Quantitative evaluation of hand cranking a roller pump in a crisis management drill

Electrical failure during cardiopulmonary bypass: a critical moment

Electrical failure during cardiopulmonary bypass is a crisis situation for the cardiac surgical team. Fortunately, it has a low incidence with low morbidity and mortality rates. Notwithstanding, institutional preventative and management measures should be taken. Here, we report a case of electrical failure during cardiopulmonary bypass, which was successfully managed during the surgery, allowing the patient to recover uneventfully. These unwanted complications can only be managed by promoting awareness and putting in place strategies against them.

Development of an Accident Reproduction Simulator System Using a Hemodialysis Extracorporeal Circulation System

Background:

Accidents that occur during dialysis treatment are notified to the medical staff via alarms raised by the dialysis apparatus. Similar to such real accidents, apparatus activation or accidents can be reproduced by simulating a treatment situation. An alarm that corresponds to such accidents can be utilized in the simulation model.

Objectives:

The aim of this study was to create an extracorporeal circulation system (hereinafter, the circulation system) for dialysis machines so that it sets off five types of alarms for: 1) decreased arterial pressure, 2) increased arterial pressure, 3) decreased venous pressure, 4) increased venous pressure, and 5) blood leakage, according to the five types of accidents chosen based on their frequency of occurrence and the degree of severity.

Materials and Methods:

In order to verify the alarm from the dialysis apparatus connected to the circulation system and the accident corresponding to it, an evaluation of the alarm for its reproducibility of an accident was performed under normal treatment circumstances. The method involved testing whether the dialysis apparatus raised the desired alarm from the moment of control of the circulation system, and measuring the time it took until the desired alarm was activated. This was tested on five main models from four dialyzer manufacturers that are currently used in Japan.

Results:

The results of the tests demonstrated successful activation of the alarms by the dialysis apparatus, which were appropriate for each of the five types of accidents. The time between the control of the circulatory system to the alarm signal was as follows, 1) venous pressure lower limit alarm: 7 seconds; 2) venous pressure lower limit: 8 seconds; 3) venous pressure upper limit: 7 seconds; 4) venous pressure lower limit alarm: 2 seconds; and 5) blood leakage alarm: 19 seconds. All alarms were set off in under 20 seconds.

Conclusions:

Thus, we can conclude that a simulator system using an extracorporeal circulation system can be set to different models of dialyzers, and that the reproduced treatment scenarios can be used for simulation training.

Use of an extracorporeal circulation perfusion simulator: evaluation of its accuracy and repeatability

Medical simulators have mainly been used as educational tools. They have been used to train technicians and to educate potential users about safety. We combined software for hybrid-type extracorporeal circulation simulation (ECCSIM) with a CPB-Workshop console. We evaluated the performance of ECCSIM, including its accuracy and repeatability, during simulated ECC. We performed a detailed evaluation of the synchronization of the software with the console and the function of the built-in valves. An S-III heart–lung machine was used for the open circuit. It included a venous reservoir, an oxygenator (RX-25), and an arterial filter. The tubes for venous drainage and the arterial line were connected directly to the ports of the console. The ECCSIM recorded the liquid level of the reservoir continuously. The valve in the console controlled the pressure load of the arterial line. The software made any adjustments necessary to both arterial pressure load and the venous drainage flow volume. No external flowmeters were necessary during simulation. We found the CPB-Workshop to be convenient, reliable, and sufficiently exact. It can be used to validate procedures by monitoring the controls and responses by using a combination of qualitative measures.

Perfusion safety: new initiatives and enduring principles

Perfusion safety has been studied and discussed extensively for decades. Many initiatives occurred through efforts of professional organizations to achieve recognition, establish accreditation and certification, promote consensus practice guidelines, and develop peer-reviewed journals as sources for dissemination of clinical information. Newer initiatives have their basis in other disciplines and include systems approach, Quality Assurance/Quality Improvement processes, error recognition, evidence-based methodologies, registries, equipment automation, simulation, and the Internet. Use of previously established resources such as written protocols, checklists, safety devices, and enhanced communication skills has persisted to the present in promoting perfusion safety and has reduced current complication rates to negligible levels.

Crisis in the operating room: fires, explosions and electrical accidents

Fires, explosions and electrical accidents in the operating theater are rare events, but are devastating in terms of structural damage to the equipment in theaters and to human lives. While various circumstances lead to these troubles, we can avoid and manage them by learning from the instructive cases accumulated so far. We describe operating room crises such as fires, explosions and electrical breakdowns, and discuss causes and countermeasures.