Thomas W. Moore

A Body Current Activated Circuit Breaker

The body current activated circuit breaker (BAB), provides a new means of protection from accidental electric shock. It senses the current flowing in the body and reacts to, a dangerous situation by interrupting the power source. An experimental model using a toroidal coil sensor was built and tested successfully.

Cardiac energy considerations during intraaortic balloon pumping

Cardiac oxygen availability and oxygen consumption were used in a theoretical study as indexes of myocardial energy supply and utilization, respectively. A detailed computer simulation of the closed-loop canine cardiovascular system was utilized to study the dependence of these indexes on timing of the intraaortic balloon pump. Oxygen availability exhibited higher sensitivity to balloon timing than oxygen utilization. While maximum augmentation of oxygen availability was 58%, oxygen consumption could be reduced by only 13%. Animal experiments were initiated to validate the theoretical results. The results of both the animal experiments and the computer simulation suggested that neither balloon timing that maximizes oxygen availability nor timing that minimizes oxygen consumption correlates with timing that minimizes aortic end diastolic pressure. Thus, end diastolic pressure, presently used as a determinant of proper timing in patients undergoing cardiac assistance, was found to be a poor index of ventricular energy consumption.<<ETX>>

Theoretical Considerations Regarding the Optimization of Cardiac Assistance by lntraaortic Balloon Pumping

A lumped parameter model representing the effects of cardiac assistance by intraaortic balloon pumping was developed. The model permits closed-form calculations of important hemodynamic events in the system. The equations derived from the model were used to determine pumping parameters for optimum assistance. The model indicates that, in the ideal case, optimization of assistance requires instantaneous inflation of the balloon to maximum volume at end systole and instantaneous complete deflation at end diastole. Since an impulse flow rate is not realizable in practice, the model was used to investigate the effects of finite inflation/deflation periods. In general, it was found that fast inflation/deflation rates give higher benefits than slow rates. The optimal time to begin inflation is end systole. Timing of deflation was shown to involve a tradeoff between lower end diastolic pressure (achieved with early deflation) and increase of mean diastolic pressure and cardiac output (achieved with late deflation). The models predictions were validated using a nonlinear distributed parameter digital computer model previously described. The lumped model results should make possible a quantitative as well as a simple approach to automatic control of in-series cardiac assistance.

Control of intraaortic balloon pumping: theory and guidelines for clinical applications

The effectiveness of intraaortic balloon pumping was investigated by using a lumped parameter model of the cardiovascular/assist device system. The model consists of a time-varying elastance left ventricular simulation, a 2-element windkessel arterial simulation, and an RC venous return and pulmonary simulation. The four major hemodynamic variables, stroke volume (SV), aortic mean diastolic pressure (MDP), tension time index (TTI), and aortic end diastolic pressure (EDP), were divided into two categories related to system energy supply and demand: “external” and “internal” variables. The effects of balloon pumping on these variables can be described by closed-form equations that yield an optimal solution. The model prediction suggests that, in the ideal case, optimization of balloon pumping calls for instantaneous inflation of the balloon to maximum volume at end systole and instantaneous complete deflation at end diastole. For finite inflation/deflation rates, the optimal time for the start of inflation is end systole. Deflation timing, however, involves a tradeoff between maximizing the external variables and minimizing the internal variables. These predictions were tested using a nonlinear digital computer model. The results also suggest that when SV is not being monitored, optimal inflation timing can be controlled from the measurements of TTI or pulmonary venous pressure; optimal deflation timing can be controlled by a weighted combination of MDP and EDP.

A compartmental model for oxygen-carbon dioxide coupled transport in the microcirculation

We present a multicompartmental model for an oxygen-carbon dioxide transport system. The compartmental equations and their lumped parameters are derived through space averaging of the corresponding distributed model. The model can predict compartmental distributions of oxygen and carbon dioxide partial pressures, oxygen-hemoglobin saturation, and pH. Other unique features include the effects of the radial distribution of partial pressures and the difference in metabolic rates between vessel wall and tissue. A model for the cat brain, based on this formulation, is compared with results of experiments and with two types of earlier models: one without space averaging and one without carbon dioxide transport. The results suggest that space averaging the convective terms significantly affects the behavior of the model. This is consistent with conclusions from our earlier oxygen-only model. Our observations also demonstrate, however, significant differences between the results from the oxygen-carbon dioxide model and the oxygen-only model. For instance, at low blood flow rates or at low level of oxygen input, predicted oxygen partial pressures can differ by as much as 30% between the two models. Results obtained from the present model are supported by available experimental findings.

Performance optimization of left ventricular assistance. A computer model study.

Performance of temporary parallel left ventricular assistance was investigated and the theoretic conditions leading to optimal behavior of the mechanical system were explored. Computer models of nonpulsatile and pulsatile left ventricular assist devices (LVADs) were incorporated into a previously reported closed-loop simulation of the canine cardiovascular system. Assuming the assisted heart was capable of recovery, LVAD performance was assessed based on both myocardial oxygen balance and cardiac output. With a synchronous LVAD, and operating in a counterpulsation mode, these variables were sensitive to the phasing of pump ejection. Maximum reduction in cardiac oxygen consumption, maximum increase in oxygen availability, and maximum increase in cardiac output with the atrio-aortic device were obtained when pump ejection immediately followed aortic valve closure. These variables were directly proportional to the magnitude of bypass volume. The pulsatile asynchronous and nonpulsatile LVAD models affected oxygen balance in a similar manner, but neither performed so well as the synchronous model when equal bypass volumes were used. Ventricular uptake of blood provided a further 27% decrease in oxygen consumption and further 78% increase in oxygen availability than atrial uptake. In summary, the model predicted that the pulsatile synchronous LVAD, filling from the ventricle during heart systole and ejecting into either the ascending or descending aorta just after ventricular systole, would be most beneficial to both myocardial oxygen balance and cardiac output.

Computer simulation of the mechanically-assisted failing canine circulation

A model of the cardiovascular system is presented. The model includes representations of the left and right ventricles, a nonlinear multielement model of the aorta and its main branches, and lumped models of the systemic veins and the pulmonary circulation. A simulation of the intra-aortic balloon pump and representations of physiological compensatory mechanisms are also incorporated in the model. Parameters of the left ventricular model were set to simulate either the normal or failing canine circulation. Pressure and flow waveforms throughout the circulation as well as ventricular pressure and volume were calculated for the normal, failing, and assisted failing circulation. Cardiac oxygen supply and consumption were calculated from the model. They were used as direct indices of cardiac energy supply and utilization to assess the effects of cardiac assistance.

Optimal control system for the intra-aortic balloon pump

An optimal control system for the intra-aortic balloon pump (IABP) is presented. Control of the IABP is based on a performance index formulated to reflect a tradeoff between maximising cardiac oxygen supply and minimising cardiac oxygen consumption. In the performance index, mean diastolic pressure (MDP) was used to represent oxygen availability and peak systolic pressure (PSP) was used to represent oxygen consumption. An algorithm, implemented using an 8-bit microcomputer, changes the deflation time of the IABP to maximise this performance index by using an optimisation technique that employs both a search and an approximation. The search produces three equally spaced points which define a region that includes the maximum of the performance index. From these points, the optimum deflation time is estimated by a quadratic approximation. The algorithm has been successfully tested using performance index curves generated by computer simulations.

Optimal controller for intraaortic balloon pumping

An optimal control algorithm was adapted to identify and track the optimal deflation time of the intraaortic balloon pump (IABP). Routines for handling physiologically imposed constraints were added to the algorithm, which was implemented in a computer-controlled system. The system was designed to provide real time optimization for the clinical setting. Proper values for the algorithm parameters were determined and the system was tested in animal experiments. The results indicate that the controlling deflation time relative to the R wave, which precedes the next ejection phase, reduces the time required for optimization when the heart rate varies.<<ETX>>

Incorporating vessel taper and compliance properties in Navier-Stokes based blood flow models.

A popular and useful technique used to model blood flow in cardiovascular simulations is to divide each blood vessel into a series of segments, each with its own lumped resistance, intertance, and compliance parameters. The values of these parameters are usually obtained through a simplification of the Navier-Stokes equations for fluid flow. However, the simplification often ignores the nonlinear and convective terms of the equations, resulting in errors in the parameter values, especially in the value found for resistance per unit length. We report a new method for the calculation of vessel resistance per unit length which takes into account the effects of vessel taper and wall compliance. It is shown that these effects can be addressed by the addition of two time-varying terms to the calculation of resistance per unit length. One term, due to vessel taper, is proportional to volumetric flow rateQ. The other term, due to vessel compliance, is proportional to ∂p/∂t. These variables are readily available in computer simulations of blood flow in lumped parameter systems. Using data for the descending aorta, the new parameter values, when averaged over a cardiac cycle, compare favorably with results in the literature.