Operating mainly in the UK, with subsidiaries in the USA and Spain, Deltex Medical manufactures and markets the CardioQ–ODM™.
Deltex Medical’s CardioQ–ODM oesophageal Doppler monitor (ODM) changes the way doctors can care for patients having major surgery or in intensive care.ODM is the only technology to measure blood flows in the central circulation; it is highly sensitive to changes in flow and measures them immediately and accurately. ODM is simple to use and enables doctors to intervene quickly and safely based on small changes in circulating blood volume and so avoid the dangers of reduced oxygen delivery.
ODM-guided fluid management is a cornerstone of Enhanced Recovery, delivering better quality, more cost effective care as it means patients recover from their surgery faster and leave hospital sooner and in better health than they otherwise would do. Having established a substantial high quality evidence base supporting wide-scale use of its products on both clinical and economic grounds, Deltex Medical is working with leading hospitals around the world to introduce ODM-guided fluid management into routine use.
The first haemodynamic monitor to measure both flow and pressure directly
“Not only but also”
To date cardiac output monitors have either been ideal intervention devices, fast precise response but non-continuous, or continuous monitors with complex calibration systems but which can be cumbersome as intervention devices. The CardioQ-ODM+ provides the user with not only a proven highly sensitive intervention tool but also the simplest calibration of a continuous monitoring mode yet devised.
The CardioQ-ODM+ achieves this through the use of Doppler ultrasound to guide intervention and also to calibrate a stable pulse pressure waveform analysis (PPWA) algorithm to track cardiac output continuously.
The clinical benefits of the CardioQ-ODM stem directly from the use of a low-frequency ultrasound signal to measure blood flow directly in the central circulation.
The evidence in support of individually guided fluid management is centred on the implementation of oesophageal Doppler monitoring (ODM), using the CardioQ-ODM. The device has established an incomparable evidence base that is today acknowledged and endorsed by the National Institute for Health and Clinical Excellence (NICE MTG3)1.
“the easiest calibration to date”
Effective PPWA Calibration
The CardioQ-ODM+ is an exciting new technology upgrade to the proven Doppler technology and is targeted at intensive care and high risk surgical applications. By combining the truly minimally invasive technology of ODM for intervention management of fluids and drugs, with a pulse pressure wave analysis (PPWA) system, patients can be monitored continuously between intervention and calibration episodes. ODM provides the simplest and most economical calibration system for a PPWA algorithm. Additionally Deltex Medical has chosen the most stable and extensively researched PPWA algorithm currently available 2,3.
Deltex Medical has chosen the algorithm originally proposed by Liljestrand & Zander in 19282. Trials of this algorithm have been extensively reported in the literature and Deltex Medical has also performed its own clinical evaluations of its performance in a wide range of clinical situations. Only the formula proposed by Liljestrand and Zander has been shown to be a significantly better quantitative estimator of CO than MAP. The Liljestrand method has been shown to be even more accurate when applied to the cleanest ABP waveforms. Other investigational algorithms have been shown not to be significantly superior to MAP as quantitative estimators of CO3,4.
Whilst some devices have taken an uncalibrated approach, or used a reference calibration initially, PPWA algorithms are known to drift which has resulted in calls for frequent recalibration periods. Linton and Linton reported that “clinically significant differences can occur between methods” simply PPWA algorithms can drift due to changes in compliance. Linton and Linton also strongly recommended calibration before major clinical decisions were taken5. Thus recalibration may be more important than initial calibration. Uncalibrated/un-recalibrated PPWA may be useful to monitor lower risk critical care patients, e.g. in postoperative recovery and High Dependency Units. However, without the ability to recalibrate before intervention their use has limitations. The CardioQ-ODM+ provides the capability to calibrate and recalibrate using a quick and easy minimally invasive and clinically proven method.
One current calibrated PPWA device has been reported to require three averaged lithium dilution curves to discern accurately a change in Cardiac Output (CO) of 15% and the same device would require averaging of six dilution curves to discern a change of CO of 10%6. The clinically proven intervention procedure for Doppler guided fluid management as recommended by NICE MTG3 utilised a 10% change1. Attempting six calibration dilution curves to achieve this level of precision would take in excess of 30 minutes to implement and is impractical in a clinical setting.
In contrast the CardioQ-ODM+ offers calibration at the highest level of precision in a matter of seconds.
Studies of PPWA devices recommend that in critically ill patients that the device should be re-calibrated at least every four hours7 and that recalibration should be performed before major clinical decisions are made4.
The ease of calibration offered by the CardioQ-ODM+ is truly revolutionary, affording the user the ability to accurately recalibrate at any time ensuring the highest quality of clinical information.
The CardioQ-ODM+ version 3 provides all the standard Doppler parameters:
Cardiac Output, Cardiac Index, Stroke Volume, Stroke Volume Index, Stroke Distance, Stroke Volume Variation, Stoke Distance Variation, Peak Velocity Variation, Flow Time corrected, Flow Time to peak, Mean Acceleration, Minute Distance, Systemic Vascular Resistance, Systemic Vascular Resistance Index, DO2, DO2I, Heart Rate.
The monitor can also provide pressure based parameters:
Cardiac Output, Cardiac Index, Stroke Volume, Stroke Volume Index, Systemic Vascular Resistance, Systemic Vascular Resistance Index, Mean Arterial Pressure, Heart Rate, Pulse Pressure Variation or Stroke Volume Variation (only one selected at any one time), Systolic Pressure Variation.
Additionally the monitor can provide pressure combined parameters:
Cardiac Power (CP) and Cardiac Power Index (CPI). German-Austrian guidelines have indicated CP and CPI to be important parameters in the diagnosis, monitoring and treatment of cardiogenic shock8.
No other haemodynamic monitor provides the benefits of both the clinically proven Doppler based intervention mode and a stable easily calibrated continuous monitoring system.
Ideal for use in:
- Intensive Care
- High Dependency
- High Risk surgical patients transferring to overnight surgical recovery unit, HDU or ICU
- Surgical cases where displacement of the oesophagus may interrupt Doppler measurement
- Surgical cases where cross-clamping of the aorta may disrupt aortic flow and interfere with Doppler measurement
- Prolonged periods of diathermy
Deltex Medical Group Plc Board MembersEwan Phillips - Chief Executive
Paul Mitchell - Finance Director
Andy Mears - Global Sales Director
Peter Rose - International Sales Director
Tim Taylor - UK Sales Director
Dr Graham Lowe - Marketing and Operations Director
Company website for Deltex Medical Group Plchttp://www.deltexmedical.com/
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