In 2024 the University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) urgently needed to replace an aging fleet of defibrillators across 9 sites in Bristol as device parts would soon be discontinued.

This posed a huge challenge. Defibrillator technologies had advanced considerably since the last tender. While the technologies would provide valuable data for the Trust's specialist cardiac centre - also known as the 'Cath Lab' - which specialises in diagnosing and treating patients with heart problems, there would be 7,000 staff to train on using the new equipment.

UHBW serves a core population of more than 500,000 people in southwest England. Its team of over 13,000 professional clinicians provides more than 100 diverse clinical services across 10 locations, encompassing renowned facilities such as Bristol Royal Infirmary, Bristol Heart Institute, and Bristol Royal Hospital for Children.

The Trust needed a defibrillator that struck the right balance between cutting-edge and ease of use.

Justin Blackett

Head of Resuscitation Services

Ultimately we needed a solution that abided by Resuscitation Council UK (RCUK) guidelines while still being versatile enough for every clinical setting across our Bristol sites.

With such a large user base, the defibrillators would have to be intuitive for users. However, they would also need to provide suitable levels of data for the resuscitation team and Cath Lab such as CPR impact and ECG readings.

Justin continued, ¡°Our Cath Labs and cardiac centre had the biggest influence on the decision-making. They treat a whole range of heart conditions such as heart arrhythmia; they can also fix structures of the heart under x-ray instead of doing invasive surgery. For them, the interventional needs were most important. The data they can get from a defibrillator can make a big difference in terms of treatment and diagnostics.¡±

UHBW Resuscitation Services knew of Mindray¡¯s defibrillators through the company's collaborations with RCUK. The service was pleased to see that the company approached the Trust wide tender process.

A tabletop exercise was done by the Trust to assess a shortlist of equipment. Around 500 members of staff evaluated devices for aspects such as ease of use, consumables, and training support. After Mindray came out the clear winner, UHBW trialled the BeneHeart D30 defibrillator in their Cath Lab.

The D30 aims to raise standards in resuscitation using Mindray's rescue triangle concept. Rescuers can get real-time feedback for hot and cold debriefing, and use this data alongside the dedicated training function to enhance resuscitation training and simulation. The D30 also incorporates a patented non-invasive CQI (care quality index) technology which can illustrate blood flow in cardiac arrest. This enables resuscitation teams to comment on the efficiency of chest compressions and return of spontaneous circulation without the need for invasive technologies.

Justin said, ¡°Technologies like the 360 Joules and quick charge are great for wider use - it means less prep time. With the structured debriefing we can be much more responsive during resuscitation and still have quality data for cold debriefing and identifying training needs. For our cardiac specialists, they were really impressed with technologies like the hot and cold debriefing, the monitoring and ECG analysis. The trial also demonstrated potential for the D30 to feed into research, which is very exciting, and the suite of technologies at our disposal really future-proofs our investment.¡±

The Cath Lab at UHBW is heavily involved in research and is ranked second in the UK for microchip implants. Funded by the Department of Health, the state-of-the-art ?60 million centre unites cardiology and cardiac surgery as well as cardiac imaging and research. It provides services for the whole South West of the UK and is the biggest on-call centre in the area, with the next nearest centres located in Oxford and London.

The specialist centre has a team of around 80, ranging from nurses to physiotherapists, consultants and radiographers, who treat around 5,000 patients a year. Thomas Greenslade, Lead for Intervention and Structural Cardiology, leads the percutaneous coronary intervention (PCI) and structural interventions teams in the UHBW Cath Lab.

Thomas Greenslade

Lead for Intervention and Structural Cardiology, leads the percutaneous coronary intervention (PCI) and structural interventions teams in the UHBW Cath Lab.

ECG measurement, shock and pacing were really important for us. We already do a lot of monitoring but the tools on the D30 mean we can easily assess the heart's underlying rhythm and ensure we administer adrenaline every 2 minutes. Combined with the patient's status and medication, we can get the shock level right faster. The potential for WiFi connectivity adds another level of convenience which we can take advantage of as the Trust continues its digitalisation journey. You can get lots of data from a defib, so the ability to automatically populate EPRs would save a lot of time, and help us streamline analysis.

¡°The practicality of the D30 really stood out too - it's compact, quick to charge, easy to use, portable, and compatible with the pads we use. Considering how much equipment we have, the fact that the D30 can conduct its own daily test too is a valuable time-saver. It made a lot of sense to use it, and the transition has been seamless.¡±

With the D30 firmly selected, from August 2023, Justin¡¯s team of 11 resuscitation practitioners now had the challenge of training 8,500 staff.

¡°Resuscitation training is mandatory so we deliver training every day, but even then, we can only capture a small number of staff at a time. We needed to get everyone up to speed as quickly as possible. ¡±

¡°We had 150 volunteers who became cascade trainers. They underwent training from us, and in turn, trained others on their team. Mindray loaned us ten D30 simulators so we could easily swap machines and train people quickly.¡±

The Resuscitation Services department was targeted with getting 70% of staff in each department competent using the D30 before the device was deployed. With the D30 in place, rescuers can get real-time feedback on the quality of CPR and the effect on the patient. This hot debriefing means rescuers can adapt quickly to patient needs and improve their chances of successful resuscitation.

¡°Mindray's clinical representatives were extremely supportive and helped us deliver training in-person and over Teams. We were meeting our training goals much faster than anticipated. That additional support was invaluable, especially in the early stages as we adjusted to a new configuration.¡±

Thomas added, ¡°The Mindray team have been really responsive and helped us implement our own configurations in the Cath Lab. For instance, we only use the manual mode and have set our own shock levels - 200J first, then 300, then 360. For larger patients we go straight to 360J. This is reflective of best evidence. As we've got a lot of monitoring already in place we've also adjusted the alarm settings to avoid unnecessary alarms. It's small changes like this that can make a big difference and the team has responded quickly to meet our needs. It's been a seamless transition.¡±

To ensure devices are in good working order, UHBW plans to streamline its fleet management with the adoption of Mindray¡¯s M-IoT solution. This will provide a centralised means of tracking and managing all medical devices in the hospital, including defibrillators. Tagged devices can be geo-located in just a few seconds, software updates can be deployed to multiple devices with the touch of a button, and engineers can do pro-active repairs with automatic alerts to device issues, reducing time-consuming manual checks and updates.