• 제목/요약/키워드: post-cardiopulmonary

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스마트올인원 심폐순환보조장치의 안전성 및 성능평가에 관한 연구 (A Study on Safety and Performance Evaluation of Smart All-in-one Cardiopulmonary Assist Device)

  • 박준현;호예지;이예림;이덕희;최재순
    • 대한의용생체공학회:의공학회지
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    • 제40권5호
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    • pp.197-205
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    • 2019
  • The existing Extracorporeal membrane oxygenation(ECMO) and Cardiopulmonary bypass system(CPB) have been developed and applied to various devices according to their respective indications. However, due to the complicated configuration and difficult usage method, it causes inconvenience to users and there is a risk of an accident. Therefore, smart all-in-one cardiopulmonary circulation device is being developed recently. The smart all-in-one cardiopulmonary assist device consists of a blood pump for cardiopulmonary bypass, a blood oxidizer for cardiopulmonary bypass, a blood circuit for cardiopulmonary bypass, and an artificial cardiopulmonary device. It is an integrated cardiopulmonary bypass device that can be used for a variety of purposes such as emergency, intraoperative, post-operative intensive care, and long-term cardiopulmonary assist, combined with CPB used in open heart surgery and ECMO used when patient's cardiopulmonary function does not work normally. The smart all-in-one cardiopulmonary assist device does not exist as a standard and international standard applicable to advanced medical devices. Therefore, in this study, we will refer to the International Standard for Blood Components, the International Standard for Blood, the Guideline for Blood Products, and prepare applicable performance and safety guidelines to help quality control of medical devices, and contribute to the improvement of the health of people. The guideline, which is the result of conducted a survey of the method of safety and performance test, is based on the principle of all-in-one cardiopulmonary aiding device, related domestic foreign standards, the status of domestic and foreign patents, related literature, blood pump(ISO 18242), blood oxygenator (ISO 7199), and blood circuit (ISO 15676) for cardiopulmonary bypass.The items on blood safety are as follows: American Society for Testing and Materials ASTM F1841-97R17), and in the 2010 Food and Drug Administration's Safety Assessment Guidelines for Medical Assisted Circulatory Devices. In addition, after reviewing the guidelines drawn up through expert consultation bodies including manufacturers / importers, testing inspectors, academia, etc. the final guideline was established through revision and supplementation process. Therefore, we propose guidelines for evaluating the safety and performance of smart all-in-one cardiopulmonary assist devices in line with growing technology.

Cardiopulmonary Resuscitation: New Concept

  • Lee, Kwang-Ha
    • Tuberculosis and Respiratory Diseases
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    • 제72권5호
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    • pp.401-408
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    • 2012
  • Cardiopulmonary resuscitation (CPR) is a series of life-saving actions that improve the chances of survival, following cardiac arrest. Successful resuscitation, following cardiac arrest, requires an integrated set of coordinated actions represented by the links in the Chain of Survival. The links include the following: immediate recognition of cardiac arrest and activation of the emergency response system, early CPR with an emphasis on chest compressions, rapid defibrillation, effective advanced life support, and integrated post-cardiac arrest care. The newest development in the CPR guideline is a change in the basic life support sequence of steps from "A-B-C" (Airway, Breathing, Chest compressions) to "C-A-B" (Chest compressions, Airway, Breathing) for adults. Also, "Hands-Only (compression only) CPR" is emphasized for the untrained lay rescuer. On the basis of the strength of the available evidence, there was unanimous support for continuous emphasis on high-quality CPR with compressions of adequate rate and depth, which allows for complete chest recoil, minimizing interruptions in chest compressions and avoiding excessive ventilation. High-quality CPR is the cornerstone of a system of care that can optimize outcomes beyond return of spontaneous circulation (ROSC). There is an increased emphasis on physiologic monitoring to optimize CPR quality, and to detect ROSC. A comprehensive, structured, integrated, multidisciplinary system of care should be implemented in a consistent manner for the treatment of post-cardiac arrest care patients. The return to a prior quality and functional state of health is the ultimate goal of a resuscitation system of care.

소아에서 인공심폐기 충전액의 첨가용액으로서 사용한 crystalloid와 colloid 용액에 관한 임상연구 (A Prospective Clinical Study of Crystalloid and Colloid Solutions as Priming Additive Fluids for Cardiopulmonary bypass of the Small Children)

  • 한재진;서경필
    • Journal of Chest Surgery
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    • 제25권5호
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    • pp.469-479
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    • 1992
  • Searching for the clinical effects of colloid solutions that used to increasing the oncotic pressure of priming solutions at the cardiopulmonary bypass, 29 patients [who were diagnosised as simple VSD around 10kg of body weight and scheduled to be operated from June 1990 to December 1990 at Sejong General Hospital] were divided randomly and prospectively to the two groups: A group [15] was received 4gm% albumin as addition to the priming solutions and B Group [14] the same amount of Ringer`s lactated solution. 34 clinical parameters [Body weight, sex, age, body surface area, Qp/Qs, pulmonary arterial pressure, cardiopulmonary bypass time, anesthetic time, intraoperatively infused crystalloid and colloid amount, hemoglobin, hematocrit, serum sodium concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum protein, serum albumin concentration, urine output, central venous pressure, postoperatively infused colloid amount, immedediate post-operative peak inspiratory pressure, cardiac index, blood pressure and pump flow during cardiopulmonary bypass, inotro-pic assist, diuretics, extubation period, total drain amount, duration of ICU] were measured and compaired between the two groups. There were no differences of preoperative and operative clinical parameters. And postoper-atively, practically there were no nearly differences at the clinical outcomes between the two groups, but some parameters [cardiac index, PIP, BP and pumpflow during CPB, etc] contributed to being preferable to the Group A at certain times [P<0.05]. Conclusively, it might be thought that the priming solution of cardiopulmonary bypass added by colloid solution had some beneficial effects on the patients, especially younger and associated with complex anomaly to be expected taken longer time of cardiopulmonary bypass, and more studies about the neonatal and complex anomaly cases were needed in that points.

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줄넘기 운동 훈련이 심폐기능 항진에 미치는 효과 (Effect of Rope-skipping Exercise on the Enhancement of Cardiopulmonary Function)

  • 황상익
    • The Korean Journal of Physiology
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    • 제20권1호
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    • pp.79-88
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    • 1986
  • 줄넘기 운동의 신체 단련 효과를 측정하기 위하여 사병 9명에게 9주 동안 규칙적으로 줄넘기 운동을 시키면서 심폐기능의 변화를 관찰하여 다음과 같은 결과를 얻었다. 효과를 측정하기 위해 부하한 운동은 줄넘기, 40 cm 및 45 cm 높이의 계단운동이었다. 1) 심장박동수는 단련에 의해 안정시와 운동후 회복기 전 시간대를 통해 매우 유의하게 감소하였으며 효과는 단련 시작 1주후부터 나타났다. 2) 단편으로 수축기 동맥혈압은 안정시와 회복기 전 시간대에서 거의 유사하게 감소하였는데 이러한 효과는 단련 한달경부터 나타났다. 3) 회복기의 호흡회수는 단련에 의해 별 변화가 없었으나 단지 줄넘기 운동 회복 초기에만 유의하게 감소하였다. 4) 심폐기능 상의 단련 효과는 검사시 부하하는 운동량이 경할수록 더욱 뚜렷하였다. 이상의 결과로 보아 9주간의 줄넘기 운동으로 심폐기능 특히 심장순환계 기능에 뚜렷한 향상이 온다고 할 수 있겠다.

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건강운동 프로그램이 중년여성의 신체조성과 심폐기능 및 체력에 미치는 영향 (The Effect of Health Exercise Program on the Body Composition, Cardiopulmonary Function, Physical Fitness in Middle-Aged Women)

  • 김도희
    • 보건교육건강증진학회지
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    • 제18권3호
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    • pp.177-186
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    • 2001
  • The purpose of this study was to investigate the of regular worksite health exercise program participation on related fitness. Subject for study were 34 middle-aged women in Kwangju-city. To achieve this, body composition, cardiopulmonary function, physical fitness of every subjects were measured before and post regular health exercise program participation during 12 week. The results of this study were as follows: 1. Regular health exercise program participation result from improving the body composition, but there is not significant different statistically(p〈.05). 2. Significant differences were observed in the cardiopulmonary function(vital capacity, VO$_2$ max) after regular exercise program during 12 week(p〈.05). 3. Significant differences were observed in the flexibility(sitting trunk flexion), abdominal endurance(sit-ups), power (standing high jump), agility(trunk reaction time) after regular exercise program during 12 week(p〈.05).

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좌심실에 발생한 진성심실류 (2례 보고) (Left ventricular aneurysm (Two cases report))

  • 이철세
    • Journal of Chest Surgery
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    • 제16권2호
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    • pp.175-183
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    • 1983
  • Ventricular aneurysm which was first described by John Hunter on 18th century, has been experienced by many surgeons after successful using of cardiopulmonary bypass by Cooley on 1958. According to Gorlin, the definition of ventricular aneyrysm is portion of the ventricle which is not motile at systole (akinesis) or which has paradoxical dilatation at systole(dyskinesis). The ventricular aneurysm is classified to anatomical and functional. The anatomical ventricular aneurysm is devided into true or false again. Average age incidence is ranged from 49 to 60 and male predominance is reported. The cause is ischemic coronary artery disease in almost cases but hypertropoc cardiomyopathy, congenital abscence of myocardium, complication after mitral valvular replacement and trauma may also cause the ventricular aneurysm. Angina pectoris and congestive heart failure are most common clinical manifestations Ventricular tachycardia and systemic embolization are also complained. Using cardiopulmonary bypass, aneurysmectomy alone or combination with coronary artery revasculization are currently done for surgical treatment with steady improvenment of mortality. The first patient was 33 years old man who had true type of ventricular aneurysm on inferior wall the left ventricle near apex with protruded huge organized thrombus. The thromboembolic phenomenon was noted on both lower extremities. Under cardiopulmonary bypass, aneurysmectomy and thrombectomy were done. The aneurysmal orifice was repaired with Teflon buttless suture. The second patient was 30 years old female who had large true type of ventricular aneurysm on inferior wall of the left ventricle. Under cardiopulmonary bypass, aneurysmectomy with repair of aneurysmmal orifice defect by means of double layered Dacron patch was done with reinforce by outer silastic sheet covering. She was discharged from hospoital at post op. 15th day uneventfully.

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동영상 심폐소생술 교육이 간호사의 심폐소생술 수행능력에 미치는 효과 (The Effects of Video Programs of Cardiopulmonary Cerebral Resuscitation Education)

  • 변규리;박정은;홍해숙
    • Journal of Korean Biological Nursing Science
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    • 제17권1호
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    • pp.19-27
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    • 2015
  • Purpose: The aim of this study was to identify the effect of video programs of cardiopulmonary cerebral resuscitation (CPCR) education of cardiopulmonary cerebral resuscitation of nurses. Methods: The subjects of the study were 64 nurses working in a university hospital. Nurse's CPCR performance have been measured four times (pre-test, post-test at immediately, 3 months and 6 months after intervention). Data were collected from February to August 2013. Results: There were significant differences in knowledge, attitude, self-efficacy, and performance between groups by measure time. And there were significant interactions in knowledge, self-efficacy, and performance between groups, within groups, except for the attitude. The video programs of CPCR interventions appear to be effective in the improvement of knowledge, self-efficacy, and performance, as compared to the control group. Conclusion: The video programs of CPCR education was an effective intervention to improve and retain the level of knowledge, attitude, self-efficacy and performance. And the video program of CPCR education have an advantage of self-learning effect for nurses with shift work. Therefore video programs of CPCR education will be utilized for continuing nurse's education.

Change in fibrinogen levels and severe postoperative bleeding in cardiac surgery

  • Kim, Eun-Jung;Kim, Joo-Yun;Kim, Hee Young;Hwang, Boo-Young;Cho, Ah-Reum;Jung, Young-Hoon;Baek, Seung-Hoon;Hong, Jeong-Min
    • International Journal of Oral Biology
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    • 제45권2호
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    • pp.51-57
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    • 2020
  • Thromboelastography or rotational thromboelastometry, is being increasingly utilized in cardiac surgery of late. However, it is an indirect test and is not available in all centers. Low fibrinogen levels before and after cardiopulmonary bypass (CPB) have been described to be associated with postoperative bleeding in cardiac surgery. This study explored the usefulness of reduction ratio of the fibrinogen levels before CPB (preCPB) and after CPB (postCPB) in predicting postoperative hemorrhage. A retrospective, observational study of adult patients who underwent cardiac surgery with CPB between February 2014 and January 2016 was conducted, which included a total of 264 patients. The fibrinogen levels were measured twice, preCPB and postCPB, and the fibrinogen reduction ratio was acquired [(preCPB - postCPB)/preCPB]. Postoperative blood loss, which was defined as the blood collected from the chest drain for 12 hours following arrival at the intensive care unit, was considered severe if it was more than 1,000 mL. A multivariate analysis showed that fibrinogen reduction ratio, sex, and postCPB platelet count were significantly associated with severe postoperative bleeding. However, the pre- and postCPB fibrinogen levels were not significantly associated with severe bleeding. Furthermore, a fibrinogen reduction ratio of > 41.3% was independently associated with postoperative severe bleeding, with an odds ratio of 3.472 (1.483-8.162). These results suggest that the reduction ratio of pre- and postCPB fibrinogen levels may be utilized in predicting postoperative bleeding.

운동형태에 따른 최대 운동이 심근 산소소비량과 혈중 젖산 농도의 변화에 미치는 영향 (The effects of different exercise type for maximal exercise on RPP and blood lactate)

  • 김재성;김성수;장경모
    • 대한물리치료과학회지
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    • 제10권1호
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    • pp.149-157
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    • 2003
  • The purpose of this study was to compare the effects of different exercise types including isokinetic, isometric, and istonic exercise of same exercise intensity on cardiopulmonary function and blood lactate level. The subjects of this study included 17 males college students. Each subjects after pretraining measurement performed isokinetic, isometric and isotonic exercise of 1 week interval using Cybex 6000 System. KBI-C and YSI 1500 were used to measure changes in cardiopulmonary function and blood lactate level respectively. First, comparing changes in RPP relative to exercise type, isokinetic group showed significant difference between before exercise ($7.08{\pm}1.12mg/kg/min$) and post exercise ($18.98{\pm}1.75mg/kg/min$). Isometric group showed that significant difference between before exercise($7.89{\pm}0.98mg/kg/min$) and post exercise($20.22{\pm}2.41mg/kg/min$). Isotonic group showed significant difference between before exercise ($8.14{\pm}0.11mg/kg/min$) and post exercise ($19.84{\pm}2.30\;mg/kg/min$). Second, comparing changes in blood lactate level relative to exercise type, isokineic group showed significant difference between before exercise ($2.99{\pm}0.65mmol$) and post exercise ($6.55{\pm}6.55mmol$). Isometric group showed significant difference between before exercise($1.71{\pm}5.48mmol$) and post exercise ($5.48{\pm}1.97mmol$). Isotonic group showed significant difference between before exercise($1.16{\pm}0.48mmol$) and post exercise($5.21{\pm}1.28mmol$). The results of this study indicate significant differences RPP in isometric exercise and significant differences blood lactate in isotonic exercise.

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스마트 러닝을 활용한 심폐소생술 재교육이 간호대학생의 심폐소생술 지식, 자기효능감, 수행능력에 미치는 영향 (The Effects of Repeated Cardiopulmonary Resuscitation Training using Smart Learning on Nursing Students' Knowledge, Self-efficacy, Clinical Competency.)

  • 김은정
    • 한국산학기술학회논문지
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    • 제19권2호
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    • pp.261-269
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    • 2018
  • 본 연구는 스마트 러닝을 활용한 심폐소생술 재교육이 간호대학생의 지식, 자기효능감, 수행능력에 미치는 효과를 확인하기 위한 연구이다. 비동등성 대조군 사전사후 유사실험설계를 사용하였다. 연구의 참여자는 심폐소생술 교육을 받은지 6개월이 지난 간호대학생으로 총 102명이었다. 심폐소생술 재교육을 스마트 러닝, 강의식 교육, 실습교육으로 나누어 실시하였다. 자료수집 기간은 2016년 11월부터 12월이었다. 수집된 자료는 SPSS 21.0을 이용하여 실수와 백분율, 평균과 표준편차, ${\chi}^2$-test, t-test, one way ANOVA로 분석하였다. 심폐소생술 재교육 후 지식은 강의식 교육이 스마트 러닝과 실습 교육보다 높았고, scheffe의 사후검정결과도 통계적으로 유의하게 나타났다(F=8.23, p=<.001). 자기효능감은 실습교육이 스마트 러닝과 강의식 교육보다 높았지만 통계적으로 유의하지 않았다(F=2.46, p=.091). 수행능력은 실습교육이 가장 높았으며, 스마트 러닝과 강의식 교육 순으로 나타났으며, scheffe의 사후검정결과도 통계적으로 유의한 차이가 있었다(F=59.90, p=<.001). 이상의 연구결과를 통해 볼 때, 간호학생의 지식, 자기효능감, 수행능력에 대한 효과적인 교육방법이 다르다는 것을 보여준다. 더욱 효과적인 심폐소생술 재교육을 위해서는 복합적인 교육이 되어야 할 것이다.