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Martínez-Rubio A, Gusi G, Guillaumet E, Cazorla M, Galán S, Bagà R, Guilera E, Bonastre M, Raimón Gumà J, Anguera I, Ibars S, Ochagavia A, Mestre J, Font J, Saura P, Dalmases M, Blanch L, Artigas A. The fully automatic external cardioverter defibrillator: reality of a new meaningful scenario for in-hospital cardiac arrests. Expert Rev Med Devices 2014; 2:33-9. [PMID: 16293026 DOI: 10.1586/17434440.2.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sudden cardiac death is an unresolved problem which causes significant mortality and morbidity in both the community and in-hospital setting. Cardiac arrest is often caused by ventricular tachyarrhythmias which may be mostly interrupted by cardioversion or defibrillation. The single most critical factor for survival is the response time. Over the last 30 years, there have been virtually no procedural changes in the way hospitals address in-hospital resuscitation. A unique device has been developed that eliminates human intervention and assures defibrillation therapy is administered in seconds. This is accomplished with a fully automatic, external bedside monitor defibrillator designed to be prophylactically attached to hospitalized patients at risk of ventricular tachyarrhythmia. The safety and efficacy of the device has been demonstrated in multicenter US and European trials. Thus, this device allows a new scenario which may increase survival and enables meaningful redistribution of health resources.
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Affiliation(s)
- Antoni Martínez-Rubio
- Hospital de Sabadell, Department of Cardiology, Fund. Universitaria Parc Taulí, Parc Taulí s/n, E-08208 Sabadell, Barcelona, Spain.
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Yun JG, Jeung KW, Lee BK, Ryu HH, Lee HY, Kim MJ, Heo T, Min YI, You Y. Performance of an automated external defibrillator in a moving ambulance vehicle. Resuscitation 2010; 81:457-62. [DOI: 10.1016/j.resuscitation.2009.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/16/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
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Dichtwald S, Matot I, Einav S. Improving the outcome of in-hospital cardiac arrest: the importance of being EARNEST. Semin Cardiothorac Vasc Anesth 2009; 13:19-30. [PMID: 19223286 DOI: 10.1177/1089253209332212] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiopulmonary resuscitation techniques were introduced more than 50 years ago, yet the rate of survival from cardiac arrest, particularly in the hospital setting, remains dismally low. This article reviews the prevalence, etiology, and outcome of in-hospital cardiac arrest, with a focus on the determinants of outcome that are amenable to improvement. These include principally components of basic life support that may be supported by either prompting or mechanical assistance (eg, chest compression, ventilation, and defibrillation). Also reviewed are preevent and postevent effectors such as medical staff skills and recognition of impending arrest, induction of mild hypothermia, and stabilization after return of spontaneous circulation.
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Affiliation(s)
- Sara Dichtwald
- Department of Anesthesiology and Critical Care Medicine, Sourasky Medical Center affiliated with the Tel Aviv University, Tel Aviv, Israel
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Timing of defibrillation shocks for resuscitation of rapid ventricular tachycardia: Does it make a difference? Resuscitation 2009; 80:183-8. [DOI: 10.1016/j.resuscitation.2008.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 07/05/2008] [Accepted: 09/14/2008] [Indexed: 11/21/2022]
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Ali B, Bloom H, Veledar E, House D, Norvel R, Dudley SC, Zafari AM. Automated external cardioversion defibrillation monitoring in cardiac arrest: a randomized trial. Trials 2008; 9:36. [PMID: 18547438 PMCID: PMC2440367 DOI: 10.1186/1745-6215-9-36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 06/11/2008] [Indexed: 11/29/2022] Open
Abstract
Background In-hospital cardiac arrest has a poor prognosis despite active electrocardiography monitoring. The initial rhythm of approximately 25% of in-hospital cardiopulmonary resuscitation (CPR) events is pulseless ventricular tachycardia/ventricular fibrillation (VT/VF). Early defibrillation is an independent predictor of survival in CPR events caused by VT/VF. The automated external cardioverter defibrillator (AECD) is a device attached by pads to the chest wall that monitors, detects, and within seconds, automatically delivers electric countershock to an appropriate tachyarrhythmia. Study Objectives • To evaluate safety of AECD monitoring in hospitalized patients. • To evaluate whether AECDs provide earlier defibrillation than hospital code teams. Methods The study is a prospective trial randomizing patients admitted to the telemetry ward to standard CPR (code team) or standard CPR plus AECD monitoring (PowerHeart CRM). The AECD is programmed to deliver one 150 J biphasic shock to patients in sustained VT/VF. Data is collected using the Utstein criteria for cardiac arrest. The primary endpoint is time-to-defibrillation; secondary outcomes include neurological status and survival to discharge, with 3-year follow-up. Results To date, 192 patients have been recruited in the time period between 10/10/2006 to 7/20/2007. A total of 3,655 hours of telemetry data have been analyzed in the AECD arm. The AECD has monitored ambulatory telemetry patients in sinus rhythm, sinus tachycardia, supraventricular tachycardia, atrial flutter or fibrillation, with premature ventricular complexes and non-sustained VT without delivery of inappropriate shocks. One patient experienced sustained VT during AECD monitoring, who was successfully defibrillated (17 seconds after meeting programmed criteria). There are no events to report in the control arm. The patient survived the event without neurological complications. During the same time period, mean time to shock for VT/VF cardiac arrest occurring outside the telemetry ward was 230 ± 50 seconds. Conclusion AECD monitoring is safe and likely results in earlier defibrillation than standard telemetry monitoring. Trial Registration National Institutes of Health registration ID: NCT00382928
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Affiliation(s)
- Bakhtiar Ali
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
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6
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Abstract
OBJECTIVE Current versions of automated external defibrillators (AEDs) mandate interruptions of chest compression for rhythm analyses because of artifacts produced by chest compressions. Interruption of chest compressions reduces likelihood of successful resuscitation by as much as 50%. We sought a method to identify a shockable rhythm without interrupting chest compressions during cardiopulmonary resuscitation (CPR). DESIGN Experimental study. SETTING Weil Institute of Critical Care Medicine, Rancho Mirage, CA. SUBJECTS None. INTERVENTIONS Electrocardiographs (ECGs) were recorded in conjunction with AEDs during CPR in human victims. A shockable rhythm was defined as disorganized rhythm with an amplitude > 0.1 mV or, if organized, at a rate of > or = 180 beats/min. Wavelet-based transformation and shape-based morphology detection were used for rhythm classification. Morphologic consistencies of waveform representing QRS components were analyzed to differentiate between disorganized and organized rhythms. For disorganized rhythms, the amplitude spectrum area was computed in the frequency domain to distinguish between shockable ventricular fibrillation and nonshockable asystole. For organized rhythms, in victims in whom the absence of a heartbeat was independently confirmed, the heart rate was estimated for further classification. MEASUREMENTS AND MAIN RESULTS To derive the algorithm, we used 29 recordings on 29 patients from the Creighton University ventricular tachyarrhythmia database. For validation, the algorithm was tested on an independent population of 229 victims, including recordings of both ECG and depth of chest compressions obtained during suspected out-of-hospital sudden death. The recordings included 111 instances in which the ECG was corrupted during chest compressions. A shockable rhythm was identified with a sensitivity of 93% and a specificity of 89%, yielding a positive predictive value of 91%. A nonshockable rhythm was identified with a sensitivity of 89%, a specificity of 93%, and a positive predictive value of 91% during uninterrupted chest compression. CONCLUSIONS The algorithm fulfilled the potential lifesaving advantages of allowing for uninterrupted chest compression, avoiding pauses for automated rhythm analyses before prompting delivery of an electrical shock.
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Ibrahim WH. Recent advances and controversies in adult cardiopulmonary resuscitation. Postgrad Med J 2007; 83:649-54. [PMID: 17916874 PMCID: PMC2600120 DOI: 10.1136/pgmj.2007.057133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 07/18/2007] [Indexed: 11/03/2022]
Abstract
Since its introduction more than four and half decades ago, the science of cardiopulmonary resuscitation has been enriched with a significant amount of scientific evidence. This in turn has led to the birth of new evidence based guidelines for resuscitation published by the European Resuscitation Council and the American Heart Association in late 2005. This article aims to review the recent advances and controversies in the science of resuscitation.
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Affiliation(s)
- Wanis H Ibrahim
- Department of Pulmonary Medicine, Hamad General Hospital, Doha, PO Box 3050, Qatar.
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Faddy SC. Reconfirmation algorithms should be the standard of care in automated external defibrillators. Resuscitation 2006; 68:409-15. [PMID: 16387407 DOI: 10.1016/j.resuscitation.2005.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 07/13/2005] [Accepted: 07/19/2005] [Indexed: 10/25/2022]
Abstract
Non-sustained and self-terminating arrhythmias pose a significant challenge during resuscitation. Delivery of a defibrillation shock to a non-shockable rhythm has a poorly understood effect on the heart. The importance of assessing rhythm right up until the delivery of a shock is of increased importance when "blind" shocks are being delivered by automatic defibrillators or minimally trained rescuers. Reconfirmation algorithms are common in current-generation implantable defibrillators but this investigation of current-generation AEDs shows that only 71% of devices presently available have reconfirmation algorithms. A case of spontaneous reversion of a non-sustained arrhythmia is presented. The implications of delivering a defibrillator shock to a non-shockable rhythm are discussed.
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Affiliation(s)
- Steven C Faddy
- Cardiology Department. St Vincent's Hospital, Sydney, Victoria Street, Darlinghurst, NSW 2010, Australia.
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Cusnir H, Tongia R, Sheka KP, Kavesteen D, Segal RR, Nowakiwskyj VN, Cassera F, Scherer H, Costello D, Valerio L, Yens DP, Shani J, Hollander G. In hospital cardiac arrest: a role for automatic defibrillation. Resuscitation 2004; 63:183-8. [PMID: 15531070 DOI: 10.1016/j.resuscitation.2004.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Revised: 05/10/2004] [Accepted: 05/10/2004] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Sudden cardiac death (SCD) survival decreases by 10% for each minute of delay in defibrillation, however, survival rates of 98% can be achieved when defibrillation is accomplished within 30s of collapse. Recently, a fully automated external cardioverter-defibrillator (AECD) was approved by the FDA for in-hospital use. The AECD can be programmed to automatically defibrillate when a life threatening ventricular arrhythmia occurs. The purpose of this study was to assess the potential impact of in-hospital AECDs on the critical time to defibrillation in monitored hospital units. METHODS Mock emergency (n = 18) were conducted using simulated ventricular fibrillation in various monitored units. Observers were stationed to record the time staff responded to the arrhythmia, and the time to shock. These times were compared to an AECD protocol that defibrillates automatically in an average of 38.3 s from onset of arrhythmia (n = 18). RESULTS Staff versus AECD response time to arrhythmia (s) was 76.3 +/- 113.7 (CI 19.8-132.8) versus 7.6 +/- 0.6 (CI 7.3-7.9). Staff versus AECD time to shock was 169.2 +/- 103.1 (CI 117.9-220.4) versus 38.3 +/- 0.7 (CI 37.9-38.6). P-values are <0.0001 for differences between the groups. CONCLUSION The use of AECDs on monitored units would significantly reduce the critical time to defibrillation in patients with SCA. We anticipate this would translate to improved survival rates, and better neurologic outcomes.
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Affiliation(s)
- Henry Cusnir
- Division of Cardiology, Maimonides Medical Center, 953 49th Street, Brooklyn, NY 11219, USA
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Bento AM, Cardoso LF, Timerman S, Moretti MA, Peres EDB, de Paiva EF, Ramires JAF, Kern KB. Preliminary in-hospital experience with a fully automatic external cardioverter-defibrillator. Resuscitation 2004; 63:11-6. [PMID: 15451581 DOI: 10.1016/j.resuscitation.2004.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 03/30/2004] [Accepted: 04/15/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ventricular fibrillation (VF) and ventricular tachycardia (VT) are frequently present as initial rhythms during in-hospital cardiac arrest. Although ample evidence exists to support the need for rapid defibrillation, the response to in-hospital cardiac arrest remains without major advances in recent years. The delay between the arrhythmic event and intervention is still a challenge for clinical practice. OBJECTIVE To analyze the performance and safety of in-hospital use of a programmable, fully automatic external cardioverter-defibrillator (AECD). METHODS We conducted a prospective study at the Emergency Department of a university hospital. A total of 55 patients considered to be at risk of sustained VT/VF were included. Patients underwent monitoring of their cardiac rhythm by the AECD. Upon detection of a ventricular tachyarrhythmia, the AECD was programmed to automatically deliver shock therapy. RESULTS We recorded 19 episodes of VT/VF in 3 patients. The median time between the beginning of the arrhythmia and the first defibrillation was 33.4 s (21-65 s). One episode of spontaneous reversion of VT was documented 20 s after its origin and shock therapy was aborted. The defibrillation success was 94.4% (17/18) for the first shock and 100% (1/1) for the second shock. No case of inappropriate shock discharge was registered during the study period. CONCLUSION The AECD has the feasibility to combine long-term monitoring with automatic defibrillation safely and effectively. It presents the possibility of providing rapid identification of, and response to, in-hospital ventricular tachyarrhythmias.
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Affiliation(s)
- André Moreira Bento
- Valvular Heart Disease Unit, Instituto do Coração (InCor), University of São Paulo Medical School, Av Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000, Brazil.
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Mattioni T, Kanaan N, Riggio D, Bahu M, Lin D, Welch S, Williams C. Performance of an automatic external cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia. Am J Cardiol 2003; 91:1323-6. [PMID: 12767424 DOI: 10.1016/s0002-9149(03)00321-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An automatic external cardioverter-defibrillator (AECD) with a programmable supraventricular-ventricular tachycardia (VT) zone underwent evaluation of arrhythmia discrimination performance in the electrophysiologic laboratory during induced supraventricular tachycardia (SVT) and unipolar and bipolar atrial pacing. The AECD SVT zone was programmed so that the induced SVT rate would fall within this zone. Atrial pacing was also performed at a rate within this zone. The ability of the AECD to accurately discriminate between VT and SVT and to recommend shock delivery was assessed. A total of 98 patients underwent conventional diagnostic electrophysiologic studies (49 men, age 59 +/- 19 years) with a total of 55 inducible sustained SVTs. High right atrial pacing was performed in 56 patients in unipolar and in 82 patients in bipolar fashion. In response to induced sustained SVT, the AECD correctly classified 47 episodes as nonshockable, 4 incorrectly as shockable, and 4 episodes correctly as shockable with a resultant sensitivity of 100% and specificity of 92%. Bipolar high right atrial pacing was correctly identified as nonshockable in 75 episodes, incorrectly identified as shockable in 5 episodes, and correctly identified as shockable in 2 episodes with a resultant sensitivity of 100% and specificity of 94%. The Powerheart AECD accurately discriminates SVT from VT and is expected to correctly deliver automatic external shocks rapidly in the presence of spontaneous life-threatening tachycardia and appropriately withhold therapy during SVT.
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Affiliation(s)
- Thomas Mattioni
- Arizona Heart Institute, 2632 North 20th Street, Phoenix, AZ 85006, USA.
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Martínez-Rubio A, Kanaan N, Borggrefe M, Block M, Mäkijärvi M, Fedele F, Pappone C, Haverkamp W, Merino JL, Esquivias GB, Cinca J. Advances for treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003; 41:627-32. [PMID: 12598075 DOI: 10.1016/s0735-1097(02)02865-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to prospectively analyze the performance and safety of a new programmable, fully automatic external cardioverter-defibrillator (AECD) in a European multicenter trial. BACKGROUND Although, the response time to cardiac arrest (CA) is a major determinant of mortality and morbidity, in-hospital strategies have not significantly changed during the last 30 years. METHODS Patients (n = 117) at risk of CA in monitored wards (n = 51) and patients undergoing electrophysiologic testing or implantable cardioverter-defibrillator (ICD) implantation (n = 66) were enrolled. The accuracy of the automatic response of the device to any change of rhythm (lasting >1 s and >4 beats) was confirmed by reviewing the simultaneously recorded Holter data and the programmed parameters. RESULTS During 1,240 h, 1,988 episodes of rhythm changes were documented. A total of 115 episodes lasted > or =10 s or needed treatment (pacing, n = 32; ICD, n = 51; AECD, n = 35) for termination. The device detected ventricular tachyarrhythmias with a sensitivity of 100% and specificity of 97.6% (true negatives, n = 1,454; true positives, n = 499; false positives, n = 35; false negatives, n = 0). The false positives were all caused by T-wave oversensing during ventricular pacing. There were no complications or adverse events. The mean response time was 14.4 s for those episodes needing a full charge of the capacitor. CONCLUSIONS This new AECD is safe and effective in detecting, monitoring, and treating spontaneous arrhythmias. This fully automatic device shortens the response time to treatment, and it is likely that it will significantly improve the outcome of patients with in-hospital CA.
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Affiliation(s)
- Antoni Martínez-Rubio
- Cardiology, University Hospital de la Sta. Creu i St. Pau, Avda. St Antoni Ma. Claret 167, E-08025 Barcelona, Spain.
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Kliegel A, Eisenburger P, Sterz F, Holzer M, Losert H, Havel C, Stix G, Laggner AN. Survivors of ventricular tachyarrhythmias due to a transient or reversible disorder have a high recurrence rate of lethal cardiac events. Resuscitation 2002; 54:237-43. [PMID: 12204456 DOI: 10.1016/s0300-9572(02)00123-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The recurrence rate of lethal cardiac events after the survival of a primary cardiac arrest in patients not having received an implantable cardioverter defibrillator (ICD) is investigated. BACKGROUND According to current guidelines, only a small percentage of patients after successful cardiopulmonary resuscitation due to an underlying cardiac problem are eligible for the implantation of an ICD. METHODS For retrospective analysis, we used a data registry of patients admitted to an emergency department after cardiac arrest. Patients who had a primary cardiac cause for their cardiac arrest and who did not die within the first month after successful restoration of spontaneous circulation were selected. RESULTS From 1246 patients, 360 met the inclusion criteria. A second lethal cardiac event occurred in 94 (26%). Of those 94 patients, 57 (61%) had good neurological function before their second cardiac arrest. Of the survivors with good neurological function, 47 (82%) did not have an ICD or a cardiac transplant. Another cardiac arrest due to a primary cardiac event occurred in 34 (72%) of these patients. CONCLUSIONS Cardiac arrest survivors without an apparent indication for an ICD have a high risk of suffering from a re-arrest of cardiac origin.
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Affiliation(s)
- Andreas Kliegel
- Department of Emergency Medicine, University of Vienna, Vienna, Austria
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Abstract
Today's intensivists are provided with more information than ever before, yet current monitors present data from multiple sources in a relatively raw form with virtually no intelligent data integration and processing. In the next century, technological advances in miniaturization, biosensors and computer processing, coupled with an improved understanding of critical illnesses at the molecular level, will lead to the development of a new generation of monitors. Monitoring will move from the traditional macroscopic invasive approach to a noninvasive, molecular analysis of evolving critical disease processes. It is likely that disturbances in homeostasis will become known immediately or before they would otherwise be manifest clinically. Nanotechnology will permit monitoring of critical changes in the intracellular environment or the by-products of cellular metabolism and signal messaging. This article discusses monitoring technologies that hold promise for further development in the next century and point out techniques likely to be abandoned.
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Affiliation(s)
- R Kohli-Seth
- Department of Surgery, Mount Sinai Medical Center, City University of New York, New York, USA
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