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Abstract
IntroductionNon-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements.MethodsThis study was a secondary analysis of 7 stroke patients from a prospectively collected data set of patients that received 2 hours of hemodynamic monitoring in the ED. Stroke patients were included if hemorrhagic or ischemic stroke was confirmed by neuroimaging, and symptom onset was within 24 hours. They were excluded for the presence of a stroke mimic or transient ischemic attack. Monitoring was performed using the Nexfin device (Edwards Lifesciences, Irvine CA).ResultsThe mean age of the cohort was 71 ± 17 years, 43% were male, and the mean National Institute of Health Stroke Scale (NIHSS) was 6.9 ± 5.5. Two patients had hemorrhagic stroke. We obtained 42,456 hemodynamic data points, including beat-to-beat blood pressure measurements with variability of 18 mmHg and cardiac indices ranging from 1.8 to 3.6 l/min/m2. The correlation coefficient between continuous blood pressure measurements with the Nexfin device and standard ED readings was 0.83.ConclusionThis exploratory investigation revealed that continuous, noninvasive monitoring in the ED is feasible in acute stroke. Further research is currently underway to determine how such monitoring may impact outcomes in stroke or replace the need for invasive monitoring.
Highlights
Non-invasive, continuous hemodynamic monitoring is entering the clinical arena
This study was a secondary analysis of 7 stroke patients from a prospectively collected data set of patients that received 2 hours of hemodynamic monitoring in the Emergency Department (ED)
The correlation coefficient between continuous blood pressure measurements with the Nexfin device and standard ED readings was 0.83. This exploratory investigation revealed that continuous, noninvasive monitoring in the ED is feasible in acute stroke
Summary
Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements. The management of acute stroke is increasingly relying on frequent measurements of blood pressure, in hemorrhagic stroke and for thrombolytic candidates.[1,2] New technologies are making continuous hemodynamic measurements feasible in the emergency department (ED), including measurements of blood pressure and cardiac ouput.[3,4] This study explores the ED use of arterial waveform analysis for capturing continuous hemodynamic measurements in stroke. Non-invasive devices have been introduced that provide continuous monitoring using algorithms to estimate hemodynamic parameters from blood pressure waveform analysis. Studies have indicated that cardiac output measured by the device closely correlates with pulmonary artery catheter measurements.[5,6]
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