Non-invasive Continuous Blood Pressure Monitoring

The purpose of this study is to validate PyrAmes's non-invasive blood pressure measurements against invasive blood pressure measurements taken with a reference device that is routinely used in a hospital setting, is generally regarded as accurate, and is routinely used in the diagnosis and treatment of patients. In this case, the reference device is the invasive arterial line, which is routinely used in the care of infants in intensive care settings to collect accurate, continuous invasive blood pressure measurements.

The specific aim of this study is to record data obtained by use of the Boppli device, along with invasive measurements of blood pressure, for use in validating the Boppli device measurements and algorithm. The changes in capacitance will serve as an input for the Boppli algorithm and systolic, diastolic, and mean arterial pressure will be output. The measurements generated from the non-invasive Boppli Device will be validated against the invasive measurements from the reference device. This is a prospective, multi-center clinical study to validate the effectiveness of the Boppli Blood Pressure Monitor as compared to an invasive arterial reference. The study will evaluate the accuracy and precision of the Boppli system for continuous blood pressure monitoring by comparing SBP (systolic blood pressure), DBP (diastolic blood pressure), and MAP (mean arterial pressure) against the reference methodology.

Invasive arterial lines (IAL) were selected as the comparator for this study. IALs are the current gold standard for continuous blood pressure monitoring for infants in intensive care settings. Sphygmomanometers are widely used for non-invasive blood pressure monitoring among other populations but have documented issues with accuracy in patients with very low blood pressures, which includes many neonates and pediatric patients. Due to their potentially low accuracy in detecting blood pressure in infants, the manual sphygmomanometer is not regarded as an appropriate comparator for the Boppli device.

As stated in reference standards ISO 81060-2 and ANSI SP10, intra-arterial methods should not be used for subjects solely for the purpose of validating instrument performance. However, the SP10 standard states that in validation studies in children less than 3 years of age, the intra-arterial method should be used as the reference standard. In addition, it is noted that ISO 81060-2 explicitly states that children less than 3 years of age should not be included in clinical investigations using auscultatory reference readings. Therefore, this study will be conducted on clinical subjects (neonates/infants) in whom an intra-arterial line has already been placed for reasons other than validating instrument performance.

Primary objective: To assess the accuracy and precision of the Boppli system in measuring SBP, DBP, and MAP as compared to an invasive arterial line for continuous blood pressure monitoring.

Secondary Objective: To assess the safety of the Boppli system in a clinical setting.

Methods: Data to assess device efficacy, subject safety, and subject demographics will be collected from the Investigational sites. Data will be collected using an electronic data collection system (EDC) designed to comply with 21 CFR Part 11 and will be recorded into the electronic Case Report Form (eCRF). Primary source documentation will come directly from the subject's medical record

Inclusion criteria

Groups 1 - 4:

• Pediatric patients less than 1 year of age and less than 5000 g in weight (primary target)
• Requires intra-arterial blood pressure monitoring

Group 5:

• Pediatric patients
• Requires intra-arterial blood pressure monitoring

NOTE: Under no circumstance should an invasive arterial line be implanted in a patient due to this study, if not medically necessary.

Exclusion criteria

• Skin conditions that limit the placement of the device
• Patients connected to or treated by other devices that may alter the pulse waveform
• Patients with a cardiac or vascular malformation that results in an abnormal waveform inappropriate to be considered a reference standard.