LiDCO Group plc : Anaesthetists guidelines supports LiDCO’s Multi Modal Monitoring Strategy

20 January 2014

LiDCO Group Plc (AIM:LID), the cardiovascular monitoring company, welcomes the publication of The Association of Anaesthetists of Great Britain and Ireland ('AAGBI') guidelines for the perioperative care of the elderly and a paper from Dr David Green and colleagues at Kings College Hospital. The recommendations within the AAGBI guidelines and the direct experience with Multi Modal Monitoring ('MMM') described in Dr David Green's paper are a very positive reinforcement for LiDCO's product strategy that allows MMM to be achieved with the use of a single monitor - the LiDCOrapidv2.

MMM involves the measurement and monitoring of several physiological outputs and the AAGBI guidelines suggest these include the following which are incorporated into the LiDCOrapidv2:

• Continuous monitoring of intra-arterial blood pressure
• Haemodynamic response to fluid administration
• Depth of anaesthesia monitoring - this is also recommended by NICE - and is particularly relevant for older patients who typically require lower levels of sedation

AAGBI Guidelines - Perioperative Care of the Elderly
Disease-related declines in physiological reserves in the elderly population increase the risk of both mortality and complications secondary to oxygen debt due to poor perfusion during major surgery. Anaesthetic, fluid and drug interventions in and around surgery, should therefore be monitored with the aim of reducing oxygen demand, maintaining oxygen delivery and avoiding excessive anaesthesia and hypotension (low blood pressure). To achieve these goals, the guidelines strongly suggest the use of MMM. The LiDCOrapidv2 monitor with Unity Software can be used to invasively (arterial line) or completely non invasively (without insertion of an arterial line) monitor arterial pressure, cardiac output, fluids and depth of anaesthesia with the goal of avoiding the accumulation of an oxygen debt in this fragile patient group.

The AAGBI Guideline can be found here: http://onlinelibrary.wiley.com/doi/10.1111/anae.12524/full

Dr David Green's Paper
This paper reports the outcome, following MMM, of 120 high risk elderly vascular surgery patients. MMM with the LiDCOrapid monitor and BISTM depth of anaesthesia was used as part of a pre-emptive hemodynamic strategy to optimally deliver anesthesia, drugs and fluids. Intraoperative cardiac output and oxygen delivery were successfully maintained at around 90% of pre surgery values in these high risk elderly patients. Without MMM, a predicted mortality rate of 9% would be expected, however in this study using MMM the mortality rate was much lower at 0.8% (one patient). The authors also report that optimising patients this way "reduces dramatically the requirement for post operative high dependency management of the patient." Post operatively only 8% (10 patients) needed to be taken to a high dependency unit (high cost), with the majority of patients being able to be nursed post operatively on general wards, thereby incurring a lower recovery cost of care.

Reference: Green D, Bidd H, Rashid H.
Multimodal intraoperative monitoring: An observational case series in high risk patients undergoing major peripheral vascular surgery
International Journal of Surgery (2014) 1-6 In Press
doi.org/10.1016/j.ijsu.2013.12.016

Terry O'Brien, Chief Executive Officer of LiDCO, commented: "An increasing number of elderly patients are undergoing surgery and it's critical that they receive the right monitoring to reduce costs, mortality and complication rates. The use of LiDCO's MMM (LiDCOrapidv2) allows the hospital to provide this very necessary advanced level of care. The recent addition of a non invasive option now allows all high risk elderly patients to be monitored without the use of a highly invasive catheter."

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About LiDCO Group Plc (www.lidco.com)

LiDCO is a supplier of non-invasive and minimally invasive hemodynamic equipment to hospitals used to monitor the amount of blood flowing around the body and ensure that vital organs are adequately oxygenated. LiDCO's products facilitate the application of hemodynamic optimisation protocols for high risk patients in both critical care units and in the operating theatre.

Increasingly clinical studies are showing that the optimisation of patients' hemodynamic status in high risk patients produces better outcomes and reduced hospital stay. LiDCO's computer-based technology, developed at St Thomas' Hospital in London, has been shown to significantly reduce morbidity and complications, length of stay and overall costs associated with major surgery.

Key Products:

LiDCOplus: a computer-based platform monitor used in the Intensive Care Unit for real-time continuous display of hemodynamic parameters including cardiac output, oxygen delivery and fluid-volume responsiveness (PPV% and SVV%).

LiDCOrapid: a cardiac output monitor designed specifically for use in the operating theatre for fluid and drug management. The monitor enables anaesthetists to receive accurate and immediate feedback on the patient's fluid and hemodynamic status - a key measure of overall well-being before, during and after surgery. The LiDCOrapid provides:

• early and rapid warning of hemodynamic change to aid choice of therapeutic route: fluid or drug
• quantification of hemodynamic response
• guidance on effective delivery of fluids to ensure the right amount at the right time

LiDCOview: an easy-to-use graphical display of historical LiDCOplus and LiDCOrapid hemodynamic data.

LiDCO Unity Software: software incorporated into LiDCOrapidv2 that allows the LiDCOrapid monitor to co-display Covidien's level of consciousness parameter ('BISTM')* and add the convenience of CNSystem's continuous non-invasive blood pressure monitoring ('CNAP')**. This will address a growing requirement for non-invasive monitoring solutions that are more comprehensive and can effectively replace multiple single parameter monitors.

*BISTM and Bispectral Index are trademarks of Covidien LP registered in the US and foreign countries.

* CNAPTM is a trademark of CNSystems Medizintechnik AG.

LiDCO monitors use single-patient disposables (sensors or smartcards) which provide an ongoing revenue stream.

LiDCO Distribution Network:

LiDCO sells directly to hospitals in the UK and USA and through a network of specialty critical care and anaesthesia distributors in the rest of the world.

LiDCO's marketing office is in Cambridge, its manufacturing facility and headquarters are in London and its shares are traded on AIM.