The Compensatory Reserve Index Responds to Acute Hemodynamic Changes in Patients with Congenital Heart Disease: A Proof of Concept Study

Ehrmann, Daniel; Leopold, David; Phillips, Ryan; Shahi, Niti; Campbell, Kristen; Ross, Michael; Zablah, Jenny E.; Moulton, Steven L.; Morgan, Gareth J.; Kim, John S.

doi:10.1007/s00246-020-02374-3

Cited by 7 publications

(5 citation statements)

References 35 publications

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“…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%

“…Previous studies have shown the discriminatory ability of the CRM to predict early onset of hemodynamic collapse (4,5) with superior sensitivity and specificity to predict impending physiologic decline and provide accurate goal-directed whole blood resuscitation (6,7) compared with less complex measures of arterial waveform feature analysis (e.g., pulse pressure variation, peripheral perfusion index) (7). Prior clinical investigations on the use of CRM in monitoring hemodynamic status of subjects have focused primarily on early resuscitation in hemorrhaging trauma patients (8)(9)(10)(11)(12)(13)(14)(15)(16)), but we are unaware of previous reports of CRM for continuous assessment of blood volume loss or guiding blood product resuscitation in the intraoperative setting. The challenge arises with the inherently complex use of multiple methods of hemodynamic support (e.g., vasopressors, inotropes, blood product resuscitation, crystalloid infusion), in comparison with prior studies of the CRM where there was a single defined hemorrhagic event (i.e., traumatic injury).…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…12,13 The CRI has not previously been evaluated in patients following CHS with CPB, who often experience hemodynamic changes from factors not limited to hemorrhage. The CRI may detect elements of cardiovascular compensation shared between hemorrhage and other forms of shock, including low cardiac output 16 and capillary leak 17,18 that are prevalent after CPB. 19,20 It is currently unknown whether early changes in the CRI precede clinically meaningful outcomes in patients after CHS, as has been found in other studies of critically ill pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Ehrmann

Leopold

Campbell

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: Early warning systems that utilize dense physiologic data and machine learning may aid prediction of decompensation after congenital heart surgery (CHS). The Compensatory Reserve Index (CRI) analyzes changing features of the pulse waveform to predict hemodynamic decompensation in adults, but it has never been studied after CHS. This study sought to understand the feasibility, safety, and potential utility of CRI monitoring after CHS with cardiopulmonary bypass (CPB). Methods: A single-center prospective pilot cohort of patients undergoing pulmonary valve replacement was studied. Compensatory Reserve Index was continuously measured from preoperative baseline through the first 24 postoperative hours. Average CRI values during selected procedural phases were compared between patients with an intensive care unit (ICU) length of stay (LOS) <3 days versus LOS ≥3 days. Results: Twenty-three patients were enrolled. On average, 17,445 (±3,152) CRI data points were collected and 0.33% (±0.40) of data were missing per patient. There were no adverse events related to monitoring. Five (21.7%) patients had an ICU LOS ≥3 days. Compared to the ICU LOS <3 days group, the ICU LOS ≥3 days group had a greater decrease in CRI from baseline to immediately after CPB (−0.3 ± 0.1 vs −0.1 ± 0.2, P = .003) and were less likely to recover to baseline CRI during the monitoring period (20% vs 83%, P = .017). Conclusions: Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.

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“…It has been reported that compensatory reserve index can accurately reflect haemodynamic changes in children with CHD at risk of decompensation. 5 Thanks to technological advances in pulse oximetry devices in recent years, it has become possible to calculate the perfusion index, a parameter that is derived from the ratio between pulsatile and non-pulsatile signals of the absorbed light. 6 Perfusion index is a novel, easy-to-use, non-invasive, continuous parameter derived from pulse oximetry.…”

mentioning

confidence: 99%

“…It has been reported that compensatory reserve index can accurately reflect haemodynamic changes in children with CHD at risk of decompensation. 5…”

mentioning

confidence: 99%

Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns

et al. 2023

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Introduction: Peripheral perfusion index has been proposed as a possible method for detecting circulatory impairment. We aimed to determine the normal range of peripheral perfusion index in healthy newborns and compare it with that of newborns with CHD. Methods: Right-hand saturation and right-hand peripheral perfusion index levels were recorded, and physical examination and echocardiography were performed in newborns who were 0–28 days old and whom were evaluated in our paediatric cardiology outpatient clinic. The saturation and peripheral perfusion index levels of newborns with normal heart anatomy and function were compared with those of newborns with CHD. Results: Out of 358 newborns (238 mature and 75 premature) enrolled in the study, 39 had CHD (20 mild CHD, 13 moderate CHD, and 6 severe CHD), of which 29 had CHD with left-to-right shunting, 5 had obstructive CHD, and 5 had cyanotic CHD. No newborn had clinical signs of hypoperfusion or heart failure, such as prolonged capillary refill, weakened pulses, or coldness of extremities. Peripheral perfusion index level was median (interquartile range) 1.7 (0.6) in healthy newborns, 1.8 (0.7) in newborns with mild CHD, and 1.8 (0.4) in newborns with moderate and severe CHD, and there was no significant difference between the groups regarding peripheral perfusion index level. Conclusion: Peripheral perfusion index remains unchanged in newborns with CHD without the clinical signs of hypoperfusion or heart failure. Larger studies with repeated peripheral perfusion index measurements can determine how valuable this method will be in the follow-up of newborns with CHD.

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The Compensatory Reserve Index Responds to Acute Hemodynamic Changes in Patients with Congenital Heart Disease: A Proof of Concept Study

Cited by 7 publications

References 35 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

Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns

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