The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of...
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Transcript of The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of...
The value of non-invasive measurement of the Compensatory
Reserve Index in monitoring and triage of patients experiencing minimal blood
loss
Roy Nadler, Victor A. Convertino, Gadi Lending, Sami Gendler,
Ari M. Lipsky, Sylvain Cardin,, Elon Glassberg
" , ר מקרפ המבצעית הרפואה ענף
IDF-MC Mission for 2020:Eliminating preventable death
Triage&
Monitoring
3
Key concepts
90% of potentially salvageable casualties exsanguinate
Rapid evacuation & treatment as main objectives
Prioritizing is a key concept of point of injury care
Early detection of hemorrhage is crucial
The gap with currently available Indices
Volume of blood lost
Desired vital sign
Available vital signs
Triage criteria limitations
• Assessment of physiological reserve
• Non-invasive recording & analyzing of the arterial waveforms
using machine learning techniques.
• Ranges from 0 (complete decompensation) to 1
• Has been shown to correlate with central blood volume loss in
laboratory conditions1
• Not operator dependent, Small and non-invasive device
The Compensatory Reserve Index (CRI)
Convertino VA et al. Use of Advanced Machine-Learning Techniques for NoninvasiveMonitoring of Hemorrhage. J Trauma 2011;71: S25–S32
Patients and Methods
Test groupControl groupP ValueAge22.5 (5.6)24.5 (7)0.12Male/Female144/8621/131 Time between measurements
43.7 (19.5)49.3 (22)0.17
264 Subjects
Test Group (donated blood)
N=230
Control GroupN=34
Pre & post blood donation
Δ 3% Δ 5%
Δ 18%
Differences – study Vs. control group
One time measurements
TreatmentControl% DifferenceP ValueSystolic BP119114 4%0.02 *Diastolic BP6964 7%0.006 *Heart rate8472 14%<0.01 *saturation98980%0.53CRI0.610.8125%<0.01 *
Blood loss
No Blood loss
ResultsIndexAUC
Saturation0.55
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Results
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Shock index0.64
Results
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Shock index0.64
Heart rate0.73
Results
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Shock index0.64
Heart rate0.73
CRI0.84 P= 0.02
Results
Sensitivities and specificities of CRIThresholdSpecificitySensitivity0.450.970.170.60.970.430.70.910.650.750.740.780.770.630.840.80.510.86
Heart rateSpecificitySensitivity80 b/m0.630.65
Current triage modelsThresholdSpecificitySensitivity0.770.630.84
Limitations
• Technology under development• Tested in sterile environment
Summary
• In our study CRI demonstrated superiority over conventional vital signs in detecting mild blood loss
• CRI shows potential as a triage and monitoring tool• Unknown value in life-threatening hemorrhage • Unknown value in non hemorrhaging patients
IDF-MC Mission for 2020:Eliminating preventable death
The value of non-invasive measurement of the Compensatory
Reserve Index in monitoring and triage of patients experiencing minimal blood
loss
Roy Nadler, Victor A. Convertino, Gadi Lending, Sami Gendler,
Ari M. Lipsky, Sylvain Cardin, Elon Glassberg
" , ר מקרפ המבצעית הרפואה ענף