1. 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 ענף הרפואה המבצעית, מקרפ " ר

2. IDF-MC Mission for 2020: Eliminating preventable death Injury prevention Trauma medicine Evacuation ICCC (doctrine) Triage & Monitoring

3. 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

4. The gap with currently available Indices Volume of blood lost Desired vital sign Available vital signs

5. Triage criteria limitations

6. 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 conditions 1 Not operator dependent, Small and non-invasive device The Compensatory Reserve Index (CRI) Convertino VA et al. Use of Advanced Machine-Learning Techniques for Noninvasive Monitoring of Hemorrhage. J Trauma 2011;71: S25–S32

7. Patients and Methods Test groupControl groupP Value Age22.5 (5.6)24.5 (7)0.12 Male/Female144/8621/131 Time between measurements 43.7 (19.5)49.3 (22)0.17 264 Subjects Test Group (donated blood) N=230 Test Group (donated blood) N=230 Control Group N=34 Control Group N=34

8. Pre & post blood donation Δ 3% Δ 5% Δ 18%

9. Differences – study Vs. control group

10. One time measurements TreatmentControl% DifferenceP Value Systolic BP1191144%0.02 * Diastolic BP69647%0.006 * Heart rate847214%<0.01 * saturation98 0%0.53 CRI0.610.8125%<0.01 * Blood loss Blood loss No Blood loss No Blood loss

11. Results AUCIndex 0.55Saturation

12. AUCIndex 0.55Saturation 0.61Diastolic BP 0.6Systolic BP Results

13. AUCIndex 0.55Saturation 0.61Diastolic BP 0.6Systolic BP 0.64Shock index Results

14. AUCIndex 0.55Saturation 0.61Diastolic BP 0.6Systolic BP 0.64Shock index 0.73Heart rate Results

15. AUCIndex 0.55Saturation 0.61Diastolic BP 0.6Systolic BP 0.64Shock index 0.73Heart rate 0.84CRI P= 0.02 Results

16. Sensitivities and specificities of CRI ThresholdSpecificitySensitivity 0.450.970.17 0.60.970.43 0.70.910.65 0.750.740.78 0.770.630.84 0.80.510.86 Heart rateSpecificitySensitivity 80 b/m0.630.65

17. Current triage models ThresholdSpecificitySensitivity 0.770.630.84

18. Limitations Technology under development Tested in sterile environment

19. 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

20. IDF-MC Mission for 2020: Eliminating preventable death Injury prevention Trauma medicine Evacuation ICCC (doctrine)

21. 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 ענף הרפואה המבצעית, מקרפ " ר