13949 IH FB Sales support guide A5 v4

First Breath Support Guide

Inspiration Healthcare First Breath support guide Low Work of Breathing – fluidic flip principle, as Inspire nCPAPTM and InfantFlow some 25 years before: the concept that changed non-invasive support of the newborn from the moment it was introduced. Easy fixation, simplified design, in line with current customer expectations. Single person application. Improved design means that there is no threading of felt straps through the bonnet, making the application faster and hassle-free. Facilitates patient checks: easier to apply, remove and re-apply. Less sizes of headgear (5 sizes) make it easier to manage stock and are less frequently changed (reduced patient handling). Comfort and device stability. Headgear with adjustable width and length for better fit to the head. Anti-slip material to prevent dislocation of the interface. Fixation with adjustable straps and attachment block to secure position and provide better alignment. Attachment block Adjustable length Single tube Adjustable width Nasal prong Adjustable Anti-slip straps 2

First Breath Support Guide Can put a hat/bonnet over the headgear for better thermoregulation. Single tube design, reduces clutter over the baby’s head. Helpful for developmental care and patient observation. Prongs included in the Generator: price and convenience advantage. Sometimes users complain about the wasted prongs for typically 2 reasons: one, it is wasted money and two, not environmentally friendly. From a cost perspective the answer is, material costs are dwarfed by the costs of labour, inventory and storage and having a selection included within the pack and therefore the correct interface at your fingertips was based on clinical feedback. From an environmental point of view, you can keep them and use them where appropriate but again the packaging and energy expenditure on supplying prongs individually would easily outweigh any unused silicone. The headgear will be the common fixation method between rPAP and nCPAP This will present an opportunity to revisit rPAP if they are not already a user. If already an rPAP user, it will make financial sense and will be convenient to use the same headgear/bonnet from the delivery room to the NICU. Number of circuit configurations is available to fit different drivers/ventilators. The Generator can be part of the breathing circuit pack or bought separately. Circuits are available with or without the white plastic connector. 3

Inspiration Healthcare Fluidic flip principles Fresh gas is accelerated through the inspiratory tube before entering the Generator chamber. As the gas enters the Generator, the geometry of the chamber causes the gas to become unstable, allowing it to follow the path of least resistance. As the infant makes a spontaneous Inspiratory effort, the incoming fresh gas is delivered to the baby. As Inspiration stops, the flow is ‘flipped’ around and it exits through the expiratory tube, creating a reduced pressure allowing the baby to breathe out easily. The Expiratory limb and the Generator angled chamber act as a reservoir of fresh gas, so should the infants peak flow demand rise above set flow rate, additional fresh gas can be easily drawn without increasing the Work of Breathing. Open System Expiratory limb Infant Nasal Connection Chamber Inspiratory Inlet 4

Inspiratory Flow First Breath Support Guide Expiratory Infant Nasal Connection limb Chamber Inspiratory Inlet Expiratory Flow Expiratory limb Infant Nasal Connection Chamber Inspiratory Inlet 5

Inspiration Healthcare Overview of the circuits offering Single limb breathing circuits • Designed to drive the First Breath nCPAP Generator (as well as Inspire nCPAP) • Options of high flow circuits • Fabian dry limb can be sold with the standard circuit or separately Single HW ventilation circuits with watertrap • Low cost • No requirement for dual heated wire cable • Watertrap can be emptied without interrupting ventilation 6

First Breath Support Guide Dual HW ventilation circuits • Dual heated wire reduces rainout in the expiratory limb • No requirement to empty a watertrap • Less requirement for changing expiratory filters Key features • Nitric oxide ports available in the chamber input connection – one less adaptor required • Additional limb for positioning the temperature probe outside the incubator or as close to the patient when using an open cot • Ventilation circuits have swivel manifolds for easier positioning close to the patient and to offset the weight of the tube, reducing the chances of inadvertent extubation • Spiral heated wire, heats the tube evenly to reduce condensation and deliver optimal humidification to the patient • Option for Connector Pack means that the breathing circuits can be used for a number of Therapies (single/dual NIV, High Flow) and cover all ventilation modes • Work with a number of popular ventilators (Acutronic, Drager, SLE) • Option for humidification chamber to be in the pack or sold separately • Clover leaf adaptor for the humidifier heated wire adaptor • With or without proximal airway tube, depending on the ventilator model 7

Inspiration Healthcare Situational Review 1 Opening Questions What is your approach to NIV? How much nCPAP they use. Are they using High Flow, BiLevel (DuoPAP), Bubble CPAP. Are there any gestational age or weight considerations when choosing ventilation strategies. Are there any champions in the unit that we need to know of. What devices and circuits do you use for nCPAP? Typically Fabian Therapy, SiPAP, SLE1000, H&L, Wilamed or alternative. Depending on the product you get an idea if they will replace their devices soon or are open to different ideas. If H&L or Wilamed, it will mean they are very price conscious, as these devices typically have low tender pricing. How long have you been using that device This will give you an idea of the replacement cycle in capital/consumables. What did you use before Depending on what the change was from and why will give us an idea as to their change receptivity. What prompted the change We are looking at what could help us introduce our own device or what benefits to focus on when selling. 8

First Breath Support Guide Situational Review 2 Opening Questions Is price or performance the deciding factor for the equipment you choose This will further help us to decide how to position our product. If you were going to change any equipment how would that happen and what would be the process This is to give us a guide of what we need to be doing to move the opportunity forward and be able to facilitate this process. If we can improve on convenience, performance, cost, would that make you look at another system Depending on what we find out if we demonstrate improvement or find out by how much could we motivate them to change current equipment. If we can show a meaningful benefit in performance, price and convenience, can you change today? This is a trial close to see if we are on track, they might say ‘yes’ at this point or at least we will get confirmation of the process and what we need to do next to bring the sale home. Ultimately, there are two reasons to change: Improve quality/performance without changing the cost. Maintain quality/performance and reducing the cost. 9

Inspiration Healthcare Mitigations Prongs and masks sizes Masks and prongs are discreetly sized (smallest prong too big, then select small mask. Biggest prong too small then select the larger mask). Interchangeability is common place based on ‘resting the nares’ but was never the original intention. The original 3 size prong concept was intended to be assessed 4-hourly for size and seal – ‘massaging’ the nares was recommended. More sizes would imply more frequent checks and changes based on patient growth. Generator pack contents used with the nCPAP system 10

First Breath Support Guide Fixation Improvements in sceptal condition and physiological condition related to fixation are all down to attention to detail. Improvements in fixation complications when introducing new systems is down to necessity of re-introducing that attention to detail. With First Breath nCPAP, we are introducing a much better fixation system. This gives us the advantage over our competitors and this must be one of the key points we put across. Angled prongs Vyaire’s prongs have an angled prong design, which is thought to help with positioning. The mitigation against this point is that our Generator has the angle incorporated in the generator body. Market feedback has suggested that Vyaire’s prongs can get blocked easily and stop delivering flow to the patient. Their generator design also makes nasal masks more difficult to position and makes the nurses overtighten the interface. 11

Inspiration Healthcare Competitor information Armstrong NeoFlow Spanish | Español General Information Neonatal Care • Armstrong are an Irish company (£12m turnover, 140 employees). Neonatal care, Critical Care and Perioperative Care products • The nFlow system is a direct copy of the Inspire nCPAP but with improved fixation Features • Circuits with BioCote® antimicrobial silver additive, reduces microbial colonisation • Claim improved prong tip (thing walled feather tip/flared prong design) • Crimped tie end • Suitable adaptors and high flow conversion kit • Tubing clips • 1.3m Inspiration limb with 1.2m heated section • Detachable incubator limb Price • Armstrong appear to be very active in Neonatal care and are targeting our accounts. They have been trying to match our prices whenever possible Range of interface and sizes • 3 Prong sizes (S, M, L). XS size in progress but not available • 4 Mask sizes (S, M, L, XL) Fixation • 6 Bonnet sizes (XXS, XS, S, M, L, XL) Upper range 42cm, smaller range unknown (up to 24cm, no low measurement) 12

First Breath Support Guide Pack sizes • AquaVENT® NEO neonatal limb for infant flow/SiPAP (box of 20) • AquaVENT® NEO neonatal limb for SiPAP and Fabian (box of 20) • nHFOT to nCPAP adapter set (box of 20) • Incubator limb with pressure line, NeoFlow generator set and exhaust silencer (box of 40) • No option without nasal prongs Other related accessories • Silencers, filters • Armstrong sell a humidifier (Aquavent), Resuscitation system including driver & blender, Bubble CPAP system, Nasal cannula, range of circuits for all applications Training packages/Ongoing support • Feedback is that they have invested in training materials and are really keen to grow the business, therefore they spend time trying to convert Inspire accounts Vyaire Infant Flow LP Infant Flow® LP system bonnet General Information • A product by Vyaire ($800m turnover, 5k employees) • The Infant Flow LP is a different design than the original Infant Flow system, therefore it doesn’t employ the fluidic flip principle • Works with a lower pressure than the rest of the nCPAP generators (LP stands for Low Pressure). The benefit of this is the lower noise level and less chance of increased back pressure at the chamber Features • Easy fixation system – first manufacturer to deviate from the classic bonnet with threaded straps • Both bonnets and headgear available • In-built pressure relief valve • Angled and longer prongs that sit further away from the patient’s nares. • Longer prongs 13

Inspiration Healthcare Price • Positioned at the higher end of the spectrum - trying to capitalise on the large SiPAP install base Range of interface and sizes • 5 Prong sizes (XS, S, M, L, XL) • 5 Mask sizes (XS, S, M, L, XL) Fixation • 6 Headgear sizes (XS, S, S/M, M, L, XL) • 10 Bonnet sizes (from 18cm to 38cm) Pack sizes • Offered as a box of 20 generators with S/M/L prongs in the pack • Option without the prongs • Also offered as a box of 20 with F&P RT124 or a box of 10 with F&P RT324 (RT324 includes an autofill chamber, RT124 doesn’t) Other related accessories • Silencers Training packages/Ongoing support • Vyaire doesn’t seem to be offering as much customer support and experience on the product as we could Intersurgical nFlow Information Sheet • Critical Care General Information • Intersurgical are a 3.5k employee, $240m turnover Infant nasal CPAP system Critical Care • Breathing Systems company selling airway management, anaesthesia, critical care, oxygen/aerosol therapy and home care products, predominantly consumables • The nFlow system is a direct copy of the Inspire nCPAP Features • None worth mentioning Quality, innovation and choice lnteract with us www.intersurgical.com 14

First Breath Support Guide Price • Intersurgical’s list price appears high, however they can offer a much lower price when bidding for contracts Range of interface and sizes • 4 Nasal Prong sizes (XS, S, M, L) • 4 Nasal Mask sizes (S, M, L, XL) Fixation • 12 Bonnet sizes (from 18cm to 42cm) Pack sizes • 1.6m system with Generator(box of 12) • 1.8m system with Generator (box of 12) • 1.6m system with Generator, for Fabian (box of 10) • Adaptor system for Fabian: Generator, proximal line, Fabian fresh gas line (box of 15) • Chambers, prongs and masks are always sold separately Other related accessories • Silencer kit • Bonnet ties (box of 20) • Intersurgical sell a humidifier (7000 series), which is based on the F&P MR850 but has control of the temperature Training packages/Ongoing support • Intersurgical are not interested in providing ongoing support, as they are not focused on the Neonatal market 15

Inspiration Healthcare First Breath Support Guide Baby Respiration Sensor • Proven and familiar technology • Accurately monitors the baby’s respiration • Applications of mechanical breath triggering and respiration monitoring • Doesn’t restrict baby’s movement • Performance not impaired when covered by baby’s clothes • Non-kink plastic tubing • Compatible with SiPAP and Infant Flow Advance • Compatible with Graseby MR10, MR10+ and MR10S apnoea monitors • Compatible with Stephan systems