Presentation delivered at William G. Barsan Emergency Medicine Research Forum, Ann Arbor, April 27, 2016

1. William G. Barsan Research Forum
Together, we will change the face of Critical Care Medicine

2. The Critical Care Challenge
Critical Care in the U.S. | Annual Statistics

3. The Critical Care Challenge
Critical Care at UMHS

4. 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.

5. Transform Critical Care Medicine
Establish the Nation’s First Comprehensive Critical Care Center

6. Leverage Every Discovery…
…Across the Spectrum of Care.

7. The Critical Care Challenge
Situational Awareness in the ICU
Processing Big Data: Volume + Variety + Velocity + Veracity
Clinicians may be confronted with 200 time-related variables, but can only
determine the relationship between two variables unassisted.

8. MCIRCC Led Big Data Analytic Platform

9. Novel Complexity Measures from
Heart Rate Variability (HRV)
Novel Morphology Based ECG
Contour Analytics
Continuous Monitoring and Assessment of
Hemodynamic Conditions
Using Computer-Aided Analysis of Physiological Signals
Analytic for Hemodynamic Instability
AHI

10. Monitoring in the ICU
Filtering Noise from Real Meaningful Change

11. 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

12. The Massey TBI Innovation Fund
Targeting Severe TBI During the “Golden Hours”

13. Oral Tissue Oxygenation Monitor:
Equivalent to Mixed Venous Oxygen Saturation

14. A
B
InspirationExpiration
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 monitoring
2) Real time Respiratory rate and
quality monitoring
3) Real-time CVP monitoring
4) Temperature, Heart Rate, Sleep,
and more

15. 15
Team # | 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 Assessment
Normal
IDH-Risk
Decay of
reflection
waves.
Feature
Extraction

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

17. e-
e-
NP
Au
Planar
Au
= Redox
Species
=
Albumin
Pin hole
World’s First Whole Blood Oxidant Stress
Monitor

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

19. Automated Image Analysis

20. 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

21. 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

22. 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)

23. Noninvasive REBOA

24. 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

25. Inflatable
balloon
Pilot
Balloon
Hollow member or clip to go over ET Tube
Hollow Member to ventilate
through and pass additional
endotracheal tube through,
stylet or fiberopitc.
MCIRCC Rescue Airway Device

26. Innovating from the Past
Civil War Era Go Blue Tourniquet 2016

27. 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

28. MCIRCC Leadership

29. 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

30. 2014/15 Output Summary
Member 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

31. 2014/15 Output Summary
Intellectual 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.

32. “Remembering the Future”
BIG WINS in Critical Care 2025
Sepsis
½ Mortality
Hemorrhagic
Shock
½ Mortality
Traumatic
Brain Injury
(moderate to severe)
2x Good Outcome
Cardiac Arrest
2x Survival