Patent ID: 12246122

Like reference numbers represent corresponding parts throughout.

DETAILED DESCRIPTION

This document describes medical systems that have features for initiating operational settings at the beginning of a medical procedure. For example, this document describes HLM systems that are programmed and integrated with features by which the HLM can perform semi-autonomous start-up procedures.

Now referring to the figures, inFIG.1, various types of medical procedures can be performed on a patient10while the patient10is connected to a life-sustaining HLM system100. In this example, the patient10is undergoing open-heart surgery during which the heart12and lungs of the patient10are temporarily intentionally caused to cease functioning. Because the body of the patient10continues to have a metabolic need to receive a supply of circulating oxygenated blood during the medical procedure, however, the HLM system100performs such functions. That is, as described further below, the HLM system100is connected to the patient10and performs the functions of the heart12and lungs of the patient10so that the patient10stays alive and healthy during open-heart surgery.

The HLM system100can be used for many different types of medical procedures. For example, the medical procedures for which the HLM system100can be used include, but are not limited to, coronary artery bypass grafts, heart valve repairs, heart valve replacements, heart transplants, lung transplants, ablation procedures, repair of septal defects, repair of congenital heart defects, repair of aneurysms, pulmonary endarterectomy, pulmonary thrombectomy, and the like.

The HLM system100is typically set up and operated by a specially-trained clinician called a perfusionist. Perfusionists form part of the wider cardiovascular surgical team that includes cardiac surgeons, anesthesiologists, and nurses. During medical procedures using the HLM system100, the perfusionist is tasked with many responsibilities, not the least of which is ensuring that the patient10is kept alive and healthy by operating the HLM system100in a manner that maintains blood flow to the patient's tissues, and which regulates levels of oxygen and carbon dioxide in the blood of the patient10. Other responsibilities of the perfusionist include, but are not limited to, administering blood products, administering anesthetic agents or drugs, measuring selected laboratory values (such as blood cell count), monitoring circulation, monitoring blood gases, surveilling anticoagulation, induction of hypothermia, and hemodilution. The responsibilities of the perfusionist are diverse, dynamic, and critically important to achieving successful outcomes of procedures performed on the patient10using the HLM system100.

In the depicted example, the HLM system100includes components and sub-systems such as a HLM110, an extracorporeal circuit120, one or more temperature control systems130, a blood monitoring system140(e.g., a CDI® Blood Parameter Monitoring System), a perfusion data management system150, and a regional oximetry system160. Some types of procedures that use the HLM system100may not require all of the components and sub-systems that are shown. Some types of procedures that use the HLM system100may require additional components and/or sub-systems that are not shown.

The extracorporeal circuit120is connected to the patient10, and to the HLM110. Other systems, such as the temperature control system130, blood monitoring system140, and perfusion data management system150may also be arranged to interface with the extracorporeal circuit120. The extracorporeal circuit120is connected to the patient10at the patient's heart12. Oxygen-depleted blood (venous blood) from the patient10is extracted from the patient10at the patient's heart12using a venous catheter121. As described further below, the blood is circulated through the extracorporeal circuit120to receive oxygen and remove carbon dioxide. The oxygenated blood is then returned through the extracorporeal circuit120to the patient's heart12via an aortic cannula129.

The extracorporeal circuit120can include, at least, a venous tube122that is coupled to the venous catheter121, a blood reservoir123, a centrifugal pump124, an oxygenator125, an arterial filter126, one or more air bubble detectors128, and an arterial tube127that is coupled to the aortic cannula129. The venous catheter121and venous tube122are in fluid communication with the venous side of the circulatory system of the patient10. A venous occluder170and a first tube clamp172acan be located along the venous tube122. The venous tube122is also in fluid communication with an inlet to the reservoir123. An outlet from the reservoir123is connected by tubing to an inlet of the pump124. The outlet of the pump124is connected by tubing to an inlet of the oxygenator125. The outlet of the oxygenator125is connected by tubing to an inlet of the arterial filter126. An outlet of the arterial filter126is connected to the arterial tube127. One or more pressure transducers can be located along the arterial tube127to detect a heart-lung machine (HLM) system line pressure of the blood in the arterial tube127, which is measured by the HLM110and monitored by the perfusionist. In some embodiments, one or more air bubble detectors are located along the extracorporeal circuit120. The arterial tube127is connected to the arterial cannula129, which is in physical contact with the heart12and in fluid communication with the arterial side of the circulatory system of the patient10.

Briefly, the extracorporeal circuit120operates by removing venous, oxygen-depleted blood from the patient10via the venous catheter121, and depositing the venous blood in the reservoir123via the venous tube122. In some cases, gravity is used to cause the blood to flow or drain from the patient10to the reservoir123. In some cases, vacuum is used to assist the blood to flow from the patient10to the reservoir123. At least some amount of blood is intended to be maintained in the reservoir123at all times during the surgical procedure. One or more level sensors174can be used to detect the level of the blood in the reservoir123, and to provide feedback used to control the system100to maintain the level within a desired range. Otherwise, if the reservoir123becomes empty, air could be pumped into the extracorporeal circuit120, and potentially into the vasculature of the patient10. Such a result would likely be catastrophic for the patient10. Accordingly, the perfusionist is tasked with monitoring the level of the blood in the reservoir123. In addition, the level detectors174can be included in conjunction with the reservoir123to issue an alarm in response to detection of low-level conditions within the reservoir123. Moreover, one or more air bubble detectors128can be located at various sites along the extracorporeal circuit120.

Blood from the reservoir123is drawn from the reservoir123by the pump124. While the depicted embodiment includes a one-time use centrifugal pump as the pump124, in some cases a peristaltic pump of the HLM110is used instead. The pressure generated by the pump124propels the blood through the oxygenator125. The perfusionist will adjust the pump124to operate as desired, while avoiding operational issues such as negative cavitation that could create micro air in the blood of the extracorporeal circuit120. In the oxygenator125, the venous blood is enriched with oxygen, and carbon dioxide is removed from the blood. The now oxygen-rich arterial blood exits the oxygenator125, travels along the arterial tube127through multiple components that can include an arterial pressure sensor176, an arterial fast clamp178, the arterial filter126to remove emboli, and a second tubing clamp172b. The arterial tube127returns oxygenated blood to the patient10via the aortic cannula129.

The extracorporeal circuit120can also include tubing and other components for facilitating functions such as, but not limited to, drainage of blood accumulating in the heart of the patient10, providing surgical suction for maintaining visibility of the surgical field, delivery of cardioplegia solution to the heart12of the patient10during the procedure, measuring blood parameters, removing air from the blood, hemoconcentration, drug addition, obtaining blood samples, heating and cooling of the blood, and the like.

During a surgical procedure using the HLM system100, various vital signs of the patient10are measured and/or monitored. For example, a patient mean arterial pressure (“MAP”) may be measured. The MAP of the patient10is a parameter that a perfusionist operating the HLM system100will monitor in order to ensure that the HLM system100is functioning as desired during the surgical procedure. In some cases, the MAP reading is displayed on a screen of an anesthesia system, and/or displayed on the operating room screen. If the MAP of the patient10is outside of a desired range, the perfusionist may make adjustments to the HLM system100to improve the MAP of the patient10.

The HLM system100also includes the HLM110. The HLM110is a complex system that includes multiple pumps, monitors, controls, user interfaces, alarms, safety devices, and the like, that are all monitored and operated/adjusted by the perfusionist during a surgical procedure. For example, the depicted HLM110includes an arterial pump111(which can be a drive system for a disposable centrifugal pump124as shown, or a peristaltic pump), a suction pump112, a vent/drainage pump113, a cardioplegia solution pump114, and a cardioplegia delivery pump115. The HLM110can also include, or be interfaced with, devices such as a tubing occluder, electronic gas blender system, hemoconcentrator, and the like. The parameters of the HLM110, such as the rotational speed and other parameters of each of the pumps, are set and adjusted by the perfusionist. For example, the speed of the arterial pump111is adjusted to maintain a desirable level of blood in the reservoir123, and to provide a requisite level of blood circulation within the patient10.

The HLM system100also includes one or more temperature control systems130. In a first aspect, the temperature control system(s)130is/are used to heat and cool the patient's blood in the oxygenator125via a heat exchanger. Additionally, the temperature control system(s)130is/are used to heat and cool the cardioplegia solution being delivered to the heart12of the patient10. In general, the temperature control system(s)130is/are used in cooling modes during the procedure (to reduce metabolic demands), and subsequently used to warm the blood and/or cardioplegia solution when the surgical procedure is nearing its end. The perfusionist is tasked with setting up and monitoring/adjusting the temperature control system(s)130as needed during the surgical procedure.

The HLM system100, as depicted, also includes the blood monitoring system140. The blood monitoring system140is used to monitor the extracorporeal blood of the patient10during the surgical procedure. Parameters being monitored can include, but are not limited to, pH, pCO2, pO2, K+, temperature, SO2, hematocrit, hemoglobin, base excess, bicarbonate, oxygen consumption and oxygen delivery. The perfusionist is tasked with setting up and monitoring the blood monitoring system140during the surgical procedure. In some cases, the perfusionist will need to adjust other components or subsystems of the HLM system100in response to readings from the blood monitoring system140.

The HLM system100, as depicted, also includes the perfusion data management system150and the regional oximetry system160. These systems can also be used by the perfusionist to monitor the status of the patient10and/or the status of the HLM system100during surgical procedures.

Various systems, sub-systems, and components of the HLM system100have been described above. In some cases, the HLM system100for a particular patient10will be fully configured with all of the systems, sub-systems, and components described above. In other cases, one or more of the above-described systems, sub-systems, and components of the HLM system100may not be put in use for other patients10. Such variations in terms of what systems, sub-systems, and components are used for a particular procedure can be due to many different factors and combinations of factors, such as the type of patient (e.g., adult, pediatric, body mass, comorbidities, etc.), the healthcare institution's standard procedures, a surgeon's preferences, a perfusionist's preferences, equipment availability, and so on. Accordingly, the perfusionist must be prepared to set-up and start-up a wide variety of different configurations of the HLM system100. This can be very challenging and stressful for the perfusionist.

From the above description, it can be observed and understood that the perfusionist is tasked with a vast amount of very important responsibilities to set-up and start-up a surgical procedure using the conventional HLM system100. Some of the tasks pertain to the HLM110, others pertain to the extracorporeal circuit120, and still others pertain to additional sub-systems of the HLM system100. Accordingly, this disclosure describes systems and techniques that can assist the perfusionist to perform successfully the set-up and start-up of the HLM system100.

FIGS.2aand2bare a flowchart of a semi-autonomous initiation mode process400(“AIM process400”) for starting-up the HLM system100. The AIM process400describes the operations of a semi-autonomous initiation mode system (“AIM system”) for the start-up of the HLM system100and other medical equipment systems. In some embodiments, the AIM process400would be performed after set-up and priming, and while awaiting surgeon direction to initiate cardiopulmonary bypass.

Some of the purposes and benefits of the AIM system and the AIM process400include mitigation of the risks related to perfusionist oversights such as not activating all of the safety alarms, not turning on the oxygen supply to the oxygenator125, not fully closing the venous occluder170or fast clamp178, not activating the level sensors174, not activating the air bubble detector (“ABD”), and so on. In addition, the AIM system and the AIM process400can beneficially reduce the number of tasks that the perfusionist must otherwise perform to set-up, activate and test the systems, sub-systems, and components of the HLM system100.

It should be understood that some steps of the AIM process400may be omitted in some cases. The omission of certain steps can be attributable to, or based on, the particular configuration of the HLM system100being used, the perfusionist's preferences, and other factors. Moreover, the AIM system can be configured to perform, or not perform, any of the steps of the AIM process400. Accordingly, each of the steps of the AIM process400should be considered to be optional steps.

The AIM system can be integrated with the HLM system100. In some embodiments, the AIM process400can be a part of, or can be executed by, the central computer of the HLM110.

In step401of the AIM process400, the AIM system tab on the user interface of the HLM110is accessed by a user (e.g., perfusionist). In response, the user interface of the HLM110will display the AIM system menu in step402. In some embodiments, this action provides the perfusionist with an opportunity to review and/or adjust the systems, sub-systems, and components of the HLM system100that will be semi-autonomously checked and/or activated during the performance of the AIM process400.

From the AIM system menu, the perfusionist can start the semi-autonomous checking and activating process by selecting an element on the user interface such as the pre-initiation tab403. In response, the user interface of the HLM110will display an overview of the systems, sub-systems, and components of the HLM system100that will be semi-autonomously checked. In addition, the semi-autonomous checking and activating process will begin. That is, the AIM system will start sequentially querying and sending activation signals to systems, sub-systems, and components of the HLM system100, as described in the following steps of the AIM process400. As each of the following steps is performed, indications of the statuses of the systems, sub-systems, and components of the HLM system100can be provided on the user interface display. For example, in some embodiments the AIM system display screen on the user interface can have a tabular listing of the parameters to be checked. Indications, such as a green light beside each parameter, can be provided when the parameter has been successfully and properly activated.

In steps404and405of the AIM process400, the AIM system queries the air detector (e.g., air bubble detector as described above) to determine whether the air detector is activated (or “armed”). If the air detector is armed, then the next action of the AIM process400is step407. However, if the air detector is not armed then the next action of the AIM process400is step406. In step406of the AIM process400, the AIM system arms the air detector. Then, the AIM system once again performs step405in which the AIM system checks to confirm that the air detector is armed. When the AIM system has confirmed that the air detector is armed, the user interface display provides an indication, and then the AIM system proceeds to step407. Hence, as can be envisioned from this first example (which is representative of the other steps of the AIM process400), it can be said that the AIM system performs the AIM process400semi-autonomously because the AIM system will arm the air detector in step406when the AIM system finds (in step405) that the air detector is not armed.

In steps407and408of the AIM process400, the AIM system checks/queries the reservoir level detector(s) to determine whether the reservoir level detector(s) is/are armed. If the AIM system determines, in step408, that the reservoir level detector(s) is/are not armed, then the AIM system arms the reservoir level detector(s) in step409. It should be understood that at this time the reservoir may not yet contain fluid in the area of the reservoir level detector(s). Accordingly, even though the reservoir level detector(s) is/are armed, the AIM system can initially suppress alarms from the reservoir level detector(s) that would otherwise be generated by the lack of fluid (e.g., blood) in the area of the reservoir level detector(s). However, when fluid is initially detected in the area of the reservoir level detector(s), in response the AIM system can then discontinue the suppression of the alarms. When the AIM system confirms that the reservoir level detector(s) is/are armed, the user interface display provides a corresponding indication and the AIM process400proceeds to step410.

In steps410and411of the AIM process400, the AIM system checks/queries the arterial pressure sensor sub-system (e.g., the arterial pressure sensor176ofFIG.1). In particular, in some embodiments the AIM system can check and verify that a low pressure limit and a high pressure limit have been set, and that an arterial pressure sensor is communicative to the AIM system.

In step412of the AIM process400, the AIM system troubleshoots the arterial pressure sensor sub-system. For example, this can include troubleshooting a non-displayed line pressure by checking points to determine whether the transducer is zeroed correctly, whether the stopcock is turned inline in the correct position to read the line pressure, whether the pressure cable is secured correctly to the transducer, and so on.

In step413of the AIM process400, the AIM system determines whether the arterial pressure is in range. At this step, the surgeon has already cannulated the aorta and connected the arterial tubing of the primary circuitry to the cannula and removed the clamp at that connection. Once the connection is made, the perfusionist monitors the line pressure that is being transduced from the aorta. This range typically may be from 100 to 200 mmHg, depending on the systemic pressure of the patient and the pressure in the aorta. The perfusionist then places a clamp on the arterial line near him/her to safely secure the patient until it is time to initiate bypass.

When the AIM system confirms that the arterial pressure sensor sub-system is properly operating, the user interface display provides a corresponding indication and the AIM process400proceeds to step414.

In steps414and415of the AIM process400, the AIM system checks/queries the fast clamp sub-system (e.g., the arterial fast clamp178ofFIG.1) to determine whether the fast clamp is employed and, if so, whether the fast clamp is armed and closed. If the fast clamp is employed, but not armed and/or closed, the AIM system can semi-autonomously arm and/or close the fast clamp in step416. When the AIM system confirms that the fast clamp is properly operating (and is closed), the user interface display provides a corresponding indication and the AIM process400proceeds to step417.

In steps417and418of the AIM process400, the AIM system checks/queries the venous occluder sub-system (e.g., the venous occluder170ofFIG.1) to determine whether the occluder is employed and, if so, whether the occluder is armed and closed. If the occluder is employed, but not armed and/or closed, the AIM system can semi-autonomously arm and/or close the occluder in step419. When the AIM system confirms that the occluder is properly operating (and is closed), the user interface display provides a corresponding indication and the AIM process400proceeds to step420.

In steps420and421of the AIM process400, the AIM system checks/queries the centrifugal pump (if a centrifugal pump is employed). For example, the AIM system checks that the RPM of the centrifugal pump is set at a configurable coast speed set-point. If not, the AIM system can semi-autonomously increase or decrease the RPM of the centrifugal pump to operate at the configured coast speed (RPM). When the AIM system confirms that the centrifugal pump is properly operating (and its RPM is at the established coast speed), the user interface display provides a corresponding indication in step423, and the AIM process400proceeds to step424.

In steps424and425of the AIM process400, the AIM system checks/queries to determine whether the tubing clamps (e.g., the clamps172aand172bofFIG.1) are clamping closed the extracorporeal circuit, or whether the tubing clamps are not clamping the extracorporeal circuit. In some embodiments, this is performed by providing a message on the user interface and asking the perfusionist to confirm that the clamps are removed by inputting a response into the user interface. In some cases, if the AIM system determines that one or more of the clamps are closing the extracorporeal circuit, a message can be displayed on the user interface to prompt the perfusionist to remover the one or more clamps. When the AIM system determines that the clamps are not closing the extracorporeal circuit, then the AIM process400proceeds to step427.

At step427of the AIM process400, the AIM system initiates CPB. This step can include one or more of the following actions that are performed by the AIM system and/or by the central computer system of the HLM in an autonomous or a semi-autonomous manner. The pump time clock can be started. The gas sweep can be adjusted to a pre-configured setting (e.g., 1 L/min for adults for a semi-autonomous target flow). The FiO2 can be adjusted to a pre-configured setting (e.g., 100 percent for adults for a semi-autonomous target). The arterial fast clamp (if employed) can be opened. The arterial blood flow can be gradually ramped up over a period of time (configurable, for example 20 seconds) to a pre-configured target value (e.g., 1 L/min for adults). The AIM system would be limited by a configurable safe upper flow limit to keep the semi-autonomous operations in control. That is, it would still be incumbent on the Perfusionist to adjust the blood flow to a full flow target value and to control the venous return. The venous occluder (if employed) can be opened to a pre-configured setting (e.g., 50 percent open for a semi-autonomous target flow).

In some embodiments, the AIM system and/or by the central computer system of the HLM would autonomously or semi-autonomously monitor the perfusion system in terms of venous reservoir level, arterial line pressure, and air detection, with appropriate responses for all, as the AIM system reaches its target flow value.

Intervention by the perfusionist on the arterial pump blood flow (e.g., speed adjustment knob or cursor) during the AIM system-controlled start up would immediately disengage the AIM system, returning full control to the perfusionist. Once the AIM system and/or the central computer system of the HLM reaches its pre-configured semi-autonomous target arterial flow, the perfusionist assumes manual control of CPB and increases arterial pump flow to full flow index and adjusts control of venous return. The AIM system automatically disengages with the adjustment of the arterial pump blood flow.

FIG.3is a schematic diagram of an example monitoring and control system used during a medical procedure200. The procedure200can include the patient10and a practitioner206. The practitioner206can be a perfusionist or other professional who performs the procedure200and/or portions of the procedure200. The patient10can be hooked up or in communication with the HLM (e.g., HLM system100), as depicted and described throughout this disclosure. Sensor(s)208can also be attached to the patient10or the extracorporeal circuit. The sensor(s)208can further be in communication with the HLM system100and/or any other devices used during the procedure200. The sensor(s)208can capture real-time conditions of the patient10, the HLM system100, and parameters that are being monitored during the procedure200.

The practitioner206can use a user device204(user interface) to monitor conditions or parameters of the patient10, the HLM system100, and other devices used during the procedure200. In some embodiments, the user device204is part of the HLM system100, or physically attached thereto. In some embodiments, the user device204can be separate from the HLM system100. In some embodiments, the user device204can be a mobile computing device, such as a smartphone or tablet. The user device204can also be a computer or laptop. The user device204can have a user interface (e.g., touchscreen, monitor, etc.) configured to display monitored conditions and parameters in real-time. The user device204can also have one or more input devices configured to receive adjustments from the practitioner206. The practitioner206can make adjustments to any one of the conditions and parameters by providing input to the user device204.

The user device204can be in communication with a computer system202(e.g., monitoring and control system). In some embodiments, the computer system202is part of the HLM system100. In some embodiments, the user device204is part of the computer system202. Moreover, the computer system202can include one or more input devices and/or displays. The AIM system can be installed to run on the computer system202.

The computer system202can be configured to provide the user device204with a user interface that displays monitored conditions and parameters. In some implementations, the computer system202and the user device204can be the same system. In other implementations, the computer system202and the user device204can be remote from each other. The computer system202can also facilitate one or more adjustments made or suggested by the practitioner206during the procedure200. Therefore, the computer system202can also be in communication with the HLM system100, the sensor(s)208, and any other devices that are used during the procedure200. Communication between one or more components (e.g., the user device204, the FILM110, the sensor(s)208, and the computer system202) can be wireless and/or wired via network(s)210.

Still referring toFIG.2, before the procedure200begins, the practitioner206can set parameter ranges and semi-autonomous adjustments at the user device204(A). The user device204can provide a display to the practitioner206, prompting the practitioner206to set values for each of the parameters that will be monitored during the procedure200. The practitioner206can also be prompted to input desired adjustments to the parameters that the practitioner206may want implemented during the procedure200if the parameters stray from the practitioner-defined parameter ranges. In other words, before the procedure200, the practitioner206can indicate what actions (e.g., pre-defined adjustments) can be taken should any of the parameters exceed or fall below ideal ranges that the practitioner206also defines before the procedure200. Then, during the procedure200, if any of the parameters do in fact stray outside of the practitioner-defined ranges, the practitioner206can select and perform one of the pre-defined adjustments. Such adjustments can be performed manually by the practitioner206. Such adjustments can also be performed semi-autonomously by the computer system202.

The practitioner206can set parameter ranges and semi-autonomous adjustments that apply generally to all similar procedures or a specific practice area. Therefore, regardless of which patient undergoes the procedure200, the same parameter ranges and semi-autonomous adjustments can be applied to the procedure200. This can be beneficial for the practitioner206to perform all procedures the same way, which can improve patient safety and overall procedure outcomes. Moreover, using the same parameter ranges and semi-autonomous adjustments in a specific practice area can be advantageous for the computer system202to more accurately predict and/or generate parameter trend analysis. In other examples, the practitioner206can set parameter ranges and semi-autonomous adjustments per procedure per patient. In other words, first and second patients can undergo the same procedure. However, the practitioner206can set different parameter ranges and adjustments for each of the patients. This can be beneficial where the patients have different health conditions or sensitivities.

Next, the computer system202can receive the parameter settings from the user device204(B). These parameter settings can be one or more of the practitioner-defined parameter ranges and/or semi-autonomous parameter adjustments.

Based on the received parameter settings, the computer system202can generate one or more user interface displays (C). For example, the computer system202can generate interactive/selective options on a user interface, wherein each of the selective options correlates to a semi-autonomous adjustment that the practitioner206defined at the user device204. In other words, if the practitioner206defined an adjustment to increase blood flow through the extracorporeal circuit in the HLM system100, the computer system202can generate a button that, when clicked on by the practitioner206during the procedure200, can automatically cause the blood flow to be increased through the circuit. As another example, the computer system202can also generate one or more graphs or other depictions for each of the parameters that the practitioner206defined at the user device204.

The generated user interface display can be received at the user device204(D). In other words, the user interface can be displayed on the user device204during the procedure200. The display can be updated during the procedure200to reflect real-time changes in parameters, parameter trends, and/or conditions of the patient10. The display, as depicted and described throughout this disclosure, can provide information for each of the monitored or defined parameters on a single user interface. As a result, in some embodiments the practitioner206can monitor all parameters during the procedure200concurrently. In other implementations, the practitioner206can switch between multiple different user interface displays/screens. Each of the user interface displays/screens can be related to a particular parameter. Each of the user interfaces can be related to a subset of all of the practitioner-defined parameters.

In some cases, consolidating the parameters into a singular user interface display can be advantageous. This is because the practitioner206can more easily and continuously monitor all parameters during the procedure200. With real-time updates, the practitioner206can also more quickly and accurately respond to any undesired changes in the parameters.

The user device204can receive real-time parameter information from the HLM system100and/or the sensor(s)208during the procedure (E). The computer system202can also receive real-time parameter information from the HLM system100and/or the sensor(s)208(E). Based on the real-time parameter information, the computer system202can generate parameter trends (F). For example, the computer system202can generate graphs depicting a trend analysis of each of the monitored parameters. The graphs can indicate past, current, and projected trends of the monitored parameters. The graphs can also indicate past, current, and projected trends of the monitored parameters relative to the practitioner-defined parameter ranges.

The generated parameter trends can be provided from the computer system202to the user device204. Therefore, the parameter trends can be displayed at the user interface (G). Thus, the user interface can be dynamically updated as real-time parameter information is received (E) and parameter trends are generated (F). In some implementations, the user device204can determine and generate the parameter trends. The user device204can also display the real-time parameter information that is received from the HLM system100and/or the sensor(s)208(G). For example, the user device204can update the user interface with parameter values that are sensed in real-time by the sensor(s)208. That user interface can also be updated to reflect the parameter trends generated by the computer system202(F). Thus, the user interface can display both the present or current parameter values as well as the projected parameter trends.

As all this information is displayed to the practitioner206at the user device204, the practitioner can choose whether or not to make any adjustments to affect the monitored parameters. For example, if one of the parameters is projected to trend out of the practitioner-defined range for that parameter, then the practitioner206can select one of the practitioner206′s pre-defined parameter adjustments from the user interface (H). As mentioned, the pre-defined parameter adjustments can be displayed in the user interface as a selectable option, such as a button.

When the practitioner206selects one or more of the pre-defined parameter adjustments, the computer system202can receive the adjustment from the user device204(I). In some implementations, the practitioner206can select more than one pre-defined parameter adjustment. Selections by the practitioner206can be communicated and performed simultaneously by the computer system202.

The parameter adjustment(s) can then be performed (J). In some embodiments, the parameter adjustment can be semi-autonomously performed by the computer system202. In other words, the practitioner206defined the adjustment before the procedure200began. When the practitioner206selected the pre-defined parameter adjustment during the procedure200, the computer system202received instructions to execute the adjustment. Therefore, the practitioner206maintains control of what type of adjustments occur during the procedure200. In some embodiments, the computer system202does not predict or suggest to the practitioner206what adjustment(s) to make. Alternatively, in some embodiments the computer system202does suggest to the practitioner206what adjustment(s) to make.

In other examples, the adjustment(s) can be performed manually by the practitioner206. The practitioner206can also override a semi-autonomous adjustment by selectively controlling one or more buttons or other physical components of the user device204, the HLM system100, and/or any other device that is used during the procedure200. For example, the practitioner206may have established a pre-defined parameter adjustment before the procedure200that required increasing pressure through a particular portion of the extracorporeal circuit by a first value. During the procedure200, the practitioner206may still want to perform that adjustment but increase pressure through the particular portion of the extracorporeal circuit by a second value instead of the first value. The second value can be greater or less than the first value. Therefore, the practitioner206can manually take control and operate one or more physical buttons to adjust the pressure by the second value. This can be a manual or semi-manual performance of a pre-defined adjustment.

The user device204and the computer system202can continue to receive real-time parameter information during the procedure200, after such one or more adjustments have been made. As a result, the practitioner206can continuously monitor the parameters and make any necessary adjustments throughout the procedure200.

While this specification contains many specific implementation details, these should not be construed as limitations on the scope of any inventions or of what may be claimed, but rather as descriptions of features specific to particular embodiments of particular inventions. Certain features that are described in this specification in the context of separate embodiments can also be implemented in combination in a single embodiment. Conversely, various features that are described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a subcombination or variation of a subcombination.

Similarly, while operations are depicted in the drawings in a particular order, this should not be understood as requiring that such operations be performed in the particular order shown or in sequential order, or that all illustrated operations be performed, to achieve desirable results. In certain circumstances, multitasking and parallel processing may be advantageous. Moreover, the separation of various system components in the embodiments described above should not be understood as requiring such separation in all embodiments, and it should be understood that the described program components and systems can generally be integrated together in a single software product or packaged into multiple software products.

Particular embodiments of the subject matter have been described. Other embodiments are within the scope of the following claims. For example, the actions recited in the claims can be performed in a different order and still achieve desirable results. As one example, the processes depicted in the accompanying figures do not necessarily require the particular order shown, or sequential order, to achieve desirable results. In certain implementations, multitasking and parallel processing may be advantageous.