Heart Rate Variability and Its Association with Mortality in Prehospital Trauma Patients

Cooke, William H.; Salinas, José; Convertino, Víctor A.; Ludwig, David A.; Hinds, Denise; Duke, James H.; Moore, F. A.; Holcomb, John B.

doi:10.1097/01.ta.0000196623.48952.0e

Cited by 124 publications

(105 citation statements)

References 20 publications

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“…This was a retrospective analysis of clinical data originally collected and analyzed by Cooke and colleagues, 22 with institutional review board approval, of trauma patients during transport by air ambulance from the scene of injury to a level 1 trauma center. In a convenience sample of prehospital trauma patients, vital-sign data were obtained using a Propaq The following data were archived using a networked personal digital assistant: electrocardiogram (ECG) and associated continuous HR; impedance pneumogram (IP) and associated continuous RR; and systolic BP (SBP) and diastolic BP (DBP) measured intermittently at multi-minute intervals.…”

Section: Clinical Data Collectionmentioning

confidence: 99%

Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

Reisner

Chen

Kumar

et al. 2014

Journal of Neurotrauma

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We hypothesized that vital signs could be used to improve the association between a trauma patient's prehospital Glasgow Coma Scale (GCS) score and his or her clinical condition. Previously, abnormally low and high blood pressures have both been associated with higher mortality for patients with traumatic brain injury (TBI). We undertook a retrospective analysis of 1384 adult prehospital trauma patients. Vital-sign data were electronically archived and analyzed. We examined the relative risk of severe head Abbreviated Injury Scale (AIS) 5-6 as a function of the GCS, systolic blood pressure (SBP), heart rate (HR), and respiratory rate (RR). We created multi-variate logistic regression models and, using DeLong's test, compared their area under receiver operating characteristic curves (ROC AUCs) for three outcomes: head AIS 5-6, all-cause mortality, and either head AIS 5-6 or neurosurgical procedure. We found significant bimodal relationships between head AIS 5-6 versus SBP and HR, but not RR. When the GCS was < 15, ROC AUCs were significantly higher for a multi-variate regression model (GCS, SBP, and HR) versus GCS alone. In particular, patients with abnormalities in all parameters (GCS, SBP, and HR) were significantly more likely to have high-mortality TBI versus those with abnormalities in GCS alone. This could be useful for mobilizing resources (e.g., neurosurgeons and operating rooms at the receiving hospital) and might enable new prehospital management protocols where therapies are selected based on TBI mortality risk.

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Section: Clinical Data Collectionmentioning

confidence: 99%

Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

Reisner

Chen

Kumar

et al. 2014

Journal of Neurotrauma

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“…40,43,55 Moreover, human data on heart rate variability in the acute phase after TBI indicates that increased HF/LF ratios are associated with poor outcome and higher mortality. 31,56,57 These results suggest that increased vagal activity is beneficial in sterile inflammation induced by LPS or chemical compounds that evoke inflammation, but may impair the body's ability to combat an infection with live bacteria.…”

Section: Discussionmentioning

confidence: 86%

Increased vagal tone accounts for the observed immune paralysis in patients with traumatic brain injury

Kox¹,

Pompe²,

Pickkers³

et al. 2008

Neurology

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Traumatic brain injury (TBI) is a leading cause of death and disability, especially in the younger population. In the acute phase after TBI, patients are more vulnerable to infection, associated with a decreased immune response in vitro. The cause of this immune paralysis is poorly understood. Apart from other neurologic dysfunction, TBI also results in an increase in vagal activity. Recently, the vagus nerve has been demonstrated to exert an anti-inflammatory effect, termed the cholinergic anti-inflammatory pathway. The anti-inflammatory effects of the vagus nerve are mediated by the ␣7 nicotinic acetylcholine receptor present on macrophages and other cytokineproducing cells. From these observations, we hypothesize that the immune paralysis observed in patients with TBI may, at least in part, result from augmented vagal activity and subsequent sustained effects of the cholinergic anti-inflammatory pathway. This pathway may counteract systemic proinflammation caused by the release of endogenous compounds termed alarmins as a result of tissue trauma. However, sustained activity of this pathway may severely impair the body's ability to combat infection. Since the cholinergic anti-inflammatory pathway can be pharmacologically modulated in humans, it could represent a novel approach to prevent infections in patients with TBI. Neurology

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“…Importantly, it has been also documented in real life situations, using data of true trauma victims that unlike other arterial pressure values, pulse pressure does differ between survivors and nonsurvivors (10). Pulse pressure changes in response to volume depletion in some extent mirrors those of stroke volume (4).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive continuous arterial pressure measurements in the assessment of acute, severe central hypovolemia

Simon¹,

Farkas²,

Gingl³

et al. 2015

Acta Physiologica Hungarica

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Acute, severe hypovolemia is a medical emergency. Traditional vital sign parameters allow no optimal triage. High predictive power of finger plethysmography-based stroke volume (SV) and pulse pressure (PP) was recently suggested. To assess the performance of the PP and SV parameters, lower body negative pressure of -40 mmHg, than -60 mmHg -corresponding to moderate and severe central hypovolemia -was applied in 22 healthy males (age 35 ± 7 years). Slow breathing induced fluctuations in the above indices, characterized by stroke volume variability (SVV), and pulse pressure variability (PPV), were assessed. Responses in heart rate (HR) and shock index (SI) were also studied. Discriminative capacity of these parameters was characterized by the area under the ROC (receiver operating characteristic) curves (AUC). Results: In comparison of baseline to severe central hypovolemia SV, PP, HR and SI showed good discriminating capacity (AUC 99%, 88%, 87% and 93%, respectively). The discriminating capacity of SVV and PPV was poor (77% and 70%, respectively). In comparison of moderate and severe hypovolemia, the discriminating capacity of the studied parameters was uniformly limited. Conclusions: Plethysmography-based SV and PP parameters can be used to detect acute severe volume loss. Sensitive parameters discriminating moderate and severe central hypovolemia are still lacking.

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Heart Rate Variability and Its Association with Mortality in Prehospital Trauma Patients

Cited by 124 publications

References 20 publications

Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

Increased vagal tone accounts for the observed immune paralysis in patients with traumatic brain injury

Noninvasive continuous arterial pressure measurements in the assessment of acute, severe central hypovolemia

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