The Evidence Base for Precision Hemodynamic Monitoring
Flashback Technologies is committed to an evidence-first approach, with the Compensatory Reserve Index (CRI) being one of the most rigorously validated parameters in modern patient monitoring. To date, more than 20 published studies—including human blood loss experiments, non-human primate models, and prospective clinical trials—have established the reliability of our proprietary algorithms.
Rigorous Human Volunteer TestingThe foundation of the CRI algorithm rests on large-scale physiological data collection designed to mimic real-world hemorrhage.
- Lower Body Negative Pressure (LBNP) Models: CRI was developed by collecting reference signals from 230 healthy human volunteers undergoing LBNP to the point of hemodynamic decompensation. This model shift blood volume to the legs, accurately mimicking the effects of central hypovolemia.
- Blood Withdrawal Validation: A key validation study involved 42 healthy participants undergoing controlled blood withdrawal of approximately 20% of their intravascular volume. The results showed that the CRI algorithm accurately estimated volume status with a root-mean-squared error of less than 0.1.
- Sensitivity to "Symptomatic" Collapse: In these studies, symptomatic subjects demonstrated a decrease in CRI per liter of blood removed that was three times larger than that of asymptomatic subjects, proving the index’s predictive power.
Expanding Clinical Applications: From Trauma to PediatricsWhile initially developed with adult training data, the application of CRI has expanded into diverse clinical settings.
- Pediatric Triage: In studies at Children’s Hospital Colorado, CRI was found to accurately reflect acute hemodynamic changes in children with conditions such as burns, sepsis, and perforated appendicitis.
- Congenital Care: Research has demonstrated that postnatal CRI values are significantly lower in newborns with congenital diaphragmatic hernia (CDH) who require ECMO compared to those who do not, offering a potential new prognostic tool for neonatal ICUs.
- Cardiac and Surgical Monitoring: Studies have evaluated the safety and utility of CRI monitoring after cardiac surgery with cardiopulmonary bypass, finding that patients with longer ICU stays had a significantly greater decrease in CRI from baseline.
A Validated Tool for Diverse EnvironmentsThe CipherOx CRI-M1 has been tested for performance across varied pulse oximetry platforms and clinical environments.
- Usability and Interpretation: Simulation studies have confirmed that medical providers can correctly interpret CRI values in both hemorrhage and non-hemorrhage scenarios to identify when intervention is required.
- Pre-Hospital and Battlefield Utility: Extensive research supported by the U.S. Army has validated CRI as a "game-changing" tool for non-invasive monitoring in austere environments where traditional diagnostic tools are often unavailable.
Leading the Transition to Data-Driven CareAs we move through 2026, Flashback Technologies continues to support a nationwide clinical trials network to further refine our machine-learning models. By standardizing how genetic, biomarker, and physiological data inform diagnosis, we are ensuring that every validation study leads directly to improved patient outcomes and more efficient healthcare operations.
