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March 2011 saw the publication of the NICE Medical Technology Guidance for CardioQ-ODM Oesophageal Doppler Monitor (MTG3). The recommendation is specifically for the use of the CardioQ-ODM Oesophageal Doppler Monitor to guide fluid optimisation during surgery in over 800,000 procedures in England annually. The CardioQ-ODM is the only technology with sufficient evidence-base to support such extensive recommendation and guidance.

The NICE Guidelines advise the consideration of use of CardioQ-ODM in patients undergoing major or high-risk surgery. This is supported by a large evidence base and can provide NHS Hospital Trusts with significant cost savings, estimated by NICE to be £1,100 per patient. 800,000 procedures annually, in England, were identified as suitable for fluid management, monitored by the CardioQ-ODM.

The cost saving per patient, when the CardioQ-ODM is used instead of a central venous catheter in the peri-operative period, is about £1100 based on a 7.5-day hospital stay.

NICE state that ‘The “Case for Adoption” is based on the claimed advantages for introducing the specific technology compared with the current management of the condition… the technology has been found to offer advantages to patients and the NHS’. The evidence based used to form the conclusion of the NICE guidelines was based on randomised controlled trials in surgical procedures including: Colorectal, Cardiac, Orthopaedics.

Recommendations:

  • 1.1  The case for adopting the CardioQ-ODM in the NHS, when used as described in 1.2, is supported by the evidence. There is a reduction in post-operative complications, use of central venous catheters and in-hospital stay (with no increase in the rate of re-admission or repeat surgery) compared with conventional clinical assessment with or without invasive cardiovascular monitoring. The cost saving per patient, when the CardioQ-ODM is used instead of a central venous catheter in the peri-operative period, is about £1100 based on a 7.5-day hospital stay.
  • 1.2  The CardioQ-ODM should be considered for use in patients undergoing major or high-risk surgery or other surgical patients in whom a clinician would consider using invasive cardiovascular monitoring.

Clinical Evidence:

  • 3.1 Clinical outcomes relevant to the use of the CardioQ-ODM are mortality, peri-operative complications, reductions in the use of central venous catheters, length of critical care and in-hospital stay and re-admission rates. Full details of all clinical outcomes considered by the Committee are available in the assessment report at http://guidance.nice.org.uk/MT/80

Conclusions:

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