Figure 1 - uploaded by Mark Thielen
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(a) An illustration of an uncompressed classical CPR manikin, (b) chest compression at a location left of centre and (c) chest compression at the centre of the thorax. In both examples of compression, Dz 1 = Dz 2 which is unrealistic when compared to the human body.
Source publication
Cardiopulmonary resuscitation manikins are used for training personnel in performing cardiopulmonary resuscitation.State-of-the-art cardiopulmonary resuscitation manikins are still anatomically and physiologically low-fidelity designs. The aim of this research was to design a manikin that offers high anatomical and physiological fidelity and has a...
Contexts in source publication
Context 1
... Despite the aforementioned recommendations and a clinical desire for physiologically and anatomically high-fidelity manikin designs, even the technologically most advanced manikins such as the SimMan 3G (Laerdal, Stavanger, Norway) and Apollo (CAE healthcare, Sarasota, FL, USA) do not fulfil all these requirements. This is partly due to the fact that like other classical designs, these manikins consist of a sin- gle spring-damper configuration, as illustrated in Figure 1(a), where the spring is represented by the diag- onal stripes and the damper by the yellow cylinder. The behaviour of the spring with spring constant k 1 is that a vertical force F leads to a vertical displacement Dz 1 = F/k 1 (Figure 1(b)). ...
Context 2
... is partly due to the fact that like other classical designs, these manikins consist of a sin- gle spring-damper configuration, as illustrated in Figure 1(a), where the spring is represented by the diag- onal stripes and the damper by the yellow cylinder. The behaviour of the spring with spring constant k 1 is that a vertical force F leads to a vertical displacement Dz 1 = F/k 1 (Figure 1(b)). This displacement is independent of the axial location (Figure 1(c)) of the applied force since the manikin sternum is stiff and does not tilt, a behaviour unrealistic when compared to the human body. ...
Context 3
... behaviour of the spring with spring constant k 1 is that a vertical force F leads to a vertical displacement Dz 1 = F/k 1 (Figure 1(b)). This displacement is independent of the axial location (Figure 1(c)) of the applied force since the manikin sternum is stiff and does not tilt, a behaviour unrealistic when compared to the human body. Furthermore, while most classical manikins offer depth detection and the rate of chest compression, thereby providing information on the adherence to CPR guidelines, they provide no feedback on the phy- siological and mechanical effects of performing CPR, for example, oxygen saturation and cardiac output. ...
Citations
... Rarely, if ever, was peripheral venous circulation a main factor in design. An article by Theilen et al. (9) describes the design of a high-delity CPR model that embeds a human-like thorax and ow sensors. ...
... This design allowed for better delity in physiological force-displacement compared to human anatomy, and accounted for blood ow to the brain and abdominal areas that included the relevant amount of blood present in an average female-sized ventricle (9). This new feedback was an integral innovation, but did not account for blood ow to peripheral spaces. ...
... This new feedback was an integral innovation, but did not account for blood ow to peripheral spaces. Further, this model was not tested by medical professionals (9). ...
Introduction: Feedback devices for cardiopulmonary resuscitation (CPR) currently register compression rate, depth, recoil and land marking. There remains a gap in determining the impact of peripheral vascularization, blood pressure, and blood flow as a result of quality CPR compressions.
Methods: Our team designed a closed-loop CPR mannequin model that represented the vascularization of a human, including peripheral lower limbs. A disposable, ultrasound bandage (Flosonics Flopatch™) was applied to measure the blood flow. The model consisted of a CPR mannequin and feedback software, pressure monitoring device, patient monitor, Polyvinyl chloride (PVC) tubing and connectors, siphon bulb, 3D printed parts and wood for stabilization, Kelly clamps, and water mixture to replicate blood. A full cost breakdown and set-up is provided.
Results: 28 Basic Life Saving-trained individuals tested the device both clamped and unclamped to peripheral vasculature. CPR was performed for 5 minutes at 60bpm to mimic human heart rate with siphon bulb limitations. Findings demonstrate that pulse pressure mean was 69.9mmHg clamped and 65.0mmHg unclamped (p = 0.03), consistent with expected values anticipated during effective compressions. Blood flow velocity was statistically insignificant, and cannot be inferred on due to inconsistencies with the ultrasound bandage.
Conclusions: The CPR vascularization prototype was effective in replicating blood pressures of a human adult circulatory system, including peripheral vasculature. There remains limitations to state the model was effective for replicating blood flow velocity with the Flopatch™, further testing is required. The use of Kelly clamps was effective in restricting blood flow to tube sections.
... [4]. Cardiopulmonary resuscitation, an immediate procedure for patients with cardiac arrest, has a high potential for recirculation of heart and air in the lungs by compression of the chest and artificial ventilation of the lungs [5]. In recent decades, CPR has become a significant emergency procedure to save the lives of patients with cardiac arrest [6]. ...
Cardiopulmonary resuscitation (CPR) is an emergency procedure performed on patients during cardiac and respiratory arrest. This procedure externally activates the cardiac and respiratory systems via the delivery of chest compression and artificial ventilation. As the main purpose of CPR is to recirculate the blood flow, prediction of the myocardium behavior has great importance. This prediction allows us to have a better understanding of the needed force to recirculate blood without hurting the heart. Finite element method offer the possibility of noninvasive quantification of myocardial deformation. This method is attractive to use for the assessment of myocardial function. To investigate the behavior of the heart wall, a 3D model of thoracic organs has been prepared using medical images. In this study, to simulate the behavior of different organs, Code-Aster open software is used. For every organ, the material properties are defined. The most important parameters in the study are displacement, normal stress, and Von-Mises stress in the myocardium. Using these parameters, displacement and stress distribution have been predicted. Effects of the applied force on the chest during CPR and deformation of the myocardium have been predicted by the finite element model. A linear deformation is observable for each organ during force application. Besides, the final location of the heart and ribs and also involved parameters in predicting myocardium deformation are extracted from the model simulations. This finite element model enables us to have a good vision of the deformation of the myocardium during CPR. Using this method, it is possible to predict the deformation of every part of the heart, especially right and left ventricles.
... In medical simulation area, 3D printing (3DP) holds great promise because of its commercially accessible 3DP material and ease of manufacturing [1]. Thielen demonstrated a 3DP ribs cage for the realistic infant's manikin for cardiopulmonary resuscitation (CPR) procedure training [2]. However, they focus on exploiting mechanical properties of the new material and their production methods (not colour). ...
A high fidelity baby manikin with a colour changing mechanism is required for medical training, especially for cyanosis skin colouration assessment in a newborn baby. However, commercially available baby manikin simulators do not have the real colour-change of cyanosis skin. The efforts in increasing the fidelity of the manikin might improve the accuracy of cyanosis evaluation among the novices, thus enhances the quality of the medical training. This study contributes towards designing a colour change actuator for central cyanosis simulation in a baby manikin for medical training. The actuation method of the 3D print photochromic PLA using a low-voltage UV LED and the evaluation of its colour properties using a colour measurement device are described. The colorimetric properties of the photochromic PLA were evaluated in CIE υ′ν′ colour space. Results are presented, showing a strong relationship between the colour intensity of the UV LED and the colour of the photochromic PLA. We reflect on the potential of the photochromic PLA as an actuator in imitating the cyanosis in a baby manikin. The specific PLA we used still cannot simulate the cyanosis well. However, the idea of using PLA photochromic is still considered promising.
... The future applications of the heart models produced using this method aim at the integration into neonatal training manikins. This model, combined with the integration of sensors can provide clinicians with cardiac output and blood pressure data due to chest compressions as shown in previous research 8 . Secondly, it could be used as a potential in vitro cardiovascular testbed for testing novel micro sensors 11 on their compliance with moving conditions in a beating heart. ...
... A resuscitation manikin with a real-time feedback mechanism to allow self-study and practice enhances performance both during training and after debriefing [15] [16]. New HFM designed for timely measuring of the core components of CPR performance (e.g., compression rate and depth, ventilation volume), using intuitive graphics and easy-to-follow guidance have been in line [17] [18]. ...
... Simulation based learning entails the use of simulators such as mannequins and other devices to simulate or reproduce the state and behaviour of a real world object or condition. These simulators can be of high-fidelity (HFMs) or low-fidelity make (LFMs) [2,[4][5][6][7]. High-fidelity simulators are technologically advanced and more accurately mimic the real environment. ...
... To that end, the literature demonstrates a benefit in the use of High Fidelity Mannequins (HFMs) in simulation training [8][9][10][11][12][13]. Such mannequins allow not only an improvement in clinical skill performance, but also facilitate training in communication amongst team members, which ultimately improve patient outcome [14][15][16][17][18]. ...
