EPOC System Research Articles

Abstract 201: 3D-Printed Automated Pressure-Cycled Resuscitator Maintains Respiratory Homeostasis in Swine With Normal to Moderately Low Lung Compliance

Background: During resuscitation, manual ventilation is commonly used. However, the effectiveness of this approach heavily relies on the skills of the individuals performing, often leading to inconsistent tidal volumes and respiratory rates. Such variations in ventilation can disrupt the removal of CO 2 resulting in altered pH. To address this problem, we leveraged advancements in fluidics and 3D printing to develop a miniature, automated, pressure-cycled resuscitator (inVent) that operates without any moving parts or settings. Hypothesis: The inVent will be able to maintain a pH of 7.2 or higher in swine with a dynamic compliance (Cdyn) of 25-50 ml/cmH 2 O. Goals/Aims: To assess the inVent’s performance in an animal model with normal to severe lung injury. Methods: Hybrid Landrace swine were studied under a protocol approved by the Institutional Animal Care and Use Committee. All swine were anesthetized, and underwent oral intubation. Breath by breath measurements were obtained using the NM3 Monitor (Phillips). All 3 inVent (fluidIQ) resuscitators pressure modules were used pre and post lung injury to fully characterize how each of the modules would react in different lung conditions. Lung injury was induced through a repeated bronchoalveolar lavage. ABG analysis was performed using the epoc system (Siemens). pH values 7.2 or less were considered acidotic while those over 7.2 were considered acceptable. Results: 8 swine with an average weight of 36 (5.8) Kg were studied. 7 swine contributed to 39,770 breaths of pulmonary mechanics and 33 ABGs recorded. Mean Cdyn was lower than anticipated at 25.8 (14.7) mL/cmH 2 O and a pH 7.32 (0.16). Figure 1 demonstrates a linear relationship with compliance and pH. Conclusions: The inVent resuscitator was able to maintain a pH of at least 7.2 in moderate compliance ranges, however struggled to maintain pH of 7.2 or higher in the severely injured. Higher lung compliance ranges are needed to explore possible hyperventilation events.

“Thick and Viscous” or “Light and Easy”: An Oil Overlay Comparison

Background: Oil overlay in IVF culture media is essential in the maintenance of pH and prevention of evaporation. The recent proliferation of “Heavy oil” raises questions of how oil density and viscosity affect CO2 diffusion into and out of culture media. Aim: To compare the effects of “Heavy oil” versus standard oil on pH stability in embryo culture dishes. Method: Density (g/ml) readings of each oil (Ovoil, Ovoil Heavy and LifeGuard) were obtained in triplicate using a volumetric flask and analytical balance in both refrigerated (4[Formula: see text]C) and warmed state (37[Formula: see text]C). Viscosity testing was performed externally by Intertek laboratory. pH was measured at regular intervals using a blood gas analyser (EPOC system) in culture dishes under standard and ‘Heavy’ oil overlays. Results: Density measurements showed Ovoil Heavy to be the least dense (0.8227g/ml) followed by Ovoil (0.8476g/ml), with LifeGuard the most dense at 0.8640g/ml. There was a significant difference (p<0.0001) when comparing densities between oil types in both 4[Formula: see text]C and 37[Formula: see text]C. Viscosity testing reported LifeGuard the most viscous at 153.6mm2/s followed by Ovoil Heavy at 57.98mm2/s and Ovoil at 30.68mm2/s. Media equilibrated more slowly under denser oil, requiring 5 hours to read pH 7.4 under LifeGuard with lighter oil requiring 3 hours to reach equilibration. Equilibrated dishes exposed to reduced CO2 concentration (4%) showed quicker pH loss in Ovoil at 0.049/hour when compared to LifeGuard at 0.034/hour (p=0.006). Culture dishes placed in a humidicrib with open cuffs, emulating real world settings, showed slower pH loss under LifeGuard (0.06/hour) compared to Ovoil (0.08/hour). Conclusion: Higher density oil overlay takes longer to equilibrate to optimal pH but can slow down loss of pH when dishes are exposed to ambient conditions.

The Race to Equilibrate

Background: While it is well documented that culture in hypoxic conditions produces superior outcomes, the mechanics of establishing such conditions within the embryo’s liquid environment is less clear. It is not uncommon for laboratories, while ‘culturing’ in low-oxygen, to equilibrate dishes in CO2 only environments prior to use, meaning embryos are exposed to high oxygen tension in their media even after placing into the hypoxic environment, but for how long is so far unclear. Aim: To assess the equilibration rate of oxygen within embryo culture media when exposed to hypoxic conditions. Method: A handheld blood gas analyser (EPOC system, ‘BGEM’ cartridges) was used to determine the pO2 of G1+ culture media after exposure to a reduced oxygen environment. Results: Culture media in atmospheric oxygen (with or without the presence of CO2) showed mean pO2 values of 150mmHg. Media fully equilibrated over 24 hours in 5% oxygen fell to approximately 70mmHg. This was well above the theoretically expected value but shown to be consistent across multiple measurements including various dish and incubator types. Initial equilibration to hypoxic conditions occurred relatively rapidly, with dishes undergoing 50% of the required oxygen reduction in only 30 minutes. Within 1.5 hours of exposure 5% O2, media achieved 83% of the required change, with full equilibration reached at approximately 2.5 hours. Pre-equilibration of dishes in 6% CO2 did not appear to affect the oxygen diffusion rate compared with non-equilibrated media. Oxygen exhibited similarly rapid diffusion into culture media when dishes equilibrated at 5% O2 were exposed to atmospheric conditions, with pO2 increasing by 1.46mmHg per minute. Conclusion: The diffusion rate of oxygen appears to be significantly faster than the more widely studied CO2, however, oxygen tension in media still requires greater than 2 hours to reach optimum levels, requiring us to consider oxygen in our equilibration practices.

Performance evaluation of all analytes on the epoc® Blood Analysis System for use in hospital surgical and intensive care units

ObjectiveTo evaluate the performance of the epoc hand-held analyzer against the RAPIDPoint 500 blood gas analyzer and laboratory analyzers where applicable. MethodsVenous or arterial whole blood samples collected in balanced heparinized syringes were obtained from 69 patients (35 females, 34 males) predominantly (77%) from the surgical unit and intensive care unit (ICU). Method comparison was performed for all analytes on the epoc System against the RAPIDPoint 500 Blood gas analyzer or laboratory analyzers where applicable. Results: Mean bias was <5% for blood gases, electrolytes, lactate and glucose. Hematocrit showed a bias of -6.76% (95% CI ​= ​-8.91, - 4.61) compared to the HemataSTAT-II method, whereas calculated total hemoglobin showed a bias of 1.51% (95% CI ​= ​-1.04, 4.06) against the Sysmex XN-10 hematology analyzer. Creatinine showed the largest bias relative to laboratory analyzers, Abbott Architect c8000 Jaffe method (13.54%, 95% CI ​= ​5.43, 21.65) and Roche Cobas c702 enzymatic method (30.01%, 95% CI ​= ​12.64, 47.38). Conclusions: The epoc system is fit for use in the surgical and ICU setting for the measurement of all analytes except for creatinine.

Point-of-care blood analysis of hypotensive patients in the emergency department

ObjectiveThe aim of this study is to compare a point-of-care (POC) analysis, Enterprise POC (epoc), using the capillary blood obtained from skin puncture with conventional laboratory tests using arterial and venous blood in hypotensive patients. MethodsThis study was conducted at the emergency department of a tertiary care hospital between June and November 2018. 231 hypotensive patients were enrolled. Three types of blood samples (capillary blood from skin puncture and arterial and venous blood from blood vessel puncture) were collected and analyzed. We compared a total of 13 parameters (pH, pCO2, pO2, HCO3−, Ca2+, lactate, Na+, K+, Cl−, glucose, Hb, Hct, and creatinine) between the POC analysis and reference analyzers by performing the equivalence test and Bland-Altman plot analysis. ResultsIn hypotensive patients, with the exception of two parameters (pCO2, pO2), the pH, HCO3−, Ca2+, lactate, Na+, K+, Cl−, glucose, Hb, Hct, and creatinine parameters measured by the POC analysis were equivalent to or correlated with the reference values. In the patients with cardiac arrest group, nine parameters (pH, HCO3−, Ca2+, Na+, K+, glucose, Hb, Hct, and creatinine) analyzed by the epoc system were equivalent to the reference values. ConclusionMost parameters, except pO2, measured by the epoc system using the capillary blood in hypotensive patients were equivalent to or correlated with those measured by the reference analyzers.

Validation of capillary blood analysis and capillary testing mode on the epoc Point of Care system

BackgroundLaboratory test in transport is a critical component of patient care, and capillary blood is a preferred sample type particularly in children. This study evaluated the performance of capillary blood testing on the epoc Point of Care Blood Analysis System (Alere Inc). MethodsTen fresh venous blood samples was tested on the epoc system under the capillary mode. Correlation with GEM 4000 (Instrumentation Laboratory) was examined for Na+, K+, Cl-, Ca2+, glucose, lactate, hematocrit, hemoglobin, pO2, pCO2, and pH, and correlation with serum tested on Vitros 5600 (Ortho Clinical Diagnostics) was examined for creatinine. Eight paired capillary and venous blood was tested on epoc and ABL800 (Radiometer) for the correlation of Na+, K+, Cl-, Ca2+, glucose, lactate, hematocrit, hemoglobin, pCO2, and pH. Capillary blood from 23 apparently healthy volunteers was tested on the epoc system to assess the concordance to reference ranges used locally. ResultsDeming regression correlation coefficients for all the comparisons were above 0.65 except for ionized Ca2+. Accordance of greater than 85% to the local reference ranges were found in all assays with the exception of pO2 and Cl-. ConclusionData from this study indicates that capillary blood tests on the epoc system provide comparable results to reference method for these assays, Na+, K+, glucose, lactate, hematocrit, hemoglobin, pCO2, and pH. Further validation in critically ill patients is needed to implement the epoc system in patient transport. Impact of the studyThis study demonstrated that capillary blood tests on the epoc Point of Care Blood Analysis System give comparable results to other chemistry analyzers for major blood gas and critical tests. The results are informative to institutions where pre-hospital and inter-hospital laboratory testing on capillary blood is a critical component of patient point of care testing.

A Multi-Dimensional Electronic Point-of-Care Evaluation System for Milestones Assessment

BACKGROUND: Previously, surgical and nursing evaluations of residents were completed on paper and infrequently submitted. Clinic, topic, and Morbidity &amp; Mortality (M&amp;M) presentations were never formally evaluated. METHODS: We developed three separate interventions. First, each evaluation's content (surgical, nursing, clinic, topic, and M&amp;M) was modified to more closely match the Milestones assessments. Second, we implemented a new E-POC system, a Quick Response (QR) code based delivery method which displays the evaluation form on the evaluator's smartphone. Finally, we developed custom identification cards with the QR codes and trained the residents, nurses and attendings in their use. For the topic and M&amp;M presentations, the presenter's final slide contained a QR code, which the audience could scan and then evaluate in real time. RESULTS: We received a total of 1,209 E-POC submitted evaluations in the first 12 months of implementation. The E-POC method resulted in a significantly greater number of surgical evaluations per resident-year (8.92 versus 4.24, P&lt;.05). We received 236 clinic presentation evaluations, 98 topic evaluations, and 614 M&amp;M evaluations; these were never previously formally evaluated. While the nursing evaluation frequency during the early implementation of the E-POC system was high, over the year fewer nursing evaluations were received per resident-year compared to the paper system (11.46 versus 1.96, P&lt;.05). DISCUSSION: The implementation of a multi-dimensional E-POC evaluation system resulted in a greater frequency of evaluations of our residents by faculty.

Mutual information-based feature selection for low-cost BCIs based on motor imagery.

In the present study a feature selection algorithm based on mutual information (MI) was applied to electro-encephalographic (EEG) data acquired during three different motor imagery tasks from two dataset: Dataset I from BCI Competition IV including full scalp recordings from four subjects, and new data recorded from three subjects using the popular low-cost Emotiv EPOC EEG headset. The aim was to evaluate optimal channels and band-power (BP) features for motor imagery tasks discrimination, in order to assess the feasibility of a portable low-cost motor imagery based Brain-Computer Interface (BCI) system. The minimal sub set of features most relevant to task description and less redundant to each other was determined, and the corresponding classification accuracy was assessed offline employing linear support vector machine (SVM) in a 10-fold cross validation scheme. The analysis was performed: (a) on the original full Dataset I from BCI competition IV, (b) on a restricted channels set from Dataset I corresponding to available Emotiv EPOC electrodes locations, and (c) on data recorded with the EPOC system. Results from (a) showed that an offline classification accuracy above 80% can be reached using only 5 features. Limiting the analysis to EPOC channels caused a decrease of classification accuracy, although it still remained above chance level, both for data from (b) and (c). A top accuracy of 70% was achieved using 2 optimal features. These results encourage further research towards the development of portable low cost motor imagery-based BCI systems.

Linearity analysis and comparison study on the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients

The epoc® blood analysis system (Epocal Inc., Ottawa, Ontario, Canada) is a newly developed in vitro diagnostic hand-held analyzer for testing whole blood samples at point-of-care, which provides blood gas, electrolytes, ionized calcium, glucose, lactate, and hematocrit/calculated hemoglobin rapidly. The analytical performance of the epoc® system was evaluated in a tertiary hospital, see related research article “Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients” [1]. Data presented are the linearity analysis for 9 parameters and the comparison study in 40 cardiopulmonary bypass patients on 3 epoc® meters, Instrumentation Laboratory GEM4000, Abbott iSTAT, Nova CCX, and Roche Accu-Chek Inform II and Performa glucose meters.

Measuring the face-sensitive N170 with a gaming EEG system: A validation study

BackgroundThe N170 is a “face-sensitive” event-related potential (ERP) that occurs at around 170ms over occipito-temporal brain regions. The N170's potential to provide insight into the neural processing of faces in certain populations (e.g., children and adults with cognitive impairments) is limited by its measurement in scientific laboratories that can appear threatening to some people. New methodThe advent of cheap, easy-to-use portable gaming EEG systems provides an opportunity to record EEG in new contexts and populations. This study tested the validity of the face-sensitive N170 ERP measured with an adapted commercial EEG system (the Emotiv EPOC) that is used at home by gamers. ResultsThe N170 recorded through both the gaming EEG system and the research EEG system exhibited face-sensitivity, with larger mean amplitudes in response to the face stimuli than the non-face stimuli, and a delayed N170 peak in response to face inversion. Comparison with existing methodThe EPOC system produced very similar N170 ERPs to a research-grade Neuroscan system, and was capable of recording face-sensitivity in the N170, validating its use as research tool in this arena. ConclusionsThis opens new possibilities for measuring the face-sensitive N170 ERP in people who cannot travel to a traditional ERP laboratory (e.g., elderly people in care), who cannot tolerate laboratory conditions (e.g., people with autism), or who need to be tested in situ for practical or experimental reasons (e.g., children in schools)

Validation of the Emotiv EPOC EEG system for research quality auditory event-related potentials in children.

Background. Previous work has demonstrated that a commercial gaming electroencephalography (EEG) system, Emotiv EPOC, can be adjusted to provide valid auditory event-related potentials (ERPs) in adults that are comparable to ERPs recorded by a research-grade EEG system, Neuroscan. The aim of the current study was to determine if the same was true for children.Method. An adapted Emotiv EPOC system and Neuroscan system were used to make simultaneous EEG recordings in nineteen 6- to 12-year-old children under “passive” and “active” listening conditions. In the passive condition, children were instructed to watch a silent DVD and ignore 566 standard (1,000 Hz) and 100 deviant (1,200 Hz) tones. In the active condition, they listened to the same stimuli, and were asked to count the number of ‘high’ (i.e., deviant) tones.Results. Intraclass correlations (ICCs) indicated that the ERP morphology recorded with the two systems was very similar for the P1, N1, P2, N2, and P3 ERP peaks (r = .82 to .95) in both passive and active conditions, and less so, though still strong, for mismatch negativity ERP component (MMN; r = .67 to .74). There were few differences between peak amplitude and latency estimates for the two systems.Conclusions. An adapted EPOC EEG system can be used to index children’s late auditory ERP peaks (i.e., P1, N1, P2, N2, P3) and their MMN ERP component.

Empirical Evaluation of the Emotiv EPOC BCI Headset for the Detection of Mental Actions

This study evaluated the detection accuracy of one of the first brain-computer interfaces intended for personal use by normal, healthy users: the Emotiv EPOC. This system allows the user to directly interact with computer software through thoughts alone. The system was evaluated on its ability to accurately detect and classify six sets of paired mental actions over three evaluation phases. Results found the system to perform significantly better than chance for all mental actions, and improve over time with additional training data. The system detected all actions with equivalent accuracy. Additional investigation of individual differences revealed that a user’s gender, age, handedness, attentional control, vividness of visual imagery, and mental rotation ability all had no bearing on the detection accuracy of the system. These results indicate the Emotiv EPOC system performs its function as a brain-computer interface with an acceptable level of accuracy, yielding many new possibilities for human-computer interaction.

Evaluation of the Enterprise Point-of-Care (EPOC) System for Blood Gas and Electrolyte Analysis

Objective: To evaluate the analytical performance of a new point-ofcare blood gas and electrolyte analyzer, the EPOC system. Materials and Methods: Evaluation of analytical precision and method comparison was conducted at the manufacturing facilities and at several locations in a 630-bed tertiary acute care hospital in New England, an intensive care unit, cardiac intensive care unit, an outpatient hematology/oncology clinic, and the Baystate Health system central laboratory (Springfield, Mass). The evaluation was conducted by nursing staff, medical laboratory technicians, medical technologists, and pathology residents. Results: Within-run precision (0.07%Y2.3% coefficient of variation [CV]) and total precision (0.14%Y3.8% CV) were estimated by analysis of aqueous and hematocrit control materials. A total of 143 samples leftover from laboratory analysis were compared with the predicate device, the i-STAT. One sample was excluded for potential benzalkonium interference with electrolytes, and another sample was excluded from the hematocrit correlation because of suspected incomplete mixing. The EPOC system was comparable to the i-STAT for all analytes with correlation coefficients of 0.880 to 0.990, linear regression slopes of 0.91 to 1.07, and SE of the estimates of 1.5% to 2.5% CV for electrolytes and pH, 3.9% for hematocrit, and 4.9% to 7.3% CV for blood gases. Conclusions: The EPOC system demonstrated excellent analytical precision and comparability of patient results to the i-STAT. The EPOC system has room temperature storage of test cards and wireless connectivity that provides an operational advantage over other pointof-care blood gas analyzers on the market.