Cognitive Cost of Using Augmented Reality Displays.

This paper presents the results of two cognitive load studies comparing three augmented reality display technologies: spatial augmented reality, the optical see-through Microsoft HoloLens, and the video see-through Samsung Gear VR. In particular, the two experiments focused on isolating the cognitive load cost of receiving instructions for a button-pressing procedural task. The studies employed a self-assessment cognitive load methodology, as well as an additional dual-task cognitive load methodology. The results showed that spatial augmented reality led to increased performance and reduced cognitive load. Additionally, it was discovered that a limited field of view can introduce increased cognitive load requirements. The findings suggest that some of the inherent restrictions of head-mounted displays materialize as increased user cognitive load.

Novel multi-functional life support system.

UNLABELLED: Concepts of cardiopulmonary support (CPS), extracorporeal membrane oxygenation (ECMO), and ventricular support (VS) have been thoroughly studied and refined. These perfusion adjuncts often require multiple devices, skill sets, and significant financial burden to purchase, maintain, deploy, and use. We describe a novel system that is rapidly deployable, user-friendly, portable, safe, and economical. Over a 1-year period we have used a multi-functional life support system (MLS) in the cardiac catheterization laboratory, cardiovascular intensive care unit, and cardiac surgical suites. Further, we have conducted multiple transports within the hospital and one to an alternate facility. Applications have included ECMO, cardiopulmonary resuscitation-supported cardiogenic shock, high risk percutaneous coronary intervention (PCI), valvuloplasty, right ventricular assist device transition to ECMO post cardiotomy, left ventricular assist device transition to ECMO, ventricular septal defect closure, and ECMO transition to conventional cardiopulmonary bypass (CPB). Duration of support has ranged from approximately 39 minutes to several days. KEYWORDS: extracorporeal membrane oxygenation (ECMO), percutaneous ventricular assist device, cardiopulmonary support, portable cardiopulmonary life support, ventricular assist.

Argatroban in short-term percutaneous ventricular assist subsequent to heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia paradoxically is a transient pro-thrombotic disorder triggered by heparin exposure. If not treated appropriately, it can be life threatening because of its related thromboembolic complications. In particular, it presents a unique challenge in patients needing extracorporeal life support, because anticoagulation is essential for safe management. This case report describes the safe, efficacious use of Argatroban during short-term support of a patient with a percutaneously inserted left ventricular assist TandemHeart device.

Oxygenation failure during cardiopulmonary bypass prompts new safety algorithm and training initiative.

Developing new strategies to improve patient safety and risk reduction is fundamental to hospital and patient success. Currently, there is a tendency in hospital safety management to focus solely on human error rather than organizational and educational causes that contribute to medical accidents. Although health care providers are the primary safety systems in medical facilities, there must be a more global, perhaps automated, approach using modern technology to prevent or reduce medical mishaps. Herein, we present an oxygenation failure with root cause analysis that prompted a new oxygenation safety algorithm and multi-service training initiative.

Quality assessment of platelet rich plasma during anti-platelet therapy.

Platelet rich plasma (PRP) is being used with increased frequency in many surgical procedures for its known benefits of accelerated surgical wound site healing. Speculations in its efficacy in the presence of anti-platelet therapy have been proposed. To aid in defining a quality platelet rich plasma product in the presence of acetylsalicylic acid (ASA) and Plavix (clopidogrel bisulfate), we investigated three (3) groups (n = 18) of cardiac surgical patients receiving PRP. Platelet function test, platelet concentration, and quantification of growth factors (PDGF-bb and TGF-b1) were evaluated. Results showed no statistical evidence of decreased growth factors delivered to the surgical wound site in the presence of acetylsalicylic acid (ASA) and/or Plavix (clopidogrel bisulfate). Evidence in this pilot study supports the use of PRP for patients receiving Plavix and aspirin therapy without compromising the quantity of specific growth factors delivered to a wound site.

Resuscitation of fat embolism syndrome with extracorporeal membrane oxygenation.

Embolization of marrow fat appears to be an inevitable consequence of long bone fractures. Pulmonary fat embolism (FE) with cardiovascular collapse is associated with a high mortality rate because of acute right ventricular failure and hypoxia. Immediate and appropriate resuscitation is required to prevent sudden death. Although extracorporeal membrane oxygenation (ECMO) has been used for a multitude of applications involving respiratory and circulatory collapse, its full potential as a standard conventional therapy has yet to be exploited. Herein, we describe the successful use of veno-venous (V-V) ECMO in a trauma patient who initially presented with fractures of the right ulna and femur. After surgery, the patient rapidly decompensated despite massive ventilatory support and was placed on ECMO. ECMO support lasted approximately 120 hours followed by an uneventful recovery and discharge 10 days later.