TMC PULSE

t m c » p u l s e | j u n e 2 0 1 9 23 The Early Bird An innovative device uses electrodes to detect internal bleeding B y A l e x a n d r a B e c k e r E leven years ago, while driving along Interstate 45, a spark of ingenuity hit Mehdi Razavi, M.D. The electrophysiologist was leaving one hospital and heading to another when he received a call that the patient he'd just left was experiencing complications, including a sudden drop in blood pressure. Razavi feared the worst—in this case, internal bleeding. It was something he dealt with in his line of work, testing and treating elec- trical activity and rhythm problems of the heart, and he was perpetually frustrated that there were no tools to detect bleeding complications until symptoms appeared. When that happened, it usually meant treat- ment was urgent, blood transfusions would be required and hospitaliza- tion would be extended. And that's if the patient survived. But what if, Razavi thought, his eyes fixed on the road, there was a way to discover bleeding before symptoms manifested? What if it was as simple as creating a sheath outfitted with electrodes that could detect impedance—a term used to describe electrical resistance. The electrodes, Razavi speculated, would probably measure extremely low in an area pooling with blood. It turns out, that is exactly what happens. "In my subspecialty, we look at electrical impedance all the time, but that's because we're looking at ablation catheters and not for other reasons," explained Razavi, the director of electrophysiology, clinical research and innovations at Texas Heart Institute (THI). "This idea came from the right combina- tion of need and background." Razavi worked out his concept and initial design, then brought it to Maria Oden, Ph.D., a professor of bioengineering and director of the Oshman Engineering Design Kitchen (OEDK) at Rice University, a workshop where undergraduate students interested in engineering, math, science, technology and other related fields design and create pro- totypes to help solve real-world chal- lenges. There, Razavi and a group of students refined what would plastic tube, or sheath, much like the ones commonly used for keeping arteries and blood vessels open during surgical procedures so that catheters and other devices can be inserted. The Saranas sheath is fixed with sensors designed to measure the impedance across a blood vessel. When the sheath senses a change in the vessel's electrical resistance, the device responds with audible and visual notifications to alert the clinical team of a potential bleed. The device is able to detect bleeds almost as soon as they begin, allowing health care pro- viders to avoid what can be costly and sometimes life-threatening complications. "It's the canary in the coal mine for cardiologists," explained Zaffer Syed, president and chief execu- tive officer of Saranas. In fact, the company's name itself is derived from the Latin word for the Atlantic canary—serinus canaria. The name Early Bird followed easily from there. "There is no technology out there that does real-time detection of internal bleeding during these transcatheter types of procedures," Syed said. Bleeds can occur for a number of reasons related to a patient's condition and the type of procedure performed. Usually, procedures that create a larger hole in the vessel are more difficult to close and can cause more disruptions farther up—including deploying transcatheter valves, percutaneous heart pumps, even thoracic stents. With these proce- dures, the risk of bleeding can be as high as 20 percent, on average, Syed said. ➟ Mehdi Razavi, M.D., director of electrophysiology, clinical research and innovations at Texas Heart Institute, holds The Early Bird Bleed Monitoring System. soon become The Early Bird Bleed Monitoring System. Not long after, Razavi founded a new company to develop the device—Saranas—and brought some of those same under- grads on board as summer interns. Saranas' Early Bird Bleed Monitoring System detects and monitors bleeding complications associated with vascular access procedures by employing a special Credit: Courtesy Texas Heart Institute m e d i c a l d e v i c e

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