CARDIOHELP BASIC TRAINING - Getinge Login6DD17E4C... · CARDIOHELP BASIC TRAINING. NOTE: The hole...
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CARDIOHELP BASIC TRAINING
NOTE:
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PRESENTATION OVERVIEW
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)
Topic 1 – CARDIOHELP Movie Presentation
CARDIOHELP VIDEO PRESENTATION
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.
AREAS OF APPLICATION WITH CARDIOHELP
© MAQUET 6
Intensive care medicine:
CARDIOHELP System opens up new treatment options in intensivecare medicine which put far less stress on the patient and are alsocomparatively inexpensive. In cases of respiratory failure, the deviceprovides the oxygen supply.
Further areas of use include:
Acute respiratory distress syndrome (ARDS)
Septic shock
Pulmonary embolism
AREAS OF APPLICATION WITH CARDIOHELP
© MAQUET 7© MAQUET 7
Cardiology:
In the event of cardiogenic shock, a frequent consequenceof a heart attack, it is crucial to provide circulatory supportas quickly as possible. This must be guaranteed until thebody is able to resume this function itself. CARDIOHELPSystem can prevent organ damage resulting frominsufficient 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
AREAS OF APPLICATION WITH CARDIOHELP
© MAQUET 8© MAQUET 8
Cardiac surgery:
At the end of the 1990s, MAQUET developed the minimizedextracorporeal circulation system (MECC System). Its clinicaluse in the operating room led to new applications ofextracorporeal life support (ECLS) which required immediate orextended circulatory support. This principle has been perfectedwith CARDIOHELP System and the compact, integrateddesign 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) duringextracorporeal 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.)
AREAS OF APPLICATION WITH CARDIOHELP
Emergency medicine:
CARDIOHELP Device weighs in at approx. 11 kg and caneasily be carried by one person and is sufficientlycompact to be used during transport. The system is usedin emergencies to restore and stabilize the atient’scardiopulmonary functions. It may have to be used duringcardiopulmonary resuscitation caused by, amongst others:
Anaphylactic shock
Intoxication
Hypothermia
AREAS OF APPLICATION 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 CO2 removal to enable protective ventilation.
DIFFERENT THERAPY APPLICATIONS
WITH CARDIOHELP
Veno-venous ECLSRespiratory 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 CO2 removal and oxygenation for up to 30 days.
Access to Patient: percutaneous cannulation of jugular and femoral veins
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
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
DIFFERENT THERAPY APPLICATIONS
WITH CARDIOHELP
RevascularizationMinimized 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
DIFFERENT THERAPY APPLICATIONS
WITH CARDIOHELP
CARDIOHELP SYSTEM COMPONENTS
CARDIOHELP SYSTEM COMPONENTS
CARDIOHELP CARDIOHELP-i
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
DIFFERENCES BETWEEN
CARDIOHELP AND CARDIOHELP-i
No venous probe available
No internal sensors from disposable available
Internal sensors from disposable available
Venous probe available
Differences Hardware
CARDIOHELP-i
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
Differences Hardware
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
SVO2, Hb, Hct--- YES
Flow/bubble sensor YES YES
Venous probe
with connection cable--- YES
Disposable connection cable --- YES
USB Stick --- YES
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 !
DIFFERENCES BETWEEN
CARDIOHELP AND CARDIOHELP-i
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.
To activate the “Global Override” mode, hold down the “safety” button and press the “Global Override”
Symbol . . The color of symbol changes .
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 .
MODES OF CARDIOHELP
Zero flow MODE
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.
HLS Module Advanced, the disposable:
The core of the complete HLS Set integrates not only a cutting-
edge 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.
DISPOSABLE FOR CARDIOHELP
Integrated gas exchanger with diffusion membrane
Integrated heat exchanger
Integrated cutting edge VAD centrifugal pump
Approval for 30 days and transportation approval
BIOLINE Coating
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)
HLS Module Advanced 7.0:
DISPOSABLE FOR CARDIOHELP
DISPOSABLE FOR CARDIOHELPHOW DOES IT WORK?
Gas (O2)
Water from
heater cooler unit
Blood from patient
(Low in oxygen)
Blood to patient
(Rich in oxygen )
Blood goes through
centrifugal pump into
the membrane of
oxygenator.
Venous blood flows via
gravity to the pump
Step 1:
Step 2:
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.
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
2
7
6
5
4
3
1
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
1
2
3
4
DISPOSABLE FOR CARDIOHELP
OVERVIEWDISPOSABLE 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
sensorsNO
YES (1x Arterial Infrared Sensor)
YES(1x Arterial Infrared Sensor)
Internal pressure
sensorsNO
YES
(pInt / pVen / pArt)
YES
(pInt / pVen / pArt)
Venous probe
connectionNO NO YES
Approval(s) 6 hours 30 days 30 days / transport
(* HIT Set with 6 hour approval)
HLS SET FOR CARDIOHELP
HLS SET
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
Rx Tx
reflector
Flow
Tx
reflector
Flow
Rx
Measurement against flow t2 Measurement flow direction t1 = ∆t flow
reflector reflector
ULTRASONIC FLOWMETER BASICS
Hose wall
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).
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.
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.
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.
LEVEL SENSOR
1
2
[1] Level pad (disposable)
[2] Level Sensor
Distance holder
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.
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.
J
Dete
ctin
gare
a
LEVEL SENSOR
VENOUS PROBE
Blood parameter measurement:
The venous probe of the CARDIOHELP-i measures
the venous blood parameters:
SVO2 Oxygen saturation
Hb Hemoglobin
Hct Hematrocrit
TVen Venous blood temperature[1] LEDs
[2] Optical sensors
[3] Infrared temperature sensor
1
2 3
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 TVen 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.
THANK YOU!
MAQUET Cardiopulmonary AG
Hechinger Strasse 38
D-72145 Hirrlingen, Germany
Phone: +49 (0) 7478 921-414
Your support contact:
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