clincal results

CRI has already been the subject of more than 20 peer reviewed studies by top research organizations in the DoD. Third party labs have sponsored the majority of these studies without financial support from Flashback. Key funding support has come from the DoD, contributing over $9 million to date. 

 
 

Research institutions

·US Army Institute for Surgical Research
·US Army Medical Research & Materiel Command
·Human Pharmacology & Physiology Lab, Duke University Medical Center
·Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas
·University of Texas Health Science Center at San Antonio
·Southwest Texas Regional Advisory Council (STRAC)/ RemTORN (Remote Trauma Outcomes Research Network).

Key conclusions of research to date

·CRI represents a novel technology for early hemorrhage detection in trauma (Johnson M., et al., 2018),(Johnson M., et al., 2017). (Stewart, et al., 2016)
·CRI is a more sensitive indicator of blood loss than standard vital signs (HR, BP, SpO2, Stroke Index, Base Deficit) in trauma and in controlled blood draws (Johnson M., et al., 2018),(Johnson M., et al., 2017), (Stewart, et al., 2016),(Nadler et al. 2014), (Stewart et al. 2014), (Convertino et al. 2015).
·Initial findings show CRI trends with volume loss in exertional dehydration (Gagnon et al.’16). JSOM observed CRI may have potential “as a sensitive field hydration monitor that could be used for directing effective fluid replacement” and such an application would have "significant applications in assessment of field performance and Warfighter readiness." (Stewart et al. 2016)
·New CRI-based decision support algorithms for fluid resuscitation detect ongoing hemorrhage, identify whether fluid is required and how much (Grudic et al. 2019).
·Initial findings show CRI trends with volume loss in exertional dehydration (Gagnon et al.’16).

Breakdown of study demographics

To date, CRI has been studied in over 1000 human subjects, ages 4-89.

·Controlled blood draw 18-78, 550 subjects, 49% male
·Trauma age 15-89, 229 subjects, 55% male
·Pediatric age 4-13, 121 subjects, 59% male
·LBNP age 18-55, 134 subjects, 59% male

Building on these initial results in trauma and resuscitation, field trials are in motion evaluating CRI applications in tactical and critical care environments.

clinical bibliography

•    G. Grudic, J. Mulligan, K. Bui, R. Phillips, S. Moulton and D. MacLeod, "The Compensatory Reserve Index: A Continuous, Non-invasive Metric for Whole Blood Resuscitation," in Western Trauma Association, Snow Mass, CO, 2019.

•    H. Pynn and J. Smith, "The Compensatory Reserve Index – potential uses in a military context," Journal of the Royal Naval Medical Service, vol. 104, no. 2, pp. 120-123, 2018.

•   Metzger, J. Mulligan and G. Grudic,"Development of a non-invasive cerebrovascular status algorithm to estimate cerebral perfusion pressure and intracranial pressure in a porcine model of focal brain injury," Military Medicine, vol. 183, no. suppl 1, p. 119–123, 2018. 

•    D. Leopold, K. Campbell, L. Pyle, R. Ing, J. Mulligan, M. Twite and S. Moulton, "Perioperative central volume status in healthy children and in children with congenital heart disease.," in International Anesthesia Research Society (IARS), Society of Critical Care Anesthesiologists (SOCCA) and Association of University Anesthesiologists (AUA) Annual Meetings, Chicago, IL, 2018.

•    D. Leopold, K. Campbell, L. Pyle, R. Ing, J. Mulligan, M. Twite and S. Moulton, "Joint modeling and the Compensatory Reserve Index: Insight into hemodynamic compensation during the induction of general anesthesia.," in International Anesthesia Research Society (IARS), Society of Critical Care Anesthesiologists (SOCCA) and Association of University Anesthesiologists (AUA) Annual Meetings, Chicago, IL, 2018.

•    Y. Choi, D. Leopold, K. Campbell, J. Mulligan, G. Grudic and S. Moulton, "Noninvasive monitoring of physiologic compromise in acute appendicitis: New insight into an old disease,"Journal of pediatric surgery, vol. 53, no. 2, pp. 241-246, 2018.

•    M. Johnson, A. Alarhayem, V. Convertino, R. Carter, K. Chung, R. Stewart, J. Myers, D. Dent, L. Liao, R. Cestero, S. Nicholson, M. Muir, M. Schwacha, D. Wampler, M. DeRosa and B. Eastridge, "Compensatory reserve index: performance of a novel monitoring technology to identify the bleeding trauma patient,"SHOCK, vol. 49, no. 3, p. 295–300, 2018.

•    M. Johnson, A. Alarhayem, V. Convertino, R. Carter, K. Chung, R. Stewart, J. Myers, D. Dent, L. Liao, R. Cestero, S. Nicholson, M. Muir, M. Schwaca, D. Wampler, M. DeRosa and B. Eastridge,"Comparison of compensatory reserve and arterial lactate as markers of shock and resuscitation.," Journal of Trauma and Acute Care Surgery, vol. 83, no. 4, pp. 603-608, 2017.

•    S. Moulton, J. Mulligan, M. Santoro, K. Bui, G. Grudic and D. MacLeod, "Validation of a noninvasive monitor to continuously trend individual responses to hypovolemia,"Journal of Trauma and Acute Care Surgery, vol. 83, no. 1, p. S104–S111, 2017.

•    C. Stewart, J. Mulligan, G. Grudic, M. Talley, G. Jurkovich and S. Moulton, "The Compensatory Reserve Index Following Injury: Results of a Prospective Clinical Trial.,"SHOCK, vol. 46, no. 3S, p. 61–67, 2016.

•       C. Stewart, C. CD Nawn, J. Mulligan, G. Grudic, S. Moulton and V. Convertino, "Compensatory Reserve for Early and Accurate Prediction of Hemodynamic Compromise: Case Studies for Clinical Utility in Acute Care and Physical Performance.," Journal of Special Operations Medicine, vol. 16, no. 1, pp. 6-13, 2016.

•    D. Gagnon, Z. Schlader, A. Adams, E. Rivas, J. Mulligan, G. Grudic, V. Convertino, J. Howard and C. Crandall, "The effect of passive heat stress and exercise-induced dehydration on the compensatory reserve during simulated hemorrhage.," SHOCK, vol. 46, no. 3S, pp. 74-82, 2016.

•    J. Howard, J. Janak, C. Carmen Hinojosa-Laborde and V. Convertino, "Specificity of compensatory reserve and tissue oxygenation as early predictors of tolerance to progressive reductions in central blood volume," SHOCK, vol. 46, no. 3S, pp. 68-73, 2016.

•    C. Hinojosa-Laborde, J. Howard, J. Mulligan, G. Grudic and V. Convertino, "Comparison of compensatory reserve during lower-body negative pressure and hemorrhage in nonhuman primates," American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, vol. 310, no. 11, p. R1154–R1159., 2016.

•    V. Convertino, J. Howard, C. Laborde, S. Cardin, P. Batchelder, J. Mulligan, G. Grudic and D. Macleod, "Individual-specific, beat-to-beat trending of significant human blood loss: The compensatory reserve.,"SHOCK, vol. 44, p. 27–32, 2015.

•    J. Janak, J. Howard, K. Goei, R. Weber, G. Muniz, C. Hinojosa-Laborde and V. Convertino, "Predictors of the onset of hemodynamic decompensation during progressive central hypovolemia: comparison of the peripheral perfusion index, pulse pressure variability, and compensatory reserve index.," SHOCK, vol. 44, no. 6, pp. 548-553, 2015.

•    C. Stewart, J. Mulligan, G. Grudic, L. Pyle and S. Moulton, "A noninvasive computational method for fluid resuscitation monitoring in pediatric burns: a preliminary report.," Journal of Burn Care Research, vol. 36, no. 1, pp. 145-50, 2015.

•    C. Stewart, J. Mulligan, G. Grudic, V. Convertino and S. Moulton, "Detection of low-volume blood loss: Compensatory reserve versus traditional vital signs.," Journal of Trauma and Acute Care Surgery, vol. 77, no. 6, pp. 892-898, 2014.

•    P. Poh, R. Carter, C. Hinojosa-Laborde, J. Mulligan, G. Grudic and V. Convertino, "Respiratory pump contributes to increased physiological reserve for compensation during simulated haemorrhage",Experimental Physiology, vol. 99, no. 10, pp. 1421-1426, 2014.

•    R. Nadler, V. Convertino, S. Gendler, G. Lending, A. Lipsky, S. Cardin, A. Lowenthal and E. Glassberg, "The value of noninvasive measurement of the compensatory reserve index in monitoring and triage of patients experiencing minimal blood loss,"SHOCK, vol. 42, no. 2, pp. 93-98, 2014.

•    S. Moulton, J. Mulligan, G. Grudic and V. Convertino, "Running on empty? the compensatory reserve index.,"Journal of Trauma and Acute Care Surgery, vol. 75, no. 6, pp. 1053-1059, 2013.

•    G. Muniz, D. Wampler, C. Manifold, G. Grudic, J. Mulligan, S. Moulton, R. Gerhardt and V. Convertino, "Promoting early diagnosis of hemodynamic instability during simulated hemorrhage with the use of a real-time decision-assist algorithm," Journal of Trauma and Acute Care Surgery, vol. 75, no. 2, p. S184–S189, 2013.

•    C. I. Van Sickle, K. Schafer, J. Mulligan, G. Grudic, S. Moulton and V. Convertino, "A sensitive shock index for real-time patient assessment during simulated hemorrhage," Aviation, Space, and Environmental Medicine, vol. 84, no. 9, pp. 907-912, 2013.

•    V. Convertino, G. Grudic, J. Mulligan and S. Moulton, "Estimation of individual-specific progression to impending cardiovascular instability using arterial waveforms.,"Journal of Applied Physiology, vol. 115, no. 8, pp. 1196-202, 2013.

•      V. Convertino, S. Moulton, G. Grudic, C. Rickards, C. Hinojosa-Laborde, R. Gerhardt, L. Blackbourne and K. Ryan, "Use of Advanced Machine-Learning Techniques for Noninvasive Monitoring of Hemorrhage,"Journal of Trauma and Acute Care Surgery, vol. 71, no. 1, pp. S25-S32, 2011.

•      C. Stewart, C. CD Nawn, J. Mulligan, G. Grudic, S. Moulton and V. Convertino, "Compensatory Reserve for Early and Accurate Prediction of Hemodynamic Compromise: Case Studies for Clinical Utility in Acute Care and Physical Performance.," Journal of Special Operations Medicine, vol. 16, no. 1, pp. 6-13, 2016.