Featured Conference
 AAST Annual Meeting September 18-21, 2013 San Francisco, CA, USA |
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Conferences in October
EACTS
October 5-9, 2013
Vienna, Austria
ESICM
Lives 26th Annual Congress
October 5-9, 2013
Paris, France
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Photos
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Janice Pieretti MD, transplant cardiologist from Newark Beth Israel (Newark, NJ), assesses a patient's hemodynamic status using the ClariTEE probe
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| Subbarao Elapavaluru MD imaging a transplant patient at Allegheny General Hospital (Pittsburgh, PA) |
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| Prof. Serban Bubenek MD PhD from Prof. C.C. Iliescu Emergency Institute for Cardiovascular Diseases (Bucharest, Romania) utilizes hTEE for his most advanced critically-ill patients |
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| Fellows from the Hospital of the University of Pennsylvania (Philadelphia, PA) train on an hTEE simulator |
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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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hTEE-guided Management of a Hemodynamically Unstable LVAD Patient Margarita T. Camacho MD, and Claudia G. Gidea MD Newark Beth Israel Medical Center, Barnabas Health, Newark, NJ, USA (Excerpted, to read the full case report, please click here) Post-op care. Ten hours post-op, around 11:00 pm, CVP rose to 22, PA pressures 38/20, urine output dropped to 15-20 cc/hr. Concerns were tamponade (requiring surgical re-exploration) vs. RV failure (requiring adjustment of drips or RVAD). An ImaCor hTEE probe (ClariTEEŽ) was inserted for immediate visualization, and revealed tamponade. Patient returned to OR for evacuation of clot. The ImaCor probe was left in place, since the patient would require routine repeat echo on POD#1 to re-adjust RPMs under TEE guidance. Repeat hTEE imaging led us to increase speed from 8400 RPM to 9000 RPM in stages, improving septal position and optimizing flow (VIDEOS BELOW).  | | 8400 LVAD RPM |
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 | | 8800 LVAD RPM |
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 | | 9000 LVAD RPM |
Note improvement of septal position as speed is increased from 8400 to 9000 RPM and absence of septal shift at final speed of 9000 RPM.
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 Weaning of Extracorporeal Membrane Oxygenation Using Continuous Hemodynamic Transesophageal Echocardiography
Nicholas C. Cavarocchi MD, Harrison Pitcher MD, Qiong Yang MD, Pawel Karbowski MS, Joseph Miessau MS, Harold M. Hastings PhD1, Hitoshi Hirose MD Thomas Jefferson University Hospital, Philadelphia, PA, USA and 1ImaCor Inc, Garden City, NY, USA In Press Article in The Journal of Thoracic and Cardiovascular Surgery, August 30, 2013.
Results
 | | Hirose et al., ASAIO 2013 |
Of the 21 patients, 6 (29%) had left and right ventricular recovery and underwent optimal medical therapy or revascularization for underlying coronary artery disease; 7 (33%) had nonrecoverable left and right ventricular function; and 8 (38%) had right ventricular recovery without improvement of the left ventricular function. These 8 patients underwent left VAD placement; none subsequently developed profound right ventricular failure. The positive predictive value for ventricular recovery by hTEE was 100% using our standardized ECMO weaning protocol (95% confidence interval, 73%-100%).
Conclusions
The hTEE-guided ECMO weaning protocol accurately predicted the ability to wean ECMO to decision. This protocol can be applied by cardiac intensivists as a part of standard bedside intensive care unit assessment.
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 TJU Team Publishes ECMO Weaning Protocol - The Fourth hTEE Study In A High Impact Journal This Year
by Harold M. Hastings PhD, Co-Founder and Chief Technology Officer
(Excerpted, please click to read full article)
 Why is echocardiographic assessment of ECMO patients so critical? "Patients presenting with acute cardiogenic shock may require urgent placement of venoarterial extracorporeal membrane oxygenation (VA ECMO), before adequate assessment of either left or right ventricular function." [1], emphasis added.
Why a protocol? Timing of attempted ECMO weaning is critical. Premature withdrawal of ECMO support "may result in a protracted intensive care unit (ICU) course to support a borderline right ventricle or emergent placement of an RVAD [5]. ..." "Unnecessary delays in the weaning process increase the chance of complications from prolonged ECMO support and the ICU cost." "In addition, continuing prolonged ECMO support on a patient with no evidence of any ventricular recovery on repeated weaning studies and no option for LVAD or biventricular assist device bridging would not be cost- effective and would be ethically questionable. For patients demonstrating biventricular failure after repeated attempts at weaning, families may be able to use this information as guidance for end-of-life planning." [1] The success of the TJU team demonstrates that their ECMO weaning protocol provides a rational approach to assessment and weaning guided by continuous direct visualization of cardiac filling and function with hTEE. Why hTEE? The TJU weaning process requires a staged approach with decreased ECMO support, volume loading, and inotrope support over 4 to 6 hours. Conventional TEE over such a period would typically require general anesthesia in an operating room, with full-time services of a TEE specialist. To contact this author or any ImaCor team member, please dial +1-516-393-0970. |
Measuring hTEE's Economic Impact
by Michael Burns, Director of Customer Development
(Click here to read the full article)
As hospital executives evaluate new technology in this ever-challenging healthcare economic environment, they are often asked how they will measure the value of the investment in both qualitative and quantitative ways. It is no longer enough that a device or service provides clinical value. In this economy that is already assumed. However, even after making a decision to move forward with technology, hospital administrators are commonly asking themselves:
- How will I incorporate a new technology into my workflow?
- How will it impact my physicians, my staff, and my patients?
- What is the economic impact?
- How will I measure it?
As a partner in your healthcare delivery, ImaCor has developed several new tools to help you achieve the best possible patient outcomes and measure the resulting economic impact.
To contact this author or any ImaCor team member,, please dial +1-516-393-0970.
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In this new era of Accountable Care, clinicians can no longer bring a new technology into the hospital on the basis of its value and life-saving properties alone. In today's climate, physicians must arm themselves with cost benefit analyses or, even better, a predictive model that will illustrate how improved patient outcomes generate cost savings for the hospital. To that end we are sharing a predictive model with our customers as part of an overall business toolset they can use in conversation with hospital administration. And as you saw in last month's interview with Scott Silvestry MD, hTEE technology compliments a surgeon's strategy to leverage advanced hemodynamic management to extubate patients faster, and discharge them from the ICU more rapidly. The sheer number of these conversations is growing, as our customers work with their administrations to achieve change in the intensive care unit. It is a paradigm shift. Getting to the root cause of a patient's hemodynamic instability faster is driving this, as physicians can chart a course for stability more expeditiously. Leading academic and teaching hospitals such as Stanford, UAB, Columbia, Thomas Jefferson University, Vanderbilt and Newark Beth Israel are pointing the way to greater patient safety. Purpose- built for the ICU, direct visualization at the bedside is changing medicine. As we look ahead this Autumn, we see a great opportunity to learn more from our users at the American Association for the Surgery of Trauma (AAST), the European Society of Intensive Care Medicine (ESICM) and the European Association for Cardio-Thoracic Surgeons (EACTS). If you would like to share our insights on new technology assessments at your hospital, please contact me at ceo@imacorinc.com. With best regards, Peter Pellerito President & CEO |
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