The timing and degree of fetal systemic and cerebral inflammatory responses correlate with a subset of heart rate variability measures: Evidence of cholinergic anti-inflammatory pathway activation in sepsis

Abstract

48 Real-time heart rate complexity on hospital arrival predicts the need for life-saving interventions in trauma activation patients Ali Mejaddam, Oscar Birkhan, Antonis Sideris, Gwen Van Der Wilden, Ayesha Imam, John Hwabejire, Yuchiao Chang, George Velmahos, Hasan Alam, Peter Fagenholz, Daniel Yeh, Marc Demoya Massachusetts General Hospital, Boston, MA, USA Objectives:Heart rate complexity (HRC), commonly described as a “new vital sign,” has shown promise in predicting injury severity, but its use in clinical practice has been precluded by the absence of real-time data. This study was conducted to evaluate the use of realtime, automated, instantaneous entropy analysis in predicting the need for lifesaving interventions (LSI). Methods: Prospective enrollment of patients who met the criteria for trauma code activation was conducted at a level I trauma center (September 2011–February 2012). Electric impedance cardiography was used to calculate HRC and time-domain heart rate variability continuously in real time for 2 hours with a portable, handheld device from the moment of arrival in the trauma center. Patients who received an LSI were compared with patients without any intervention (non-LSI). Multivariable analysis was performed to control for differences between the groups. Results: Of 82 patients enrolled, 21 (26%) received 67 LSIs within 24 hours of hospital arrival. Initial systolic blood pressure was similar in both groups, but heart rate was significantly higher in the LSI group. Also, LSI patients had a lower Glasgow Coma Score (9.2 ± 5.1 vs 14.9 ± 0.2, P b .0001). The mean HRC value on presentation was 0.8 ± 0.6 in the LSI group compared with 1.5 ± 0.6 in the non-LSI group (P b .0001). Using logistic regression, initial HRC was the only significant predictor of LSI. A cutoff value for HRC of 1.1 yields sensitivity, specificity, negative predictive value, and positive predictive value of 86%, 74%, 94%, 53%, respectively, with an accuracy of 77% for predicting an LSI. Conclusions: Decreased HRC on hospital arrival is an independent predictor of the need for LSI in patients with trauma activation. RealtimeHRCmay be a useful adjunct to standard vital signsmonitoring. http://dx.doi.org/10.1016/j.jcrc.2012.10.064