The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of...
-
Upload
gilbert-parker -
Category
Documents
-
view
216 -
download
1
Transcript of The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of...
![Page 1: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/1.jpg)
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
![Page 2: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/2.jpg)
IDF-MC Mission for 2020:Eliminating preventable death
Triage&
Monitoring
![Page 3: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/3.jpg)
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
![Page 4: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/4.jpg)
The gap with currently available Indices
Volume of blood lost
Desired vital sign
Available vital signs
![Page 5: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/5.jpg)
Triage criteria limitations
![Page 6: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/6.jpg)
• 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
![Page 7: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/7.jpg)
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
![Page 8: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/8.jpg)
Pre & post blood donation
Δ 3% Δ 5%
Δ 18%
![Page 9: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/9.jpg)
Differences – study Vs. control group
![Page 10: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/10.jpg)
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
![Page 11: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/11.jpg)
ResultsIndexAUC
Saturation0.55
![Page 12: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/12.jpg)
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Results
![Page 13: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/13.jpg)
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Shock index0.64
Results
![Page 14: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/14.jpg)
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Shock index0.64
Heart rate0.73
Results
![Page 15: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/15.jpg)
IndexAUC
Saturation0.55
Diastolic BP0.61
Systolic BP0.6
Shock index0.64
Heart rate0.73
CRI0.84 P= 0.02
Results
![Page 16: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/16.jpg)
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
![Page 17: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/17.jpg)
Current triage modelsThresholdSpecificitySensitivity0.770.630.84
![Page 18: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/18.jpg)
Limitations
• Technology under development• Tested in sterile environment
![Page 19: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/19.jpg)
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
![Page 20: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/20.jpg)
IDF-MC Mission for 2020:Eliminating preventable death
![Page 21: The value of non-invasive measurement of the Compensatory Reserve Index in monitoring and triage of patients experiencing minimal blood loss Roy Nadler,](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ce05503460f949a9acc/html5/thumbnails/21.jpg)
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