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Acumen Hypotension Prediction Index software

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Hypotension prediction index image

Acumen Hypotension Prediction Index (HPI) software is a first-of-its-kind technology that detects hemodynamic instability.

Studies have shown Acumen HPI software:

Demonstrated a 57% reduction in duration of intraoperative hypotension^*1

*Prospective, single-arm multicenter study in noncardiac surgical patients requiring arterial line monitoring compared to a historical control.

Demonstrates accuracy to predict the likelihood of hypotension.²

Demonstrates superior predictive abilities for hypotension over common hemodynamic parameters such as cardiac output (CO), stroke volume (SV), and changes in mean arterial pressure (MAP).³

Key elements of the Acumen HPI software

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HPI Parameter

The HPI parameter displays as a value ranging from 0 to 100, with higher values indicating higher likelihood of a hypotensive event.*

The HPI parameter value is updated every 20 seconds, providing continuous predictive insights into developing hypotension.

HPI High Alert Popup

The HPI high alert popup alerts you when your patient is trending towards or experiencing a hypotensive event.*

If the HPI parameter value exceeds 85 for two consecutive 20-second updates or reaches 100 at any time, the HPI high alert popup window will appear, prompting you to review the patient hemodynamics using the HPI secondary screen.

HPI high alert popup

HPI Secondary Screen

The secondary screen provides you insights into the cause of hypotension, and hemodynamic parameters are arranged visually by preload, afterload and contractility.

It provides a complete hemodynamic picture of your patient. Parameters displayed include MAP, CO, CI, SVR, PR, SV and SVV/PPV, as well as HPI, dP/dt, and Eadyn.

Relationship View screen

Preload

Stroke volume variation (SVV) or pulse pressure variation (PPV)

The percent difference between minimum and maximum stroke volume (SV) or pulse pressure (PP) during a respiratory cycle.

Contractility

Systolic slope (dP/dt)

Maximum upslope of the arterial pressure waveform from a peripheral artery.

Afterload

Dynamic arterial elastance (Ea_dyn)

The ratio of pulse pressure variation to stroke volume variation.

HPI high alert popup

Relationship View screen

HPI Parameter

The HPI parameter displays as a value ranging from 0 to 100, with higher values indicating higher likelihood of a hypotensive event.*

The HPI parameter value is updated every 20 seconds, providing continuous predictive insights into developing hypotension.

HPI High Alert Popup

The HPI high alert popup alerts you when your patient is trending towards or experiencing a hypotensive event.*

If the HPI parameter value exceeds 85 for two consecutive 20-second updates or reaches 100 at any time, the HPI high alert popup window will appear, prompting you to review the patient hemodynamics using the HPI secondary screen.

HPI Secondary Screen

The secondary screen provides you insights into the cause of hypotension, and hemodynamic parameters are arranged visually by preload, afterload and contractility.

It provides a complete hemodynamic picture of your patient. Parameters displayed include MAP, CO, CI, SVR, PR, SV and SVV/PPV, as well as HPI, dP/dt, and Eadyn.

Preload

Stroke volume variation (SVV) or pulse pressure variation (PPV)

The percent difference between minimum and maximum stroke volume (SV) or pulse pressure (PP) during a respiratory cycle.

Contractility

Systolic slope (dP/dt)

Maximum upslope of the arterial pressure waveform from a peripheral artery.

Afterload

Dynamic arterial elastance (Ea_dyn)

The ratio of pulse pressure variation to stroke volume variation.

*A hypotensive event is defined as MAP <65 mmHg for a duration of at least one minute.

Clinical evidence

2020 Wijnberge, et al.

Publication in JAMA: “Effect of a Machine Learning–Derived Early Warning System for Intraoperative Hypotension vs Standard Care on Depth and Duration of Intraoperative Hypotension During Elective Noncardiac Surgery: The HYPE Randomized Clinical Trial"^†

This study demonstrated that Acumen HPI software combined with a treatment protocol achieved statistically significant reduction in hypotension vs. standard of care.

Elective, noncardiac surgery patients monitored with Acumen HPI had a median time of hypotension per patient of 8 minutes compared to 32.7 minutes in the control group.

Time-weighted average of hypotension combines the duration and the severity of hypotension corrected for the total duration of the procedure. With Acumen HPI, the study showed a median .38 mm Hg (95% CL) difference between the interventional and control group.⁴

2019 Schneck, et al.

Publication in the Journal of Clinical Monitoring and Computing: "Hypotension Prediction Index based protocolized haemodynamic management reduces the incidence and duration of intraoperative hypotension in primary total hip arthroplasty: a single centre feasibility randomised blinded prospective interventional trial"^†

In this single center feasibility study, Acumen HPI software combined with protocolized treatment was shown to reduce the relative and absolute duration of hypotension in total hip arthroplasty patients, in comparison to a historical and prospective control group.⁵

2019 Davies, et al.

Publication in Anesthesia and Analgesia: "Ability of an Arterial Waveform Analysis–Derived Hypotension Prediction Index to Predict Future Hypotensive Events in Surgical Patients"^†

In this 255 patient, 2-center retrospective analysis study, when compared with hemodynamic parameters such as SV, CO, SVV, and MAP, Acumen HPI software showed a higher predictive performance at 5 and 10 minutes before hypotension.³

2018 Hatib, et al.

Publication in Anesthesiology: "Machine-learning Algorithm to Predict Hypotension Based on High-fidelity Arterial Pressure Waveform Analysis"^†

Acumen HPI software demonstrated high accuracy in predicting hypotension.

An internal validation of 350 patient records demonstrated that 10 minutes before an event, Acumen HPI software predicted hypotension with a specificity and sensitivity of 89% and 90% respectively, and with an AUC of 0.95 (CL 95%).²

^†Studies conducted with arterial line monitoring

Risk of hypotension

Though intraoperative hypotension (IOH) is common in surgical patients, numerous studies indicate that it is strongly associated with risk of myocardial injury (MI), acute kidney injury (AKI), and mortality.^6,7

Acumen HPI software is effective in detecting hemodynamic instability and substantially reducing the duration of IOH during noncardiac surgery.^*

*Compared to a retrospective historical control group, in patients requiring arterial line monitoring¹

IOH is common⁹

88% of patients continuously monitored with an arterial line still experienced hypotension, defined as MAP <65 mmHg for 1 minute.⁹

IOH has elevated risks

Prolonged exposures below MAP thresholds of 65 mmHg are associated with increased risk of mortality, myocardial injury and AKI after noncardiac surgery.^6,7,10,11

IOH can be reduced¹

Acumen HPI software demonstrated a 57% reduction in duration of intraoperative hypotension.^*1

^*Perspective, single-arm multicenter study in noncardiac surgical patients requiring arterial line monitoring compared to a historical control

Learn more about the risks of IOH

Acumen intelligent decision support suite

Advanced hemodynamic monitoring provides access to continuous pressure and flow parameters, giving you valuable insight into the adequacy of perfusion.

Acumen IQ sensor (minimally-invasive)

Acumen IQ sensor (minimally-invasive)

Acumen IQ sensor unlocks Acumen HPI and Acumen Assisted Fluid Management (AFM) software. The sensor connects to any existing radial arterial line and offers you patients’ hemodynamic status.

Acumen IQ cuff (noninvasive)

Acumen IQ cuff (noninvasive)

Acumen IQ cuff unlocks Acumen HPI software* and provides continuous blood pressure and advanced hemodynamic parameters from a noninvasive finger cuff.

* Acumen HPI parameter is indicated for surgical patients only when using an Acumen IQ cuff

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Acumen Analytics software

Acumen Analytics software allows you to retrospectively view and analyze monitored hemodynamic parameters, including mean arterial pressure, providing you insights into the frequency, duration and prevalence of intraoperative hypotension in your practice.

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Hemodynamic education empowering clinical advancement

With a long-term commitment to improving the quality of care for surgical and critical care patients through education, Edwards clinical education meets you no matter where you are in the learning process — with a continuum of resources and tools that continuously support you as you solve the clinical challenges facing you today, and in the future.

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References

U.S. Food and Drug Administration. 2021. K203224 510k Summary, Acumen Hypotension Prediction Index.
Hatib, F., Zhongping, J., Buddi, S., Lee, C., Settels, J., Sibert, K., Rinehart, J., Cannesson, M. (2018). Machine-learning Algorithm to Predict Hypotension Based on High-fidelity Arterial Pressure Waveform Analysis. Anesthesiology 129, 663-74.
Davies SJ, Vistisen ST, Jian Z, et al. Ability of an arterial waveform analysis-derived hypotension prediction index to predict future hypotensive events in surgical patients. Anesth Analg 2019.
Wijnberge, M., Geerts, B., Hol, L., Lemmers, N., Mulder, M., Berge, P., Schenk, J., Terwindt, L., Hollman, M., Vlaar, A., Veelo, D. (2020) Effect of a Machine Learning-Derived Early Warning System for Intraoperative Hypotension vs Standard Care on Depth and Duration of Intraoperative Hypotension During Elective Noncardiac Surgery: The HYPE Randomized Clinical Trial. JAMA Online, February 17, 2020.
Schneck, E., Schulte, D., Habig, L., Ruhrmann, S., Edinger, F., Markmann, M., Habicher, M., Rickert, M., Koch, C., Sander, M. (2019) Hypotension Prediction Index based protocolized haemodynamic management reduces the incidence and duration of intraoperative hypotension in primary total hip arthroplasty: a single centre feasibility randomized blinded prospective interventional trial. Journal of Clinical Monitoring and Computing online, November 29, 2019.
Salmasi V, et al. Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology. 2017 Jan;126(1):47-65.
Mascha EJ, et al. Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery. Anesthesiology. 2015 Jul;123(1):79-91.
Wijnberge M, et al. Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis. BJS Open. 2021 Jan 8;5(1):zraa018.
Shah, N., Mentz, G., Kheterpal, S. The incidence of intraoperative hypotension in moderate to high risk patients undergoing non-cardiac surgery: A retrospective multicenter observational analysis. Journal of Clinical Anesthesia. 2020: 66; 1-12.
Walsh M, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013 Sep;119(3):507-15.
Sun LY, et al. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015 Sep;123(3):515-23.
Wesselink EM, et al. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. BRJ Anaesth. 2018;121(4):706-721.