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The Concept and Building of a Simulation Device to Check the Cardiac Output Measurement Through the Pulmonary Artery Catheter

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Abstract

In this article, the authors present the building of a new cardiac output (CO) simulator that aims to provide a reliable pre-surgical test of instruments used by clinical teams to measure the patient’s condition during pulmonary artery catheterization. This procedure applies the thermodilution method, in which the Swan-Ganz catheter (also known as pulmonary artery catheter) and the hemodynamic monitor are used to collect real-time patient data. The authors designed, built, and tested a system containing both hardware and software prototypes to simulate the human body and cardiac monitor performances. The shortcoming of current simulators available commercially in the market is related to the fact that they generate electrical signals for the input of the cardiac monitor, reproducing the variations of the temperature sensor (thermistor) of the pulmonary artery catheter, but not physically providing the thermodilution curve for the sensor. The novelty of this project compared to existing simulators is the creation of a device with superior environment testing capabilities, covering the entire system with catheter and cardiac monitor connected, physically creating temperature variations on the catheter’s sensor and at the same time reproducing the cardiac output monitor calculation in the computer. The prototype showed similar accuracy compared to existing simulators of ± 0.1 L/min approximately (considering a total of 18 trials with standard deviation of 0.05745 L/min), but with the competitive advantage of creating the thermodilution curve for the catheter’s thermistor with real temperature environment and calculating CO value in real time. The prototype was able to provide similar simulation options as the software database contains a large range of catheter models, injectate volumes, injectate temperatures, and computation constants compared to the literature from MicroSim COS®, SimSlim® SL-8, PS-2200® Series, AMPS-1®, Seculife PS300®, ProSim® 3, and ProSim® 8 simulators. With such a pre-surgical test equipment, the irregularities in the cardiac output invasive monitoring system, and more specifically the limitations in the current method of checking the accuracy of the pulmonary artery catheter’s temperature sensor and CO monitor’s calibration, could be identified and mitigated before the catheterization. Thus, it could avoid complications (e.g., malfunction and infections), reducing costs and delays in medical treatments due to non-calibrated devices which are not in proper conditions of functioning for ICU staff and healthcare teams. Beyond it, the developed simulator can be used as educational tool for cardiac catheterization, helping to train medical and clinical professionals and contributing to the design iteration of new cardiac simulation devices.

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Data Availability

Supplementary data are available upon reasonable request. Further inquiries can be directed to the corresponding author.

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Acknowledgements

The authors thank the ISCMPA for providing the medical equipment for prototype validation tests. The authors thank Unisinos University and Fundação Liberato for providing access to the laboratories necessary for developing and adjusting the hardware and software of this research. The authors thank J. Larsen, T. Adamson, M. Delgado, D. Bertolozi, and J. Neto for providing comments that brought improvements to the manuscript. Last but not least, the authors are grateful for the valuable help and guidance of Professor A. Lawisch since day one and the support of our families who were with us on this journey.

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Authors and Affiliations

  1. Department of Industrial Engineering, University of the Sinos Valley – UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil

    Caio Francisco Ternus de Abreu

  2. Department of Biomedical Engineering, University of the Sinos Valley – UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil

    Bernardo Ternus de Abreu

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  1. Caio Francisco Ternus de Abreu
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Contributions

CFTdA participated in the conceptualization; investigation; hardware and software design, writing of the original draft and reviewing and editing of the manuscript; data curation; methodology; data analysis and discussion; and final considerations. BTdA participated in the writing, reviewing, and editing of the manuscript; methodology reviewing; and data analysis reviewing.

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Correspondence to Caio Francisco Ternus de Abreu.

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The authors declare no conflict and non-competing interests for developing this research.

Ethical Approval

The final tests of the prototype conducted in this research were approved by the Ethical Committee and Coordination of Biomedical Engineering Department of the ISCMPA. The authors followed all the guidelines, legislation, legal and ethical standards for use of the medical equipment.

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de Abreu, C.F.T., de Abreu, B.T. The Concept and Building of a Simulation Device to Check the Cardiac Output Measurement Through the Pulmonary Artery Catheter. Biomedical Materials & Devices (2023). https://doi.org/10.1007/s44174-023-00130-8

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