Double closed-loop feedback control strategy for enhanced external counterpulsation to regulate hemodynamic response of human common carotid artery

Enhanced external counterpulsation (EECP) is a mechanical therapy for the clinical management of ischemic cardio-cerebrovascular diseases. Applying different EECP modes to different patients would be based on the experience of physicians. Existing hemodynamic models could describe the quantitative relationship between different EECP modes and hemodynamic parameters of specific parts of human blood circulatory system. However, currently there is no closed-loop control system available for precisely, personally, and intelligently performing the EECP. Therefore, to significantly improve the clinical benefits of rehabilitation treatment of ischemic cardio-cerebrovascular diseases with the EECP, this study developed a double closed-loop physiological control algorithm for the EECP device. Firstly, a detailed lumped parameter model describing the hemodynamics of human blood circulatory system was updated based on the available models; then the EECP device was coupled to it and the updated model was tested with the clinical data; finally, a double closed-loop feedback control strategy for precise regulation of the carotid hemodynamic response by the EECP was proposed. The control objectives were to maintain the mean arterial pressure and EECP pressure amplitude of patients with two gain-scheduled proportional-integral (PI) controllers. In-silico results showed that the clinical data can prove the accuracy of the updated model, and the appropriate EECP pressure amplitude could provide patients with the best benefits. The proposed control system could generate satisfied hemodynamic effects even with noise, demonstrating its feasibility and robustness. It is also easy to apply with high accuracy, and may be the effective solutions for developing intelligent and personalized EECP devices.