• Bret D Alvis, Reid McCallister, Monica Polcz, Jose Lucio O Lima, Jenna Helmer Sobey, Daniel R Brophy, Merrick Miles, Colleen Brophy, and Kyle Hocking.
• 422 MAB, 1211 21st Ave South, Vanderbilt University Medical Center, Nashville, TN 37212, USA. Electronic address: bret.d.alvis@vumc.org.
• J Clin Anesth. 2020 May 1; 61: 109664.

Study ObjectiveThere is an unmet need for a non-invasive approach to diagnose hemorrhage early, before changes in vital signs occur. Non-Invasive Venous waveform Analysis (NIVA) uses a unique physiological signal (the peripheral venous waveform) to assess intravascular volume. We hypothesized changes in the venous waveform would be observed with blood loss in healthy adult blood donors and characterized hemorrhage using invasive monitoring in a porcine model.DesignProspective observational study.SettingAmerican Red Cross donation center.Patients50 human blood donors and 12 non-donating controls; 7 Yorkshire pigs.InterventionsA venous waveform capturing prototype (NIVA device) was secured to the volar aspect of the wrist in human subjects. A central venous catheter was used to obtain hemodynamic indices and venous waveforms were obtained using the prototype NIVA device over the saphenous vein during 400 mL of graded hemorrhage in a porcine model.MeasurementsVenous waveforms were transformed from the time to the frequency domain. The ratiometric power contributions of the cardiac frequencies were used to calculate a NIVA value representative of volume status.Main ResultsA significant decrease in NIVA value was observed after 500 mL of whole blood donation (p < .05). A ROC curve for the ability of the NIVA to detect 500 mL of blood loss demonstrated an area under the curve (AUC) of 0.94. In the porcine model, change in NIVA value correlated linearly with blood loss and with changes in hemodynamic indices.ConclusionsThis study provides proof-of-concept for a potential application of NIVA in detection of blood loss. NIVA represents a novel physiologic signal for detection of early blood loss that may be useful in early triage and perioperative management.Copyright © 2019 Elsevier Inc. All rights reserved.

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