Adaptive closed-loop resuscitation controllers for hemorrhagic shock resuscitation

Area of Science:

• Biomedical Engineering
• Control Systems
• Critical Care Medicine

Background:

• Fluid resuscitation is critical after hemorrhage control but challenging to manage, especially in mass casualty incidents.
• Autonomous medical systems could manage tasks like fluid resuscitation when human providers are scarce.
• Physiological closed-loop control systems (PCLCs) are central to developing such autonomous systems.

Purpose of the Study:

• To design and optimize adaptive resuscitation controllers (ARCs) for autonomous fluid resuscitation of hemorrhage patients.
• To evaluate the performance of purpose-built ARCs against traditional control architectures.

Main Methods:

• Three ARC designs were developed, measuring pressure-volume responsiveness to adapt infusion rates.
• Controllers estimated required infusion flow rates based on patient volume responsiveness.
• A hardware-in-loop test platform evaluated ARC implementations across various hemorrhage scenarios.

Main Results:

• The purpose-built adaptive resuscitation controllers demonstrated superior performance compared to a traditional fuzzy-logic controller.
• Optimization of ARCs led to improved fluid resuscitation management in simulated hemorrhage scenarios.

Conclusions:

• Purpose-built ARCs show promise for autonomous fluid resuscitation in hemorrhage.
• Future work will focus on enhancing controller robustness to physiological signal noise and in vivo testing.