LUCAS Device Use Associated with Prolonged Pauses during Application and Long Chest Compression Intervals.

BACKGROUND: Tenets of high-quality out-of-hospital cardiac arrest (OHCA) resuscitation include early recognition and treatment of shockable rhythms, and minimizing interruptions in compressions. Little is known about how use of a mechanical compression device affects these elements. We hypothesize that use of such a device is associated with prolonged pauses in compressions to apply the device, and long compression intervals overall. METHODS: We systematically abstracted CPR metrics from 4 months of adult non-traumatic OHCA cases, each of which had at least 10 minutes of resuscitation, used a LUCAS device, and had a valid monitor file attached to the patient care report. Our primary outcomes of interest were the duration of each pause in compressions and the duration of compressions between pauses, stratified by whether or not the LUCAS device was used/applied during the segment. Each pause was further evaluated for a possible associated procedure based on pre-defined criteria. Descriptive statistics, chi-square, and Kruskal-Wallis tests were used as appropriate. RESULTS: Fifty-eight cases were included, median age 62.5 years (IQR 49.3-70.8), 47% female, 66% nonwhite. Overall, 633 compression-pause segments were analyzed (517 with and 116 without LUCAS applied). Spacing of pauses was significantly longer with the LUCAS than without [median (IQR) 133 (82-213) seconds vs. 38 (18-62) seconds, p < 0.05]. When using a LUCAS, compressions were continuous for at least 3 min in 166/517 segments, at least 4 min in 89/517 segments, and at least 5 min in 56/517 segments. Without a LUCAS, compressions were longer than 3 min in 7/116 segments. Pauses exceeded 10 s more frequently with LUCAS application (32/38) than airway management or defibrillation (27/80, p < 0.05). Peri-LUCAS pauses exceeded 30 s in 6/38 cases. CONCLUSION: LUCAS use was associated with long compression intervals without identifiable pauses to assess for pulse or cardiac rhythm, and device application was associated with longer pauses than airway management or defibrillation. The clinical significance and effect on patient outcomes remain uncertain and require further study.

A Magnetically Tunable Check Valve Applied to a Lab-on-Chip Nitrite Sensor.

Presented here is the fabrication and characterization of a tunable microfluidic check valve for use in marine nutrient sensing. The ball-style valve makes use of a rare-earth permanent magnet, which exerts a pulling force to ensure it remains passively sealed until the prescribed cracking pressure is met. By adjusting the position of the magnet, the cracking pressure is shown to be customizable to meet design requirements. Further applicability is shown by integrating the valve into a poly(methyl methacrylate) (PMMA) lab-on-chip device with an integrated optical absorbance cell for nitrite detection in seawater. Micro-milling is used to manufacture both the valve and the micro-channel structures. The valve is characterized up to a flow rate of 14 mL min-1 and exhibits low leakage rates at high back pressures (<2 µL min-1 at ~350 kPa). It is low cost, requires no power, and is easily implemented on microfluidic platforms.

Continuous Flow with Reagent Injection on an Inlaid Microfluidic Platform Applied to Nitrite Determination.

A continuous flow with reagent injection method on a novel inlaid microfluidic platform for nitrite determination has been successfully developed. The significance of the high-frequency monitoring of nutrient fluctuations in marine environments is crucial for understanding our impacts on the ecosystem. Many in-situ systems face limitations in high-frequency data collection and have restricted deployment times due to high reagent consumption. The proposed microfluidic device employs automatic colorimetric absorbance spectrophotometry, using the Griess assay for nitrite determination, with minimal reagent usage. The sensor incorporates 10 solenoid valves, four syringes, two LEDs, four photodiodes, and an inlaid microfluidic technique to facilitate optical measurements of fluid volumes. In this flow system, Taylor-Aris dispersion was simulated for different injection volumes at a constant flow rate, and the results have been experimentally confirmed using red food dye injection into a carrier stream. A series of tests were conducted to determine a suitable injection frequency for the reagent. Following the initial system characterization, seven different standard concentrations ranging from 0.125 to 10 µM nitrite were run through the microfluidic device to acquire a calibration curve. Three different calibrations were performed to optimize plug length, with reagent injection volumes of 4, 20, and 50 µL. A straightforward signal processing method was implemented to mitigate the Schlieren effect caused by differences in refractive indexes between the reagent and standards. The results demonstrate that a sampling frequency of at least 10 samples per hour is achievable using this system. The obtained attenuation coefficients exhibited good agreement with the literature, while the reagent consumption was significantly reduced. The limit of detection for a 20 µL injection volume was determined to be 94 nM from the sample intake, and the limit of quantification was 312 nM. Going forward, the demonstrated system will be packaged in a submersible enclosure to facilitate in-situ colorimetric measurements in marine environments.

An Automated Microfluidic Analyzer for In Situ Monitoring of Total Alkalinity.

We have designed, built, tested, and deployed an autonomous in situ analyzer for seawater total alkalinity. Such analyzers are required to understand the ocean carbon cycle, including anthropogenic carbon dioxide (CO2) uptake and for mitigation efforts via monitoring, reporting, and verification of carbon dioxide removal through ocean alkalinity enhancement. The microfluidic nature of our instrument makes it relatively lightweight, reagent efficient, and amenable for use on platforms that would carry it on long-term deployments. Our analyzer performs a series of onboard closed-cell titrations with three independent stepper-motor driven syringe pumps, providing highly accurate mixing ratios that can be systematically swept through a range of pH values. Temperature effects are characterized over the range 5-25 °C allowing for field use in most ocean environments. Each titration point requires approximately 170 µL of titrant, 830 µL of sample, 460 J of energy, and a total of 105 s for pumping and optical measurement. The analyzer performance is demonstrated through field data acquired at two sites, representing a cumulative 25 days of operation, and is evaluated against laboratory measurements of discrete water samples. Once calibrated against onboard certified reference material, the analyzer showed an accuracy of -0.17 ± 24 µmol kg-1. We further report a precision of 16 µmol kg-1, evaluated on repeated in situ measurements of the aforementioned certified reference material. The total alkalinity analyzer presented here will allow measurements to take place in remote areas over extended periods of time, facilitating affordable observations of a key parameter of the ocean carbon system with high spatial and temporal resolution.

A submersible phosphate analyzer for marine environments based on inlaid microfluidics.

In situ sensors are needed to further our understanding of phosphate flux dynamics in marine environments during short term events such as tidal cycles, algae blooms and runoff periods. Here, we present a fully automated in situ phosphate analyzer based on an inlaid microfluidic absorbance cell technology. The microfluidic device employs colorimetric absorbance spectrophotometry, using the phosphomolybdenum blue (PMB) assay modified by the addition of polyvinylpyrrolidone (PVP), to measure phosphate concentrations in seawater. Bench top calibrations were performed with both copper(II) sulfate dye and the PMB assay, as well as temperature sensitivity studies to characterize the sensor's performance in a range of conditions. It achieves a limit of detection of 15.2 nM, a limit of quantification of 50.8 nM, and a high in situ precision with a relative standard deviation of less than 1.5% across three consecutive measurements. Two consecutive field deployments are conducted as assessments for its intended in situ applications. The sensor is first deployed from a pier at a depth of 6 m, with simultaneous bottle samples taken to perform cross-validation. It is next deployed on the Stella Maris testbed, a multi-sensor seabed platform (MSSP), 100 m offshore and 9 m deep in the inlet to the Bedford Basin in Nova Scotia, Canada. Over 300 successful phosphate measurements were acquired, showing the influence of the tidal cycle, and confirming the sensor's viability in observing nutrient flux dynamics with nanomolar variations.