Accurate, continuous monitoring of cardiac output (CO) is crucial for effective resuscitation management in hemorrhagic trauma, yet current gold-standard methods are invasive and impractical in field settings. This study introduces a fully non-invasive and wearable sensing-based approach utilizing electrocardiography (ECG), seismocardiography (SCG), and photoplethysmography (PPG) signals, integrated with machine learning algorithms, to enable stroke volume (SV) and CO estimation without requiring baseline calibration or normalization. This critical feature makes the model especially suitable for casualty care scenarios where baseline measurements are often unavailable. The proposed methodology was evaluated on a porcine model$(\mathrm{n}=6)$subjected to controlled hemorrhage and resuscitation protocols. Clinically-validated cardiovascular features were used as inputs for regression models, including linear, ridge, LASSO, random forest, and XGBoost regressors. Among these, the LASSO demonstrated the best performance, achieving a high correlation$(R=0.79)$and a mean absolute percentage error (MAPE) of 14.31%, well within clinically-acceptable limits for non-invasive CO monitoring. The framework reliably tracked SV trends crucial for clinical decision-making during resuscitation scenarios. This work highlights the potential for intelligent, noninvasive CO monitoring systems to improve clinical and trauma care outcomes.

Wearable systems can provide accurate cardiovascular evaluations by estimating hemodynamic indices in real-time. Key hemodynamic parameters can be non-invasively estimated using the seismocardiogram (SCG), a cardiomechanical signal whose features link to cardiac events like aortic valve opening (AO) and closing (AC). However, tracking a single SCG feature is unreliable due to physiological changes, motion artifacts, and external vibrations. This work proposes an adaptable Gaussian Mixture Model (GMM) to track multiple AO/AC correlated features in quasi-real-time from the SCG. The GMM calculates the likelihood of an extremum being an AO/AC feature for each SCG beat. The Dijkstra algorithm selects heartbeat-related extrema, and a Kalman filter updates the GMM parameters while filtering features. Tracking accuracy is tested on a porcine hypovolemia dataset with varying noise levels. Blood volume loss estimation accuracy is also evaluated using the tracked features on a previously developed model. Experimental results show a 4.5 ms tracking latency and average root mean square errors (RMSE) of 1.47 ms for AO and 7.67 ms for AC at 10 dB noise, and 6.18 ms for AO and 15.3 ms for AC at -10 dB noise. When considering all AO/AC correlated features, the combined RMSE remains in similar ranges, specifically 2.70 ms for AO and 11.91 ms for AC at 10 dB noise, and 7.50 ms for AO and 16.35 ms for AC at -10 dB noise. The proposed algorithm offers low latency and RMSE for all tracked features, making it suitable for real-time processing. These systems enable accurate, timely extraction of hemodynamic indices for many cardiovascular monitoring applications, including trauma care in field settings.

Although respiratory failure is one of the primary causes of admission to intensive care, the importance placed on measurement of respiratory parameters is commonly overshadowed compared to cardiac parameters. With the increased demand for unobtrusive yet quantifiable respiratory monitoring, many technologies have been proposed recently. However, there are challenges to be addressed for such technologies to enable widespread use. In this work, we explore the feasibility of using load cell sensors embedded on a hospital bed for monitoring respiratory rate (RR) and tidal volume (TV). We propose a globalized machine learning (ML)-based algorithm for estimating TV without the requirement of subject-specific calibration or training. In a study of 15 healthy subjects performing respiratory tasks in four different postures, the outputs from four load cell channels and the reference spirometer were recorded simultaneously. A signal processing pipeline was implemented to extract features that capture respiratory movement and the respiratory effects on the cardiac (i.e., ballistocardiogram, BCG) signals. The proposed RR estimation algorithm achieved a root mean square error (RMSE) of 0.6 breaths per minute (brpm) against the ground truth RR from the spirometer. The TV estimation results demonstrated that combining all three axes of the low-frequency force signals and the BCG heartbeat features best quantifies the respiratory effects of TV. The model resulted in a correlation and RMSE between the estimated and true TV values of 0.85 and 0.23 L, respectively, in the posture independent model without electrocardiogram (ECG) signals. This study suggests that load cell sensors already existing in certain hospital beds can be used for convenient and continuous respiratory monitoring in general care settings.

The ballistocardiogram (BCG), a cardiac vibration signal, has been widely investigated for continuous monitoring of heart rate (HR). Among BCG sensing modalities, a hospital bed with multi-channel load-cells could provide robust HR estimation in hospital setups. In this work, we present a novel array processing technique to improve the existing HR estimation algorithm by optimizing the fusion of information from multiple channels. The array processing includes a Gaussian curve to weight the joint probability according to the reference value obtained from the previous inter-beat-interval (IBI) estimations. Additionally, the probability density functions were selected and combined according to their reliability measured by q-values. We demonstrate that this array processing significantly reduces the HR estimation error compared to state-of-the-art multi-channel heartbeat detection algorithms in the existing literature. In the best case, the average mean absolute error (MAE) of 1.76 bpm in the supine position was achieved compared to 2.68 bpm and 1.91 bpm for two state-of-the-art methods from the existing literature. Moreover, the lowest error was found in the supine posture (1.76 bpm) and the highest in the lateral posture (3.03 bpm), thus elucidating the postural effects on HR estimation. The IBI estimation capability was also evaluated, with a MAE of 16.66 ms and confidence interval (95%) of 38.98 ms. The results demonstrate that improved HR estimation can be obtained for a bed-based BCG system with the multi-channel data acquisition and processing approach described in this work.

Hypovolemia remains the leading cause of preventable death in trauma cases. Recent research has demonstrated that using noninvasive continuous waveforms rather than traditional vital signs improves accuracy in early detection of hypovolemia to assist in triage and resuscitation. This work evaluates random forest models trained on different subsets of data from a pig model (n = 6) of absolute (bleeding) and relative (nitroglycerin-induced vasodilation) progressive hypovolemia (to 20% decrease in mean arterial pressure) and resuscitation. Features for the models were derived from a multi-modal set of wearable sensors, comprised of the electrocardiogram (ECG), seismocardiogram (SCG) and reflective photoplethysmogram (RPPG) and were normalized to each subject.s baseline. The median RMSE between predicted and actual percent progression towards cardiovascular decompensation for the best model was 30.5% during the relative period, 16.8% during absolute and 22.1% during resuscitation. The least squares best fit line over the mean aggregated predictions had a slope of 0.65 and intercept of 12.3, with an R2value of 0.93. When transitioned to a binary classification problem to identify decompensation, this model achieved an AUROC of 0.80. This study: a) developed a global model incorporating ECG, SCG and RPPG features for estimating individual-specific decompensation from progressive relative and absolute hypovolemia and resuscitation; b) demonstrated SCG as the most important modality to predict decompensation; c) demonstrated efficacy of random forest models trained on different data subsets; and d) demonstrated adding training data from two discrete forms of hypovolemia increases prediction accuracy for the other form of hypovolemia and resuscitation.

The seismocardiogram (SCG) measures the movement of the chest wall in response to underlying cardiovascular events. Though this signal contains clinically-relevant information, its morphology is both patient-specific and highly transient. In light of recent work suggesting the existence of population-level patterns in SCG signals, the objective of this study is to develop a method which harnesses these patterns to enable robust signal processing despite morphological variability. Specifically, we introduce seismocardiogram generative factor encoding (SGFE), which models the SCG waveform as a stochastic sample from a low-dimensional subspace defined by a unified set of generative factors. We then demonstrate that during dynamic processes such as exercise-recovery, learned factors correlate strongly with known generative factors including aortic opening (AO) and closing (AC), following consistent trajectories in subspace despite morphological differences. Furthermore, we found that changes in sensor location affect the perceived underlying dynamic process in predictable ways, thereby enabling algorithmic compensation for sensor misplacement during generative factor inference. Mapping these trajectories to AO and AC yielded $R^2$ values from 0.81-0.90 for AO and 0.72-0.83 for AC respectively across five sensor positions. Identification of consistent behavior of SCG signals in low dimensions corroborates the existence of population-level patterns in these signals; SGFE may also serve as a harbinger for processing methods that are abstracted from the time domain, which may ultimately improve the feasibility of SCG utilization in ambulatory and outpatient settings.

The seismocardiogram (SCG) is a noninvasively-obtained cardiovascular bio-signal that has gained traction in recent years, however is limited by its susceptibility to noise and motion artifacts. Because of this, signal quality must be assured before data are used to inform clinical care. Common methods of signal quality assurance include signal classification or assignment of a numerical quality index. Such tasks are difficult with SCG because there is no accepted standard for signal morphology. In this paper, we propose a unified method of quality indexing and classification that uses multi-subject-based methods to overcome this challenge. Dynamic-time feature matching is introduced as a novel method of obtaining the distance between a signal and reference template, with this metric, the signal quality index (SQI) is defined as a function of the inverse distance between the SCG and a large set of template signals. We demonstrate that this method is able to stratify SCG signals on held-out subjects based on their level of motion-artifact corruption. This method is extended, using the SQI as a feature for classification by ensembled quadratic discriminant analysis. Classification is validated by demonstrating, for the first time, both detection and localization of SCG sensor misplacement, achieving an F1 score of 0.83 on held-out subjects. This paper may provide a necessary step toward automating the analysis of SCG signals, addressing many of the key limitations and concerns precluding the method from being widely used in clinical and physiological sensing applications.

The development of a monitor based on guided-to-leaky-mode waveguide modulators is discussed. Recent changes in design are described including the use of grating input couplers to reduce the cost of the entire bill of materials to under one thousand dollars, a collinear surface acoustic wave and input optical wave geometry that improves efficiency of output coupling, and a chassis redesign based on 3D printed and laser cut materials that is more vibration resistant and transportable. Future work is briefly noted.