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

Abstract

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.