title: Use of artificial intelligence to identify cardiovascular compromise in a model of hemorrhagic shock.
abstract: OBJECTIVE
  To determine whether a prototype artificial intelligence system can identify volume of hemorrhage in a porcine model of controlled hemorrhagic shock.
  
  
  METHODS
  Prospective in vivo animal model of hemorrhagic shock.
  
  
  METHODS
  Research foundation animal surgical suite; computer laboratories of collaborating industry partner.
  
  
  METHODS
  Nineteen, juvenile, 25- to 35-kg, male and female swine.
  
  
  METHODS
  Anesthetized animals were instrumented for arterial and systemic venous pressure monitoring and blood sampling, and a splenectomy was performed. Following a 1-hr stabilization period, animals were hemorrhaged in aliquots to 10, 20, 30, 35, 40, 45, and 50% of total blood volume with a 10-min recovery between each aliquot. Data were downloaded directly from a commercial monitoring system into a proprietary PC-based software package for analysis.
  
  
  RESULTS
  Arterial and venous blood gas values, glucose, and cardiac output were collected at specified intervals. Electrocardiogram, electroencephalogram, mixed venous oxygen saturation, temperature (core and blood), mean arterial pressure, pulmonary artery pressure, central venous pressure, pulse oximetry, and end-tidal CO(2) were continuously monitored and downloaded. Seventeen of 19 animals (89%) died as a direct result of hemorrhage. Stored data streams were analyzed by the prototype artificial intelligence system. For this project, the artificial intelligence system identified and compared three electrocardiographic features (R-R interval, QRS amplitude, and R-S interval) from each of nine unknown samples of the QRS complex. We found that the artificial intelligence system, trained on only three electrocardiographic features, identified hemorrhage volume with an average accuracy of 91% (95% confidence interval, 84-96%).
  
  
  CONCLUSIONS
  These experiments demonstrate that an artificial intelligence system, based solely on the analysis of QRS amplitude, R-R interval, and R-S interval of an electrocardiogram, is able to accurately identify hemorrhage volume in a porcine model of lethal hemorrhagic shock. We suggest that this technology may represent a noninvasive means of assessing the physiologic state during and immediately following hemorrhage. Point of care application of this technology may improve outcomes with earlier diagnosis and better titration of therapy of shock.
authors.affiliation: Department of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Todd F
authors.initials: TF
authors.lastname: Glass
authors.forename: Jason
authors.initials: J
authors.lastname: Knapp
authors.forename: Philip
authors.initials: P
authors.lastname: Amburn
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Clay
authors.forename: Matt
authors.initials: M
authors.lastname: Kabrisky
authors.forename: Steven K
authors.initials: SK
authors.lastname: Rogers
authors.forename: Victor F
authors.initials: VF
authors.lastname: Garcia
mesh_terms: D000818:Animals; D001185:Artificial Intelligence; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology*; D004195:Disease Models, Animal; D005260:Female; D008297:Male; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000150:complications*; D013552:Swine