William G. Barsan Research Forum

Together, we will change the face of Critical Care Medicine

The Critical Care ChallengeCritical Care in the U.S. | Annual Statistics

The Critical Care ChallengeCritical Care at UMHS

Big Bold Solutions• Integrate Non-Traditional Partners

– Engineering, Data Science, Population Health, Local and Regional Entrepreneurs

• Leverage Big Data– Data in Motion for Cognitive Computing, Quantified Self, Integration of

Digital Assets for transitions of care

• Develop Strategic Partnerships– Industry as “one stop shopping” and co-product development, Department

of Defense, Other leading AMCs, Nontraditional Health Care partners

• Reduce Energy Barrier to Transformative Team Science– Proposal Develop Unit for multi-investigator grants, Ideation Sessions,

Grand Challenges, Technology Development, etc.

Transform Critical Care MedicineEstablish the Nation’s First Comprehensive Critical Care Center

Leverage Every Discovery…

…Across the Spectrum of Care.

The Critical Care ChallengeSituational Awareness in the ICU

Processing Big Data: Volume + Variety + Velocity + VeracityClinicians may be confronted with 200 time-related variables, but can only

determine the relationship between two variables unassisted.

MCIRCC Led Big Data Analytic Platform

Novel Complexity Measures from Heart Rate Variability (HRV)

Novel Morphology Based ECGContour Analytics

Continuous Monitoring and Assessment of Hemodynamic Conditions

Using Computer-Aided Analysis of Physiological Signals

Analytic for Hemodynamic InstabilityAHI

Monitoring in the ICUFiltering Noise from Real Meaningful Change

MCIRCC Sepsis Grand Challenge

• 2014: Two day event• 70 clinicians, engineers, data

scientists, basic scientist• Educating each other on what

sepsis is, technology gaps,UM lab and engineering assets

• 300K to fund medicine-engineering partnerships to develop transformative technologies

• 14 proposals submitted and six eventually funded

• Commercialization coaching and product management guidance provided

The Massey TBI Innovation FundTargeting Severe TBI During the “Golden Hours”

Oral Tissue Oxygenation Monitor:Equivalent to Mixed Venous Oxygen Saturation

A

BInspirationExpiration

InspirationExpiration

A

B

Figure 2: Changes in IVC diameter during A. Before hemodialysis B. At the end of hemodialysis. And corresponding bioimpedance changes. A. Before and B. After hemodialysis

Wearable Volume Monitoring:1) Real-time continuous monitoring of

IVC Diameter for Volume monitoring2) Real time Respiratory rate and

quality monitoring3) Real-time CVP monitoring4) Temperature, Heart Rate, Sleep,

and more

15Team # | Project Name

Technology:• Piezoelectric

polymer (PVDF) sensing band.

• Waveform feature extraction and analysis

• Reflects real time changes in vascular tone-compensation

• Predicts hypotension

Dynamic Arterial Morphology AssessmentNormal

IDH-Risk

Decay of reflection

waves.

FeatureExtraction

Point of Care Visocelastic Coagulation Monitoring (1 Drop of Blood)

e-e-

NP AuPlanar

Au

= Redox Species

= Albumin

Pin hole

World’s First Whole Blood Oxidant Stress Monitor

Redefining Sepsis: Bringing Precision Medicine to Sepsis through Data-in-Motion Phenotyping

Automated Image Analysis

Ocular Cerebral Autoregulation Monitor

Cross section and impedance pathway

• Animal intubated and mechanically ventilated• Three Burr holes for ICP measurement, LDF and subdural hematoma induction• Electrodes over eye for ocular impedance measurement• Carotid artery cannulated for blood pressure measurement

Chemical Oxygen Generation

• Oxygen tanks cannot go or be placed at many locations

• Hypoxia is a huge killer in cardiovascular and trauma conditions

• Maternal and neonatal hypoxia are major causes of death during and after child birth

• Produces 6 l/min for 20 minutes. No heat or explosive hazards

• Funded by ONR

High Fidelity Systolic Blood Pressure Monitoring

• Use SpO2 or PZT waveform to determine SBP during cuff inflation.

• Set minimum cuff inflation (90-100 mmHg).

• Loss of waveform = SBP less than set point

• Algorithm continues to find true SBP and then set at minimum target.

• Could be connected to infusion devices (Smart autonomous resuscitation)

Noninvasive REBOA

ICU Bed of the Future

• Therapeutic Platform– Vibration, Temperature

• Diagnostic Platform– Physiologic signal capture

• Rehabilitation Platform– Physical Therapy in the ICU

• ICU to Home

24

Inflatable balloon

Pilot Balloon

Hollow member or clip to go over ET Tube

Hollow Member to ventilate through and pass additionalendotracheal tube through, stylet or fiberopitc.

MCIRCC Rescue Airway Device

Innovating from the Past

Civil War Era Go Blue Tourniquet 2016

Biphasic Cuirass Ventilation

• Sepsis and ARDS• Cardiogenic Shock• Multisystem Trauma• Traumatic Brain Injury• Enhanced Weaning• Asthma/COPD with or

without BiPAP

• Enhance cardiac output, decrease ICP, enhance venous return, decrease PPV complications

MCIRCC Leadership

Scaling MCIRCC Impact

MCIRCC Core Assets- Scaling for bigger Impact:• Big Data Analytic Platform and Data Mart: Analytics research + Cognitive

computing + Clinical expertise = transformative leadership position in critical care- improved patient outcomes at reduced cost

• Large Animal ICU and OR: Complex animal models of sepsis, trauma, TBI, Cardiac Arrest

• Proposal Development Unit and Virtual Institute: Rapid Alert+ Integrative Team Mobilization + Project Management = more large grant awards

• Catalyst Core: Strategic Partnerships (industry, DOD)+ Entreprenurial Donors = New funding streams and business models

• MCIRCC Innovation Portfolio: Research funding plans ( FFMI MTRAC, COE Coulter, donors) + Grand Challenges Platform= more licenses and royalty streams

2014/15 Output SummaryMember Engagement

• 140 members from 6 U-M Schools and Colleges; actively onboarding new members. 20% COE, 70% UMMS

• Regular communications and networking activities to support membership and accelerate multidisciplinary team research.– MCIRCC Innovation Underground: Bourbon, Beer and Ideas =

Opportunity

• MCIRCC Virtual Institute (member intranet).– Most sophisticated array of funding curation and grant development

services within the UM.

• Cultivating “foundational” research communities: sepsis, traumatic brain injury (TBI), hemodynamic surveillance monitoring, cardiac arrest, combat casualty care, transfusion medicine, critical care informatics and clinical decision making

2014/15 Output SummaryIntellectual Property

• Over 40 patents and invention disclosures actively managed in the MCIRCC portfolio.

• Almost all involve Medical School and Engineering faculty.

• Largest number of Medical School Innovation grants awarded

• In licensing discussions with industry over 10 technologies.– Large, Medium and Small companies: Valued in the 100K’s to the

Billions

– 2 new spin-off with 2 more in the works.

“Remembering the Future” BIG WINS in Critical Care 2025

Sepsis½ Mortality

Hemorrhagic Shock

½ Mortality

Traumatic Brain Injury

(moderate to severe)2x Good Outcome

Cardiac Arrest2x Survival