Brain and Heart Function Diagnosis
Development and Manufacture of an Operating Mock-up of a Complex for Automatized Brain and Heart Function Diagnosis
Tech Area / Field
- MED-DID/Diagnostics & Devices/Medicine
- INS-DET/Detection Devices/Instrumentation
3 Approved without Funding
VNIITF, Russia, Chelyabinsk reg., Snezhinsk
- Ural State Advanced Training Institute for Doctors (USATID), Russia, Chelyabinsk reg., Chelyabinsk
Project summaryThe objective of this project is development and experimental check on operating mock-up of complex for automatized monitoring diagnosis of brain and heart functions in extreme situations, caused by disturbance of brain blood supply and acute cardiac insufficiency.
The necessity of creation of such complex is caused by need of monitoring diagnosis of brain and heart functions during performance of reconstruction surgery of brain vessels, cardiosurgery, neurosurgery and etc., giving quick and reliable integral evaluation of progress of critical changes in brain with giving alarm signal at the stage, when these changes do not become irreversible and they can be completely eliminated.
Diagnostic complex corresponding to such problems should be developed on the basis of instantaneous use of three monitoring techniques: electroencephalography (EEG), electrocardiography (ECG) and transcranial dopplerography (TCDG), working to common algorithm and displaying integral information at the screen of single computer monitor.
Recently, there is an increase of interest in TCDG as means of diagnostic control over blood flow through arteriae of brain base. Joint instantaneous use of TCDG and multichannel EEG will permit to raise truth of diagnosis of critical disturbances in brain from 87 - 90% to 93 - 95% owing to a simultaneous evaluation of electric activity of brain and hemodynamic parameters of arteriae of its base (circle of Diller), and instantaneous evaluation of ECG will permit to evaluate mutual pathologic influence of hemodynamic and brain catastrophes. Instruments, realizing TCDG monitoring systems are not known to us, as well as instruments realizing instantaneously all three above-named techniques.
Lack of such diagnostic complexes causes necessity of purchase of several expensive devices for different types of monitoring and diagnosis. Control over their instantaneous operation in critical for patient situations are difficult and require special trained medical personnel and nurses.
Proposed diagnostic complex is based on instantaneous evaluation of state of brain and heart functions with the simultaneous use of three techniques (ECG, EEG and TCDG) operating in monitoring condition with displaying information at the screen of single monitor and giving alarm signal about critical changes in brain at the stage, when these changes may be eliminated.
In reconstruction surgery of vessels, supplying brain with blood, one of the main problems is timely diagnosis of critical level of brain disturbances at clamping of carotids. It is impossible to reconstruct carotids without clamping of them, but up to now publications about frequency of insult of 9 - 12% during surgical intervention are continued. Integral fast evaluation of progress of brain critical disturbances with the use of EEG and TCDG will permit to reduce frequency of periooperative insult to 3% level and less, i.e. to limits, recommended by Committee on Carotid Surgery of American Heart Association. Besides, 50 - 60% of patients, requiring operations over carotids, suffer from ischemic disease and have potential risk of myocardial infarction in connection with surgical intervention. Thus, monitoring in these cases should be directed to control of central nervous and cardiovascular systems.
In cardiac surgery (operations concerning ischemic heart disease, congenital and acquired diseases, cardiac rhythm disturbances) during operations with artificial circulation (apparatus "heart - lungs") diagnostic complex will give opportunity to monitor brain condition, degree of artificial blood circulation efficiency, and to change parameters of operation, anesthesia and artificial blood circulation on course. Monitoring of activity of patient's restored cardiac output will be added to this in postoperative period. The result will be reduction of heaviness of postoperative cardiac insufficiency and damages of central nervous system.
In neurosurgery at operations concerning aneurysm and congenital anomalies of intracranial arteries and veins, sometime tumors of brain, it will be possible to monitor safety of selected operation technique for patient. In practice it has the following form: turning-off of aneurysm from blood flow by clipping of inlet and outlet sections of arterial bed can be at once assessed from positions of possibility of penetration of critical blood circulation disturbances and levels of clipping can be changed if necessary. Situation during hemostasis at ablation of tumor is analogous. For old persons it will be possible to connect safety with the cycle of cardiac activity.
Permanent monitoring of ECG in cardiology at acute myocardial infarction (reduction of contractility and progress of distolic dysfunction of left ventricle of the heart) or at reduction of heart ejection owing to atrioventricular block, atrial fibrillation or flutter is required because of danger of sudden death. Low heart ejection is secondary ischemic of brain, also requiring impartial proximate evaluation. Monitoring in such situation is not only means of control over condition, but also means of determination of treatment efficiency.
In emergency medical service at myocardial infarction, insult, serious injury, comas of various etiology diagnostic complex will permit to monitor quickly, authentically and instantaneously function of heart and brain.
In neurologic departments of urgent mode of operation diagnostic complex will enable quickly and authentically differentiate nature of brain catastrophes - ischemic or hemorrhagic disturbance of brain, to diagnose so-called cardiocerebral syndrome (instantaneous disturbance of brain and heart function). EEG is not sufficient for evaluation of brain state in all aspects. EEG will reveal retardation of electric activity during cortical infarctions, will predict progress of fits of posttraumatic epilepsy at penetrating wound of skull (occurrence of alpha rhythm and occurrence of local slow waves). However, EEG is not capable to evaluate all aspects of brain disturbances and TCDG greatly extends capabilities of monitoring at the expense of determination of hemodynamic indexes. Correct interpretation of specified situations will permit to decrease mortality and invalidism.
From scientific point of view as a result of project fulfillment algorithm of double monitoring of heart and brain function, criteria of a complex evaluation (EEG and TCDG) of brain function at different situations (insult, myocardial infarction, shock) depending on central hemodynamics level (ECG) will be developed, changes in technical aspects of surgical interventions over arteries, supplying brain with blood and vessels of brain will be made.
Scope of activity under the project provides writing of intermediate and final reports on technological development of complex and manufacture of operating mock-up of diagnostic complex. The check of its operability is supposed to carry out at USMAAE State Centre of Vascular and Coronary Surgery (Chelyabinsk). Participants of the project are going to invite to cooperation medical institutions of USA, European countries, Japan and South Korea, having interest in the given problem, and also foreign companies and companies, producing medical equipment as collaborators of the project. Forms of cooperation: exchange of information, obtained during project performance, scientific consultations at foreign medical centres, participation in joint reports on the project at appropriate international conferences, transfer of working documentation to companies, producing medical equipment and etc. (see information in INTERNET, http://www.istc.ru).
Participants of the project have experience of development and putting into production of medical diagnostic monitoring complexes.
Methodology of project performance provides combination of scientific-medical and engineer-technological investigations with experimental check of operability of diagnostic complex on operating mock-up in clinical conditions.
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