Safety and applicability of a pre-stage public access ventilator for trained laypersons: a proof of principle study.

BACKGROUND: Contemporary resuscitation guidelines for basic life support recommend an immediate onset of cardiac compressions in case of cardiac arrest followed by rescue breaths. Effective ventilation is often omitted due to fear of doing harm and fear of infectious diseases. In order to improve ventilation a pre-stage of an automatic respirator was developed for use by laypersons. METHODS: Fifty-two healthy volunteers were ventilated by means of a prototype respirator via a full-face mask in a pilot study. The pre-stage public access ventilator (PAV) consisted of a low-cost self-designed turbine, with sensors for differential pressure, flow, FO2, FCO2 and 3-axis acceleration measurement. Sensor outputs were used to control the respirator and to recognize conditions relevant for efficiency of ventilation and patients' safety. Different respiratory manoeuvres were applied: a) pressure controlled ventilation (PCV), b) PCV with controlled leakage and c) PCV with simulated airway occlusion. Sensor signals were analysed to detect leakage and airway occlusion. Detection based upon sensor signals was compared with evaluation based on clinical observation and additional parameters such as exhaled CO2. RESULTS: Pressure controlled ventilation could be realized in all volunteers. Leakage was recognized with 93.5% sensitivity and 93.5% specificity. Simulated airway occlusion was detected with 91.8% sensitivity and 91.7% specificity. CONCLUSION: The pre-stage PAV was able to detect potential complications relevant for patients' safety such as leakage and airway occlusion in a proof of principle study. Prospectively, this device provides a respectable basis for the development of an automatic emergency respirator and may help to improve bystander resuscitation.

Investigation of an acoustic-mechanical method to detect implant loosening.

Precise diagnosis of loosening of endoprosthetic implants plays an important role in timely, adequate treatment. However, today's diagnostic tools, mainly radiological evaluation, do not yield satisfactory results. Therefore, a new approach based on the transmission of an internally generated combined acoustic and vibration signal, was investigated. For signal generation, a magnetic oscillator which impinges inside an implant component, can be used. The signal can be detected by an external accelerometer being positioned on the skin surface. Differences in the signal generated result from varying degrees of implant fixation. This principle was tested in seven porcine foreleg specimens with a custom implant. Influence of the measurement location at the porcine skin and different levels of fixation were investigated (pressfit, slight loosening, advanced loosening), with regard to the pull-out strength. Evaluation of different parameters, especially the frequency spectrum resulted in differences of up to 12% for the comparison between pressfit and slight loosening, and 30% between pressfit and advanced loosening. A significant correlation between the measured frequency and the pull-out strength for different levels of fixation was found. Thus, the novel diagnostic method shows potential for the precise detection of implant loosening. Further work is required to determine the sensitivity and specificity of the proposed system in animal experiments.

Investigation of a passive sensor array for diagnosis of loosening of endoprosthetic implants.

Currently, imaging methods are used to diagnose loosening of endoprosthetic implants, but fail to achieve 100% accuracy. In this study, a passive sensor array which is based on the interaction between magnetic oscillators inside the implant and an excitation coil outside the patient was investigated. The excited oscillators produce sound in the audible range, which varies according to the extent of loosening. By performing several experimental tests, the sensor array was optimized to guarantee reproducible and selective excitation of the sound emission. Variation in the distance between the oscillators demonstrated a definite influence on the quality of the generated sound signal. Furthermore, a numerical design analysis using the boundary element method was generated for consideration of the magnetic field and the selectivity of the oscillators during excitation. The numerical simulation of the coil showed the higher selectivity of a coil with a C-shape compared to a cylindrical coil. Based on these investigations, the passive sensor system reveals the potential for detection of implant loosening. Future aims include the further miniaturization of the oscillators and measurements to determine the sensitivity of the proposed sensor system.