Page 123 - Journal of Special Operations Medicine - Winter 2015

benefited from research efforts. Current research has blood collection tubes, results are given in 30 seconds. In
shown acidemia, hypothermia, and hemodilution are real-world use in Africa, USSOCOM medical personnel
causal factors in the coagulopathy of trauma patients. were impressed with its overall ease of use. The device is
5
Efforts to combat this “triad of coagulopathy” form the portable and battery powered, has wireless capabilities,
basis of many stabilization–resuscitation protocols in and allows for room temperature smart card storage.
the military. Similarly, studies on the clearance of lac- Downsides of the users’ experience included no “emer-
tate as well as hyperglycemia have shown them both to gency” setting (170-second calibration, then more time
be prognostic markers in trauma patients. In malarial to results) and the requirement for two different power
6,7
patients, laboratory values also provide vital informa- cords. Compared with the other two options detailed
tion. The World Health Organization defines “severe next, the EPOC’s most unique feature would be the abil-
malaria” with several laboratory abnormalities includ- ity to store the reagent smart cards at room temperature
ing severe anemia and hypoglycemia. 8 for a 6-month shelf-life.

Abaxis’ Piccolo costs US$12,100 and can evaluate more
Comparison of POCT Devices
comprehensive metabolic tests including a liver profile
Several portable laboratory devices are now under in- and a lipid panel. Although its reagents are bulky and
vestigation by medical leadership in Air Force Special require refrigeration, they also have the longest shelf-life
Operations Command (AFSOC) as well as Special Op- among the three devices described here. Special Opera-
erations Command Africa (SOCAF): the Alere EPOC , tions personnel in Africa noted this device to be reliable
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Abaxis Piccolo Express , and the Abbott iSTAT (Table and have internal memory to recall previous values. The
©
©
1 9–11 ). samples have to be transported in heparin-coated tubes,
or “green tops,” and the machine notably lacks the abil-
Table 1 Comparative Analysis of POC Testing Devices ity to measure blood gases or hematocrit levels.
The iSTAT from Abbott is the most affordable with a
price of US$6500. Its reagent requires similar tempera-
ture control as the Piccolo and, like the EPOC, is capable
of basic metabolic laboratory measures, blood gases, and
hemoglobin/hematocrit levels. The iSTAT uses various
cartridges that must be stored in a refrigerator at 35–46°F
(2–8°C). At time of use, the cartridges must “equalize” at
room temperature for 5 minutes per cartridge at a tem-
perature of less than 86°F/30°C (1 hour for a complete
box of cartridges) and cannot be returned to the refrig-
erator after equilibration at room temperature. Different
cartridges expire at different times at room tempera-
ture—ranging from 5 days to 2 months. The iSTAT ana-
lyzer cannot be stored in direct sunlight and must be kept
within 61–86°F (16–30°C). Additionally, the cartridges
must be filled exactly to the fill line without air bubbles
and must be kept level and face-up for successful results,
which are normally given in 2 minutes. This limits its use
The EPOC (Enterprise Point Of Care) Blood Analysis on ground vehicles since users may have to stop the ve-
System is produced by the Alere Corporation and comes hicle for this device to function accurately. Experience by
at a cost of US$7500. This system performs blood gas, users in Africa noted the iSTAT’s simple operation, famil-
electrolyte, and metabolite analysis on either venous iarity from use in US Army emergency departments, and
or arterial blood but has no coagulation analysis avail- the machine’s physical sturdiness. However, the machine
able at this time. The device uses “smart cards” instead that we used malfunctioned after 1 month in an environ-
of cartridges, which must be stored within 59–86°F ment in temperatures of greater than 95°F (Table 2 9–11 ).
(15–30°C) and cannot be refrigerated or frozen. Smart
cards require calibration in the EPOC device before use, Conclusion
which takes about 170 seconds. After calibration, the
card is ready for a blood sample, which must be given Today, machines capable of providing useful clinical
within 7.5 minutes or the card will “time out” and no data are readily available and can provide a wealth of
longer accept a sample. Once blood is delivered to the information right at the bedside. As our nation’s stra-
sensor area via a 1mL or 3mL syringe or the included tegic goals continue to evolve and USSOCOM pivots

Point-of-Care Blood Analyzers in Austere Deployment 111