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Blood Gas Electrolyte

Aiding COVID-19 efforts

For COVID-19 patients that show signs of respiratory distress, or who have been placed on ventilation support, blood gas testing is critical. Calculating arterial blood gas values from venous blood may circumvent the need to draw blood from arterial punctures.

The damage that COVID-19 causes in patients requires a number of medical interventions, assisted by a number of different diagnostics. While there is much focus on reverse transcription polymerase chain reaction (RT-PCR) tests for detecting SARS-CoV-2 infection in patients or in the population, once a patient is at the hospital, other tests come into play.

Critical care tests such as electrolytes and blood gases are essential for treatment decisions. Blood gas, or more specifically, arterial blood gas, is one of the most commonly used tests to measure oxygenation and blood acid levels and diagnose respiratory and renal conditions. If a COVID-19 patient cannot move oxygen into the blood and remove carbon dioxide from the blood, his or her respiratory system is critical.

Thus, it should be no surprise that reports from test vendors and indications as Kalorama Information point to blood gas testing as one of the few test category winners amid sagging test volumes generally. Hospital end users reported increased volume recently. Because blood gas is also used in trauma and surgeries, and those have declined due to nationwide surgery cancellations and fewer emergency room visits, even a slight uptick in volume is notable.

In critical care medicine, blood gas analysis is combined with other critical care analytes including bilirubin for neonates, glucose, blood urea nitrogen (BUN), creatinine, calcium, ionized calcium, magnesium, lactate, pH, hemoglobin, and hematocrit. Blood gases, oximetry, and a cardiac marker panel are added for patients with chest pain. The most advanced critical care test devices include various cartridge combinations of gases, electrolytes, and others depending on the patient care situation. These may be used for point-of-care testing in intensive care units, emergency rooms, ambulances, and other acute care venues as well as in laboratories.

Though it is a mature test category, blood gas test technology has changed over time. Information technology innovations have improved performance and interpretation in blood gas testing. Vendors have announced CE Mark availability and digital software that allows clinicians to obtain results for arterial blood gas values through the use of a digital algorithm. Custom connectivity addition is also being done to the systems, featuring an at-a-glance dashboard, and simple web access from any browser, with remote control of analyzer configuration and the ability to monitor critical care operators from a central location.

Market dynamics
The analyzers are important in the critical care units to determine the blood gas, pH, electrolytes, and some metabolites in the whole blood specimen. The technological advancement in the past decade has significantly improved the method of diagnosis and treatment in the healthcare facilities. The recent advances have enabled clinicians to direct therapy and improve patient outcomes.

Modern analyzers come in a variety of sizes from hand-held to portable desktop systems, which are more user-friendly, more automated, and require less technical expertise and maintenance by the end user compared with earlier analyzers.

Current new analyzers are a typical instrument for point-of-care testing (POCT) and are being installed in emergency treatment facilities and can rapidly evaluate multiple items. PoC analyzers combine increased accessibility and cost-effectiveness with reduced maintenance requirements compared with more traditional benchtop analyzers, facilitating their increasing use in routine perioperative and intensive care settings.

PoC blood gas and electrolyte analyzers also facilitate analysis of the blood sample near the bedside (and especially in the delivery room), which results in accelerated clinical decision making versus that in the hospital central laboratory. Arterial, venous, and capillary blood gas samples can now be analyzed in the NICU, reducing pre- and post-sample collection errors and reducing time to results.

The oxygen saturation of hemoglobin calculation fails to account for dyshemoglobins. A co-oximeter is preferable in this instance as it can directly measure different hemoglobin species. For this reason, most modern blood gas analyzers also incorporate a co-oximeter.

Introduction of innovative technologies in combination analyzers has led to drastic evolution of blood gas and electrolyte measurement and analysis and has also allowed the advent of hybrid, portable analyzers. Latest technologies incorporated in these systems also facilitate the introduction of blood analysis with the smallest possible quantity of blood sample.

The market is also witnessing introduction of analyzers that are compact in nature, and offer more sensitive test results, along with increasing multi-parameter monitoring capabilities. Recently, there has also been a significant increase in the demand of high throughput and integrated systems that are capable of integrating with EMRs/EHRs enabling high efficiency and workflow.

According to Global Market Insights, India is one of the fastest growing markets in APAC region and is expected to grow at a CAGR of 10.5 percent from 2019–2023 attributed to rise in awareness regarding diagnosis of asthma, and other respiratory disorders. The country has faced a challenge of air pollution leading to high prevalence rate of respiratory diseases.

Increasing prevalence of diseases and alarming loss of human capital due to aging population has also raised serious health concerns across the nation. Obesity is also a prime predisposing factor for cardiovascular diseases, arthritis, and diabetes, among others.

Hence, government is encouraging innovation in medical technology to curb this crisis. Shortage of technical expertise in the country to operate the analyzers and huge maintenance costs has led to increase in adoption of automated and self-contained analyzers.

The global blood gas and electrolyte analyzers market size surpassed USD 3.6 billion in 2019 and is poised to grow at a CAGR of over 6.9 percent between 2020 to 2026, estimates Global Market Insight. Growing prevalence of chronic disorders coupled with technological advancements in blood gas and electrolyte analyzers are major factors for market growth. In addition, rising geriatric population will positively influence the market growth. The geriatric population is mostly prone to hypoxemia, cardiogenic shock, cardiopulmonary resuscitation and cardiac arrhythmias.

The management of these life-threatening conditions immensely relies on rapid blood gas analysis thereby upsurge the market demand. Furthermore, increasing adoption of high throughput and integrated systems in central laboratories, as well as point-of-care systems, will help in driving the market size.

However, high cost associated with advanced analyzers and stringent regulatory landscape may hamper blood gas and electrolyte analyzers industry growth over the next 6 years.

The bench top segment was valued around USD 1.3 billion in 2019 and is estimated to grow significantly. Adoption of bench top analyzers for arterial blood gas analysis will upsurge segmental growth. Bench top analyzers provide a range of benefits such as individual biosensor technology, broad test menu and low cost of operation. Such benefits will drive in expanding the market growth.

Prominent players in the segment include Radiometer Medical (Danaher), Instrumentation Laboratory, Nova Biomedical, Roche, Abbott Laboratories, OPTI Medical (IDEXX Laboratories), Siemens Healthcare, Medica Corporation, Techno Medica Co., Ltd, Sensa Core Medical Instrumentation, Sphere Medical, JOKOH Co., Ltd., LifeHealth, Meizhou Cornley Hi-Tech, Perlong Medical, Edan Instruments, and Wuhan EasyDiagnosis Biomedicine.

Increasingly diagnostic centers, hospitals and R&D centres are getting equipped with advanced infrastructure as well as equipment needed in ICU, and  different types of blood gas and electrolyte analyzers are becoming a part of their must have list. Furthermore, applications of blood gas and electrolyte analyzers, in the measurement of various elements and disease detection such as sodium, pH, and glucose are anticipated to foster the blood gas and electrolyte analyzers industry growth. 

Industry Speak

Technological advancements and emerging trends

Santosh Aghamkar
Director–South Asia
Medica Corporation

Over the past three decades, the power of simplicity and ease-of-use has enabled many technologists to report fast and accurate patient results in the most critical settings. Moving forward, the industry is aligned in designing innovative products that meet and exceed the expanding needs of critical care, biochemistry, and hematology segments within various hospital classes and private labs in India and globally.

Blood gas measurements have evolved from gas tank-based, large analyzers to small, compact analyzers that are easy to use and operate with self-contained, liquid-tonometered calibrators in convenient snap-in packs. The technology interface used in many blood gas analyzers facilitates measurement of PO2, PCO2, and pH, as well as electrolytes, utilizing disposable, maintenance-free electrodes. The development of simplified user interfaces using complex, internal algorithms has allowed for the expansion of result reporting to include calculation of parameters important for accurate and timely patient care, such as temperature correction, oxygen saturation, base excess, and bicarbonate concentrations.

The use of minimal sample volumes allows for testing in environments where the collection of syringe samples is not achievable, such as neonates with cardiopulmonary problems where capillary samples are the preferred choice. Blood gas analyzers commonly include universal samplers, which aid in accommodating varying sample collection devices, such as syringes or capillaries used in diverse patient populations.

Acid-base disturbances are common in hospitalized patients, especially in patients with severe viral infections, such as COVID-19. The accurate interpretation of blood gas results is key to managing the progression of disease of patients in critical condition. The prevalent patient conditions and the need for timely results are key factors when deciding on a blood gas analyzer.

Most hospitals, laboratories and COVID-19 centers are in search of a system that will deliver total automation at affordable pricing without making any civil changes in set up, since space is also a major constraint.

In all, those in search of a blood bas analyzer should consider the following features during the selection process:

– Simplicity in operation;

– Accuracy and precision of results;

– Software that supports a quality-control program acceptable worldwide, such as Levey-Jennings charts and plots;

– Consumption of reagent should be as minimal as possible, resulting in lower cost per sample; and

– Capabilities, such as barcode reading and LIS/HIS connectivity are important for accurate result reporting and improvement in the
turn-around-time of reporting patient results.

Second Opinion

Blood gas analyzer–Clinician’s perspective

Dr Tanu Shree
Consultant Intensivist, Obstetric ICU,
Sultaniya Zanana Hospital, GMC, Bhopal

Blood gas and electrolyte analyzers are used to measure different parameters from whole-blood samples, such as pH, blood gas (pCO2 and pO2), electrolytes, and metabolites. The pH value of blood and serum or plasma is an indicator of the balance between the blood, renal (kidney), and lung (respiratory) systems, while the pCO2 value of arterial blood is used to assess efficient elimination of carbon dioxide from the body, a by-product of metabolism; and the pO2 value of arterial blood is a measure of oxygen absorbance by the body in the lungs.

Electrolytes and metabolites give further information about body metabolism. The need for expanded test menus is additionally integrating the functionalities of both blood gas and electrolyte analysis to offer multiple testing of electrolytes, bilirubin, creatinine, and blood urea nitrogen from a single sample.

Blood gas and electrolyte analyzers market size surpassed USD 3.6 billion in 2019 and is poised to grow at a CAGR of over 6.9 percent between 2020 and 2026.

The blood gas and electrolyte analyzer market has been growing rapidly owing to the ageing population, growing prevalence of chronic diseases, rising healthcare expenditure, improving healthcare infrastructure, growing healthcare awareness, and rising demand for point-of-care (POC) testing in ICUs, NICUs, and emergency and trauma units. The geriatric population is mostly prone to hypoxemia, cardiogenic shock, cardiopulmonary resuscitation, and cardiac arrhythmias. The management of these life-threatening conditions immensely relies on rapid blood gas analysis, thereby upsurge in the market demand.

Furthermore, increasing adoption of high-throughput and integrated systems in central laboratories, as well as POC systems, will help in driving the market size.

With current advancements, analyzers have become smaller in size and easier to use. These products have gradually migrated into PoC areas. These advanced products are easy to use in emergency departments where these analyzers help to monitor.

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