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Oklahoma City, OK – January 10, – ESCCO hired Wendi Wilson as President & CEO. With an over twenty year passion for nonprofits and the work they do, Wilson. AbstractBackground. The esCCO monitor (ECG– estimated Continuous Cardiac Output, Nihon Kohden®) is a new non-invasive tool for estimating cardiac output. Background. The esCCO monitor (ECG–SpO2 estimated Continuous Cardiac Output, Nihon. Kohdenw) is a new non-invasive tool for estimating cardiac output (CO). APPLE MACBOOK AIR MODEL A1466 EMC 2925 Accept Reject Cookie and Privacy Policy. Readout can be nice to make it was a. Connect and share me to manage x appears in.

Brad93 Member. Messages 14, Location Essex. Swift cut are doing silly prices on their machines at the minute. Swift cut are doing silly prices on their machines make sure you get Mach 3 software. Revs said:. I would be interested to hear from anyone with an escco machine out there. I remember they came out to my workshop a couple of years back with their display van.. At the time i had never seen a cnc plasma and it blew my mind. I have a site visit booked in on tuesday to see what the procut can do Intrested in the fact it has a higher gantry and can apparently cut up to mm box if i got what the rep was saying correctly.

Thanks Revs Apart from the initial problem with the setup have you had much dealings with swift cut since-any longstanding issues? Just wondering how good their aftercare is. Im just wondering about crap building up on the exposed gantry rails etc I had a problem with the z axis which required a new stepper motor to be fitted. They posted 2 of them down to me so I have a spare. Pretty easy to swap over.

Machine is in Plymouth so not the closest to send an engineer. It is very intermittent. The warranty has ran out, and strangely not been contacted to see if I want to extend it. Just before the big C hit, I was in the process of arranging a service with a local company who work on behalf of Swiftcut I believe. They will do a full service on it, replace bearing etc. They will also set it up again to get the best cut on any thickness and hopefully sort out the intermittent head raising too.

The service guy did tell me to get it super clean prior to his visit so I can get more of his time to set it up, rather than him cleaning it. Obviously with any complex machine there maybe teething problems like a car or van Booked into see escco next week and i will give the forum some feedback if i get the chance Really appreciate having someone who's not a rep to sound off with I bought a Mantech plasma 4 years ago, still going strong with the hypertherm. My wife has a business making Ovens, im looking on a small 4 x 4 for her but must be right price, mantech , essco and swift are quoting but i had a quote from xtreme last night, the responses are spot on, not hypertherm but a chinese plasma 3 years warranty though and can use hypertherm consumables, doesnt look as heavily built as the mantech but its less than half the price, but has 12 weeks waiting list.

Anyway, Mantech are good ive found and after sales is spot on, but there is lots of competiton now and all offer similar warranties. Jamez New Member. Messages 1 Location leicestershire, England. Hi Johnny, only just seen the thread about this - did you buy a cnc plasma yet?

Thanks , James. Hi james i went with the swift cut in the end but the jury is still out. Having alot of teething problems. Costing time and money. Not sure if its lack of training or genuine hardware issues already had some replacment parts sent still havent had any training sessions so im learning on the fly. Essco messed me around when organising a trip down to their site to see the machine and were genrally slow on response, couldnt offer a competative price unlike swift cut..

Mantech seemed to be quite new on the scene with their plasma table so i went with established firm Overall the swift cut is a very slick machine and the user inteface is straightforward to use althougth there seem to be a few bugs and things to iron out.

However, it does not allow continuous monitoring of CO, hence the search for alternative techniques such as esCCO. For assessing trending ability, despite no current consensus, we have used: i four quadrant plot of serial change in CO with concordance analysis, which is the method most frequently used with the advantage of showing the relationship between paired measurement and permit to compare results from different study and ii the polar plot as described recently by Critchley and colleagues.

Therefore, the esCCO monitor cannot be recommended for critically ill patients. An improved calibration algorithm seems necessary for increasing the accuracy of esCCO in the future. No other funding supported this work. The authors wish to thank all the paramedical team of Narbonne Hospital for their help during the implementation of the study. Google Scholar. In the study of Ishihara, 3 the results were not corrected for repeated measurements, therefore the precision 1 SD was underestimated because the statistical analysis was inadequate.

The bias was different, but in this study the author showed a correlation between systemic vascular resistances SVR and the bias. Therefore, the bias shown in the Bland Altman analysis is clearly dependent of the mean SVR of the studied population. Moreover, in the 2 articles mentioned by Drs Faraoni and Barvais, 3, 4 the calibration was different of our study because the calibration for non invasive CO esCCO measurements was made with invasive thermodilution TD.

As describe in our study, the calibration was fully non invasive because the esCCO algorithm with demographics data 5 was used and consequently it was not necessary to insert a pulmonary arterial catheter for non invasive measurements with the esCCO monitor. To our knowledge, only the recent study of Ishihara, 5 published after the acceptation of our article, used the same technique. We think that this difference of 0.

In conclusion, a reliable continous non-invasive monitor of cardiac output represents the "grail" of hemodynamic monitoring, therefore it is very tempting to believe it. But actually, until proven otherwise, it is only an illusion Comparison of esCCO and transthoracic echocardiography for non-invasive measurement of cardiac output intensive care.

Br J Anaesth ; doi A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg ; A new non-invasive continuous cardiac output trend solely utilizing routine cardiovascular monitors. J Clin Monit Comput ; Multicenter study verifying a method of noninvasive continuous cardiac output measurement using pulse wave transit time: a comparison with intermittent bolus thermodilution cardiac output. The ability of a new continuous cardiac output monitor to measure trends in cardiac output following implementation of a patient information calibration and an automated exclusion algorithm.

J Clin Monit Comput ; doi: In our published article, we have already covered many of the questions raised by Dr Dhonneur, but we hope to clarify some of the points raised. The number of measurements was different for each patient and this fact was included in the statistical methodology.

In practice, without a reliable continuous non invasive cardiac output measurement technique, it is difficult to detect a variation of CO and therefore multiple measurements with TTE are necessary for hemodynamic optimization. Moreover this methodology "with a variable number of measurement for each patient" has been used in other publications and was corrected by the use of a linear mixed effect model.

Many operators has used TTE, and it therefore reflects real life. As already described in our study, only one technique was used by all operators using the velocity-time integral of flow through the left ventricular outflow tract. We think Dr Dhonneur is contradicting himself when he note that esCCO studies may be conducted "in pre-hospital medicine field", therefore without diagnosis for the inclusion of the patients, when elsewhere he wrote that the "indications of CO monitoring should have been strictly defined in a selected population" or "did local skin temperature allow CO estimation?

We are not sure that the author included these preliminary conclusions for the adjustment of the alpha and beta risks. And we don't understand how does he make "primary observations" in a "blind fashion" before the end of its study Perhaps the conflict of interest of Dr. Dhonneur disrupts the objectivity of its findings. The author raises the problem of sub-group and selected populations. Moreover, our article is actually the first and only published study on esCCO without conflict of interest.

However, our results are slightly better than the most recent study of Ishihara and colls. British journal of anaesthesia ; Statistical models for assessing agreement in method comparison studies with replicate measurements. Myles PS, Cui J. Using the Bland-Altman method to measure agreement with repeated measures.

Br J Anaesth ; Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation ; Curzer HJ, Santillanes G. Managing conflict of interest in research: some suggestions for investigators. Accountability in research ; Assessment of trending ability of cardiac output monitors by polar plot methodology.

J Cardiothorac Vasc Anesth ; Comparison of esCCO and transthoracic echocardiography for non- invasive measurement of cardiac output intensive care. Editor - I have read with interest the article published by Bataille et al.

The authors aimed to evaluate the correlation and agreement of esCCOTM with that of transthoracic echocardiography TTE for non-invasive cardiac output CO monitoring in critically ill patients. I would like to address some comments regarding this study. I am surprised that the authors with the blessing of the editors managed to publish this article with responsibility, while it suffers so many methodological gaps.

However, correspondence-induced traffic may be beneficial to the Journal. I believe that a correctly-designed study would have at least required a standardized protocol of CO measurements, in predefined both stable and dynamic situations rather than be based upon hazardous unacceptable "random" decision to evaluate or not CO. Moreover, it would have been interesting and valuable for the quality of the publication to have information regarding the operators that performed CO measurement using TTE.

It seems that the authors performed a mean of mean of Thus changing of operator possibly in quality for the same patient, at 3 different moments of measures performed in different conditions and using diffrent echography techniques to measure CO could be major source of bias. Indications of CO monitoring should have been strictly defined in a selected population of patients which characteristics fit exclusion criteria of the technique.

Unfortunately, the authors did not give any characteristics of the patients they have studied. Without such details, we can only speculate about many possible sources of bias that were not evaluated in this study. What was the cardiac rhythm of the studied patients? Did local skin temperature allow CO estimation? Did the amount of vasoactive agents administered to the patients also influence CO estimation?

How acceptable were the readings of arterial oxygen saturation in these patients? Does the vasomotor tonus in these patients permit adequate CO estimation? What was the level of the quality signal? Timing of measurements should have been anticipated and standardized.

The authors did not propose any classical maneuvers or response to cardiovascular treatment to evaluate not only precision and bias but also the trending reliability of the esCCOTM system. Measurements should have been done in static conditions and after dynamic standardized maneuvers affecting CO. Measurements in response to specific therapeutically active cardiovascular agents, usually a standard for such normally conducted comparative trial, should have been done.

If they had used such recommended standard methodology, the authors would have been able to draw some conclusions regarding possible differences or agreement between the esCCOTM and TEE. Of interest, esCCOTM monitors are equipped with data exportation system allowing data quality monitoring.

It would be very interesting reviewing this data in order to confirm the reliability of the results and the pertinence of the conclusions. I am not a specialist in CO monitoring and I declared a conflict of interest.

We are comparing these monitors in a blind fashion in more than 50 patients to referenced methods which are TTE, transesophageal echocardiography and thermo dilution Swan-Ganz catheter. Although, it is premature to make our results public, our primary observations are quite different from that of the authors. Before discussing our observations, I would like to clear up a semantic difference between: estimation and "exact" measure.

To estimate relates to calculate approximately the amount, extent, magnitude, position, or value of something. To estimate also relates to form an opinion, to make a judgment about something. Based upon our primary results, esCCOTM gave the physician a "clinically" acceptable approximate of CO, a "clinically" pertinent position of the patient cardiac status in the range of CO, and finally, probably most important, esCCOTM allowed the clinicians judging the impact of maneuvers or therapeutics upon CO.

In our experience esCCOTM was pertinent to show the extent or magnitude of change due to cardiovascular therapeutics in the extreme CO value ranges, although less interesting in the normal CO range patients. We agree with some items of the conclusion of Bataille and colls. We are aware that bias and precision calculation is important to compare two techniques of measurement of a physiological parameter.

However, we think that these parameters are possibly not fully adapted when comparing exact measure with estimation. Clinical pertinence should be defined with respect of the potentially beneficial or deleterious outcome for the patients. We believe that esCCOTM should be viewed and tested as a triage monitor allowing 1-identifying abnormal range CO patients, 2- selecting patients that should be monitored more invasively using precise validated CO measurement methods, 3- identifying initial response of the patients to cardiovascular therapeutics, and 4- defining the time to lighten cardiovascular invasive monitoring to fully non-invasive calibrated esCCOTM.

In the present study, the lack of anticipated study design, associated with no preemptive dimensioning strategy for this trial has prevented scientific results to be exploited and lead to possibly wrong conclusion. The authors are possibly right, but they have certainly used the wrong weapon for the wrong war. They are proposing the BJA readers superb but useless radar figures possibly presented to hide the poverty and the gaps of the method.

Finally, the authors armed in a "non scientific way" esCCOTM which is the only strictly non invasive and continuous method proposed to estimate CO. With their study the authors attempted to nip in the bud, free of charge, using an inappropriate way, a possibly promising method which could become, if validated scientifically, a standard of care for many patients. Br J Anaesth doi Editor - We read with interest the article published by Bataille et al.

The study tried to evaluate the correlation and agreement of esCCO compared to transthoracic echocardiography TTE for non-invasive cardiac output CO monitoring in critically ill patients. The authors did not standardize the timing for CO measurement. Indeed, they wrote that cardiac output was repeated each time a patient required a CO reading during a period when an investigator was available.

They also describe that a variable number of CO readings were obtained per patient but no data is given to understand the timing, the clinical condition and the reason why the operator chose to measure CO. This design is particularly unusual. We thought that a well-designed study needs a standardized protocol and should not be based on a random decision to evaluate or not the CO.

Moreover, no information was given about the physician who performed TTE. Indeed, it is well established that echography is an operator-dependent technique and changing operators could be a major source of bias. We agree that esCCO is a new device and further studies are needed to assess the correlation between this device and "gold standard" monitoring. We also agree that echocardiography appears the "gold standard" for CO evaluation by a non-invasive method.

If the authors wanted to evaluate the efficacy of esCCO to monitor non-invasive CO, they need to perform a well-designed study, with standardized timing measures, by taking into account patients characteristics, and possible source of bias.

Unfortunately, the authors did not give any information about patient's characteristics. Without such details, we could imagine that they put into the same group: patients with severe sepsis, trauma, acute respiratory distress syndrome, postoperative patients and others. We could not agree with this design because none, invasive or non-invasive, monitoring should be used without a careful attention to the patient. Moreover, different possible source of bias were not yet evaluated with esCCO.

Does local skin temperature influence the result? Does the amount of vasoactive agents administered to the patient also influence? Does the vasomotor tonus in septic patient permit adequate measurement? Finally, we agree that correlation tests and Bland-Altman method appear adequate for this study.

However, the Bland-Altman Analysis has led to poor results. This could easily be explained by the small number of patients included in the analysis and the heterogeneity between the different measures timing, patient status, co- morbidities, temperature, The esCCO was initially compared to continuous thermodilution CO in 36 postoperative cardiac surgery patients.

These results are fare away from the results found in the BJA's study. In conclusion, we thought that even this study could be of some interests, the design do not permit an adequate evaluation of the utility of esCCO to monitor non-invasive CO in critically ill patient.

In order to evaluate the quality of this device, well-designed study is required. The protocol might be systematized, must take into account patient characteristics but also identify potential sources of bias by adequate statistical analysis.

Limits and pitfalls of haemodynamic monitoring systems in liver transplantation surgery. Minerva Anestesiol August 2. Epub ahead of print. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

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SSC Amanda Corley et al. Highflow nasal cannulae for respiratory support in adult intensive care patients. Asfar P et al. Engl J Med ; Accuracy of procalcitonin for diagnosis of sepsis in adults: a Meta-analysis. Christopher W. Seymour et al. Published online Dec Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, Intensive Care Med. Dellinger RP, et al. Recommendations for sepsis management in resource-limited settings.

Intensive Care Medicine ;—74 Crit Care. Leisman DE et al. Crit Care Med ; Leone M et al. Crit Care Mar 10; Levy, Mitchell M. Maurizio Cecconi et al. Consensus on circulatory shock and hemodynamic monitoring. Eur J Anaesthesiol dysfunction in cirrhosis. Your most recent searches Delete. Frequent searches. Other sections. Catalog excerpts. Open the catalog to page 2.

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