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Thinking Out of the (Big) Box: A Wearable Near-Infrared Spectroscopy Monitor for the Helicopter Emergency Medical Service.

OBJECTIVE: In prehospital helicopter emergency medical service (HEMS) settings, the medical team has limited monitoring options, usually restricted to systemic variables. Regional tissue oxygenation (rO2 ) can be assessed by near-infrared spectroscopy (NIRS), but clinical NIRS monitors are unpractical ("big boxes" and additional cables) in HEMS. As an alternative, we identified a wearable, athlete training NIRS device (Moxy; Idiag, Fehraltorf, Switzerland) and hypothesized that it would be applicable in our HEMS setting.

METHODS: This feasibility study was performed at the Dutch HEMS Lifeliner 1. The Moxy sensor was tested in-flight and on ground. We tested various anatomic measurement spots, and multiple conditions and interventions were imposed to track rO2 .

RESULTS: The rO2 measurements with the wearable Moxy NIRS device are both feasible and practical in an HEMS setting. Multiple conditions and interventions were tested successfully (eg, tourniquet placement [rO2 ↓], muscle compression [rO2 ↓], reperfusion [rO2 ↑], oxygen administration [rO2 ↑], hyperemia [rO2 ↑], and venous congestion [rO2 ↓]).

CONCLUSION: Our results suggest that rO2 measurements with the wearable Moxy NIRS device are both feasible and practical in HEMS, and Moxy allows the tracking of simulated pathophysiologic effects on rO2 . Future studies will have to verify our preliminary data and elucidate if and how wearable NIRS monitoring may support treatment in HEMS and improve patient outcome.

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