

  11. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Whitlock, Richard P; Chan, Simon; Devereaux, P J;

    2008-01-01

    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality...

  12. Bridging to Heart Transplantation from the Biventricular Pulsatile Berlin Heart EXCOR Assist Device Support in a Patient with Advanced End-Organ Failure

    Directory of Open Access Journals (Sweden)

    Zumrut Tuba Demirozu

    2016-03-01

    Full Text Available Long-term mechanical circulatory support is a life-saving technology while briding to heart transplantation. It increases the quality of life and preserves end-organ function for patients with  advanced heart failure. The number of patients with advanced heart failure scheduled for heart transplantation before comorbidities escalate is on the rise. However, the device function is complicated by the bleeding-thrombosis and infection paradigm, hence the interest in understanding device thrombosis and infection. We describe a 27-year-old man with idiopathic cardiomyopathy, advanced end-organ failure, and severe infection, who was bridged to heart transplantation after 8 months on the Berlin Heart EXCOR (Berlin Heart AG, Berlin, Germany biventricular support. The patient was discharged from the hospital in the third postoperative week after the recovery of his end-organ functions. At 29 months’ post-transplantation follow-up, his last cardiac biopsy was grade 0, his ejection fraction was 60%, and he was enjoying a good quality of life.

  13. Bridging to Heart Transplantation from the Biventricular Pulsatile Berlin Heart EXCOR Assist Device Support in a Patient with Advanced End-Organ Failure

    Science.gov (United States)

    Tuba Demirozu, Zumrut; Suha Kucukaksu, Deniz

    2015-01-01

    Long-term mechanical circulatory support is a life-saving technology while briding to heart transplantation. It increases the quality of life and preserves end-organ function for patients with advanced heart failure. The number of patients with advanced heart failure scheduled for heart transplantation before comorbidities escalate is on the rise. However, the device function is complicated by the bleeding-thrombosis and infection paradigm, hence the interest in understanding device thrombosis and infection. We describe a 27-year-old man with idiopathic cardiomyopathy, advanced end-organ failure, and severe infection, who was bridged to heart transplantation after 8 months on the Berlin Heart EXCOR (Berlin Heart AG, Berlin, Germany) biventricular support. The patient was discharged from the hospital in the third postoperative week after the recovery of his end-organ functions. At 29 months’ post-transplantation follow-up, his last cardiac biopsy was grade 0, his ejection fraction was 60%, and he was enjoying a good quality of life. PMID:26985209

  14. Cost-effectiveness analysis of a low-cost bubble CPAP device in providing ventilatory support for neonates in Malawi - a preliminary report.

    Science.gov (United States)

    Chen, Ariel; Deshmukh, Ashish A; Richards-Kortum, Rebecca; Molyneux, Elizabeth; Kawaza, Kondwani; Cantor, Scott B

    2014-11-25

    A low-cost bubble continuous positive airway pressure (bCPAP) device has been shown to be an excellent clinical alternative to nasal oxygen for the care of neonates with respiratory difficulty. However, the delivery of bCPAP requires more resources than the current routine care using nasal oxygen. We performed an economic evaluation to determine the cost-effectiveness of a low-cost bCPAP device in providing ventilatory support for neonates in Malawi. We used patient-level clinical data from a previously published non-randomized controlled study. Economic data were based on the purchase price of supplies and equipment, adjusted for shelf life, as well as hospital cost data from the World Health Organization. Costs and benefits were discounted at 3%. The outcomes were measured in terms of cost, discounted life expectancy, cost/life year gained and net benefits of using bCPAP or nasal oxygen. The incremental cost-effectiveness ratio and incremental net benefits determined the value of one intervention compared to the other. Subgroup analysis on several parameters (birth weight categories, diagnosis of respiratory distress syndrome, and comorbidity of sepsis) was conducted to evaluate the effect of these parameters on the cost-effectiveness. Nasal oxygen therapy was less costly (US$29.29) than the low-cost bCPAP device ($57.78). Incremental effectiveness associated with bCPAP was 6.78 life years (LYs). In the base case analysis, the incremental cost-effectiveness ratio for bCPAP relative to nasal oxygen therapy was determined to be $4.20 (95% confidence interval, US$2.29-US$16.67) per LY gained. The results were highly sensitive for all tested subgroups, particularly for neonates with birth weight 1- cost effective. The bCPAP is a highly cost-effective strategy in providing ventilatory support for neonates in Malawi.

  15. Exercise hemodynamics during extended continuous flow left ventricular assist device support: the response of systemic cardiovascular parameters and pump performance.

    Science.gov (United States)

    Martina, Jerson; de Jonge, Nicolaas; Rutten, Marcel; Kirkels, J Hans; Klöpping, Corinne; Rodermans, Ben; Sukkel, Eveline; Hulstein, Nelienke; Mol, Bas; Lahpor, Jaap

    2013-09-01

    Patients on continuous flow left ventricular assist devices (cf-LVADs) are able to return to an active lifestyle and perform all sorts of physical activities. This study aims to evaluate exercise hemodynamics in patients with a HeartMate II cf-LVAD (HM II). Thirty (30) patients underwent a bicycle exercise test. Along with exercise capacity, systemic cardiovascular responses and pump performance were evaluated at 6 and 12 months after HM II implantation. From rest to maximum exercise, heart rate increased from 87 ± 14 to 140 ± 32 beats/minute (bpm) (P<0.01), while systolic arterial blood pressure increased from 93 ± 12 to 116 ± 21 mm Hg (P<0.01). Total cardiac output (TCO) increased from 4.1 ± 1.1 to 8.5 ± 2.8 L/min (P<0.01) while pump flow increased less, from 5.1 ± 0.7 to 6.4 ± 0.6 L/min (P<0.01). Systemic vascular resistance (SVR) decreased from 1776 ± 750 to 1013 ± 83 dynes.s/cm(5) (P<0.001) and showed the strongest correlation with TCO (r= -0.72; P<0.01). Exercise capacity was affected by older age, while blood pressure increased significantly in men compared with women. Exercise capacity remained consistent at 6 and 12 months after HM II implantation, 51% ± 13% and 52% ± 13% of predicted VO2 max for normal subjects corrected for age and gender. In conclusion, pump flow of the HM II may contribute partially to TCO during exercise, while SVR was the strongest determinant of TCO.

  16. Opportunities and barriers to cardiopulmonary resuscitation training in English secondary schools.

    Science.gov (United States)

    Lockey, Andrew S; Barton, Katherine; Yoxall, Heather

    2016-10-01

    Cardiopulmonary resuscitation rates and survival from out-of-hospital cardiac arrest are poor in the UK compared with areas abroad that deliver mandatory training to all school children. We sought to identify barriers to training and develop a strategy to enable delivery of this training. Qualitative analysis, comprising semistructured interviews and group discussions, covering 14 schools in the metropolitan borough of Calderdale in West Yorkshire. Only three schools out of 14 were delivering training to entire year groups. Barriers include lack of resources, lack of training for teachers and difficulty in initiating a programme. Strategies were developed to overcome these barriers with the result that four additional schools are now teaching a whole year group. There is no single solution and bespoke plans may be needed for each school. The establishment of cardiopulmonary resuscitation training in secondary schools in the UK is achievable. The commonly perceived barriers to establishment of training are all surmountable, but solving them does not necessarily ensure universal coverage. Support from healthcare professionals, in particular public health, is essential to ensure that the training is as widespread as possible. Mandatory inclusion of this training on the school curriculum, as seen in other countries, would result in significantly improved survival rates from out-of-hospital cardiorespiratory arrest. Solutions to improve training have been proposed, which could be used in other parts of Europe where such training is not a mandatory requirement.

  17. Marginally effective medical care: ethical analysis of issues in cardiopulmonary resuscitation (CPR)

    Science.gov (United States)

    Hilberman, M; Kutner, J; Parsons, D; Murphy, D J

    1997-12-01

    Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated.

  18. Support vector machine and mel frequency Cepstral coefficient based algorithm for hand gestures and bidirectional speech to text device

    Science.gov (United States)

    Balbin, Jessie R.; Padilla, Dionis A.; Fausto, Janette C.; Vergara, Ernesto M.; Garcia, Ramon G.; Delos Angeles, Bethsedea Joy S.; Dizon, Neil John A.; Mardo, Mark Kevin N.

    2017-02-01

    This research is about translating series of hand gesture to form a word and produce its equivalent sound on how it is read and said in Filipino accent using Support Vector Machine and Mel Frequency Cepstral Coefficient analysis. The concept is to detect Filipino speech input and translate the spoken words to their text form in Filipino. This study is trying to help the Filipino deaf community to impart their thoughts through the use of hand gestures and be able to communicate to people who do not know how to read hand gestures. This also helps literate deaf to simply read the spoken words relayed to them using the Filipino speech to text system.

  19. Support-Free Transfer of Ultrasmooth Graphene Films Facilitated by Self-Assembled Monolayers for Electronic Devices and Patterns.

    Science.gov (United States)

    Wang, Bin; Huang, Ming; Tao, Li; Lee, Sun Hwa; Jang, A-Rang; Li, Bao-Wen; Shin, Hyeon Suk; Akinwande, Deji; Ruoff, Rodney S

    2016-01-26

    We explored a support-free method for transferring large area graphene films grown by chemical vapor deposition to various fluoric self-assembled monolayer (F-SAM) modified substrates including SiO2/Si wafers, polyethylene terephthalate films, and glass. This method yields clean, ultrasmooth, and high-quality graphene films for promising applications such as transparent, conductive, and flexible films due to the absence of residues and limited structural defects such as cracks. The F-SAM introduced in the transfer process can also lead to graphene transistors with enhanced field-effect mobility (up to 10,663 cm(2)/Vs) and resistance modulation (up to 12×) on a standard silicon dioxide dielectric. Clean graphene patterns can be realized by transfer of graphene onto only the F-SAM modified surfaces.

  20. Orbital Fitness: An Overview of Space Shuttle Cardiopulmonary Exercise Physiology Findings

    Science.gov (United States)

    Moore, Alan D.

    2011-01-01

    Limited observations regarding the cardiopulmonary responses to aerobic exercise had been conducted during short-duration spaceflight before the Space Shuttle program. This presentation focuses on the findings regarding changes observed in the cardiopulmonary exercise responses during and following Shuttle flights. During flight, maximum oxygen uptake (VO2max) remained unchanged as did the maximum work rate achievable during cycle exercise testing conducted during the last full flight day. Immediately following flight, the ubiquitous finding, confirmed by investigations conducted during the Spacelab Life Sciences missions 1 and 2 and by NASA Detailed Supplemental Objective studies, indicated that VO2max was reduced; however, the reduction in VO2max was transient and returned to preflight levels within 7 days following return. Studies regarding the influence of aerobic exercise countermeasures performed during flight on postflight performance were mostly limited to the examination of the heart rate (HR) response to submaximal exercise testing on landing day. These studies revealed that exercise HR was elevated in individuals who performed little to no exercise during their missions as compared to individuals who performed regular exercise. In addition, astronauts who performed little to no aerobic exercise during flight demonstrated an increased HR and lowered pulse pressure response to the standard stand test on landing day, indicating a decrease in orthostatic function in these individuals. With regard to exercise modality, four devices were examined during the Shuttle era: two treadmills, a cycle ergometer, and a rowing device. Although there were limited investigations regarding the use of these devices for exercise training aboard the Shuttle, there was no clear consensus reached regarding which proved to be a "superior" device. Each device had a unique operational or physiologic limitation associated with its use. In conclusion, exercise research conducted

  1. 复杂设备维修保障数据预处理技术研究%Maintenance Support Data Preprocessing Technology for Complex Devices

    Institute of Scientific and Technical Information of China (English)

    李季; 孙凯; 白文

    2016-01-01

    The preprocessing of maintenance support data for complex devices is an important guarantee of its correct ‐ness and accuracy ,which also determines the quality and effectiveness of the subsequent maintenance support work .The ap‐plication requirements and characteristics of complex equipment maintenance support data are analyzed ,the related technolo‐gies and methods are summarized ,and the basic process of data preprocessing is constructed .Finally ,a numerical example is analyzed with the information entropy theory for data protocol .%复杂设备维修保障数据的预处理是其正确性与准确性的重要保证,决定着后续维修保障工作的质量与效益。论文分析了复杂设备维修保障数据的应用需求及特点,对其预处理过程中的相关技术和方法进行了归纳,并在此基础上总结建立了维修保障数据预处理的基本流程,最后结合某设备维修性数据采用信息熵理论进行了数据规约实例分析。

  2. Exercise blood pressure response during assisted circulatory support: comparison of the total artificial [corrected] heart with a left ventricular assist device during rehabilitation.

    Science.gov (United States)

    Kohli, Harajeshwar S; Canada, Justin; Arena, Ross; Tang, Daniel G; Peberdy, Mary Ann; Harton, Suzanne; Flattery, Maureen; Doolin, Kelly; Katlaps, Gundars J; Hess, Michael L; Kasirajan, Vigneshwar; Shah, Keyur B

    2011-11-01

    The total artificial heart (TAH) consists of two implantable pneumatic pumps that replace the heart and operate at a fixed ejection rate and ejection pressure. We evaluated the blood pressure (BP) response to exercise and exercise performance in patients with a TAH compared to those with a with a continuous-flow left ventricular assist device (LVAD). We conducted a single-center, retrospective study of 37 patients who received a TAH and 12 patients implanted with an LVAD. We measured the BP response during exercise, exercise duration and change in tolerated exercise workload over an 8-week period. In patients with a TAH, baseline BP was 120/69 ± 13/13, exercise BP was 118/72 ± 15/10 and post-exercise BP was 120/72 ± 14/12. Mean arterial BP did not change with exercise in patients with a TAH (88 ± 10 vs 88 ± 11; p = 0.8), but increased in those with an LVAD (87 ± 8 vs 95 ± 13; p exercise, the association was not statistically significant (β = -0.1, p = 0.4). MAP correlated positively with METs achieved in patients with LVADs (MAP: β = 0.26, p = 0.04). Despite the abnormal response to exercise, patients with a TAH participated in physical therapy (median: 5 days; interquartile range [IQR] 4 to 7 days) and treadmill exercise (19 days; IQR: 13 to 35 days) early after device implantation, with increased exercise intensity and duration over time. During circulatory support with a TAH, the BP response to exercise was blunted. However, aerobic exercise training early after device implantation was found to be safe and feasible in a supervised setting. 2011 International Society for Heart and Lung Transplantation. All rights reserved.

  3. A revolution in preventing fatal craniovertebral junction injuries: lessons learned from the Head and Neck Support device in professional auto racing.

    Science.gov (United States)

    Kaul, Anand; Abbas, Ahmed; Smith, Gabriel; Manjila, Sunil; Pace, Jonathan; Steinmetz, Michael

    2016-12-01

    Fatal craniovertebral junction (CVJ) injuries were the most common cause of death in high-speed motor sports prior to 2001. Following the death of a mutual friend and race car driver, Patrick Jacquemart (1946-1981), biomechanical engineer Dr. Robert Hubbard, along with race car driver and brother-in-law Jim Downing, developed the concept for the Head and Neck Support (HANS) device to prevent flexion-distraction injuries during high-velocity impact. Biomechanical testing showed that neck shear and loading forces experienced during collisions were 3 times the required amount for a catastrophic injury. Crash sled testing with and without the HANS device elucidated reductions in neck tension, neck compression, head acceleration, and chest acceleration experienced by dummies during high-energy crashes. Simultaneously, motor sports accidents such as Dale Earnhardt Sr.'s fatal crash in 2001 galvanized public opinion in favor of serious safety reform. Analysis of Earnhardt's accident demonstrated that his car's velocity parallel to the barrier was more than 150 miles per hour (mph), with deceleration upon impact of roughly 43 mph in a total of 0.08 seconds. After careful review, several major racing series such as the National Association for Stock Car Auto Racing (NASCAR) and Championship Auto Racing Team (CART) made major changes to ensure the safety of drivers at the turn of the 21st century. Since the rule requiring the HANS device in professional auto racing series was put in place, there has not been a single reported case of a fatal CVJ injury.

  4. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation.

    Science.gov (United States)

    Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; Araújo, Claudio Gil Soares de; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; Almeida, Antonio Eduardo Monteiro de; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel

    2016-11-01

    Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. Resumo O teste cardiopulmonar de exercício (TCPE) vem ganhando importância crescente como método de avaliação funcional tanto no Brasil quanto no Mundo. Nas suas aplicações mais frequentes, o teste consiste em submeter o indivíduo a um exercício de intensidade gradativamente crescente até a exaustão ou o

  5. A numerical performance assessment of a commercial cardiopulmonary by-pass blood heat exchanger.

    Science.gov (United States)

    Consolo, Filippo; Fiore, Gianfranco B; Pelosi, Alessandra; Reggiani, Stefano; Redaelli, Alberto

    2015-06-01

    We developed a numerical model, based on multi-physics computational fluid dynamics (CFD) simulations, to assist the design process of a plastic hollow-fiber bundle blood heat exchanger (BHE) integrated within the INSPIRE(TM), a blood oxygenator (OXY) for cardiopulmonary by-pass procedures, recently released by Sorin Group Italia. In a comparative study, we analyzed five different geometrical design solutions of the BHE module. Quantitative geometrical-dependent parameters providing a comprehensive evaluation of both the hemo- and thermo-dynamics performance of the device were extracted to identify the best-performing prototypical solution. A convenient design configuration was identified, characterized by (i) a uniform blood flow pattern within the fiber bundle, preventing blood flow shunting and the onset of stagnation/recirculation areas and/or high velocity pathways, (ii) an enhanced blood heating efficiency, and (iii) a reduced blood pressure drop. The selected design configuration was then prototyped and tested to experimentally characterize the device performance. Experimental results confirmed numerical predictions, proving the effectiveness of CFD modeling as a reliable tool for in silico identification of suitable working conditions of blood handling medical devices. Notably, the numerical approach limited the need for extensive prototyping, thus reducing the corresponding machinery costs and time-to-market.

  6. Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass

    Science.gov (United States)

    Salameh, Aida; Dhein, Stefan; Dähnert, Ingo; Klein, Norbert

    2016-01-01

    Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain. PMID:27879647

  7. [Virtual educational proposal in cardiopulmonary resuscitation for the neonate care].

    Science.gov (United States)

    Gonçalves, Gilciane Ribeiro; Peres, Heloisa Helena Ciqueto; Rodrigues, Rita de Cássia; Tronchin, Daisy Maria Rizatto; Pereira, Irene Mari

    2010-06-01

    The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1--Fundamentals of the heart anatomy and physiology in newborns; Module 2--Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3--Planning nursing care; Module 4--Medications used in cardiopulmonary arrests in newborns; and Module 5--Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care.

  8. Role of cardiopulmonary mechanoreceptors in the postural regulation of renin

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, R.A.; Marco, E.J.; Oliveri, C.; Otero, F.J.; Degrossi, O.; Moledo, L.I.; Julius, S.

    1987-04-01

    To change the stretch on cardiopulmonary mechanoreceptors, large shifts of blood in the capacity space were elicited by tilting and by exerting positive lower body pressure in the tilted position. Twelve volunteers underwent invasive hemodynamic studies and in 10 other subjects cardiac size was determined by radionuclide cardiography. In all 22 subjects tilting caused the expected increase of renin, which was abolished by lower body compression. Decompression caused renin to increase again. Right atrial pressure in invasive studies and end-systolic and end-diastolic counts in noninvasive studies showed a significant and strong negative correlation with renin and norepinephrine levels. Thus, the degree of stretch of the cardiopulmonary mechanoreceptors is a major determinant of reflex regulation of renin release in humans.

  9. Virtual Training Devices Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — The Virtual Training Devices (VTD) Laboratory at the Life Cycle Software Engineering Center, Picatinny Arsenal, provides a software testing and support environment...

  10. Use of the Nippon-Zeon pneumatic ventricular assist device as a bridge to cardiac transplantation.

    Science.gov (United States)

    Deleuze, P H; Le Besnerais, P; Mazzucotellu, J P; Abe, Y; Miyama, M; Mourtada, A; Benvenuti, C; Loisance, D Y

    1994-01-01

    The Nippon-Zeon (NZ) ventricular assist device is a sac type, air driven, heterotopic, external pump. Its performance has been evaluated in Japan as a bridge to myocardial recovery. Few data are available on the device as a bridge to heart transplantation. Since 1991, 10 patients (9 men) were bridged to heart transplantation with NZ, all in biventricular support. The mean age was 39 +/- 13 years (range, 21-60 years), mean body weight was 75 +/- 13 kg (range, 51-95 kg). Five patients had a dilated cardiopathy, and five were ischemic (three acute myocardial infarctions). Despite maximal inotropic support, including enoximone in seven, epinephrine in three, and intraaortic balloon pumping in one, eight patients were anuric, three were in acute hepatic failure, and three were intubated. Preoperative hemodynamic and biologic values were: cardiac index, 1.57 +/- 0.4 l/min/m2; pulmonary capillary wedge pressure, 34 +/- 5 mmHg; creatinine, 200 +/- 80 mumol/l; blood urea nitrogen, 17.5 +/- 8 mmol/l; total bilirubin 36 +/- 6 mumol/l; aspartate aminotransferase, 1,000 +/- 2,000 IU/l. In all patients, a biventricular assist device was implanted without the use of cardiopulmonary bypass. Improvement occurred immediately in all but one. Mean left ventricular flow was 4.5 +/- 0.8 l/min. Anticoagulation was maintained with intravenous heparin. Recently for bleeding was required in one case (10%), and two patients had positive blood cultures that were successfully treated. There was no mechanical failure. Hemolysis was not significant (lactate dehydrogenase, 378 +/- 50 IU/l; plasma-free hemoglobin below 10 mg/dl). Each device was free of thrombi and deposits at time of explantation. One patient died while on assist. Nine patients (90%) were transplanted after 11 +/- 8 days (range, 1-32 days). Three died early after transplantation, one of graft failure, two of sepsis. Six patients (66%) could be discharged. The follow-up ranges from 7 to 28 months. NZ is a simple, reliable

  11. Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation.

    Directory of Open Access Journals (Sweden)

    Victor Rene Navarro Machado

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation. It is the group of procedures that should be accomplished to restore circulation and ventilation in a patient with cardiac arrest, including actions to reintegrate upper neurological functions after restoring cardiac function. This document includes a review of concepts, aetiology and updates the main clinical aspects related with diagnosis and treatment aimed at the post-resuscitation syndrome. It includes assessment guidelines focused on the most important aspects to be accomplished.

  12. Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans

    DEFF Research Database (Denmark)

    Christensen, S F; Stadeager, Carsten Preben; Siemkowicz, E

    1990-01-01

    /kg/min). The cortical CBF was found between 14 and 211 ml 100 g-1.min-1 with mean 42 ml 100 g-1.min-1 and mean white matter CBF equal to 27 ml 100 g-1.min-1. It is suggested that the external cardiac massage in humans may be of poor efficacy in terms of brain revival. Cortical CBF after long-lasting cardiopulmonary...

  13. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    OpenAIRE

    Ferreira, Cristiana Araujo G.; Flavia Simphronio Balbino; Balieiro,Maria Magda F. G.; Myriam Aparecida Mandetta

    2014-01-01

    Objective:To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units.Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords family, invasive procedur...

  14. Hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    苏肇伉; 周成斌; 张海波; 祝忠群

    2003-01-01

    Objective To study the hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass.Methods Six pregnant ewes underwent fetal cardiopulmonary bypasses with artificial oxygenators and roller pumps for 30 minutes, which maintained the blood gas value at the fetal physiological level. The fetal blood pressure, heart rate, pH value and blood lactate levels were monitored. The levels of catecholamine, cortisol and insulin were measured pre-bypass and then again 30 minutes later. The blood glucose and free fatty acid levels were monitored continuously during the bypass. Fetal hepatic PAS staining was also carried out.Results There were no changes before and during the bypass in fetal blood pressure, heart rate and blood gas. However, pH values decreased and blood lactate levels increased (P<0.05). The fetal catecholamine and cortisol levels increased significantly (P<0.01), while the levels of insulin did not change. The blood glucose and free fatty acid levels increased at the beginning of the bypass (P<0.01), and then gradually slowed down during the bypass. The fetal hepatic PAS staining showed that hepatic glycogen was consumed in large amounts. After 30 minutes of bypass, the fetal lamb would not survive more than 1 hour.Conclusion The fetal lamb has a strong negative reaction to cardiopulmonary bypass.

  15. Cardiopulmonary resuscitation and contrast media reactions in a radiology department

    Energy Technology Data Exchange (ETDEWEB)

    O' Neill, John M.; McBride, Kieran D

    2001-04-01

    AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000.

  16. Predictive values for cardiopulmonary exercise testing in sedentary Chinese adults.

    Science.gov (United States)

    Ong, Kian Chung; Loo, Chian Min; Ong, Yong Yau; Chan, Siew Pang; Earnest, Arul; Saw, Seang Mei

    2002-09-01

    Normative data for cardiopulmonary exercise testing (CPET) may vary among subjects of different races. The objectives of the present study were to: (i) establish normal standards for cardiopulmonary responses during incremental cycle ergometer testing in order to derive predictive equations for clinically useful variables during CPET of Chinese subjects; and (ii) determine the validity of existing prediction equations of maximal exercise performance for use in our local Chinese population. The maximal and submaximal cardiopulmonary responses were analysed for 95 healthy sedentary adult Chinese subjects (48 men and 47 women; aged 20-70 years) who underwent CPET using a cycle ergometer and an incremental work-rate protocol until symptom limitation. Measurements, at maximal exercise, of oxygen uptake (VO2(max)), power output and heart rate were regressed on age, height, weight and gender. The predictive equations for these exercise parameters performed better than those published previously in out-sample predictive accuracy. Comparison with previous studies also showed that prediction equations of VO2(max) derived from studies based predominantly or exclusively on Caucasian populations overestimated the actual values for our subjects. Previously established prediction equations for maximal exercise performance during CPET based on non-Chinese populations may not be applicable to Chinese subjects in our population.

  17. Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation

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    Pervez Sultan

    2014-01-01

    Full Text Available Explanatory mechanisms for the association between poor exercise capacity and infections following surgery are underexplored. We hypothesized that aerobic fitness—assessed by cardiopulmonary exercise testing (CPET—would be associated with circulating inflammatory markers, as quantified by the neutrophil-lymphocyte ratio (NLR and monocyte subsets. The association between cardiopulmonary reserve and inflammation was tested by multivariable regression analysis with covariates including anaerobic threshold (AT and malignancy. In a first cohort of 240 colorectal patients, AT was identified as the sole factor associated with higher NLR (P=0.03 and absolute and relative lymphopenia (P=0.01. Preoperative leukocyte subsets and monocyte CD14+ expression (downregulated by endotoxin and indicative of chronic inflammation were also assessed in two further cohorts of age-matched elective gastrointestinal and orthopaedic surgical patients. Monocyte CD14+ expression was lower in gastrointestinal patients (n=43 compared to age-matched orthopaedic patients (n=31. The circulating CD14+CD16− monocyte subset was reduced in patients with low cardiopulmonary reserve. Poor exercise capacity in patients without a diagnosis of heart failure is independently associated with markers of inflammation. These observations suggest that preoperative inflammation associated with impaired cardiorespiratory performance may contribute to the pathophysiology of postoperative outcome.

  18. Incidence and Impact of On-Cardiopulmonary Bypass Vasoplegia During Heart Transplantation.

    Science.gov (United States)

    Truby, Lauren K; Takeda, Koji; Farr, Maryjane; Beck, James; Yuzefpolskaya, Melana; Colombo, Paolo C; Tokpara, Veli; Mancini, Donna; Naka, Yoshifumi; Takayama, Hiroo

    2017-08-02

    Despite significant advances in the medical management of heart transplant (HT) recipients, perioperative complications, including vasoplegia, remain a significant contributor to morbidity and mortality. This is a retrospective review of patients who received HT at our institution between 2012 and 2015. Mean systemic vascular resistance (SVR) was calculated during the bypass run. Vasoplegia was defined as a mean SVR 1,500 μg neosynephrine bolused). The primary outcome of interest was 30 day post-transplant survival. There were 138 patients included in the current study. A total of 16% (n = 22) patients were identified as having developed on-cardiopulmonary bypass vasoplegia. Vasoplegic patients had a significantly higher body mass index (BMI) (30.1 ± 5.0 vs. 26.5 ± 4.7; p = 0.005) and were more likely to be male (95.5% vs. 66.4%; p = 0.004). Use of continuous-flow left ventricular assist device (CF-LVAD) as bridge-to-transplant (BTT) was prevalent among vasoplegic patients (81.8% vs. 57.8%; p = 0.033). These patients had significantly decreased survival at 30 and 60 days (86.4% vs. 99.1% at 30 days; 77.3% vs. 92.8% at 60 days). Bridge-to-transplant with CF-LVAD was an independent predictor of on-cardiopulmonary bypass (CPB) vasoplegia. On-CPB vasoplegia complicated 16% of HTs in the current study and was associated with increased mortality. Bridge-to-transplant with CF-LVAD was an independent predictor of this phenomenon.

  19. Cardiopulmonary exercise testing – the gold standard in physical performance assesment

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    Claudiu Avram

    2008-12-01

    Full Text Available Background: Cardiopulmonary exercise testing (CPX is a modern procedure that allows us to evaluate the global performanceof a subject. Because CPX devices are expensive and less popular due to a less amount of specialists in this field, many oflaboratories uses the more common ECG stress tests for physical performance assessment. Aim: to demonstrate theimportance and accuracy of cardiopulmonary exercise testing comparing with traditional maximal electrocardiographic (ECGstress test without gas exchange analysis. Methods: 18th elite soccer players (age 22.7±6 years, body mass 74.6±9.5 kg,height 175.4±9.8 cm participated in the study. The subjects accomplished two treadmill effort tests with and without gasanalyses, in 2 consecutive days interval. Results: At the end of the study we noticed a highly significant statistical difference(p<0.0001 between the investigated testing methods. In gas exchange testing method we found a decreased level of all theparameters evaluated comparing to stress ECG: VO2 peak (ml*kg-1*min-1 = 55.4±5.2 vs. 67.8±5.7; AT (ml*kg-1*min-1 =41.2±7.6 vs. 47.4±6.9; VO2/HR (ml = 23.8±2.5 vs. 23.8±2.5. Conclusions: Asessment of exercise performance based solelyon a maximal stress ECG without gas analyzing is inaccurate. Furthermore, estimation of peak exercise responses based uponcalculation of VO2 peak from peak work rate are inappropriate in sportsman. The study demonstrate once again that CPXremain the most accurate and reliable test for detection of AT and for a comprehensive physical performance assessment andcannot be replace by other surrogate laboratory exercise tests like stress ECG.

  20. Modern recommendations on children’s baseline cardiopulmonary resuscitation (BLS 2010

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    R.F. Tepaev

    2012-01-01

    Full Text Available The main reason for children’s and adolescents’ mortality in Russia is external causes, such as injuries, poisonings, drownings and road traffic collisions. Many of the external causes may be prevented. Besides, the popularization of modern baseline cardiopulmonary resuscitation methods is one the methods of mortality reduction in children on the pre-hospital stage. The article gives children’s baseline cardiopulmonary resuscitation basics recommended by the American Heart Association.Key words: cardiopulmonary resuscitation, children, adolescents.

  1. Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit.

    Science.gov (United States)

    Kawahito, Shinji; Higuchi, Seiichi; Mita, Naoji; Kitagawa, Tetsuya; Kitahata, Hiroshi

    2013-12-01

    We tried to perform continuous blood glucose monitoring during cardiovascular surgery involving cardiopulmonary bypass using an artificial endocrine pancreas (STG-22 or -55; Nikkiso, Tokyo, Japan); however, we often encountered problems during these procedures because insufficient blood was obtained for monitoring. Thus, we started performing the blood sampling via the venous side of the cardiopulmonary bypass circuit. As a result, continuous blood glucose monitoring using an artificial endocrine pancreas was proven to be stable and reliable during cardiovascular surgery involving cardiopulmonary bypass.

  2. Complete removal of infected devices and simultaneous implantation of new devices for infective endocarditis after pacemaker implantation.

    Science.gov (United States)

    Miura, Takuya; Inoue, Kazushige; Yokota, Takenori; Iwata, Takashi; Yoshitatsu, Masao

    2017-02-01

    Two cases of infective endocarditis after pacemaker implantation were reported. Complete removal of infected devices was performed under cardiopulmonary bypass, and simultaneous implantation of new devices was performed using epicardial leads and generator on the abdominal wall. The postoperative course was uneventful and recurrence was not recognized. These procedures may be suitable for the patients who depend on the pacemaker or who have repeat bacteremia with other infectious disease or conditions.

  3. Persistent blood stream infection in patients supported with a continuous-flow left ventricular assist device is associated with an increased risk of cerebrovascular accidents.

    Science.gov (United States)

    Trachtenberg, Barry H; Cordero-Reyes, Andrea M; Aldeiri, Molham; Alvarez, Paulino; Bhimaraj, Arvind; Ashrith, Guha; Elias, Barbara; Suarez, Erik E; Bruckner, Brian; Loebe, Matthias; Harris, Richard L; Zhang, J Yi; Torre-Amione, Guillermo; Estep, Jerry D

    2015-02-01

    Common adverse events in patients supported with Continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection (BSI) and CVA. Medical records of patients who received Heartmate II (HMII) CF-LVADs in 2008-2012 at a single center were reviewed. CVA was categorized as either hemorrhagic (HCVA) or ischemic (ICVA). BSI was divided into persistent (pBSI) and nonpersistent (non-pBSI). pBSI was defined as BSI with the same organism on repeated blood culture >72 hours from initial blood culture despite antibiotics. Univariate and multivariate analyses were performed to determine predictors. A total of 149 patients had HMII implanted; 76% were male, and the overall mean age was 55.4 ± 13 years. There were a total of 19 (13%) patients who had CVA (7 HCVA and 12 ICVA) at a median of 295 days (range 5-1,096 days) after implantation. There were a total of 28 (19%) patients with pBSI and 17 (11%) patients with non-pBSI. Patients with pBSI had a trend toward greater BMI (31 kg/m(2) vs 27 kg/m(2); P = .09), and longer duration of support (1,019 d vs 371 d; P CVA on multivariate analysis (odds ratio [OR] 5.97; P = .003) as well as persistent Pseudomonas aeruginosa infection (OR 4.54; P = .048). Persistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

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    Bartholomay Eduardo

    2003-01-01

    Full Text Available OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58% patients, and 42 (28% were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6, when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3, when the time of cerebral cardiopulmonary resuscitation was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

  5. The Effect of Repeat Cardiopulmonary bypass on Epicardial Microflow and Graft Flow during Intra-operative Heart Failure

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective The relationship between graft blood flow, epicardial microflow,mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure.Methods These parameters were done to evaluate the use of repeated cardiopulmonary bypass supportfor the intraoperative heart failure following aorto-coronary bypass surgery. Included in this study were10 patients with a mean age of 7 0 and unstable angina undergoing coronary bypass grafting and suffer-ing from intraoperative heart failure. The epicardiai microflow, graft flow, mean arterial pressureand blood cell filterability were measured. Resluts During heart failure, the mean arterial pressurefell by 41 % ( P < 0. 01 ), graft flow by 67 % ( P < 0. 01 ) and epicardialmicro flow by 64 % ( P <0. 01 ). After 1 5 to 56 min of assisted cardiopulmonary bypass support, the epicardial mioroflow andgraft flow were partially restored, while red cell and white cell filterability was reduced by 31% and644 % respectively ( P < 0. 01 ). There were significant correlations between graft flow, epicardial mi-croflow, blooxd cell filterability and cardiopulmonary bypass time. All patients recovered and were dis-charged from the hospital. Conclusion It is concluded that the use of temporary assisted CPB sup-port to treat intrapoperative heart failure allows the recovery of the myocardium and thereby restores themean arterial pressure. The recovery of graft flow and epicardial flow occurred to a lesser extent. TheCPB support seemed to be suitable for about 60 rain probably because of increasing disturbance to theblood cell filterability, graft flow and the epicardial microcirculation.

  6. Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

    Science.gov (United States)

    Siebert, Johan N; Ehrler, Frederic; Gervaix, Alain; Haddad, Kevin; Lacroix, Laurence; Schrurs, Philippe; Sahin, Ayhan; Lovis, Christian; Manzano, Sergio

    2017-05-29

    The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario-pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other

  7. Predictors of inotrope use in patients undergoing concomitant coronary artery bypass graft (CABG and aortic valve replacement (AVR surgeries at separation from cardiopulmonary bypass (CPB

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    Nelson William B

    2009-06-01

    Full Text Available Abstract Background Left ventricular dysfunction is common after coronary artery bypass graft and valve replacement surgeries and is often treated with inotropic drugs to maintain adequate hemodynamic status. In this study, we aimed to identify the demographic, clinical, laboratory, echocardiographic and hemodynamic factors that are associated with use of inotropic drugs in patients undergoing concomitant coronary artery bypass graft and aortic valve replacement surgery. Methods The study included 97 patients who had undergone concomitant coronary artery bypass graft and aortic valve replacement at Regions Hospital, University of Minnesota Medical School from January 2006 to December 2008. All data were collected retrospectively after reviewing electronic medical records. Inotropic support was defined as the use of dopamine [greater than or equal to] 5 ug/kg/min; any dose of epinephrine, norepinephrine, dobutamine, and milrinone at the separation from cardiopulmonary bypass. Results Inotropic support was used in a total of 50 patients (52% at the separation from cardiopulmonary bypass. Average age of the patients requiring inotropic support was 72.2 +/- 8.8 years. The study identified four significant, independent predictors of inotrope use: (1 Cardiac index [less than or equal to]2.5 L/min/m2, (2 LVEDP [greater than or equal to] 20 mm Hg, (3 LVEF [less than or equal to]40%, and (4 CKD stage 3 to 5. Conclusion We identified four independent risk factors for postoperative use of inotropic support in patients undergoing concomitant coronary artery bypass graft and arotic valve replacement surgery at the separation from cardiopulmonary bypass. The study results will be helpful to prospectively identify patients who will likely to require inotropic support at the separation from cardiopulmonary bypass.

  8. Comparison of geometric uncertainties using electronic portal imaging device in focal three-dimensional conformal radiation therapy using different head supports

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    Budrukkar Ashwini

    2008-01-01

    Full Text Available Aims and Objectives: To study the geometric uncertainties in the treatment and evaluate the adequacy of the margins employed for planning target volume (PTV generation in the treatment of focal conformal radiotherapy (CRT for patients with brain tumors treated with different head support systems. Materials and Methods: The study population included 11 patients with brain tumors who were to be treated with CRT. Contrast-enhanced planning CT scan (5-mm spacing and reconstructed to 2 mm of brain were performed. Five patients were immobilized using neck support only (NR-only and six patients had neck support with flexion (NRF, the form of immobilization being decided by the likely beam arrangements to be employed for that particular patient. The data was transferred to the planning system (CadPlan where three-dimensional conformal radiation therapy was planned. Digitally reconstructed radiographs (DRRs were created for the orthogonal portals with the fixed field sizes of 10 x 10 taken at the isocenter. Treatment verification was done using an amorphous silicon detector portal imaging device for using orthogonal portals and the DRR was used as a reference image. An image matching software was used to match the anatomical landmarks in the DRR and the portal imaging and the displacement of the portals in x, y axis and rotation were noted in the anteroposterior (AP and lateral images. Electronic portal imaging was repeated twice weekly and an average of 8-14 images per patient was recorded. The mean deviation in all the directions was calculated for the each patient. Comparison of setup errors between the two head support systems was done. Results: A total 224 images were studied in anterior and lateral portals. The patient group with NR-only had 100 images, while the NRF group had 124 images. The mean total error in all patients, NR-only group, and NRF group was 0.33 mm, 0.24 mm, and 0.79 mm in the mediolateral (ML direction; 1.16 mm, 0.14 mm, and 2

  9. Reliability and Responsiveness of Cardiopulmonary Exercise Testing in Fatigued Persons with Multiple Sclerosis and Low to Mild Disability

    NARCIS (Netherlands)

    Heine, Martin; van den Akker, Lizanne Eva; Verschuren, Olaf; Visser-Meily, Anne; Kwakkel, Gert

    2015-01-01

    Background Peak oxygen uptake (VO(2)peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons

  10. Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: frequency, time course and risk factors.

    Science.gov (United States)

    Nys, Monique; Venneman, Ingrid; Deby-Dupont, Ginette; Preiser, Jean-Charles; Vanbelle, Sophie; Albert, Adelin; Camus, Gérard; Damas, Pierre; Larbuisson, Robert; Lamy, Maurice

    2007-05-01

    Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively.

  11. Human Biomechanical and Cardiopulmonary Responses to Partial Gravity – A Systematic Review

    Science.gov (United States)

    Richter, Charlotte; Braunstein, Bjoern; Winnard, Andrew; Nasser, Mona; Weber, Tobias

    2017-01-01

    The European Space Agency has recently announced to progress from low Earth orbit missions on the International Space Station to other mission scenarios such as exploration of the Moon or Mars. Therefore, the Moon is considered to be the next likely target for European human space explorations. Compared to microgravity (μg), only very little is known about the physiological effects of exposure to partial gravity (μg gravity gravity environments. This systematic review summarizes the different effects of partial gravity (0.1–0.4 g) on the human musculoskeletal, cardiovascular and respiratory systems using data collected during the Apollo missions as well as outcomes from terrestrial models of reduced gravity with either 1 g or microgravity as a control. The evidence-based findings seek to facilitate decision making concerning the best medical and exercise support to maintain astronauts' health during future missions in partial gravity. The initial search generated 1,323 publication hits. Out of these 1,323 publications, 43 studies were included into the present analysis and relevant data were extracted. None of the 43 included studies investigated long-term effects. Studies investigating the immediate effects of partial gravity exposure reveal that cardiopulmonary parameters such as heart rate, oxygen consumption, metabolic rate, and cost of transport are reduced compared to 1 g, whereas stroke volume seems to increase with decreasing gravity levels. Biomechanical studies reveal that ground reaction forces, mechanical work, stance phase duration, stride frequency, duty factor and preferred walk-to-run transition speed are reduced compared to 1 g. Partial gravity exposure below 0.4 g seems to be insufficient to maintain musculoskeletal and cardiopulmonary properties in the long-term. To compensate for the anticipated lack of mechanical and metabolic stimuli some form of exercise countermeasure appears to be necessary in order to maintain reasonable astronauts

  12. Indications for Cardiopulmonary Bypass During Pregnancy and Impact on Fetal Outcomes

    Science.gov (United States)

    Yuan, S.-M.

    2014-01-01

    Background: Cardiac operations in pregnant patients are a challenge for physicians in multidisciplinary teams due to the complexity of the condition which affects both mother and baby. Management strategies vary on a case-by-case basis. Feto-neonatal and maternal outcomes after cardiopulmonary bypass (CPB) in pregnancy, especially long-term follow-up results, have not been sufficiently described. Methods: This review was based on a complete literature retrieval of articles published between 1991 and April 30, 2013. Results: Indications for CPB during pregnancy were cardiac surgery in 150 (96.8 %) patients, most of which consisted of valve replacements for mitral and/or aortic valve disorders, resuscitation due to amniotic fluid embolism, autotransfusion, and circulatory support during cesarean section to improve patient survival in 5 (3.2 %) patients. During CPB, fetuses showed either a brief heart rate drop with natural recovery after surgery or, in most cases, fetal heart rate remained normal throughout the whole course of CPB. Overall feto-neonatal mortality was 18.6 %. In comparison with pregnant patients whose baby survived, feto-neonatal death occurred after a significantly shorter gestational period at the time of onset of cardiac symptoms, cardiac surgery/resuscitation under CPB in the whole patient setting, or cardiac surgery/resuscitation with CPB prior to delivery. Conclusions: The most common surgical indications for CPB during pregnancy were cardiac surgery, followed by resuscitation for cardiopulmonary collapse. CPB was used most frequently in maternal cardiac surgery/resuscitation in the second trimester. Improved CPB conditions including high flow, high pressure and normothermia or mild hypothermia during pregnancy have benefited maternal and feto-neonatal outcomes. A shorter gestational period and the use of CPB during pregnancy were closely associated with feto-neonatal mortality. It is therefore important to attempt delivery ahead of

  13. Echocardiography integrated ACLS protocol versus con-ventional cardiopulmonary resuscitation in patients with

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2012-11-01

    Full Text Available 【Abstract】Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA cardiac arrest and pre-dicting the resuscitation outcomes. Methods: In this prospective interventional study, pa-tients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri-cardial effusion/tamponade and IVC size along with the ad-vanced cardiac life support (ACLS protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC and death were evaluated in both groups. Results: One hundred patients with the mean age of (58±6.1 years were enrolled in this study. Fifty patients (Group A had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR. Among them, 7 pa-tients (14% had pericardial effusion, 11 (22% had hypovolemia, and 39 (78% were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA, 43% had ROSC (positive predictive value and in the true PEA subgroup with cardiac standstill (absence of MVA, there was no recorded ROSC (negative predictive value. Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P=0.52. Conclusion: Bedside echocardiography can identify some reversible causes of PEA. However, there are no sig-nificant changes in survival outcome between the echo group and those with traditional CPR. Key words: Heart arrest; Echocardiography; Car-diopulmonary resuscitation

  14. Cardiopulmonary performance testing using a robotics-assisted tilt table: feasibility assessment in able-bodied subjects.

    Science.gov (United States)

    Saengsuwan, J; Laubacher, M; Nef, T; Hunt, K J

    2014-01-01

    Robotics-assisted tilt table technology was introduced for early rehabilitation of neurological patients. It provides cyclical stepping movement and physiological loading of the legs. The aim of the present study was to assess the feasibility of this type of device for peak cardiopulmonary performance testing using able-bodied subjects. A robotics-assisted tilt table was augmented with force sensors in the thigh cuffs and a work rate estimation algorithm. A custom visual feedback system was employed to guide the subjects' work rate and to provide real time feedback of actual work rate. Feasibility assessment focused on: (i) implementation (technical feasibility), and (ii) responsiveness (was there a measurable, high-level cardiopulmonary reaction?). For responsiveness testing, each subject carried out an incremental exercise test to the limit of functional capacity with a work rate increment of 5 W/min in female subjects and 8 W/min in males. 11 able-bodied subjects were included (9 male, 2 female; age 29.6 ± 7.1 years: mean ± SD). Resting oxygen uptake (O_{2}) was 4.6 ± 0.7 mL/min/kg and O_{2}peak was 32.4 ± 5.1 mL/min/kg; this mean O_{2}peak was 81.1% of the predicted peak value for cycle ergometry. Peak heart rate (HRpeak) was 177.5 ± 9.7 beats/min; all subjects reached at least 85% of their predicted HRpeak value. Respiratory exchange ratio (RER) at O_{2}peak was 1.02 ± 0.07. Peak work rate) was 61.3 ± 15.1 W. All subjects reported a Borg CR10 value for exertion and leg fatigue of 7 or more. The robotics-assisted tilt table is deemed feasible for peak cardiopulmonary performance testing: the approach was found to be technically implementable and substantial cardiopulmonary responses were observed. Further testing in neurologically-impaired subjects is warranted.

  15. Gene expression profile after cardiopulmonary bypass and cardioplegic arrest.

    Science.gov (United States)

    Ruel, Marc; Bianchi, Cesario; Khan, Tanveer A; Xu, Shu; Liddicoat, John R; Voisine, Pierre; Araujo, Eugenio; Lyon, Helen; Kohane, Isaac S; Libermann, Towia A; Sellke, Frank W

    2003-11-01

    This study examines the cardiac and peripheral gene expression responses to cardiopulmonary bypass and cardioplegic arrest. Atrial myocardium and skeletal muscle were harvested from 16 patients who underwent coronary artery bypass grafting before and after cardiopulmonary bypass and cardioplegic arrest. Ten sample pairs were selected for patient similarity, and oligonucleotide microarray analyses of 12,625 genes were performed using matched precardiopulmonary bypass tissues as controls. Array results were validated with Northern blotting, real-time polymerase chain reaction, in situ hybridization, and immunoblotting. Statistical analyses were nonparametric. Median durations of cardiopulmonary bypass and cardioplegic arrest were 74 and 60 minutes, respectively. Compared with precardiopulmonary bypass, postcardiopulmonary bypass myocardial tissues revealed 480 up-regulated and 626 down-regulated genes with a threshold P value of.025 or less (signal-to-noise ratio: 3.46); skeletal muscle tissues showed 560 and 348 such genes, respectively (signal-to-noise ratio: 3.04). Up-regulated genes in cardiac tissues included inflammatory and transcription activators FOS; jun B proto-oncogene; nuclear receptor subfamily 4, group A, member 3; MYC; transcription factor-8; endothelial leukocyte adhesion molecule-1; and cysteine-rich 61; apoptotic genes nuclear receptor subfamily 4, group A, member 1 and cyclin-dependent kinase inhibitor 1A; and stress genes dual-specificity phosphatase-1, dual-specificity phosphatase-5, and B-cell translocation gene 2. Up-regulated skeletal muscle genes included interleukin 6; interleukin 8; tumor necrosis factor receptor superfamily, member 11B; nuclear receptor subfamily 4, group A, member 3; transcription factor-8; interleukin 13; jun B proto-oncogene; interleukin 1B; glycoprotein Ib, platelet, alpha polypeptide; and Ras-associated protein RAB27A. Down-regulated genes included haptoglobin and numerous immunoglobulins in the heart, and factor H

  16. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Science.gov (United States)

    Gervais, H W

    2001-03-01

    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  17. Popular Hybrid Congenital Heart Procedures without Cardiopulmonary Bypass

    Science.gov (United States)

    Gupta, Aamisha; Amin, Zahid

    2017-01-01

    As surgical and catheter interventions advance, patients with congenital heart disease are now offered alternative treatment options that cater to their individual needs. Furthermore, collaboration between interventional cardiologists and cardiac surgeons have led to the development of hybrid procedures, using the best techniques of each respective field to treat these complex cardiac entities from initial treatment in the pediatric patient to repeat intervention in the adult. We present a review of the increased popularity and trend in hybrid procedures in congenital heart disease without the use of cardiopulmonary bypass.

  18. [Serum immune complexes and cardiopulmonary bypass. A review of thirty-four cases (author's transl)].

    Science.gov (United States)

    Herreman, G; Poisson-Lespassailles, C; Puech, H; Vanetti, A; Delaunay, L; Yvart, J; Fermé, I

    1982-05-20

    The immunologic status of patients undergoing cardiopulmonary bypass as investigated. Rheumatoid factor, cryoglobulinemia and serum immune complexes were looked for. Studies were performed before the operation and eight or fifteen days later. From the results, it is concluded that the immunologic changes that occur in the immediate postoperative period cannot be interpreted because of the profound modifications resulting from cardiopulmonary bypass.

  19. Possible fire hazard caused by mismatching electrical chargers with the incorrect device within the operating room.

    LENUS (Irish Health Repository)

    Hargrove, Martin

    2012-02-03

    It has come to our attention that numerous devices that need charging adaptors during cardiopulmonary bypass (CPB) have similar charging sockets but different voltage requirements. This has caused one of our devices in the operating theater to overheat and completely shut down when connected to an incorrect higher-voltage charger. The possibility of fire, device destruction, or patient harm in such circumstances is of serious concern.

  20. Better self-management and meaningful activities thanks to tablets? Development of a person-centered program to support people with mild dementia and their carers through use of hand-held touch screen devices

    NARCIS (Netherlands)

    Kerkhof, Y.J.; Graff, M.J.L.; Bergsma, A.; Vocht, H.H. de; Droes, R.M.

    2016-01-01

    BACKGROUND: To offer good support to people with dementia and their carers in an aging and Internet society the deployment of hand-held touch screen devices, better known as tablets, and its applications (apps) can be viable and desirable. However, at the moment it is not clear which apps are usable

  1. Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Lannemyr, Lukas; Bragadottir, Gudrun; Krumbholz, Vitus; Redfors, Bengt; Sellgren, Johan; Ricksten, Sven-Erik

    2017-02-01

    Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. The authors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients undergoing cardiac surgery. Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic cardiopulmonary bypass (2.5 l · min · m) were included after informed consent. Systemic and renal hemodynamic variables were measured by pulmonary artery and renal vein catheters before, during, and after cardiopulmonary bypass. Arterial and renal vein blood samples were taken for measurements of renal oxygen delivery and consumption. Renal oxygenation was estimated from the renal oxygen extraction. Urinary N-acetyl-β-D-glucosaminidase was measured before, during, and after cardiopulmonary bypass. Cardiopulmonary bypass induced a renal vasoconstriction and redistribution of blood flow away from the kidneys, which in combination with hemodilution decreased renal oxygen delivery by 20%, while glomerular filtration rate and renal oxygen consumption were unchanged. Thus, renal oxygen extraction increased by 39 to 45%, indicating a renal oxygen supply/demand mismatch during cardiopulmonary bypass. After weaning from cardiopulmonary bypass, renal oxygenation was further impaired due to hemodilution and an increase in renal oxygen consumption, accompanied by a seven-fold increase in the urinary N-acetyl-β-D-glucosaminidase/creatinine ratio. Cardiopulmonary bypass impairs renal oxygenation due to renal vasoconstriction and hemodilution during and after cardiopulmonary bypass, accompanied by increased release of a tubular injury marker.

  2. Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer

    Institute of Scientific and Technical Information of China (English)

    MAO You-sheng; WANG Yong-gang; HUANG Jin-feng; HE Jie; YAN Shao-ping; Dong Jing-si; CHENG Gui-yu; SUN Ke-lin; LIU Xiang-yang; FANG De-kang; LI Jian

    2010-01-01

    Background It is still unclear whether pulmonary function tests (PFTs) are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test (CPET) for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs (spirometry + single-breath carbon monoxide diffusing capacity of the lungs (DLCOsb) for diffusion capacity) and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone (15 cases) and operation-related complications (6 cases). Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients (25.2%) had postoperative cardiopulmonary complications. Three patients (1.5%)died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients' cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in

  3. Planar electrochemical device assembly

    Science.gov (United States)

    Jacobson, Craig P.; Visco, Steven J.; De Jonghe, Lutgard C.

    2007-06-19

    A pre-fabricated electrochemical device having a dense electrolyte disposed between an anode and a cathode preferably deposited as thin films is bonded to a porous electrically conductive support. A second porous electrically conductive support may be bonded to a counter electrode of the electrochemical device. Multiple electrochemical devices may be bonded in parallel to a single porous support, such as a perforated sheet to provide a planar array. Planar arrays may be arranged in a stacked interconnected array. A method of making a supported electrochemical device is disclosed wherein the method includes a step of bonding a pre-fabricated electrochemical device layer to an existing porous metal or porous metal alloy layer.

  4. Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection.

    Science.gov (United States)

    Kallianos, Anastasios; Rapti, Aggeliki; Tsimpoukis, Sotirios; Charpidou, Andriani; Dannos, Ioannis; Kainis, Elias; Syrigos, Konstantinos

    2014-01-01

    Lung resection is still the only potentially curative therapy for patients with localized non-small lung cancer (NSCLC). However, the presence of cardiovascular comorbidities and underlying lung disease increases the risk of postoperative complications. Various studies have evaluated the use of different preoperative tests in order to identify patients with an increased risk for postoperative complications, associated with prolonged hospital stay and increased morbidity and mortality. In this topic review, we discuss the role of cardiopulmonary exercise testing (CPET) as one of the preoperative tests suggested for lung cancer patients scheduled for lung resection. We describe different types of exercise testing techniques and present algorithms of preoperative evaluation in lung cancer patients. Overall, patients with maximal oxygen consumption (VO2max) VO2max <15 mL/kg/min and both postoperative FEV1 and DLCO<40% predicted, are at high risk for perioperative death and postoperative cardiopulmonary complications, and thus should be offered an alternative medical treatment option. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  5. Gravity and the evolution of cardiopulmonary morphology in snakes.

    Science.gov (United States)

    Lillywhite, Harvey B; Albert, James S; Sheehy, Coleman M; Seymour, Roger S

    2012-02-01

    Physiological investigations of snakes have established the importance of heart position and pulmonary structure in contexts of gravity effects on blood circulation. Here we investigate morphological correlates of cardiopulmonary physiology in contexts related to ecology, behavior and evolution. We analyze data for heart position and length of vascular lung in 154 species of snakes that exhibit a broad range of characteristic behaviors and habitat associations. We construct a composite phylogeny for these species, and we codify gravitational stress according to species habitat and behavior. We use conventional regression and phylogenetically independent contrasts to evaluate whether trait diversity is correlated with gravitational habitat related to evolutionary transitions within the composite tree topology. We demonstrate that snake species living in arboreal habitats, or which express strongly climbing behaviors, possess relatively short blood columns between the heart and the head, as well as relatively short vascular lungs, compared to terrestrial species. Aquatic species, which experience little or no gravity stress in water, show the reverse - significantly longer heart-head distance and longer vascular lungs. These phylogenetic differences complement the results of physiological studies and are reflected in multiple habitat transitions during the evolutionary histories of these snake lineages, providing strong evidence that heart-to-head distance and length of vascular lung are co-adaptive cardiopulmonary features of snakes.

  6. Hypothermia and normothermia effects on mortality rate of cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ali Rahdari

    2015-12-01

    Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.

  7. Home-based mobile cardio-pulmonary rehabilitation consultant system.

    Science.gov (United States)

    Lee, Hsu-En; Wang, Wen-Chih; Lu, Shao-Wei; Wu, Bo-Yuan; Ko, Li-Wei

    2011-01-01

    Cardiovascular diseases are the most popular cause of death in the world recently. For postoperatives, cardiac rehabilitation is still asked to maintain at home (phase II) to improve cardiac function. However, only one third of outpatients do the exercise regularly, reflecting the difficulty for home-based healthcare: lacking of monitoring and motivation. Hence, a cardio-pulmonary rehabilitation system was proposed in this research to improve rehabilitation efficiency for better prognosis. The proposed system was built on mobile phone and receiving electrocardiograph (ECG) signal from a wireless ECG holter via Bluetooth connection. Apart from heart rate (HR) monitor, an ECG derived respiration (EDR) technique is also included to provide respiration rate (RR). Both HR and RR are the most important vital signs during exercise but only used one physiological signal recorder in this system. In clinical test, there were 15 subjects affording Bruce Task (treadmill) to simulate rehabilitation procedure. Correlation between this system and commercial product (Custo-Med) was up to 98% in HR and 81% in RR. Considering the prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend were also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise.

  8. Effects of resistance exercise on cardiopulmonary factors in sedentary individuals.

    Science.gov (United States)

    Janyacharoen, Taweesak; Thayon, Methiya; Bushong, Wanwisa; Jaikla, Nussamol; Sawanyawisuth, Kittisak

    2016-01-01

    [Purpose] This study investigated the effects of resistance exercise on cardiopulmonary functions in young sedentary subjects. [Subjects] Forty-two young and healthy subjects with a sedentary lifestyle were included in this study. [Methods] The subjects were randomly divided into 2 groups: control and experimental. The control group (n=21) received health education and continued with normal activities of daily living. The experimental group (n=21) underwent resistance training, health education, and continued with normal activities of daily living. The resistance exercise program consisted of 3 postural exercises: chest press, dumbbell pullover, and flat-bench dumbbell fly. The subjects received this intervention 3 times/week for 8 weeks. [Results] The baseline characteristics were comparable between the 2 groups. The 6-minute-walk test score, peak expiratory flow, forced vital capacity, forced expiratory volume in 1 second, maximal voluntary ventilation, and chest expansions were significantly improved post-intervention in the experimental group and between the 2 groups. [Conclusion] Cardiopulmonary functions in young sedentary subjects were significantly improved with the 8-week resistance exercise program.

  9. Myocardial contractile function in survived neonatal piglets after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Popov Aron-Frederik

    2010-11-01

    Full Text Available Abstract Background Hemodynamic function may be depressed in the early postoperative stages after cardiac surgery. The aim of this study was the analysis of the myocardial contractility in neonates after cardiopulmonary bypass (CPB and mild hypothermia. Methods Three indices of left ventricular myocardial contractile function (dP/dt, (dP/dt/P, and wall thickening were studied up to 6 hours after CPB in neonatal piglets (CPB group; n = 4. The contractility data were analysed and then compared to the data of newborn piglets who also underwent median thoracotomy and instrumentation for the same time intervals but without CPB (non-CPB group; n = 3. Results Left ventricular dP/dtmax and (dP/dtmax/P remained stable in CPB group, while dP/dtmax decreased in non-CPB group 5 hours postoperatively (1761 ± 205 mmHg/s at baseline vs. 1170 ± 205 mmHg/s after 5 h; p max and (dP/dtmax/P there were no statistically significant differences between the two groups. Comparably, although myocardial thickening decreased in the non-CPB group the differences between the two groups were not statistically significant. Conclusions The myocardial contractile function in survived neonatal piglets remained stable 6 hours after cardiopulmonary bypass and mild hypothermia probably due to regional hypercontractility.

  10. Gravity and the Evolution of Cardiopulmonary Morphology in Snakes

    Science.gov (United States)

    Lillywhite, Harvey B.; Albert, James S.; Sheehy, Coleman M.; Seymour, Roger S.

    2011-01-01

    Physiological investigations of snakes have established the importance of heart position and pulmonary structure in contexts of gravity effects on blood circulation. Here we investigate morphological correlates of cardiopulmonary physiology in contexts related to ecology, behavior and evolution. We analyze data for heart position and length of vascular lung in 154 species of snakes that exhibit a broad range of characteristic behaviors and habitat associations. We construct a composite phylogeny for these species, and we codify gravitational stress according to species habitat and behavior. We use conventional regression and phylogenetically independent contrasts to evaluate whether trait diversity is correlated with gravitational habitat related to evolutionary transitions within the composite tree topology. We demonstrate that snake species living in arboreal habitats, or which express strongly climbing behaviors, possess relatively short blood columns between the heart and the head, as well as relatively short vascular lungs, compared to terrestrial species. Aquatic species, which experience little or no gravity stress in water, show the reverse – significantly longer heart–head distance and longer vascular lungs. These phylogenetic differences complement the results of physiological studies and are reflected in multiple habitat transitions during the evolutionary histories of these snake lineages, providing strong evidence that heart–to–head distance and length of vascular lung are co–adaptive cardiopulmonary features of snakes. PMID:22079804

  11. Cardiac Health Risk Stratification System (CHRiSS: a Bayesian-based decision support system for left ventricular assist device (LVAD therapy.

    Directory of Open Access Journals (Sweden)

    Natasha A Loghmanpour

    Full Text Available This study investigated the use of Bayesian Networks (BNs for left ventricular assist device (LVAD therapy; a treatment for end-stage heart failure that has been steadily growing in popularity over the past decade. Despite this growth, the number of LVAD implants performed annually remains a small fraction of the estimated population of patients who might benefit from this treatment. We believe that this demonstrates a need for an accurate stratification tool that can help identify LVAD candidates at the most appropriate point in the course of their disease. We derived BNs to predict mortality at five endpoints utilizing the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS database: containing over 12,000 total enrolled patients from 153 hospital sites, collected since 2006 to the present day, and consisting of approximately 230 pre-implant clinical variables. Synthetic minority oversampling technique (SMOTE was employed to address the uneven proportion of patients with negative outcomes and to improve the performance of the models. The resulting accuracy and area under the ROC curve (% for predicted mortality were 30 day: 94.9 and 92.5; 90 day: 84.2 and 73.9; 6 month: 78.2 and 70.6; 1 year: 73.1 and 70.6; and 2 years: 71.4 and 70.8. To foster the translation of these models to clinical practice, they have been incorporated into a web-based application, the Cardiac Health Risk Stratification System (CHRiSS. As clinical experience with LVAD therapy continues to grow, and additional data is collected, we aim to continually update these BN models to improve their accuracy and maintain their relevance. Ongoing work also aims to extend the BN models to predict the risk of adverse events post-LVAD implant as additional factors for consideration in decision making.

  12. North American neonatal extracorporeal membrane oxygenation (ECMO) devices and team roles: 2008 survey results of Extracorporeal Life Support Organization (ELSO) centers.

    Science.gov (United States)

    Lawson, D Scott; Lawson, Andrea F; Walczak, Rich; McRobb, Craig; McDermott, Patty; Shearer, Ian R; Lodge, Andrew; Jaggers, James

    2008-09-01

    In early 2008, surveys of active extracorporeal membrane oxygenation (ECMO) centers in North America were conducted by electronic mail regarding neonatal ECMO equipment and professional staff. Eighty of 103 (78%) North American ECMO centers listed in the Extracorporeal Life Support Organization directory as neonatal centers responded to the survey. Of the responding centers, 82.5% routinely used roller pumps for neonatal ECMO, and the remaining 17.5% used centrifugal pumps. Silicone membrane oxygenators were used by 67% of the respondents, whereas 19% used micro-porous hollow fiber oxygenators, and 14% used polymethylpentene hollow fiber oxygenators. Of the silicone membrane oxygenator users, 86% used the Medtronic Ecmotherm heat exchanger, 10% used the Gish HE-4 heat exchanger, and 4% used the Terumo Conducer device. Sixty-four percent of the responding centers used some form of in-line blood gas monitoring. Six percent of the centers used a bubble trap in the arterial line, and 5% used an arterial line filter. A bladder was used by 85% of the centers, and 4% of these used a mechanical bladder box for servo regulation; the remaining 96% used pressure servo regulation. An air bubble detector was used by 88% of the responding centers. A surface coating was used by 44% of the centers on all their neonatal ECMO patients. Thirty-one percent of the centers use an activated clotting time of 180-220 seconds. At 54% of the responding centers, perfusionists were involved with the ECMO program, registered nurses were involved at 70% of the centers, and respiratory therapists were involved at 46% of the centers. Compared with a 2002 survey, silicone membrane use is declining, and the use of centrifugal blood pumps and coated ECMO circuits is becoming more apparent. ECMO teams are still multidisciplinary, made up of combinations of registered nurses, respiratory therapists, and perfusionists.

  13. Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices.

    Science.gov (United States)

    Topkara, Veli K; Coromilas, Ellie J; Garan, Arthur Reshad; Li, Randall C; Castagna, Francesco; Jennings, Douglas L; Yuzefpolskaya, Melana; Takeda, Koji; Takayama, Hiroo; Sladen, Robert N; Mancini, Donna M; Naka, Yoshifumi; Radhakrishnan, Jai; Colombo, Paolo C

    2016-12-01

    Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation. Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015. Baseline demographics, comorbid conditions, clinical risk scores, and renal function were analyzed in patients with or without RRT after CF-LVAD implantation. Time-dependent receiver-operating characteristic curve analysis was performed to define optimal cutoffs for continuous risk factors. Forty-four patients (11.6%) required RRT during a median follow-up of 9.9 months. Patients requiring RRT had significantly worse renal function, lower hemoglobin, and increased proteinuria at baseline. Low estimated glomerular filtration rate (proteinuria (urine protein to creatinine ratio ≥0.55 mg/mg) were significant predictors of RRT after CF-LVAD support. Dipstick proteinuria was also a significant predictor of RRT after CF-LVAD implantation. Patients with both low estimated glomerular filtration rate and proteinuria had highest risk of RRT (63.6%) compared with those with either low estimated glomerular filtration rate or proteinuria (18.7%) and those with neither of these risk factors (2.7%) at 1-year follow-up (log-rank Pproteinuria are predictors RRT after CF-LVAD implantation and should be routinely assessed in CF-LVAD candidates to guide decision making. © 2016 American Heart Association, Inc.

  14. Descriptive Analysis of Medication Administration During Inpatient Cardiopulmonary Arrest Resuscitation (from the Mayo Registry for Telemetry Efficacy in Arrest Study).

    Science.gov (United States)

    Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Dumitrascu, Adrian; Harris, Dana; Bosworth, Veronica; Clark, Brooke; Thomas, Colleen S; Heckman, Michael G; Vadeboncoeur, Tyler; Kusumoto, Fred; Burton, M Caroline

    2016-05-15

    Advanced cardiovascular life support guidelines exist, yet there are variations in clinical practice. Our study aims to describe the utilization of medications during resuscitation from in-hospital cardiopulmonary arrest. A retrospective review of patients who suffered a cardiopulmonary arrest from May 2008 to June 2014 was performed. Clinical and resuscitation data, including timing and dose of medications used, were extracted from the electronic medical record and comparisons made. A total of 94 patients were included in the study. Patients were divided into different groups based on the medication combination used during resuscitation: (1) epinephrine; (2) epinephrine and bicarbonate; (3) epinephrine, bicarbonate, and calcium; (4) epinephrine, bicarbonate, and epinephrine drip; and (5) epinephrine, bicarbonate, calcium, and epinephrine drip. No difference in baseline demographics or clinical data was present, apart from history of dementia and the use of calcium channel blockers. The number of medications given was correlated with resuscitation duration (Spearman's rank correlation = 0.50, p <0.001). The proportion of patients who died during the arrest was 12.5% in those who received epinephrine alone, 30.0% in those who received only epinephrine and bicarbonate, and 46.7% to 57.9% in the remaining groups. Patients receiving only epinephrine had shorter resuscitation durations compared to that of the other groups (p <0.001) and improved survival (p = 0.003). In conclusion, providers frequently use nonguideline medications in resuscitation efforts for in-hospital cardiopulmonary arrests. Increased duration and mortality rates were found in those resuscitations compared with epinephrine alone, likely due to the longer resuscitation duration in the former groups. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Evaluation of Smartphone Applications for Cardiopulmonary Resuscitation Training in South Korea

    Directory of Open Access Journals (Sweden)

    Chiwon Ahn

    2016-01-01

    Full Text Available Objective. There are many smartphone-based applications (apps for cardiopulmonary resuscitation (CPR training. We investigated the conformity and the learnability/usability of these apps for CPR training and real-life supports. Methods. We conducted a mixed-method, sequential explanatory study to assess CPR training apps downloaded on two apps stores in South Korea. Apps were collected with inclusion criteria as follows, Korean-language instruction, training features, and emergency supports for real-life incidents, and analyzed with two tests; 15 medical experts evaluated the apps’ contents according to current Basic Life Support guidelines in conformity test, and 15 nonmedical individuals examined the apps using System Usability Scale (SUS in the learnability/usability test. Results. Out of 79 selected apps, five apps were included and analyzed. For conformity (ICC, 0.95, p<0.001, means of all apps were greater than 12 of 20 points, indicating that they were well designed according to current guidelines. Three of the five apps yielded acceptable level (greater than 68 of 100 points for learnability/usability. Conclusion. All the included apps followed current BLS guidelines and a majority offered acceptable learnability/usability for layperson. Current and developmental smartphone-based CPR training apps should include accurate CPR information and be easy to use for laypersons that are potential rescuers in real-life incidents. For Clinical Trials. This is a clinical trial, registered at the Clinical Research Information Service (CRIS, cris.nih.go.kr, number KCT0001840.

  16. FLUIDICS DEVICE FOR ASSAY

    DEFF Research Database (Denmark)

    2007-01-01

    The present invention relates to a device for use in performing assays on standard laboratory solid supports whereon chemical entities are attached. The invention furthermore relates to the use of such a device and a kit comprising such a device. The device according to the present invention is a......, when operatively connected, one or more chambers (21) comprising the chemical entities (41), the inlet(s) (5) and outlet(s) (6) and chambers (21) being in fluid connection. The device further comprise means for providing differing chemical conditions in each chamber (21)....

  17. Electrooptical devices

    Science.gov (United States)

    Hurwitz, C. E.

    1980-03-01

    This report covers work carried out with support of the Department of the Air Force during the period 1 October 1979 through 31 March 1980. A part of this support was provided by the Rome Air Development Center. CW operation at temperatures up to 55 C has been achieved for GaInAsP/InP double-heterostructure (DH) lasers emitting at 1.5 micrometers, which were grown without a GaInAsP buffer layer. These devices are of interest for use as sources in fiber-optics communications systems, since the lowest transmission loss reported for fused-silica optical fibers occurs at 1.55 micrometers. Surface passivation techniques developed for InP and GaInAsP avalanche photodiodes have resulted in reductions of dark current as large as four orders of magnitude, to values as low as .0000016 A/sq cm at 0.9 V(b) where V(b) is the breakdown voltage. Devices consisting entirely of InP have been passivated with plasma-deposited Si3N4, and those with a GaInAsP layer but with the p-n junction in InP have been passivated with polyimide. Neither of these techniques successfully reduces dark currents in devices with the p-n junction in the GaInAsP, but a film of photoresist sprayed with SF6 as the propellant has given excellent results. The electrical characteristics in InP ion implanted with Sn, Ge, Si, and C have been investigated. All of these column IV elements yielded n-type conductivity and Sn, Ge, and Si showed high electrical activation; however, implanted C was found to have a net electrical activation of only about 5 percent.

  18. Pulsatile flow during cardiopulmonary bypass. Evaluation of a new pulsatile pump.

    Science.gov (United States)

    Waaben, J; Andersen, K; Husum, B

    1985-01-01

    Pulsatile cardiopulmonary bypass (CPB) has been suggested to be superior to nonpulsatile CPB. This report concerns a newly developed pulsatile pump for clinical use. It is designed as a positive displacement pump, with blood allowed to collect in a valved cavity from which it is ejected by the reciprocating action of a piston. Using a uniform procedure of anaesthesia and surgery, 14 pigs were subjected to CPB at 37 degrees C for 3 hours. The pulsatile pump was used in seven pigs and a conventional roller pump in the other seven. The wave-form of the pulse during pulsatile CPB was similar to that recorded in the pigs before bypass. The values for rate of pressure change with respect to time (dp/dt) obtained in the aorta were close to the pre-CPB values. No difference was found between the two groups with respect to platelet count or haemolysis. The investigated pulsatile device appeared to be reliable and easy to handle, and the pulsation it produced closely resembled the physiologic pulse-wave form.

  19. A new device for evacuating air from the cardiac chambers.

    Science.gov (United States)

    Zhong, B T

    1993-01-01

    A new device has been developed to provide complete de-airing of the heart after cardiopulmonary bypass. The apparatus consists of a special aspiration needle threaded to the bottom of a transparent bulb. A 1-way flutter valve is mounted at the top of the bulb, which creates a vacuum when the bulb is squeezed. This device has been used in 4 adults and 2 children, for both congenital and acquired heart disease. Preliminary results have shown that this device's active suctioning of air results in effective removal of air from the cardiac chambers; the transparent bulb enables the surgeon to visually determine that the de-airing procedure is complete.

  20. Evaluation of a hollow fiber supported liquid membrane device as a chemical surrogate for the measurements of zinc (II) bioavailability using two microalgae strains as biological references.

    Science.gov (United States)

    Rodríguez-Morales, Erik A; Rodríguez de San Miguel, Eduardo; de Gyves, Josefina

    2017-03-01

    The environmental bioavailability of zinc (II), i.e., the uptake of the element by an organism, was determined using two microalgae species, Scenedesmus acutus and Pseudokirchneriella subcapitata, and estimated using hollow fiber supported liquid membrane (HF-SLM) device as the chemical surrogate. Several experimental conditions were studied including the presence of organic matter, inorganic anions and concomitant cations and pH. The results show strong positive correlation coefficients between the responses given by the HF-SLM and the microalgae species (r = 0.900 for S. acutus and r = 0.876 for P. subcapitata) in multivariate environments (changes in pH, calcium, humic and citrate concentrations). The maximum amount of zinc (II) retained by the HF-SLM (4.7 × 10(-8) mol/cm(2)) was higher than those for P. subcapitata and S. acutus (9.4 × 10(-11) mol/cm(2) and 6.2 × 10(-11) mol/cm(2), respectively). The variation in pH (pH 5.5-9) was the variable with the greatest effect on zinc internalization in all systems, increasing approximately 2.5 times for P. subcapitata and 5.5 times for S. acutus respect to pH = 5.5, while the presence of humic acids did not affect the response. The species' concentration analysis of the experimental design at pH = 5.5 indicated that the amount of internalized zinc (II) by the HF-SLM and both microalgae species is strongly dependent on the free zinc concentration (r = 0.910 for the HF-SLM, r = 0.922 for S. acutus and r = 0.954 for P. subcapitata); however, at pH = 9.0, the amount of internalized zinc (II) is strongly dependent on the sum of free zinc and labile species (r = 0.912 for the HF-SLM, r = 0.947 for S. acutus and r = 0.900 for P. subcapitata). The presence of inorganic ligands (chloride, sulfate, phosphate, carbonate, and nitrate) and metal ions (cobalt (II), copper (II), nickel (II), chromium (VI), lead (II) and cadmium (II)) produced different behaviors both in the chemical surrogate and the

  1. RSView32 in Control System of the Antarctic Expedition Support Device%RSView32在南极科考支撑装置控制系统中的应用

    Institute of Scientific and Technical Information of China (English)

    赵海伦; 方仕雄; 张侃健; 魏海坤

    2013-01-01

    南极科考支撑装置是我国首座独立自主研发的极端条件下的科考支撑装置,主控系统是其控制中枢。针对该装置在特殊工作环境下的可靠性,控制系统采用了冗余控制器及冗余关键传感器等方式。本文在介绍该控制系统的组成基础上,着重介绍了组态软件RSView32在该系统中应用情况,对系统的组态过程、画面的历史趋势和实时趋势等作出了分析。实际测试表明,该系统设计有效,且较为可靠。%The Antarctic Expedition Support Device is the first energy support device that is developed independently by China.The Master Control System is the core of the support device. Considering the special working environment where the support device is used in, redundancy controllers and sensors are designed to enhance the reliability of the system. The paper introduces to the composition of the control system of the Device ,and especially describes the conifguration software RSView32 in the control system.Also the conifguration process of the system,the historical and real-time trend of the key variable,and so on is analyzed in the paper.The test for the control system shows that the system meets the design requirement and the system is effective and reliable.

  2. Cardiopulmonary malformations in the inv/inv mouse.

    Science.gov (United States)

    McQuinn, T C; Miga, D E; Mjaatvedt, C H; Phelps, A L; Wessels, A

    2001-05-01

    The inv/inv mouse carries an insertional mutation in the inversin gene, (inv, for inversion of embryonic turning). Previously it had been reported that almost 100% of the homozygous offspring (inv/inv) were characterized by situs inversus totalis. In this report we identify the spectrum of cardiopulmonary anatomical abnormalities in inv/inv mice surviving to birth to determine whether the abnormalities seen are of the categories classically associated with human situs abnormalities. Stillborn mice, offspring that died unexpectedly (within 48 hr after birth), and neonates with phenotypic characteristics of situs inversus (right-sided stomachs, growth failure or jaundice) were processed for standard histological examination. Of 173 offspring, 34 (20%) neonates (11 stillborn, 9 unexpected deaths, and 14 mice with situs inversus phenotype) were examined, 27 of which were genotyped to be inv/inv. Interestingly, three inv/inv mice (11%) were found to have situs solitus. Twenty-four had situs inversus with normal, mirror-image cardiac anatomy (dextrocardia with atrioventricular concordance, ventriculoarterial concordance and a right aortic arch). The overall incidence of cardiovascular anomalies observed was 10 out of 27 (37%). The most frequent severe malformation, identified in 3 out of 27 animals, was a complex consisting of pulmonary infundibular stenosis/atresia with absence of pulmonary valve tissue and a ventricular septal defect. The pulmonary phenotype in inv/inv mice was situs inversus with occasional minor lobar abnormalities. We conclude that 1) cardiopulmonary malformations in inv/inv mice are not rare (37%), 2) the cardiopulmonary malformations observed in inv/inv specimens are not of the spectrum typically associated with human heterotaxia. In particular, inv/inv mice have a propensity for defects in the development of the right ventricular outflow tract and the interventricular septum, and 3) approximately one out of ten inv/inv mice is born with situs

  3. Preclinical study of a novel hydrodynamically levitated centrifugal pump for long-term cardiopulmonary support : In vivo performance during percutaneous cardiopulmonary support.

    Science.gov (United States)

    Tsukiya, Tomonori; Mizuno, Toshihide; Takewa, Yoshiaki; Tatsumi, Eisuke; Taenaka, Yoshiyuki

    2015-12-01

    An extracorporeal centrifugal blood pump with a hydrodynamically levitated impeller was developed for use in a durable extracorporeal membrane oxygenation (ECMO) system. The present study examined the biocompatibility of the blood pump during long-term use by conducting a series of 30-day chronic animal experiments. The ECMO system was used to produce a percutaneous venoarterial bypass between the venae cavae and carotid artery in adult goats. No anticoagulation or antiplatelet therapy was administered during the experiments. Three out of four animals survived for the scheduled 30-day period, and the blood pumps and membrane oxygenators both exhibited sufficient hydrodynamic performance and good antithrombogenicity, while one animal died of massive bleeding from the outflow cannulation site. The animals' plasma free hemoglobin had returned to within the normal range by 1 week after the surgical intervention, and their hemodynamic and biochemistry parameters remained within their normal ranges throughout the experiment. The explanted centrifugal blood pumps did not display any trace of thrombus formation. Based on the biocompatibility demonstrated in this study, the examined centrifugal blood pump, which includes a hydrodynamically levitated impeller, is suitable for use in durable ECMO systems.

  4. Relationship between pre-implant interleukin-6 levels, inflammatory response, and early outcome in patients supported by left ventricular assist device: a prospective study.

    Directory of Open Access Journals (Sweden)

    Raffaele Caruso

    Full Text Available PURPOSE: The immune response is crucial in the development of multi-organ failure (MOF and complications in end-stage heart failure patients supported by left ventricular assist device (LVAD. However, at pre-implant, the association between inflammatory state and post-LVAD outcome is not yet clarified. Aim of the study was to assess the relationship among pre-implant levels of immune-related cytokines, postoperative inflammatory response and 3-month outcome in LVAD-patients. METHODS: In 41 patients undergoing LVAD implantation, plasma levels of interleukin (IL-6, IL-8, crucial for monocyte modulation, and urine neopterin/creatinine ratio (Neo/Cr, marker of monocyte activation, were assessed preoperatively, at 3 days, 1 and 4 weeks post-LVAD. MOF was evaluated by total sequential organ failure assessment (tSOFA score. Intensive care unit (ICU-death and/or post-LVAD tSOFA ≥11 was considered as main adverse outcome. Length of ICU-stay, 1 week-tSOFA score, hospitalisation and 3-month survival were considered additional end-points. RESULTS: During ICU-stay, 8 patients died of MOF, while 8 of the survivors experienced severe MOF with postoperative tSOFA score ≥11. Pre-implant level of IL-6 ≥ 8.3 pg/mL was identified as significant marker of discrimination between patients with or without adverse outcome (OR 6.642, 95% CI 1.201-36.509, p = 0.030. Patients were divided according to pre-implant IL-6 cutoff of 8.3 pg/ml in A [3.5 (1.2-6.1 pg/mL] and B [24.6 (16.4-38.0 pg/mL] groups. Among pre-implant variables, only white blood cells count was independently associated with pre-implant IL-6 levels higher than 8.3 pg/ml (OR 1.491, 95% CI 1.004-2.217, p = 0.048. The ICU-stay and hospitalisation resulted longer in B-group (p = 0.001 and p = 0.030, respectively. Postoperatively, 1 week-tSOFA score, IL-8 and Neo/Cr levels were higher in B-group. CONCLUSIONS: LVAD-candidates with elevated pre-implant levels of IL-6 are associated, after

  5. The Impact of Extracorporeal Life Support and Hypothermia on Drug Disposition in Critically Ill Infants and Children

    NARCIS (Netherlands)

    E.D. Wildschut (Enno); A. van Saet (Annewil); P. Pokorna (Pavla); M.J. Ahsman (Maurice); J.N. van den Anker (John); D. Tibboel (Dick)

    2012-01-01

    textabstractExtracorporeal membrane oxygenation (ECMO) support is an established lifesaving therapy for potentially reversible respiratory or cardiac failure. In 10% of all pediatric patients receiving ECMO, ECMO therapy is initiated during or after cardiopulmonary resuscitation. Therapeutic

  6. Cardiopulmonary Response to Videogaming: Slaying Monsters Using Motion Sensor Versus Joystick Devices.

    Science.gov (United States)

    Sherman, Jeffrey D; Sherman, Michael S; Heiman-Patterson, Terry

    2014-10-01

    Replacing physical activity with videogaming has been implicated in causing obesity. Studies have shown that using motion-sensing controllers with activity-promoting videogames expends energy comparable to aerobic exercise; however, effects of motion-sensing controllers have not been examined with traditional (non-exercise-promoting) videogames. We measured indirect calorimetry and heart rate in 14 subjects during rest and traditional videogaming using motion sensor and joystick controllers. Energy expenditure was higher while subjects were playing with the motion sensor (1.30±0.32 kcal/kg/hour) than with the joystick (1.07±0.26 kcal/kg/hour; P<0.01) or resting (0.91±0.24 kcal/kg/hour; P<0.01). Oxygen consumption during videogaming averaged 15.7 percent of predicted maximum for the motion sensor and 11.8 percent of maximum for the joystick. Minute ventilation was higher playing with the motion sensor (10.7±3.5 L/minute) than with the joystick (8.6±1.8 L/minute; P<0.02) or resting (6.7±1.4 L/minute; P<0.001), predominantly because of higher respiratory rates (15.2±4.3 versus 20.3±2.8 versus 20.4±4.2 beats/minute for resting, the joystick, and the motion sensor, respectively; P<0.001); tidal volume did not change significantly. Peak heart rate during gaming was 16.4 percent higher than resting (78.0±12.0) for joystick (90.1±15.0; P=0.002) and 17.4 percent higher for the motion sensor (91.6±14.1; P=0.002); mean heart rate did not differ significantly. Playing with a motion sensor burned significantly more calories than with a joystick, but the energy expended was modest. With both consoles, the increased respiratory rate without increasing tidal volume and the increased peak heart rate without increasing mean heart rate are consistent with psychological stimulation from videogaming, rather than a result of exercise. We conclude that using a motion sensor with traditional videogames does not provide adequate energy expenditure to provide cardiovascular conditioning.

  7. Futile cardiopulmonary resuscitation for the benefit of others: an ethical analysis.

    Science.gov (United States)

    Bremer, Anders; Sandman, Lars

    2011-07-01

    It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field.

  8. Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience.

    Science.gov (United States)

    López-Herce, Jesús; Matamoros, Martha M; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, Ángel; Del Castillo, Jimena; Mencía, Santiago; Moral, Ramón; Ordoñez, Flora; Sánchez, Carlos; Lagos, Lina; Johnson, María; Mendoza, Ovidio; Rodriguez, Sandra

    2017-09-12

    To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.

  9. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation.

    Science.gov (United States)

    Cunningham, Lee M; Mattu, Amal; O'Connor, Robert E; Brady, William J

    2012-10-01

    Over the last decade, the importance of delivering high-quality cardiopulmonary resuscitation (CPR) for cardiac arrest patients has become increasingly emphasized. Many experts are in agreement concerning the appropriate compression rate, depth, and amount of chest recoil necessary for high-quality CPR. In addition to these factors, there is a growing body of evidence supporting continuous or uninterrupted chest compressions as an equally important aspect of high-quality CPR. An innovative resuscitation protocol, called cardiocerebral resuscitation, emphasizes uninterrupted chest compressions and has been associated with superior rates of survival when compared with traditional CPR with standard advanced life support. Interruptions in chest compressions during CPR can negatively impact outcome in cardiac arrest; these interruptions occur for a range of reasons, including pulse determinations, cardiac rhythm analysis, electrical defibrillation, airway management, and vascular access. In addition to comparing cardiocerebral resuscitation to CPR, this review article also discusses possibilities to reduce interruptions in chest compressions without sacrificing the benefit of these interventions. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

    Science.gov (United States)

    Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

    2012-01-01

    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

  11. Cardiopulmonary resuscitation in the elderly: a clinical and ethical perspective

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient's wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering.

  12. Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages

    Science.gov (United States)

    de Carvalho Filho, Élio Barreto; Marson, Fernando Augusto de Lima; da Costa, Loredana Nilkenes Gomes; Antunes, Nilson

    2014-01-01

    Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas. PMID:25140478

  13. Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B

    2008-01-01

    individual training. AIMS: To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. METHODS: Forty-three second year medical students were included and CPR performance (ERC Guidelines...... training (P=0.12). However, the IF group performed significantly better than the VAM group in the total score, both immediately after (P=0.0008) and 3 months after training (P=0.02). This difference was primarily related to the BVM skills. CONCLUSION: Skill retention in CPR using a bag-valve-mask......BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during...

  14. Ultrafiltration Technology and Its Application in Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Zhang Kun

    2017-01-01

    Full Text Available The application of cardiopulmonary bypass (CPB technology makes it possible to safely conduct open-heart surgery. However, as an invasive adjuvant therapeutic measure, it cures and greatly injures a human body simultaneously. In CPB, hemodilution, the contact between blood and the surface of foreign matter and other various factors activate the stress response in the body and causes tissue edema, increase in total body water and systemic inflammatory response syndrome (SIRS; in severe cases, they may give rise to organ dysfunction. Ultrafiltration (UF not only can remove the redundant moisture effectively from the body after CPB, concentrate blood cells and recover body fluid equilibrium, but also can clear away part of inflammatory medium, improve postoperative organ function and enhance the clinical effect after an open-heart surgery.

  15. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series.

    Science.gov (United States)

    Träger, Karl; Fritzler, Daniel; Fischer, Guenther; Schröder, Janpeter; Skrabal, Christian; Liebold, Andreas; Reinelt, Helmut

    2016-05-16

    The use of cardiopulmonary bypass (CPB) in cardiothoracic surgery results in a well-known activation of the immunologic response. In some cases, however, this triggered immunologic response may be excessive, leading to a severe systemic inflammatory response syndrome (SIRS) and induced organ dysfunction. For example, patients frequently develop hemodynamic instability with hypotension and low systemic vascular resistance. To date, different therapeutic approaches, such as steroids, have been tried to control this maladaptive postoperative SIRS response, yet definitive proof of clinical efficacy is missing. A new cytokine adsorber device (CytoSorb; CytoSorbents) may be a useful approach to control hyperinflammatory systemic reactions by reducing a broad range of proinflammatory cytokines and other inflammatory mediators. This may, in turn, help to reestablish a physiologic immune response and help to restore deranged clinical parameters in these patients. In this retrospective case series study, we describe 16 cardiac surgery patients following prolonged CPB with post-CPB SIRS and subsequent acute kidney injury, who were then treated with hemoadsorption using CytoSorb in combination with continuous renal replacement therapy (CRRT). Treatment of patients with CytoSorb who presented with severe post-CPB SIRS resulted in a reduction of elevated cytokine levels, which was associated with a clear stabilization of deranged hemodynamic, metabolic, and organ function parameters. Treatment was well tolerated and safe, with no device-related adverse events occurring. CytoSorb therapy combined with CRRT is a potentially promising new treatment approach to achieve hemodynamic stability, cytokine reduction, and improved organ function in cardiac surgery patients who develop post-CPB SIRS.

  16. Electroencephalography during surgery with cardiopulmonary bypass and hypothermia.

    Science.gov (United States)

    Bashein, G; Nessly, M L; Bledsoe, S W; Townes, B D; Davis, K B; Coppel, D B; Hornbein, T F

    1992-06-01

    After more than 30 yr of use, electroencephalographic (EEG) monitoring during cardiopulmonary bypass has not gained wide clinical acceptance. To assess its utility to predict central nervous system injury, two-channel recordings were made from 78 patients undergoing cardiopulmonary bypass and anesthetized with fentanyl/diazepam/enflurane. The perfusion regimen included the use of high pump flow, a bubble oxygenator, and no arterial tubing filter. Target values were 28-32 degrees C for the minimum rectal temperature, 60-80 mmHg for mean arterial pressure, and 20-25% for hematocrit. Eight descriptors of the Fourier power spectra of the EEG were calculated off-line, and outcome comparisons were made with the results from neuropsychological tests. Among 58 patients yielding complete data of acceptable quality, a statistically significant reduction in total power was observed from prebypass to postbypass, accompanied by an increase in the fractional power in the theta and beta frequency bands and in the spectral edge frequency. The shifts in total and theta power were weakly associated with short-term but not with long-term changes in neuropsychological scores. Nearly 40% of the patients' EEGs were corrupted with electrical noise at some time during bypass. In 15 patients selected for having high-quality recordings and no neuropsychological deficit, an extensive statistical analysis failed to reveal any consistent variation in the EEG descriptors with hypothermia. Under the conditions studied, it appears that for other than gross signal dropout, the strong background variability in the EEG makes it have little value for detecting harbingers of brain injury.

  17. Sequestration of fentanyl by the cardiopulmonary bypass (CPBP).

    Science.gov (United States)

    Koren, G; Crean, P; Klein, J; Goresky, G; Villamater, J; MacLeod, S M

    1984-01-01

    Immediately following the connection of pediatric patients to cardiopulmonary bypass we have consistently observed a steep decrease in fentanyl plasma concentration (74 +/- 8.7%) (mean +/- SD), much greater than would have been expected from hemodilution alone (50.6% +/- 12.0%) (p less than 0.0001). Priming of the pump with 20 ng/ml of fentanyl before connection to the patients did not prevent this phenomenon. In order to study the possibility that fentanyl is sequestered by the bypass, levels of the primed drug in the bypass were assessed before connecting the pump to the children and a steep fall from 20 ng/ml to zero was shown before initiation of bypass. Pharmacokinetic assessment of fentanyl in a closed pump circuit showed that levels of 120 ng/ml fall to 2 ng/ml within 3 min and remain stable at the lower concentration for at least 30 min. Further studies have identified the membrane oxygenator as the major site of fentanyl sequestration. Concentrations across the membrane fall from 120 ng/ml to 10 ng/ml. The attached siliconized tubing is associated with a minor binding effect sufficient to reduce concentrations from 110 to 84 ng/ml. The pvc tubing, aluminium heat exchanger and plastic reservoir had no binding effect on fentanyl. The possibility that a decrease in fentanyl protein binding caused the fall in serum concentration was checked in 5 patients undergoing open heart surgery. After initiation of the cardiopulmonary bypass, there was a significant decrease in albumin serum concentrations from 32.0 +/- 2.3 mM to 15.0 +/- 1.6 mM (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Antioxidative effect of propofol during cardiopulmonary bypass in adults

    Institute of Scientific and Technical Information of China (English)

    Shi-hai ZHANG; Shou-yong WANG; Shang-long YAO

    2004-01-01

    AIM: To investigate the antioxidative potential of propofol (an intravenous anesthetic with a chemical structure similar to phenol-based free radical scavengers such as vitamin E) during cardiopulmonary bypass (CPB). METHODS:Thirty adult patients referred for elective cardiac procedure with CPB were included and randomly allocated to a nously for anesthesia maintenance, whereas those allocated to the control group received fentanyl 10 μg/kg intravenously and inhaled enflurane (1%-1.5 %). Blood samples were collected at 7 time points: before the start of CPB,at 30 and 60 min of CPB, at the conclusion of CPB, 10 min after the administration of protamine, and 12 and 24 h after the cessation of CPB. Plasma levels of free F2-isoprostanes (sensitive markers of free radicals production)and complement C5a were determined by mass-spectrometric assay and enzyme immunoassay, respectively. Neutrophil adhesion to endothelial cells was observed at x200 magnification under a light microscope. RESULTS:Levels of F2-isoprostanes, complement C5a and neutrophil adhesion rate increased significantly during and after CPB in both groups. There were significantly higher levels of F2-isoprostanes, C5a, and more neutrophils adhering to endothelial cells in the control group than those in the propofol group, respectively. CONCLUSION: Cardiopulmonary bypass is associated with a great production of damaging free radicals. Propofol may be beneficial both as an anesthetic and as a potent free radical scavenger in patients presenting pathologies associated with free radical reactions during CPB.

  19. Coronary blood flow during cardiopulmonary resuscitation in swine

    Energy Technology Data Exchange (ETDEWEB)

    Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.

    1984-01-01

    Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic (EMF) and radiomicrosphere (RMS)) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal.

  20. Supraglottic airway devices in children

    Directory of Open Access Journals (Sweden)

    S Ramesh

    2011-01-01

    Full Text Available Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET, which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA, the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children.

  1. Impact of the initial classic section during a simulated cross-country skiing skiathlon on the cardiopulmonary responses during the subsequent period of skate skiing.

    Science.gov (United States)

    Mourot, Laurent; Fabre, Nicolas; Andersson, Erik; Willis, Sarah J; Hébert-Losier, Kim; Holmberg, Hans-Christer

    2014-08-01

    The aim of this study was to assess potential changes in the performance and cardiorespiratory responses of elite cross-country skiers following transition from the classic (CL) to the skating (SK) technique during a simulated skiathlon. Eight elite male skiers performed two 6 km (2 × 3 km) roller-skiing time trials on a treadmill at racing speed: one starting with the classic and switching to the skating technique (CL1-SK2) and another employing the skating technique throughout (SK1-SK2), with continuous monitoring of gas exchanges, heart rates, and kinematics (video). The overall performance times in the CL1-SK2 (21:12 ± 1:24) and SK1-SK2 (20:48 ± 2:00) trials were similar, and during the second section of each performance times and overall cardiopulmonary responses were also comparable. However, in comparison with SK1-SK2, the CL1-SK2 trial involved significantly higher increases in minute ventilation (V̇E, 89.8 ± 26.8 vs. 106.8 ± 17.6 L·min(-1)) and oxygen uptake (V̇O2; 3.1 ± 0.8 vs 3.5 ± 0.5 L·min(-1)) 2 min after the transition as well as longer time constants for V̇E, V̇O2, and heart rate during the first 3 min after the transition. This higher cardiopulmonary exertion was associated with ∼3% faster cycle rates. In conclusion, overall performance during the 2 time trials did not differ. The similar performance times during the second sections were achieved with comparable mean cardiopulmonary responses. However, the observation that during the initial 3-min post-transition following classic skiing cardiopulmonary responses and cycle rates were slightly higher supports the conclusion that an initial section of classic skiing exerts an impact on performance during a subsequent section of skate skiing.

  2. Toward intrinsic graphene surfaces: a systematic study on thermal annealing and wet-chemical treatment of SiO2-supported graphene devices.

    Science.gov (United States)

    Cheng, Zengguang; Zhou, Qiaoyu; Wang, Chenxuan; Li, Qiang; Wang, Chen; Fang, Ying

    2011-02-09

    By combining atomic force microscopy and trans-port measurements, we systematically investigated effects of thermal annealing on surface morphologies and electrical properties of single-layer graphene devices fabricated by electron beam lithography on silicon oxide (SiO(2)) substrates. Thermal treatment above 300 °C in vacuum was required to effectively remove resist residues on graphene surfaces. However, annealing at high temperature was found to concomitantly bring graphene in close contact with SiO(2) substrates and induce increased coupling between them, which leads to heavy hole doping and severe degradation of mobilities in graphene devices. To address this problem, a wet-chemical approach employing chloroform was developed in our study, which was shown to enable both intrinsic surfaces and enhanced electrical properties of graphene devices. Upon the recovery of intrinsic surfaces of graphene, the adsorption and assisted fibrillation of amyloid β-peptide (Aβ1-42) on graphene were electrically measured in real time.

  3. Smart Device-Supported BDS/GNSS Real-Time Kinematic Positioning for Sub-Meter-Level Accuracy in Urban Location-Based Services

    OpenAIRE

    Wang, Liang; LI Zishen; Zhao, Jiaojiao; Zhou, Kai; Wang, Zhiyu; Yuan, Hong

    2016-01-01

    Using mobile smart devices to provide urban location-based services (LBS) with sub-meter-level accuracy (around 0.5 m) is a major application field for future global navigation satellite system (GNSS) development. Real-time kinematic (RTK) positioning, which is a widely used GNSS-based positioning approach, can improve the accuracy from about 10–20 m (achieved by the standard positioning services) to about 3–5 cm based on the geodetic receivers. In using the smart devices to achieve positioni...

  4. Wireless System for Continuous Cardiopulmonary Monitoring in a Space Environment Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to develop the NJM Sense-It system based on small sensor tags, which include a cardiopulmonary MEMS sensor for measuring heartbeat and breath rates...

  5. Knowledge and preferences regarding cardiopulmonary resuscitation : A survey among older patients

    NARCIS (Netherlands)

    Zijlstra, Trudy J.; Leenman-Dekker, Sonja J.; Oldenhuis, Hilbrand K. E.; Bosveld, Henk E. P.; Berendsen, Annette J.

    Objective: Survival rates following cardiopulmonary resuscitation (CPR) are low for older people, and are associated with a high risk of neurological damage. This study investigated the relationship between the preferences, knowledge of survival chances, and characteristics among older people

  6. Increased neutrophil priming and sensitization before commencing cardiopulmonary bypass in cardiac surgical patients

    NARCIS (Netherlands)

    Gu, YJ; Schoen, P; Tigchelaar, [No Value; Loef, BG; Ebels, T; Rankin, AJ; van Oeveren, W

    2002-01-01

    Background. Neutrophil activation is implicated in postoperative complications in patients having cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to determine the temporal fluctuations in the primability of neutrophils in the preoperative, intraoperative, and postoperative

  7. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    LENUS (Irish Health Repository)

    Marshall, C

    2012-02-03

    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  8. Impaired microcirculatory perfusion in a rat model of cardiopulmonary bypass : the role of hemodilution

    NARCIS (Netherlands)

    Koning, Nick J.; de lange, Fellery; Vonk, Alexander B. A.; Ahmed, Yunus; van den Brom, Charissa E.; Bogaards, Sylvia; van Meurs, Matijs; Jongman, Rianne M.; Schalkwijk, Casper G.; Begieneman, Mark P. V.; Niessen, Hans W.; Baufreton, Christophe; Boer, Christa

    2016-01-01

    Although hemodilution is attributed as the main cause of microcirculatory impairment during cardiopulmonary bypass (CPB), this relationship has never been investigated. We investigated the distinct effects of hemodilution with or without CPB on microvascular perfusion and subsequent renal tissue

  9. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study.

    LENUS (Irish Health Repository)

    Cotter, P E

    2009-03-01

    while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.

  10. Wireless System for Continuous Cardiopulmonary Monitoring in a Space Environment Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to develop the NJM Sense-It system based on small sensor tags, which include a cardiopulmonary MEMS sensor for measuring heartbeat and breath rates...

  11. Cardiopulmonary exercise testing – Its application in cardiology and occupational medicine

    Directory of Open Access Journals (Sweden)

    Małgorzata Kurpesa

    2014-10-01

    Full Text Available Cardiopulmonary exercise testing is a method used to assess the exercise capacity. It is used in cardiology to define the diagnostic and prognostic information, the treatment and its effectiveness. This method is also useful in sport medicine and in occupational medicine. The cardiopulmonary exercise test involves measuring of gas exchange during exercise testing. The article presents the main parameters assessed during the test and the indications and contraindications for conducting the test. It also reveals the results of recently published clinical trials on the use of cardiopulmonary exercise test in patients with cardiovascular disease and in the working population. The study included variability of respiratory parameters during the cardiopulmonary exercise test and after its completion, as well as their impact on the prognostic value. In addition, the results of a study involving an optimal choice of interval training on the basis of oxygen consumption at peak exercise are summarized. Med Pr 2014;65(5:665–674

  12. Reduced embolic load during clinical cardiopulmonary bypass using a 20 micron arterial filter.

    Science.gov (United States)

    Jabur, G N S; Willcox, T W; Zahidani, S H; Sidhu, K; Mitchell, S J

    2014-05-01

    To compare the efficiency of 20 and 40 µm arterial line filters during cardiopulmonary bypass for the removal of emboli from the extracorporeal circuit. Twenty-four adult patients undergoing surgery were perfused using a cardiopulmonary bypass circuit containing either a 20 µm or 40 µm arterial filter (n = 12 in both groups). The Emboli Detection and Classification system was used to count emboli upstream and downstream of the filter throughout cardiopulmonary bypass. The mean proportion of emboli removed by the filter was compared between the groups. The 20 µm filter removed a significantly greater proportion of incoming emboli (0.621) than the 40 µm filter (0.334) (p=0.029). The superiority of the 20 µm filter persisted across all size groups of emboli larger than the pore size of the 40 µm filter. The 20 µm filter removed substantially more emboli than the 40 µm filter during cardiopulmonary bypass in this comparison.

  13. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass

    NARCIS (Netherlands)

    Severdija, E.E.; Vranken, N.P.; Teerenstra, S.; Ganushchak, Y.M.; Weerwind, P.W.

    2015-01-01

    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A t

  14. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    NARCIS (Netherlands)

    Mastenbroek, Mirjam H; van t Sant, Jetske; Versteeg, Henneke; Cramer, MJ; Doevendans, Pieter A; Pedersen, Susanne S; Meine, Mathias

    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time

  15. Relationship between reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy

    NARCIS (Netherlands)

    Mastenbroek, M.H.; Sant, Jetske Van't; Versteeg, H.; Cramer, Maarten J; Doevendans, Pieter A; Pedersen, Susanne S; Meine, Mathias

    2016-01-01

    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time

  16. Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response

    NARCIS (Netherlands)

    van den Goor, J.; Nieuwland, R.; van den Brink, A.; van Oeveren, W.; Rutten, 27818; Tijssen, J.; Eijsman, L.; Rutten, P

    2004-01-01

    Objective: In the present study the relationship was evaluated between perioperative inflammation and the postoperative acute phase response in patients undergoing elective coronary artery bypass grafting (CABG) assisted by cardiopulmonary bypass (CPB). CPB circuits contained either non-coated-

  17. Insertion devices

    CERN Document Server

    Bahrdt, J

    2006-01-01

    The interaction of an insertion device with the electron beam in a storage ring is discussed. The radiation property including brightness, ux and polarization of an ideal and real planar and helical / elliptical device is described. The magnet design of planar, helical, quasiperiodic devices and of devices with a reduced on axis power density are resumed.

  18. Temporary bilateral sensorineural hearing loss following cardiopulmonary bypass -A case report-

    OpenAIRE

    Son, Hyo Jung; Joh, Jung Hwa; Kim, Wook Jong; Chin, Ji Hyun; Choi, Dae Kee; Lee, Eun Ho; Sim, Ji Yeon; Choi, In-Cheol

    2011-01-01

    Sudden sensorineural hearing loss has been reported to occur following anesthesia and various non-otologic surgeries, mostly after procedures involving cardiopulmonary bypass. Unilateral sensorineural hearing loss resulting from microembolism is an infrequent complication of cardiopulmonary bypass surgery that has long been acknowledged. Moreover, there are few reports on the occurrence of bilateral sensorineural hearing loss without other neurologic deficits and its etiology has also not bee...

  19. Relations between cardiopulmonary function during exercise and exercise tolerance in patients with COPD

    OpenAIRE

    Cuypers, Maarten; Vos, Tine

    2015-01-01

    Methods: In part 1, a cross-sectional study took place. Sixty COPD patients performed a spirometry and a cardiopulmonary exercise test (CPET). Predictors of exercise tolerance were examined. In part 2, a longitudinal observational study took place. Twelve COPD patients completed an exercise training intervention. A study on relations between changes in cardiopulmonary function and changes in exercise tolerance was performed. Results: Significant predictors of VO2peak are peak carbon d...

  20. Reversibility of cardiopulmonary impairment after laparoscopic repair of large hiatal hernia

    Directory of Open Access Journals (Sweden)

    Emanuele Asti

    2015-01-01

    Full Text Available Giant hiatus hernia with or without intrathoracic gastric volvulus often presents with symptoms suggestive of both cardiac and pulmonary compression. Cardiopulmonary impairment may be reversible in these patients by laparoscopic crural repair and fundoplication as shown in this case report. Cardiac magnetic resonance and the cardiopulmonary exercise test may help selecting patients for surgery. These preliminary findings led us to start a prospective study using this multimodality diagnostic approach.

  1. Is it necessary to stent renal artery stenosis patients before cardiopulmonary bypass procedures?

    Institute of Scientific and Technical Information of China (English)

    ZHENG Bin; YAN Hong-bing; LIU Rui-fang; CHENG Shu-juan; WANG Jian; ZHAO Han-jun; SONG Li

    2011-01-01

    Background Acute kidney injury (AKI) is associated with poor prognosis after cardiopulmonary bypass. The aim of this retrospective study was to investigate whether stent implantation before cardiopulmonary bypass has beneficial effect on development of AKI in renal artery stenosis (RAS) patients.Methods In this retrospective study, patients with abnormal baseline serum creatinine (SCr, >106 μmol/L) were not included. Included patients (n=69) were divided into two groups. Group 1 included 31 RAS patients receiving no stent implantation before cardiopulmonary bypass. Group 2 included 38 RAS patients having received stent implantation just before cardiopulmonary bypass. To assess AKI after cardiopulmonary bypass, serum urea nitrogen, SCr and creatinine clearance were recorded at baseline, at the end of operation, during the first and second postoperative 24 hours.Results Baseline characteristics were similar between groups. Serum urea nitrogen, SCr, creatinine clearance before and after cardiopulmonary bypass were also similar class groups. Incidence of AKI in group 1 was not significantly different from group 2. In group 1, AKI defined by RIFLE between occurred in 7 (22.6%) patients: 5 (16.1%) with RIFLE-R,2 (6.5%) with RIFLE-I, and no patients with RIFLE-F. In group 2, 10 patients (26.3%) had an episode of AKI during hospitalization: 6 (15.8%) had RIFLE-R, 4 (10.5%) had RIFLE-I, and no patients had RIFLE-F.Conclusions There are no data suggesting that it is necessary to stent RAS patients with normal SCr before cardiopulmonary bypass. However, it cannot be concluded that RAS is not associated with AKI after cardiopulmonary bypass.

  2. Transesophageal echocardiography-guided thrombectomy of intracardiac renal cell carcinoma without cardiopulmonary bypass

    Science.gov (United States)

    Souki, Fouad Ghazi; Demos, Michael; Fermin, Lilibeth; Ciancio, Gaetano

    2016-01-01

    Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor. PMID:27716710

  3. Readiness of Teachers and Pupils for Use of Mobile Devices as Support for Effective Pedagogy in Nigeria: Could Location Be a Major Determinant?

    Science.gov (United States)

    Sharehu, Aminu Ladan; Emmanuel, Achor Edoja

    2015-01-01

    How prepared are teachers and pupils in Basic 6 (that is, 6th grade) to use Information and Communication Technology (ICT) such as mobile devices to aid teaching and learning in urban and rural schools at that level is a matter of concern and therefore formed the focus of this paper. The study is a survey of some urban and rural Primary schools in…

  4. Systematic review of cardiopulmonary exercise testing post stroke: Are we adhering to practice recommendations?

    Science.gov (United States)

    van de Port, Ingrid G L; Kwakkel, Gert; Wittink, Harriet

    2015-11-01

    To systematically review the use of cardiopulmonary exercise testing in people who have survived a stroke. The following questions are addressed: (i) What are the testing procedures used? (ii) What are the patient, safety and outcomes characteristics in the cardiopulmonary exercise testing procedures? (iii) Which criteria are used to determine maximum oxygen uptake (VO2peak/max) in the cardiopulmonary exercise testing procedures? Systematic review of studies of cardiopulmonary exercise testing in stroke survivors. PubMed, EMBASE, and CINAHL were searched from inception until January 2014. MeSH headings and keywords used were: oxygen capacity, oxygen consumption, oxygen uptake, peak VO2, max VO2, aerobic fitness, physical fitness, aerobic capacity, physical endurance and stroke. Search and selection were performed independently by 2 reviewers. Sixty studies were scrutinized, including 2,104 stroke survivors. Protocols included treadmill (n = 21), bicycle (n = 33), stepper (n = 3) and arm (n = 1) ergometry. Five studies reported 11 adverse events (1%). Secondary outcomes were reported in few studies, which hampered interpretation of the patient's effort, and hence the value of the VO2peak. Most studies did not adhere, or insufficiently adhered, to the existing cardiopulmonary exercise testing guidelines for exercise testing. Thus, the results of cardiopulmonary exercise testing protocols in stroke patients cannot be compared.

  5. Human Biomechanical and Cardiopulmonary Responses to Partial Gravity – A Systematic Review

    Directory of Open Access Journals (Sweden)

    Charlotte Richter

    2017-08-01

    Full Text Available The European Space Agency has recently announced to progress from low Earth orbit missions on the International Space Station to other mission scenarios such as exploration of the Moon or Mars. Therefore, the Moon is considered to be the next likely target for European human space explorations. Compared to microgravity (μg, only very little is known about the physiological effects of exposure to partial gravity (μg < partial gravity <1 g. However, previous research studies and experiences made during the Apollo missions comprise a valuable source of information that should be taken into account when planning human space explorations to reduced gravity environments. This systematic review summarizes the different effects of partial gravity (0.1–0.4 g on the human musculoskeletal, cardiovascular and respiratory systems using data collected during the Apollo missions as well as outcomes from terrestrial models of reduced gravity with either 1 g or microgravity as a control. The evidence-based findings seek to facilitate decision making concerning the best medical and exercise support to maintain astronauts' health during future missions in partial gravity. The initial search generated 1,323 publication hits. Out of these 1,323 publications, 43 studies were included into the present analysis and relevant data were extracted. None of the 43 included studies investigated long-term effects. Studies investigating the immediate effects of partial gravity exposure reveal that cardiopulmonary parameters such as heart rate, oxygen consumption, metabolic rate, and cost of transport are reduced compared to 1 g, whereas stroke volume seems to increase with decreasing gravity levels. Biomechanical studies reveal that ground reaction forces, mechanical work, stance phase duration, stride frequency, duty factor and preferred walk-to-run transition speed are reduced compared to 1 g. Partial gravity exposure below 0.4 g seems to be insufficient to maintain

  6. Coronary air embolism in off-pump surgery caused by blower-mister device.

    Science.gov (United States)

    Korkmaz, Askin Ali; Guden, Mustafa; Korkmaz, Feride; Yuce, Murat

    2008-01-01

    Gaseous emboli caused by the blower-mister result in air locks within coronary vessels. We describe the case of a coronary air embolism caused by a blower-mister device on off-pump surgery. The tip of the device unexpectedly entered the coronary artery through arteriotomy and caused the air emboli. Air locks in the coronary circulation led to hemodynamic deterioration, and cardiopulmonary bypass was started following the emergency cannulation.

  7. Evidence of Allergic Reactions and Cardiopulmonary Impairments among Traders Operating from Foodstuff Warehouses

    Science.gov (United States)

    Egbosionu, Viola; Ibeneme, Georgian; Ezuma, Amarachi; Ettu, Theresa; Nwankwo, Joseph; Limaye, Dnyanesh; Nna, Emmanuel

    2016-01-01

    Background. Foodstuff traders operating from warehouses (FTFW) are potentially exposed to dangerous rodenticides/pesticides that may have adverse effects on cardiopulmonary function. Methods. Fifty consenting male foodstuff traders, comprising 15 traders (21–63 years) operating outside warehouses and 35 FTFW (20–64 years), were randomly recruited at Ogbete Market, Enugu, in a cross-sectional observational study of spirometric and electrocardiographic parameters. Seventeen FTFW (21–57 years) participated in focus group discussions. Qualitative and quantitative data were analysed thematically and with independent t-test and Pearson correlation coefficient at p 0.05) with a significantly prolonged (p < 0.05) QTc interval. Conclusion. Allergic response was evident in the FTFW. Significant decrease in FVC may negatively impact lung flow rates and explains the marginal decrease in FEF25–75, which implies a relative limitation in airflow of peripheral/distal airways and elastic recoil of the lungs. This is consistent with obstructive pulmonary disease; a significant decrease in FEF75–85/FEV1 supports this conclusion. Significant decrease in FEF200–1200 indicates abnormalities in the large airways/larynx just as significantly prolonged ventricular repolarization suggests cardiac arrhythmias. PMID:28116288

  8. Do-not-resuscitate Order: The Experiences of Iranian Cardiopulmonary Resuscitation Team Members

    Science.gov (United States)

    Assarroudi, Abdolghader; Heshmati Nabavi, Fatemeh; Ebadi, Abbas; Esmaily, Habibollah

    2017-01-01

    Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR. PMID:28216869

  9. Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Marc Licker

    2012-01-01

    Full Text Available A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

  10. Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

    Directory of Open Access Journals (Sweden)

    Abdolghader Assarroudi

    2017-01-01

    Full Text Available Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR. This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

  11. Analisis kebijakan standardisasi keamanan perangkat telekomunikasi untuk menunjang kebijakan pertahanan dan keamanan nasional [Policy analysis on telecommunication devices security standardization to support national security and defence policy

    Directory of Open Access Journals (Sweden)

    Wirianto Pradono

    2015-12-01

    Full Text Available Beberapa tahun terakhir, kejadian yang terkait dengan pembobolan informasi meningkat dengan signifikan dan menyebabkan kerugian yang tidak sedikit baik bagi pemerintah, industri maupun perorangan. Oleh karenanya diperlukan jaminan terhadap keamanan informasi terutama yang menyangkut informasi yang sensitif dan rahasia. Untuk mengatasi hal tersebut, diperlukan kebijakan di bidang standarisasi keamanan perangkat telekomunikasi untuk menjamin validitas dan kerahasiaan informasi yang dilewatkan melalui perangkat tersebut. Pendekatan kualitatif maupun kuantitatif digunakan dalam studi ini untuk memperoleh gambaran tentang kondisi penerapan standar keamanan perangkat baik oleh pemerintah maupun industri telekomunikasi serta mengidentifikasi kendala yang dihadapi dalam menjamin keamanan perangkat telekomunikasi baik untuk kebutuhan umum maupun kebutuhan khusus baik dari aspek teknologi, kelembagaan, maupun regulasi. Hasil penelitian menunjukkan belum ada regulasi yang mengatur standarisasi keamanan perangkat telekomunikasi untuk kebutuhan khusus. Selain itu belum ada penetapan secara eksplisit tentang lembaga yang berwenang dalam pengujian dan sertifikasi keamanan perangkat telekomunikasi terutama untuk kebutuhan khusus. Sejumlah regulasi yang mengatur secara spesifik bidang standarisasi keamanan perangkat telekomunikasi saat ini masih dalam proses penyusunan oleh instansi-instansi terkait.*****In the past years, incidents involving information security breach increase significantly and cause huge damage to industry, government or individual. Due to that, information security needs to be well guaranteed especially when it comes to sensitive and confidential information. One has to be done to cope with that is the availibility of policy on telecommunication devices security standardization to assure validity and confidentiality of all information going through the devices. Both qualitative and quantitative method used in this study to describe

  12. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. Copyright © 2015. Published by Elsevier Inc.

  13. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie D'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

  14. Cardiopulmonary exercise testing responses to different external portable drivers in a patient with a CardioWest Total Artificial Heart.

    Science.gov (United States)

    Tarzia, Vincenzo; Braccioni, Fausto; Bortolussi, Giacomo; Buratto, Edward; Gallo, Michele; Bottio, Tomaso; Vianello, Andrea; Gerosa, Gino

    2016-06-01

    Management of patients treated with CardioWest Total Artificial Heart (CW-TAH) as a bridge to heart transplantation (HTx) is complicated by difficulties in determining the optimal timing of transplantation. We present a case of a 53-year-old man supported as an outpatient with a CW-TAH, whose condition deteriorated following exchange of the portable driver. The patient was followed-up with serial cardiopulmonary exercise testing (CPET) which demonstrated a fall of peak VO2 to below 12 ml/kg/min following driver substitution, and the patient was subsequently treated with urgent orthotopic HTx. This case highlights the potential utility of CPET as a means for monitoring and indicating timing of HTx in patients with CW-TAH, as well as the potential for clinical deterioration following portable driver substitution.

  15. Lay bystanders' perspectives on what facilitates cardiopulmonary resuscitation and use of automated external defibrillators in real cardiac arrests

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

    2017-01-01

    is crucial in improving survival, cannot cause substantial harm, and that the AED will provide guidance through CPR; prior hands-on training in AED use; during CPR performance, teamwork (ie, support), using the AED voice prompt and a ventilation mask, as well as demonstrating leadership and feeling a moral......BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what...... factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out-of-hospital cardiac arrest. METHODS AND RESULTS: One-hundred and twenty-eight semistructured qualitative interviews with CPR-trained lay bystanders...

  16. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.

  17. Running economy assessment within cardiopulmonary exercise testing for recreational runners.

    Science.gov (United States)

    Engeroff, Tobias; Bernardi, Andreas; Vogt, Lutz; Banzer, Winfried

    2016-03-01

    The aim of this study was to evaluate the influence of running economy (RE) on running performance within recreational runners of different maximal aerobic capacity, and the feasibility of RE assessment within routine cardiopulmonary exercise testing (CPET). Sixty-eight recreational runners (m: 49, f: 19; age: 21-54) completed a graded exercise test (GXT) until exhaustion. Maximal oxygen uptake and respiratory compensation point were obtained via CPET. RE was calculated as relative oxygen uptake per covered distance (mL/kg/km) one step below respiratory compensation point (RCP). Subjects were grouped for RE via median split and categorized into one of six fitness levels (Very Poor, Poor, Fair, Good, Excellent, Superior) (ACSM 2010). Irrespective of fitness levels, recreational runners with a more energy efficient movement (REVO2max values ranged between 35.2 and 66.0 ml/min/kg. Running velocity at RCP of runners within VO2max categories Good and Superior differed significantly (P<0.05) between RE groups. This study provides evidence that RE influences submaximal running performance in recreational distance runners within a broad range of maximal aerobic capacity. Complementing routine CPET with RE assessment at physiological threshold intensities and ACSM based categorization seems feasible to delineate the impact of movement efficiency and aerobic fitness on performance in recreational runners.

  18. Cardiopulmonary risk index does not predict complications after thoracic surgery.

    Science.gov (United States)

    Melendez, J A; Carlon, V A

    1998-07-01

    The preoperative cardiopulmonary risk index (CPRI) is a multifactorial index intended to predict postoperative outcome after thoracic surgery. It combines cardiac and pulmonary information into one parameter that ranges from 1 to 10, with 10 being the worst. A CPRI > or = 4 has been advocated as an effective predictor of postoperative pulmonary and cardiac complications. This study prospectively evaluates the predictive value of CPRI in a large population of patients undergoing thoracic surgery. We performed prospective calculation of CPRI in patients about to undergo thoracic surgery. Postthoracic surgery occurrence of pneumonia, atelectasis, arrhythmias, congestive heart failure, respiratory failure requiring therapy, or death occurring within 30 days of surgery was compared with preoperative CPRI and its components. One hundred eighty consecutive patients, aged 15 to 87 years, were studied. Operations performed included 114 lobectomies, 35 wedge resections, 19 pneumonectomies, 5 pleurectomies, 5 lymph node dissections, 1 thoracic wall resection, and 1 paravertebral tumor resection. Twenty-seven percent of patients experienced complications. CPRI and its components did not predict complications, deaths, or the number of in-hospital days. We found a CPRI > or = 4 to be a moderate predictor of outcome for patients undergoing pneumonectomy (n = 19). It correctly identified four of nine postpneumonectomy complications. The preoperative CPRI and its components are inadequate predictors of medical complications after thoracic surgery in a general population. In the subgroup of patients undergoing pneumonectomy, the index may be of some value in forecasting outcome.

  19. Factors Influencing the Success Rate of Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    Aisyah Amanda Hanif

    2015-12-01

    Full Text Available Background: Cardiopulmonary resuscitation (CPR is a series of actions performed on cardiac arrest patients. Not all patients receiving CPR can survive. The outcome of CPR is influenced by several factors. This study was conducted to determine the success rate of CPR and the factors influencing it in Dr. Hasan Sadikin General Hospital in 2013. Methods: This study was conducted by using 168 patient medical records who underwent CPR and met the inclusion criteria in the Resuscitation Room of Dr. Hasan Sadikin General Hospital from January to December 2013. The collected data consisted of age, gender, pre-arrest diagnosis, initial rhythm, response time and clinical outcome of CPR. The results were expressed in frequencies and percentage. The data were analyzed using the chi-square test. Results: The Success rate of CPR was 15.5%. The success rate was higher in patients with cardiac prearrest diagnoses (8.33%, p=0.024. The most common initial rhythm was unshockable rhythms (83.92%, yet patients with shockable heart rhythms had higher success rates (40.74%, p<0.001. All of the surviving patients had response time within the first minute from cardiac arrest. Conclusions: Success rate of CPR in the resuscitation room of Dr. Hasan Sadikin General Hospital during 2013 is still low. The factors influencing the survival rate are the pre-arrest diagnosis and initial heart rhythm.

  20. Inhibition of neutrophil activity improves cardiac function after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Grünwald Frank

    2007-10-01

    Full Text Available Abstract Background The arterial in line application of the leukocyte inhibition module (LIM in the cardiopulmonary bypass (CPB limits overshooting leukocyte activity during cardiac surgery. We studied in a porcine model whether LIM may have beneficial effects on cardiac function after CPB. Methods German landrace pigs underwent CPB (60 min myocardial ischemia; 30 min reperfusion without (group I; n = 6 or with LIM (group II; n = 6. The cardiac indices (CI and cardiac function were analyzed pre and post CPB with a Swan-Ganz catheter and the cardiac function analyzer. Neutrophil labeling with technetium, scintigraphy, and histological analyses were done to track activated neutrophils within the organs. Results LIM prevented CPB-associated increase of neutrophil counts in peripheral blood. In group I, the CI significantly declined post CPB (post: 3.26 ± 0.31; pre: 4.05 ± 0.45 l/min/m2; p 2; p = 0.23. Post CPB, the intergroup difference showed significantly higher CI values in the LIM group (p Conclusion Our data provides strong evidence that LIM improves perioperative hemodynamics and cardiac function after CPB by limiting neutrophil activity and inducing accelerated sequestration of neutrophils in the spleen.

  1. Measuring behavioral outcomes in cardiopulmonary rehabilitation: AN AACVPR STATEMENT.

    Science.gov (United States)

    Verrill, David; Graham, Helen; Vitcenda, Mark; Peno-Green, Laura; Kramer, Valerie; Corbisiero, Teresa

    2009-01-01

    Outcome measurement in cardiopulmonary rehabilitation is required for optimal assessment of program quality, effectiveness of treatments, and evaluation of patient progress. Recent position statements from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology, American Heart Association, American Thoracic Society, and American College of Chest Physicians have provided state-of-the-art information on the importance of assessing performance and outcome measures for optimal program effectiveness. Such measures are also required for AACVPR program certification. To meet current standards of practice, the AACVPR developed an Outcomes Matrix that includes 4 domains: Health, Clinical, Behavioral, and Service. Although the Clinical and Health domains have been most commonly used in outcome reporting (eg, 6-minute walk test, quality-of-life survey scores), behavioral measures have received less attention, primarily because they have been perceived as being more difficult to measure and quantify over time. This statement describes 5 common behavioral outcome measures: smoking cessation, medication use, supplemental oxygen use, exercise habits, and nutritional behaviors. Sample questions and calculations for each of these behavioral measures are also provided. By using these measures at program entry and completion, cardiac and pulmonary rehabilitation practitioners can effectively track and document behavioral changes over time for physicians, third-party insurance providers, or hospital administrators and thus demonstrate the effectiveness of exercise and educational interventions on patient overall health and well-being.

  2. Acute mesenteric ischemia after cardio-pulmonary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Bassam Abboud; Ronald Daher; Joe Boujaoude

    2008-01-01

    Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency.Several pathophysiologic events (arterial obstruction,venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow.Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities,leading to multi-organ failure and death.Early diagnosis is difficult because the clinical presentation is subtle,and the biological and radiological diagnostic tools lack sensitivity and specificity.Therapeutic options vary from conservative resuscitation,medical treatment,endovascular techniques and surgical resection and revascularization.A high index of suspicion is required for diagnosis,and prompt treatment is the only hope of reducing the mortality rate.Studies are in progress to provide more accurate diagnostic tools for early diagnosis.AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB).Several factors contribute to the systemic hypo-perfusion state,which is the most frequent pathophysiologic event.In this particular setting,the clinical presentation of AMI can be misleading,while the laboratory and radiological diagnostic tests often produce inconclusive results.The management strategies are controversial,but early treatment is critical for saving lives.Based on the experience of our team,we consider prompt exploratory laparotomy,irrespective of the results of the diagnostic tests,is the only way to provide objective assessment and adequate treatment,leading to dramatic reduction in the mortality rate.

  3. [Cardiopulmonary resuscitation already in Egypt 5,000 years ago?].

    Science.gov (United States)

    Ocklitz, A

    1997-06-06

    In light of the medically relevant features of the ancient Egyptian mouth-opening ceremony, the question of the effectiveness of medical practices in Egypt thousands of years ago is examined, whereby the religious and cultural framework also plays a significant role. In the Land on the Nile myth and reality clearly generated special conditions which favoured the systematic treatment of questions of resuscitation. Numerous examples show that this had practical consequences in the area of everyday medicine. In addition, rebirth and resurrection were central elements of the cult of the dead which had exact medical equivalents. These equivalents may demonstrate the advanced state of resuscitation practices in Egypt at that time. In this context, a reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. It appears possible that at the time of the pyramids the Egyptians already had an understanding of the technology required to perform instrument-aided artificial respiration. Whether or not they actually possessed a fundamental knowledge of the principles of cardio-pulmonary resuscitation remains unclear. Nevertheless, the astonishingly functional characteristics of the reconstructed mouth-opening instrument suggest that it was developed for more than purely symbolic purposes.

  4. Cardiopulmonary responses to combined lateral and vertical acceleration.

    Science.gov (United States)

    Popplow, J R; Veghte, J H; Hudson, K E

    1983-07-01

    To investigate the effects of a lateral G force, eight stress panel members were each subjected to a series of stresses using +/- 1.5, 2, or 2.5 Gy combined with either +/- 1 or +/- 2 Gz, for 30 s followed by a 60-s recovery period. Peripheral arterial oxygen saturation, utilizing a Hewlett-Packard 47201A ear oximeter and heart rate were recorded. A consistent fall in arterial oxygen saturation (SaO2) was observed during all the Gy/Gz exposures with the +Gy direction giving the lowest value of 90.1% SaO2 (PaO2 of less than 60 mmHg). A small but consistent increase in heart rate (HR) was also observed during, and for 15 to 20 s after the Gy/Gz exposure. These results indicate that the cardiopulmonary system is stressed during combined Gy/Gz acceleration and the most important change occurs in SaO2.

  5. Cardiopulmonary bypass considerations for pediatric patients on the ketogenic diet.

    Science.gov (United States)

    Melchior, R W; Dreher, M; Ramsey, E; Savoca, M; Rosenthal, T

    2015-07-01

    There is a population of children with epilepsy that is refractory to anti-epileptic drugs. The ketogenic diet, a high-fat, low-carbohydrate regimen, is one alternative treatment to decrease seizure activity. Special considerations are required for patients on the ketogenic diet undergoing cardiopulmonary bypass (CPB) to prevent exposure to glucose substrates that could alter ketosis, increasing the risk of recurrent seizures. A 2-year-old, 9 kilogram male with a history of infantile spasms with intractable epilepsy, trisomy 21 status post tetralogy of Fallot repair, presented to the cardiac operating room for closure of a residual atrial septal defect. All disciplines of the surgical case minimized the use of carbohydrate-containing and contraindicated medications. Changes to the standard protocol and metabolic monitoring ensured the patient maintained ketosis. All disciplines within cardiac surgery need to be cognizant of patients on the ketogenic diet and prepare a modified protocol. Future monitoring considerations include thromboelastography, electroencephalography and continuous glucose measurement. Key areas of focus with this patient population in the cardiac surgical theater are to maintain a multidisciplinary approach, alter the required CPB prime components, address cardiac pharmacological concerns and limit any abnormal hematological occurrences. © The Author(s) 2014.

  6. The amylase-creatinine clearance ratio following cardiopulmonary bypass.

    Science.gov (United States)

    Murray, W R; Mittra, S; Mittra, D; Roberts, L B; Taylor, K M

    1981-08-01

    The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB.

  7. Rib fractures in infants due to cardiopulmonary resuscitation efforts.

    Science.gov (United States)

    Dolinak, David

    2007-06-01

    Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.

  8. Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

    Science.gov (United States)

    Hoyme, Derek B; Atkins, Dianne L

    2017-02-01

    To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Cardiopulmonary resuscitation knowledge and attitude among general dentists in Kuwait

    Science.gov (United States)

    Alkandari, Sarah A.; Alyahya, Lolwa; Abdulwahab, Mohammed

    2017-01-01

    BACKGROUND: Dentists as health care providers should maintain a competence in resuscitation. This cannot be overemphasized by the fact that the population in our country is living longer with an increasing proportion of medically compromised persons in the general population. This preliminary study aimed to assess the knowledge and attitude of general dentists towards cardiopulmonary resuscitation (CPR). METHODS: A cross-sectional study was carried out among 250 licensed general dental practitioners working in ministry of health. Data were obtained through electronic self-administered questionnaire consisting of demographic data of general dentists, and their experience, attitude and knowledge about CPR based on the 2010 American Heart Association guidelines update for CPR. RESULTS: Totally 208 general dentists took part in the present study giving a response rate of 83.2%. Only 36% of the participants demonstrated high knowledge on CPR, while 64% demonstrated low knowledge. Participants’ age, gender, nationality, years of experience, career hierarchy, and formal CPR training were associated significantly with CPR knowledge. Almost all the participants (99%) felt that dentists needed to be competent in basic resuscitation skills and showed a positive attitude towards attending continuing dental educational programs on CPR. CONCLUSION: This study showed that majority of general dental practitioners in Kuwait had inadequate knowledge on CPR. It was also found that CPR training significantly influenced the CPR knowledge of the participants. Therefore, training courses on CPR should be regularly provided to general dentists in the country. PMID:28123615

  10. Internships in cardiopulmonary rehabilitation. Think win-win.

    Science.gov (United States)

    Porcari, J P; Hall, L K

    1996-01-01

    From a student's perspective, completing an internship program is the final, and maybe the most important step in his or her academic career. He or she finally gets a chance to put theory into practice and to see if he or she truly enjoys his or her chosen field. Through hard work and dedication, the efforts should provide her/himself with the practical skills and experiences necessary to propel her/himself into the work force. For the program, having interns can be viewed as just having an "extra hand," but with the proper commitment it can be much more rewarding. It is a unique opportunity to get a fresh new perspective on your own program, and a chance to mold students into eager young professionals. The internship experience truly is a "Win-Win" situation. Through the efforts of combined education--the internship site and the cardiopulmonary rehabilitation program working together--they can ensure that tomorrow's practitioners will be of the highest quality.

  11. [Cardiopulmonary exercise testing before and after blood donation].

    Science.gov (United States)

    Dellweg, D; Siemon, K; Mahler, F; Appelhans, P; Klauke, M; Köhler, D

    2008-06-01

    The link between haemoglobin and physical performance was established a long time ago and is the underlying principle of blood doping. Blood loss on the other hand decreases physical capacity. The aim of this study is to evaluate physical performance loss and underlying mechanisms following voluntary blood donation. Eleven voluntary subjects (four female) completed a symptom-limiting cardio-pulmonary exercise test before and after blood donation (500 mL blood). The haemoglobin value decreased by 1.2 mg/dL (9%, p blood donation, respectively (p = 0.001). Subjects who practise recreational endurance sports appear to be more effected by endurance loss. The haemoglobin value was the only significant predictor of maximal oxygen uptake in regression analysis (p blood donation. Haemoglobin decline accounts for the decreased oxygen uptake. As a consequence thereof the anaerobic transition occurs earlier. Subjects not engaged in regular sports activity did not experience a decline in their capacity. Inclusion of the haemoglobin value into equations predicting maximal oxygen uptake could improve prediction precision.

  12. The Protective Effect of Propofol on Erythrocytes during Cardiopulmonary Bypass

    Institute of Scientific and Technical Information of China (English)

    张诗海; 姚尚龙

    2001-01-01

    To evaluate the relationship between erythrocyte injury and intracellular calcium ion overload, and the protective effect of propofol on erythrocytes during cardiopulmonary bypass (CPB), 40 children with congenital heart diseases who underwent surgical repair under CPB were studied. The patients were randomly divided into two groups: control group (group C) and propofol group (group P). Anesthesia was maintained in the patients in group P with 6 mg*kg-1*h-1 propofol, and those in the group C inhaled 1 %-2 % isoflurane. The blood samples were taken before CPB, at the 30th min of CPB, at the end of CPB, and 2 h and 24 h after CPB to measure the content of erythrocyte intracellular calcium ion (E-Ca2+), Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities, index filtration of erythrocytes (IF), mean corpuscular volume (MCV) and the concentration of plasma free hemoglobin (F-HB). Results showed that in the control group, E-Ca2+, IF, MCV and F-Hb were gradually increased and Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities were decreased. The increase of E-Ca2+ was linearly paralleled to IF, MCV and F-Hb. In propofol group, all the above-mentioned parameters were significantly improved (P<0.05). This study suggests that erythrocyte injury is related to elevation of intracellular calcium during CPB and propofol has a protective effect on erythrocyte injury.

  13. The Protective Effect of Propofol on Erythrocytes during Cardiopulmonary Bypass

    Institute of Scientific and Technical Information of China (English)

    张诗海; 姚尚龙

    2004-01-01

    To evaluate the relationship between erythrocyte injury and intracellular calcium ion overload, and the protective effect of propofol on erythrocytes during cardiopulmonary bypass (CPB). 40 children with congenital heart diseases who underwent surgical repair under CPB were included. The patients were randomly divided into two groups: control group (group C) and propofol group (group P). Anesthesia was maintained in the patients with 6 mg/kg/h propofol in Group P, and those in the Group C inhaled 1 %-2 % isoflurane. The blood samples were taken before CPB, 30 min after CPB, at the end of CPB, and 2 h and 24 h after CPB to measure the content of erythrocyte intracellular calcium ion (E-Ca2+ ), Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities, index filtration of erythrocytes (IF), mean corpuscular volume (MCV) and the concentration of plasma free hemoglobin (F-Hb). Results showed that in the control group, E-Ca2+ , IF, MCV and F-Hb were gradually increased and Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities were decreased. The increase of E-Ca2+ was linearly paralleled to IF, MCV and F-Hb. In propofol group, all the above-mentioned parameters were significantly improved (P<0. 05). This study suggests that erythrocyte injury is related to elevation of intracellular calcium during CPB and propofol has a protective effect on erythrocyte injury.

  14. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

    Science.gov (United States)

    da Silva, Rose Mary Ferreira Lisboa; Silva, Bruna Adriene Gomes de Lima e; Silva, Fábio Junior Modesto e; Amaral, Carlos Faria Santos

    2016-01-01

    Objective The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low. PMID:28099640

  15. Photovoltaic device

    Energy Technology Data Exchange (ETDEWEB)

    Reese, Jason A; Keenihan, James R; Gaston, Ryan S; Kauffmann, Keith L; Langmaid, Joseph A; Lopez, Leonardo; Maak, Kevin D; Mills, Michael E; Ramesh, Narayan; Teli, Samar R

    2017-03-21

    The present invention is premised upon an improved photovoltaic device ("PV device"), more particularly to an improved photovoltaic device with a multilayered photovoltaic cell assembly and a body portion joined at an interface region and including an intermediate layer, at least one interconnecting structural member, relieving feature, unique component geometry, or any combination thereof.

  16. Photovoltaic device

    Science.gov (United States)

    Reese, Jason A.; Keenihan, James R.; Gaston, Ryan S.; Kauffmann, Keith L.; Langmaid, Joseph A.; Lopez, Leonardo C.; Maak, Kevin D.; Mills, Michael E.; Ramesh, Narayan; Teli, Samar R.

    2015-06-02

    The present invention is premised upon an improved photovoltaic device ("PV device"), more particularly to an improved photovoltaic device with a multilayered photovoltaic cell assembly and a body portion joined at an interface region and including an intermediate layer, at least one interconnecting structural member, relieving feature, unique component geometry, or any combination thereof.

  17. Concentration device

    DEFF Research Database (Denmark)

    2013-01-01

    A concentration device (2) for filter filtration concentration of particles (4) from a volume of a fluid (6). The concentration device (2) comprises a filter (8) configured to filter particles (4) of a predefined size in the volume of the fluid (6). The concentration device (2) comprises...

  18. Photovoltaic device

    Science.gov (United States)

    Reese, Jason A.; Keenihan, James R.; Gaston, Ryan S.; Kauffmann, Keith L.; Langmaid, Joseph A.; Lopez, Leonardo C.; Maak, Kevin D.; Mills, Michael E.; Ramesh, Narayan; Teli, Samar R.

    2015-09-01

    The present invention is premised upon an improved photovoltaic device ("PV device"), more particularly to an improved photovoltaic device (10) with a multilayered photovoltaic cell assembly (100) and a body portion (200) joined at an interface region (410) and including an intermediate layer (500), at least one interconnecting structural member (1500), relieving feature (2500), unique component geometry, or any combination thereof.

  19. Smart Device-Supported BDS/GNSS Real-Time Kinematic Positioning for Sub-Meter-Level Accuracy in Urban Location-Based Services.

    Science.gov (United States)

    Wang, Liang; Li, Zishen; Zhao, Jiaojiao; Zhou, Kai; Wang, Zhiyu; Yuan, Hong

    2016-12-21

    Using mobile smart devices to provide urban location-based services (LBS) with sub-meter-level accuracy (around 0.5 m) is a major application field for future global navigation satellite system (GNSS) development. Real-time kinematic (RTK) positioning, which is a widely used GNSS-based positioning approach, can improve the accuracy from about 10-20 m (achieved by the standard positioning services) to about 3-5 cm based on the geodetic receivers. In using the smart devices to achieve positioning with sub-meter-level accuracy, a feasible solution of combining the low-cost GNSS module and the smart device is proposed in this work and a user-side GNSS RTK positioning software was developed from scratch based on the Android platform. Its real-time positioning performance was validated by BeiDou Navigation Satellite System/Global Positioning System (BDS/GPS) combined RTK positioning under the conditions of a static and kinematic (the velocity of the rover was 50-80 km/h) mode in a real urban environment with a SAMSUNG Galaxy A7 smartphone. The results show that the fixed-rates of ambiguity resolution (the proportion of epochs of ambiguities fixed) for BDS/GPS combined RTK in the static and kinematic tests were about 97% and 90%, respectively, and the average positioning accuracies (RMS) were better than 0.15 m (horizontal) and 0.25 m (vertical) for the static test, and 0.30 m (horizontal) and 0.45 m (vertical) for the kinematic test.

  20. Smart Device-Supported BDS/GNSS Real-Time Kinematic Positioning for Sub-Meter-Level Accuracy in Urban Location-Based Services

    Directory of Open Access Journals (Sweden)

    Liang Wang

    2016-12-01

    Full Text Available Using mobile smart devices to provide urban location-based services (LBS with sub-meter-level accuracy (around 0.5 m is a major application field for future global navigation satellite system (GNSS development. Real-time kinematic (RTK positioning, which is a widely used GNSS-based positioning approach, can improve the accuracy from about 10–20 m (achieved by the standard positioning services to about 3–5 cm based on the geodetic receivers. In using the smart devices to achieve positioning with sub-meter-level accuracy, a feasible solution of combining the low-cost GNSS module and the smart device is proposed in this work and a user-side GNSS RTK positioning software was developed from scratch based on the Android platform. Its real-time positioning performance was validated by BeiDou Navigation Satellite System/Global Positioning System (BDS/GPS combined RTK positioning under the conditions of a static and kinematic (the velocity of the rover was 50–80 km/h mode in a real urban environment with a SAMSUNG Galaxy A7 smartphone. The results show that the fixed-rates of ambiguity resolution (the proportion of epochs of ambiguities fixed for BDS/GPS combined RTK in the static and kinematic tests were about 97% and 90%, respectively, and the average positioning accuracies (RMS were better than 0.15 m (horizontal and 0.25 m (vertical for the static test, and 0.30 m (horizontal and 0.45 m (vertical for the kinematic test.

  1. Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table.

    Science.gov (United States)

    Saengsuwan, Jittima; Berger, Lucia; Schuster-Amft, Corina; Nef, Tobias; Hunt, Kenneth J

    2016-09-06

    Exercise testing devices for evaluating cardiopulmonary fitness in patients with severe disability after stroke are lacking, but we have adapted a robotics-assisted tilt table (RATT) for cardiopulmonary exercise testing (CPET). Using the RATT in a sample of patients after stroke, this study aimed to investigate test-retest reliability and repeatability of CPET and to prospectively investigate changes in cardiopulmonary outcomes over a period of four weeks. Stroke patients with all degrees of disability underwent 3 separate CPET sessions: 2 tests at baseline (TB1 and TB2) and 1 test at follow up (TF). TB1 and TB2 were at least 24 h apart. TB2 and TF were 4 weeks apart. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and a real-time visual feedback system was used to guide the patients' exercise work rate during CPET. Test-retest reliability and repeatability of CPET variables were analysed using paired t-tests, the intraclass correlation coefficient (ICC), the coefficient of variation (CoV), and Bland and Altman limits of agreement. Changes in cardiopulmonary fitness during four weeks were analysed using paired t-tests. Seventeen sub-acute and chronic stroke patients (age 62.7 ± 10.4 years [mean ± SD]; 8 females) completed the test sessions. The median time post stroke was 350 days. There were 4 severely disabled, 1 moderately disabled and 12 mildly disabled patients. For test-retest, there were no statistically significant differences between TB1 and TB2 for most CPET variables. Peak oxygen uptake, peak heart rate, peak work rate and oxygen uptake at the ventilatory anaerobic threshold (VAT) and respiratory compensation point (RCP) showed good to excellent test-retest reliability (ICC 0.65-0.94). For all CPET variables, CoV was 4.1-14.5 %. The mean difference was close to zero in most of the CPET variables. There were no significant changes in most cardiopulmonary performance parameters during the 4-week period

  2. Relation Between Pressure and Volume Unloading During Ramp Testing in Patients Supported with a Continuous-Flow Left Ventricular Assist Device

    DEFF Research Database (Denmark)

    Jung, Mette H; Hassager, Christian; Balling, Louise;

    2015-01-01

    Pulmonary capillary wedge pressure (PCWP) is the key to describing left ventricular (LV) unloading, however, the relation between pressure and the echocardiography-derived surrogate of LV volume (left ventricular end-diastolic diameter (LVEDD)) as a function of pump speed (RPM) in continuous......-flow left ventricular assist device (CF-LVAD) patients is unknown. In this study the pressure-volume relationship as a function of RPM during ramp testing was investigated by simultaneously measuring PCWP by Swan-Ganz catheter and LVEDD by echocardiography. The ramp protocol started at usual pump setting...

  3. Use of plasma "reconstitution" during cardio pulmonary bypass for a heart transplant after previous left ventricular assist device implant surgery.

    Science.gov (United States)

    Babaev, A; Saczkowski, R; Hynes, M; Boodhwani, M; Hudson, C C C

    2014-01-01

    The case report describes a novel technique of pre-emptive plasma "reconstitution" prior to disengagement from cardiopulmonary bypass (CPB) to minimize RV volume overload. The concomitant use of hemoconcentration facilitates volume and blood product management in cardiac transplant after previous left ventricular assist device implant surgery.

  4. Y stenting assisted coiling using a new low profile visible intraluminal support device for wide necked basilar tip aneurysms: a technical report.

    Science.gov (United States)

    Conrad, Marcelo D; Brasiliense, Leonardo B C; Richie, Alexa N; Hanel, Ricardo A

    2014-05-01

    Many endovascular techniques have been described in recent years for the management of wide necked aneurysms. The Y stent assisted technique has been generally used for coil embolization of wide necked bifurcation aneurysms. This technique was first described for the treatment of basilar tip aneurysms in combination with several different devices, demonstrating encouraging results. We report the results of the first two cases of wide necked basilar tip aneurysms treated with Y stent assisted coil embolization using a new low profile visible intraluminal stent (LVIS Jr; MicroVention, Tustin, California, USA) delivered through a 0.017 inch microcatheter. We also reviewed the literature comparing other endovascular techniques (coiling alone, stent assisted coiling, and Y stent assisted coiling) for wide necked aneurysms. The LVIS Jr device offers a new option for the treatment of these challenging lesions, with clear advantages over currently available intracranial stents. Larger series and long term results are needed to confirm the applicability and durability of this technique/technology.

  5. Assessment of long-term impact of formal certified cardiopulmonary resuscitation training program among nurses

    Directory of Open Access Journals (Sweden)

    P P Saramma

    2016-01-01

    Full Text Available Context: Cardiopulmonary resuscitation (CPR and emergency cardiovascular care guidelines are periodically renewed and published by the American Heart Association. Formal training programs are conducted based on these guidelines. Despite widespread training CPR is often poorly performed. Hospital educators spend a significant amount of time and money in training health professionals and maintaining basic life support (BLS and advanced cardiac life support (ACLS skills among them. However, very little data are available in the literature highlighting the long-term impact of these training. Aims: To evaluate the impact of formal certified CPR training program on the knowledge and skill of CPR among nurses, to identify self-reported outcomes of attempted CPR and training needs of nurses. Setting and Design : Tertiary care hospital, Prospective, repeated-measures design. Subjects and Methods: A series of certified BLS and ACLS training programs were conducted during 2010 and 2011. Written and practical performance tests were done. Final testing was undertaken 3-4 years after training. The sample included all available, willing CPR certified nurses and experience matched CPR noncertified nurses. Statistical Analysis Used: SPSS for Windows version 21.0. Results: The majority of the 206 nurses (93 CPR certified and 113 noncertified were females. There was a statistically significant increase in mean knowledge level and overall performance before and after the formal certified CPR training program (P = 0.000. However, the mean knowledge scores were equivalent among the CPR certified and noncertified nurses, although the certified nurses scored a higher mean score (P = 0.140. Conclusions: Formal certified CPR training program increases CPR knowledge and skill. However, significant long-term effects could not be found. There is a need for regular and periodic recertification.

  6. Empiric vancomycin dosing in pediatric patients with congenital heart disease and the impact of cardiopulmonary bypass on trough concentrations.

    Science.gov (United States)

    Thomas, Christopher A; Picone, Amy; Menon, Sharad; Willis, Brigham C

    2017-08-22

    To determine the optimal vancomycin dosing regimen to achieve empiric goal trough concentrations in pediatric patients with congenital heart disease and to examine the impact of cardiopulmonary bypass on vancomycin dosing requirements. Patients younger than 18 years of age admitted to the pediatric cardiovascular intensive care unit (CVICU) at our institution from 10/1/2012 - 12/31/2014 who received at least one dose of vancomycin were retrospectively reviewed. Included patients had a steady state vancomycin trough concentration drawn during the study period. The first steady state vancomycin trough drawn after being initiated on empiric vancomycin therapy was analyzed for each patient. Excluded patients were those who received mechanical circulatory support, any form of renal replacement therapy, or had a serum creatinine result greater than 1.0 mg/dl on the day of vancomycin initiation. Seventy-seven patients met inclusion criteria, of which 57.1% had undergone cardiopulmonary bypass (CPB) prior to CVICU admission. Median age was 62 days (interquartile range [IQR]: 8.3 - 176 days). Median daily vancomycin dose was 36.25 mg/kg/day (IQR: 29 - 40 mg/kg/day), resulting in a median steady state trough of 10.0 μg/ml (IQR: 6.3 - 12.9 μg/ml). Therapeutic troughs occurred in 50.6% of patients, whereas supratherapeutic and subtherapeutic concentrations were attained in 18.2% and 31.2% of patients, respectively. A subgroup analysis of patients who were post-CPB revealed that the only additional variable to affect vancomycin trough concentrations was aortic cross-clamp time (median: 56 minutes, IQR: 0 - 123.3 minutes, p=0.02). Empiric vancomycin dosing to achieve troughs of 8 - 15 μg/dl in patients with congenital heart disease without evidence of significant acute kidney injury should be 30 mg/kg/day for neonates, 35-40 mg/kg/day for infants, and 45 mg/kg/day in children, with adjustments required for patients with elevated creatinine or significant aortic cross clamp

  7. Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index.

    Science.gov (United States)

    Epstein, S K; Faling, L J; Daly, B D; Celli, B R

    1993-09-01

    Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake (VO2) and postoperative complications but have not systematically examined other methods of risk stratification. We analyzed the findings in 42 patients who had cardiopulmonary exercise testing prior to lung cancer resection. Preoperative clinical data combining pulmonary factors (obesity, productive cough, wheezing, tobacco use, ratio of the forced expiratory volume in 1 s over the forced vital capacity [FEV1/FVC] 45 mm Hg), and an established cardiac risk index were used to generate a cardiopulmonary risk index (CPRI). When analyzed using the risk index, the incidence of postoperative complications increased with higher CPRI scores. Those with a CPRI of 4 or greater were 22 times more likely to develop a complication, compared to a CPRI of less than 4 (p CPRI of 4 or greater was associated with significant reductions in peak VO2. We conclude that both the peak VO2 during cardiopulmonary exercise testing and a multifactorial CPRI are highly predictive of complications after lung resection. Adding the peak VO2 did not enhance the risk estimation generated by the CPRI. The association between postoperative complications and peak VO2 may be explained by the correlation between identifiable cardiopulmonary disease (CPRI) and reduced oxygen uptake with exercise.

  8. Mixed venous-arterial CO2 tension gradient after cardiopulmonary bypass.

    Science.gov (United States)

    Takami, Yoshiyuki; Masumoto, Hiroshi

    2005-09-01

    Significant venous hypercarbia has been reported in septic shock and circulatory failure. Cardiopulmonary bypass also impairs systemic and pulmonary blood perfusion. The objective of this study was to determine the clinical significance of the increased venous-arterial CO2 tension gradient resulting from venous hypercarbia after cardiopulmonary bypass. On arrival in the intensive care unit, venous and arterial CO2 tensions were measured in the radial and pulmonary arteries in 140 consecutive patients who had undergone coronary (n = 79), valve (n = 34), aortic (n = 20), and other (n = 7) surgery under cardiopulmonary bypass. The mean venous-arterial CO2 tension gradient was 5.0 +/- 3.3 mm Hg (range, 7.7 to 15.7 mm Hg). By linear regression analysis, the factors that significantly correlated with venous-arterial CO2 tension gradient were bypass duration, aortic crossclamp time, initial arterial lactate level, transpulmonary arteriovenous lactate difference, arterial bicarbonate level, base excess, cardiac index, mixed venous O2 saturation, O2 delivery, O2 consumption, and the peak value of creatine kinase. The venous-arterial CO2 tension gradient may reflect impaired perfusion and anaerobic metabolism induced by cardiopulmonary bypass and could be a simple and useful indicator for patient management after surgery under cardiopulmonary bypass.

  9. Biventricular failure with low pulmonary vascular resistance was managed by left ventricular assist device alone without right-sided mechanical support.

    Science.gov (United States)

    Imamura, Teruhiko; Kinugawa, Koichiro; Nitta, Daisuke; Hatano, Masaru; Kinoshita, Osamu; Nawata, Kan; Ono, Minoru

    2015-09-01

    How to manage preoperative right ventricular dysfunction (RVD) in heart failure patients without cardiogenic shock remains as a matter to be debated because implantable biventricular assist device treatment has not been established thus far. We here presented a patient with significant RVD indicated by low RV stroke work index (0.3 g/m) and RV dilatation as well as low pulmonary vascular resistance (PVR, 0.8 Wood Unit), who was managed by the introduction of pimobendan and sildenafil after the implantation of DuraHeart and tricuspid annuloplasty without right VAD, although his New York Heart Association symptom remained class III. Preoperative low PVR may be a key for successful LVAD treatment alone without right VAD in patients with INTERMACS profile 3 suffering RVD.

  10. Hydrogen sulfide improves neural function in rats following cardiopulmonary resuscitation

    Science.gov (United States)

    LIN, JI-YAN; ZHANG, MIN-WEI; WANG, JIN-GAO; LI, HUI; WEI, HONG-YAN; LIU, RONG; DAI, GANG; LIAO, XIAO-XING

    2016-01-01

    The alleviation of brain injury is a key issue following cardiopulmonary resuscitation (CPR). Hydrogen sulfide (H2S) is hypothesized to be involved in the pathophysiological process of ischemia-reperfusion injury, and exerts a protective effect on neurons. The aim of the present study was to investigate the effects of H2S on neural functions following cardiac arrest (CA) in rats. A total of 60 rats were allocated at random into three groups. CA was induced to establish the model and CPR was performed after 6 min. Subsequently, sodium hydrosulfide (NaHS), hydroxylamine or saline was administered to the rats. Serum levels of H2S, neuron-specific enolase (NSE) and S100β were determined following CPR. In addition, neurological deficit scoring (NDS), the beam walking test (BWT), prehensile traction test and Morris water maze experiment were conducted. Neuronal apoptosis rates were detected in the hippocampal region following sacrifice. After CPR, as the H2S levels increased or decreased, the serum NSE and S100β concentrations decreased or increased, respectively (P<0.0w. The NDS results of the NaHS group were improved compared with those of the hydroxylamine group at 24 h after CPR (P<0.05). In the Morris water maze experiment, BWT and prehensile traction test the animals in the NaHS group performed best and rats in the hydroxylamine group performed worst. At day 7, the apoptotic index and the expression of caspase-3 were reduced in the hippocampal CA1 region, while the expression of Bcl-2 increased in the NaHS group; and results of the hydroxylamine group were in contrast. Therefore, the results of the present study indicate that H2S is able to improve neural function in rats following CPR. PMID:26893650

  11. Extended effects of air pollution on cardiopulmonary mortality in Vienna

    Science.gov (United States)

    Neuberger, Manfred; Rabczenko, Daniel; Moshammer, Hanns

    BackgroundCurrent standards for fine particulates and nitrogen dioxide are under revision. Patients with cardiovascular disease have been identified as the largest group which need to be protected from effects of urban air pollution. MethodsWe sought to estimate associations between indicators of urban air pollution and daily mortality using time series of daily TSP, PM 10, PM 2.5, NO 2, SO 2, O 3 and nontrauma deaths in Vienna (Austria) 2000-2004. We used polynomial distributed lag analysis adjusted for seasonality, daily temperature, relative humidity, atmospheric pressure and incidence of influenza as registered by sentinels. ResultsAll three particulate measures and NO 2 were associated with mortality from all causes and from ischemic heart disease and COPD at all ages and in the elderly. The magnitude of the effect was largest for PM 2.5 and NO 2. Best predictor of mortality increase lagged 0-7 days was PM 2.5 (for ischemic heart disease and COPD) and NO 2 (for other heart disease and all causes). Total mortality increase, lagged 0-14 days, per 10 μg m -3 was 2.6% for PM 2.5 and 2.9% for NO 2, mainly due to cardiopulmonary and cerebrovascular causes. ConclusionAcute and subacute lethal effects of urban air pollution are predicted by PM 2.5 and NO 2 increase even at relatively low levels of these pollutants. This is consistent with results on hospital admissions and the lack of a threshold. While harvesting (reduction of mortality after short increase due to premature deaths of most sensitive persons) seems to be of minor importance, deaths accumulate during 14 days after an increase of air pollutants. The limit values for PM 2.5 and NO 2 proposed for 2010 in the European Union are unable to prevent serious health effects.

  12. Cardiopulmonary function in dogs with serious chronic heartworm disease.

    Science.gov (United States)

    Kitagawa, H; Kubota, A; Yasuda, K; Hirano, Y; Sasaki, Y

    1992-08-01

    Cardiopulmonary function was examined in 18 dogs with serious chronic heartworm disease showing ascites, subcutaneous edema, prostration, weakness, jaundice and so on. After surgical heartworm removal from the pulmonary arteries, 10 dogs recovered (surviving group), and 8 dogs died or were euthanatized because of poor prognosis (nonsurviving group). The number of live heartworms residing in the pulmonary arteries of the surviving group tended to be larger than that in the nonsurviving group. At necropsy, severe pulmonary arterial lesions such as thromboembolism including dead heartworms, proliferative and villous lesions and intimal hyperplasia were noticed in all dogs examined, and tended to be severer in the nonsurviving group. Heartworm-coiling around the tricuspid valve chord was found in 1 dog of the surviving group and 4 dogs of the nonsurviving group. Before heartworm removal, there was no significant difference in the mean pulmonary arterial pressure (MPAP) between the surviving and nonsurviving group. Right atrial pressure (v-wave) was higher, and the cardiac index (CI) was lower in the nonsurviving group. Arterial oxygen tension was lower in the surviving group than in the heartworm-free group, and it was lower in the nonsurviving group than in the surviving group. Carbon dioxide tension was lower in the surviving group than in the heartworm-free group. Bicarbonate concentration (HCO3-) was lower both in the surviving and nonsurviving groups than in the heartworm-free group. One week after heartworm removal, MPAP decreased (P less than 0.05), and CI and HCO3- tended to increase in the surviving group.

  13. Elimination of gaseous microemboli from cardiopulmonary bypass using hypobaric oxygenation.

    Science.gov (United States)

    Gipson, Keith E; Rosinski, David J; Schonberger, Robert B; Kubera, Cathryn; Mathew, Eapen S; Nichols, Frank; Dyckman, William; Courtin, Francois; Sherburne, Bradford; Bordey, Angelique F; Gross, Jeffrey B

    2014-03-01

    Numerous gaseous microemboli (GME) are delivered into the arterial circulation during cardiopulmonary bypass (CPB). These emboli damage end organs through multiple mechanisms that are thought to contribute to neurocognitive deficits after cardiac surgery. Here, we use hypobaric oxygenation to reduce dissolved gases in blood and greatly reduce GME delivery during CPB. Variable subatmospheric pressures were applied to 100% oxygen sweep gas in standard hollow fiber microporous membrane oxygenators to oxygenate and denitrogenate blood. GME were quantified using ultrasound while air embolism from the surgical field was simulated experimentally. We assessed end-organ tissues in swine postoperatively using light microscopy. Variable sweep gas pressures allowed reliable oxygenation independent of carbon dioxide removal while denitrogenating arterial blood. Hypobaric oxygenation produced dose-dependent reductions of Doppler signals produced by bolus and continuous GME loads in vitro. Swine were maintained using hypobaric oxygenation for 4 hours on CPB with no apparent adverse events. Compared with current practice standards of oxygen/air sweep gas, hypobaric oxygenation reduced GME volumes exiting the oxygenator (by 80%), exiting the arterial filter (95%), and arriving at the aortic cannula (∼100%), indicating progressive reabsorption of emboli throughout the CPB circuit in vivo. Analysis of brain tissue suggested decreased microvascular injury under hypobaric conditions. Hypobaric oxygenation is an effective, low-cost, common sense approach that capitalizes on the simple physical makeup of GME to achieve their near-total elimination during CPB. This technique holds great potential for limiting end-organ damage and improving outcomes in a variety of patients undergoing extracorporeal circulation. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. EFFECT OF CARDIOPULMONARY BYPASS ON PULMONARY FUNCTION IN INFANTS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the effect of the cardiopulmonary bypass (CPB) on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect (VSD). Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups: pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded: duration for mechanical ventilation (Tmv) and staying in the cardiac intensive care unit (Tcicu) after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group ( P < 0. 01 ). By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group ( P < 0. 05),especially at 6, 9, and 15h after CPB ( P < 0. 01 ). In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB ( P <0. 05). There was a similar change in pulmonary function between two groups at 21,24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.

  15. Renal function changes after elective cardiac surgery with cardiopulmonary bypass.

    Science.gov (United States)

    de Moraes Lobo, E M; Burdmann, E A; Abdulkader, R C

    2000-01-01

    Cardiac surgery can either induce acute renal failure or improve GFR by improving the cardiac performance. In order to study renal function changes after elective cardiac surgery (CS) with cardiopulmonary bypass (CPBP), 21 patients undergoing valvular CS (VCS) or coronary artery bypass (CAB) were prospectively evaluated in three time periods: before, 24 hours after surgery and 48 hours after surgery. Patients were divided in 2 groups according to the GFR percent change in comparison to the baseline value found 24 hours after CS (deltaGFR24): Group 1, deltaGFR24 decrease higher than 20% (n = 11) and Group 2, deltaGFR24 decrease UpH) in both groups. The deltaGFR24 showed positive correlation with baseline FENa (r = 0.44 p = 0.04) and negative correlation with volume balance during the first 24h after CS (r = -0.63, p = 0.007). More patients in Group 1 required nitroprusside than in Group 2 (66% vs. 14%, p = 0.04). Anesthesia time was shorter in Group 1 as compared to Group 2: 323+/-21 vs. 395+/-26 min, p = 0.04. No significant hemolysis occurred during CS in either group. There were no differences in age, gender, CPBP time, need for dopamine and/or dobutamine between the two groups. In conclusion, patients who presented GFR decrease after CS underwent VCS more frequently, had more prevalence of previous CS, presented lower baseline FENa, required more volume infusion and more nitroprusside use. On the other hand, no tubular dysfunction was detected in the early follow-up of CS. These results suggest that the observed renal function changes should be the result of an appropriated renal response to a low effective blood volume. In fact, a low baseline FENa anticipated a GFR decrease in these patients. Consistently, CAB patients that usually improve their cardiac output after surgery showed a clear GFR improvement.

  16. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Directory of Open Access Journals (Sweden)

    Aymen N Naguib

    2015-01-01

    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  17. Feedback on the Rate and Depth of Chest Compressions during Cardiopulmonary Resuscitation Using Only Accelerometers.

    Directory of Open Access Journals (Sweden)

    Sofía Ruiz de Gauna

    Full Text Available Quality of cardiopulmonary resuscitation (CPR is key to increase survival from cardiac arrest. Providing chest compressions with adequate rate and depth is difficult even for well-trained rescuers. The use of real-time feedback devices is intended to contribute to enhance chest compression quality. These devices are typically based on the double integration of the acceleration to obtain the chest displacement during compressions. The integration process is inherently unstable and leads to important errors unless boundary conditions are applied for each compression cycle. Commercial solutions use additional reference signals to establish these conditions, requiring additional sensors. Our aim was to study the accuracy of three methods based solely on the acceleration signal to provide feedback on the compression rate and depth.We simulated a CPR scenario with several volunteers grouped in couples providing chest compressions on a resuscitation manikin. Different target rates (80, 100, 120, and 140 compressions per minute and a target depth of at least 50 mm were indicated. The manikin was equipped with a displacement sensor. The accelerometer was placed between the rescuer's hands and the manikin's chest. We designed three alternatives to direct integration based on different principles (linear filtering, analysis of velocity, and spectral analysis of acceleration. We evaluated their accuracy by comparing the estimated depth and rate with the values obtained from the reference displacement sensor.The median (IQR percent error was 5.9% (2.8-10.3, 6.3% (2.9-11.3, and 2.5% (1.2-4.4 for depth and 1.7% (0.0-2.3, 0.0% (0.0-2.0, and 0.9% (0.4-1.6 for rate, respectively. Depth accuracy depended on the target rate (p < 0.001 and on the rescuer couple (p < 0.001 within each method.Accurate feedback on chest compression depth and rate during CPR is possible using exclusively the chest acceleration signal. The algorithm based on spectral analysis showed the

  18. High-Dose Intravenous Methylprednisolone for Hantavirus Cardiopulmonary Syndrome in Chile: A Double-Blind, Randomized Controlled Clinical Trial

    Science.gov (United States)

    Vial, Pablo A.; Valdivieso, Francisca; Ferres, Marcela; Riquelme, Raul; Rioseco, M. Luisa; Calvo, Mario; Castillo, Constanza; Díaz, Ricardo; Scholz, Luis; Cuiza, Analia; Belmar, Edith; Hernandez, Carla; Martinez, Jessica; Lee, Sang-Joon; Mertz, Gregory J.; Abarca, Juan; Tomicic, Vinko; Aracena, M. Eugenia; Rehbein, Ana Maria; Velásquez, Soledad; Lavin, Victoria; Garrido, Felipe; Godoy, Paula; Martinez, Constanza; Chamorro, Juan Carlos; Contreras, Jorge; Hernandez, Jury; Pino, Marcelo; Villegas, Paola; Zapata, Viviana; León, Marisol; Vega, Ivonne; Otarola, Irisol; Ortega, Carlos; Daube, Elizabeth; Huecha, Doris; Neira, Alda; Ruiz, Ines; Nuñez, M. Antonieta; Monsalve, Luz; Chabouty, Henriette; Riquelme, Lorena; Palma, Samia; Bustos, Raul; Miranda, Ruben; Mardones, Jovita; Hernandez, Nora; Betancur, Yasna; Sanhueza, Ligia; Inostroza, Jaime; Donoso, Solange; Navarrete, Maritza; Acuña, Lily; Manriquez, Paulina; Castillo, Fabiola; Unzueta, Paola; Aguilera, Teresa; Osorio, Carola; Yobanolo, Veronica; Mardones, Jorge; Aranda, Sandra; Carvajal, Soledad; Sandoval, Moisés; Daza, Soraya; Vargas, Felipe; Diaz, Violeta; Riquelme, Mauricio; Muñoz, Miriam; Carriel, Andrea; Lanino, Paola; Hernandez, Susana; Schumacher, Patricia; Yañez, Lia; Marco, Claudia; Ehrenfeld, Mildred; Delgado, Iris; Rios, Susana; Vial, Cecilia; Bedrick, Edward

    2013-01-01

    Background. Andes virus (ANDV)–related hantavirus cardiopulmonary syndrome (HCPS) has a 35% case fatality rate in Chile and no specific treatment. In an immunomodulatory approach, we evaluated the efficacy of intravenous methylprednisolone for HCPS treatment, through a parallel-group, placebo-controlled clinical trial. Methods. Patients aged >2 years, with confirmed or suspected HCPS in cardiopulmonary stage, admitted to any of 13 study sites in Chile, were randomized by study center in blocks of 4 with a 1:1 allocation and assigned through sequentially numbered envelopes to receive placebo or methylprednisolone 16 mg/kg/day (≤1000 mg) for 3 days. All personnel remained blinded except the local pharmacist. Infection was confirmed by immunoglobulin M antibodies or ANDV RNA in blood. The composite primary endpoint was death, partial pressure of arterial oxygen/fraction of inspired oxygen ratio ≤55, cardiac index ≤2.2, or ventricular tachycardia or fibrillation within 28 days. Safety endpoints included the number of serious adverse events (SAEs) and quantification of viral RNA in blood. Analysis was by intention to treat. Results. Infection was confirmed in 60 of 66 (91%) enrollees. Fifteen of 30 placebo-treated patients and 11 of 30 methylprednisolone-treated patients progressed to the primary endpoint (P = .43). We observed no significant difference in mortality between treatment groups (P = .41). There was a trend toward more severe disease in placebo recipients at entry. More subjects in the placebo group experienced SAEs (P = .02). There were no SAEs clearly related to methylprednisolone administration, and methylprednisolone did not increase viral load. Conclusions. Although methylprednisolone appears to be safe, it did not provide significant clinical benefit to patients. Our results do not support the use of methylprednisolone for HCPS. Clinical Trials Registration. NCT00128180. PMID:23784924

  19. Report: Heparin-induced thrombocytopenia associated with cardiopulmonary bypass: Preliminary attempt with recombinant human thrombopoietin therapy.

    Science.gov (United States)

    Yuan, Shi-Min

    2015-09-01

    Recombinant human thrombopoietin (rhTPO) is popularly used for the treatment of chemotherapy-induced thrombocytopenia. However, rhTPO therapy for heparin-induced thrombocytopenia relating to cardiopulmonary bypass has not been previously described. A young patient developed heparin-induced thrombocytopenia during open-heart surgery. Postoperative rhTPO therapy (15000 units injection hypodermatica once daily for consecutive 3 days) made a quick platelet recovery without any side effects. Heparin-induced thrombocytopenia associated with cardiopulmonary bypass is more likely to be benign, and is curable to rhTPO therapy. The preliminary rhTPO administration of heparin-induced thrombocytopenia in association with cardiopulmonary bypass shows satisfactory pharmaceutical effects with lower dose, shorter duration treatment and shorter platelet increase time and recovery time in comparison with those for the treatment of chemotherapy-induced thrombocytopenia. rhTPO therapy does not produce any side effects and it could avoid or minimize necessary blood product infusions.

  20. THE BASIC LAWS AND FEATURES OF CYTOKINE DYNAMICS IN PROCESS AND EARLY TERMS AFTER CARDIOPULMONARY BYPASS

    Directory of Open Access Journals (Sweden)

    S. I. Suskov

    2011-01-01

    Full Text Available The basic variants of cytokines reactions defining type of organ dysfunctions are revealed in the course of car- diopulmonary bypass and in the early postoperative period. Their character and expression, depends on gravity preoperative an immunodeficiency and initial degree of heart insufficiency. Diphasic dynamics of development of system inflammatory reaction is confirmed after cardiopulmonary bypass: increase of levels proinflammatory cytokines is in the first phase and anti-inflammatory cytokines with development immunodepression and cellular anergy in is the second phase. Also, key role IL-1Ra is revealed in restraint of hyperactivation of system inflam- matory reaction. Blood whey levels IL-6, IL-8, G-CSF, TNF-α and IL-1Ra should be defined to cardiopulmonary bypass, in 10–12 hours, 24 hours and 3 days after cardiopulmonary bypass and may be used as prognostic criteria of development of postoperative complications. 

  1. 53. Improved outcome of cardio-pulmonary arrest in post-operative cardiac children resuscitated in critical care setup

    Directory of Open Access Journals (Sweden)

    Hussam Hamadah

    2015-10-01

    Conclusions: The current outcome of cardio-pulmonary arrest in post-operative cardiac children has improved. Majority of cardiac arrest were successfully resuscitated with ROSC and 80% survived to discharge. The current result reflects significant improvement in the reported outcome of children who had cardio-pulmonary arrest in post-operative cardiac children in PCICU setup.

  2. Reliability and Responsiveness of Cardiopulmonary Exercise Testing in Fatigued Persons with Multiple Sclerosis and Low to Mild Disability

    NARCIS (Netherlands)

    Heine, Martin; van den Akker, Lizanne Eva; Verschuren, Olaf|info:eu-repo/dai/nl/304819670; Visser-Meily, Anne|info:eu-repo/dai/nl/180428047; Kwakkel, Gert

    2015-01-01

    Background Peak oxygen uptake (VO(2)peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons w

  3. Microfluidic Device

    Science.gov (United States)

    Tai, Yu-Chong (Inventor); Zheng, Siyang (Inventor); Lin, Jeffrey Chun-Hui (Inventor); Kasdan, Harvey L. (Inventor)

    2017-01-01

    Described herein are particular embodiments relating to a microfluidic device that may be utilized for cell sensing, counting, and/or sorting. Particular aspects relate to a microfabricated device that is capable of differentiating single cell types from dense cell populations. One particular embodiment relates a device and methods of using the same for sensing, counting, and/or sorting leukocytes from whole, undiluted blood samples.

  4. Neonatal Extracorporeal Membrane Oxygenation Devices, Techniques and Team Roles: 2011 Survey Results of the United States’ Extracorporeal Life Support Organization Centers

    OpenAIRE

    Lawson, Scott; Ellis, Cory; Butler, Katie; McRobb, Craig; Mejak, Brian

    2011-01-01

    In early 2011, surveys of active Extracorporeal Life Support Organization (ELSO) centers within the United States were conducted by electronic mail regarding neonatal Extracorporeal Membrane Oxygenation (ECMO) equipment and professional staff. Seventy-four of 111 (67%) U.S. centers listed in the ELSO directory as neonatal centers responded to the survey. Of the responding centers, 53% routinely used roller pumps for neonatal ECMO, 15% reported using centrifugal pumps and 32% reported using a ...

  5. Left ventricular assist devices improve functional class without normalizing peak oxygen consumption.

    Science.gov (United States)

    Benton, Casey R; Sayer, Gabriel; Nair, Ajith P; Ashley, Kimberly; Domanski, Michael J; Henzlova, Milena J; Anyanwu, Anelechi C; Pinney, Sean P

    2015-01-01

    Heart failure patients supported with left ventricular assist devices (LVAD) enjoy improvements in functional capacity and quality of life. We reasoned that such improvements in exercise capacity should be reflected in an objective increase in peak oxygen consumption as measured by cardiopulmonary exercise testing (CPET). We performed a retrospective review of all recipients of a HeartMate II LVAD at our center from June 2009 to June 2012 who completed CPET. Thirty-seven patients completed CPET an average of 6 months after implantation. Of these, 10 patients had CPET performed before LVAD implantation. Overall, 91.4% of patients improved by at least two New York Heart Association classes, with 34.3% improving by three classes. Postimplant VO2 max was significantly less than predicted (14.7 ± 3.1 vs. 29.8 ± 6.6 ml/kg/min, p VO2 max increased significantly from 11.6 ± 5.0 to 15.4 ± 3.9 ml/kg/min (p = 0.009). VO2 max improves significantly with LVAD support but fails to normalize to predicted values, in spite of improvements in functional class. The severity of preimplantation heart failure does not associate with the degree of VO2 max improvement.

  6. Structural Analysis and Design of Suspended Torsion Supporting Device for Grinding Rollers%辊压磨机悬空扭力支承装置结构分析与设计

    Institute of Scientific and Technical Information of China (English)

    仝军锋; 赵红霞

    2013-01-01

    The working principle of grinding roller' s suspended torsion supporting device was introduced,including the analysis of its freedom and stress.The results show that this torsion supporting device can balance gear torque,and the rod link with similar structure can undertake the same force which boasting of different nature.Basing on the constraint condition of the structure,the relationships between the displacement distance of movable roller and the main elements' size was determined.%介绍了辊压机悬空扭力支承的工作原理,分析了悬空扭力支承自由度,时其机构进行了受力分析,结果证明了悬空扭力支承可以平衡传动扭矩,机构有结构相同的杆受力大小相同,但受力性质不同.根据机构约束条件,确定了活动辊移动距离与主要机构尺寸之间的关系.

  7. A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Patrickson W Clive

    2009-07-01

    Full Text Available Abstract Background Hands-Only cardiopulmonary resuscitation (CPR is recommended for use on adult victims of witnessed out-of-hospital (OOH sudden cardiac arrest or in instances where rescuers cannot perform ventilations while maintaining minimally interrupted quality compressions. Promotion of Hands-Only CPR should improve the incidence of bystander CPR and, subsequently, survival from OOH cardiac arrest; but, little is known about a rescuer's ability to deliver continuous chest compressions of adequate rate and depth for periods typical of emergency services response time. This study evaluated chest compression rate and depth as subjects performed Hands-Only CPR for 10 minutes. For comparison purposes, each also performed chest compressions with ventilations (30:2 CPR. It also evaluated fatigue and changes in body biomechanics associated with each type of CPR. Methods Twenty healthy female volunteers certified in basic life support performed Hands-Only CPR and 30:2 CPR on a manikin. A mixed model repeated measures cross-over design evaluated chest compression rate and depth, changes in fatigue (chest compression force, perceived exertion, and blood lactate level, and changes in electromyography and joint kinetics and kinematics. Results All subjects completed 10 minutes of 30:2 CPR; but, only 17 completed 10 minutes of Hands-Only CPR. Rate, average depth, percentage at least 38 millimeters deep, and force of compressions were significantly lower in Hands-Only CPR than in 30:2 CPR. Rates were maintained; but, compression depth and force declined significantly from beginning to end CPR with most decrement occurring in the first two minutes. Perceived effort and joint torque changes were significantly greater in Hands-Only CPR. Performance was not influenced by age. Conclusion Hands-Only CPR required greater effort and was harder to sustain than 30:2 CPR. It is not known whether the observed greater decrement in chest compression depth associated

  8. Methylene Blue for Vasoplegia When on Cardiopulmonary Bypass During Double-Lung Transplantation.

    Science.gov (United States)

    Carley, Michelle; Schaff, Jacob; Lai, Terrance; Poppers, Jeremy

    2015-10-15

    Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. Methylene blue inhibits inducible nitric oxide synthase and guanylyl cyclase, and has been used to treat vasoplegia during cardiopulmonary bypass. However, because methylene blue is associated with increased pulmonary vascular resistance, its use in patients undergoing lung transplantion has been limited. Herein, we report the use of methylene blue to treat refractory vasoplegia during cardiopulmonary bypass in a patient undergoing double-lung transplantation.

  9. Carbon dioxide production during cardiopulmonary bypass: pathophysiology, measure and clinical relevance.

    Science.gov (United States)

    Ranucci, Marco; Carboni, Giovanni; Cotza, Mauro; de Somer, Filip

    2017-01-01

    Carbon dioxide production during cardiopulmonary bypass derives from both the aerobic metabolism and the buffering of lactic acid produced by tissues under anaerobic conditions. Therefore, carbon dioxide removal monitoring is an important measure of the adequacy of perfusion and oxygen delivery. However, routine monitoring of carbon dioxide removal is not widely applied. The present article reviews the main physiological and pathophysiological sources of carbon dioxide, the available techniques to assess carbon dioxide production and removal and the clinically relevant applications of carbon dioxide-related variables as markers of the adequacy of perfusion during cardiopulmonary bypass.

  10. A simple technique can reduce cardiopulmonary bypass use during lung transplantation

    Directory of Open Access Journals (Sweden)

    Marcos N. Samano

    2016-04-01

    Full Text Available Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.

  11. Development of the roller pump for use in the cardiopulmonary bypass circuit.

    Science.gov (United States)

    Cooley, D A

    1987-06-01

    In 1937, John Gibbon proposed his concept of extracorporeal circulation as an aid to cardiac surgery. Subsequently, a number of different types of pumps were tried in the extracorporeal circuit. Today, the pump used most often is a positive displacement twin roller pump, originally patented by Porter and Bradley in 1855. The rotary pump has undergone some minor modifications prior to its use in clinical cardiopulmonary bypass. Cardiovascular surgeons owe much to Porter and Bradley for an invention that has proved both efficient and effective for cardiopulmonary bypass and has allowed operations on an open heart in a relatively dry, bloodless field.

  12. Myocardial revascularization in the elderly patient: with or without cardiopulmonary bypass?

    Directory of Open Access Journals (Sweden)

    Iglézias José Carlos Rossini

    2003-01-01

    Full Text Available OBJECTIVE: To verify if there is advantage in myocardial revascularization the elderly without cardiopulmonary bypass (CPB in relation to the use of the same, being considered the viability of complete myocardial revascularization (MR and the hospital morbidity and mortality. METHOD: We prospectively studied a hundred consecutive, no randomized patients, with age > or = 70 years, submitted to the primary and isolated myocardial revascularization between January and December of 2000. The patients were divided in two groups, G1 - 50 patients operated with CPB and G2 - 50 patients operated without CPB. Univariate testing of variables was performed with chi-squared analysis in the SPSS 10.0 Program and a p value less than 0.005 was considered significant. RESULTS: There was no renal failure or myocardial infarction (MI in both groups; the incidence of respiratory failure was identical in the two groups (4%; two patient of G1 they had Strokes, and 12 presented low output syndrome, occurrences not registered in G2. The need of ventilatory support > 24 hs was not significant between groups. Medium time of hospital stay was 21.8 and 11.7 days respectively (NS and the survival after 30 days were similar in the two groups. The patients' of G1 eighty percent had more than two approached arteries, against only 48% of G2 (p < 0.0001. CONCLUSION: Because the largest number of grafts in the patients of G1, we can affirm that the use of CPB can provide a larger probability of complete RM.

  13. Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance.

    Science.gov (United States)

    McDonald, Catherine H; Heggie, James; Jones, Christopher M; Thorne, Christopher J; Hulme, Jonathan

    2013-08-01

    Updated life-support guidelines were published by the European Resuscitation Council (ERC) in 2010, increasing the required depth and rate of chest compression delivery. This study sought to determine the impact of these guidelines on rescuer fatigue and cardiopulmonary resuscitation (CPR) performance. 62 Health science students performed 5 min of conventional CPR in accordance with the 2010 ERC guidelines. A SkillReporter manikin was used to objectively assess temporal change in determinants of CPR quality. Participants subjectively reported their end-fatigue levels, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery. 49 (79%) participants reported that fatigue affected their CPR performance, at an average of 167 s. End fatigue averaged 49.5/100 (range 0-95). The proportion of chest compressions delivered correctly decreased from 52% in min 1 to 39% in min 5, approaching significance (p=0.071). A significant decline in chest compressions reaching the recommended depth occurred between the first (53%) and fifth (38%) min (p=0.012). Almost half this decline (6%) was between the first and second minutes of CPR. Neither chest compression rate, nor rescue breath volume, were affected by rescuer fatigue. Fatigue affects chest compression delivery within the second minute of CPR under the 2010 ERC guidelines, and is poorly judged by rescuers. Rescuers should, therefore, be encouraged to interchange after 2 min of CPR delivery. Team leaders should be advised to not rely on rescuers to self-report fatigue, and should, instead, monitor for its effects.

  14. Effects of propofol and isoflurane on haemodynamics and the inflammatory response in cardiopulmonary bypass surgery.

    Science.gov (United States)

    Sayed, S; Idriss, N K; Sayyedf, H G; Ashry, A A; Rafatt, D M; Mohamed, A O; Blann, A D

    2015-01-01

    Cardiopulmonary bypass (CPB) causes reperfusion injury that when most severe is clinically manifested as a systemic inflammatory response syndrome. The anaesthetic propofol may have anti-inflammatory properties that may reduce such a response. We hypothesised differing effects of propofol and isoflurane on inflammatory markers in patients having CBR Forty patients undergoing elective CPB were randomised to receive either propofol or isoflurane for maintenance of anaesthesia. CRP, IL-6, IL-8, HIF-1α (ELISA), CD11 and CD18 expression (flow cytometry), and haemoxygenase (HO-1) promoter polymorphisms (PCR/electrophoresis) were measured before anaesthetic induction, 4 hours post-CPB, and 24 hours later. There were no differences in the 4 hours changes in CRP, IL-6, IL-8 or CD18 between the two groups, but those in the propofol group had higher HIF-1α (P = 0.016) and lower CD11 expression (P = 0.026). After 24 hours, compared to the isoflurane group, the propofol group had significantly lower levels of CRP (P < 0.001), IL-6 (P < 0.001) and IL-8 (P < 0.001), with higher levels CD11 (P = 0.009) and CD18 (P = 0.002) expression. After 24 hours, patients on propofol had increased expression of shorter HO-1 GT(n) repeats than patients on isoflurane (P = 0.001). Use of propofol in CPB is associated with a less adverse inflammatory profile than is isofluorane, and an increased up-regulation of HO-1. This supports the hypothesis that propofol has anti-inflammatory activity.

  15. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Farhad Heidari; Helaleh Rabiee; Mahdi Sharif-Alhoseini; Hamid Shokoohi; Vafa Rahimi-Movaghar

    2012-01-01

    Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.Methods: In this prospective interventional study,patients presenting with PEA cardiac arrest were randomized into two groups.In Group A,ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity,right ventricle dilation,left ventricle function,pericardial effusion/tamponade and ⅣC size along with the advanced cardiac life support (ACLS) protocol.Patients in Group B solely underwent ACLS protocol without applying echocardiography.The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded.The return of spontaneous circulation (ROSC) and death were evaluated in both groups.Results: One hundred patients with the mean age of (58±6.1) years were enrolled in this study.Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR).Among them,7 patients (14%) had pericardial effusion,11 (22%) had hypovolemia,and 39 (78%) were revealed the presence of MVA.In the pseudo PEA subgroup (presence of MVA),43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA),there was no recorded ROSC (negative predictive value).Among patients in Group B,no reversible etiology was detected.There was no significant difference in resuscitation results between Groups A and B observed (P=0.52).Conclusion: Bedside echocardiography can identify some reversible causes of PEA.However,there are no significant changes in survival outcome between the echo group and those with traditional CPR.

  16. Massive carbon dioxide gas embolism: a near catastrophic situation averted by use of cardiopulmonary bypass.

    Science.gov (United States)

    Mohamed, Hasratt; Zombolas, Theodore; Schultz, John; Krzyzewski, Mike; Metcalf, Randy; Yuskevich, Brian; Ginsburg, Edo

    2009-06-01

    Endovascular vein harvesting is used as a less invasive method when compared to the standard open surgical method of dissecting and procurement of the greater saphenous vein. The benefits include smaller incision, decreased blood loss, less pain, decreased transfusion, decreased risk of infection and enhanced epidermal cosmetics. However, endovascular vein harvesting does have a learning curve to master the technique and although endovascular vein harvesting is the preferred standard of practice over the open surgical technique, it does have inherent potential complications. During endovascular vein harvesting, there is a potential for the patient's circulatory system to collapse which can be identified initially through hemodynamic monitoring, blood gas results, and vigilance through clinical observation. The suspected source of the crisis was confirmed when the surgeon cannulated the right atrium, where a massive gas source that (appeared pressurized) escaped upon incision of the right atrial appendage. Cardiopulmonary bypass (CPB) was utilized to support the patient and rectify the impending catastrophic event. Once full CPB was attained, we achieved hemodynamic stability and eventually all blood gases were normalized. Massive CO2 embolism is a life threatening emergency which must be identified and corrected instantaneously. CPB was the modality used to salvage this situation. Attention to the set-up of the EVH equipment, use of the transesophageal echocardiography, cerebral cximetry, vigilance and cooperation of all disciplines in the OR are definite recommendations to prevent such an occurrence. Experience gained by the perfusion team with a previous case was applied and helped to solve the immediate problems presented in this case.

  17. Platotex: an innovative and fully automated device for cell growth scale-up of agar-supported solid-state fermentation.

    Science.gov (United States)

    Adelin, Emilie; Slimani, Noureddine; Cortial, Sylvie; Schmitz-Alfonso, Isabelle; Ouazzani, Jamal

    2011-02-01

    Among various factors that influence the production of microbial secondary metabolites (MSM), the method of cultivation is an important one that has not been thoroughly investigated. In order to increase microbial throughput and simplify the extraction and workup steps, we performed a study to compare liquid-state fermentation (LSF) with agar-supported solid-state fermentation (AgSF). We found that AgSF is not only more suitable for our applications but offers, for some microbial strains, a higher yield and broader diversity of secondary metabolites. The main limitation of AgSF is the lack of a system to allow production scale-up. In order to overcome this obstacle we developed Platotex, an original fermentation unit offering 2 m(2) of cultivation surface that combines automatic sterilization, cultivation, and drying steps. Platotex is also able to support both LSF and solid-state fermentation (SSF). Platotex conforms to international security and quality requirements and benefits from total remote automation through industrial communication and control standards.

  18. Pulsatile support using a rotary left ventricular assist device with an electrocardiography-synchronized rotational speed control mode for tracking heart rate variability.

    Science.gov (United States)

    Arakawa, Mamoru; Nishimura, Takashi; Takewa, Yoshiaki; Umeki, Akihide; Ando, Masahiko; Kishimoto, Yuichiro; Kishimoto, Satoru; Fujii, Yutaka; Date, Kazuma; Kyo, Shunei; Adachi, Hideo; Tatsumi, Eisuke

    2016-06-01

    We previously developed a novel control system for a continuous-flow left ventricular assist device (LVAD), the EVAHEART, and demonstrated that sufficient pulsatility can be created by increasing its rotational speed in the systolic phase (pulsatile mode) in a normal heart animal model. In the present study, we assessed this system in its reliability and ability to follow heart rate variability. We implanted an EVAHEART via left thoracotomy into five goats for the Study for Fixed Heart Rate with ventricular pacing at 80, 100, 120 and 140 beats/min and six goats for the Study for native heart rhythm. We tested three modes: the circuit clamp, the continuous mode and the pulsatile mode. In the pulsatile mode, rotational speed was increased during the initial 35 % of the RR interval by automatic control based on the electrocardiogram. Pulsatility was evaluated by pulse pressure and dP/dt max of aortic pressure. As a result, comparing the pulsatile mode with the continuous mode, the pulse pressure was 28.5 ± 5.7 vs. 20.3 ± 7.9 mmHg, mean dP/dt max was 775.0 ± 230.5 vs 442.4 ± 184.7 mmHg/s at 80 bpm in the study for fixed heart rate, respectively (P mode for continuous-flow LVADs reliably provided physiological pulsatility with following heart rate variability.

  19. Hitos sobre el test cardiopulmonar de ejercicio Cardiopulmonary exercise test

    Directory of Open Access Journals (Sweden)

    RODRIGO SOTO F

    2008-01-01

    Full Text Available El test cardiopulmonar de ejercicio TCPE (CPET en la literatura anglosajona evalúa aspectos dinámicos de la la fisiología cardiorespiratoria, en contraste, las pruebas funcionales estáticas no reproducen la condición activa de un individuo. No obstante su complejo montaje e interpretación, en el último decenio ha habido un creciente interés en aplicarlo en la detección de mecanismos de disnea. Al respecto, la curva flujo/volumen dinámica permite demostrar limitación de flujos e hiperinflación dinámica, también esta prueba permite profundizar en el análisis del intercambio gaseoso en ejercicio. La utilidad de estas pruebas en la evaluación funcional pre-operatoria compleja es destacada. Dada su alta reproducibilidad, el TCPE continúa siendo un alto referente en pruebas cardíacas de esfuerzo. Publicaciones cardiológicas enfatizan su valor pronóstico como indicador de sobrevida, seguimiento de terapias y enlistado para trasplante en insuficiencia cardíaca congestiva, utilizando parámetros máximos y submáximos. Entre los primeros el consumo cumbre o punta de oxígeno, y en los submáximos el equivalente ventilatorio de anhídrido carbónico y el consumo de oxígeno en el umbral lácticoCardiopulmonary exercise test (CPET evaluates cardiorespiratory function in dynamic conditions, in contrast to static pulmonary function tests which can not reproduce the dynamic situation of an individual. Despite its complex implementation there has been growing interest in CPET in evaluating the mechanisms of dyspnoea With this respect dynamic flow/volume curve is useful in identifying expiratory airflow limitation and dynamic hyperinflation. Besides gas exchange analysis during exercise deepens the quality of information in that subject. Its utility for decision making in complex perioperative evaluation can not be overemphasized. Considering its high reproducibility, this method is a highly valuable tool in cardiac stress testing. Several

  20. Bidirectional Glenn on cardiopulmonary bypass: A comparison of three techniques.

    Science.gov (United States)

    Talwar, Sachin; Kumar, Manikala Vinod; Nehra, Ashima; Malhotra Kapoor, Poonam; Makhija, Neeti; Sreenivas, Vishnubhatla; Choudhary, Shiv Kumar; Airan, Balram

    2017-05-01

    To analyze the intraoperative and early results of the bidirectional Glenn (BDG) procedure performed on cardiopulmonary bypass (CPB) using three different techniques. Between September 2013 and June 2015, 75 consecutive patients (mean age 42 ± 34.4 months) undergoing BDG were randomly assigned to either technique I: open anastomosis or technique II: superior vena cava (SVC) cannulation or technique III: intermittent SVC clamping. We monitored the cerebral near infrared spectrophotometry (NIRS), SVC pressure, CPB time, intensive care unit (ICU) stay, and neurocognitive function. Patients in technique III had abnormal lower NIRS values during the procedure (57 ± 7.4) compared to techniques I and II (64 ± 7.5 and 61 ± 8.0, P = 0.01). Postoperative SVC pressure in technique III was higher than other two groups (17.6 ± 3.7 mmHg vs. 14.2 ± 3.5 mmHg and 15.3 ± 2.0 mmHg in techniques I and II, respectively = 0.0008). CPB time was highest in technique II (44 ± 18 min) compared to techniques I and III (29 ± 14 min and 38 ± 16 min, P = 0.006), respectively. ICU stay was longer in technique III (30 ± 15 h) compared to the other two techniques (22 ± 8.5 h and 27 ± 8.3 h in techniques I and II, respectively = 0.04). No patient experienced significant neurocognitive dysfunction. All techniques of BDG provided acceptable results. The open technique was faster and its use in smaller children merits consideration. The technique of intermittent clamping should be used as a last resort. © 2017 Wiley Periodicals, Inc.