Monitoring of hemorrhage and whole blood resuscitation in non-human primates

Massive hemorrhage remains the primary cause of potentially preventable death in traumatic injuries. Monitoring hemorrhage and resuscitation accurately can improve outcomes but continues to be challenging since traditional vital signs are highly compensated by the body. Previous work has developed physiologically interpretable algorithms to assess volume status in simulated models of hemorrhage and resuscitation. In this paper, we further develop these algorithms to assess volume status in a nonhuman primate model of controlled blood loss and subsequent whole-blood resuscitation. We acquired arterial blood pressure (ABP) waveform data on 12 adult male baboons during a step-and-hold protocol for hemorrhage and a constant resuscitation rate. A gradient-boosted regression tree model trained on only the ejected-wave pulse area (EWPA) feature yielded a 19% root-mean-square-error (RMSE), 0.71 R2, and an area under the receiver operating characteristic curve of ≥ 0.9 for key operating points of volume status. The performance of this model with a single feature compares well to results reported previously from single-feature machine-learning (ML) models as well as more complex machine learning models that are difficult to interpret and computationally intensive. This study is the first investigation of these physiologically interpretable models on invasively measured ABP waveforms.