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European Journal of Trauma and Emergency Surgery

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Open Access 03-08-2022 | Hypotension | Original Article

Association between hypotension and myocardial injury in patients with severe trauma

Authors: Alexandra Stroda, Simon Thelen, René M’Pembele, Nick Khademlou, Carina Jaekel, Erik Schiffner, Dan Bieler, Michael Bernhard, Ragnar Huhn, Giovanna Lurati Buse, Sebastian Roth

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2023

Abstract

Purpose

During resuscitation of patients with severe trauma, guidelines recommend permissive hypotension prior to surgical bleeding control. However, hypotension may be associated with reduced organ perfusion and multiple organ dysfunction, e.g. myocardial injury. The association between hypotension and myocardial injury in trauma patients is underexplored. We hypothesized that hypotension is associated with myocardial injury in this population.

Materials and methods

This retrospective study included patients ≥ 18 years suffering from severe trauma [defined as Injury Severity Score (ISS) ≥ 16] that were treated in the emergency department resuscitation room between 2016 and 2019. Primary endpoint was the incidence of myocardial injury defined as high-sensitive troponin T > 14 ng/l. Main exposure was the duration of arterial hypotension during resuscitation period defined as mean arterial pressure < 65 mmHg.

Results

Out of 368 patients screened, 343 were analyzed (73% male, age: 55 ± 21, ISS: 28 ± 12). Myocardial injury was detected in 143 (42%) patients. Overall in-hospital mortality was 26%. Multivariate binary logistic regression with forced entry of nine predefined covariables revealed an odds ratio of 1.29 [95% confidence interval 1.16–1.44]; p = 0.012) for the association between the duration of hypotension and myocardial injury.

Conclusion

The duration of hypotension during resuscitation period is independently associated with the incidence of myocardial injury in patients with severe trauma.

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Title: Association between hypotension and myocardial injury in patients with severe trauma
Authors: Alexandra Stroda
Simon Thelen
René M’Pembele
Nick Khademlou
Carina Jaekel
Erik Schiffner
Dan Bieler
Michael Bernhard
Ragnar Huhn
Giovanna Lurati Buse
Sebastian Roth
Publication date: 03-08-2022
Publisher: Springer Berlin Heidelberg
Keywords: Hypotension
Hypotension
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02051-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Association between hypotension and myocardial injury in patients with severe trauma

Abstract

Purpose

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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