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Clinical considerations associated with ventricular assist device patients receiving hyperbaric oxygen therapy : a thesis submitted to the faculty of the Milwaukee School of Engineering in partial fulfillment of the requirements for the degree of Master of Science in Perfusion / by Jenna Staffaroni.

by Staffaroni, Jenna, author., Gerrits, Dr. Ronald, thesis advisor , Fennigkoh, Dr. Larry , Princer, Kathleen, committee member , Milwaukee School of Engineering

[Milwaukee School of Engineering], [2016]

Cardiovascular instruments, Implanted

Hyperbaric oxygenation

52 leaves : illustrations, some of which are in color ; 29 cm

Introduction -- Background -- Project statement -- Methods -- Results -- Discussion -- Appendix A: Raw data.

Hyperbaric Oxygen Therapy (HBOT) is a widely accepted treatment for patients suffering from conditions associated with low oxygen content or delivery, and utilizes a pressurized environment and high fraction of inspired oxygen to drive oxygen deep within the body's tissues to facilitate healing. Although a variety of patients may benefit from this therapy, many medical devices have not been tested in the hyperbaric environment, including ventricular assist devices. Such testing needs to consider both the environmental changes as well as hemodynamic changes that have been shown to occur with HBOT. These hemodynamic changes include increases in systemic vascular resistance that occur during the descent to therapeutic depth and the return to surface that occur with HBOT. The goal of this study was to identify and assess the clinical concerns that accompany a VAD patient receiving HBOT.

The main goal of this project was to determine if two common VADS (HeartWare and HeartMate II) would maintain their flow rates within 1 liter of baseline when faced with increasing afterloads. These afterloads mimicked the range of increases reported in the HBOT literature. This specification was assessed by incrementally increasing the afterload pressure for each VAD and measuring the corresponding flow rates.

Results showed that a SVR increase of 150% was needed in order to decrease the Thoratec Heart Mate II flow by roughly 1 L/min, while the HeartWare required an increase in SVR by roughly 180% for the RPM levels tested. Each of these increases is greater than the maximum increase in SVR of 130% reported in the literature. These data support that the increase in SVR that occurs during HBOT should not pose a significant threat to the patient's circulatory support. Although this study concluded that the VADS can meet the clinical needs of patients undergoing HBOT, mechanical operation of the VAD at high pressures must still be verified prior to implementing HBOT with a VAD patient.

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