Compensatory Reserve for Early and Accurate Prediction of Hemodynamic Compromise: Case Studies for Clinical Utility in Acute Care and Physical Performance

Stewart, Camille L.; Nawn, Corinne D.; Mulligan, Jane; Grudić, Gregory Z.; Moulton, Steven L.; Convertino, Victor A.

doi:10.55460/sfrb-rgn9

Cited by 29 publications

(5 citation statements)

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“…One explanation for this unexpected result may have been the influence inserted by the providers who predetermined their primary decision to transfuse based on low SBP that would have biased SBP and shock index as being more predictive of transfusion than CRM. It is notewor-thy, however, that these results (22) are not consistent with nine previous clinical studies that reinforce that the utility of CRM accurately assesses the hypovolemic status of patients in various states of hypovolemic hypotension (10)(11)(12)(13)(14)(15)19,21,23).…”

Section: Discussioncontrasting

confidence: 62%

“…Several studies have used CRM to assess hemorrhagic shock in the trauma population (9)(10)(11)(12)(13)(14)(15)(16)(19)(20)(21), and ongoing studies are assessing its validity in the prehospital setting. However, we are unaware of any clinical investigations other than the current study reported here that have presented experimental results that support the ability of CRM for use in the intraoperative setting.…”

Section: Discussionmentioning

confidence: 99%

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Evidence for Beneficial Use of the Compensatory Reserve Measurement in Guiding Intraoperative Resuscitation: A Prospective Cohort Study of Orthotopic Liver Transplant Recipients

Ciaraglia,

Osta,

Wang

et al. 2023

Shock

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Introduction The Compensatory Reserve Measurement (CRM) is a continuous non-invasive monitoring technology that provides an assessment of the integrated capacity of all physiological mechanisms associated with responses to a hypovolemic stressor such as hemorrhagic shock. No prior studies have analyzed its use for intraoperative resuscitation guidance. Methods A prospective observational study was conducted of 23 patients undergoing orthotopic liver transplant (OLT). Chart review was performed to identify timing of various intraoperative events. Data were compared based on predefined thresholds for existence of hemorrhagic shock: CRM below 40% (CRM40), systolic blood pressure below 90 mmHg (SBP90), and heart rate above 100 bpm (HR100). Regression analysis was performed for predicting resuscitation events and non-linear XGBoost models were used to compare CRM to standard vital sign measures. Results Events where CRM dropped below 40% were 2.25 times more likely to lead to an intervention, while HR100 and SBP90 were not associated with intraoperative interventions. XGBoost prediction models showed superior discriminatory capacity of CRM alone compared to the model with SBP and HR and no difference when all three were combined (CRM + HR + SBP). All XGBoost models outperformed equivalent linear regression models. Conclusions Theses results demonstrate that CRM can provide an adjunctive clinical tool that can augment early and accurate of hemodynamic compromise and promote goal-directed resuscitation in the perioperative setting.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Evidence for Beneficial Use of the Compensatory Reserve Measurement in Guiding Intraoperative Resuscitation: A Prospective Cohort Study of Orthotopic Liver Transplant Recipients

Ciaraglia,

Osta,

Wang

et al. 2023

Shock

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show abstract

“…Compensatory Reserve Metric monitoring has considerable promise within a variety of clinical settings, such as trauma, 10 emergency surgery, 21 and care of the critically ill patient 22 . Because additional investigations aim to determine the applicability and generalizability of CRM monitoring, we propose that the CRM may also be useful when deployed by the combat medic for the in-field assessment of hemodynamic status at Role 1 (prehospital) 23 .…”

Section: Discussionmentioning

confidence: 99%

Physiologic validation of the Compensatory Reserve Metric obtained from pulse oximetry: A step toward advanced medical monitoring on the battlefield

Roden,

Webb,

Pruter

et al. 2024

J Trauma Acute Care Surg

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BACKGROUND The Compensatory Reserve Metric (CRM) provides a time sensitive indicator of hemodynamic decompensation. However, its in-field utility is limited due to the size and cost-intensive nature of standard vital sign monitors or photoplethysmographic volume-clamp (PPGVC) devices used to measure arterial waveforms. In this regard, photoplethysmographic measurements obtained from pulse oximetry (PPGPO) may serve as a useful, portable alternative. This study aimed to validate CRM values obtained using PPGPO. METHODS Forty-nine healthy adults (25 females) underwent a graded lower body negative pressure (LBNP) protocol to simulate hemorrhage. Arterial waveforms were sampled using PPGPO and PPGVC. The CRM was calculated using a one-dimensional convolutional neural network. Cardiac output and stroke volume were measured using PPGVC. A brachial artery catheter was used to measure intraarterial pressure. A 3-lead ECG was used to measure heart rate. Fixed-effect linear mixed models with repeated measures were used to examine the association between CRM values and physiologic variables. Log-rank analyses were used to examine differences in shock determination during LBNP between monitored hemodynamic parameters. RESULTS The median LBNP stage reached was 70 mmHg (Range: 45-100 mmHg). Relative to baseline, at tolerance there was a 47±12% reduction in stroke volume, 64±27% increase in heart rate, and 21±7% reduction in systolic blood pressure (P<0.001 for all). CRM values obtained with both PPGPO and PPGVC were associated with changes in heart rate (P<0.001), stroke volume (P<0.001), and pulse pressure (P<0.001). Furthermore, they provided an earlier detection of hemodynamic shock relative to the traditional metrics of shock index (P<0.001 for both), systolic blood pressure (P<0.001 for both), and heart rate (P=0.001 for both). CONCLUSION The CRM obtained from PPGPO provides a valid, time-sensitized prediction of hemodynamic decompensation, opening the door to provide military medical personnel noninvasive in-field advanced capability for early detection of hemorrhage and imminent onset of shock. LEVEL OF EVIDENCE Diagnostic Tests or Criteria, Level IV.

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“…A major barrier to the widespread adoption of physiologic-directed CPR is the indentification and validation of non-invasive monitors suitable for a diverse set of clinical environments. Extensive literature supports the use of photoplethysmography (PPG) waveforms to evaluate the cardiovascular system, particularly for assessing volume status or fluid responsiveness, 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 and determining vascular distensibility, tone, 68 , 69 , 70 , 71 and BP. 72 , 73 Recent animal models indicate that PPG waveform characteristics (e.g., amplitude [Amp] and area under the curve [AUC]) can gauge CPR quality 74 and detection of ROSC.…”

Section: Current Statementioning

confidence: 99%

Wolf Creek XVII Part 6: Physiology-Guided CPR

Bray,

Rea,

Parnia

et al. 2024

Resuscitation Plus

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Compensatory Reserve for Early and Accurate Prediction of Hemodynamic Compromise: Case Studies for Clinical Utility in Acute Care and Physical Performance

Cited by 29 publications

References 0 publications

Evidence for Beneficial Use of the Compensatory Reserve Measurement in Guiding Intraoperative Resuscitation: A Prospective Cohort Study of Orthotopic Liver Transplant Recipients

Evidence for Beneficial Use of the Compensatory Reserve Measurement in Guiding Intraoperative Resuscitation: A Prospective Cohort Study of Orthotopic Liver Transplant Recipients

Physiologic validation of the Compensatory Reserve Metric obtained from pulse oximetry: A step toward advanced medical monitoring on the battlefield

Wolf Creek XVII Part 6: Physiology-Guided CPR

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