Predicting haemorrhage in pre-hospital traumatic patients: evaluation of the novel heart-to-arm time index.

Acta anaesthesiologica Scandinavica

PubMedID: 23701337

Vettorello M, Santambrogio SM, Calini AR, Tizzoni L, Marconi G, Lippi MG, Sesana G, Chiara O, Fumagalli R. Predicting haemorrhage in pre-hospital traumatic patients: evaluation of the novel heart-to-arm time index. Acta Anaesthesiol Scand. 2013;57(7):929-35.
BACKGROUND
Early recognition of hypovolaemia in trauma patients is very important. However, the most often used clinical signs, such as hypotension and tachycardia, lack specificity and sensitivity.

METHODS
We propose a non-invasive index of hypovolaemia, the heart to arm time (iHAT), based on a modified pulse transit time indexed to heart rate. Pulse transit time is the sum of pre-ejection period and vascular transit time. Following pre-load reductions due to hypovolaemia, ventricular diastolic filling time increases causing an increase in pre-ejection-period, pulse transit time, and hence iHAT. One hundred and four consecutive patients with suspected major trauma were enrolled. The primary aim was to evaluate the use of the iHAT for detecting haemorrhage in major trauma. The secondary end point was to compare the specificity and sensitivity of iHAT compared to commonly used indexes.

RESULTS
iHAT was calculated in 84 subjects, 11 of whom were haemorrhagic. iHAT discriminated haemorrhagic from non-haemorrhagic group (46.8% vs. 66.9%, P?
CONCLUSIONS
iHAT is a non-invasive index that can identify haemorrhage in trauma patients with high sensitivity and specificity. These data should be considered as an exploration, but any conclusion should be validated in a new set of consecutive patients.