BB2

15.04.2023 275’000 patient deaths in USA due to Acute Lung Injury ARDS

ICU USA 2005

$81.7 billion,

13.4% of hospital costs

4.1% of national health expenditures,

0.66% of gross domestic product

Lung collapse identification

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Gold Standard CT Scanner Chiumello, Critical Care 2011

• Costly (fixed+variable)

• Risky (patient transport)

• Not continuous

• Dangerous

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Swisstom technology makes lung collapse visible

without x-rays

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Respiratory therapy becomes easier and more effective because

results are immediately available.

In the end, clinicians can save more patients faster, administrators

can increase patient throughput, and hospitals become more efficient.

Basic principle:

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Difference between CT image and BB2 - monitor

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1 CT exposure = 310 x-ray

1 image per day or even less

Non-invasive, radiation-free

Up to 50 images per second

Patienten Interface: early attempts

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Patient Interface: Swisstom

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Shoulder strapsPositioning aidsElectrodes and electronicsMounting loopsVelcro & DockContactAgent

Patient Interface: integrated electronics

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Spacer fabric

Protective foilFlexprint

Electrode connection

EIT-ChipElectrodes, Z-Tex with Ag stripes

Swisstom BB2

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SensorBeltConnector

Instrument BB2

SensorBelt

Trolley

ContactAgent

Clinical need: Swisstom solution BB2

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25 year old male, motor vehicle accident, • multiple fractures• on ventilator

Patient develops lung failure*

*Acute Lung Injury: PaO2/FiO2<300mmHg, bi-lateral chest infiltrates, no congestive heart failure

With Swisstom real-time Lung Monitoring

• Put SensorBelt on patient

• EIT guided recruitment and positioning

Shortens ICU stay and increases survival by 46% (Amato, NEJM)

Proof of concept: monitor of regional ventilation

• Brown: Applied potential tomography: Possible clinical applications. Clin Phys Physiol Meas 1985

• Victorino: Imbalances in regional lung ventilation: A validation study on EIT. Am J Respir Crit

Care Med 2004 (patients)

• Wrigge: EIT compared with thoracic CT during a slow inflation maneuver in experimental models

of lung injury. Crit Care Med 2008 (animals)

• Costa: Bedside estimation of recruitable alveolar collapse and hyperdistension by EIT. Int care

Med 2009 (patients)

• Wolff: Mechanical ventilation guided by electrical impedance tomography in experimental acute

lung injury. Crit Care Med 2013 (outcome study) 15.04.2023 13

Aug. 2013 Adults Infants Animals

Number of subjects 471 114 248

Number of studies 27 7 28

EIT & Ventilation publications 2014

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1: Lehmann S, Tenbrock K, Schrading S, Pikkemaat R, Antink CH, Santos S, SpillnerJW, Wagner N, Leonhardt S. Monitoring of lobectomy in cystic fibrosis withelectrical impedance tomography - a new diagnostic tool. Biomed Tech (Berl). 2014Aug 5. pii: /j/bmte.ahead-of-print/bmt-2014-0019/bmt-2014-0019.xml. doi:10.1515/bmt-2014-0019. [Epub ahead of print] PubMed PMID: 25153206.

2: Bodenstein M, Boehme S, Wang H, Duenges B, Markstaller K. Hints for cyclicalrecruitment of atelectasis during ongoing mechanical ventilation in lavage andoleic acid lung injury detected by SpO2 oscillations and electrical impedancetomography. Exp Lung Res. 2014 Nov;40(9):427-38. doi:10.3109/01902148.2014.944719. Epub 2014 Aug 25. PubMed PMID: 25153803.

3: van der Burg PS, Miedema M, de Jongh FH, van Kaam AH. Unilateral atelectasisin a preterm infant monitored with electrical impedance tomography: a casereport. Eur J Pediatr. 2014 Aug 23. [Epub ahead of print] PubMed PMID: 25146419.

4: Grychtol B, Elke G, Meybohm P, Weiler N, Frerichs I, Adler A. Functionalvalidation and comparison framework for EIT lung imaging. PLoS One. 2014 Aug11;9(8):e103045. doi: 10.1371/journal.pone.0103045. eCollection 2014. PubMedPMID: 25110887; PubMed Central PMCID: PMC4128601.

5: Zhang J, Patterson R. Variability in EIT Images of Lung Ventilation as aFunction of Electrode Planes and Body Positions. Open Biomed Eng J. 2014 Jun27;8:35-41. doi: 10.2174/1874120701408010035. eCollection 2014. PubMed PMID:25110529; PubMed Central PMCID: PMC4126188.

6: Blankman P, VAN DER Kreeft SM, Gommers D. Tidal ventilation distributionduring pressure-controlled ventilation and pressure support ventilation inpost-cardiac surgery patients. Acta Anaesthesiol Scand. 2014 Sep;58(8):997-1006. doi: 10.1111/aas.12367. Epub 2014 Jul 15. PubMed PMID: 25039666.

7: Schaefer MS, Wania V, Bastin B, Schmalz U, Kienbaum P, Beiderlinden M,Treschan TA. Electrical impedance tomography during major open upper abdominalsurgery: a pilot-study. BMC Anesthesiol. 2014 Jul 5;14:51. doi:10.1186/1471-2253-14-51. eCollection 2014. PubMed PMID: 25018668; PubMed Central PMCID: PMC4094413.

8: Pomprapa A, Schwaiberger D, Pickerodt P, Tjarks O, Lachmann B, Leonhardt S.Automatic protective ventilation using the ARDSNet protocol with the additionalmonitoring of electrical impedance tomography. Crit Care. 2014 Jun 23;18(3):R128.doi: 10.1186/cc13937. PubMed PMID: 24957974.

9: Blankman P, Hasan D, Erik G, Gommers D. Detection of 'best' positiveend-expiratory pressure derived from electrical impedance tomography parametersduring a decremental positive end-expiratory pressure trial. Crit Care. 2014 May 10;18(3):R95. doi: 10.1186/cc13866. PubMed PMID: 24887391; PubMed Central PMCID: PMC4095609.

10: Zhao Z, Frerichs I, Pulletz S, Müller-Lisse U, Möller K. The influence ofimage reconstruction algorithms on linear thorax EIT image analysis ofventilation. Physiol Meas. 2014 Jun;35(6):1083-93. doi:10.1088/0967-3334/35/6/1083. Epub 2014 May 20. PubMed PMID: 24845059.

11: Grychtol B, Adler A. Choice of reconstructed tissue properties affectsinterpretation of lung EIT images. Physiol Meas. 2014 Jun;35(6):1035-50. doi:10.1088/0967-3334/35/6/1035. Epub 2014 May 20. PubMed PMID: 24844670.

12: Bläser D, Pulletz S, Becher T, Schädler D, Elke G, Weiler N, Frerichs I.Unilateral empyema impacts the assessment of regional lung ventilation byelectrical impedance tomography. Physiol Meas. 2014 Jun;35(6):975-83. doi:10.1088/0967-3334/35/6/975. Epub 2014 May 20. PubMed PMID: 24844247.

13: Pikkemaat R, Lundin S, Stenqvist O, Hilgers RD, Leonhardt S. Recent advances in and limitations of cardiac output monitoring by means of electrical impedance tomography. Anesth Analg. 2014 Jul;119(1):76-83. doi:10.1213/ANE.0000000000000241. PubMed PMID: 24810260.

14: Bodenstein M, Boehme S, Bierschock S, Vogt A, David M, Markstaller K.Determination of respiratory gas flow by electrical impedance tomography in ananimal model of mechanical ventilation. BMC Pulm Med. 2014 Apr 29;14:73. doi:10.1186/1471-2466-14-73. PubMed PMID: 24779960; PubMed Central PMCID: PMC4012093.

15: Li Y, Tesselaar E, Borges JB, Böhm SH, Sjöberg F, Janerot-Sjöberg B.Hyperoxia affects the regional pulmonary ventilation/perfusion ratio: anelectrical impedance tomography study. Acta Anaesthesiol Scand. 2014Jul;58(6):716-25. doi: 10.1111/aas.12323. Epub 2014 Apr 25. PubMed PMID:24762189.

16: Frerichs I, Becher T, Weiler N. Electrical impedance tomography imaging ofthe cardiopulmonary system. Curr Opin Crit Care. 2014 Jun;20(3):323-32. doi:10.1097/MCC.0000000000000088. PubMed PMID: 24739268.

17: Moens Y, Schramel JP, Tusman G, Ambrisko TD, Solà J, Brunner JX, Kowalczyk L,Böhm SH. Variety of non-invasive continuous monitoring methodologies includingelectrical impedance tomography provides novel insights into the physiology oflung collapse and recruitment – case report of an anaesthetized horse. VetAnaesth Analg. 2014 Mar;41(2):196-204. PubMed PMID: 24734295.

18: Crabb MG, Davidson JL, Little R, Wright P, Morgan AR, Miller CA, Naish JH,Parker GJ, Kikinis R, McCann H, Lionheart WR. Mutual information as a measure of image quality for 3D dynamic lung imaging with EIT. Physiol Meas. 2014May;35(5):863-79. doi: 10.1088/0967-3334/35/5/863. Epub 2014 Apr 8. PubMed PMID: 24710978; PubMed Central PMCID: PMC4059506.

19: Wi H, Sohal H, McEwan AL, Woo EJ, Oh TI. Multi-frequency electrical impedancetomography system with automatic self-calibration for long-term monitoring. IEEE Trans Biomed Circuits Syst. 2014 Feb;8(1):119-28. doi:10.1109/TBCAS.2013.2256785. PubMed PMID: 24681925.

20: Krause U, Becker K, Hahn G, Dittmar J, Ruschewski W, Paul T. Monitoring ofregional lung ventilation using electrical impedance tomography after cardiacsurgery in infants and children. Pediatr Cardiol. 2014 Aug;35(6):990-7. doi:10.1007/s00246-014-0886-6. Epub 2014 Feb 26. PubMed PMID: 24569885.

21: Zhao Z, Pulletz S, Frerichs I, Müller-Lisse U, Möller K. The EIT-based globalinhomogeneity index is highly correlated with regional lung opening in patientswith acute respiratory distress syndrome. BMC Res Notes. 2014 Feb 6;7:82. doi:10.1186/1756-0500-7-82. PubMed PMID: 24502320; PubMed Central PMCID: PMC3922336.

22: Shi C, Boehme S, Bentley AH, Hartmann EK, Klein KU, Bodenstein M, BaumgardnerJE, David M, Ullrich R, Markstaller K. Assessment of regional ventilationdistribution: comparison of vibration response imaging (VRI) with electricalimpedance tomography (EIT). PLoS One. 2014 Jan 27;9(1):e86638. doi:10.1371/journal.pone.0086638. eCollection 2014. PubMed PMID: 24475160; PubMedCentral PMCID: PMC3903564.

23: Marinho LS, Sousa NP, Barros CA, Matias MS, Monteiro LT, Beraldo Mdo A, CostaEL, Amato MB, Holanda MA. Assessment of regional lung ventilation by electricalimpedance tomography in a patient with unilateral bronchial stenosis and ahistory of tuberculosis. J Bras Pneumol. 2013 Nov-Dec;39(6):742-6. doi:10.1590/S1806-37132013000600013. English, Portuguese. PubMed PMID: 24473768;PubMed Central PMCID: PMC4075903.

24: Durlak W, Kwinta P. Role of electrical impedance tomography in clinicalpractice in pediatric respiratory medicine. ISRN Pediatr. 2013 Dec25;2013:529038. doi: 10.1155/2013/529038. eCollection 2013 Dec 25. Review. PubMedPMID: 24455294; PubMed Central PMCID: PMC3886230.

25: Karsten J, Krabbe K, Heinze H, Dalhoff K, Meier T, Drömann D. Bedsidemonitoring of ventilation distribution and alveolar inflammation incommunity-acquired pneumonia. J Clin Monit Comput. 2014 Aug;28(4):403-8. doi:10.1007/s10877-014-9549-7. Epub 2014 Jan 17. PubMed PMID: 24435618.

26: Czaplik M, Antink CH, Rossaint R, Leonhardt S. Application of internalelectrodes to the oesophageal and tracheal tube in an animal trial: evaluation ofits clinical and technical potentiality in electrical impedance tomography. JClin Monit Comput. 2014 Jun;28(3):299-308. doi: 10.1007/s10877-013-9536-4. Epub2013 Nov 27. PubMed PMID: 24281746.

27: Karsten J, Meier T, Iblher P, Schindler A, Paarmann H, Heinze H. Thesuitability of EIT to estimate EELV in a clinical trial compared to oxygenwash-in/wash-out technique. Biomed Tech (Berl). 2014 Feb;59(1):59-64. doi:10.1515/bmt-2012-0076. PubMed PMID: 24114891.

28: Karsten J, Heinze H, Meier T. Impact of PEEP during laparoscopic surgery onearly postoperative ventilation distribution visualized by electrical impedancetomography. Minerva Anestesiol. 2014 Feb;80(2):158-66. Epub 2013 Jul 23. PubMedPMID: 23877309.

EIT is probably a revolution in mechanical ventilation. Constantin et.al. Crit. Care 2014, 16:164

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Who is Swisstom?

Med-Tech start-up, Landquart Switzerland, operational start August 2011

Team: 2 founders (1 Ing, 1 Dr. med.), 12 highly skilled employees

Proprietary Technology: Electrical Impedance Tomography (EIT), 6 patents

Business Model: Devices and EIT modules for integration by third parties

Quality Management System: ISO 13485, CE Mark received

Financing: Private Equity

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Next challenges

Investment Round D (3 million CHF)

Increase Market Awareness

Contact: Dr. Josef X. Brunner, jxb@swisstom.com

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