The Cardiac Output in Response to Surgical Trauma

Clowes, G. H. A.

doi:10.1001/archsurg.1960.01300020040006

Cited by 39 publications

(4 citation statements)

References 18 publications

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“… 6 12 It has been shown that patients with comorbidities that compromised their ability to significantly increase their cardiac output after emergent surgical procedures due to trauma, performed poorly in the postoperative period. 7 13 Crude 30-day mortality after a traumatic injury was 3.5% among young adults compared with 8.2% among the geriatric population. 14 Patients younger than the age of 65 years with an AICD device have a survival rate greater than 10 years versus those age ≥75 years who have a survival rate of 5 years.…”

Section: Discussionmentioning

confidence: 96%

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Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries

Bhuiya,

Omeh,

Munshi

et al. 2023

Trauma Surg Acute Care Open

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BackgroundThe presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends a higher mortality. The presence of a PPM may be a surrogate marker to identify patients who are unable to increase cardiac output. We aimed to evaluate the association between the presence of PPM and clinical outcomes in elderly patients presenting with traumatic injuries.MethodsA total of 4505 patients aged ≥65 years admitted with acute trauma from 2009 to 2019 at our Level I Trauma center were evaluated and stratified into two groups using propensity matching on age, sex, injury severity score (ISS), and year of admission based on the presence of PPM. Logistic regression was performed to analyze the impact of the presence of PPM on mortality, surgical intensive care unit (SICU) admission, operative intervention, and length of stay. Prevalence of cardiovascular comorbidities was compared using χ2analysis.ResultsData from 208 patients with PPM and 208 propensity-matched controls were evaluated. Charlson Comorbidity Index, mechanism of injury, intensive care unit admission, and rate of operative intervention were comparable in the two groups. PPM patients had more coronary artery disease (p=0.04), heart failure with reduced ejection fraction (p=0.003), atrial fibrillation (AF, p<0.0001), and antithrombotic use (p<0.0001). We found no association between mortality amongst the groups after controlling for influencing variables (OR=2.1 (0.97 to 4.74), p=0.061). Patient characteristics associated with survival included female sex (p=0.009), lower ISS (p<0.0001), lower revised trauma score (p<0.0001), and lower SICU admission (p=0.001).ConclusionOur study shows no association between mortality among patients with PPM admitted for treatment of trauma. Presence of a PPM may be an indicator of cardiovascular disease, but this does not translate into increased risk in the modern era of trauma management in our patient population.Level of evidenceLevel III.

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Section: Discussionmentioning

confidence: 96%

“…It has been shown that an inability to augment cardiac output by at least 30% after injury portends a higher mortality. 7 Cardiac pacemakers have a wide beneficial effect on hemodynamics. Pacing therapy can improve cardiac function by normalizing cardiac electrical activation.…”

Section: Introductionmentioning

confidence: 99%

Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries

Bhuiya,

Omeh,

Munshi

et al. 2023

Trauma Surg Acute Care Open

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“…These phases correlate with anesthesia, the ebb phase beginning with anesthesia induction and the transition to the flow phase coinciding with lightening of anesthesia near the end of the operation. Clowes et al confirmed these findings with perioperative cardiac output monitoring in 1960 [50]. Following the introduction of practical pulmonary artery catheterization in the late 1960's, all perioperative hemodynamic monitoring has confirmed Cuthbertson's ebb and flow phases.…”

Section: Cost Containmentmentioning

confidence: 89%

Cost‐effective use of the surgical intensive care unit

Eyer

Cerra

1987

World j. surg.

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The intensive care unit (ICU) continues to be a large user of resources. There is a continued need for a balance of cost‐effective utilization and quality patient care. A data base of information currently exists that defines those groups of patients in whom reasonable success in resource allocation can be anticipated. In other cases, attempts are being made to define variables that adequately predict survival so they can be used to effect care decisions. Although some progress has been made, considerable work is needed to achieve both of these. For surgeons, the ICU has become an essential “part of the knife.” It is a necessity in modern high‐technology care and has become an essential element in surgical training programs. The use of the ICU for currently conceived high‐risk patients is now commonplace. A growing database supports this preoperative use of ICU resources. Techniques are now available to make ICU care more cost‐effective. Tools such as not having routine orders, daily rewriting of all orders, review of drug orders, and the utilization of the laboratory and radiographic resources have already reduced significantly the real cost of using these life‐saving facilities.

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“…The measured cardiac index during external cardiac massage is insufficient to support life (Clowes, Del Guercio, and Barwinsky, 1960;others, 1964, Del Guercio andothers, 1965). If these measurements are accurate and representative, external cardiac massage should rarely permit successful resuscitation.…”

Section: S S a G Ementioning

confidence: 99%

Acute circulatory arrest

Milstein

1967

British Journal of Surgery

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The Cardiac Output in Response to Surgical Trauma

Cited by 39 publications

References 18 publications

Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries

Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries

Cost‐effective use of the surgical intensive care unit

Acute circulatory arrest

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