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Journal of Clinical Monitoring and Computing

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23-01-2021 | Care | Original Research

Non-invasive electrical cardiometry cardiac output monitoring during prehospital helicopter emergency medical care: a feasibility study

Authors: Cornelis Slagt, Sjoerd Servaas, Rein Ketelaars, Geert-Jan van Geffen, Marijn Cornelia Theresia Tacken, Corien Alexandra Verrips, Lonneke Ankie Marcel Baggen, Gert Jan Scheffer, Lucas Theodorus van Eijk

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2022

Abstract

Purpose

Introducing advanced hemodynamic monitoring might be beneficial during Helicopter Emergency Medical Service (HEMS) care. However, it should not increase the on-scene-time, it should be easy to use and should be non-invasive. The goal of this study was to investigate the feasibility of non-invasive cardiac output measurements by electrical cardiometry (EC) and the quality of the EC signal during pre-hospital care provided by our HEMS.

Methods

A convenience sample of fifty patients who required HEMS assistance were included in this study. Problems with respect to connecting the patient, entering patient characteristics and measuring were inventoried. Quality of EC signal of the measurements was assessed during prehospital helicopter care. We recorded the number of measurements with a signal quality indicator (SQI) ≥ 80 and the number of patients having at least 1 measurement with a SQI ≥ 80. Furthermore, the SQI value distribution of the measurements within each patient was analysed.

Results

In the experience of the attending HEMS caregivers application of the device was easy and did not result in increased duration of on-scene time. Patch adhesion was reported as a concern due to clammy skin in 22% of all cases. 684 measurements were recorded during HEMS care. In 47 (94%) patients at least 1 measurement with an SQI ≥ 80 was registered. Of all recorded measurements 5.8% had an SQI < 40, 11.4% had an SQI 40–59, 14.9% had a SQI between 60 and 79 and 67.8% had SQI ≥ 80.

Conclusion

Cardiac output measurements are feasible during prehospital HEMS care with good quality of the EC signal. Monitoring was easy to use and quick to install. In our view it is an promising candidate for the prehospital setting. Further research is needed to determine its clinical value during clinical decision making.

World Health Statistics. Monitoring health for the sustainable development goals. Geneva: World health Organization; 2018.

Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010;34:158Y163.CrossRef

Gaarder C, Holtan A, Naess PA. Prehospital point-of-care monitoring and goal-directed therapy: does it make a difference? J Trauma Acute Care Surg. 2015;78:S60–4.CrossRef

Barbee RW, Reynolds PS, Ward KR. Assessing shock resuscitation strategies by oxygen debt repayment. Shock. 2010;33:113Y122.CrossRef

Shoemaker WC, Wo CC, Chien LC, Lu K, Ahmadpour N, Belzberg H, Demetriades D. Evaluation of invasive and noninvasive hemodynamic monitoring in trauma patients. J Trauma. 2006;61:844–53. https://doi.org/10.1097/01.ta.0000197925.92635.56.CrossRefPubMed

Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]. Crit Care. 2005;9:R687–93. https://doi.org/10.1186/cc3887.CrossRefPubMedPubMedCentral

Cecconi M, Corredor C, Arulkumaran N, Abuella G, Ball J, Grounds RM, Hamilton M, Rhodes A. Clinical review: goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups. Crit Care. 2013;17:209. https://doi.org/10.1186/cc11823.CrossRefPubMedPubMedCentral

Sangkum L, Liu GL, Yu L, Yan H, Kaye AD, Liu H. Minimally invasive or noninvasive cardiac output measurement: an update. J Anesth. 2016;30:461–80. https://doi.org/10.1007/s00540-016-2154-9.CrossRefPubMed

Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH. Development and evaluation of an impedance cardiac output system. Aerosp Med. 1966;37:1208–12.PubMed

10.

10Bernstein DP, Osypka MJ (2003) Apparatus and method for determining an approximation of the stroke volume and the cardiac output of the heart. US Patent 6,511,438 2003.

11.

Bernstein DP, Lemmens HJ. Stroke volume equation for impedance cardiography. Med Biol Eng Comput. 2005;43:443–50. https://doi.org/10.1007/BF02344724.CrossRefPubMed

12.

Kuster M, Haltmeier T, Exadaktylos A, Schnüriger B. Non-invasive cardiac output monitoring device “ICON” in trauma patients: a feasibility study. Eur J Trauma Emerg Surg. 2019;45:1069–76. https://doi.org/10.1007/s00068-018-0984-x.CrossRefPubMed

13.

Freidl T, Baik N, Pichler G, Schwaberger B, Zingerle B, Avian A, Urlesberger B. Haemodynamic transition after birth: a new tool for non-invasive cardiac output monitoring. Neonatology. 2017;111:55–60. https://doi.org/10.1159/000446468.CrossRefPubMed

14.

Suehiro K, Joosten A, Murphy L, Desebbe O, Alexander B, Kim SH, Cannesson M. Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis. J Clin Monit Comput. 2016;30:603–20. https://doi.org/10.1007/s10877-015-9757-9.CrossRefPubMed

15.

Sanders M, Servaas S, Slagt C. Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis. J Clin Monit Comput. 2020;34:433–60. https://doi.org/10.1007/s10877-019-00330-y.CrossRefPubMed

16.

Bernstein DP, Osypka MJ (2003) Apparatus and method for determining an approximation of the stroke volume and the cardiac output of the heart. US Patent 6,511,438. https://patents.google.com/patent/US6511438B2/en

17.

https://www.osypkamed.com/electrical-cardiometry-technology-ec. Assessed on 27 Nov 2020.

18.

Noori S, Drabu B, Soleymani S, Seri I. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography. Arch Dis Child Fetal Neonatal Ed. 2012;97:F340–3. https://doi.org/10.1136/archdischild-2011-301090.CrossRefPubMed

19.

Landelijk netwerk acute zorg (2013) MMT Inzet- en cancelcriteria; Een praktisch handvat voor het inzetten van MMT’s en verdeling van verantwoordelijkheden tussen MKA, ambulance en MMT. https://www.lnaz.nl/cms/Inzet-_en_cancelcriteria_MMT_-_LNAZ-AZN.PDF June 2013. In Dutch.

20.

Boyd O, Bennett ED. Enhancement of perioperative tissue perfusion as a therapeutic strategy for major surgery. New Horiz. 1996;4:453–65.PubMed

21.

Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392–402. https://doi.org/10.1213/ANE.0b013e3181eeaae5.CrossRefPubMed

22.

Shoemaker WC, Belzberg H, Wo CC, et al. Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients. Chest. 1998;114:1643–52. https://doi.org/10.1378/chest.114.6.1643.CrossRefPubMed

23.

Middleton PM, Davies SR. Noninvasive hemodynamic monitoring in the emergency department. Curr Opin Crit Care. 2011;17:342–50. https://doi.org/10.1097/MCC.0b013e328348bf9b.CrossRefPubMed

24.

Peacock WF, Summers RL, Vogel J, Emerman CE. Impact of impedance cardiography on diagnosis and therapy of emergent dyspnea: the ED-IMPACT trial. Acad Emerg Med. 2006;13:365–71. https://doi.org/10.1197/j.aem.2005.11.078.CrossRefPubMed

25.

Trinkmann F, Berger M, Michels JD, Christina Doesch C, Weiss C, Schoenberg SO, Akin I, Borggrefe M, Papavassiliu T, Saur J. Influence of electrode positioning on accuracy and reproducibility of electrical velocimetry cardiac output measurements. Physiol Meas. 2016;37:1422–35.CrossRef

26.

Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43:304–77.CrossRef

27.

Carney N, Totten AM, Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80:6–15.CrossRef

Title: Non-invasive electrical cardiometry cardiac output monitoring during prehospital helicopter emergency medical care: a feasibility study
Authors: Cornelis Slagt
Sjoerd Servaas
Rein Ketelaars
Geert-Jan van Geffen
Marijn Cornelia Theresia Tacken
Corien Alexandra Verrips
Lonneke Ankie Marcel Baggen
Gert Jan Scheffer
Lucas Theodorus van Eijk
Publication date: 23-01-2021
Publisher: Springer Netherlands
Keyword: Care
Published in: Journal of Clinical Monitoring and Computing / Issue 2/2022
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-021-00657-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-invasive electrical cardiometry cardiac output monitoring during prehospital helicopter emergency medical care: a feasibility study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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