ImaCor, Inc. (Uniondale, NY) has recently introduced a new device that will assist in the management of hemodynamically unstable patients in the ICU and perioperative situations. The ClariTEE™ probe is a miniaturized, disposable transesophageal echocardiography (TEE) monitoring probe that can be used in the assessment and management of cardiac function, intravascular volume status, and the presence of tamponade. Unlike conventional TEE probes which are large in diameter and not well tolerated for long periods of time in awake patients, the new probe is miniaturized to the size of an ng tube and may be left in a patient for up to 72 hours. Whereas conventional TEE probes provide detailed cardiac information at that point in time, the smaller sized probe is designed to remain indwelling for an extended period of time allowing critical care physicians to monitor a patient's response to medical interventions such as volume resuscitation and administration of vasoactive agents. 

 

While conventional TEE is and will continue to be an extremely valuable and useful tool in the echo lab and cardiac OR, it was not designed to be used in the ICU environment where this type of information is still useful, but difficult to obtain given current technology. The gold standard, pulmonary artery catheters, provides numbers depicting pressure and flow information as surrogates for filling and function, which have been shown in the scientific literature to be poor correlates. TEE monitoring allows physicians to directly visualize, minimally invasively and in real time, global cardiac function and filling. Additionally, conventional TEE is designed to monitor one patient at a time, which is cost prohibitive in an ICU environment where multiple critically ill patients may be present. The solution? A patient-specific probe that detaches from the machine, allowing one machine to monitor an entire unit. To further reduce costs, the probe is disposable, eliminating costly reprocessing, sterilization, and repair costs. Finally, the system is simplified and optimized to be used by critical care physicians—not exclusively specialists such as cardiologists and anesthesiologists who undergo specialized training to perform traditional TEE.

 

Transthoracic echo (TTE) is another useful modality in the office or echo lab, but is often difficult to perform in the ICU environment. In the ICU, patients are very often unable to roll on their side, hold their breath, are on a ventilator, or have chest tubes or surgical incisions which make obtaining images of the heart very difficult. 

 

ImaCor has successfully completed a clinical trial and is FDA cleared in the United States. The company has successfully completed evaluations at several major medical centers in the United States, and has recently started commercializing the system nationally.

 

Although the probe has wide utility in a number of different areas of the hospital, the company has chosen to focus its initial efforts on the ICU and perioperative areas—more specifically, managing the post-cardiac surgery patient. "These patients all undergo TEE monitoring in the operating room, but before the patient leaves the OR, the TEE probe is removed and the ability to monitor stops," said Scott L. Roth, MD, Chief Executive Officer and a founder of ImaCor. "In a number of these patients, additional TEE monitoring is desired, but has not been available. Our probe allows physicians to extend the continuity of care from the cardiac OR to the ICU," added Roth.

 

 "We believe that the ClariTEE probe will be a major contribution to the care of the critically ill, especially in ICU and perioperative situations," added Roth. "Current methods of monitoring hemodynamics in this patient population are either invasive, inconclusive, or both. The ClariTEE probe is minimally invasive and allows physicians to directly visualize cardiac size and function, and to assess changes as medical interventions are made, which we believe allows them to take better care of their patients, " according to Roth.

 

Many patients are hemodynamically unstable in the ICU after surgery, trauma or illness. Dr. Alexander Levitov, Professor of Medicine at Eastern Virginia Medical School in Norfolk, Virginia and a leader in the field of critical care medicine said, "This is a technology that intensive care physicians have been waiting for; the ClariTEE probe has the potential to become the standard of care in managing hemodynamically unstable patients in the ICU."