As part of their review of esophageal Doppler guided fluid management, CMS commissioned a technology assessment from the Agency for Healthcare Research and Quality (AHRQ).

The technology assessment (TA) reviewed some 317 articles, including seven independently conducted, randomized controlled trials. The report was published by CMS on 14 March 2007 and is available at www.cms.hhs.gov/mcd/viewtechassess.asp?where=index&tid=45

The technology assessment process grades the quality of evidence for a given technology as being 'strong', 'moderate', 'weak' or 'inconclusive'. Strong evidence is defined as "evidence supporting the qualitative conclusion is convincing. It is highly unlikely that new evidence will lead to a change in this conclusion".

The technology assessment for EDM concluded that in "patients undergoing surgical procedures with an expected substantial blood loss or fluid compartment shifts requiring fluid replacement" the clinical evidence for EDM was strong in respect of the following three statements:

1. "Doppler-guided fluid replacement during surgery leads to a clinically significant reduction in major complications";
   
2. "Doppler-guided fluid replacement during surgery leads to a clinically significant reduction in the total number of complications"; and
   
3. "Doppler-monitored fluid replacement leads to a reduction in hospital stay".

It should be noted that these comments are only applicable to EDM. No other hemodynamic monitoring technology has been proven capable of replicating the results obtained using EDM. It is the belief of Deltex Medical that only flow-based (that is, EDM) technologies can provide the benefits demonstrated in the published clinical trials of the CardioQ™.

A copy of the AHRQ technology assessment is available to download from the link on the right.

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