A medication dosing error in a paediatric emergency can be fatal. Auckland GP Dr Adrian Ng has invented a device to reduce the risk of mistakes and has successfully completed a seed funding round for the next phase of development.
Consider this scenario. Chaos at a swimming pool. A child drowned and is in cardiac arrest. Paramedics must work out critical weight-based calculationsto deliver safe, and possibly lifesaving, doses of adrenaline (epinephrine). They must deliver that adrenaline every four minutes. Resuscitation like this can sometimes continue for up to 40 minutes.
Adrenaline comes in two different concentrations in look-a-like ampoules; using the wrong ampoule – will overdose a child by tenfold – could be fatal. One study from Western Michigan University found one in 10 children were given tenfold overdose in such a situation. The child’s life may depend on just two to three ambulance staff versus an ED where there may be six to eight people to help. Paediatric cardiac arrest is also rare; health professionals may encounter it only once or twice in their careers. It is extremely intense; a situation where every second counts.
North Shore GP Dr Adrian Ng felt there had to be something simpler and more accurate for such emergencies.
“RAPIDOSE is a simple, four-syringes device pre-loaded with adrenalineand a lever to set the correct weight-based dosage,” says Ng.
While Ng is a GP, his main interest outside clinical medicine ismedical innovation. He has been working on RAPIDOSE with Professor Stuart Dalziel, John Windsor andAnthony Phillips from the University of Auckland Surgical and Translational Research Centre (STaR), and Starship Children’s Hospital.
“RAPIDOSE delivers the right dose of adrenaline in high stress situations where we currently have those complex calculations and consequent potential for error. It’s particularly important for what we call Out-of-Hospital Cardiac Arrest (OHCA) where resuscitation often needs to be done with minimal resources and personnel.
“If we can eliminate the risk of overdose or underdose, RAPIDOSE enhances safety and improves outcomes when it matters most,” says Ng.
“RAPIDOSE can prepare four doses of adrenaline in 10 seconds with no calculations required, whereas the current method can take three minutes, three minutes that the child may not have.”
Ng says RAPIDOSE will increase clinician confidence in emergency care, add a critical step in preventing harm, and save young lives.
While RAPIDOSE is designed for emergency situations, it may also help reduce risk in hospital paediatric practice. A 2020 article in Hospital Paediatrics from Kate D Brune says: “The most common cause of medication error in the NICU is related to dose calculation. The risk of medication error is increased during neonatal resuscitation by the emotional stress of a resuscitation, noise, time pressure, and the use of unfamiliar medications. … It requires weight-based dosing, which increases the risk of medication errors and delayed delivery.” Brune talks about the ‘high cognitive load’ in paediatric resuscitation, caused by the complexity of the process.
Ng believes there is a market for RAPIDOSE beyond paediatric adrenaline. “It could also work for weight-critical benzodiazepine and opioid drugs such as midazolam, fentanyl and ketamine where you can have asimilar under- or overdose situation.”
A 2024 article in Prehospital Care cites a Children’s Hospital of Michigan study shows that the error rate for midazolam and fentanyl were greater than 50%.
The RAPIDOSE device is the resultof intensive Human Factors and Ergonomics work, requiring countless cycles of design, prototyping, and end-user feedback. "It took two years and 26 rounds of prototyping to ensure this device is simple enough to operate in one of the most stressful and chaotic clinical environments," says Ng.
Now,he's hopeful that the capital raised will enable him and his team to make progress toward FDA 510(k) clearance.
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