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Early-stage innovation report
Evaluation of a novel wireless near-infrared spectroscopy (NIRS) device in the detection of tourniquet induced ischaemia
  1. Madelaine Gimzewska1,
  2. Melissa Berthelot2,
  3. Pawandeep Sarai3,
  4. Luke Geoghegan1,
  5. Sarah Onida1,
  6. Joseph Shalhoub1,
  7. Paul Strutton3,
  8. Alun Davies1
  1. 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
  2. 2 The Hamlyn Centre, Imperial College London, London, UK
  3. 3 The Nick Davey Laboratory, Department of Surgery and Cancer, Imperial College London, London, UK
  1. Correspondence to Madelaine Gimzewska, Department of Academic Vascular Surgery, Imperial College London, London, UK; m.gimzewska{at}imperial.ac.uk

https://doi.org/10.1136/bmjinnov-2021-000752

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    Summary box

    What are the new findings?

    • Current near-infrared spectroscopy (NIRS) and visible light spectroscopy devices are expensive, cumbersome, wired and have a large footprint, limiting their use in clinical practice.

    • This study proposes the use of a novel NIRS device, which is small, wireless and inexpensive, overcoming current physical and technological barriers to other spectroscopy device uptake.

    How might it impact on healthcare in the future?

    • The real-time assessment of tissue perfusion may detect ischaemia earlier than in current clinical practice, especially in high-risk patients.

    • Future work should include large-scale prospective studies using wireless, real-time NIRS monitoring to determine its impact on outcomes in acute limb ischaemia.

    Introduction

    Acute limb ischaemia is a vascular emergency threatening both life and limb, with estimated mortality rates of 9%–22%,1 and 30-day extremity amputation rates of 10%–30%.2 3 Timely identification of the acutely ischaemic limb is pivotal.4 Conventional methods of assessing limb ischaemia rely on repeated clinical examination, serial assessment of Doppler signals and imaging technology such as duplex ultrasound, digital subtraction angiography, CT angiography and MR angiography. While able to assess arterial compromise, these technologies are limited as they provide data for only a single time point, and imaging modalities are high in cost and low in portability. The ability to non-invasively and continually monitor for limb ischaemia could enable identification of compromised tissue earlier, prompting faster revascularisation and reducing complications associated with prolonged ischaemia.

    A growing interest in the role of the microcirculation in tissue perfusion5 has led to the use of near-infrared spectroscopy (NIRS) devices in the evaluation of limb ischaemia.4 6 NIRS is a non-invasive spectroscopy method of obtaining regional tissue oxygen saturation (StO2), using light wavelengths in the red and near-red range of the spectrogram. NIRS-based devices can reliably identify the ratio of oxygenated haemoglobin (HbO2) and deoxyhaemoglobin (HHb) present in tissue, and as such are able to …

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