Predictive value of tachycardia for mortality in trauma-related haemorrhagic shock: a systematic review and meta-regression

Abstract

ObjectivesHeart rate (HR) is one of the physiological variables in the early assessment of trauma-related haemorrhagic shock, according to Advanced Trauma Life Support (ATLS). However, its efficiency as predictor of mortality is contradicted by several studies. Furthermore, the linear association between HR and the severity of shock and blood loss presented by ATLS is doubtful. This systematic review aims to update current knowledge on the role of HR in the initial haemodynamic assessment of patients who had a trauma.DesignThis study is a systematic review and meta-regression that follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.Data sourcesEMBASE, MEDLINE, CENTRAL and Web of Science databases were systematically searched through on 1 September 2020.Eligibility criteriaPapers providing early HR and mortality data on bleeding patients who had a trauma were included. Patient cohorts were considered haemorrhagic if the inclusion criteria of the studies contained transfusion and/or positive focused assessment with sonography for trauma and/or postinjury haemodynamical instability and/or abdominal gunshot injury. Studies on burns, traumatic spinal or brain injuries were excluded. Papers published before January 2010 were not considered.Data extraction and synthesisData extraction and risk of bias were assessed by two independent investigators. The association between HR and mortality of patients who had a trauma was assessed using meta-regression analysis. As subgroup analysis, meta-regression was performed on patients who received blood products.ResultsFrom a total of 2017 papers, 19 studies met our eligibility criteria. Our primary meta-regression did not find a significant relation (p=0.847) between HR and mortality in patients who had a trauma with haemorrhage. Our subgroup analysis included 10 studies, and it could not reveal a linear association between HR and mortality rate.ConclusionsIn accordance with the literature demonstrating the multiphasic response of HR to bleeding, our study presents the lack of linear association between postinjury HR and mortality. Modifying the pattern of HR derangements in the ATLS shock classification may result in a more precise teaching tool for young clinicians.

A bibliometric analysis of publications on trauma-related hemorrhagic shock from 2012 to 2022: Research landscape and future trends

“…One review reported that hypocalcemia could potentially be used as an independent predictor of multiple transfusions in trauma and hemostatic resuscitation. [ 48 ] Jávor et al [ 49 ] denied the predictive value of tachycardia for mortality in trauma-related hemorrhagic shock. Other predictors include age, [ 50 ] shock index, [ 51 , 52 ] end-tidal CO 2 .…”

Adopting a culture of remote damage control resuscitation in the military: Insights from the Israel defense forces decade of experience

“…Although heart rate is a commonly used measure of blood loss, it has been criticized for its lack of specificity and for potentially undermining the concept of permissive hypotension. This is because heart rate can be influenced by many factors other than blood loss, such as anxiety, pain, and medications, making it difficult to accurately assess the extent of blood loss based on this measure alone 49 . Accordingly, in 2021, the RDCR CPGs were revised, mandating systolic blood pressure measurement as a prerequisite for volume administration, with altered consciousness or non‐palpable radial pulse absence serving as alternatives if blood pressure cannot be measured (Figure 3).…”

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

“…Specificity refers to the selectivity of the technique for volume depletion and bleeding. Methods directly examining macro-or microvascular systems received the highest specificity value (3). Hb and Hct also obtained a high specificity score (3) for bleeding [16,28,29].…”

“…Despite the development of trauma care in the past few decades, roughly 25% of post-injury mortality may be potentially preventable by early detection and proper treatment of life-threatening deteriorations. The further development in the management of hemorrhagic shock (HS) is of utmost importance, since HS can be referred as the main cause of potentially preventable trauma mortality [1][2][3].…”