In Vivo Evaluation of Two Hemorrhagic Shock Resuscitation Controllers with Non-Invasive, Intermittent Sensors

Abstract

Hemorrhage is a leading cause of preventable death in military and civilian trauma medicine. Fluid resuscitation is the primary treatment option, which can be difficult to manage when multiple patients are involved. Traditional vital signs needed to drive resuscitation therapy being unavailable without invasive catheter placement is a challenge. To overcome these obstacles, we propose using closed-loop fluid resuscitation controllers managed by non-invasive, intermittent signal sensor inputs to simplify their use in far-forward environments. Using non-invasive, intermittent sensor controllers will allow quicker medical intervention due to negating the need for an arterial catheter to be placed for pressure-guided fluid resuscitation. Two controller designs were evaluated in a swine hemorrhagic shock injury model, with each controller only receiving non-invasive blood pressure (NIBP) measurements simulated from invasive input signals every 60 s. We found that both physiological closed-loop controllers were able to effectively resuscitate subjects out of life-threatening hemorrhagic shock using only intermittent data inputs with a resuscitation effectiveness of at least 95% for each respective controller. We also compared this intermittent signal input to a NIBP cuff and to a deep learning model that predicts blood pressure from a photoplethysmography waveform. Each approach showed evidence of tracking blood pressure, but more effort is needed to refine these non-invasive input approaches. We conclude that resuscitation controllers hold promise to one day be capable of non-invasive sensor input while retaining their effectiveness, expanding their utility for managing patients during mass casualty or battlefield conditions.