Abstract
BackgroundThe assessment of hemodynamic status is a crucial task in the initial evaluation of trauma patients. However, blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative.MethodsA systematic literature review was conducted. Only studies that explicitly investigated non-invasive hemodynamic monitoring devices in trauma patients were considered.ResultsA total of 7 studies were identified as suitable and were included into this review. These studies evaluated in a total of 1,197 trauma patients the accuracy of non-invasive hemodynamic monitoring devices by comparing measurements to pulmonary artery thermodilution, which is the gold standard for cardiac output measuring. The correlation coefficients r between the two methods ranged from 0.79 to 0.92. Bias and precision analysis ranged from -0.02 +/- 0.78 l/min/m2 to -0.14 +/- 0.73 l/min/m2. Additionally, data on practicality, limitations and clinical impact of the devices were collected.ConclusionThe accuracy of non-invasive cardiac output monitoring devices in trauma patients is broadly satisfactory. As the devices can be applied very early in the shock room or even preclinically, hemodynamic shock may be recognized much earlier and therapeutic interventions could be applied more rapidly and more adequately. The devices can be used in the daily routine of a busy ED, as they are non-invasive and easy to master.
Highlights
When managing trauma patients, it is crucial to evaluate the hemodynamic status to exclude hemorrhage
The devices can be used in the daily routine of a busy Emergency Department (ED), as they are non-invasive and easy to master
This is in accordance with many studies that have demonstrated that surviving patients exhibit significantly different hemodynamic patterns from non-survivors, and that these differences are already apparent in the Emergency Department (ED)
Summary
It is crucial to evaluate the hemodynamic status to exclude hemorrhage. Low cardiac output indicates blood loss, whereas normal or elevated cardiac output implies that blood loss is unlikely and that there may be other reasons for hypotension [1] This is in accordance with many studies that have demonstrated that surviving patients exhibit significantly different hemodynamic patterns from non-survivors, and that these differences are already apparent in the Emergency Department (ED). Blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative
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