Mechanical CPR devices are becoming more common in EMS, fire departments, and hospital emergency rooms. With the rise in popularity of this technology, it is important that both providers and even bystanders understand what these devices are and how they work. Covering the basics, following this list of do’s and don’ts of mechanical CPR in emergencies will help you understand the technology a bit better.
In the case of a cardiac arrest where a Mechanical CPR device is available…
Do start manual CPR right away.
A cardiac arrest victim’s chance of survival can be significantly increased by starting manual compressions as soon as possible.
Do make sure that the victim is securely strapped to the spine board before transport.
All mechanical CPR devices can migrate on a patient, but the chances of this happening can be significantly reduced by making sure the patient stays in place on the spine board.
Do have an extra power supply at hand, whether it is an oxygen tank or a battery.
The #1 cause of failure for mechanical CPR devices is a loss of power and the easiest way to avoid it is to carry a spare. In the event of a loss of power, it is usually faster to swap out the power supply than to remove the device and continue with manual CPR.
Do monitor the patient carefully for ROSC and/or responsiveness.
None of the mechanical CPR devices currently on the market have the ability to monitor patients, or the ability to react changes in a patient’s condition.
To be effective, CPR must be aggressive, manual or mechanical. All mechanical CPR systems have been designed to give cardiac arrest victims the best chance of survival. To ensure effective CPR, only compress the chest as far as necessary to create a palpable pulse. The AHA recommends a 2” minimum compression at 100 compressions per minute.
Don’t forget that machines are only as effective as the people that use them.
Mechanical CPR will never trump the ability of an experienced first responder to react to an abnormal situation. Many cardiac arrests can occur in situations that are ideal for the application of mechanical CPR but some scenarios might make the application of these machines impossible. Emergency service providers are most effective when they act with both versatility and speed.
If you would like to add to this list please do so by submitting a comment below.
A number of our customers have been requesting information on how to simulate a pneumothorax using the Michigan Instruments Dual Adult Lung. The following will describe how this condition can be simulated on a Training & Test Lung, using setup options offered by this device. The principles described can be applied to many laboratory situations that do not require the use of this lung.
A pneumothorax is usually characterized in humans by a collection of gas or fluid between a lung and the wall of the chest cavity. The added pressure (usually on only one lung) created by this condition often results in a patient having one uncompliant lung and one healthy lung—a situation in which standard ventilation can be difficult or even dangerous to perform.
This scenario can be simulated on a model 1600 or 5600i TTL by reducing the compliance of one lung (usually to 0.02 or 0.03 liters/cmH2O) while leaving the second lung in a healthy state (0.05 liters/cmH2O).
Airway resistances should be left within the normal healthy range (Rp20 for upper airway, Rp5 for lower airway) unless a compound pneumothorax is being simulated. When a TTL set up in this manner is ventilated the operator will note that, while pressures are relatively even throughout the system, volume and flow are heavily skewed toward one lung (as it would be in an actual patient scenario).
The pneumothorax can be accentuated (for observational purposes only) by further reducing the compliance of the affected lung (to 0.01 liters/cmH2O) and setting the upper and both lower airway resistances to Rp20. This extreme scenario, while effective at conveying the effects of a pneumothorax, is not representative of a simple pneumothorax in humans and should not be used to assess the effectiveness of treatment methods for this condition.
Most test lungs can be used to simulate many different pulmonary conditions. If you have questions on how to create a specific scenario on your test lung please leave a comment below or contact firstname.lastname@example.org. More information is available at https://www.michiganinstruments.com/training-test-lungs/.
It is no secret that military spending has gone down since sequestration (and other spending cuts), and simulation was one of the areas to take a major hit from this. This has led to increased private simulation lab interest and funding.
I remember attending the International Meeting on Simulation in Healthcare at the San Diego Convention Center in 2012. The sounds of my automated ventilator were constantly drowned out by faux gunfire and helicopter blades. Half of the people that walked by my booth were in uniform. Mannequins sported ragged gashes, shrapnel and even face paint.
Fast forward to 2014 in Orlando, these curiosities were nowhere to be found. Instead many of the rubber cadavers wore hospital gowns. Plenty of grave injuries made themselves present, but they were along the lines of blocked airways and organ complications. The focus of this industry is changing. While military spending is down, private spending in the realm of simulation is still very high. Simulation labs are becoming a new standard in modern hospitals, and those on the cutting edge of this industry are always looking for a way to improve their users’ experience.
Private User Attractiveness
As this change occurs, companies are beginning to ask questions about what will make their devices more appealing to private users. Cost is clearly not an issue. In 2012, a very high-end lung simulator would have cost between 25,000 and 35,000 USD. Just last week, at a show in Paris, I was introduced to a new lung simulation system with a base price of 46,000 Euros—well over 60,000 USD at the time.
Key Factors in Increasing Private Lab Simulation Attention
So, if cost is not an issue, how do we tap into this growing wealth of enthusiasm for simulation equipment? I won’t claim to have all of the answers, but customers have repeatedly asked questions that lead me to believe that the key factors are:
- Anthropomorphism—Simulation lab directors tend to want their hardware to look human. This helps users to relate to the procedures that they are performing and increases the learning experience.
- Durability—No one wants to spend 60,000 dollars on a device that will not last. Some of the most marketable simulation devices that I have seen have boxy steel frames or rugged, built-in carts that make transportation safe and easy.
- Availability of Support—It’s a lot easier to be confident buying a unit with a substantial guarantee, warranty, or support policy.
- The Range of Use—Very few customers will buy an extravagant device to simulate a single condition. The most successful simulators have a wide range of both “normal” and “abnormal” settings.
- Reputation—The industry talks. If one intubation simulator has been bought by the majority of the simulation labs in a given area, new simulation labs nearby are likely to purchase it. It is becoming more important than ever to maintain excellent relationships with customers, as both complaints and praise can be spread worldwide on popular media sites.
The industry is in a constant state of flux of change; at Michigan Instruments, we always keep our ear to the ground and function in a consistent state of improvement, ensuring quality products no matter what. Reach out to us anytime to learn more and see how we can best help you.
For many medical entities, the process of international regulation and approval can be long and confusing. While this is not always an easy process, there are a few things that you should remember whenever you are attempting to get your products approved in a new country.
The International Organization of Standardization
ISO, or the International Organization of Standardization, is the primary supplier of international regulatory standards, but compliance with ISO standards does not guarantee compliance with the rules and regulations of many countries.
Regulatory approval does not have a set timeline. Some countries can approve products within a couple weeks of the initial request while others can easily take longer than a year to complete all of the necessary actions.
The approval timeline can be affected by any number of things. Some countries (like Malaysia) base their standards off of standard ISO requirements. This helps to streamline the process, especially if you are already in compliance with the standards. Many countries (such as China and Japan) have national institutions similar to the FDA (Food and Drug Administration). These require a more focused effort and completion of the process can take months.
Countries, as well as prospective buyers of your product, can require a site inspection or audit of your company prior to approval. This is more common when it comes to Asian countries.
One saving grace of regulation as an institution is the push for consistent worldwide standards. This is an ongoing effort between the ISO, the FDA, and a number of other regulatory bodies to provide global harmonization of regulatory standards. Major standards included in ISO 13485 and 9001 provide general standards for a quality system and are recognized by many countries and companies throughout the world.
Regulatory practices have spread across a number of industries over the last 50 years. As they become more commonplace we can expect a global standard to emerge. It may happen slowly, but we can hope that someday companies will only need a handful of certifications to safely and legally distribute to the entire world.
Michigan Instruments has been the site of incremental development and constant change through the years. Today, our test lungs are recognized worldwide by thousands of users and are considered the gold standard of respiratory simulation.
Contact us to learn more about our array of respiratory products and medical applications today.
Acute Respiratory Distress Syndrome, or ARDS, is by no means a new condition in the respiratory care industry, but there are certainly some new treatments being tested to help treat it. Herneations, H1N1, SARS and many other conditions are all forms of ARDS, and it can affect patient of almost any age. High-frequency oscillatory ventilation (or HFOV) is an innovative form of respiratory care that, in America, is not widely used or understood. Michigan Instruments provides an explanation below.
High-frequency oscillatory ventilation explained:
Fortunately, the concept is simple. A healthy person in need of respiratory assistance is usually ventilated at a rate of 12-14 breaths per minute, each consisting of 400-700mL of air. HFOV, on the other hand, will deliver tiny ventilations, perhaps about 10-30mL, hundreds of times every minute. These tiny injections are understood to put less strain on the already distressed lungs than the conventional 600mL ventilations.
Unfortunately there are very few testers that can analyze the performance of an HFOV ventilator, and it is for this reason, at least in part, that the practice has not become more widespread. Flow measurements are particularly hard to perform on HFOV injections, and the diffusion path of delivered gas through the respiratory system is almost impossible to monitor.
In part two of this 3-part series, Michigan Instruments will dive into the details regarding output assessment and how to properly monitor the effectiveness of this technique.
If you have any questions about the use of high-frequency oscillatory ventilation, don’t hesitate to contact Michigan Instruments anytime.
This is part 2 of our series focusing on assessing high-frequency oscillatory ventilation. Check out part one here.
Due to difficulties in assessing the outputs (from the patient’s perspective) of HFOV ventilators, many analysts have resorted to monitoring pressure outputs. The theory is that so long as an adequate FIO2 (fraction of inspired oxygen) reaches the patient and the pressures remain safe, the ventilation is a success. Unfortunately, this method does little to help us understand HFOV on a deeper level, and without this understanding, it is difficult to know how the science and practice of modern ventilation will progress in the future.
Why is it important to understand volume and flow parameters?
Measuring ventilated volume is a common way of fact-checking a ventilator. For the display on a ventilator to show an accurate delivered volume the vast majority of the unit’s internal systems must be working properly. Flow, similarly, can offer insight into what might be going wrong with one of these ventilators, should it malfunction or require calibration. These parameters are sometimes overlooked in testing as the ventilator itself will display variations of them. Other variables make themselves in apparent when the problem of calibration is approached scientifically. Compressible volume in the airway and lungs can damage the accuracy of calculations performed by the ventilator, and without the ability to control airway resistance and lung compliance to a known value outputs are not always consistent.
The patient’s perspective.
Changes in flow and volume must be explored from the perspective of the patient as a way to understand, calibrate, and tweak ventilators. This sort of testing, however, requires a new type of test lung device capable of measuring flows, volumes, and pressures at different points throughout the respiratory system of a simulated patient.
We’ll get into test lung devices in part three. In the meantime, if you have any questions about the use of high-frequency oscillatory ventilation, don’t hesitate to contact Michigan Instruments anytime.
In using high frequency oscillatory ventilation (HFOV) tidal volume and LPM (flow) values can be exceptionally difficult to monitor. Several third-party devices have been developed to monitor this, but due to a lack of any solid standard of operation, it is still considered to increase patient risk over conventional ventilation. Regardless, let’s take a look at its current applications and uses.
Currently, HFOV has found a niche in non-conventional settings, primarily in the treatments of neonatal patients and some adult cases where the patient is considered to be past the point at which traditional ventilation would be beneficial. It is important to note that the largest fear surrounding HFOV concerns is the lack of understanding of the delivered tidal volume and other common parameters used to describe breaths.
HFOV, in some medical systems, has become a “last resort” treatment option.
It doesn’t expose the lungs of a patient to the same dramatic swings in pressure and flow that a standard ventilator does. Damaged lungs can be further exacerbated by such swings, and the underdeveloped lungs of premature infants are especially susceptible.
HFOV is such a departure from a standard breath that it invites mistrust, and without the ability to really explore the WHY of the effectiveness of HFOV, such a departure is difficult to justify. It is often found, in medical studies, that the human body is very well adapted to its’ natural processes.
The mention of a ventilator forcing hundreds of miniature breaths onto a patient every minute is, admittedly, a bit intimidating. It could, however, offer some excellent treatment options to future patients. We aren’t saying advocating to press this sort of treatment—not until we find a way to confirm effectiveness and minimize risk to patients—but we do believe that the benefits of better understanding this non-conventional form of ventilation would far outweigh the cost.
Review part one and part two of the series and contact us with any follow-up questions or comments.