In the News
 | | Photo credit: Chuck Fadely | Dr. Scott L. Roth, Co-Founder / CMO of ImaCor, holds the probe that his company developed to monitor a patient's heart for up to 72 hours, solving a problem common in the ICU. (July 12, 2013) |
Cost-Benefit Prognosis
Pitching probe's medical, economic value to hospitals
By NICOLE LEVY
"Economics," according to ImaCor president Peter Pellerito "is what's at the forefront of health care."
To Read Full Article, please visit Newsday.com at:
click here
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Conferences
First Annual Perioperative and Critical Care Monitoring Conference sponsored by UPMC August 24-25, 2013 Pittsburgh, PA, USA AAST 72nd Annual Meeting September 18-21, 2013 San Francisco, CA, USA EACTS October 5-9, 2013 Vienna, Austria ESICM Lives 26th Annual Congress October 5-9, 2013 Paris, France |
Video
Testimonial
Joseph Rossi MD Co-Director, Cardiothoracic / Surgical ICU West Penn Allegheny Health System Allegheny, PA, USA |
Thomas Jefferson University
CME Course
Video Vignettes
 | | hTEE Ease of Use |
 | | ECMO Weaning Protocol |
 | | hTEE Identifies RV Dysfunction Early |
 | | Hemodynamic Optimization in Trauma and Sepsis |
 | | Value of hTEE in Non-Cardiac Units |
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Contact Us www.ImaCorInc.com info@ImaCorInc.com +1.516.393.0970 or 1.877.244.0657 |
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Episodic Monoplane Transesophageal
Echocardiography Impacts Postoperative
Management of the Cardiac Surgery Patient
Simon Maltais MD PhD, William T. Costello MD, Frederic T. Billings IV MD MSc, Julian S. Bick MD, John G. Byrne MD, Rashid M. Ahmad MD, and Chad E. Wagner MD
Vanderbilt University Medical Center, Nashville, TN, USA
Published in the Journal of Cardiothoracic and Vascular Anesthesia, August 2013
Excerpted, Please click to read the full Abstract
Measurements and Main Results: From June 2010 to February 2011, 21 unstable cardiac surgery patients with postoperative instability were identified. Two patients (10%) required reoperation for bleeding and tamponade physiology. Right ventricular dysfunction was diagnosed by episodic TEE monitoring in 7 patients (33%), while hypovolemia was documented in 12 patients (57%). Volume responsiveness was documented in 11 patients. In this observational study,discordance between hemodynamic monitoring and episodic TEE was qualitatively observed in 14 patients (66%).
Conclusion: The authors demonstrated the ability of episodic monoplane TEE to identify discordance between hemodynamic monitoring to better define clinical scenarios in unstable cardiac surgery patients. For these challenging patients, limited episodic TEE assessment has become a cornerstone of ICU care in this institution. |
Scott Silvestry MD: Interview on Sophisticated hTEE Hemodynamic Management Scott Silvestry MD, Barnes-Jewish Hospital (To Read Full Interview please click here)
 In your 2-year experience in treating VAD patients with hTEE, where have you seen the value in hTEE's Advanced Hemodynamic Management approach?
One of the ways we add value with hTEE is not just for the difficult RV but the difficult RV with pulmonary hypertension. If while assessing pulmonary hypertension you image the RV, if the RV is doing well, it helps gauge how aggressive to be in treating the pulmonary hypertension in terms of inhaled agents like Flolan or nitric. There is a significant cost associated with nitric specifically, and prolonged intubation with Flolan, as well. We are trying to use strategies to minimize RV damage, RV strain, and intubation time. Do you use hTEE just for your VAD population, or do you use it for all of your high risk cardiac surgery patients? We use it selectively for our high risk cardiac surgery and VAD patients. Whom do you consider to be high risk cardiac surgery patients? High risk cardiac patients include any with preoperative RV dysfunction, low ejection fraction, anyone with an added RV insult or RV dysfunction that adds to the morbidity, mitral surgery, pulmonary hypertension patients, CABG patients, and tricuspid valve disease patients. How did you identify RV dysfunction prior to using hTEE? We just basically looked at the CVP and PA pressures and calculated PVR and right ventricular stroke work. Even with these parameters it was, at best, a guess. Specifically, is it the ability to see the heart over-time that has been so helpful in your VAD post-op care? hTEE is helpful in analyzing the septal position and movement, and trying to stay away from the septal deviation beginning with even septal bounce to normalize RV geometry. |
Dr. Higgins Leads hTEE Study at OSU
Republished from SURGERY TODAY, Quarterly Newsletter of The Ohio State University Department of Surgery, August 2013
 Dr. Higgins and the cardiothoracic team have introduced a new technology to the ICU that raises the standard of care and improves outcomes for high-acuity patients. It's called "hTEE" (hemodynamic Transesophageal Echocardiography), and is enabled through a miniaturized TEE probe that can be left in the patient for up to 72-hours. hTEE has been proven to identify the underlying cause of hemodynamic instability and safely guide resuscitation. A recent multi-center study showed hemodynamic assessments with hTEE made a direct, therapeutic impact in 66% of patients. (Intensive Care Med 2013; 39:629-35).
 Dr. Ravi Tripathi, assistant professor of anesthesiology, has been integral to the use of hTEE at Ohio State. "We care for complex cardiac surgical patients in our area," commented Dr. Tripathi. "hTEE has added an innovative approach to managing advanced and complicated hemodynamics, which has been particularly impactful in the care of our ECMO and VAD patients."
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It's the RV, No Surprise
by Harold M. Hastings PhD, Co-Founder and CTO
(To read the full article, please click here)
In the latest of three 2013 articles on hTEE in high-impact journals, Maltais and the Vanderbilt team found right ventricular dysfunction "diagnosed by episodic TEE monitoring" in 33% of "21 unstable cardiac surgery patients with postoperative instability" Was I surprised? Should you be surprised? What does this mean?
Before answering these questions, let me begin with a rhetorical question from Cardiac Physiology 101 (can't help it after 40+ years prior experience as a university faculty member): Suppose that the RV can deliver 2 liters/min, and the LV can deliver 6 liters per minute, what cardiac output might be obtained in this state (a) 2 liters/minute, (b) 6 liters/minute, (c) 8 liters/minute, (d) none of the above? The answer is clearly (a) 2 liters/minute: RV dysfunction can severely limit cardiac output even if the LV is working well, and preload and afterload are appropriate.
Maltais et al. concluded: "In this case series, key areas for which direct visualization added more information than achieved from clinical assessment and hemodynamic monitors included ... assessment of RV function [and] biventricular filling in the presence of RV failure ..." (emphasis added).
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ImaCor Prepares 2013 Fellows
by Kristy Kuhl, Director of Clinical Sales and Training
In response to customer demand, July served to be a very busy month for fellow training at ImaCor. In many institutions it is the fellow who is ever- present in the unit and can therefore catch patients in the initial signs of hemodynamic instability, place a probe where appropriate, and make targeted management changes based on hTEE direct visualization.
The comprehensive hTEE 2013 Fellow Training Program consists of system in-service, and hours of image recognition, interpretation, and bedside imaging with a seasoned cardiac sonographer. Full immersion in hTEE hemodynamic management allows any physician (including fellows) to reach competence and confidence in a relatively short period of time.
Because of the overwhelming demand, we will be conducting fellow training again throughout the month of August. If you are interested in one of the few remaining slots, please contact us at info@ImaCorInc.com.
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New Software Release by Nicolas Heron, Director of Software Development
We are pleased to announce the release of new software upgrades resulting in improved user experience and workflow on both our Zura™ and Zura EVO™ systems. The Zura 2.1.6 software now offers hTEE reports, essentially a record keeping checklist for physicians that enables tracking of pre- and post-assessments in real time, as well as more rapid image connection. The Zura EVO 2.2.2 software significantly adds to improved ICU workflow, with an uninterruptable power supply capability for system transfer between ICU beds.
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ImaCor's vision is that hTEE-guided hemodynamic management will be the gold standard in advanced hemodynamic management globally for critical care, significantly impacting the quality and economics of patient care. Each month we advance toward our goal, with our customers capturing clinical data, reporting peer-reviewed studies, and developing economic models. Our mission is practiced and shared each time clinicians use hTEE to enable more effective treatment. We are building for the future, but every day of every month, we are affecting hundreds of patients in the ICU by caring for what matters most: critically-ill patients. July brought several milestones for us as a company. The Journal of Cardiothoracic and Vascular Anesthesia published a study led by Simon Maltais MD, PhD and Chad Wagner MD of Vanderbilt examining the impact of hTEE in the post-op care of cardiac surgery patients. They discovered hTEE identified RV dysfunction in 33% of patients and that there was discordance between hTEE and conventional hemodynamic monitoring in 66% of the patients. On the development front, our engineering team released advanced software for both the Zura and Zura EVO systems, improving image quality and workflow to ensure greater clinical confidence. Our customers continued to impress us with how they apply hTEE and track its value. hTEE is not just a technology, but an entire, sophisticated program used to treat patients requiring a more advanced hemodynamic management approach. This program and approach was reflected in our conversation with the Surgical Director of Heart Transplants, Scott Silvestry MD of Barnes-Jewish. We appreciate Dr. Silvestry's work and time spent in conversation. Candid conversations with leading hTEE users inspire all members of our team and guide us to a better understanding of how we can make the most impact in key patient areas like Mechanical Circulatory Support and Acute Care Surgery. Our customers also developed hTEE economic predictive modeling to ensure optimal patient selection and track cost savings. This has proven to be our standard practice in creating consultative partnerships with our hTEE users. And as we saw in this newsletter edition, training fellows in an immersive clinical program is integral to clinical success. Fellows are often required to diagnose the root cause of patient complexity in the middle of the night when a patient is simply not responding as expected. Our 2013 Fellowship Program is designed to arm these physicians with the tools they need to assess and manage the sickest ICU patients. These Fellows learn that early intervention can head off the catastrophic situations that often result from the cascading effect of hemodynamic instability. Finally, I am pleased to note that our vision and mission was shared with new institutions this month, including the University Hospital of Zurich and the California Pacific Medical Center. Welcome to the new clinical world of hTEE Advanced Hemodynamic Management and thank you for inviting us to be a part of the sophisticated treatment of your patients! With warmest regards, Peter Pellerito President & CEO |
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