Pyreos has the opportunity to introduce a world-first development that could help to radically shift the landscape for ICU (intensive care unit) capability in low-income countries. The company is looking to introduce a significantly more affordable capnography kit based on the use of digital SMD gas detectors, which cost around three times less than the company’s analogue TO-39 systems. In addition, these integrated solutions save on BOM cost and board space as they include power management, filtering, amplification and a DAC. The upshot is that a capnography kit can be made for far less cost than systems using conventional detectors.

The benefits of capnography, a process that monitors the concentration or partial pressure of CO2 in a patient’s respiratory gases, have long been recognised. For example, in 2011, the Fourth National Audit Project (NAP4) of the Royal College of Anaesthetists and Difficult Airway Society found that failure to use capnography contributed to 74% of deaths or persistent neurological injury cases related to airway complications in ICU. NAP4 also stated that the increasing use of capnography in ICU is the single change with the greatest potential to prevent deaths, but that cost and technical difficulties may be practical impediments to its rapid introduction.

Of course, the cost of purchasing a capnography kit is significantly more prohibitive for low-income countries, which is why the proposed development by Pyreos could prove such a breakthrough.

Closing the capnography gap

A report published by the British Journal of Anaesthesia (April 2020), entitled ‘Impact of capnography on patient safety in high and low-income settings – a scoping review’, stated that capnography is frequently unavailable in low- and middle-income countries (LMICs). The review added that although randomised studies are limited, existing data sets suggest an association between the use of capnography and a reduction in serious airway complications, and that better access to this vital monitoring technique in LMICs may represent a significant opportunity to improve patient safety worldwide.

Given its infrequent utilisation in many parts of the developing world, closing the so-called ‘capnography gap’ represents a real chance to prevent unnecessary deaths. However, just how big is the gap? A lack of data means this is difficult to quantify. Although detailed studies in the developing world are rare, a notable exception is the ‘Global Capnography Project (GCAP): implementation of capnography in Malawi’, which was published in 2018. To the knowledge of the authors, GCAP was the first project to study the implementation of this technology and its impact in a low‐income country.

At the start of the GCAP project in January 2017, the project team discovered that only one capnograph existed among eight hospital in southern Malawi. As a whole, a 97% gap in capnography provision in Malawi’s operating theatres and a 100% gap in capnography provision in intensive care was reported.

Assuming intubation rates in Malawi to be representative of Sub‐Saharan Africa, with a population of circa 1022 million, the GCAP study estimated that over 11,000 oesophageal intubations could occur per year, posing a very significant safety risk to patients that would effectively be mitigated by the implementation of capnography.

The safety issue that exists in low-income countries due to the absence of capnography clearly represents both risk and opportunity; opportunity to improve and save lives. To develop a gas detection kit with a markedly lower price tag  suitable for adoption in the developing world, Pyreos has a globally unique semiconductor-scale detector: a high-speed yet low-cost CO2 detection device for monitoring lung performance that provides, among other things, checks on intubation, as well as lung and heart diagnostics.

Low-income countries are expected to leapfrog analogue platforms in favour of digital pyroelectric solutions for capnography systems because they deliver lower system cost, faster time-to-market and greater efficiency. Pyreos is one of only a handful of companies around the world that can supply the core gas sensors for capnography, and demand from existing customers in Europe and Asia has grown by several multiples in recent years.

Partners are currently being sought by Pyreos to develop and ship its proposed cost-effective systems into low-income/developing world applications. The company is currently in touch with NGOs and academics to assemble the necessary skills and support.

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