J Trauma Acute Care Surg. 2025 Aug 1;99(3S Suppl 1):S20-S26. doi: 10.1097/TA.0000000000004699. Epub 2025 Aug 6.
ABSTRACT
BACKGROUND: Hemorrhage resulting from trauma is a leading cause of potentially survivable death. Current monitoring devices that offer measures of traditional vital signs can delay patient management during the early compensatory phases of treatment, creating a capability gap for advanced decision support in the austere prehospital setting. In this investigation, we tested the hypothesis that arterial waveform feature analysis outperforms standard vital signs (SVSs) for early detection of progressive reductions in central blood volume and prediction of hemodynamic decompensation.
METHODS: Tolerance to progressive reductions in central blood volume was determined for 187 human subjects (aged 18 to 55 years) who underwent exposure to lower-body negative pressure as a model to simulate human hemorrhage. Tolerance was defined by the onset of clinical decompensated shock as defined by a systolic blood pressure of <80 mm Hg with concurrent expression of presyncopal symptoms (e.g., nausea, cold sweat, tunnel vision). Continuous noninvasive beat-to-beat measurements of systolic, diastolic, and mean arterial blood pressures; heart rate; shock index; blood oxygen saturation; and respiration rate were measured. Arterial waveforms were recorded for arterial waveform feature analysis using a machine learning algorithm called the compensatory reserve measurement. Receiver operating characteristic area under the curve was calculated for predicting the onset of hemodynamic decompensation, and statistical assessment was performed on measurements of sensitivity, specificity, and accuracy for detection of reduced central blood volume.
RESULTS: Compensatory reserve measurement receiver operating characteristic area under the curve (0.94) for predicting onset of decompensated shock was greater (p < 0.001) compared with eight SVSs (0.57 to 0.83). Sensitivity, specificity, and accuracy for detecting reduced central blood volume were significantly higher (0.88, 0.87, 0.85) compared with the respective SVSs (0.57 to 0.83).
CONCLUSION: Arterial waveform feature analysis provides a breakthrough monitoring capability with earlier detection of ongoing hemorrhage and superior discriminative ability to predict the onset of decompensated shock compared with standard vital signs.
LEVEL OF EVIDENCE: Diagnostic Test or Criteria; Level III.
PMID:40768656 | DOI:10.1097/TA.0000000000004699
