J. Fernandez1, P. Frank1, J. Resnik2, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Division Of Cardiothoracic Surgery,Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles,Department Of Anesthesiology And Perioperative Medicine,Los Angeles, CA, USA
Introduction: Training of physicians and healthcare professionals in the management of cardiopulmonary bypass (CPB) poses major challenges. These include the complexity of the cardiovascular system as well as the rarity of catastrophic events. In light of these challenges, a widely available and realistic simulator for bypass is needed and is yet lacking. We aimed to design an artificial, computer-controlled CPB simulator that would generate the responses of the human body to various hemodynamic states. Further, we hoped that this CPB simulator could be coupled to the CPB machine that is typically used by cardiac perfusionists during cardiac surgery.
Methods: The CPB simulator was driven by computer control and feedback. LabVIEW 2013 software (National Instruments, Austin TX) was used to design a graphic user interface similar to a patient monitor. The computer also controlled a pump via a customizable pulse-width modulated waveform to simulate cardiac ejection of arbitrary strength and duration. A series of control valves were placed in the circuit to simulate the systemic vascular resistance.
Results: A computer algorithm was able to generate normal and abnormal scenarios that commonly present in the emergency department or operating room. The CPB simulator uses an algorithm for increasing and/or reducing the cardiac output of the system based on heart rate and preload without user input. The system generated various conditions, including hypovolemic, cardiogenic and distributive shocks. The CPB simulator was able to respond to virtual administration of chronotropes, inotropes, vasoconstrictors, and vasodilators in real time. The system was successfully connected to a clinical bypass machine and initiation and weaning of bypass was performed. The simulator was found to be realistic by a cardiac surgeon and a perfusionist.
Conclusion: We have demonstrated the feasibility of a simulator that incorporates computer algorithms, displays, and actual mechanical fluid dynamics to provide a suitable platform for cardiopulmonary bypass practice. Given its simplicity and low cost, this CBP simulator should be used in individual and team scenarios. Routine practice may potentially be lifesaving in cases of pump emergencies such as power failure and air embolism. The simulator also provides an ideal setup for team training that would include members of surgical, anesthesia, and perfusion training programs.
