The effect of blood transfusion on compensatory reserve

Benov, Avi; Yaslowitz, Ori; Hakim, Tal; Amir-Keret, Rotem; Nadler, Roy; Brand, Anat; Glassberg, Elon; Yitzhak, Avraham; Convertino, Víctor A.; Paran, Haim

doi:10.1097/ta.0000000000001474

Cited by 29 publications

(41 citation statements)

References 43 publications

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“…We applied the Generalized Estimating Equation method (GEE) to produce a Receiver Operating Characteristic (ROC) area under the curve (AUC) for the point of decompensation of 0.8910, as shown in Figure 6. This ROCAUC produced by the 1D CNN of the present study compares favorably with ROCAUCs generated from a previous machine-learning [14], [15], 0.79-0.83 for bleeding trauma patients [16], [17], [18], and 0.81-0.90 in humans with controlled blood loss [19], [20], [21]. This metric focuses only the CRM algorithm performance at the single point of decompensation, while the mean squared error (MSE) computed over the entire experiment is indicative of algorithm performance during a progressive hypovolemic episode.…”

Section: Resultssupporting

confidence: 58%

1D Convolutional Neural Networks for Estimation of Compensatory Reserve from Blood Pressure Waveforms

Techentin¹,

Felton²,

Schlotman

et al. 2019

2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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We propose a Deep Convolutional Neural Network (CNN) architecture for computing a Compensatory Reserve Metric (CRM) for trauma victims suffering from hypovolemia (decreased circulating blood volume). The CRM is a single health indicator value that ranges from 100% for healthy individuals, down to 0% at hemodynamic decompensationwhen the body can no longer compensate for blood loss. The CNN is trained on 20 second blood pressure waveform segments obtained from a finger-cuff monitor of 194 subjects. The model accurately predicts CRM when tested on data from 22 additional human subjects obtained from Lower Body Negative Pressure (LBNP) emulation of hemorrhage, attaining a mean squared error (MSE) of 0.0238 over the full range of values, including those from subjects with both low and high tolerance to central hypovolemia.

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Section: Resultssupporting

confidence: 58%

1D Convolutional Neural Networks for Estimation of Compensatory Reserve from Blood Pressure Waveforms

Techentin¹,

Felton²,

Schlotman

et al. 2019

2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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“…The CRM, designed to measure physiologic reserve, was the only parameter to demonstrate a difference between the groups. Previous reports also support the capability of CRM measurements to detect low volumes of blood loss . Despite the decline in CRM values throughout the testing day, the CRM nadir, reached at the end of the testing day, was 0.69 ± 0.24, well above the manufacturer's cutoff for moderate compromise .…”

Section: Discussionsupporting

confidence: 56%

Cognitive and physical performance are well preserved following standard blood donation: A noninferiority, randomized clinical trial

et al. 2020

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BACKGROUND A walking blood bank (WBB) refers to the use of fellow combatants for battlefield blood donation. This requires pretesting combatants for infectious diseases and blood type. A fundamental prerequisite for this technique is that the donating soldier will suffer minimal physiological and mental impact. The purpose of the current study is to assess the effect of blood shedding on battlefield performance. METHODS This is a double‐blind randomized control trial. Forty Israel Defense Forces combatants volunteered for the study. Participants underwent baseline evaluation, including repeated measurement of vital signs, cognitive evaluation, physical evaluation, and a strenuous shooting test. Three weeks after the baseline evaluation, subjects were randomized to either blood donation or the control group. For blinding purposes, all subjects underwent venous catheterization for the duration of a blood donation. Repeated vital signs and function evaluation were then performed. RESULTS Thirty‐six patients were available for randomization. Baseline measurements were similar for both groups. Mean strenuous shooting score was 80.5 ± 9.5 for the control group and 82 ± 6.6 for the test group (p = 0.58). No clinically or statistically significant differences were found in tests designed to evaluate cognitive performance or physical functions. Vital signs taken multiple times were also similar between the test and control groups. CONCLUSIONS Executive, cognitive, and physical functions were well preserved after blood donation. This study supports the hypothesis that a WBB does not decrease donor combat performance. The categorical prohibition of physical exercise following blood donation might need to be reconsidered in both military and civilian populations.

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“…In one study, CRM was found to be significantly lower (0.17) in patients with severe hemorrhage due to penetrating trauma resulting in relative anemia (as indicated by lower hematocrit and hemoglobin) compared with a CRM of 0.56 in patients with blunt trauma who were not actively bleeding . When patients with gastrointestinal bleeding required red blood cell transfusion, a nearly 11% increase in CRM was associated with a 22% increase in hemoglobin . CRM has consistently shown accuracy in assessing fluid interventions when applied during resuscitative treatment of hemorrhage in patients suffering from Dengue hemorrhagic fever, blunt or penetrating trauma with significant blood loss, internal bleeding, and sepsis or septic shock .…”

Section: Evidence For Crm Use In Clinical Settingsmentioning

confidence: 99%

The compensatory reserve: potential for accurate individualized goal‐directed whole blood resuscitation

Convertino

Koons

2020

Transfusion

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Hemorrhagic shock can be mitigated by timely and accurate resuscitation designed to restore adequate delivery of oxygen (DO2). Current doctrine of using systolic blood pressure (SBP) as a guide for resuscitation can be associated with increased morbidity. The compensatory reserve measurement (CRM) is a novel vital sign based on the recognition that the sum of all mechanisms that contribute to the compensatory response to hemorrhage reside in features of the arterial pulse waveform. CRM can be assessed continuously and non‐invasively in real time. Compared to standard vital signs, CRM provides an early, as well as more sensitive and specific, indicator of patient hemorrhagic status since the activation of compensatory mechanisms occurs immediately at the onset of blood loss. Recent data obtained from our laboratory experiments on non‐human primates have demonstrated that CRM is linearly related to DO2 during controlled progressive hemorrhage and subsequent whole blood resuscitation. We used this relationship to determine that the time of hemodynamic decompensation (i.e., CRM = 0%) is defined by a critical DO2 at approximately 5.3 mL O2∙kg−1∙min−1. We also demonstrated that a target CRM of 35% during whole blood resuscitation only required replacement of 40% of the total blood volume loss to adequately sustain a DO2 more than 50% (i.e., 8.1 mL O2∙kg−1∙min−1) above critical DO2 (i.e., threshold for decompensated shock) while maintaining hypotensive resuscitation (i.e., SBP at ~90 mmHg). Consistent with our hypothesis, specific values of CRM can be used to accurately maintain DO2 thresholds above critical DO2, avoiding the onset of hemorrhagic shock with whole blood resuscitation.

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The effect of blood transfusion on compensatory reserve

Abstract: Care management, level II.

Cited by 29 publications

References 43 publications

1D Convolutional Neural Networks for Estimation of Compensatory Reserve from Blood Pressure Waveforms

1D Convolutional Neural Networks for Estimation of Compensatory Reserve from Blood Pressure Waveforms

Cognitive and physical performance are well preserved following standard blood donation: A noninferiority, randomized clinical trial

The compensatory reserve: potential for accurate individualized goal‐directed whole blood resuscitation

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