Abbott POC i-STAT
I’ll begin with the smallest of the machines, the i-STAT System from Abbott Point Of Care. These POC test machines are very small indeed. They are just a bit bigger than the Masimo Rad-57. You fill the test cartridge with a blood sample and insert it to the bottom of the i-STAT and results will be processed in short order. For a good all-around and fast reading, I recommend the CG8+ cartridge to retrieve the following from the electrolyte, blood gas, and blood counts categories in about 2 minutes for all results:
- Sodium (Na)
- Potassium (K)
- Ionized Calcium (iCa)
- Glucose (Glu)
- Hematocrit (Hct)
- Hemoglobin* (Hgb)
* = calculated values
There are also separate individual test cartridges for Troponin I, CK-MB, and BNP. These take 5-10 minutes each depending on the test. This system comes with optional printer and dock to upload results to their i-STAT tracking system. I don’t have sufficient information to suggest that the results could be uploaded into your own ePCR’s, but I wouldn’t think that would be a huge challenge for Abbott POC to conquer. If you are interested, you might contact their sales staff to inquire.
Siemens RAPIDPoint 400
Next up, I introduce to you the Siemens RAPIDPoint 400 series analyzer. This would be the largest of the small form factor POC test machines. The cartridge-based test system has a 28-day life from installation until it must be discarded. It is noteworthy that Siemens advertises that full results can be obtained in about 60 seconds. The photos of the device and the online brochure suggest a user-friendly touchscreen display with built-in training videos.
An optional integrated barcode scanner can be helpful in a multi-casualty situation saving time and effort in tracking what patient the results will be assigned to. Results can be uploaded, and the device can be centrally monitored if connected to a network.
- RAPIDPoint 400/405 Test Menu
- Blood Gas (pH, pCO2, pO2)
- Electrolytes (Na+, K+, Ca++, Cl-)
- Metabolites (Glucose)
- CO-oximetry (tHb, HHb, O2Hb, COHb, MetHb)*
- Neonatal total bilirubin*
*RAPIDPoint 405 only
Roche cobas b 123
Finally, I present to you, the Roche cobas b 123 POC testing system. Roche highlights important features compared to other POC machines such as the ability replace the sensor without having to waste testing reagents, and the reagents can be migrated to another machine without waste. It is only slightly smaller than the Siemens system. The Roche system also offers a 9-month shelf-life of reagents at room temperature. Networked remote monitoring is also possible with this system.
Measured parameters include:
- Ionized calcium
Many patients we encounter in the prehospital arena could benefit from having these POC tests performed prior to arrival at a hospital. It could easily benefit patients with cardiac conditions, metabolic conditions, respiratory conditions, burns, and even trauma with significant blood loss or abdominal injuries.
These POC tests could be deployed on Community Paramedicine units, Critical Care Transports, helicopter and fixed-wing EMS, and even in fire base camps and on fire rehab units. I see enormous benefit to having these systems available for rural EMS systems with > 1 hour of transport time to their local trauma and cardiac centers. With software integration and a network connection, results could be automatically uploaded into an ePCR (electronic patient care report), which can in turn be sent to a receiving facility.
Each of these machines has self-calibration, which is a great advantage to people who don’t have an advanced degree in clinical laboratory technologies. Worthy of mention, when I first contacted Roche about the possibility of using these types of machines in the prehospital environment, they suggested a licensed medical lab technologist would likely be required to oversee the use of the machines.
That should be no problem for hospital-based EMS systems, but it may require another person on the payroll or a cooperative agreement with a local lab to provide the testing system oversight. Since the EMS crews don’t have to do anything to calibrate the devices, that should make securing an agreement even easier. Quality control is essential in the clinical laboratory. The Siemens POC machine is networkable, allowing a lab tech to keep tabs on device performance and environment.