ICU-in-a-Box: Autonomous Extracorporeal Multiple-Organ Support Therapies

Severe hemorrhage is the number one cause of preventable combat deaths, followed by airway compromise (Eastridge, 2012), with increased artillery, thermobaric and incendiary munitions use (Remondelli et al. 2023) potentially increasing lung injury prevalence in future conflicts. Following initial trauma, sepsis and multiple-organ failure predominate (Neff et al. 2013). While improvements in point of injury care (tourniquets, hemostatic dressings, etc.) have significantly increased survival in early trauma phases (Chovanes et al, 2012, Cohen et al., 2012), such care is ideally followed by pre-hospital care from trained medical providers during casualty evacuation. However, as reflected by the large-scale combat operations (LSCO) in the Russia-Ukraine war and with Special Operations missions in remote, austere locations, access to definitive medical care may not be available for days, especially in conflict with near-peer adversaries (Keenan and Riesberg, 2017; Remondelli et al. 2023; Epstein et al., 2023).More people surviving early phases of trauma combined with decreased evacuation opportunities highlights a pressing need for solutions that can provide advanced and sustained resuscitative care for the organ failure sequalae of severe trauma (e.g., hypotension, respiratory failure, acute renal failure). A growing body of technical capabilities and supporting literature suggests that by focusing on the key drivers of mortality, advances in autonomous systems across several areas of critical care could be combined into a single "ICU-in-a-Box". In particular, extracorporeal membrane oxygenation (ECMO) is an alternative to using intubation and mechanical ventilation (under deep sedation) for acute respiratory distress syndrome (Geetha 2024). Because an ECMO system is essentially just a pump and a membrane lung, it offers a strong opportunity to automate oxygenation support—along with other key combat casualty care needs. While current ECMO systems require highly trained operators, largely because of the need to insert large cannulas and the associated thrombotic risks, recent advances can mitigate these limitations. For example, assistive insertion devices (Brattain 2021) and ECMO systems with smaller cannulas (Osmani et al., 2026) reduce the difficulty of insertion; antithrombotic coatings, portable systems (Szentgyorgyi 2025), and alternatives to conventional membrane oxygenators (Conrad 1994) reduce thrombotic risk (at least over shorter periods); and AI/ML advances in general as well as ECMO management computer models (Pladet 2023, Geetha 2024) could support automation. Once venous access is established for automated ECMO, it enables additional interventions. For example, automated algorithms have stabilized mean arterial pressure (MAP) and heart rate for short periods following severe hemorrhage in porcine models (Pinsky 2024); renal replacement therapy (RRT) could mitigate life-threatening electrolyte abnormalities; and extracorporeal blood purification techniques could remove inflammatory mediators, infectious agents, or toxins (Neff 2013).This SBIR seeks to combine such capabilities into a single, portable, integrated intervention and delivery platform for resuscitation, cardiovascular and lung support. There is additional potential to automate sedation (Daga 2026, Nagata 2023), analgesia (Aissou 2012), and renal replacement therapies (Wieringa 2025). Although these efforts remain relatively immature, their addition to the integrated system could further extend ICU-level, autonomous extracorporeal life support (ECLS) in the austere and operational setting.