Prehospital coagulation measurement by a portable blood analyzer in a helicopter emergency medical service (HEMS)

Schober, Patrick; Bossers, Sebastiaan M.; Koolwijk, Jasper; Terra, Maartje; Schwarte, Lothar A.

doi:10.1016/j.ajem.2021.04.023

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…To the best of our knowledge, this study was the first to analyze the performance of i-STAT Alinity for PT/INR testing. Schober et al [5] recently reported that a blood analysis with the i-STAT-1 POC PT/INR coagulation measurement was feasible in a helicopter emergency medical service in a cohort of 15 patients. However, the analytical performance of the PT/INR test was not assessed.…”

Section: Discussionmentioning

confidence: 99%

“…We found an excellent correlation between devices. However, assessment of the PT/INR test capability to guide anticoagulant treatment in patients with a prosthetic cardiac valve (particularly in the mitral position) or plasma transfusion in severe trauma patients remains mandatory [3,5,27].…”

Section: Discussionmentioning

confidence: 99%

“…Thanks to advances in technologies and the miniaturization of electronic devices, just in minutes, novel POC analyzers are now able to measure a large number of parameters from a small blood sample. Indeed, beyond a simple blood gas analysis with basic chemistry and hematology, measurements such as renal, cardiac or inflammatory biomarkers and coagulation tests are now available [4][5][6][7]. The limitations of the turnaround times of these investigations hold promise to change patients' care with acute coronary syndromes [3], hemorrhage [5], sepsis [8] or metabolic disorders [9], among others.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, beyond a simple blood gas analysis with basic chemistry and hematology, measurements such as renal, cardiac or inflammatory biomarkers and coagulation tests are now available [4][5][6][7]. The limitations of the turnaround times of these investigations hold promise to change patients' care with acute coronary syndromes [3], hemorrhage [5], sepsis [8] or metabolic disorders [9], among others.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, analytical performance studies in real-world situations are mandatory for novel POC devices. Given the large number of POC systems available, and the large number of biological parameters measured, data are scarce in the literature, especially on novel POC devices such as the i-STAT Alinity system (Abbott laboratories, Chicago, IL, USA) [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Analytical Performances of the Novel i-STAT Alinity Point-of-Care Analyzer

et al. 2023

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Many Point-of-Care devices have been released over the past decade. However, data regarding their analytical performances in real-world situations remains scarce. Herein, we aimed to assess the analytical performances of the i-STAT Alinity system. We conducted an analytical performances study with the i-STAT Alinity device using cartridges CG4+ (pH, Pco2, Po2, lactate, bicarbonate and base excess); CHEM8+ (Na, K, Cl, ionized Ca, urea, creatinine, glucose, hematocrit and hemoglobin) and PT/INR (prothrombin time and international normalized ratio). We assessed the imprecision and compared the results to those obtained on existing instruments in the central laboratory. We found that the within-lab coefficients of variation (CV) were very low (<2%) or low (2–5%), except for creatinine and PT (CV = 5.2% and CV = 6.3%, respectively). For almost all the parameters, the results were strongly (R2 = 90–95%) or very strongly (R2 > 95%) correlated with those of the existing laboratory instruments, and the biases were very low (<2%) or low (2–5%). However, correlations of the PT and INR measurements with existing instruments were lower (R2 = 86.0% and 89.7%), and biases in the Po2 (7.9%), creatinine (5.4%) and PT (−6.6%) measurements were higher. The i-STAT Alinity appeared as a convenient device for measurements of numerous parameters. However, clinicians should interpret Po2, creatinine and PT results with caution.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analytical Performances of the Novel i-STAT Alinity Point-of-Care Analyzer

et al. 2023

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A review of temperature-related challenges and solutions for the Abbott i-STAT and Siemens Healthineers epoc devices

Füzéry

Elian

Kost

2023

Clinical Biochemistry

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GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma

Zylyftari,

Luger,

Blums

et al. 2024

Crit Care

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Background Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospective study was to test whether prehospital GFAP measurements on a point-of-care device have the potential to rapidly differentiate intracranial hemorrhage from other causes of acute coma. Methods This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min) shortly after hospital admission. Results 143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613–10001] vs. 43 pg/mL [IQR 29–91.25], p < 0.001). When using an optimal cut-off value of 101 pg/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). In-hospital mortality risk was associated with prehospital GFAP values. Conclusion Increased GFAP plasma concentrations in patients with acute coma identify intracranial hemorrhage with high diagnostic accuracy. Prehospital GFAP measurements on a point-of-care platform allow rapid stratification according to the underlying cause of coma by rescue services. This could have major impact on triage and management of these critically ill patients. Graphical Abstract

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Prehospital coagulation measurement by a portable blood analyzer in a helicopter emergency medical service (HEMS)

Cited by 7 publications

References 25 publications

Analytical Performances of the Novel i-STAT Alinity Point-of-Care Analyzer

Analytical Performances of the Novel i-STAT Alinity Point-of-Care Analyzer

A review of temperature-related challenges and solutions for the Abbott i-STAT and Siemens Healthineers epoc devices

GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma

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