1.

Chapter 1 Patient Monitoring with Head-Mounted Displays

The role of the anesthesiologist in the operating room is often portrayed as simply
providing patients with pain relief and inducing unconsciousness in preparation for surgery.
The true role of the anesthesiologist, however, is considerably more complex and includes
managing the major side effects of surgery, managing the patient’s coexisting diseases, and
maintaining and supporting the homeostatic control of oxygenation, ventilation, and
perfusion to the patient’s core organ systems1,2 . Anesthesiologists also vigilantly monitor
the patient’s wellbeing during surgery to detect and treat problems before they cause harm
to the patient3 . In fact, monitoring the patient’s status was considered such an important
activity that “vigilance” has been the motto of the American Society of Anesthesiologists
since it was founded in 19054 . Before the advent of modern electronic patient monitors,
anesthesia monitoring was traditionally performed using clinical means such as
auscultation, palpation, and visual inspection5,6 . In the 1950s, it was discovered that visual
methods for detecting cyanosis were unreliable7 , and in the 1980s similar studies reported
that detecting hypoxia or inadequate ventilation via clinical signs alone was also
unrealiable4 . Beginning in the 1950s, advances in computing and electronics technologies
facilitated the development of sophisticated monitoring devices that provided the ability to
measure an increasingly large range of physiological variables6,8 . Many professional
societies have since mandated the use of monitoring devices during the administration of all
anesthetics6,9 . The increasing complexity of anesthesia equipment, however, led to many
incidents due to equipment misuse – with a landmark study attributing 82% of equipment
incidents to preventable human errors10. Since then, researchers and engineers increasingly
used human factors techniques to improve the design and safety of advanced anesthesia
equipment in the operating room11,12,13. In particular, the human factors problems
associated with patient monitors have been extensively documented in the literature. For
example, monitors are often awkwardly positioned in the operating room where they are
out of view14,15,16 and cluttered with too much

2. LIFEPAK CR2

The interesting capability of this automatic external defibrillator (AED) is that it is able to
analyze the stricken patient’s electrocardiogram (ECG) while someone is performing chest
compressions.
Normally, movements and another person’s electrical signals would confuse a defibrillator,
but the cprINSIGHT technology within the LIFEPAK CR2 manages to identify the source
of the electrical signals and separates the two. This capability increases the amount of time
a person is receiving compressions.

Children can also receive defibrillation using the device, as there’s a button that can be
pressed to change the settings to better suit pediatric patients.The device has WiFi built-in,
allowing it to be tracked, batteries recharged and replaced, and electrodes renewed as
necessary. If the device is actually used, the central office can be alerted and medical help
can be automatically sent, helping to speed up the overall treatment time. As the patient is
transported to the hospital, the same device can be used to transmit patient waveforms and
the shocks administered to the emergency room in anticipation of arrival

3. HEMAsavR

For blood capture and transfer during surgeries. The product helps to avoid allogeneic
blood transfusions by not requiring specialized resources for collection and return to
patient. Hospitals will therefore be able to gather more useful sterile and anti-coagulated
blood that can be evaluated for cell salvage and for return.

Allogeneic transfusions are among the costliest contributors to healthcare expenditures,” in

a published statement said David Yurek, CEO of Ecomed Solutions. “Reducing the need
for allogeneic transfusions has a dramatic impact on healthcare costs and patient outcomes.
Further, as our healthcare system is strained by shrinking donor pools, HEMAsavR can
reduce that burden and improve care by providing a patient’s own blood back to them

The HEMAsavR is a closed and sterlie system that works with all surgical suction and
autotransfusion systems, and clinicians should have no problem integrating it into existing
workflows.

4. Butterfly Network
The product consists of a transducer that plugs right into an iPhone or iPad via the
Lightning port, and uses a matching app to display live images, change settings, and review
previously obtained scans.

The “ultrasound-on-chip” ultra wide band matrix array makes within the Butterfly iQ lets it
work as though it has three different transducers built-in. A clinician can now perform a
variety of scans using this one portable device, and since it can be taken just about
anywhere, this may be one of the most versatile ultrasounds on the market.

Within the transducer component, the matrix array of microelectromechanical (MEMS)

sensors is a part of an integrated circuit that contains all the necessary electronics. This tight
integration supposedly results in a fast, high-resolution device that can perform tasks that
only full size ultrasound machines were capable just a few short years ago. The company
compares its technology to how photo camera sensors have been integrated within
smartphones, enabling anyone to have high quality photo imaging in their pocket

5. Rad-67 Pulse CO-Oximeter

The device can be used for quick noninvasive hemoglobin measurement and features the
Masimos’s own Measure-through Motion and Low Perfusion SET pulse oximetry.
Combined with the rainbow DCI-mini sensor, Rad-67 offers spot-check monitoring with
Masimo’s Next Generation SpHb.

The device is portable, thanks to a rechargeable battery that will run for up to six hours, and
can be used in a variety of settings, including ERs, pre/post op rooms, and doctors’ offices.
It’s controlled via a touch-screen interface that changes its brightness depending on the
surrounding light levels, helping clinicians go from room to room without the screen being
too dim or too bright.

The device has a few features to make sure everything goes smoothly on every test,
including providing a vibration feedback when the sensor has been properly connected to
its port. A series of feedback screens help guide the operator through the hemoglobin
measurement process.
All the measurements are saved and organized by patient, while wireless capability allows
the Rad-67 to upload its data to the hospital’s electronic medical records.

6. Eko DUO

The Eko DUO works along with a paired smartphone or tablet, allowing a physician to
simultaneously record heart sounds and ECG (single lead) tracings at the point of care. The
DUO makes it easy to capture ECG intervals and systolic time intervals that can help to
diagnose heart failure and detect atrial fibrillation.

All the data the device captures can be shared with other physicians, if a second opinion is
necessary. The same can be automatically uploaded to a patient’s electronic medical record,
all thanks to HIPAA-compliant encryption. Physicians can actually prescribe the Eko DUO
to their patients, allowing for anytime/anywhere gathering of basic heart data, which can
help with tuning of drugs and treatments.

The Eko DUO comes with an earpiece that resembles traditional ones, but which doesn’t
put as much pressure on the ear while blocking out the surrounding noise. Since the system
is digital, the device is able to deliver the necessary bass and higher frequencies even in
loud environments. If you prefer your own headphones, you can plug them into the DUO’s
standard 3.5mm.

7. Quantra QPlus System

For its Quantra QPlus System and accompanying QPlus cartridge for point-of-care The
system provides easy and rapid coagulation status, requiring only about a minute of labor
from clinicians for each test. Initial results are available in about five minutes and the rest
within about fifteen minutes.

The system uses a sealed, disposable cartridge inside of which a panel of viscoelastic blood
coagulation tests is run. Along with traditional measures, the system can assess platelet
contribution to clot stiffness and the chance that residual heparin is in the tested sample.
The cartridge relies on the firm’s own SEER sonorheometry ultrasound technology, which
is essentially fully automated and doesn’t expose clinicians to patient blood. There’s no
pipetting necessary and the system isn’t sensitive to vibration, making it easy to use in busy
clinical environments.

“Critical bleeding occurs frequently in cardiac and major orthopedic surgeries,” said
Timothy Fischer, President and Chief Executive Officer of HemoSonics. “The Quantra
QPlus System revolutionizes point-of-care management by delivering accurate and novel
results in a fraction of the time required previously, near the OR, surgical suite, or ICU.
Faster results can mean better management of critical bleeding, more cost-effective
treatment, and ultimately better outcomes for patients.”

8. SedLine

The system for use on pediatric patients over one years old. The technology,
already cleared in U.S. and Europe for adult patients, helps to assess brain function while
the patient is under anesthesia. This can assist with maintaining the proper depths of
anesthesia to prevent side effects, while helping to improve post-surgical recovery.

SedLine processes and analyzes signals from four electroencephalogram (EEG) leads
positioned in a bilateral arrangement, outputting a number of parameters including
Masimo’s own Patient State Index (PSi). The PSi within the SedLine has optimizations
specific to pediatric patients that aims to provide consistent and accurate results.

Compared to the original SedLine, the Next Generation SedLine sports a PSi that is not as
easily modulated by electromyography (EMG) interference and a Multitaper Density
Spectral Array (DSA) that improves the fidelity of the EEG output.

“Next Generation SedLine is doing for brain function monitoring what Masimo SET® did
for pulse oximetry,” said Joe Kiani, CEO of Masimo. “We believe Next Generation
SedLine is the best and most advanced way to monitor depth of sedation, crucial to helping
ensure patients with even the most challenging brains are appropriately anesthetized. We
are gratified that its benefits are now available to those younger patients whose brains are
particularly delicate and to whose wellbeing Masimo has always been so committed.”
 9. MightySat Rx

Pulse oximeter to be used to spot check the respiration rate. These days the breathing rate is
still counted manually more often than not. Though there are devices in existence, even
contact-free ones, that can measure the breathing rate, they tend to be pricey, designed for
bedridden patients, and they can’t be properly used in a variety of settings.

The MightySat Rx uses the company’s Respiration Rate from the Pleth (RRp) technology
to measure a patient’s breathing, and also provides oxygen saturation (SpO2), pulse rate,
perfusion index, and Pleth Variability Index (PVi). RRP notices how the respiratory cycle
changes the nature of the pulses detected by the oximeter. While it’s accurate in most
patients, it’s not so for those that move a lot and people with certain conditions that produce
irregular breathing.

The device weighs less than 100 grams, including the batteries, and is water resistant. The
two AAA batteries provide enough juice to perform about 1,800 spot-checks, the results of
which, including the plethysmographic waveforms, are displayed on the color screen. The
readings can be easily transferred via Bluetooth to Masimo Professional Health app to
provide historical trends and to share the data with other clinicians.