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