Dr. Adam Power, Co-Founder & Chief Medical Officer, Front Line Medical Technologies Inc.
When did you start your journey as a vascular surgeon and CMO of Front Line Medical Technologies? Please share your experience with our audiences.
Surgeons have the privileged position of seeing first-hand which tools work well and which ones don’t when operating on patients. Combine this with the fact that my job as a vascular surgeon is to manipulate blood flow and I figured I was in as good of a position as anyone to find a better way to control bleeding, especially for non-vascular surgeons. I truly believe that simplifying medical devices to accomplish complex procedures is key to treating more patients with fewer complications;. You can’t always have a vascular surgeon immediately available for every major hemorrhage, but you can have better medical devices available. I, therefore, teamed up with my invaluable partner, co-founder, and biomedical engineer, Dr Asha Parekhto from Front Line Medical Technologies and the COBRA-OS was born. Fast-forward 5 years and this little device is helping to save lives all over North America and soon, the rest of the world.
What was the motivation behind the creation of the world’s smallest device used to control bleeding: the COBRA-OS, which envisions saving lives everywhere from the battlefield to the ER, to the OR, and beyond?
When I was in surgical training, I vividly remember patient bleeding to death in front of me and I had to open his chest (Resuscitative Thoracotomy) and clamp his aorta to try and save his life. It unfortunately failed but it left me always wanting to find a better way to control bleeding. Becoming a vascular surgeon opened my eyes to minimally invasive endovascular surgery (manipulating wires and catheters through the body’s vascular system to perform procedures remote from the access site), which provided the foundation to come up with the COBRA-OS. When you are accessing blood vessels through the skin, the size of the device matters immensely to reduce complications and simplify procedures. The COBRA-OS is the world’s smallest REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) device and can amazingly accomplish the same thing as clamping the aorta through the chest but instead through just a tiny IV-sized sheath in the groin.
How effective are these Health Canada-approved and FDA-cleared devices in saving more lives as it is less invasive and helps in reducing complications?
We have had the incredible opportunity to work with some of the pioneers of REBOA, who got great patient results even with older technology. However, they all agree that lowering the profile is key to reducing complications, especially when this tool is being used in less experienced hands. I am obviously biased but having used all available REBOA devices myself, the COBRA-OS is the smallest, fastest, and safest bleeding control device on the market. It is also the most cost-effective, which is very important to us in lowering all of the barriers to hemorrhage control worldwide.
The unique Safety Shoulder Reservoir being incorporated into the device, how helpful it is in preventing aortic rupture during inflation?
As a vascular surgeon, I would never have been able to look my colleagues’ in the eye if we didn’t incorporate some additional safety mechanisms into the device to help prevent complications. After all, vascular surgeons are usually the ones called if there are any major complications with REBOA. The Safety Shoulder Reservoir is one of those innovations and helps to prevent the aorta and the balloon from rupturing when the balloon is accidentally overinflated. We have done multiple animal studies and have yet to damage an aorta despite massive overinflation, while competitive devices all rupture the balloon or aorta at much lower inflation volumes.
With the COBRA-OS being the smallest in size, how can it contribute to saving the time of the typical REBOA procedures that usually take between five to 10 minutes or longer?
During REBOA procedures with older technology, you first access the blood vessel with a needle and IV-sized sheath but then go through an additional procedure to upsize the opening in the vessel to allow larger devices to be inserted and advanced up to block the aorta. The COBRA-OS removes this step and therefore speeds up the procedure immensely. In our first-in-human study, we were able to accomplish this in just over a minute, compared to almost ten minutes in other studies.
What’s your opinion about the use of this device in multiple situations, including non-compressible torso hemorrhage in trauma, postpartum hemorrhage, and gastrointestinal hemorrhage?
The COBRA-OS allows you to temporarily turn off the tap to the lower body’s blood supply to preserve flow to the brain and heart. Once bleeding is controlled, you can turn the tap on again. There are a variety of bleeding applications where this is a useful strategy, as mentioned. However, there are even non-bleeding applications where increased blood flow to the brain or heart can be extremely beneficial. One of these applications is in non-traumatic cardiac arrest. The COBRA-OS can make cardiopulmonary resuscitation (CPR) more effective at achieving a return of spontaneous circulation and we have been encouraged by the early use of our device in these situations. There are multiple trials forthcoming that will hopefully pave the way for the COBRA-OS to help patients literally come back to life after dying from cardiac arrest.