CARDIOHELP BASIC TRAINING

Transcription

1 CARDIOHELP BASIC TRAINING

2 PRESENTATION OVERVIEW Topic 1 CARDIOHELP Movie Presentation Topic 2 Areas of Application with CARDIOHELP Topic 3 Different Therapy Application with CARDIOHELP Topic 4 CARDIOHELP System Components Topic 5 Differences between CARDIOHELP and CARDIOHELP-i Topic 6 Modes of CARDIOHELP Topic 7 Disposable for CARDIOHELP Topic 8 HLS Set Topic 9 CARDIOHELP Sensors (Flow / Bubble / Level / Venous probe) NOTE: The hole presentation can be downloaded as a PDF-document with the button. This button is located at the right upper corner of the window.

3 CARDIOHELP VIDEO PRESENTATION

4 AREAS OF APPLICATION WITH CARDIOHELP CARDIOHELP System is the world s smallest portable heart-lung support system. It is ideal for use in: Intensive care units cardiac catheter laboratory operating room trauma room Furthermore, it is the perfect solution for safe and effective patient transport. There are, therefore, now new areas of use and treatment possibilities for extracorporeal circulation.

5 AREAS OF APPLICATION WITH CARDIOHELP Intensive care medicine: CARDIOHELP System opens up new treatment options in intensive care medicine which put far less stress on the patient and are also comparatively inexpensive. In cases of respiratory failure, the device provides the oxygen supply. Further areas of use include: Acute respiratory distress syndrome (ARDS) Septic shock Pulmonary embolism MAQUET 6

6 AREAS OF APPLICATION WITH CARDIOHELP Cardiology: In the event of cardiogenic shock, a frequent consequence of a heart attack, it is crucial to provide circulatory support as quickly as possible. This must be guaranteed until the body is able to resume this function itself. CARDIOHELP System can prevent organ damage resulting from insufficient oxygen supply to the vital organs. Areas of application include: Cardiogenic shock As stand-by or prophylactic support during high risk PCI As a bridging system (bridge to recovery, bridge to bridge, bridge to decision, etc.), e. g., for myocarditis MAQUET 7

7 AREAS OF APPLICATION WITH CARDIOHELP Cardiac surgery: At the end of the 1990s, MAQUET developed the minimized extracorporeal circulation system (MECC System). Its clinical use in the operating room led to new applications of extracorporeal life support (ECLS) which required immediate or extended circulatory support. This principle has been perfected with CARDIOHELP System and the compact, integrated design of the HLS Modules. Thanks to the system s mobility, patients can undergo further therapeutic measures (e. g., intensive care) and diagnostic investigations (e. g., CT) during extracorporeal life support. The areas of use: Pre-operative heart-lung support (e. g., cardiogenic shock) Post-operative heart-lung support (e. g., low cardiac output syndrome) As a bridging system (bridge to recovery, bridge to bridge, bridge to decision, etc.) MAQUET 8

8 AREAS OF APPLICATION WITH CARDIOHELP Emergency medicine: CARDIOHELP Device weighs in at approx. 11 kg and can easily be carried by one person and is sufficiently compact to be used during transport. The system is used in emergencies to restore and stabilize the atient s cardiopulmonary functions. It may have to be used during cardiopulmonary resuscitation caused by, amongst others: Anaphylactic shock Intoxication Hypothermia

9 DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP The individual operating modes and the disposables make the CARDIOHELP life support system suitable for all indications where cardiac and/or respiratory support is needed. Thus, the principle of ECLS for supplying the heart and/or lungs with oxygen is now available in new areas as a means of life support and to save lives. During open heart surgery, for example minimal extracorporeal circulation (MECC) with the CARDIOHELP life support system, ECLS is less stressful for the patient than the use of a conventional heart-lung machine. In cases of respiratory failure without cardiac impairment CARDIOHELP provides respiratory assistance with veno-venous ECLS. During veno-arterial ECLS the life support system provides cardiopulmonary support. In cases of severe respiratory failure CARDIOHELP can also be used for pump assisted lung protection (PALP) with extracorporeal CO 2 removal to enable protective ventilation.

10 DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP Veno-venous ECLS Respiratory assistance for lung disorders: This form of ECLS is mostly used when the heart is still able to pump blood through the circulatory system without any additional support, as in the case of acute respiratory failure or a massive pulmonary embolism. The blood is removed from the jugular vein or a femoral vein for enrichment with oxygen, after which it is returned to a vein. Place of use: ICU Fields of applications: Respiratory failure without cardiac impairment: ARDS Septic shock Bridge to lung transplant Customer and Patient value: Little complexity, safe to use and more security due to little to no change of components during entire system run. Special feature: Enables CO 2 removal and oxygenation for up to 30 days. Access to Patient: percutaneous cannulation of jugular and femoral veins

11 DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP Veno-arterial ECLS Cardiac and respiratory support: Veno-arterial ECLS is used with patients whose hearts are not adequately supporting the circulation, or have stopped. This occurs with a myocardial infarction (heart attack). It is vitally important to ensure cardiopulmonary support as early as possible to prevent organ damage. Furthermore, the CARDIOHELP life support system can increase the patient s chances of survival by enabling examination in the cardiac catheter laboratory and revascularization by means of catheters or cardiac surgery. Place of use: ICU, Cath. Lab, ER, OR Fields of application: respiratory and circulatory failure: Cardiogenic shock During cardiopulmonary resuscitation As preventive left ventricular support in the event of low cardiac output During PTCA In cases of acute cardiac arrest or severe cardiogenic shock during the intervention As standby during high-risk PTCA In cases of acute post-infarction VSD Customer and patient value: One system fits all, from a fast deployable emergency life saving circulatory support system to a long term VAD with oxygenation possibility. Special feature: for a cardiac support and respiratory assistance up to 30 days Access to patient: percutaneous cannulation of the femoral vein and femoral or subclavian artery

12 DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP CO2 Removal Pump Assisted Lung Protection (PALP) In severe cases of respiratory failure the CARDIOHELP life support system can be used in combination with protective ventilation for pump assisted lung protection (PALP) to reduce the CO2 level in the blood. In these cases, protective ventilation focuses on 6 ml/kg (instead of 12 ml/kg BW) tidal volume within the limits of a certain airway pressure and respiratory rate. These ventilation limits cause higher CO2 levels than normal, which is acceptable in many situations(concept of permissive hypercapnia). However, in some cases complications due to high CO2 levels (acidosis, pulmonary hypertension) occur and some patients need low to normal CO2 levels to protect the brain. Places of use: ICU Fields of applications: Severe respiratory failure, e.g. ARDS; Severe COPD (chronic obstructive pulmonary disease) Customer and patient value: extracorporeal CO2 removal enables protective ventilation to be used Special feature: allows CO2 removal for up to 30 days of ECLS Access to patient: percutaneous cannulation of either jugular or subclavian and femoral veins

13 DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP Revascularization Minimized Extracorporeal Circulation for cardiac surgery (MECC) Minimal extracorporeal circulation (MECC) with the CARDIOHELP life support system makes ECLS for cardiopulmonary support during open heart surgery less stressful for the patient than when a conventional heart-lung machine is used. With the compact, integral design of the QUADROX-iR oxygenator-pump module, the priming volume and blood surface contact are kept as small as possible. Combined with the exceptionally small pressure drop plus the BIOLINE Coating of the disposable, trauma is minimized. Moreover, the CARDIOHELP life support system is an intuitively operated system, which is ready for use in minutes for emergency situations. Thanks to the system s mobility, the patient can undergo further therapeutic measures and diagnostic investigations during ongoing circulatory support. Place of use: OR Procedure: minimally-invasive perfusion system with full support for heart and gas exchange for up to 6 h Fields of application: On-pump CABG surgery. Postoperative "low cardiac output" syndrome Patient transport from and into the cardiac operating room, from the emergency/trauma room, from and into the catheterization laboratory Customer and Patient Value: minimally invasive, less blood product use¹, shorter stay in ICU² Special feature: no blood to air contact, minimal hemodilution Access to Patient: surgical cannulation of right atrium and aorta

14 CARDIOHELP SYSTEM COMPONENTS

15 CARDIOHELP SYSTEM COMPONENTS

16 DIFFERENCES BETWEEN CARDIOHELP AND CARDIOHELP-i Differences Hardware CARDIOHELP CARDIOHELP-i No venous probe available Venous probe available No internal sensors from disposable available Internal sensors from disposable available QUADROX-iR adult QUADROX-iR small adult HLS Set Advanced 7.0 HLS Set 7.0 HLS Set Advanced 5.0 HLS Set 5.0

17 DIFFERENCES BETWEEN CARDIOHELP AND CARDIOHELP-i Differences Hardware Depending on the CARDIOHELP version, different applications are available. Essentially, they differ in the information displayed and available functions.the user is only provided with the functions needed for his/her area of work, thus keeping the system clear, simple and quick to operate. OR application ( Operation Room ): designed for use in the operating room ICU application ( Intensive Care Unit ): designed for use in the intensive care unit (only CARDIOHELP-i) TM application ( Transport Mode ): designed for interhospital patient transport (only CARDIOHELP-i) If more than one application is available, you can switch between the applications The OR, ICU and TM applications are designed and optimized for the environments mentioned above. Nevertheless, the intended use of the applications is not limited to the specific environment. Within the intended environment of the CARDIOHELP System, you can use any available application that is suitable and safe for the patient and the current situation CARDIOHELP CARDIOHELP-i

18 DIFFERENCES BETWEEN CARDIOHELP AND CARDIOHELP-i Differences Overview CARDIOHELP CARDIOHELP-i Support of disposable s sensors --- YES Applications OR OR, ICU, TM Blood parameters screen --- YES Offline recording --- YES Monitor blood parameters S V O 2, Hb, Hct --- YES Flow/bubble sensor YES YES Venous probe with connection cable --- YES Disposable connection cable --- YES USB Stick --- YES

19 DIFFERENCES BETWEEN CARDIOHELP AND CARDIOHELP-i User interface Differences between software applications : STARTUP SCREEN OR software application ICU software application TM software application Alarm delay button only in ICU application available!

20 MODES OF CARDIOHELP RPM and LPM MODES The CARDIOHELP can be operated in LPM or RPM mode: RPM mode (speed control, revolutions per minute ) In RPM mode, you can set the pump s setpoint speed. The CARDIOHELP operates the pump constantly at the set speed. This enables the flow to be varied, according to the resistance of the extracorporeal circulation. LPM mode (flow control, liters per minute ) In LPM mode, you can set the setpoint flow. The CARDIOHELP operates the pump in such a way that the set flow is maintained. This enables the speed to be varied, according to the resistance of the extracorporeal circulation.

21 MODES OF CARDIOHELP Zero flow MODE In the zero flow mode, the CARDIOHELP aims at a flow of 0 l/min by controlling the pump accordingly. In this way, a backflow can be prevented. The zero flow mode can be activated manually or is activated automatically by backflow prevention. To activate the zero flow mode, hold down the safety button and press the Zero flow mode button. Backflow Prevention The backflow prevention can detect and react to a backflow of blood. For this, the CARDIOHELP monitors the blood flow, displays any necessary alarms and activates the zero flow mode automatically, to prevent any backflow. Global Overwrite MODE In Global Override mode, all interventions, acoustic alarms and backflow prevention are disabled. To activate the Global Override mode, hold down the safety button Symbol.. The color of symbol changes. and press the Global Override

22 DISPOSABLE FOR CARDIOHELP HLS Module Advanced, the disposable: The core of the complete HLS Set integrates not only a cuttingedge VAD centrifugal pump and a special gas exchanger, but also sensors for three pressure parameters and arterial temperature. Equipped with a high-quality diffusion membrane with a biocompatible, blood-friendly BIOLINE Coating, the module can be used for up to 30 days of continuous function. This is the world s first disposable combination of VAD and gas exchanger incorporating a high-tech sensor for measuring venous oxygen saturation, hematocrit, hemoglobin and venous temperature. HLS Module Advanced 7.0: Integrated gas exchanger with diffusion membrane Integrated heat exchanger Integrated cutting edge VAD centrifugal pump Approval for 30 days and transportation approval BIOLINE Coating

23 DISPOSABLE FOR CARDIOHELP HLS Module Advanced 7.0: Unprecedented integrated sensors for: Venous pressure (Pven), Internal pressure (Pint), Arterial pressure (Part), Arterial temperature (Tart) Integrated cell to connect venous probe to measure: Venous oxygen saturation Hemoglobin / Hematocrit Venous temperature (Tven)

24 DISPOSABLE FOR CARDIOHELP HOW DOES IT WORK? Step 1: Step 3: In the membrane venous blood will enriched with oxygen and will cool down or heated up by the water. Blood flows around the hollow fibers. Water and gas flows through the hollow fibers. Venous blood flows via gravity to the pump Gas (O 2 ) Blood from patient (Low in oxygen) Step 2: Blood goes through centrifugal pump into the membrane of oxygenator. Blood to patient (Rich in oxygen ) Water from heater cooler unit

25 DISPOSABLE FOR CARDIOHELP HLS Module Advanced 7.0: Integrated VAD pump on the blood inlet side of the gas-exchanger [1] Gas inlet [2] De-airing membrane [3] Centrifugal pump [4] Water connectors [5] Venous cell [6] Connection for internal sensors [7] Quick de-airing 4

26 DISPOSABLE FOR CARDIOHELP HLS Module Advanced 7.0: Integrated VAD pump on the blood inlet side of the gas-exchanger [1] Blood inlet [2] Blood outlet [3] Temperature sensor [4] Gas outlet

27 OVERVIEW DISPOSABLE TYPES FOR CARDIOHELP Name QUADROX-iR HLS Module HLS Module Advanced Picture 5 Liter/min Version YES (QUADROX-iR small adult) YES (HLS Module 5.0) YES (HLS Module Advanced 5.0) 7 Liter/min Version YES (QUADROX-iR adult) YES (HLS Module 7.0) YES (HLS Module Advanced 7.0) BIOLINE COATING YES YES YES (HIT Set with SOFTLINE COATING available*) Internal temperature sensors Internal pressure sensors Venous probe connection NO NO YES (1x Arterial Infrared Sensor) YES (p Int / p Ven / p Art ) YES (1x Arterial Infrared Sensor) YES (p Int / p Ven / p Art ) NO NO YES Approval(s) 6 hours 30 days 30 days / transport (* HIT Set with 6 hour approval)

28 HLS SET FOR CARDIOHELP HLS SET

29 CARDIOHELP FLOW/BUBBLE SENSOR Flow and bubble monitoring : The flow of blood is measured by a flow/bubble sensor. This means, in one housing we have a combined measuring tool for the flow and a sensor to detect air bubbles. A detected air bubble stops immediately the centrifugal pump (called intervention) to prevent an air embolism. The sensor have to be fitted so that the blood flows in the direction of the arrow on the cover. NOTE: Only 3/8 x 3/32 PVC tubes approved for this system. [1] Cover with flow indicator [2] Connection cable to CARDIOHELP [3] Tube retainer [4] Locking mechanism

30 ULTRASONIC FLOWMETER BASICS The transit-time method The transit-time method exploits the fact that the propagation rate of an ultrasonic signal depends on the flow rate of the carrier medium. Like a swimmer swimming against the current, the ultrasonic signal moves more slowly against the flow direction than in the flow direction of the medium. The transit time of the sonic signals which flow through the medium in flow direction is shorter than the transit time of the sonic signals which flow through it against flow direction. By measuring the difference in flow rate Δt, it is possible to calculate the mean flow rate on the path taken by the ultrasonic impulse. This process involves transmitting one ultrasonic impulse in flow direction and a second impulse in the opposite direction through the medium. The sensors work alternately as transmitters (Tx) and receivers (Rx). Measurement against flow t 2 Measurement flow direction t 1 = t flow Rx Tx Tx Rx Flow Flow Hose wall reflector reflector reflector reflector Since ultrasonic waves also penetrate solid objects, the sensors can be attached to the outer wall of the hose. Therefore measuring is not invasive and inserting the sensors does not require any intrusion into the system.

31 LEVEL SENSOR Capacitive level sensor monitoring : The blood level in the reservoir is measured by a capacitive level sensor. The level pad will be attached to the lowest level limit of reservoir. If the liquid s surface falls below this limit, the CARDIOHELP gives an optical and an acoustical alarm and stops the pump. 1 The level pad must be attached with the double-faced Scotch tape horizontally to the desired position on the blood reservoir. NOTE: Sensor pad must be replaced after every perfusion. 2 [1] Level pad (disposable) [2] Level Sensor

32 LEVEL SENSOR Capacitive level sensor monitoring : Front side: At the front side of level pad are a lot of distance holder mounted to avoid influences from front side. The detecting area of the sensor pad is same as the height of the pad self. Distance holder J Detecting area Back side: Behind the double-faced Scotch tape the sensor surface area is located. This sensor surface area is made of a thin aluminium foil.

33 VENOUS PROBE Blood parameter measurement: 1 The venous probe of the CARDIOHELP-i measures the venous blood parameters: S V O 2 Oxygen saturation Hb Hemoglobin Hct Hematrocrit T Ven Venous blood temperature 2 3 [1] LEDs [2] Optical sensors [3] Infrared temperature sensor

34 VENOUS PROBE Blood measurement Principe: The probe has three LEDs which irradiate the blood through the BMU Cell at different wavelengths. An optical sensor measures Hb and Hct concentration without contact. A second optical sensor measures the SvO2 value in the same way. The temperature T Ven is measured by a non-invasive, thermopile infrared sensor. Probe fixation: For measurement, the probe is connected to the disposable s measuring cell. When the probe is not in use, it is hooked into the holder on the safety bar to protect the sensors.

35 THANK YOU! Your support contact: MAQUET Cardiopulmonary AG Hechinger Strasse 38 D Hirrlingen, Germany Phone: +49 (0) The final quiz will start at next page!!!