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Open Access 01-12-2023 | Hypotension | Research

Prediction of episode of hemodynamic instability using an electrocardiogram based analytic: a retrospective cohort study

Authors: Bryce Benson, Ashwin Belle, Sooin Lee, Benjamin S. Bassin, Richard P. Medlin, Michael W. Sjoding, Kevin R. Ward

Published in: BMC Anesthesiology | Issue 1/2023

Abstract

Background

Predicting the onset of hemodynamic instability before it occurs remains a sought-after goal in acute and critical care medicine. Technologies that allow for this may assist clinicians in preventing episodes of hemodynamic instability (EHI). We tested a novel noninvasive technology, the Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI), which analyzes a single lead of electrocardiogram (ECG) and extracts heart rate variability and morphologic waveform features to predict an EHI prior to its occurrence.

Methods

Retrospective cohort study at a quaternary care academic health system using data from hospitalized adult patients between August 2019 and April 2020 undergoing continuous ECG monitoring with intermittent noninvasive blood pressure (NIBP) or with continuous intraarterial pressure (IAP) monitoring.

Results

AHI-PI’s low and high-risk indications were compared with the presence of EHI in the future as indicated by vital signs (heart rate > 100 beats/min with a systolic blood pressure < 90 mmHg or a mean arterial blood pressure of < 70 mmHg). 4,633 patients were analyzed (3,961 undergoing NIBP monitoring, 672 with continuous IAP monitoring). 692 patients had an EHI (380 undergoing NIBP, 312 undergoing IAP). For IAP patients, the sensitivity and specificity of AHI-PI to predict EHI was 89.7% and 78.3% with a positive and negative predictive value of 33.7% and 98.4% respectively. For NIBP patients, AHI-PI had a sensitivity and specificity of 86.3% and 80.5% with a positive and negative predictive value of 11.7% and 99.5% respectively. Both groups performed with an AUC of 0.87. AHI-PI predicted EHI in both groups with a median lead time of 1.1 h (average lead time of 3.7 h for IAP group, 2.9 h for NIBP group).

Conclusions

AHI-PI predicted EHIs with high sensitivity and specificity and within clinically significant time windows that may allow for intervention. Performance was similar in patients undergoing NIBP and IAP monitoring.

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Title: Prediction of episode of hemodynamic instability using an electrocardiogram based analytic: a retrospective cohort study
Authors: Bryce Benson
Ashwin Belle
Sooin Lee
Benjamin S. Bassin
Richard P. Medlin
Michael W. Sjoding
Kevin R. Ward
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Hypotension
Care
Published in: BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-023-02283-x

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Prediction of episode of hemodynamic instability using an electrocardiogram based analytic: a retrospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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