Hypoperfusion is a life-threatening condition characterised by poor circulation of blood from heart and lungs to the body’s organs. Hypoperfusion reduces oxygen and nutrient availability, increasing the risk of multi-organ failure and death. Each year 6 million emergencies and over 1.3 million high-risk surgical patients are admitted to NHS hospitals and are at increased risk of hypoperfusion because of their acute illness. Accurately diagnosing, preventing, or promptly treating, hypoperfusion reduces the risk of preventable illness and death.
Over 20 years of research led by our BRC investigator Professor Mervyn Singer has developed the oesophageal Doppler, marketed as CardioQ, a minimally-invasive technology that can diagnose and manage hypoperfusion. CardioQ uses ultrasound waves to assess the amount of blood flowing out of the heart via a probe inserted into the oesophagus. It enables doctors and nurses to perform rapid bedside assessment of circulation and informs the type of treatment required to avoid and/or treat hypoperfusion. Multiple trials in patients undergoing major surgery, some led by Singer and Professor Monty Mythen (UCLH), have shown CardioQ reduces postoperative complications by up to 50% and hospital length of stay by several days1. CardioQ is used in over 30 countries and is recommended by NHS guidelines2.
Singer and his research group also found that changes in oxygen levels in the bladder wall could be used as a substitute measure of oxygen levels in other organs (e.g. the liver and kidney)3. Since hospitalised critically-ill or high-risk surgical patients routinely have a urinary catheter inserted, a specially modified catheter enables straightforward placement of the light-based sensor device into the bladder to monitor oxygen levels and detect very early signs of hypoperfusion. Supported by the Wellcome Trust and Department of Health, Singer and Dr David Brealey (UCLH) are leading the first-in-human study of this device (“Wellbeing”) in 50 high-risk surgical and critical care patients (UCLH). If successful, interventional studies using Wellbeing alongside CardioQ will be undertaken, aiming to detect and treat hypoperfusion earlier than currently possible, and thereby reduce mortality and long-term illness. The ease of use of both devices will aid clinicians in preventing and treating hypoperfusion in patients undergoing major surgery and suffering critical illness, potentially saving many lives and reducing hospital length of stay.
1. Kuper M et al. BMJ, 2011; 2. CardioQ-ODM oesophageal doppler monitor; NICE MTG3, 2011; 3. Parker T et al. Br. J. Anaesth, 2019
