USCOM cost effective replacement for ICU Ultrasound
New evidence for USCOM 1A guidance of fluid and cardiovascular therapy in critical care
Uscom announced the publication of a study demonstrating excellent correlation and agreement (96% and 95%) of the USCOM 1A with echocardiography, the current gold standard, for measurement of heart function. The USCOM 1A also identified the need for fluid with excellent sensitivity and specificity (95%) in the prospective, observational, multi-centre trial of 121 ICU patients.
Fluid is the most common critical care and peri-operative intervention in critically ill neonates, children and adults, with more than 50% of all fluids currently used being unnecessary or harmful. Fluid management remains one of the great clinical challenges in medicine, with particular relevance in paediatrics, anaesthesia, critical care and sepsis. An accurate and widely adopted solution to this problem has potentially enormous cost effectiveness benefits for medicine worldwide. This study demonstrates the USCOM 1A to be a cost effective solution to this problem.
A recent study of fluid administration in 655,426 patients having routine surgery across 524 US Hospitals found that more than 50% of all patients received too much or too little fluid, and this was associated with increased length of hospital stay, increased complications and increased cost of care. The current study found USCOM 1A use resulted in 95% of patients receiving appropriate fluid, suggesting improved care, significant cost savings and reduced in hospital stay.
Previously invasive BP monitoring devices, such as PiCCO, LiDCO, FloTrac, were demonstrated to fail in free breathing patients, those with cardiac dysrhythmias, and in those with serious diseases such as sepsis. The noninvasive USCOM 1A device, which directly measures blood flow, was shown to demonstrate high levels of effectiveness even in the most difficult ICU patients.
While Echocardiography is considered accurate the American Society of Echocardiography don't recommend its use as a monitor as it is complex to implement, is time consuming (45 minutes per exam), requires years of training and accreditation, and its use is not yet supported by evidence. However, USCOM has been demonstrated to have a short learning curve (two days training), is simple to implement (less than 5 minutes per exam), is relatively inexpensive, and has widespread proof of effectiveness. The current market for echocardiography is in the order of $1.5B and growing.
Executive Chairman of Uscom, Associate Professor Rob Phillips said, “This is the kind of evidence we need to support widespread adoption in cost stressed global health systems. Not only is USCOM 1A equivalent to the current gold standard but it increases the accuracy of identifying fluid responsiveness from 50% to 95%, and is applicable in the most complex of ICU patients. This evidence demonstrates that patients examined using USCOM 1A receive improved and cost effective cardiovascular care. A number of public health groups in the USA are purchasing USCOM 1A across their organisation so they can implement non-invasive advanced haemodynamics and this new Australian data should accelerate this adoption.”
References:
- Elgendy A, Seppelt IM, Lane AS. Comparison of continuous-wave Doppler ultrasound monitor and echocardiography to assess cardiac output in intensive care patients. Crit Care Resusc 2017; 19: 222-229
- Thacker JKM, Mountford WK, Ernst FR, Krukas MR, Mythen MG. Perioperative Fluid Utilization Variability and Association With Outcomes Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations. Annals of Surgery 2016, 263(3):502-510. doi:10.1097/SLA.0000000000001402
- Porter TR, Shillcutt SK, Adams MS, et al. Guidelines for the Use of Echocardiography as a Monitor for Therapeutic Intervention in Adults: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2015;28:40-56
- Overview of the global echocardiography market