Intelligent Mobile Ultrasound for Noninvasive Intracranial Pressure Estimation in Prehospital and PFC Settings
Abstract
Objectives and Rationale: In the prehospital setting, reliable identifiers of brain injury and tools to indicate severity of brain injury or make in-field triage decisions about traumatic brain injury (TBI) patient care do not exist. Intracranial pressure (ICP) is a key physiologic parameter whose changes have been associated with TBI at various stages. Despite the potential power of using ICP as an early-onset indicator of TBI, the ability to track it in the pre-hospital setting is not currently possible. Requiring surgical penetration of the skull, current ICP monitoring methods are highly invasive and thus restricted to severe cases. We have previously shown that ICP can be estimated noninvasively using cerebral blood flow velocity and arterial blood pressure measurements utilizing a mathematical model in a neuro-ICU setting. However, expanding this approach to a prehospital setting requires mobile and easy to use ultrasound devices. Thus, the goal of this proposal is to develop an intelligent, mobile ultrasound system to enable novice ultrasound users in making reliable blood flow velocity measurements for noninvasive ICP (nICP) estimation. The device will then undergo a series of validation steps, starting from laboratory testing on healthy volunteers to neuro-ICU patients (with gold-standard ICP measurement) to ambulance testing on healthy volunteers. Ultimate Applicability of the Research: This research project will set up a follow-on, large-scale, pre-hospital data gathering project (ICP and other physiological parameters, such as continuous blood pressure, heart rate, etc.). These studies would provide the basis for clinical trials studying the benefit of early ICP measurements on patient outcomes following existing prehospital TBI care management guidelines closely taking into account brain injury severity, possible with nICP measurements. Fiscal Year 2016 Prolonged Field Care Research Award Focus Area Addressed: The proposal targets the needs defined in Focus Area 2: Develop next-generation resuscitation and stabilization methods for prolonged field care (PFC) and prolonged damage control resuscitation (pDCR), specifically: "Novel or improved methods for resuscitation and stabilization of casualties with combined hemorrhagic shock and acute TBI, with or without other concomitant injuries" and "point-of-injury/point-of-need/pre-hospital capabilities to monitor and/or stabilize acute TBI casualties." The goal is to enable earlier detection of life-threatening conditions, improve decision-making timelines, and/or mitigate progression of brain injury in pDCR and/or remote operating environment scenarios. How Proposed Research Will Impact the Focus Area Addressed: Due to the austere nature of prehospital environments, ICP and other measurements must be collected noninvasively. However, battlefield physician extenders (e.g., medic or other first responders) are often undertrained in the use of ultrasound, presenting a challenge in assessing ICP in PFC settings. We will study the feasibility of conducting noninvasive ICP measurement, a novel physiological measurement in pre-hospital settings. Early estimation of ICP will enable medics in pre-hospital and PFC settings to more closely adhere to TBI management guidelines and improve their decision making timelines. Potential Clinical Applications, Benefits and Risks: This research proposal enables novice ultrasound users to successfully use an ICP measurement system in a pre-hospital environment. The development of a technique to measure ICP non-invasively and in a robust manner, especially in a pre-hospital or PFC setting where other indicators of TBI perform poorly, would significantly advance caregivers ability to enable earlier detection of life-threatening conditions, improve decision-making timelines, and more closely adhere to current TBI management guidelines. Military and/or Civilian Patient Populations to Be Helped: Both military a
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810332
Entities
People
- Balasundar Raju
Organizations
- Koninklijke Philips NV
- United States Army