CRADLE Scale up South London

CRADLE VSA at-a-glance

A handheld device that spots women who at at-risk of rapid deterioration due to bleeding.
Working with maternity units in developing countries where the shock index was developed to help recognise and treat bleeding promptly.
• Deteriorating patients are complex and speed really matters. Innovation in this area is vital.
• Recent reports have specifically highlighted earlier recognition of bleeding, and lack of recognition of deteriorating vital signs, as points for improvement in NHS maternity care.
• If successfully rolled out, this will help teams spot women who need help faster and make care for women safer.


Shock Index device introduced to save lives in maternity wards

HIN Innovation Award funding will be used to pilot a device that helps teams identify patients experiencing serious bleeding in maternity wards more quickly. The new device, CRADLE VSA (CVSA), is a hand-held, upper arm, semi-automated blood pressure device that has been specifically designed and validated for use in pregnancy and pre-eclampsia by King’s College London.

Globally, bleeding is one of most common reasons women die around the world in childbirth. The main reason things get so serious is that the issue is not recognised and managed quickly enough. Identifying women with dangerous bleeding can be very difficult and it is widely acknowledged that delays in spotting and starting treatment for bleeding patients contributes to death and harm. Additionally, clinicians are not able to predict haemorrhage (bleeding) from risk factors very easily. This means the focus needs to be on early recognition of a compromised patient, appropriate escalation and prompt management.

Although the NHS has sophisticated systems to spot deteriorating patients in many clinical settings, the predictive capacity of early warning systems in pregnancy is less well-evidenced and most blood pressure devices are not designed with pregnant women in mind. The CRADLE VSA device was created by UK doctors working in developing countries, in response to a severe and urgent need to spot bleeding patients in the context of very high maternal death rates. However, its simplicity and effectiveness could also have huge benefits in other healthcare settings globally, including in the NHS.

How does it work? CRADLE VSA uses a simple traffic light system to warn clinicians when a woman may be in trouble after giving birth. The lights are triggered by standard thresholds of blood pressure as well as shock index to alert health care professionals to a patients’ risk of compromise. The shock index is an innovative and simple measure. It is calculated by dividing heart rate by systolic blood pressure and it is a highly effective way of signalling that someone is in trouble and needs help.

The biggest impact of this device is expected to be on patient safety. Use of this device should reduce delays and reduce maternal death rates and morbidity. This would also lead to a reduction in length of stay for patients and faster return to daily activities and time with their newborn.

The Innovation Grant funding will be used to introduce the CRADLE VSA device into labour wards and high dependency units at Kingston Hospital and St Thomas’ Hospital. The results will be analysed using PSDA cycles and a quality improvement toolkit will be created so that the device can be used more widely if successful in these settings.

This ground-breaking device has been extensively validated. It was recognised in the PATH – Innovation Countdown 2030 award as one of the top 30 high impact global health innovations to help accelerate progress towards the United Nations Sustainable Development Goals. It also won the prestigious Newton Prize in 2017 for excellence in research and innovation.

Find out more about our work in maternity and patient safety


Innovator Spotlight

Professor Andrew Shennan, Professor of Obstetrics at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, said:

“If we can find ways to spot women who need interventions more quickly, we will save lives. I was inspired, with colleagues, to develop this device to help maternity wards in Africa but we believe that the simplicity and effectiveness of the device mean that it could also be really useful here.  I’m passionate about the potential for high-income countries to learn from low-income countries and think that some of most eye-catching innovations can come from teams working in extremely difficult circumstances.

“We’re starting with maternity wards for this initial project, but it’s possible that this device could improve safety in a wide range of settings in countries around the globe.”

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