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FUSING TWO GREAT IDEAS INTO A LIFE-SAVING PROTOCOL

January 27, 2012

The best innovations often arise from the joining of two distinct, independently developed innovations. Two members of the Faculty of Medicine are on their way to proving that principle yet again.

Peter von Dadelszen, a Professor in the Department of Obstetrics and Gynaecology, has combined his model for diagnosing pre-eclampsia (high blood pressure during pregnancy) with mobile technology, developed by Mark Ansermino, an Associate Professor in the Department of Anesthesiology, Pharmacology and Therapeutics, that measures oxygen saturation in the blood.

The pairing of the diagnostic and treatment plan with the mobile technology was deemed so compelling that it won a seed grant of $250,000 from the international competition, “Saving Lives at Birth: A Grand Challenge for Development.”  Their selection was one of 19 chosen from among 600 applicants in the competition sponsored by the U.S. Agency for International Development, the Bill & Melinda Gates Foundation, Grand Challenges Canada, the World Bank, and the Government of Norway.

The goal of Dr. von Dadelszen and Dr. Ansermino, both scientists at the Child & Family Research Institute, is to catch the onset of pre-eclampsia, which could lead to seizures, stroke or failure of the lungs, kidneys or liver. It’s the second-leading cause of maternal death worldwide, killing 76,000 women a year – almost all of them in lower- and middle-income countries.

Dr. von Dadelszen has devoted much of his career to developing a diagnostic and triage framework tailored to low-resource settings. Last year, the Gates Foundation awarded him $7 million to test a battery of new strategies to monitor, prevent and treat the condition, including a trial to determine the efficacy of calcium supplements, a program for diagnosis and triage with simple lab tests (or no lab tests at all) and creation of a “treatment pipeline” from remote villages to properly-equipped medical facilities. (See “Setting a Global Dragnet for Pre-eclampsia,” UBC Medicine, spring 2011.)

Meanwhile, Dr. Ansermino has spent years working with Guy Dumont, a Professor in the Department of Electrical and Computer Engineering, on various ways of collecting, synthesizing and transmitting data to anesthesiologists and surgeons. After developing tools intended for operating rooms in Canada and other nations with advanced medical systems, they have turned their attention to technology for low-resource settings – in particular, a mobile phone-based pulse oximeter, which uses a probe fitted over a patient’s finger to measure blood oxygen levels. Their work won the prestigious and lucrative ($250,000) Brockhouse Canada Prize from the Natural Sciences and Engineering Research Council of Canada this year. (See “Applying Algorithms to Anesthesia,” UBC Medicine, spring 2011.)

With both the pre-eclampsia project and the anesthesia efforts receiving high-profile recognition, it was perhaps inevitable that these two strands – with their focus on improving health in the developing world – would come together.

The key element of their proposal is the fact that low oxygen levels, or hypoxia, is not only a threat during surgery; it also is one of the symptoms of pre-eclampsia. A level below 93 per cent of baseline is associated with a high risk of adverse outcomes, either for the mother or the fetus.

“So we are integrating a cellphone-based pulse oximeter with the predictive scoring system for diagnosing the risk of pre-eclampsia, to better predict the likelihood that a pregnant woman will develop complications,” Dr. Ansermino says.

The funding will be used to develop a customized pulse oximetry application geared specifically for pre-eclampsia detection, along with data-entry fields for additional information that is necessary to calculate a risk score. The application will respond with advice to the user about next steps, including treatment or referral.  While the device can function on its own without connection to a network, if connected it can also transmit that information to referral centres.

Once developed, Dr. Ansermino and Dr. von Dadelszen will test the application and hardware in Zimbabwe and South Africa, comparing results with clinics that aren’t using the technology.  In two years, if their idea proves its worth in the field, it’s eligible for another $2 million from the Saving Lives at Birth competition.

“We have to get this device into the hands of people in the community – work it through, find the bugs, refine the algorithms,” Dr. von Dadelszen says. “If it works, it has the potential of saving many women’s lives.”

REPRINTED WITH PERMISSION FROM UBC MEDICINE, FALL 2011, VOL. 7, NO. 2