On the brink of changing the way medicine works | Martyn Boutelle | TEDxLSE

so imagine imagine you’re going for a

so imagine imagine you’re going for a meeting you’re late you’re rushing but

meeting you’re late you’re rushing but

meeting you’re late you’re rushing but you trip it’s a small trip but you’re on

you trip it’s a small trip but you’re on

you trip it’s a small trip but you’re on the stairs so you fall first slowly then

the stairs so you fall first slowly then

the stairs so you fall first slowly then faster then faster then bang you hit

faster then faster then bang you hit

faster then faster then bang you hit your head you’re unconscious it’s a

your head you’re unconscious it’s a

your head you’re unconscious it’s a medical emergency so what happens next

medical emergency so what happens next

medical emergency so what happens next if you’re lucky you’re taken by an air

if you’re lucky you’re taken by an air

if you’re lucky you’re taken by an air ambulance to a major trauma center

ambulance to a major trauma center

ambulance to a major trauma center something like King’s College Hospital

something like King’s College Hospital

something like King’s College Hospital isn’t mary’s hospital there the doctors

isn’t mary’s hospital there the doctors

isn’t mary’s hospital there the doctors assess you and they determine you’ve got

assess you and they determine you’ve got

assess you and they determine you’ve got a severe traumatic brain injury they

a severe traumatic brain injury they

a severe traumatic brain injury they take you into the intensive care unit

take you into the intensive care unit

take you into the intensive care unit they put your brain to sleep to try and

they put your brain to sleep to try and

they put your brain to sleep to try and save it and then they wait and they wait

save it and then they wait and they wait

save it and then they wait and they wait and they wait and see for five days for

and they wait and see for five days for

and they wait and see for five days for 10 days to see if you’re developing

10 days to see if you’re developing

10 days to see if you’re developing what’s called secondary brain injury

what’s called secondary brain injury

what’s called secondary brain injury basically there’s a 50/50 chance it’s a

basically there’s a 50/50 chance it’s a

basically there’s a 50/50 chance it’s a toss of a coin do you wake up do you not

toss of a coin do you wake up do you not

toss of a coin do you wake up do you not wake up do you i fine aid severe

wake up do you i fine aid severe

wake up do you i fine aid severe disability do you live do you die a 1 a

disability do you live do you die a 1 a

disability do you live do you die a 1 a 0

0

0 I’m a bioengineer and what we do is try

I’m a bioengineer and what we do is try

I’m a bioengineer and what we do is try and develop new technologies to try and

and develop new technologies to try and

and develop new technologies to try and help us predict the one for 0 maybe even

help us predict the one for 0 maybe even

help us predict the one for 0 maybe even to turn a 0 into a 1 when you’re in the

to turn a 0 into a 1 when you’re in the

to turn a 0 into a 1 when you’re in the intensive care unit when we first went

intensive care unit when we first went

intensive care unit when we first went into the intensive care unit we appeared

into the intensive care unit we appeared

into the intensive care unit we appeared to be surrounded by data there were

to be surrounded by data there were

to be surrounded by data there were screens behind us blinking

screens behind us blinking

screens behind us blinking beeping but none of that data was

beeping but none of that data was

beeping but none of that data was telling us how our brains actually were

telling us how our brains actually were

telling us how our brains actually were how healthy the brains were and so

how healthy the brains were and so

how healthy the brains were and so instead we had to try and develop

instead we had to try and develop

instead we had to try and develop technologies to make this work ok

technologies to make this work ok

technologies to make this work ok the intensive care staff here are in the

the intensive care staff here are in the

the intensive care staff here are in the dark basically they are trying to care

dark basically they are trying to care

dark basically they are trying to care for your brain that

for your brain that

for your brain that they’re caring so intensively for these

they’re caring so intensively for these

they’re caring so intensively for these patients and yet they have no data on

patients and yet they have no data on

patients and yet they have no data on which to place their decisions so they

which to place their decisions so they

which to place their decisions so they have to wait and see now that’s amazing

have to wait and see now that’s amazing

have to wait and see now that’s amazing I mean if you take your phone out of

I mean if you take your phone out of

I mean if you take your phone out of your pocket you know everything about

your pocket you know everything about

your pocket you know everything about your friends you know what they are

your friends you know what they are

your friends you know what they are wearing you know what they had for

wearing you know what they had for

wearing you know what they had for dinner last night you’ve seen the

dinner last night you’ve seen the

dinner last night you’ve seen the pictures so imagine that you could use

pictures so imagine that you could use

pictures so imagine that you could use that technology as a way of finding out

that technology as a way of finding out

that technology as a way of finding out moment by moment what’s happening inside

moment by moment what’s happening inside

moment by moment what’s happening inside your brain and that’s what we’re going

your brain and that’s what we’re going

your brain and that’s what we’re going to try and do so what data do the

to try and do so what data do the

to try and do so what data do the clinicians actually have so here’s an

clinicians actually have so here’s an

clinicians actually have so here’s an example of one sort of data this is an

example of one sort of data this is an

example of one sort of data this is an x-ray section through somebody’s head

x-ray section through somebody’s head

x-ray section through somebody’s head and this patient has been hit hard on

and this patient has been hit hard on

and this patient has been hit hard on the head you can see there’s some

the head you can see there’s some

the head you can see there’s some swelling inside there and critically

swelling inside there and critically

swelling inside there and critically it’s pushed the black lines which are

it’s pushed the black lines which are

it’s pushed the black lines which are the ventricles in the middle it’s pushed

the ventricles in the middle it’s pushed

the ventricles in the middle it’s pushed them to one side and it’s squeezing the

them to one side and it’s squeezing the

them to one side and it’s squeezing the brain against the skull that’s a bit of

brain against the skull that’s a bit of

brain against the skull that’s a bit of information if you have a whole series

information if you have a whole series

information if you have a whole series of stacks like this you can build

of stacks like this you can build

of stacks like this you can build slightly a better picture so the data

slightly a better picture so the data

slightly a better picture so the data has given us a better picture we can see

has given us a better picture we can see

has given us a better picture we can see now for this patient they’ve been hit on

now for this patient they’ve been hit on

now for this patient they’ve been hit on the forehead there the computer has told

the forehead there the computer has told

the forehead there the computer has told us in red where there’s possibly blood

us in red where there’s possibly blood

us in red where there’s possibly blood in blue where there’s some swelling in

in blue where there’s some swelling in

in blue where there’s some swelling in the brain now with this we can tell

the brain now with this we can tell

the brain now with this we can tell where the injury is but what we can’t

where the injury is but what we can’t

where the injury is but what we can’t tell is what happens next and that’s the

tell is what happens next and that’s the

tell is what happens next and that’s the vital piece of information if we want to

vital piece of information if we want to

vital piece of information if we want to care for these patients so just imagine

care for these patients so just imagine

care for these patients so just imagine that we could build tools that could

that we could build tools that could

that we could build tools that could give us data that could tell us what’s

give us data that could tell us what’s

give us data that could tell us what’s happening inside your brain moment by

happening inside your brain moment by

happening inside your brain moment by moment to do that we need understand a

moment to do that we need understand a

moment to do that we need understand a bit more about neuroscience so as we fly

bit more about neuroscience so as we fly

bit more about neuroscience so as we fly into the brain we can see at the chanted

into the brain we can see at the chanted

into the brain we can see at the chanted loom of connections between neurons each

loom of connections between neurons each

loom of connections between neurons each spark is a thought an action a feeling

spark is a thought an action a feeling

spark is a thought an action a feeling but each spark consumes considerable

but each spark consumes considerable

but each spark consumes considerable amounts of energy and that’s provided to

amounts of energy and that’s provided to

amounts of energy and that’s provided to your brain by blood flow rushing into

your brain by blood flow rushing into

your brain by blood flow rushing into the brain bringing oxygen bringing

the brain bringing oxygen bringing

the brain bringing oxygen bringing glucose to keep the cells alive now we

glucose to keep the cells alive now we

glucose to keep the cells alive now we can’t normally see blood flow

can’t normally see blood flow

can’t normally see blood flow this but there’s one special

this but there’s one special

this but there’s one special circumstance when we can so that’s doing

circumstance when we can so that’s doing

circumstance when we can so that’s doing your a surgery because they remove the

your a surgery because they remove the

your a surgery because they remove the skull so you can see the brain this is

skull so you can see the brain this is

skull so you can see the brain this is my great friend and colleague professor

my great friend and colleague professor

my great friend and colleague professor Tony strong who’s a neurosurgeon

Tony strong who’s a neurosurgeon

Tony strong who’s a neurosurgeon now sometimes during your surgery you

now sometimes during your surgery you

now sometimes during your surgery you can actually see what’s going on and

can actually see what’s going on and

can actually see what’s going on and this is a video from a cosmic colleague

this is a video from a cosmic colleague

this is a video from a cosmic colleague you had a sack of it you sack of it and

you had a sack of it you sack of it and

you had a sack of it you sack of it and your hands Wojcik in Germany and what

your hands Wojcik in Germany and what

your hands Wojcik in Germany and what we’re seeing here at the bottom of so

we’re seeing here at the bottom of so

we’re seeing here at the bottom of so the first thing that we see are the

the first thing that we see are the

the first thing that we see are the curves of the brain right the folds of

curves of the brain right the folds of

curves of the brain right the folds of the cortex but we then see this starting

the cortex but we then see this starting

the cortex but we then see this starting from the bottom this angry hurricane and

from the bottom this angry hurricane and

from the bottom this angry hurricane and is a hurricane of blood flow that’s

is a hurricane of blood flow that’s

is a hurricane of blood flow that’s crawling out across the brain surface so

crawling out across the brain surface so

crawling out across the brain surface so what’s underneath that underneath that

what’s underneath that underneath that

what’s underneath that underneath that are neurons and they’re undergoing a

are neurons and they’re undergoing a

are neurons and they’re undergoing a wave of depolarization where every

wave of depolarization where every

wave of depolarization where every single neuro loses its energy it then

single neuro loses its energy it then

single neuro loses its energy it then screened out for more blood flow to try

screened out for more blood flow to try

screened out for more blood flow to try and bring it back to life now we can’t

and bring it back to life now we can’t

and bring it back to life now we can’t normally see a picture like this but

normally see a picture like this but

normally see a picture like this but maybe we could make some technology that

maybe we could make some technology that

maybe we could make some technology that allows us to get that information here

allows us to get that information here

allows us to get that information here is a strip electrode this is a metal

is a strip electrode this is a metal

is a strip electrode this is a metal strip that’s placed onto the brain

strip that’s placed onto the brain

strip that’s placed onto the brain surface at neurosurgery each contact

surface at neurosurgery each contact

surface at neurosurgery each contact then looks downwards and listens to the

then looks downwards and listens to the

then looks downwards and listens to the neurons underneath and it listens to

neurons underneath and it listens to

neurons underneath and it listens to hear the electrical sounds of them

hear the electrical sounds of them

hear the electrical sounds of them firing and you can see also the little

firing and you can see also the little

firing and you can see also the little white tube is a probe that we’re

white tube is a probe that we’re

white tube is a probe that we’re sticking into the brain to measure

sticking into the brain to measure

sticking into the brain to measure something about the brain chemistry

something about the brain chemistry

something about the brain chemistry what’s going on then so as that way the

what’s going on then so as that way the

what’s going on then so as that way the depolarization moves up the strip we can

depolarization moves up the strip we can

depolarization moves up the strip we can it hits the first electrode and we get

it hits the first electrode and we get

it hits the first electrode and we get this signature of the depolarization

this signature of the depolarization

this signature of the depolarization wave and we hits the electrode number

wave and we hits the electrode number

wave and we hits the electrode number one then electrode number two then three

one then electrode number two then three

one then electrode number two then three then four as the wave moves across the

then four as the wave moves across the

then four as the wave moves across the brain now this spreading depolarization

brain now this spreading depolarization

brain now this spreading depolarization wave as is called is really

wave as is called is really

wave as is called is really extraordinarily destructive it’s in many

extraordinarily destructive it’s in many

extraordinarily destructive it’s in many ways it’s a brain tsunami this is the

ways it’s a brain tsunami this is the

ways it’s a brain tsunami this is the famous image of under the great wave of

famous image of under the great wave of

famous image of under the great wave of Kanagawa

Kanagawa

Kanagawa and the neurons rather like the poor men

and the neurons rather like the poor men

and the neurons rather like the poor men in the boat here are sitting there

in the boat here are sitting there

in the boat here are sitting there there’s an enormous wave of destruction

there’s an enormous wave of destruction

there’s an enormous wave of destruction coming and we have to wait and see we

coming and we have to wait and see we

coming and we have to wait and see we have to wait and see whether they live

have to wait and see whether they live

have to wait and see whether they live or whether they die but to understand

or whether they die but to understand

or whether they die but to understand that we need more data so the wave the

that we need more data so the wave the

that we need more data so the wave the electrical information has told us that

electrical information has told us that

electrical information has told us that the wave is coming but it doesn’t tell

the wave is coming but it doesn’t tell

the wave is coming but it doesn’t tell us yet whether the brain survives for

us yet whether the brain survives for

us yet whether the brain survives for that we need some chemical information

that we need some chemical information

that we need some chemical information so what we do is we take a thing called

so what we do is we take a thing called

so what we do is we take a thing called a micro dialysis probe and that’s the

a micro dialysis probe and that’s the

a micro dialysis probe and that’s the white probe and that’s placed into the

white probe and that’s placed into the

white probe and that’s placed into the brain tissue

brain tissue

brain tissue we then pump liquid through it really

we then pump liquid through it really

we then pump liquid through it really slowly so slowly that it would take an

slowly so slowly that it would take an

slowly so slowly that it would take an hour to make a tear drop of that liquid

hour to make a tear drop of that liquid

hour to make a tear drop of that liquid when the liquid comes out at the brain

when the liquid comes out at the brain

when the liquid comes out at the brain we carry it in a tube and it’s a it’s a

we carry it in a tube and it’s a it’s a

we carry it in a tube and it’s a it’s a stream of chemical data that goes into

stream of chemical data that goes into

stream of chemical data that goes into our bedside analysis instrument inside

our bedside analysis instrument inside

our bedside analysis instrument inside that we’ve got chemical sensors so each

that we’ve got chemical sensors so each

that we’ve got chemical sensors so each one is a bit like a needle but the key

one is a bit like a needle but the key

one is a bit like a needle but the key bit is at the tip the little electrodes

bit is at the tip the little electrodes

bit is at the tip the little electrodes at the tip about the size of a human

at the tip about the size of a human

at the tip about the size of a human hair

hair

hair we can then coat them with a special gel

we can then coat them with a special gel

we can then coat them with a special gel and inside that gel there are a reagents

and inside that gel there are a reagents

and inside that gel there are a reagents so that that sensor records the

so that that sensor records the

so that that sensor records the concentration of just one chemical be it

concentration of just one chemical be it

concentration of just one chemical be it glucose or potassium or lactate so the

glucose or potassium or lactate so the

glucose or potassium or lactate so the liquid comes out of the patient goes

liquid comes out of the patient goes

liquid comes out of the patient goes into a specially designed microfluidic

into a specially designed microfluidic

into a specially designed microfluidic chip and so it flows past the tip of

chip and so it flows past the tip of

chip and so it flows past the tip of each sensor allowing each sensor to

each sensor allowing each sensor to

each sensor allowing each sensor to taste what’s going on in the solution so

taste what’s going on in the solution so

taste what’s going on in the solution so let’s now try and put this data together

let’s now try and put this data together

let’s now try and put this data together this is data from a real human patient

this is data from a real human patient

this is data from a real human patient and we see at the bottom that signature

and we see at the bottom that signature

and we see at the bottom that signature of the brain tsunami coming past it hits

of the brain tsunami coming past it hits

of the brain tsunami coming past it hits electrode one then two then three then

electrode one then two then three then

electrode one then two then three then four but we can now add on to it the

four but we can now add on to it the

four but we can now add on to it the chemical data and we’ll start at the top

chemical data and we’ll start at the top

chemical data and we’ll start at the top start with the potassium potassium is

start with the potassium potassium is

start with the potassium potassium is normally inside the neurons and what’s

normally inside the neurons and what’s

normally inside the neurons and what’s happening as they depolarize they’re

happening as they depolarize they’re

happening as they depolarize they’re spilling out all of their potassium and

spilling out all of their potassium and

spilling out all of their potassium and that means the level goes up and we can

that means the level goes up and we can

that means the level goes up and we can see that we can see the glucose the

see that we can see the glucose the

see that we can see the glucose the glucose is what the brain is desperately

glucose is what the brain is desperately

glucose is what the brain is desperately using to try and bring that cell back to

using to try and bring that cell back to

using to try and bring that cell back to life and so the concentration of glucose

life and so the concentration of glucose

life and so the concentration of glucose goes down lactate there’s not

goes down lactate there’s not

goes down lactate there’s not of oxygen in the brain anymore and so

of oxygen in the brain anymore and so

of oxygen in the brain anymore and so the lactic acid level goes up in the

the lactic acid level goes up in the

the lactic acid level goes up in the brain so we have this little signature

brain so we have this little signature

brain so we have this little signature of what’s happening to the brain in

of what’s happening to the brain in

of what’s happening to the brain in response to that stimulus we also see

response to that stimulus we also see

response to that stimulus we also see something else here which is that the

something else here which is that the

something else here which is that the wave repeats and it repeats in these

wave repeats and it repeats in these

wave repeats and it repeats in these patients again and again 30 times 50

patients again and again 30 times 50

patients again and again 30 times 50 times this wave of destruction hitting

times this wave of destruction hitting

times this wave of destruction hitting the brain so what effect does that have

the brain so what effect does that have

the brain so what effect does that have so when I am looking at the level of

so when I am looking at the level of

so when I am looking at the level of glucose at the brain from normal going

glucose at the brain from normal going

glucose at the brain from normal going down towards danger levels at the bottom

down towards danger levels at the bottom

down towards danger levels at the bottom and the first spreading depolarization

and the first spreading depolarization

and the first spreading depolarization when it hits the brain it takes the

when it hits the brain it takes the

when it hits the brain it takes the brain glucose level down a bit but that

brain glucose level down a bit but that

brain glucose level down a bit but that repeats and repeats and repeats and that

repeats and repeats and repeats and that

repeats and repeats and repeats and that takes the brain glucose level down into

takes the brain glucose level down into

takes the brain glucose level down into the danger level so we can now put this

the danger level so we can now put this

the danger level so we can now put this complete picture together with our data

complete picture together with our data

complete picture together with our data we’ve seen when there is a problem

we’ve seen when there is a problem

we’ve seen when there is a problem that’s the electrical wave coming across

that’s the electrical wave coming across

that’s the electrical wave coming across the surface but we’ve seen what it’s

the surface but we’ve seen what it’s

the surface but we’ve seen what it’s done to the brain it’s taken the brain

done to the brain it’s taken the brain

done to the brain it’s taken the brain glucose level from healthy down to a

glucose level from healthy down to a

glucose level from healthy down to a danger level where that neuron can’t

danger level where that neuron can’t

danger level where that neuron can’t survive and so he’s going to die and

survive and so he’s going to die and

survive and so he’s going to die and that’s going to give us the secondary

that’s going to give us the secondary

that’s going to give us the secondary brain injury we’ve completed the picture

brain injury we’ve completed the picture

brain injury we’ve completed the picture and we’ve done that with data so we’ve

and we’ve done that with data so we’ve

and we’ve done that with data so we’ve taken then we use data to take pieces of

taken then we use data to take pieces of

taken then we use data to take pieces of this puzzle we’ve worked out what they

this puzzle we’ve worked out what they

this puzzle we’ve worked out what they are weave out worked out how to put them

are weave out worked out how to put them

are weave out worked out how to put them together to give us understanding and

together to give us understanding and

together to give us understanding and maybe just maybe by doing that we can

maybe just maybe by doing that we can

maybe just maybe by doing that we can save lives thank