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EQUANOX™ Regional Oximetry
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 2 Founded in 1986 World Headquarters located in Plymouth, Minnesota USA European Headquarters located in Hudiksvall, Hälsingland SWEDEN 100+ OEM Partnerships Worldwide Distribution in 125 Countries Over 1.3 million oximeters sold! Nonin Medical, Inc.
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 3 What is NIRS Regional Tissue Oximetry? Brain Kidney Liver BowelMuscleVascular A non-invasive, continuous measure of oxygenation status in specific tissue bed. Tissue oximetry assesses the relative balance of oxygen delivery and oxygen demand at the site.
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 4 Superior Signal Processing = Consistency
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 5 Light Receiver Light Source Short Long Photon Pathways Principles of Spatially-resolved NIRS Technology Optical array eliminates measurements of shallow blood and surface variations from measurements of blood in the cerebral cortex
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 6 NIRS Framework: Beer Lambert Law Beer-Lambert Law: absorption of light is related to the properties of the material/distance it is traveling through Specific wavelengths to isolate specific chromophores log(I 1 /I 0 ) = - C l Hemoglobin Extinction Coefficient (mMol -1 cm -1 ) versus Wavelength (nm) HbO 2 Hb
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 7 Equanox Advance (8004CA) Accuracy Absolute accuracy A rms 4.1 Expanded application Improved trending accuracy A rms 1.9 SavO 2 =0.7*SjvO 2 + 0.3*SaO 2 MacLeod, et al, IARS, 2011.
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 8 Equanox™: Greater Accuracy Normal Subjects (8004CA - 4 λ) 8004CA Mean + SD SavO2 Mean + SD 75.9 ± 4.675.8 + 4.6 (68 – 84) MacLeod, et al, IARS, 2011.
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 9 12 Normal subjects Pneumatic cuff on head Equanox superior in eliminating superficial contamination Emitter array design: dual emitter/dual detector allows for adjustment for difference in shallow tissue under detector sites Emitter/detector spacing Impact of Extracranial Contamination Davie S; Grocott H: Anesthesiology Davie S; Grocott H. The Impact of Extracranial Contamination on NIRS measurements: a comparison of three different cerebral oximeters. Anesthesiology, April 2012, 116:1–1 NOTE: 8000CA three wavelength sensor included in this study.
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 10 Improved Accuracy Through Added Wavelengths MacLeod DB, Ikeda K, Vacchiano C, Shaw AD. ASA, October 19, 2011.
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 11 Circ Arrest CPB Rewarm Highly refined signal processing algorithms Advanced ambient light tolerance Sensor design /shielding Equanox™: Stable and Responsive Illustrative sample data on file at Nonin
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 12 Multicenter, prospective N=90 patients Time to discharge associated with rSO2 Low rSO 2 = longer stay Hazard model, p=0.002 Cerebral Oxygen and LOS Apostolidou I, Nussmeier NA, Sarwar MF, et al. ASA Oct., 18, 2011.
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 13 EP Digest, June 2011
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 14 Consistent and reliable measure of patient status Industry leading accuracy Absolute A RMS = 4.1 Trending A RMS = 1. 9 Reliable performance in challenging conditions/patients Not impacted by peripheral tissue, skin color Signal processing 25 years of experience “built in” Stable/reliable signal Not affected by ambient light Nonin Medical, Inc. Healthy, experienced company founded in technology Rich pipeline of development consistent with history of “game changing” advances Equanox™ Technology
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 15 Equanox Bibliography 1.Calibration and Validation of the Nonin Non-invasive Regional Oximeter with Cerebral Sensor, David MacLeod, Duke University, ASA, Oct 2009. 2.EQUANOX Technology with Dual Emitter-Dual Detector Cancels Surface and Shallow Tissue Variation When Measuring Cerebral Oxygenation. Aaron Lobbestael, MS; Lori Roth, RN, BSN; and Matthew Prior, Ph.D; Nonin Medical, Inc., Plymouth, Minnesota. 3.Continuous Cerebral Oximetry Patient Monitoring During Post-Operative Transport Identifies Desaturation R.W.M. Keunen MD PhD, A. Falsafi MD PhD, J. van Alphen MD PhD, D.L. Tavy MD. 4.Multi-Modality Monitoring in Carotid Surgery: The Importance of Reliable Readings R.W.M. Keunen MD PhD, D.L. Tavy MD, B. Knippenberg, MD 5.Near-infrared Spectroscopy as an Index of Brain and Tisuse Oxygenation, JM Murkin and M Arango. Britihs Journal of Anesthesia, 2009 Dec;103 Suppl 1:i3-13 6.Cerebral Oximetry Monitoring During Transapical Aortic Valve Replacement, J Abicht, C. Schmitz, R. Sodian, M. Wolf, N. Nikolaou, F. Christ. German Thoracic and Heart Surgery, Feb 2010. 7.Cerebral oximetry in cardiac and major vascular surgery, GW Fischer, G Silvay, HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010; 2: 249-256 8.Cerebral Oximetry Monitoring During Transapical Aortic Valve Replacement, J Abicht, C. Schmitz, R. Sodian, M. Wolf, N. Nikolaou, F. Christ. ASA, Oct 2010. 9.Alterations In Tissue Oxygenation And Metabolic Variables During Acute Cyanide Toxicity, J.R. Srikanthan, H. Singh, D. Beebe, R. Vince, S. Patterson, K.G. Belani; NYPGA Dec 2010 10.Are cerebral oximeters designed to measure ambient light?, Annelies Moerman, Stefan De Hert. British Journal of Anesthesia - ePub, Feb 2011. 11.Peripheral tissue oxygenation measurement by NIRS (near-infrared spectroscopy) using the Nonin/Equanox-7600 is not disturbed in helicopter-EMS (HEMS) environment. Schober P., Christiaans H.M.T., Loer S.A., Schwarte L.A.; ESTES, April, 2011 12.Noninvasive regional oximetry correlates with direct Laser Doppler measurement of intestinal perfusion, Jeffrey D. Cizenski, et al. FASEB, April, 2011 13.Cerebral Oximetry Device Evaluation for Shoulder Arthroscopy in Beach chair Position, Ty Walker, AmSect, April 2011 14.Comparison of EQUANOX 7600 and INVOS 5100 cerebral oximeters in cardiac surgery patients; S. G. de Hert, et al SCA May 2011 15.Choosing A Cerebral Oximeter, Is It Really A No –Brainer, C. Ty Walker. AACP Newsletter, Spring, 2011. 16.The Impact of Extracranial Contamination on NIRS Measurements of Regional Cerebral Oxygen Saturatio: A Comparison of Three Different Cerebral Oximeters, Grocott, et al; SCA May 2011 17.Nonin EQUANOX 8004CA Advance Cerebral Oximeter Sensor Provides Valid Assessment of True Tissue Oxygen Saturation; MacLeod, et al; IARS May 2011 18.Near infrared spectroscopy (NIRS) measured rSO 2 may provide a clinically useful means to assess end organ ischemia and correlate with global ischemia., Kramer, et al; Shock, June 2011 19.The Use of Cerebral Oximetry Monitoring in the Electrophysiology Lab, M Neal. Electrophysiology Lab Digest. June 2011
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 16 EQUANOX™ Regional Oximeter System Advanced rSO 2 technology to more effectively isolate cerebral and somatic tissue Accurate – Absolute accuracy of 4.1 Arms Consistent – Proven repeatability of ± 2 digits Reliable – Patented dual-emitter/ dual-detector sensor architecture to more effectively isolate brain tissue
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 17 Sensor Shielding Adult SomaSensor SAFB EQUANOX™ Advance 8004CA Sensor
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 18 Sensor Shielding Adult SomaSensor SAFB EQUANOX™ Advance 8004CA Sensor
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 19 Sensor Design Adult SomaSensor SAFB EQUANOX™ Advance 8004CA Sensor
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©2010 Nonin Medical, Inc. All trademarks are the property of Nonin Medical, Inc. unless otherwise noted. M-2710 CONFIDENTIAL 20 Sensor Design EQUANOX™ Advance 8004CA Sensor CASMED Fore-Sight Sensor Large
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