Every passing year sees medical innovation and technology breaking new ground. From new drugs, devices and treatments to improvements in the day-to-day processes of care and new ways to secure and share patient data. This year has been no different. Here in no particular logical order are a handful of innovations in a variety of fields that have caught our eye:
Spinal trauma vaccine
A team from the University of Michigan have successfully used nanoparticles to reprogram innate immune cells, dampening the damaging immune response to spinal cord injury which further contributes to tissue degeneration. Furthermore, the site of spinal cord injury is infiltrated by pro-regenerative immune cell phenotypes and the expression of regeneration associated genes, which substantially improved functional recovery.
MTP Scorekeeper
With damage control resuscitation now standard practice, the simple practicality of keeping track of blood product ratios has been largely overlooked until now. This year saw the launch of the long-awaited MTP Scorekeeper. With its simple, intuitive and (crucially) portable design the trauma team can ensure the delivery of optimal transfusion ratios whilst limiting crystalloid use.
ShotSpotter
The scourge of gun violence continues to blight America. From a public health perspective, the Stop the Bleed campaign has been effective at spreading basic first aid knowledge to members of the public caught up in the aftermath of mass shooting events. ShotSpotter is an acoustic gunshot detection system first developed in the 1990s which uses strategically placed sensors to detect gunshots and record contextual information such as location and type of firearm. The system can automatically dispatch law enforcement to suspected firearms incidents within seconds and is currently used by law enforcement in over 90 US cities and within the global private security industry. A study published this year analysed analysed over 600 shootings during a 9 year period in Camden, New Jersey both before and after the implementation of the ShotSpotter system. The study found that the system significantly decreased the response time of both police and EMS to the scene of a shooting and therefore allowed for more rapid contact with injured victims. Furthermore, the system’s use resulted in reduced transport time to hospital.
Drones
In March I wrote an article on this very blog page examining the use of drone technology in the treatment of the severely injured. Since then a comprehensive review looking into the utility of drones on the battlefield has been published highlighting the potential for greater integration into operations requiring crisis management, biochemical hazard detection and monitoring, casualty search and evacuation, blood product transport and telemedicine capabilities.
Cerebrotech Visor
In December 2018 the UK’s National Institute for Health and Clinical Excellence (NICE) published a medtech briefing on the new Cerebrotech Visor. This device, resembling a VR headset is worn on the head of a patient and uses Volumetric Impedance Phase-shift Spectroscopy to detect asymmetry in bioimpedance measurements which may be an indication of stroke, bleeding and/or cerebral oedema. Although currently intended as a prehospital diagnostic tool for stroke patients, it’s not hard to see this technology being used to detect the presence and extent of intracranial haemorrhage following trauma.
Endo-SPONGE
Any surgeon that has ever done trauma or emergency general surgery has had to deal with an anastomotic breakdown at some point. As painful as these can be, both for the patient and the ego of the surgeon, there's finally been a new approach after all these years. The Endo-SPONGE treats these leaks from a trans-luminal approach, with a 90.1% success rate. This is truly a breakthrough which proves how technology and innovation can solve a problem which has vexed surgeons for over 100 years.
The march toward artificial intelligence and beyond
The hot topic in all aspects of healthcare is artificial intelligence (AI) and how this will shape things in future. The use of artificial intelligence within the healthcare industry is expected to grow rapidly at an annual rate of 40% through 2021 – to $6.6 billion, from approximately $600 million in 2014. AI may be able to augment clinical judgement by way of early warnings about intraoperative events such as bleeding and flag action points such as hypothermia, aberrant anatomy, or instrument use that may be linked to the risk. In 2018 researchers from the University of Washington, Seattle developed an AI-based warning system called Prescience that predicts hypoxemia during surgical procedures up to 5 minutes before it occurs. This system monitors vital signs and provides the clinician with a risk score that updates in real time.
Augmented reality via hardware such as Google Glass has been around for a number of years and it’s use in helping run trauma resuscitations has been previously explored. No doubt there will be a continued interest in its use and other similar virtual reality endeavours such as holographic telepresence to truly bring the expertise required to the patient’s bedside regardless of the level of trauma center they find themselves in.
We live in exciting times for technological innovation and 2020 is expected to be no different. Trauma care stands to benefit hugely and that can only be good news for patients and surgeons alike.
Obi Nnajiuba is a British general surgical resident with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.
