CARDIOHELP TRAINING June 18-19, 2013 This is the standard title slide with the “corporate” image motif. The image is merely a placeholder. The image can be changed using “View – Master – Slide Master”. The image has to be entirely within the frame.

AREAS OF APPLICATION WITH CARDIOHELP CARDIOHELP System is the world’s smallest portable heart-lung support system. It is ideal for use in: Intensive care units cardiac catheter laboratory operating room trauma room Furthermore, it is the perfect solution for safe and effective patient transport. There are, therefore, now new areas of use and treatment possibilities for extracorporeal circulation.

AREAS OF APPLICATION WITH CARDIOHELP Intensive care medicine: CARDIOHELP System opens up new treatment options in intensive care medicine which put far less stress on the patient and are also comparatively inexpensive. In cases of respiratory failure, the device provides the oxygen supply. Further areas of use include: Acute respiratory distress syndrome (ARDS) Septic shock Pulmonary embolism © MAQUET 3

AREAS OF APPLICATION WITH CARDIOHELP Cardiology: In the event of cardiogenic shock, a frequent consequence of a heart attack, it is crucial to provide circulatory support as quickly as possible. This must be guaranteed until the body is able to resume this function itself. CARDIOHELP System can prevent organ damage resulting from insufficient oxygen supply to the vital organs. Areas of application include: Cardiogenic shock As stand-by or prophylactic support during high risk PCI As a bridging system (bridge to recovery, bridge to bridge, bridge to decision, etc.), e. g., for myocarditis © MAQUET © MAQUET 4 4

AREAS OF APPLICATION WITH CARDIOHELP Cardiac surgery: At the end of the 1990s, MAQUET developed the minimized extracorporeal circulation system (MECC System). Its clinical use in the operating room led to new applications of extracorporeal life support (ECLS) which required immediate or extended circulatory support. This principle has been perfected with CARDIOHELP System and the compact, integrated design of the HLS Modules. Thanks to the system’s mobility, patients can undergo further therapeutic measures (e. g., intensive care) and diagnostic investigations (e. g., CT) during extracorporeal life support. The areas of use: Pre-operative heart-lung support (e. g., cardiogenic shock) Post-operative heart-lung support (e. g., low cardiac output syndrome) As a bridging system (bridge to recovery, bridge to bridge, bridge to decision, etc.) © MAQUET © MAQUET 5 5

AREAS OF APPLICATION WITH CARDIOHELP Emergency medicine: CARDIOHELP Device weighs in at approx. 11 kg and can easily be carried by one person and is sufficiently compact to be used during transport. The system is used in emergencies to restore and stabilize the atient’s cardiopulmonary functions. It may have to be used during cardiopulmonary resuscitation caused by, amongst others: Anaphylactic shock Intoxication Hypothermia

DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP The individual operating modes and the disposables make the CARDIOHELP life support system suitable for all indications where cardiac and/or respiratory support is needed. Thus, the principle of ECLS for supplying the heart and/or lungs with oxygen is now available in new areas as a means of life support and to save lives. During open heart surgery, for example minimal extracorporeal circulation (MECC) with the CARDIOHELP life support system, ECLS is less stressful for the patient than the use of a conventional heart-lung machine. In cases of respiratory failure without cardiac impairment CARDIOHELP provides respiratory assistance with veno-venous ECLS. During veno-arterial ECLS the life support system provides cardiopulmonary support. In cases of severe respiratory failure CARDIOHELP can also be used for pump assisted lung protection (PALP) with extracorporeal CO2 removal to enable protective ventilation.

DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP Veno-venous ECLS Respiratory assistance for lung disorders: This form of ECLS is mostly used when the heart is still able to pump blood through the circulatory system without any additional support, as in the case of acute respiratory failure or a massive pulmonary embolism. The blood is removed from the jugular vein or a femoral vein for enrichment with oxygen, after which it is returned to a vein. Place of use: ICU Fields of applications: Respiratory failure without cardiac impairment: ARDS Septic shock Bridge to lung transplant Customer and Patient value: Little complexity, safe to use and more security due to little to no change of components during entire system run. Special feature: Enables CO2 removal and oxygenation Access to Patient: percutaneous cannulation of jugular and femoral veins

DIFFERENT THERAPY APPLICATIONS WITH CARDIOHELP Veno-arterial ECLS Cardiac and respiratory support: Veno-arterial ECLS is used with patients whose hearts are not adequately supporting the circulation, or have stopped. This occurs with a myocardial infarction (heart attack). It is vitally important to ensure cardiopulmonary support as early as possible to prevent organ damage. Furthermore, the CARDIOHELP life support system can increase the patient’s chances of survival by enabling examination in the cardiac catheter laboratory and revascularization by means of catheters or cardiac surgery. Place of use: ICU, Cath. Lab, ER, OR Fields of application: respiratory and circulatory failure: Cardiogenic shock During cardiopulmonary resuscitation As preventive left ventricular support in the event of low cardiac output During PTCA In cases of acute cardiac arrest or severe cardiogenic shock during the intervention As standby during high-risk PTCA In cases of acute post-infarction VSD Customer and patient value: One system fits all, from a fast deployable emergency life saving circulatory support system to a long term VAD with oxygenation possibility. Special feature: for a cardiac support and respiratory assistance Access to patient: percutaneous cannulation of the femoral vein and femoral or subclavian artery