Anesthesia Patient Safety Podcast

#263 Blood Pressure Blind Spots

• Anesthesia Patient Safety Foundation • Episode 263

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The standard of care for monitoring blood pressure during surgery hasn't changed in nearly 40 years, despite technological advances that could prevent serious complications and save lives. This eye-opening episode takes listeners inside a recent Capitol Hill briefing where healthcare professionals, lawmakers, and patient safety advocates made the case for continuous blood pressure monitoring as a critical patient safety measure.

Alarming statistics frame the urgency of this issue: one in nine Americans undergoes surgery annually, with 88% experiencing potentially dangerous hypotension. Traditional arm cuffs that measure blood pressure only every few minutes leave dangerous blind spots where rapid drops may go undetected. The consequences can be devastating – kidney injury, heart damage, stroke, and even death. For pregnant women undergoing cesarean sections, the risks extend to their babies, with maternal hypotension potentially causing fetal acidosis and neurological compromise.

With the United States maintaining the highest maternal mortality rate among wealthy nations and evidence showing that more than half of pregnancy-related deaths are potentially avoidable, this episode makes a powerful case for updating our standards. The technology exists, the evidence supports it, and the benefits are clear – it's time for healthcare providers, policymakers, and industry leaders to collaborate in making continuous blood pressure monitoring the new standard of care.

Ready to become a champion for continuous blood pressure monitoring at your institution? Visit APSF.org to learn more about this lifesaving technology and join the movement to ensure no one is harmed by anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/263-blood-pressure-blind-spots/

© 2025, The Anesthesia Patient Safety Foundation

Speaker 1:

You're listening to the Anesthesia Patient Safety Podcast, the official podcast of the Anesthesia Patient Safety Foundation. We're bringing you the very best from the APSF newsletter and website, as well as the latest information in perioperative patient safety. Thanks for joining us.

Speaker 2:

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel and I'm your host. Thank you for joining us for another show. The APSF is bringing you the latest in perioperative patient safety, and today we have a special show for you. We are going to be tuning in to the recent Capitol Hill briefing on enhancing patient safety with continuous blood pressure monitoring. This represents a campaign to reduce surgical harm from intraoperative hypotension. Anesthesia professionals are charged with monitoring circulation and blood pressure during surgery and anesthesia care, and there are serious complications associated with intraoperative hypotension, so we need to remain vigilant. Check out episodes number 70 and number 219 on this podcast, where we talk about intraoperative hypotension and the associated threats to anesthesia patient safety. Our show today focuses on the important issues of continuous blood pressure monitoring, intraoperative hypotension and maternal morbidity and mortality. Before we dive into the episode today, we'd like to recognize Solventum, a major corporate supporter of APSF. Solventum has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, solventum. We wouldn't be able to do all that we do without you.

Speaker 2:

Our featured resource today is the recording of the live stream of the briefing on Capitol Hill with members of Congress, healthcare professionals and patient safety advocates that took place on June 10, 2025. This briefing covers the urgent need to safeguard patients through continuous blood pressure monitoring during surgery. There is bipartisan representation on the panel, which highlights the public health and patient safety implications of dangerously low blood pressure and the need for an updated standard of care for blood pressure monitoring. To follow along with us, head over to apsforg and click on the patient safety resources heading. The third one down is continuous blood pressure monitoring, and I will include a link in the show notes as well. We are going to be tuning into the live stream later in the show, but first let's take a quick look at this resource.

Speaker 2:

We'll start with the big picture. Why does this matter? Did you know that each year, one in nine people in the United States undergo a surgical procedure? Did you also know that the majority of these patients 88% of them experience some level of hypotension during surgery? Interoperative hypotension is associated with serious complications, including kidney injury, heart damage, stroke, longer hospital stays and mortality. These are all serious complications that can be mitigated through timely detection and intervention.

Speaker 2:

Interoperative hypotension is a big threat to anesthesia patient safety. The problem comes from monitoring, or rather lack of monitoring. Our standard non-invasive intermittent oscillometric blood pressure arm cuffs are the minimal standard for monitoring during surgery. This monitor provides a blood pressure every few minutes but fails to provide continuous blood pressure monitoring and, as a result, we can miss rapid drops in blood pressure. This is something that may occur during any procedure and with all patients. During surgery and anesthesia care, studies have shown the following One-third of patients experience more than 15 minutes of dangerously low blood pressure. It is more common in younger, healthier patients undergoing routine procedures, and arm cuffs can misclassify up to 50% of hypotensive readings as normal, putting patients at unrecognized risk.

Speaker 2:

Now we know that interoperative hypotension is a big problem and this has important maternal health implications, especially during cesarean deliveries. Rapid decreases in blood pressure are common and dangerous for the mom and baby. Key concerns include low blood pressure are common and dangerous for the mom and baby. Key concerns include low blood pressure during and after cesarean delivery can signal serious issues like hemorrhage or sepsis. Maternal hypotension during c-section can lead to nausea, vomiting, unconsciousness and poor placental perfusion, which can put the baby at risk. For newborns, it can result in fetal acidosis and poor neurological function due to reduced oxygen delivery.

Speaker 2:

Obstetric anesthesiologists increasingly recognize the need for continuous blood pressure monitoring to stabilize maternal hemodynamics and improve safety for both mother and baby. Continuous blood pressure monitoring provides real-time data that allows anesthesia professionals to respond immediately to hypotensive events or even downtrending blood pressure readings, rather than waiting for the next intermittent cuff reading. This is a way to eliminate these blind spots between readings. To help improve patient safety, there have been important technological advances in continuous blood pressure monitoring, including non-invasive finger cuffs that provide real-time measurement of blood pressure. The benefits of these non-invasive continuous blood pressure monitors is earlier detection of hypotension, decreased severity and duration of intraoperative hypotension and decreased reliance on invasive arterial lines. In addition, these new devices have been shown to be as accurate as invasive methods in clinical trials to be as accurate as invasive methods in clinical trials.

Speaker 2:

So what do the experts and medical societies have to say about all of this? Here are some of the recommendations from around the world the Anesthesia Patient Safety Foundation recommends accelerating the adoption and integration of continuous, non-invasive monitoring. The Perioperative Quality Initiative concludes that there is high-quality evidence that continuous blood pressure monitoring helps reduce the severity and duration of hypotension compared to intermittent monitoring, and the German Society of Anesthesiology and Intensive Care Medicine recommends that continuous blood pressure monitoring via invasive or non-invasive methods should be used in patients at risk of blood pressure-related complications to enable real-time detection and management of hypotension or hypertension. There is a call to action to support non-invasive, continuous blood pressure monitoring during every surgery.

Speaker 2:

Remember, intraoperative hypotension is common, even in low-risk surgeries, and increases the risk of serious complications. Our current standard intermittent cuff monitoring may miss intraoperative hypotension. We have a better option available, since continuous, non-invasive monitoring has been shown to reduce intraoperative hypotension and improve patient safety. We started with the highlights, but now it's time to hear all the details. Let's take a listen to the Capitol Hill briefing on enhancing patient safety with continuous blood pressure monitoring.

Speaker 3:

I want to welcome you here. Thank you for joining us today for this briefing entitled Enhancing Patient Safety with Continuous Blood Pressure Monitoring, something I feel very passionate about and I'll share the story behind that in a moment, along with many other champions in the room. So I'm Monty Mython I know it had to happen to somebody. I'm Senior Vice President of Medical Affairs for BD Advanced Patient Monitoring. I'm also an Emeritus Professor of Anesthesia and Critical Care at University College London, where I was actually the inaugural professor, and the relevance of that fact will come here in a moment, I hope. I want to thank Congresswoman Young Kim for making this event possible today. I know she's busy elsewhere at the moment, but her commitment to patient safety is commendable, so thank you for that. This briefing is co -sponsored. We have other sponsors in the room. You'll hear from a representative from the Anesthesia Patient Safety Foundation during this briefing, along with industry associates California Life Sciences and Biocom California. Both will have some speakers to address us from those two bodies. So thank you for that co-sponsorship. We're also joined by several other champions within the room. I think one of my colleagues in the UK gets the prize for travelling the longest distance to be a champion for this cause. So thank you, professor Davis, and online as well. So those of you online listening, thank you for your passion about this.

Speaker 3:

So I'm just going to give a very brief history to give us some context about how young anesthesia is. General anesthesia is a specialty, so the first anesthetic was famously given in Boston, the first public demonstration in October of 1846. And following that, just two months later remember, there's no internet, there's no mobile phones the first anaesthetic in public in Europe was given at University College London hospitals and, interestingly, that anaesthetic was given by a medical student. And remember, general anaesthesia is the thing that has enabled all surgical developments to this date. No complex surgery of any form would be possible without general anaesthesia.

Speaker 3:

Jump forward to December 1982, 136 years later. I'm in an operating room at University College London Hospitals, the place where the first anaesthetic was given in Europe, as a medical student volunteering to monitor a patient under general anaesthesia. There are none of those fancy boxes on the wall, none of those TVs, blinking lights with little waveforms on them. They're just me, a scared little boy with my finger on the pulse, on the ear of the patient, watching them breathe and making sure that their lips are not blue. That was the level of monitoring that we had. Interesting intervention I think I know what that means. Interesting intervention I think I know what that means. That's not true alarm? I don't think so. If we jump forward four years later so it's now 140 years since the first anaesthetic in Boston an amazing thing happened.

Speaker 3:

Harvard Medical School and we have a representative from Harvard here today published the first minimal monitoring standards in the Journal of the American Medical Association. They stated three simple things that they thought it was important that a qualified anaesthetist, not a scared medical student, should be in the room for the duration of the whole general anaesthetic. The second thing they said was there should be continuous monitoring of the circulation and breathing, and that enabled a whole draft of fantastic monitors to be brought to bear. Those standards were rapidly adopted by the American Society of Anesthesiology, who champion them to this day. They were then amplified by the Anesthesia Patient Safety Foundation, who are represented here today, and then by the World Federation of Society of Anesthesiologists and the World Health Organization, such that those standards became a global standard in more than 150 countries, which stands to this day. Let's jump forward now to December 1990. So four years after those minimum monitoring standards.

Speaker 3:

Eight years after I was a scared medical student in the operating room, I'm back there as a fully qualified anaesthetist. I'm a fellow of the Royal College of Anaesthetics in the UK and I'm standing there with this beautiful array of all those monitors you see on the TV. I've got those little things that are going beep. I've got the numbers popping up automatically. I'm relaxed, I'm calm, I'm confident the patient is safe. I was able to get those monitors because of the minimal monitoring standards. There was no debate about the cost of buying them. On the day they said this is right for our patients. In the wake of that did things get better? I'm not taking personal credit for this. They did dramatically so. Safety from the provision of anesthesia improved very dramatically. People used to die from general anesthesia. That pretty much was eliminated by introducing those minimal monitoring standards with an exception that I'll get to in a moment.

Speaker 3:

The only thing that's not changed in the 40 years since the minimal monitoring standards were introduced is the measurement of blood pressure.

Speaker 3:

Everything else is measured continuously. Blood pressure is recommended to be measured once every five minutes as a minimum. That means you can have four minutes and 59 seconds with no blood pressure and we don't know that, or an inadequate blood pressure. We don't think that's good enough. We think the standards should change, and next year is the 40th anniversary of those standards.

Speaker 3:

The reason they were every five minutes at the time was the technology was not available to robustly, reliably and affordably measure blood pressure continuously. Well, it is today. We, as BDAPM and other companies have made that possible. So continuous non-invasive blood pressure is available today and that's what we'll be discussing. To put that into stark focus, we're going to take the context of maternal morbidity and mortality, although this just applied to general anesthesia overall, but it's in particular in reference to cesarean section. We have a diverse group of experts to discuss both in the room and outside the room, but I think we may first have an opportunity to hear from one of our congressmen. I think that's Congressman Scott Peters, who's just arrived to join us. Sorry to jump on you straight away if you are a congressman. Call me up.

Speaker 3:

Yes, if that's okay, sir, that was the brief I was given.

Speaker 1:

I said, as soon as someone comes in who looks like a congressman.

Speaker 5:

Congressmen don't all look like congressmen anymore. So thanks for having me and good afternoon everyone. It's great to be with you today. What a nice crowd on such an important topic. Just a little bit about where I come from. Literally, san Diego is home to the third largest biotech cluster in the country, where ground we feel groundbreaking research, device innovation, life-saving treatments that benefit patients nationwide I would say parenthetically. We really want to keep that ecosystem going. We depend so much on NIH and NSF grants. I think it's always been bipartisan and I don't want to make any big mistakes with that ecosystem. So to the extent you have people to just generally support science innovation, it's really important for the country and thanks for being here. So I have been a strong advocate for life sciences throughout my time in Congress because I know the first firsthand the power that it brings to to create jobs, transform health care and improve lives. I work to expand federal investments in biomedical research, streamline regulatory pathways, support initiatives that improve access to life-saving technologies, because when we invest in innovation, we invest in better health outcomes for all Americans both better outcomes and more cost-effective outcomes.

Speaker 5:

So we're here today to talk about the risk of low blood pressure during surgery, which is a critical patient safety concern in healthcare today. It's not something you see making the headlines, but it should, because the numbers don't lie. Every year, one in nine Americans undergoes surgery and in nearly 90% of those procedures patients experience some level of low blood pressure. When that happens, the risks skyrocket Kidney injury, heart complications and even brain damage. And notably, low blood pressure-related complications are a particular concern for women undergoing C-sections. Rapid shifts in blood pressure can be dangerous for both the mother and the baby, and yet many hospitals don't have continuous blood pressure monitoring in place to catch these changes fast enough to prevent these complications. I'm just paying particular attention to this because in November I'm supposed to have my first grandchild, so I'm into all the maternal health stuff. Right, I just observed from across the room before. But I have fought for stronger protections in maternal health and I know we have a responsibility to ensure expecting mothers have access to the safest care possible. So I've co-sponsored the Preventing Maternal Deaths Reauthorization Act, which strengthens efforts to reduce maternal mortality and improve care for mothers across the country. I also opposed the House Republicans' reconciliation bill which would make drastic cuts to Medicaid. Really I think lethal cuts to Medicaid, cutting access to maternity care and forcing 16 million people off their health insurance.

Speaker 5:

One of the most promising solutions to the challenge of low blood pressure is continuous blood pressure monitoring, which enables real-time detection and response, giving health care providers the tools they need to prevent complications before they happen. It's like driving a car. Would you rather rely on an occasional speed check every few miles, or have a dashboard that tells you in real time how fast you're going? That's an obvious choice, but at times we can be stuck in the past, using outdated monitoring methods that don't detect dangerous changes until it's too late. And it's amazing how much information is available. Today. I'm becoming available. We should take advantage of it. Maybe you have an aura ring? I do tells me by pulse all the time, and this is the kind of thing that we're getting used to having more and more information, we should take advantage of it.

Speaker 5:

Advancing patients safety requires strong collaboration among industry, health care providers, patients, health care systems and the government, including Congress, to drive innovation and enhance access. Affordability isn't the only hurdle. We need education, training and widespread adoption to ensure the clinicians and healthcare systems are ready to implement these life-saving tools. So I've worked to strengthen federal investments in medical research to ensure that innovative technologies like continuous pressure monitoring can reach more patients and improve outcomes. And the bottom line is this that continuous blood pressure monitoring has the potential to revolutionize patient safety, especially for critical groups like pregnant women and babies. We know the problem, we know the solution and now we have to work together to make it the new standard of care. So I remain committed to supporting patient safety, expanding access to life-saving technologies and advancing maternal health through smart health care policy.

Speaker 5:

So I want to thank our moderator, professor Mython, and our esteemed panelists, mike Guerra, pn Smith and Dr McCleary, for leading today's important discussion, which you'll enjoy. I also want to thank the Anesthesia Patient Safety Foundation, biocom California and California Life Sciences for sponsoring the briefing and for your continued commitment to medical innovation. And a special thanks, of course, to BD for sponsoring this event and inviting me here today. I've had the opportunity to visit BD in my district. I always enjoy learning about their exciting work to shape the future of healthcare. Again, we are at an amazing time in healthcare and the rate of change, the rate of discovery, is huge. We have to figure out ways to take that discovery, deploy it in our system to make sure that we're serving patients in the most effective and cost-effective ways, and, with your help, we can do just that with respect to this issue. I thank you for being here and I do thank you for making the trip.

Speaker 5:

I come from California every week. Sometimes I wonder why, but it's really helpful to have real people who are in the middle of these things. Come talk to us about it, and I would encourage you to think of yourself as educators. So there's 435 members of Congress. Each of us has a different background. My background is in environmental law, and if you want to talk to me about a subtitle D compliant municipal solid waste landfill liner, we can talk peer to peer right, but I don't know about maternal health and you're going to have to teach me about that. You, we could talk peer-to-peer right, but I don't know about maternal health and you're going to have to teach me about that. You're going to have to teach me about blood pressure monitoring, and so I hope you use the opportunity to be an educator, and this is also something that touches every congressional district. I mean, this issue comes up. You know babies are everywhere. So thanks again for being here in person, and we hope you have a great visit while you're here.

Speaker 3:

Thank you, Congressman Peters. Thank you very much indeed for setting the scene so effectively there, and good luck to you. Is it your daughter that's having the baby?

Speaker 5:

My daughter yes, good luck with that, you'll be fine. Thank you very much, I need it.

Speaker 3:

You know where we are. If you need to call us, we'll look up.

Speaker 5:

Give me an election day name, so someone will be in the business, fantastic.

Speaker 3:

So thank you also, Congressman, for setting up the panel. So I've been given permission to call my colleagues by their first name. So, Mike, can you tell us just a little bit more about yourself and your organization?

Speaker 6:

Sure. Thank you for having me here, mike Guerra. I'm very honored to be the president and CEO of California Life Sciences. We represent about 1,300 companies across California and I think what makes us unique really is the diversity of our membership. We represent academia and research institutions, and then also early stage companies all the way through to late stage, the biggest of the big med tech and the big biotech, big pharma and, in particular, bd as well, which is why we're here today. Thanks for having me, thank you.

Speaker 3:

Megan, if I may.

Speaker 7:

Yeah, I'm Megan McCleary. I'm a general OBGYN. I work out of Phoenix, arizona, at Banner Thunderbird, which is a level one trauma center, level four NICU. We do about 4,000 deliveries a year. So we kind of see all of the low risks to severely high risk moms and babies.

Speaker 3:

May.

Speaker 8:

I'm May Pian Smith. I'm a practicing obstetric anesthesiologist from Boston and for the last 35 years I've been affiliated with MGB, Mass General Brigham. We have about 16,000 deliveries each year, many high risk, and today I'm proud to represent the Anesthesia Patient Safety Foundation, which is a co-sponsor of this event.

Speaker 3:

So I'm just going to start off with some statistics, and I chose my two doctor colleagues here that I would be sharing these, so I've had these verified as a transatlantic doctor. So I've worked in the united states of america at duke university medical center, transatlantic father, transatlantic husband, etc. These statistics still shock. The US continues to have the highest maternal mortality rate among the 14 richest industrialized countries in the world so far, higher than every European country, than Canada, than for Korea, for example. There are about 4 million births each year in the United States of America. About 700 of those women will die and there are about 70,000 who will have near-fatal complications. And those maternal mortality rates have allegedly doubled in the last 30 years and more than half of them are pregnancy-related deaths that were thought to be avoidable. Sorry to split you both on the spot. Do those numbers resonate? Do you believe them to be true?

Speaker 8:

Yes, and it's really become kind of a crisis, this maternal morbidity and mortality situation. It's pretty shocking that in the US we have the worst of all developed countries. Every day I talk about this with somebody and they're just surprised that the US is in such a sad state. Ultimately, I think it's going to require a lot of collaboration between different disciplines, as well as industry and government, to really move the needle on this. But I'm really glad we're talking about this on Capitol Hill today, because this problem affects everyone and even though we're not all moms or we're not aspiring to be moms necessarily, certainly we were all birthed from a mom and so I think you know, really solving this problem is of critical importance to everyone.

Speaker 7:

Yeah, I said it fantastic. I couldn't agree more. I think often we take for granted pregnancy because it happens every day, but it really is one of the most dangerous things a woman could choose to do. It is you're remodeling her entire body and most of her. You know organ systems, especially our cardiovascular system, so it's embarrassing, kind of, what our rates are and you know advocating for women's health. I think it's very important.

Speaker 3:

Mike.

Speaker 6:

Yeah, the only thing I would add there is you mentioned collaboration, which I think is absolutely important, but those numbers are staggering and one of the things that we do within our organization is educate, and I think education on those numbers and those statistics and the outcomes is one of the most important things we can do with the collaboration, because folks here on the Hill and everywhere around the country really need to understand the risks and the new technologies that are out there and how we protect patients more. So you throw that education with the collaboration and all the other things that we're talking about and you have a recipe for success.

Speaker 3:

So we've already had teed up from Congressman Peters the challenges that can be faced by anybody under anesthesia or having surgery of a low blood pressure and sometimes we refer to that as intraoperative hypotension, which is distinct from hypertension, something that I have, so May. Can you explain, can you decode that for us and what the risks are and why the Anesthesia Patient Safety Foundation drew attention to it?

Speaker 8:

Yes, thank you for asking.

Speaker 8:

So the mission or vision of APSF is that no one should be harmed by anesthesia care, and so you can understand how this issue of interoperative hypotension or low blood pressure is really on our radar, because it's very prevalent, it can cause harm to patients and it's totally avoidable, and so it seems like a perfect recipe for somebody to get in there and innovate and make a difference.

Speaker 8:

It turns out that hypotension, low blood pressure, during operations happens, as we heard, as frequently as 90% of cases, and sometimes it can be mild and very brief, or it could be long and more severe, and it can be the result of all different kinds of things that are going on with the patient at the time.

Speaker 8:

So blood pressure can drop because of anesthesia, sleep or relaxation. It can be due to reactions to medications, or it could be a reflection of something going on with the patient, either their chronic illness, their frailty, or something that's going on with the operation itself, for example, hemorrhage and bleeding, which I know we're going to talk about because it's such an important issue for our moms. The reason why we're so concerned about it is that we know the longer the blood pressure is low and the lower the blood pressure is low, the more chance of even permanent harm. The more chance of even permanent harm. So, for example, this can lead to kidney injury, heart injury, stroke, prolonged hospitalizations and even death. So for all these reasons, we feel like we need a call to action to really figure out what we can do better.

Speaker 3:

And Megan, from the point of view of the pregnant mom, and particularly around the time of cesarean sectional childbirth, and the baby, are there additional risks there?

Speaker 7:

Absolutely. I mean, if you're thinking about all of those risks that may just point it out. And now you have two patients we're worrying about and you have this. You know everyone, on the surface level when they're pregnant, usually looks young and healthy, but her body is already compensating. So once she becomes hypotensive or her blood pressure drops, she's not in a position where she can compensate as quickly as somebody who's not pregnant.

Speaker 7:

So moms, you know they immediately get nauseous and vomiting. You know that not only impacts their delivery experience which nobody wants to be having a C-section in the first place but it also makes the surgery more dangerous as a surgeon than you're. You know having to operate around moving targets For babies. You know the placenta. You know what kind of gives baby. All of the blood, nutrients and oxygen isn't something that we consider auto-regulated, so it doesn't have the compensatory mechanisms to say, okay, mom's blood pressure is low, I'm going to shunt blood to myself, it just doesn't get that blood and oxygen. So when moms has low blood pressure, baby just isn't being oxygenated. You see lower APGAR scores, potential neurologic injury.

Speaker 3:

Now, moms, when they're pregnant, often have their blood pressure, or they choose to measure their blood pressure frequently because there's a condition associated with the interaction with the baby causing high blood pressure. Is that in play as well?

Speaker 7:

Absolutely so. You know. Thinking about what we call preeclampsia gestational hypertension, we do this dance of you don't want the blood pressure too low, but you also don't want it too high, because if moms become preeclamptic or their blood pressure gets too high, you're increasing further risk to them. Interventions they need additional medications. Often it leads us, as the obstetrician, to need to intervene for delivery. We worry about stroke, peripartum, postpartum cardiomyopathy or long-term damage to their hearts.

Speaker 3:

You know peripartum, postpartum cardiomyopathy or long-term damage to their hearts. And it's increasingly common that to facilitate cesarean section we don't use general anesthesia. We put it crudely we put a needle in the back and inject local anesthetic to make the body go numb, you know, to facilitate the surgery. But that can upset the blood pressure as well, can't it?

Speaker 8:

Yes, absolutely. We think it's terrific that moms can be awake during an operation and meet their babies right away, and in many cases, dad or partner can be there as well and be a family right away. Spinal anesthesia or epidural anesthesia is associated with a drop in blood pressure temporarily, and so we have almost made it as a common practice to pre-treat with medications that will elevate the blood pressure or keep it normal under these circumstances, and that's become a pretty standard practice across the country. All of these things that we do are a little bit empirical, in that we try not to wait for the blood pressure to drop, and so having some kind of monitoring where we have real data on which to base these interventions would be really helpful.

Speaker 3:

Now, traditionally, we have had monitors that have worked automatically but based on an arm cuff, similar to that that we might have at home for measuring our own blood pressure, and arm cuffs some of us are that that we might have at home for measuring our own blood pressure.

Speaker 8:

What's wrong with this technology? Yeah, so I like that. You mentioned that originally, technologic limitations made it so that those arm blood pressure cuffs could only cycle every five minutes. Now we have the ability to do it more often, but certainly not we don't have the beat-to-beat monitoring abilities, so we don't know what we don't know right, and so during those intervals where we don't have live data coming through, we can't identify problems quickly and treat them quickly and minimize harm as best as we can.

Speaker 3:

So, Megan, you've been using continuous non-invasive blood pressure measurement for a while now, I believe. Can you expand on that for us please?

Speaker 7:

Yeah, it's been phenomenal because, thinking about the arm cuff, it's, you know, equivocal to almost like your dial-up internet. It's historic. It works kind of in the most basic circumstances, but anything goes wrong. Your patient bends her arm. She doesn't have the right body habitus. She's shaking after delivery, she's trying to breastfeed her baby. Now I don't have data Versus. If you know, using the continuous blood pressure monitoring that we have access to now, I have beat-to-beat data. I have data I can trust and so I can intervene much faster and I also don't have to prevent mom from you, mom from bonding with her baby. I provide a safer surgery as well as postpartum experience.

Speaker 3:

So has continuous blood pressure measurement been demonstrated to improve care, or one just gets the impression it clearly improves care?

Speaker 8:

It does, and many of you may know that historically, when necessary, we've done B2B monitoring with invasive monitoring. For example, arterial lines are catheters that we place under sterile conditions in an artery, most commonly in the wrist, and that's been a way to monitor B2B variability. It does come with its downsides, though. It's a sink in terms of our workforce. It takes the attention away from other things that are going on. It is painful to be placed in a patient's arm. It can be associated with nerve or blood vessel damage and infection. So it's certainly not ideal and in clinical cases where we're expecting, maybe, blood pressure to be unstable for a very brief period of time, it doesn't feel ideal to subject a patient to that kind of invasive monitoring. And there is data, indeed, to get back at what you said, monty, that when we identify drops in blood pressure sooner and quicker and treat it, it does result in decreased harm.

Speaker 3:

So, megan, the technology from BD. There are other technologies. We obviously clearly think ours is the best. It goes on the finger looking a bit like a pulse oximeter wraps around the finger, Originally, I think, think, developed for space in the space agencies, but taken up by bd and advanced the point it is today.

Speaker 7:

It's up and running in about a minute yeah, and then it gives you what looks like an invasive arterial line right and it provides a significant amount of data, similar to an a-line um, which I hope is the obstetrician to never need, but having it there, I think it creates a dialogue and partnership with my anesthesia colleagues. Patients don't mind it. Like you said, it's a pulse ox and it kind of hugs your finger a little bit and then they don't know it's there. Using it like we do at the hospital I work at, patients will request it. They don't want the arm cuff and especially if you tell them what we're doing, you know I think their delivery experience is better. We showed a decrease in our postpartum hemorrhage rate. We showed a decrease in our ICU transfers and I think it's when you have up-to-date, accurate information you can trust as a clinician, you're going to intervene faster.

Speaker 7:

Anybody who's been at the bedside knows the arm cuff. Anytime you get a blood pressure reading, one of the first questions is well, was the arm cuff positioned right? You know? Was she moving? Was her arm bent? You know you're going to second guess it. Can you repeat it? You know, was it the right size? It's just not data you can trust.

Speaker 6:

Also disruptive, I assume, to the patient, to their sleep and different things when they're trying to get a good night's sleep versus having a finger cuff on there every two hours, going off.

Speaker 7:

Oh yeah, my C-section was terrible and I at least could advocate for myself, you know. Hey, stop doing this like I'm fine, but a lot of patients don't have that knowledge. We're just, you know, trying to spread the awareness.

Speaker 8:

So I think both of you are mentioning something which is really key and important to us, which is the patient experience. So, yes, we care about patient safety and clinical outcomes, but more and more, all these things create happier memories, I guess around the birth, rather than having cumbersome devices that have obvious failures in their own right.

Speaker 7:

Well, nobody's electing for a C-section. Rarely would I ever have a patient like this. Is my birth plan to have a C-section, so it's already a traumatic experience to begin with and I think providing them a safer surgery, a better experience, helps improve that kind of okay, you had to have a C-section but at least you got to enjoy it. You got to see your baby versus. She's nauseous and vomiting, the whole case.

Speaker 3:

So when in 1986 the minimal monitoring standards were originally introduced, the ASA were going to adopt it and according to the minutes which are available, you can read them they debated whether to include pulse oximetry, which we're all familiar with today, the finger clip that goes on that gives you a pulse and tells you the amount of oxygen in the bloodstream so you don't need to say are the lips blue or are the lips red. They debated that and in the first round they concluded that they would not adopt pulse oximetry because they said it was too expensive. They said we're brave to introduce minimal monitoring standards, but because the cost of this is higher, we we're going to back off, we're going to chicken out is one way of putting it. Now one of the past presidents is minuted said I think you're wrong. This is such a compelling better safety tool that within a year it will become a natural standard.

Speaker 3:

So by 1990, when the minimal monitoring standards affected me in the uk, we all got pulse oximeters straight away. But it required the bravery to change the standards, to say you should have it continuously to make it robust, reliable and affordable because of market forces. And I think that's exactly where we are today. So, May. Why can't we just tomorrow agree to go and change the standards?

Speaker 8:

Well, we're all human and changes are difficult, right? So oftentimes the benefits need to be very compelling and I think we're making a story for that and the cost needs to be sustainable or feasible, and I think that you know, as we make these types of monitoring more commonplace, I would expect the cost of such new innovations to drop, as we see in all different kinds of new technology. So I think we're going to hear from Megan actually about how leadership in her local place and bravery I think was one of the words you mentioned in our leaders can help us make a difference for our patients. And it's 40 years is too long. We need to do it again.

Speaker 7:

Yeah, I'm very blessed the hospital I work at, the Women's and Infants Service Line Director, zoe Coleman, she strongly advocated for women's health so she, you know, took the chance bringing it because she wants the safest you know, took the chance bringing it because she wants the safest, you know, labor and delivery unit. We can provide our patients and I think she has seen it not only provide better patient experiences but we're also creating a safer environment, you know, at our hospital. And I mean, like you said, it's, she kind of took a chance on it and wanted the best for her patients and that's why we get it.

Speaker 3:

Wonderful, mike, reflections on. You know, from the point of view of technology, wonderful opportunities. Many companies have now advanced it, but they can't get over that unless people are prepared to adopt, you can't make the big change.

Speaker 6:

Yeah, I, you know one. I think this is one how we do it, because it is that education and it's that collaboration. And this is step one. Unfortunately, there's many more steps to get there right. I mean the fact that we're talking about something from 40 years ago and how do we make a change there that's going to give patients better access, better outcomes? We have to figure that out. So I'm optimistic that these are those steps and the members of Congress and the staff that are here and in the room and hopefully watching or will watch this are going to see what all those benefits are.

Speaker 6:

And I like to equate it to people as well. When you have these conversations and you're trying to educate folks is to them. Almost everybody has family members who have either given but they were certainly given birth to to your point. But you know what did they go through.

Speaker 6:

And if you have a spouse, my wife had a horrible pregnancy and out came with some difficult positions and the blood theft monitoring is what made me think of that when I said it's distracting because she was like ah, keeps waking me up. You know that would have helped with more sleep might mean for a loved one, to a spouse, a mother, a granddaughter, congressman Peter's soon-to-be grandbaby from his daughter. That's where you get the rubber that meets the road and when we're talking to elected officials a lot, when you find those commonalities where people can feel it and see it, that's where we can make a difference together. So I was thinking about how can we do it and what's the probability that we had talked about and I was originally going to say, well, I hope we can do it.

Speaker 6:

After hearing this, I think we can. I think it's a matter of how do we bring these people here, the companies in the room, our elected officials not just BD, but there's other companies out there that have similar technologies and how do we bring those to the forefront with the goal of providing better patient access and better patient care, protecting innovation along the way, which is becoming more and more difficult to do, unfortunately, under the current challenges. We'll call it. But if we keep that in mind and we all continue to work together and partner, I think there's definitely things we can move and make that momentum and it's kind of those baby steps that will get us there.

Speaker 3:

In the anesthesia patient safety document about monitoring in the broader sense in hospital. In one section it suggested that part of the call to arms should be a public facing public health sort of message to say, do you know, this is what goes on once you're put off to sleep, et cetera. And then there's that balance of some people say, well, you don't want to scare patients. You say, well, you're suggesting they can't handle the truth. May, where do you stand on that one?

Speaker 8:

I totally don't believe patients can't handle the truth. I think care is always improved when patients are part of shared decision-making and they are very much informed, as we talked about, educated and part of the team dynamic, so absolutely.

Speaker 7:

And I think patients are educating themselves anyway. Whether it's a Reddit blog or a mommy blog, they're finding the information out there that they want, so providing good information to patients, I think is the key Dr.

Speaker 6:

Google can be dangerous.

Speaker 7:

That's key you know, and I have to always talk to my patients all the time like come to me with your questions or here's the resources you can look to, because in today's world patients want to educate themselves. They don't want to take just what I say, they want to verify it. So having good, verifiable information out there, I think, is important.

Speaker 3:

Great, Thank you. If anyone from the audience would like to make a comment or ask a question, please do indicate by waving at me raising your hand, and we'll ask the panel to address those or I'll do my best to address it, and that's available for the next few minutes. Anyone Right at the moment? Yes, please, sir. Could you identify yourself? Oh, I'm so sorry. My name is Erin.

Speaker 10:

I'm actually a nursing student working on my master's in science and nursing and I work in a faculty. I'm here representing the office. We see a lot of A-lines, we see a lot of invasive blood pressure monitoring, of course, in my space.

Speaker 11:

This is very compelling to me, but what is the data? How does this?

Speaker 10:

compare to invasive monitoring versus blood pressure cuts that usually drives how we adopt practice change in my hospital, so I'm curious to know a little bit more about how it compares to A-line data.

Speaker 3:

I'll give you one answer to that. Then I'll hand over to the clinician. Can you repeat the question for the webcam audience? Certainly so. The question is the accuracy of the monitoring. In other words, arterial lines which are invasive, placed into an artery, are the gold standard. The question is are the continuous non-invasive alternatives of similar accuracy? The answer from the industry perspective is to get regulatory approval you have to demonstrate equivalence to an arterial line. So it's approved to have the accuracy and precision equivalent to an arterial line without the risks of the invasion you know there is. Although arterial lines are pretty safe I've had many myself for experiments they're not completely safe and certainly the pain you're left with afterwards is not nice in that perspective. So that's the industry answer and the personal answer May accuracy of them.

Speaker 8:

It's perfect what you said. I couldn't have said it better. Oh, thank you for that.

Speaker 3:

I hope my mum is listening.

Speaker 7:

I'll just chime in. Nobody wants you know who's going to deliver a baby wants an A-line, and nobody wants to put an A-line in a pregnant patient. We've also used this in situations where I need better data. You know, I have a patient come into triage. Am I going to admit her or am I not going to admit her? Well, I don't want to put an A-line in just so I can get good blood pressure, because her arm is not the right shape for an arm cuff. So I can use this and just get good data and make my clinical decisions, versus admitting her for an A-line, which would be absurd.

Speaker 8:

Megan, I think that's a really key point that you make, because a lot of clinical decision-making is affected by cognitive biases. And you're right, nobody wants to do those painful, invasive things in young, healthy moms, for example, and probably we have a lot of missed opportunities where things head south and we just don't have ideal monitoring to identify it and to treat it most effectively. So having something that you just clip on the finger would be fabulous.

Speaker 7:

I mean, I've used it in triage. I use it in the middle of a hemorrhage where, okay, this is she's actually more hypotensive than I think Now I can intervene faster. This is going to take me to my next step, versus. She's shaking and her arm cuff tells me her blood pressure is fine but it doesn't fit the heart rate and you're kind of trying to get a better clinical picture why I'm calling anesthesia to bedside so I can do this.

Speaker 3:

I can do this. And the other side of it is we me back in the hospital used to think an A-line was virtually free, because it's just a little plastic pipe we pop in. We forget all the other bits that go with it, which leaves a huge pile of plastic at the end of it. It's a massive pile of plastic that goes into landfill, probably. The other thing is you have to have skilled nurses afterwards to look after the arterial line, so it's another nursing burden that's in place to make sure the a-line is safe, because if it comes detached you can bleed out from it, literally bleed out from it.

Speaker 3:

so it's not yeah you know they're wonderful things but they're not perfect. Any more questions, thank you. Perhaps a wonderful question by thank you? Yes, please go identify yourself and I'll repeat the message for the question.

Speaker 11:

I'm curious about it. This would become a standard that you can do this blood monitoring monitoring. How would we address issues with world health care? How would we address the accessibility chain and make sure this could be uniformly distributed across different areas that they experience these technology gaps, specifically with high-cost, new and innovative technologies, and how can private partnerships kind of help fill that gap?

Speaker 3:

That's a great question, so please comment on that and I'll give my own version of it at the end, if I may. May, do you want to go first?

Speaker 8:

Yeah, I think that this is a real opportunity to help improve inequities and disparities in care. You know, if we're saying that this non-invasive continuous blood pressure monitoring is as effective as arterial lines, then we are greatly expanding the footprint of patients who would have this available to them. And it occurs to me too that a lot of women die postpartum not in the hospital but at home, and so these sorts of technologies, I think, rapidly, could become something you have at home as well and really make an impact on patient outcomes.

Speaker 7:

And, to that, I think, a lot of the rural locations. You don't have the same resources I have working in a big hospital where I can call my anesthesia colleagues to do an A-line. I have all of these resources in a blood bank. So having the accurate, up-to-date information immediately accessible is so important and I think by making it the standard of care then you're going to drive competition and the cost down.

Speaker 6:

Yeah, I think standard of care is certainly one of the most important pieces of that and working with the providers to make sure they understand the standard of care. I mean up front. You made a good point just in your question alone. Right, the price is obviously high up front. There's R&D costs and there's the initial production costs and all those different things they're recouping. But over time as demand goes up and cost of goods comes down and everything falls into place, the pricing in these types of spaces typically come down as well. So you need all those factors to come together.

Speaker 6:

But I think what you all said and those two pieces will help bring that accessibility and just the ease of it. I mean, it just seems like you know, I've had to use a blood pressure cuff at home. My wife and I have opposite I'm high blood pressure, she's low blood pressure, but you know you still have to get the cuff on right and all those different things. It seems like a pretty easy application that if it has the in-home use or rural community, et cetera, that you're going to get significant advantages out of it.

Speaker 3:

And I and we think a lot about that from the industry perspective, and I've crossed over now from my academic role, the hospital role, to work in industry, and that is the ambition to make the measurement possible. You know, robust, reliable, affordable is the mantra we talk about. But to do that take the example of pulse oximetry, which I reflect on quite often used to be incredibly expensive at the beginning. It's widespread adoption and market forces that make it affordable to everybody over the passage of time. That's why there's the tension between are we brave enough to change the standards or not? Because until we change the standards that doesn't happen. That's the tipping point that makes the difference. So, in the interest of time to keep the panel here, we'll have a few more questions towards the end. I'm just going to ask Megan Kastner from Viacom California to say a few words, which is reflected on so far. Megan, welcome.

Speaker 12:

Thank you, monty, and thank you panelists. This is such an informative and important discussion, so really appreciate it. Good afternoon everyone. My name is Megan Kastner and I am the Federal Advocacy Manager with BioCom California, one of today's sponsors. For those of you who aren't aware of our work or familiar, biocom California represents over 1,700 innovative biotech and medtech companies, as well as research institutes and universities across California. Our mission is to ensure that breakthrough technologies like the one you heard about today are one successfully developed and two reach healthcare providers and their patients.

Speaker 12:

At BioCom California, we've witnessed many promising technologies face the valley of death, or the gap between researching an idea and bringing that idea to market. Innovators face many challenges along the way, from securing investment funding to getting regulatory approval, but often, even after a technology is approved, it may not reach the provider and the patient because of a lack of reimbursement or sometimes just because of a lack of awareness that this technology exists. Today, you've heard about continuous blood pressure monitoring, a technology that you may not have known existed, and, along with that, you may not have known about the devastating impact low blood pressure can have on pregnant women undergoing C-sections and their babies. Thanks to this technology, we can ensure patient safety and care is improved in hospitals across the country, but to increase access, we have to increase awareness. At BioCom California, we stand ready to work with you all here today to bring this technology, along with many others, to the patient's bedside.

Speaker 12:

We need robust partnerships amongst industry, healthcare providers, patient groups and policymakers to improve patients' access to these life-saving innovations. Successful partnerships are built on authenticity, transparency and, most importantly, putting the patient first. From what I've seen today, both on this panel and in general in this room, we possess the qualities necessary to advance the awareness and adoption of this transformative technology. Together, we can ensure that continuous blood pressure monitoring becomes a standard of care for patients undergoing surgery. I want to thank my colleagues at BD for putting together this incredible panel Again, fantastic information. So thank you again. And with that, monty, I will turn it back over to you.

Speaker 3:

Thank you, madam Chair. Thank you, madam Chair, indeed, and thank you again for your sponsorship. Any more comments or questions from the room?

Speaker 6:

Yes, please over here, and then over here you start first. My name is Elliot. I'm an intern with Congressman Stutzman. My question was sort of building off of your last comment about needing the market to drive innovation.

Speaker 1:

What does the market space look like right now? Is BD the only manufacturer or producer of these technologies?

Speaker 3:

The answer to that is no, which is very important, because when you have a monopoly position in this space, then trying to advocate for change means that you get pushed back the whole time from having a monopoly position. Do we think we've got a monopoly on the best technology? Obviously, that's my job to be here to point that out and I think that's absolutely true. But the important thing is there are other ways of doing it, and that's absolutely true. But the important thing is there are other ways of doing it and that's really, really important. So there's choice, which means there's competition, and therefore market forces will deliver over time, but they're going to be caught in whatever is called the spiral of death if the standards don't change soon, because all of their efforts and endeavors and investment will have come to nothing because of failure for us to adopt. Have you seen other technologies?

Speaker 7:

Honestly, I think kind of spreading awareness is key, because I didn't realize this technology even existed until it kind of showed up in our you know, showed up in my OR. So you know, starting with the education and even educating other providers that, hey, this, you don't need an A-line, you have this other technology available.

Speaker 3:

There are other things out there, so thank you for the great question. Thank you, there's another one over here, my name is Judith.

Speaker 11:

I'm from Congressman Kevin Kern's office. My question is is there any specific legislation that's currently proposed that would solve this issue and provide the fair use for people.

Speaker 3:

Who's the expert on legislation from this perspective?

Speaker 6:

I don't know that there's anything currently being proposed yet. I think that's part of what this is is the education and the appetite and to figure out how we bring that forward, making sure that we get the folks in the insurance companies and everybody else on board. So that would be probably the next step.

Speaker 8:

Can we nominate you to get it going? Is your?

Speaker 3:

congressman willing to carry it forward and sponsor, and I would hope a bit like happened the last time in 1986, that we, the profession, would rise to the challenge and therefore rewrite our own standards to try and universally do what we now believe to be the right thing. So, hopefully, it would be great if we could have the help, but maybe we could just lead as a profession first, which would be, I think, a nicer result Does that make sense.

Speaker 3:

Yes, Thank you. Thank you for the great question. Sorry, just behind you. First and then you Thank you. Thank you for the great question. Sorry, just behind you first and then you.

Speaker 10:

Thank you all so much for being here. My name is Hayley. I'm from Congressman Dr Conway's office. I just wanted to ask a question because you talked about post-op symmetry a lot and I know in the past there have been issues with post-op symmetry in that sometimes with people with more mellot, that mellot and their skin that it doesn't quite work as well, and so I was wondering in terms of this.

Speaker 11:

you said it was a very similar application. Are there any similar issues in that regard?

Speaker 3:

Shall I take that one Sure Sure. So the skin tone issues with regards to pulse oximetry, which were very real, have been largely addressed from the point of view of modifying the technology. The way we measure blood pressure at BD does use a light-based system, so part of getting its approval is to ensure the fact that it works reliably, precisely and accurately with all skin tones. So it's a great question to bring it up. It's a very real issue for our technologies that do use light, but we have quite rightly been asked to address them and we have addressed them. So I think that's reassuring for everyone.

Speaker 7:

And from a clinical user standpoint, I haven't had any issues like that. It's kind of a one-size-fits-all. It doesn't you know? Bmi 70, bmi 15, you know, her finger fits in it.

Speaker 8:

Thank you for thank you for asking that, because we definitely, you know, if we're going to push for change, we want everyone to benefit from it. So thank you.

Speaker 10:

I'm. I'm Gwathamah Sohani, I'm from Columbus, from the Evette Clark's office, kind of. Along a similar vein, you guys have talked a lot about the maternal mortality crisis. There's no discussion of the maternal mortality crisis without talking about the way it is racialized in the United States and the disproportionate impacts on black women in particular. I was just looking up some statistics. I also see that black women are much more likely to receive antihypertensive medication and less likely to receive antihypertensive drugs. And I'm just wondering you know you guys are talking about outreach to specific organizations. You know, is there any outreach being done to the populations that are suffering? You know the brunt of the impacts of this crisis, specifically black women in the United States.

Speaker 7:

I think that's a great question and it's something, you know, as a practicing clinician I deal with every day. It's building that trust because I think over the years you know a lot of the minorities don't necessarily trust the medical system. And so getting them to trust me, you know, getting my patients to advocate for themselves and know that this, you know different technologies are out there, they can, they have a voice, you know, when you come into my office room or my OR, and I think elevating the standard of care will provide safer care and will kind of help rebuild that trust With regard to treatment of hypertension, it's a very nuanced problem requiring a nuanced solution, in that some races have a higher incidence of preeclampsia, for example, and so that may fold into some of the data that you're looking at.

Speaker 8:

So thank you for asking that.

Speaker 3:

And we hope before the end. We're going to hear from Congressman Rajna Krishnamoorthy and I noticed from his bio that one of the areas that he's highlighted is for the Caucus for Black Maternal Health, for example, and being involved in bodies, for example the black maternal health momnibus, which is a great term, a momnibus and from my perspective from back in the UK, exactly the same issue exists. There's disproportionately high mortality amongst women of color having babies, but in particular women having babies, so we need to address that head-on. Any more questions or comments from the audience, please? Thank you.

Speaker 9:

But I remember spending a lot of time researching hospitals and I'm wondering if, for suspected mothers, is there a way for them to know which hospitals provide such technology and how they should go about it and have any recommendations to find that information?

Speaker 3:

So should you be advertising that you're using CNIBP to moms who want to be better informed?

Speaker 7:

I think so and I think educating our patients, and then, whether or not the hospital advertises it, it's going to show up in your Reddit blog or kind of post where you're looking at other people's experience, because I think word of mouth.

Speaker 8:

Where did you'm immediate past president of the Society for Obstetric Anesthesia and Perinatology. We nickname it SOAP, and SOAP has identified centers of excellence for OB anesthesia care across the country and they use certain criteria, such as you know, accessibility to blood banks, the number of high-risk patients that they take care of, the use of simulation and so forth, as measures of excellence. And I'm just thinking how provocative and wonderful it might be to have continuous blood pressure monitoring as one of those criteria as well, blood pressure monitoring as one of those criteria as well. We're thinking that as this becomes more well-known to patients and also to hospital administrators, there'll be a motivation for hospitals to improve the quality of care that they provide.

Speaker 3:

Thank you, We've got time for one more question or comment from the floor. I believe.

Speaker 10:

Yes please. We can give a response to that as well.

Speaker 3:

We've tried over the years to present it to the broadest sweep of providers possible. When they get a chance to see the technology, they're universally impressed. One of the ironies of what's happened in the last few decades with the interaction between industry and providers in the United States of America in particular it's much less obvious in the United States of America in particular, it's much less obvious in the United Kingdom and in Europe is you don't get the same access to show people your new technology. There's this sort of barrier that's put up to say you should stay away and not show us your new technology because we might buy it or use it if you should mean. And that strange tension is there such that it's often that people just don't know it exists.

Speaker 8:

So I think we have to lead with the patient at the center, and how can we better keep our promise to mothers, for example, that we're going to protect their safety and help assure a smooth delivery, and then, hopefully, more organically and grassroots wise it'll be elevated from there. More organically and grassroots-wise it'll be elevated from there. The Anesthesia Patient Safety Foundation, apsf, is a foundation of ASA and ASA has been supportive in propagating a lot of the press and social media that's surrounding this particular event on Capitol Hill.

Speaker 6:

I think one of the things Monty just pointed out and part of it really is show and tell and getting access. We haven't figured out a way to do it as effectively here in DC, aside from doing fly-ins and maybe bringing them with us to meet with all of you in your offices and the members. But in California we would do a MedTech showcase and we were successful a few years back getting continuous glucose monitoring through legislation because we had it there in the room and the elected officials literally were able to I'm using the cuff for that it was on the arm in the app and to see what you can get. And for small children and different things that parents used to have to figure out, or for elder care, to be able to watch it on your phone and get alarms. I mean it really is a no-brainer, but once you touch it, feel it, see it.

Speaker 6:

Work was the selling point, and I'm certainly not a doctor compared with my three esteemed colleagues on the panel, but I tend to believe that when people start to see this in action and how easy it is from somebody that works in an OR to use non-evasive with the same results, I can't imagine it's going to not catch fire. But we got to get those points up, we have to get that education, we have to find those opportunities. So for those of you in the audience here that are working with different members, please accept some of those invites. I know tomorrow some folks are on the Hill from Abamed and this will be one of those topics. We're in support of Abamed, but making sure that happens is key because it really touchy-feely with technology like this especially the easily applicable with major benefits is huge easily applicable with major benefits is huge.

Speaker 3:

So I think it's the moment to introduce Congressman Rajana Krishnamoorthy, who's kindly agreed to come on along and say a few comments as we get towards the end of this session. If I may welcome you. Sorry to jump on you straight away there, okay, hi everybody, monty, thank you for straight away Okay. All right, hi everybody, monty Python, thank you for coming, monty Python.

Speaker 12:

Monty. No one's ever mentioned him.

Speaker 6:

You missed his whole skit.

Speaker 4:

Your name was Monty Python.

Speaker 6:

Okay.

Speaker 4:

Okay, look, it's wonderful to be with you. This is the first time I've ever talked about this, but I just recently learned that the topic that you folks have been focusing on is a big issue. Now, before I do that, I want to say thank you to all of you. Thank you to BD, thank you to the anesthesiologists and others for focusing attention on this. I should say full disclosure my wife is an anesthesiologist. The joke is that we both put people to sleep and so just have a little bit of additional caffeine about now.

Speaker 4:

But look, I think that this issue of hypotension during a surgery is a new topic for me, because I wasn't aware that it happens, I guess, in 90% of operations, and it leads to all kinds of harm, including damage to internal organs, and apparently, especially in maternal situations, it could be downright catastrophic. And so the question is, what do we do about this? And so I'm really glad that there's a discussion of constant I'm just going to use my layman's terms here, I'm sorry basically constant blood pressure monitoring, and I always think if you were kind of constantly monitoring my blood pressure, you'd be like sending, you'd be rushing EMS to me around here in Congress, but obviously my blood pressure is spiking a lot of the time, but in a surgery it's dropping, and so that kind of constant monitoring will probably help prevent the catastrophic effects and harm of sudden drops in blood pressure.

Speaker 4:

I think that, from what I understand talking to others, it appears that from a public policy standpoint, we need to start to look out for this, and maybe even someday I don't want to say require or mandate but begin to put additional emphasis on it, and so I'm glad that you're talking about that as well, and we will eventually, I'm sure, see it turn up in rules and regulations and so forth. But for now I'm glad that you're talking about it and giving more exposure to it. And now I have something else to impress my wife with tonight.

Speaker 4:

So, thank you again for allowing me to address you briefly, and I hope you have a great rest of your conference. So thank you, thank you.

Speaker 3:

So to bring us to a close here, just briefly, I'm going to ask our three panelists to give us a call to action of some form. Mike, I think you gave us one already. Let's get the technology out there and get people looking at it Any more.

Speaker 6:

No, I mean, I think certainly that is a big one and the collaboration and education. I think that is for us what one of our main missions is is to working with our member companies and the industry to protect innovation, to grow innovation and to get more access to patients and better patient outcomes and experiences.

Speaker 2:

Megan.

Speaker 7:

It's very similar. You know, we, pregnant women and their babies, deserve better care and so elevating the standard of care. You know, hopefully we can not be number one, maternal morbidity and mortality we can, you know, at least fall to number two.

Speaker 8:

I'm going to go with the slogan time is ticking, and it has two layers for me. One layer is that we can't settle for non-invasive blood pressure coughs that only cycle every few minutes. We're missing data in between those checks, and time is ticking because we have a maternal health crisis and we know about the problem, we know about possible solutions, and so we need to collaborate and make a difference.

Speaker 3:

Thank you very much indeed, and we, bd and other biomedical companies in the space, we are here to help. That's what we're here to do. We just need to be given the opportunity to do what we think is the right thing. So thank you again for coming along today. Thank you to Congresswoman Young Kim for backing us to have this opportunity to present. Thank you to Congressman Scott Peters and Raja Krishnamoorththy for saying a few kind words. Thank you to our panelists and representatives from our sponsors, the APSF, biocom California and California Life Sciences. There will be a chance to hang around for a little bit longer after this if you want to chat to people. There's also a landing site, a website that you can find from the Anesthesia Patient Safety Foundation. The longer version of that's available if you want it, but the key bit is apsforg. So thanks for coming.

Speaker 2:

Enjoy the rest of your day. If you have any questions or comments from today's show, please email us at podcast at APSForg. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSForg for detailed information and check out the show notes for links to all the topics we discussed today. If you were inspired by the Capitol Hill briefing and this podcast, we want to make sure that you don't miss out on the latest updates. By providing your email on the Continuous Blood Pressure Monitoring resource page, we will make sure that you receive regular updates about the benefits of continuous blood pressure monitoring and the continuing discussion about standard of care. You can be a continuous blood pressure monitoring champion at your institution as you work to improve anesthesia patient safety. As you work to improve anesthesia patient safety. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.