Board 508 - Technology Innovations Abstract Spoofing ETCO2 Sensor Data Streams

Abstract

Introduction/Background Clinical monitors and smart defibrillators interact with patients such that necessary clinically relevant physiologic findings and measurements of provider performance are input into these devices using a variety of different sensors. The majority of high-technology patient simulators are unable to provide the comprehensive set of connectivity elements for all of these critical patient characteristics and, instead, display simulated patient characteristics on a simulator-specific monitor. Simulator-specific monitors do not reflect the user interface of clinical monitors and smart defibrillators. It has been observed at this institution that unrealistic presentation of patient data during simulation-based training causes provider confusion and reduces training authenticity, demonstrating the need for a device that interfaces simulation technology with real clinical devices. The technology described here translates a number of end-tidal carbon dioxide (ETCO2) inputs, which replace the Respironics Capnostat5 ETCO2 sensor output, to be displayed as ETCO2 waveforms and numeric outputs on the Zoll R-series defibrillator. Tested ETCO2 inputs include, but are not limited to, the Laerdal SimMan 3G human patient simulator, a custom-designed waveform generator software, and printed rhythm strips. Methods This technology is composed of software components, which manage ETCO2 signal data, and a hardware component, which interfaces the software components to the clinical monitor or defibrillator. The software components are written in Microsoft Visual C# and individually manage ETCO2 signal data encoding, decoding, sending, receiving, storage and retrieval. The operator-controllable ETCO2 waveform data from a Laerdal SimMan 3G human patient simulator was accessed using the Laerdal software development kit and streamed to encoding and sending software components. The sending software component routes the data to the hardware interface and finally into the defibrillator. ETCO2 waveforms drawn or printed on rhythm strips can also be isolated, stored, encoded, and sent to the defibrillator using this technology. The hardware component provides a vehicle for RS232 serial communication between the computer-run software programs and the clinical monitor or defibrillator. Tests for signal modification have been conducted. This device has been shown to successfully generate and encode ETCO2 signals to replace the Capnostat5 sensor output, and hardware components effectively interface software-managed ETCO2 data streams with the Zoll R-series defibrillator. Results: Conclusion Use of clinical monitors and defibrillators in simulation-based training of healthcare providers increases the authenticity of training scenarios and likely increases training effectiveness; however, existing simulators do not interface with real clinical monitors. Add-on technologies (Zoll ECG Simulator, Fluke Biomedical Patient Simulators), which connect directly to clinical monitors and defibrillators, are used to bypass simulator-monitor connectivity issues. No add-on technology currently exists to allow for use of clinical ETCO2 sensors with clinical monitors and defibrillators in simulation-based training. The 2010 AHA guidelines for CPR and ECC recommend the use of ETCO2 to measure the quality of chest compressions and guide the quality of resuscitation1; however, few high-technology simulators allow for the realistic integration of ETCO2 into simulation-based training. Incorporation of this simulator-independent technology will allow for the transition of simulation-based CPR and ECC training to include clinical monitors and defibrillators without the need to alter existing simulators. This device effectively interfaces simulators to Capnostat5-compatible clinical devices, and this research will be continued to provide device compatibility with additional clinical sensors.