Another ACEP Scientific Assembly has come and gone. One of my favorite things to do at this convention is walk the exhibit floor and check out the new toys and tools. The floor seemed a little barren in comparison to years past – not to mention an overabundance of physician management or recruiting firms – but there were still plenty of interesting ideas and products out there. We’ll spend the next couple of articles looking at emerging products and ideas on the technology front. I will intentionally be avoiding systems technology such as computerized patient tracking as you really cannot properly review these products without implementing them in your ED.
This month we’ll focus on what I view as the biggest “trend” emerging in medical tech at this years Scientific Assembly: Non-invasive monitoring technology. The theme for this sector seems to be, “get more from less”. Imagine getting routine vital signs from patients via the mattress they are sitting on while in street clothes and with no monitoring equipment attached to the patient. How about a single lead ECG monitor that you can place on lower-risk patients who are either in your waiting room or are boarding awaiting an inpatient bed allowing continuous monitoring despite where they might be within the ED. But that’s not all! You can also obtain nearly all of the data you’d get from a Schwan-Ganz catheter simply with an IV, a few electrodes, and a small blood pressure cuff on a finger-tip. Every product wants to give you more information with a less invasive platform. There are too many products to have an in-depth review of each so we’ll go through them with quick bullets and hopefully you’ll have a better sense of what’s on the horizon.
The Prime ECG by Heartscape
The Gist: The Prime ECG doesn’t just leave your father’s ECG in the dust, it drives right over it and never looks back. The motto behind this device: “more IS more”. If 12 leads are good, imagine what we can do with 80. This is a bit akin to the leap made by radiologists a decade or so ago when multirow CT scanners began replacing standard radiographs for evaluating the chest, face, spine, etc… Just as the radiologists sometimes get bogged down by the amount of data presented in finer imaging studies the same could happen to the average EP in a hectic setting when faced with multiple 80-lead ECGs. The Prime system tries to alleviate this with 3-D mapping that is color-coded to show areas of concern. Heartscape boasts increased detection of inferior MI’s as well as MI in the setting of LBBB and has multiple papers to support its use. While providing useful data in the right patients, if Prime ECGs were implemented in my ED I’d be a bit concerned about overuse.
ETA: Currently Available
www.heartscape.com
The Gist: An interesting device that consists of a fingertip blood pressure cuff and a bracelet similar in size to a “house arrest” anklet (I know we have all seen these before). Via this small device BMEYE purports to be able to monitor continuous blood pressure (not just intermittent snapshots). They also measure cardiac output, cardiac index, stroke volume, and systemic vascular resistance using “proprietary algorithms.” The algorithms have been validated but the only articles included in the documentation were sponsored by the vendor.
ETA: Currently Available
www.bmeye.com
LifeGurney by Hoana
The Gist: The LifeGurney and LifeBed systems from Hoana take the term “more from less” to the extreme. This is simply a mattress that can be used with existing beds. When a patient lies on the bed the system begins acquiring data that it uses to display the patient’s respiratory rate and heart rate. After a few seconds of data acquisition the system shows a clean tracing for both vital signs. This data can be acquired through multiple layers of clothing and bedding. The system continues to monitor the patient if they are sitting up in bed even if their only point of contact with the mattress is their derrière. The system will feed into existing monitoring systems and allow for trend collection, alarm parameters, and fall alarms. As simple as the data is, seeing this work in person is nothing short of sorcery and I found the device very intriguing. This device has great utility in the boarding population.
ETA: Currently Available
www.hoana.com
InSpectra StO2 Tissue Oxygenation The Gist: The InSpectra StO2 monitor is an infrared device that is placed on the thenar eminence. It does pulse oximetry and ScvO2 one better by not only measuring the oxygen in the blood on the sending or receiving side but by actually measuring oxygen saturation of the tissues themselves. The theory is that as shock ensues, one of a patient’s first physiological responses is peripheral vaso-constriction resulting in decreased tissue saturation. If monitored closely this first indicator of shock can be noted and the underlying cause discovered and treated. It also allows the luxury of continuous real-time monitoring as opposed to the delayed snapshots of lactates. While mainly studied in the setting of trauma there are many other patient populations to which this technology may apply.
ETA: Currently Available
www.htibiomeasurement.com
NetGuard by Datascope
The Gist: The NetGuard is not so much a “more from less” device as it is a device that provides data where normally we’d have none. This is a single lead ECG device that is wireless. It is simply placed on the chest in the V4 and V5 positions and communicates with a wireless network allowing for monitoring of lower-risk patients who may be in triage or boarding awaiting an inpatient bed. The monitoring system alarms for concerning arrhythmias and allows for 20 second waveforms to be pulled up at any time. One shortcoming of the system is that the current generation has no location abilities but this is planned for the future.
ETA: Entering final production phase. Available soon.
www.datascope.com