Gem premier 4000

Manufactured by Werfen

Sourced in United States, France, Germany, United Kingdom, Italy, Spain

The GEM Premier 4000 is a comprehensive blood gas, electrolyte, and metabolite analyzer. It is designed to provide rapid, accurate, and reliable results for critical care applications.

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41 protocols using gem premier 4000

Central Venous Oxygen Metrics in Septic Shock

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Demographic data, ICU admission diagnosis, and the Simplified Acute Physiology Score were obtained on the day of enrollment. Mean arterial pressure, the ventilation type (mechanical or spontaneous), and the use of vasopressor drugs were also registered. Septic shock was defined according to the Sepsis-3 criteria [8 (link)].
Central venous oxygen tension (PcvO₂), central venous carbon dioxide tension (PcvCO₂), measured central venous oxygen saturation (Co-oximetry_ScvO₂), calculated central venous oxygen saturation (Calc_ScvO₂), central venous pH, central venous blood lactate levels, hemoglobin concentration, and central venous base excess were measured using the GEM Premier 4000 (Instrumentation Laboratory Co, Paris, France). Co-oximetry ScvO₂ is determined by measuring the hemoglobin level of oxygen saturation based on a spectrophotometry optical system that monitors over 100 wavelengths in the absorbance spectra of oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin, and methemoglobin.
Both the Co-oximetry_ScvO₂ and Calc_ScvO₂ measurements were performed using the same point-of-care blood gas analyzer (GEM Premier 4000, Instrumentation Laboratory Co, Paris, France) on the same blood sample so that no additional blood withdraws was needed.

Oliveira B.D., Prasanna M., Lemyze M., Tronchon L., Thevenin D, & Mallat J. (2018). A comparison between measured and calculated central venous oxygen saturation in critically ill patients. PLoS ONE, 13(11), e0206868.

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Measuring Blood Gas Analytes and Platelets

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The pH and the glucose and lactate levels were measured immediately after sampling with a GEM Premier 4000 blood-gas analyzer (Instrumentation Laboratory, Zaventem, Belgium) at 37°C. As the upper measuring limit for lactate of this analyzer is 20 mmol/L, some samples were diluted 1:1 with 0.9% saline to accurately determine lactate levels. Platelet concentration and mean platelet volume (MPV) were determined in the citrated plasma with a Coulter cell counter (Beckman Coulter, Woerden, the Netherlands).

Kicken C.H., Roest M., Henskens Y.M., de Laat B, & Huskens D. (2017). Application of an optimized flow cytometry-based quantification of Platelet Activation (PACT): Monitoring platelet activation in platelet concentrates. PLoS ONE, 12(2), e0172265.

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Arterial Blood Analysis During Rest and Exercise

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Arterial blood was sampled at rest and during the last minute of exercise from a radial artery, and immediately analyzed for blood gases and hemoglobin content (GEM® Premier 4000, Instrumentation Laboratory, Lexington, MA, USA). Operators took note of the time elapsed from the start of the rest and exercise phases and arterial blood sampling, which allowed temporal alignment of arterial blood and ergospirometric data.

Mezzani A., Pistono M., Agostoni P., Giordano A., Gnemmi M., Imparato A., Temporelli P, & Corrà U. (2018). Exercise gas exchange in continuous-flow left ventricular assist device recipients. PLoS ONE, 13(6), e0187112.

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Metabolic Differences in Kidney Perfusion

Cited 1 time

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Differences in metabolic activity between cold and warm perfused kidneys were analysed by measuring glucose (mmol/L), lactate (mmol/L), pH, pO₂ (kPa) and pCO₂ (kPa) with a blood gas analyser (GEM Premier 4000, Instrumentation Laboratory, Lexington, USA) using standardized laboratory methods. Lactate dehydrogenase (LDH, U/L) and total glutathione-S-transferase (GST, U/L) were measured using a Roche Cobas 8000 system (Roche Diagnostic International Ltd, Rotkreuz, Switzerland). Machine perfusion fluid samples taken at t = 10, 60, 120, 180 and 240 minutes were analysed. Perfusate taken at different time points was analysed for the presence of histone H3 using semi-quantitative Western blotting as previously described [18 (link), 27 (link)].

van Smaalen T.C., Beurskens D.M., Kox J.J., Polonia R., Vos R., Duimel H., van de Wetering W.J., López-Iglesias C., Reutelingsperger C.P., Ernest van Heurn L.W., Peutz-Kootstra C.J, & Nicolaes G.A. (2023). Extracellular histone release by renal cells after warm and cold ischemic kidney injury: Studies in an ex-vivo porcine kidney perfusion model. PLOS ONE, 18(1), e0279944.

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Comprehensive Liver Perfusion Analysis

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Perfusate samples for blood gas analyses were withdrawn from the cannula placed in hepatic artery at the three-way stopcock and analyzed using an automatic blood gas analyzer (GEM Premier 4000, Instrumentation Laboratory Co., Lexington, USA). Perfusate samples were taken from the PV cannula for measurements of alanine aminotransferase (ALT) (c009-2-1,Nanjing Jiancheng Bioengineering Institute, CHINA) and aspartate aminotransferase (AST) (c010-2-1, Nanjing Jiancheng Bioengineering Institute, CHINA) using standard biochemical methods. Liver biopsies harvested from the perfused liver were immediately snap frozen for mRNA and protein detection, fixed with 10% buffered formalin for morphological evaluation by hematoxylin and eosin (HE) staining, and immunohistochemistry (IHC) and kept at 0~4°C for assessment of superoxide dismutase (SOD) activity, malondialdehyde (MDA) content, ATP content, GSH content, oxidized glutathione (GSSG) content and the level of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6).

Cheng N., Shi J.H., Jin Y., Shi Y.B., Liu X.D., Zhang H.P., Cao S.L., Yang H., Guo W.Z, & Zhang S.J. (2021). Pharmacological Activating Transcription Factor 6 Activation Is Beneficial for Liver Retrieval With ex vivo Normothermic Mechanical Perfusion From Cardiac Dead Donor Rats. Frontiers in Surgery, 8, 665260.

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Comprehensive Blood Analysis Protocol

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Whole blood was collected at BSLN, EOS, PFC (hour) 1, 2, 4, END PFC, EHC, and Final. Arterial blood gas parameters were assessed using a GEM Premier 4000 (Instrumentation Laboratory, Bedford, MA). Basic metabolic panels and liver-associated enzymes were evaluated on Catalyst One Chemistry Analyzers (IDEXX Laboratories, Westbrook, ME).

Morgan C.G., Neidert L.E., Hathaway E.N., Rodriguez G.J., Schaub L.J., Cardin S, & Glaser J.J. (2019). Evaluation of prolonged ‘Permissive Hypotension’: results from a 6-hour hemorrhage protocol in swine. Trauma Surgery & Acute Care Open, 4(1), e000369.

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Comprehensive Blood Coagulation Analysis

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WB was collected as BSLN, EOS, PFC (hour) 1, 2, and 4, END PFC, EHC, and Final. Arterial blood gas parameters were assessed using a GEM Premier 4000 (Instrumentation Laboratory, Bedford, MA). Complete blood counts were evaluated by the ProCyte Dx Hematology (IDEXX Laboratories, Inc., Westbrook, ME). WB viscoelastic clotting properties were evaluated by rotational thromboelastometry (ROTEM Delta System, TEM Systems Inc., Durham, NC). ROTEM analyses included evaluation of extrinsic coagulation pathway function (ExTEM) and fibrin activity (FibTEM) to measure clotting time (CT), clot formation time (CFT), alpha-angle (α), amplitude 10 min after CT, (A10), and maximum clot firmness (MCF).
Concentrations of coagulation factors were evaluated using STAGO STA Compact (Diagnostica Stago Inc., Parsippany, NJ). STAGO analysis included prothrombin time (PT), partial thromboplastin time (PTT), antithrombin (ATIII), von Willebrand factor (vWF), fibrinogen (FIB), and D-dimer, in addition to a panel that included factors from both intrinsic and extrinsic pathways.

Neidert L.E., Morgan C.G., Hathaway E.N., Hemond P.J., Tiller M.M., Cardin S, & Glaser J.J. (2023). Effects of hemodilution on coagulation function during prolonged hypotensive resuscitation in a porcine model of severe hemorrhagic shock. Trauma Surgery & Acute Care Open, 8(1), e001052.

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Evaluation of Preserved Liver Viability

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Perfusate samples for blood gas analysis were withdrawn from the cannula placed in the hepatic artery at the three-way stopcock and analyzed using an automatic blood gas analyzer (GEM Premier 4000, Instrumentation Laboratory Co., Lexington, USA). Perfusate samples were taken from the portal vein cannula for measurements of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) using standard biochemical methods. The viability of the preserved livers was evaluated by changes in ALT (ΔALT = postperfusion ALT level – preperfusion ALT level) and AST (ΔAST = postperfusion AST level – preperfusion AST level) in the perfusate.
Liver biopsies obtained from the perfused liver were immediately snap-frozen with liquid nitrogen and stored at − 80 °C for the further detection of PPARγ and cytochrome P450 2E1 (CYP2E1), fixed with 10% buffered formalin for further morphological evaluation by performing hematoxylin/eosin (HE) staining, and kept at 0~4 °C for assessment of superoxide dismutase (SOD) activity, malondialdehyde (MDA) level and CYP2E1 activity, and tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) using an enzyme-linked immunosorbent assay (ELISA).

Shi J.H., Yang D.J., Jin Q., Cheng N., Shi Y.B., Bai Y., Yu D.S., Guo W.Z., Ge G.B, & Zhang S.J. (2022). Cytochrome P450 2E1 predicts liver functional recovery from donation after circulatory death using air-ventilated normothermic machine perfusion. Scientific Reports, 12, 7446.

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Blood Glucose and Lactate Measurement

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65 μL of blood was collected from each mouse pup and glucose and lactate levels were immediately determined (GEM Premier 4000, Instrumentation Laboratory, Bedford, MA).

Griffiths K.K., Wang A., Wang L., Tracey M., Kleiner G., Quinzii C.M., Sun L., Yang G., Perez-Zoghbi J.F., Licznerski P., Yang M., Jonas E.A, & Levy R.J. (2020). Inefficient Thermogenic Mitochondrial Respiration Due to Futile Proton Leak in a Mouse Model of Fragile X Syndrome. FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 34(6), 7404-7426.

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Comprehensive Biomarker Evaluation in ED

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All patients finally included in the study underwent ABG testing at the time of ED admission, thus including the assessment of arterial pH, pCO₂, pO₂, base excess (BE), bicarbonate and lactate (GEM Premier 4000, Instrumentation Laboratory, Lexington, MA, USA). An additional blood sample was taken for the assessment of the CBC (including haemoglobin and RDW) (Sysmex XE-2100; Sysmex Inc, Kobe, Japan) and creatinine (Jaffe compensated assay on Siemens Dimension Vista; Siemens Healthcare Diagnostics, Tarrytown, NY, USA). The laboratory is certified according to the ISO 15189 standard, and the quality of data was validated throughout the study period by using internal quality control (IQC) procedures and participation to an External Quality Assessment (EQA) scheme (18) (link).

Turcato G., Cervellin G., Luca Salvagno G., Zaccaria E., Bartucci G., David M., Bonora A., Zannoni M., Ricci G, & Lippi G. (2017). The Role of Red Blood Cell Distribution Width for Predicting 1-year Mortality in Patients Admitted to the Emergency Department with Severe Dyspnoea. Journal of Medical Biochemistry, 36(1), 32-38.

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