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Comparing the compensatory reserve metric obtained from invasive arterial measurements and photoplethysmographic volume-clamp during simulated hemorrhage

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Abstract

Purpose

The compensatory reserve metric (CRM) is a novel tool to predict cardiovascular decompensation during hemorrhage. The CRM is traditionally computed using waveforms obtained from photoplethysmographic volume-clamp (PPGVC), yet invasive arterial pressures may be uniquely available. We aimed to examine the level of agreement of CRM values computed from invasive arterial-derived waveforms and values computed from PPGVC-derived waveforms.

Methods

Sixty-nine participants underwent graded lower body negative pressure to simulate hemorrhage. Waveform measurements from a brachial arterial catheter and PPGVC finger-cuff were collected. A PPGVC brachial waveform was reconstructed from the PPGVC finger waveform. Thereafter, CRM values were computed using a deep one-dimensional convolutional neural network for each of the following source waveforms; (1) invasive arterial, (2) PPGVC brachial, and (3) PPGVC finger. Bland-Altman analyses were used to determine the level of agreement between invasive arterial CRM values and PPGVC CRM values, with results presented as the Mean Bias [95% Limits of Agreement].

Results

The mean bias between invasive arterial- and PPGVC brachial CRM values at rest, an applied pressure of -45mmHg, and at tolerance was 6% [-17%, 29%], 1% [-28%, 30%], and 0% [-25%, 25%], respectively. Additionally, the mean bias between invasive arterial- and PPGVC finger CRM values at rest, applied pressure of -45mmHg, and tolerance was 2% [-22%, 26%], 8% [-19%, 35%], and 5% [-15%, 25%], respectively.

Conclusion

There is generally good agreement between CRM values obtained from invasive arterial waveforms and values obtained from PPGVC waveforms. Invasive arterial waveforms may serve as an alternative for computation of the CRM.

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Data availability

All data pertaining to the study will be made available upon reasonable request to the corresponding author.

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Acknowledgements

The authors sincerely thank all participants within the study. We acknowledge the contributions of the Mayo Clinic Clinical Research and Trials Unit (CRTU), the Special Purpose Processor Development Group (SPPDG), as well as the assistance of the members of the Human Integrative Physiology Lab, Shelly K. Roberts, Nancy J. Meyer, Pam A. Engrav, Olaf H. Morkeberg, Ellen K. Gorman, Jonathon W. Senefeld, and Cecile El-Borgi.

Funding

The presented work was funded in part by the Congressionally Directed Medical Research Program (Award No. DM180240).

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA

    Kevin L. Webb, Wyatt W. Pruter, Christopher P. Johnson, Riley J. Regimbal, Michael J. Joyner, Chad C. Wiggins & Timothy B. Curry

  2. Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America

    Kevin L. Webb & Clifton R. Haider

  3. Special Purpose Processor Development Group, Mayo Clinic, Rochester, Minnesota, United States of America

    Ruth J. Poole, Robert W. Techentin & Kaylah J. Berndt

  4. Biomedical Analytics and Computational Engineering Laboratory, Mayo Clinic, Rochester, Minnesota, United States of America

    David R. Holmes III

  5. Battlefield Health & Trauma Center for Human Integrative Physiology, Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States of America

    Victor A. Convertino

  6. Department of Kinesiology, Michigan State University, East Lansing, Michigan, United States of America

    Chad C. Wiggins

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  1. Kevin L. Webb
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Contributions

All authors take responsibility for the integrity, accuracy, and interpretation of the information and data presented in this report. T.B.C., V.A.C., M.J.J., C.R.H., and D.R.H conceived the presented study. K.L.W., W.W.P, R.J.P., R.W.T, C.P.J, R.J.R, K.J.B., D.R.H., C.R.H., and C.C.W. assisted with data collection. K.L.W. and W.W.P. performed data processing, data analyses, and drafted the original manuscript. All authors revised the manuscript and approved the final version of the article.

Corresponding author

Correspondence to Timothy B. Curry.

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The authors declare no conflicts of interest. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, Department of the Navy, or the Department of Defense.

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Webb, K.L., Pruter, W.W., Poole, R.J. et al. Comparing the compensatory reserve metric obtained from invasive arterial measurements and photoplethysmographic volume-clamp during simulated hemorrhage. J Clin Monit Comput (2024). https://doi.org/10.1007/s10877-024-01166-x

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