The ReFit system can be seen in the foreground, as emergency clinicians and researchers check the pig it was tested on. — TNS
On four occasions last year (2023), medical helicopters flew over the city of Pittsburgh in Pennsylvania, the United States transporting not injured humans, but wounded pigs.
The pigs – bleeding heavily from the abdomen – were stabilised in the air by an autonomous medical intervention system developed by the University of Pittsburgh as part of a US military-funded study with the potential for “groundbreaking” advances in healthcare.
“What we did with the Department of Defense was try to solve their number one cause of preventable death on the battlefield,” said Pitt Center for Military Medicine director Prof Dr Ronald Poropatich.
“This is the future of medicine, whether it’s military or civilian.”
Machine as physician
In the five-year proof-of-concept study – published on May 24 (2024) in the journal Intensive Care Medicine Experimental – Pitt researchers and physicians worked with computer scientists at Carnegie Mellon University, also in Pittsburgh, to build the ReFit (Resuscitation based on Functional Hemodynamic Monitoring) system.
About the size of a microwave, the computer system can function as a highly-trained critical care physician, administering fluids, blood and medication without human intervention.
It was funded by a US$3.71mil (RM17.461mil) grant over four years from the US Department of Defense.
In the experiment, four pigs were fully anaesthetised in accordance with animal research protocols, and then given liver lacerations in a laboratory to mimic a gunshot wound to the abdomen or other non-compressible haemorrhage.
The pigs were allowed to bleed for 30 minutes and then connected to the ReFit system.
At this point, a human medical professional still has to manually insert an IV (intravenous) line, but after that, no human intervention is required.
Two of the pigs were placed on a stretcher and taken to the hospital helipad, where they flew for several hours around Pittsburgh.
The other two pigs were taken via ambulance to the Allegheny County Airport (11km from Pittsburgh), and then flown on a medical helicopter as far as Kittanning (58km from Pittsburgh) and then back to Oakland (in Pittsburgh).
The ReFit system was able to stabilise the pigs and return them in adequate condition for life-saving surgery.
“For the first time in the history of medicine, we took an animal in a critical state onto a helicopter and autonomously brought it back healthier than when it was placed in emergency transport hours earlier,” said study lead author and Pitt Center professor of critical care, bioengineering, and critical and translational medicine Dr Michael Pinsky.
“This has profound implications for trauma resuscitation in the field, and of course, in military medicine.”
Extending the ‘golden hour’
In emergency medicine, physicians have long referred to the “golden hour”, an idea dating back to World War I that it is critical to get a seriously injured patient to a trauma centre within one hour of their injury to avoid death or long-term complications.
What ReFit can do is extend that timeline so that patients are stable for much longer – up to five hours in the study – before hospital care.
“It is all about extending the golden hour,” said Prof Poropatich.
“All we are trying to do is keep the casualty alive long enough to get to an operating room.”
Although the technology was developed for the military, there are numerous scenarios in civilian medicine where it would be useful.
Take the case of a serious car accident in an area of Pennsylvania that is far from a trauma hospital, said Prof Pinsky.
An emergency medicine technician (EMT) could insert an IV into a patient and the ReFit system could then administer care equivalent to what they would receive from an experienced physician while they were being transported.
In a military scenario, the technology is well suited for large-scale combat operations with dispersed medical assets, such as the war going on in Ukraine, said Prof Poropatich, who served in the US Army for 30 years before retiring in 2012 as a colonel.
“It’s the concept of trauma care in a backpack,” he said.
“It could provide the technology to resuscitate without having a critical care doctor there with you.”
Further refinements
The team at Pitt Center is working on further advancements to the technology, such as the ability to deliver the ReFit system via a drone, to extend its reach into remote locations.
Other research centres, such as Carnegie Mellon, are also working on robotic technology to insert an IV without a human.
“There is great interest in making it truly autonomous,” said Prof Poropatich. “Autonomous care in an autonomous aircraft.”
To do so, the system will need to be tested on humans, in addition to pigs.
While there are aspects of human testing that they plan to begin within this year (2024), full clinical trials are realistically two or three years away, said Prof Pinsky.
“We at the University of Pittsburgh, and especially emergency medicine, are completely excited about going to the next level here,” he said.
“Everyone sees the realistic application of this now – to treat human beings.” – By Anya Sostek/Pittsburgh Post-Gazette/Tribune News Service
