A Wearable Limb Monitoring System (LiMS)
Abstract
Objectives and Rationale: Compartment syndrome of the limbs (peripheral compartment syndrome, PCS) is an extremely common and insidious consequence of battlefield limb trauma to the extremities, especially those with complex fractures or those to which a tourniquet is applied to control bleeding. Inflammation caused by limb trauma, as well as cell swelling caused by the blockage of blood flow cause injured muscles to expand within the limb compartments and compress surrounding tissues as well as the muscles’ own cells. This phenomenon causes the progressive death of nerves, blood vessels, muscles, and skin. Consequently, a large number of Service members develop limb complications; endure a prolonged recovery; do not regain complete limb function, causing permanent disability; and may not return to duty at the same level of performance. PCS can even cause organ injuries and increase mortality. Timely detection of PCS is critical to drive prompt treatment that can halt this deleterious escalation of events. Although some techniques to monitor limbs and detect PCS have been available for long, these strategies are outdated, often not precise, invasive, based on a single marker of injury, and not designed for quick and automated diagnosis of early signs of PCS. In addition, currently available systems are often not suitable for use on the battlefield or during medical evacuation. As a consequence, the severity or urgency of limb PCS cannot be assessed and cannot guide point-of-injury therapeutic interventions, allow precision care, prioritize evacuation, or alert/adequately prepare receiving medical facilities. Advances in biomedical engineering allow us to design wearable “smart bandages” that integrate multiple, minimally invasive, and safe sensors to continuously monitor the biological markers of limb PCS and inform in real-time both field medical personnel and receiving medical facilities of the precise status of the limb. This project will develop a novel strategy and device for monitoring tourniquet-induced PCS limb injury for military and civilian patients. We will engineer a field-ready, wearable diagnostic device with the ability to monitor limb PCS damage during transportation and transmit critical information to receiving medical facilities to optimize treatment. Applicability: Over the last 15 years, tourniquets have saved the lives of 1,000–2,000 Service members in Iraq and Afghanistan (a 33-60% reduction in preventable deaths on the battlefield). Tourniquet use among civilian Emergency Medical Services (EMS), police personnel, firefighters, and other first responders is ubiquitous. The White House has recently launched the “Stop the Bleed” campaign to promote availability and use of tourniquets among civilians in response to the dramatic increase in civilian mass casualties related to terrorism and natural disasters. The widespread adoption of tourniquets and their pivotal impact on the lives so many demands the development of improved devices to limit tourniquet-induced limb PCS damage. Beside trauma care, tourniquets are routinely used in reconstructive and orthopedic limb surgeries in both the military and civilians. Prolonged use of surgical tourniquets (although less than in trauma care) has been associated with surgical PCS, prolonged pain, and slower recovery. Yet, surgical PCS limb damage is not routinely monitored. DoD FY19 PRORP-ARA Focus Areas: This project addresses the Focus Area, “Compartment Syndrome Models: diagnostic and/or treatment strategies developed in a large animal model that replicates compartment syndrome.” The project will provide a material and knowledge product to support automated, personalized, and effective diagnosis and monitoring of PCS on the field, en route and in far forward medical facilities. Collection of large datasets will benefit evidence-based precision trauma care and indirectly benefit all trauma patients.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010589
Entities
People
- Giorgio Giatsidis
Organizations
- United States Army
- University of Massachusetts Medical School