Matthias Kuster1, Tobias Haltmeier1, Aristomenis Exadaktylos2, Beat Schnüriger3. 1. Division of Acute Care Surgery, Department of Visceral and Transplant Surgery, Bern University Hospital, 3010, Bern, Switzerland. 2. Department of Emergency Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. 3. Division of Acute Care Surgery, Department of Visceral and Transplant Surgery, Bern University Hospital, 3010, Bern, Switzerland. beat.schnuriger@gmail.com.
Abstract
PURPOSE: Assessment of hemodynamics is crucial for the evaluation of major trauma patients. Cardiac output (CO) monitoring provides additional information and may improve volume resuscitation. The goal of this prospective pilot study was to evaluate the feasibility of a new non-invasive CO monitoring (NICOM) device in the emergency department (ED). METHODS: Single-center prospective observational pilot study including 20 trauma patients admitted to a level 1 trauma center. CO was continuously monitored for 60 min after ED admission using the new NICOM device ICON®. This device measures changes of the thoracic bioimpedance to calculate CO. Conventional vital signs were recorded simultaneously. Feasibility, safety, reliability, user-friendliness, and impact of the device on standard ED procedures were assessed. RESULTS: Thirteen (65%) patients were male, median age was 57.5 (IQR 25), and median ISS was 10.5 (IQR 14.8). Median CO over time was 9.8 l/min (IQR 4.6). No adverse effects were recorded. The device proved to be user-friendly with no negative impact on routine ED care. In four patients, detachment of electrodes was observed, and in four patients, the CO recording was temporary discontinued. Short-term changes of the CO were observed 44 times after the placement of electrodes and during patient transfers. CONCLUSIONS: Non-invasive CO monitoring proved to be feasible and safe for the initial hemodynamic evaluation of trauma patients. Problems with the NICOM device were detachment of electrodes and temporary signal loss. Due to the small sample size and relatively low injury burden of the patients included in this study, further prospective investigation is warranted.
PURPOSE: Assessment of hemodynamics is crucial for the evaluation of major traumapatients. Cardiac output (CO) monitoring provides additional information and may improve volume resuscitation. The goal of this prospective pilot study was to evaluate the feasibility of a new non-invasive CO monitoring (NICOM) device in the emergency department (ED). METHODS: Single-center prospective observational pilot study including 20 traumapatients admitted to a level 1 trauma center. CO was continuously monitored for 60 min after ED admission using the new NICOM device ICON®. This device measures changes of the thoracic bioimpedance to calculate CO. Conventional vital signs were recorded simultaneously. Feasibility, safety, reliability, user-friendliness, and impact of the device on standard ED procedures were assessed. RESULTS: Thirteen (65%) patients were male, median age was 57.5 (IQR 25), and median ISS was 10.5 (IQR 14.8). Median CO over time was 9.8 l/min (IQR 4.6). No adverse effects were recorded. The device proved to be user-friendly with no negative impact on routine ED care. In four patients, detachment of electrodes was observed, and in four patients, the CO recording was temporary discontinued. Short-term changes of the CO were observed 44 times after the placement of electrodes and during patient transfers. CONCLUSIONS: Non-invasive CO monitoring proved to be feasible and safe for the initial hemodynamic evaluation of traumapatients. Problems with the NICOM device were detachment of electrodes and temporary signal loss. Due to the small sample size and relatively low injury burden of the patients included in this study, further prospective investigation is warranted.
Authors: C Michael Dunham; Thomas J Chirichella; Brian S Gruber; Jonathan P Ferrari; Joseph A Martin; Brenda A Luchs; Barbara M Hileman; Renee Merrell Journal: J Trauma Acute Care Surg Date: 2012-08 Impact factor: 3.313
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