A new study reveals that a closed loop, autonomous intervention has significantly increased the amount of time surgeons have to save the lives of severely injured individuals in remote locations. The intervention has extended the “golden hour,” during which medical professionals have the best chance of saving a patient’s life. This advancement in trauma care was published in the journal Intensive Care Medicine Experimental by physician-scientists from the University of Pittsburgh.The School of Medicine at the University of Pittsburgh, with funding from the U.S. Department of Defense, holds significant promise in the effort to save the lives of severely injured military members in remote combat zones or civilians in mass casualty incidents or rural areas lacking access to advanced medical treatment.
“Under normal circumstances, if we can transport a severely injured person to the hospital within an hour, there is a high likelihood of saving their life,” said Dr. Michael R. Pinsky, the lead scientist on the project and a professor of critical care medicine, bioengineering, and clinical and translational medicine at the University of Pittsburgh. “For the first time in medical history, the opportunity to save lives The team successfully transported a critically injured animal on a helicopter and returned it in better health than when it was first transported. This breakthrough could have significant implications for treating trauma patients in the field.
Collaborating with computer scientists from Carnegie Mellon University, the multidisciplinary Pitt team tested a crucial element of the Trauma Care in a Rucksack (TRACIR) system. This system is designed to be compact enough to fit inside a backpack and be delivered via drone to remote areas. The closed loop algorithm, called Resuscitation based on Functional Hemodynamic Monitoring (ReFit), is minimally invasive and capable of autonomously guiding the animal’s care.The study involved providing intravenous fluids, blood, and medication to pigs with a severe liver injury to maintain their vital functions for three to five hours. This was done while the pigs were being transported via ground ambulance and helicopter without human intervention. The pigs were then brought back to the laboratory surgical suite as part of a demonstration project.
Over the course of several days, four fully anesthetized pigs, whose anatomy and response to injury closely resemble that of humans, underwent surgical liver laceration in the laboratory surgical suite. This was done in accordance with approved animal research guidelines. The pigs were allowed to hemorrhage for 30 minutes before being resuscitated with the necessary treatments.The ReFit computer algorithm system, roughly the size of a microwave, was activated to resuscitate pigs without human medical intervention, except for monitoring by an emergency medicine doctor. Two pigs connected to ReFit were taken to a hospital helipad by emergency medical technicians for a simulated emergency rescue, while the other two were transported by ground ambulance to Allegheny Co.The pigs were transported from the University of Pittsburgh Medical Center to a county airport and then flown back to the hospital helipad using prolonged flight paths to simulate long distance transport. After being returned, the research team confirmed that they could revive the anesthetized pigs autonomously for several hours without human intervention using only a computer-generated autonomous care algorithm. “By keeping these animals with a lethal injury alive for up to five hours with a computer driving the resuscitation, you can see how that extends the golden hour,” said principal investigator Ronald Poropatich.The Center for Military Medicine Research and a professor of medicine at Pitt, M.D. expressed enthusiasm for the potential of applying this technology to saving the lives of people injured in challenging environments. The next step for the team is to test transporting injured animals connected to ReFit by unmanned aerial drones to improve the effectiveness of rescuing injured individuals in hard-to-reach locations, such as mountainsides or military battlefields. Other authors on this research include M.D. Hernando Gomez, M.D. Francis X. Guyette, M.D. Leonard Weiss, M.D. Lisa Gordon, Theodore Lagattuta, and David Sal.The research was conducted by a team of experts from the University of Pittsburgh and Carnegie Mellon University, including Dr. Pedro Cido, Dr. Artur Dubrawski, Dr. Jim Leonard, and Dr. Robert MacLachlan. The project received support from the US Army Medical Research and Materiel Command under Contract No. W81XWH-19-C-0101 and W81XWH-19-C-0083. The views, opinions, and findings expressed in the report are those of the authors and do not necessarily reflect the official position, policy, or decision of the Department of the Army, unless otherwise specified in other documentation. Additionally, the researchers followed the Animal Welfare Act Regulations and other Federal statutes concerning the use of animals in their research.The research facility abides by the principles outlined in the current version of the Guide for Care and Use of Laboratory Animals, National Research Council, when conducting experiments involving animals. This includes following ethical guidelines and standards for the treatment and care of animals in research.
