Art Medical has raised $20 million, led by Advanced Medical Technologies LLC. The Israeli startup, which specializes in smart tubes for ICU patients, has unveiled its platform of sensor-based smart tubes solutions for more comprehensive patient data collection and the reduction in risk of medical complications. Art Medical has raised $27 million since it was founded, including the current round.
Art Medical was founded in 2008 by CEO Liron Elia. He has a relationship with a doctor who told him of her frustration when patients whose lives had been saved by complex medical procedures later died from various complications, primarily from pneumonia.
Tube-related reflux and secretion may cause aspiration pneumonia and ventilator associated pneumonia (VAP). Both are dangerous complications for ICU patients, resulting in prolonged length of stay and higher risk of mortality, and both are unrelated to the original reason for hospitalization. Therefore, gastric reflux and saliva must be identified in real-time and treated immediately. In the ICU, nurses and doctors are required to constantly monitor patients in order to identify those events and minimize their complications. To date, this activity is done manually, often missing time-sensitive actions that could reduce the likelihood of patient complications. With ART MEDICAL’s platform, gastric reflux, saliva and urine output are monitored continuously and automatically to alert the attending nurse and physician of any abnormalities as well as actively prevent related patient complications
"This young doctor was so frustrated," Elia told "Globes." She told me, 'I did the most I could, and the patient eventually died from complications.' It wasn't her fault - it was a basic failure in the system."
"My background is in mathematics and computer science," Elia says, "but following my encounter with this problem, I began reading medical books. I got an idea fairly quickly, and I registered a patent. I met Professor Eitan Scapa, head of the gastroenterology institute at Assaf Harofeh Medical Center (now Yitzhak Shamir Medical Center), and told him, 'Invest money, and you can be the chief medical officer.' He introduced me to Dr. Gabi (Gavriel) Iddan, who invented Given Imaging's diagnostic pill. He also invested in the company, and became the chief technology officer. At first, they worked part time; now they work full time. Two such brilliant and nice people - they are such geniuses, and so charming."
"A low-tech tube"
Elia first tried to solve the severe mortality from pneumonia among patients being tube fed and ventilated. "Today, they insert a low-tech tube with no indicator, and start feeding the patient. Sometimes, the tube moves out of its place (for example, when the patient is moved in order to avoid bedsores, or when suddenly wakes up and absentmindedly tries to take the uncomfortable tube out of his stomach). The food rises into the mouth, from where it is breathed into the lung - this is called aspiration. Another problem is when the tube is in place, but because the patient is in ש serious condition with severe digestive problems, in addition to his other problems, the food itself rises upward. This is called regurgitation. It can be then also be breathed in."
Food absorbed into the lungs can lead to a lung infection, followed by death.
Elia's first idea was to produce a tube with sensors on it providing information about the tube's location and about the location of the food around it. Another bit of information produced by the system is the quantity of food that the patient actually ate.
"There is currently only one effective treatment that reduces the risk of aspiration - having the patient elevated at a 30-degree angle. Another solution is to regularly suction food from the patient's mouth, but even regular pumping takes place only every few hours at best. It is possible for food to be breathed into the lung between two pumpings," Elia explains.
"The pumping is designed to reduce the risk of aspiration, and to give an indication of how much the patient ate," Elia says. Beyond the medical consideration, it is also economically important to understand what exactly happens to the food. "This frequent pumping of food from the mouth, and the patients' digestive problems, result in the patients digesting only a small proportion of the food offered to them; the rest is thrown out. Medical food is very expensive, and this is a significant cost," Elia says. "The other side of this question is that 80% of the patients do not receive enough food, but there is no indication of food movement, so no one knows which patients are experiencing severe malnutrition."
When Elia began developing his solution for preventing pneumonia caused by breathing food, he discovered another cause of the same infections. "I sat in hospitals - I spent, and still spend, a lot of time in hospitals in the intensive care units - and I saw two patients on respirators. One of them was partially conscious, and he was constantly spitting. He was unable to swallow the saliva, because he had a tube stuck in his throat. The patient next to him was completely unconscious, and did not spit. What happened to his saliva?" Saliva sometimes reaches the lungs in a process called micro-aspiration, which also causes pneumonia.
Art Medical thereupon developed the next part of its solution. In addition to monitoring sensors on the feeding tube in the vicinity of the stomach and the throat, sensors were added on the respiratory or feeding tube in the mouth area, which detect whether the mouth cavity is full of saliva. "The doctor does not find out what is happening until he or she does a lung X-ray and sees the infection," Elia says.
When he realized that he was not creating a "smart feeding tube," as he initially thought, but an entire system of sensors showing doctors what happens within the digestive and respiratory systems of patients being fed through tubes and patients on respirators, he decided to add another element - sensors on the urinary tube. Today, the production of urine among patients with catheters is measured very inaccurately by nurses looking at the bag. "If urine production has been decreasing for the past four hours, however, there is no information about this, and it is liable to indicate severe kidney failure," Elia says.
The final system includes information about all the above-mentioned aspects, and the information is processed in the cloud. "Today, no part of this information exists," Elia emphasizes. "Because very difficult patients are involved, we have to connect all the elements in order to understand what is really happening with them, and what is liable to endanger the patient. We are creating a comprehensive system for risks resulting from tube feeding and respiration that are unconnected to the original medical problem."
"A violent process"
Some of the patients in intensive care will recover and resume their lives, but many of them are in severe condition. Cynics might say that the healthcare system will not do much to prevent them from getting pneumonia, because if they do not get pneumonia, their treatment will have to continue. "That's absolutely false, and my experience does not bear it out. The doctors in intensive care are extremely committed. They only want to save the patient and stabilize him, so that he can leave the intensive care unit. They do not think in this cynical way at all. As for the hospital's financial stake, it is paid for treating the original problem that brought the patient to intensive care; it receives no additional payment for complications. It therefore has an interest in preventing complications.
"One of the things we realized is that if we try to make doctors use tubes other than the ones they are used to, it will not succeed. This is particularly true for a respirator tube, which is usually inserted on the scene, and which no one wants to replace after it has been inserted, because that is a very violent process. Our product is not a "smart tube"; it is a system of sensors that fits onto an existing tube, even after it has been inserted. Even if a hospital department head is brought to hospital injured, the staff will not replace the cheap tube inserted on the spot."
"Globes": How much time did you spend in intensive care units in order to understand the work procedures there?
Elia: "Many hours every week. I sometimes stayed in the unit for several days at a time. Nothing is more important than this for the company's development."
Did you also study the work procedures at overseas hospitals, or only in Israel?
"I started in Israel, so that I would be logistically able to devote time to it. We are now starting to spend time in overseas hospitals. The company has already obtained FDA approval for some of the system's elements, but we decided to launch the system only when it provides a complete solution, so that no additional trials will be necessary."
It's not easy for a young company to market a medical device.
"The clinical proof is opening doors. When we show hospitals that we are lowering hospitalization costs, and even saving an average of one day of hospitalization in intensive care, the price of the system will no longer be an issue. In the future, we may be connected with intensive care monitoring systems, such as those of GE and Royal Philips, which provide a lot of information about the patient, but which have nothing in our area."
"We kept quiet for eight years, and that suited me," Elia adds. "Quiet avoids attention from potential competitors, who can start taking an interest in the idea, even if they do not copy it exactly.
"Even though I kept out of the media, I met with many investors, actually with every potential investor I could reach, including those who told me in advance that they could only invest a small amount. I fought for every $50,000, and a small investor like that eventually put me in touch with a bigger investor, who came up with most of the money."
Why are you taking the wraps off now?
"We're looking for employees in all the areas relevant to our business."
Published by Globes [online], Israel Business News - www.globes-online.com - on June 8, 2017
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