Handheld Tissue Oximetry for the Prehospital Detection of Shock and Need for Lifesaving Interventions: Technology in Search of an Indication?

Jason S. Radowsky, Joseph J. DuBose, Thomas M. Scalea, Catriona Miller, Douglas J. Floccare, Robert Sikorski, Colin F. MacKenzie, Peter Hu, Peter Rock, Samuel M. Galvagno

Research output: Contribution to journalArticle

Abstract

Improved prehospital methods for assessing the need for lifesaving interventions (LSIs) are needed to gain critical lead time in the care of the injured. We hypothesized that threshold values using prehospital handheld tissue oximetry would detect occult shock and predict LSI requirements. This was a prospective observational study of adult trauma patients emergently transported by helicopter. Patients were monitored with a handheld tissue oximeter (InSpectra Spot Check; Hutchinson Technology Inc, Hutchinson, MN), continuous vital signs, and 21 laboratory measurements obtained both in the field with a portable analyzer and at the time of admission. Shock was defined as base excess ≥ 4 or lactate > 3 mmol/L. Eighty-eight patients were enrolled with a median Injury Severity Score of 16 (interquartile range, 5-29). The median hemoglobin saturation in the capillaries, venules, and arterioles (StO 2 ) value for all patients was 82% (interquartile range, 76%-87%; range, 42%-98%). StO 2 was abnormal (< 75%) in 18 patients (20%). Eight were hypotensive (9%) and had laboratory-confirmed evidence of occult shock. StO 2 correlated poorly with shock threshold laboratory values (r = −0.17; 95% confidence interval, −0.33 to 1.0; P =.94). The area under the receiver operating curve was 0.51 (95% confidence interval, 0.39-0.63) for StO 2 < 75% and laboratory-confirmed shock. StO 2 was not associated with LSI need on admission when adjusted for multiple covariates, nor was it independently associated with death. Handheld tissue oximetry was not sensitive or specific for identifying patients with prehospital occult shock. These results do not support prehospital StO 2 monitoring despite its inclusion in several published guidelines.

Original languageEnglish (US)
JournalAir Medical Journal
DOIs
StatePublished - Jan 1 2019

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Oximetry
Shock
Technology
Confidence Intervals
Injury Severity Score
Venules
Vital Signs
Aircraft
Arterioles
Observational Studies
Lactic Acid
Hemoglobins
Prospective Studies
Guidelines
Wounds and Injuries

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Handheld Tissue Oximetry for the Prehospital Detection of Shock and Need for Lifesaving Interventions : Technology in Search of an Indication? / Radowsky, Jason S.; DuBose, Joseph J.; Scalea, Thomas M.; Miller, Catriona; Floccare, Douglas J.; Sikorski, Robert; MacKenzie, Colin F.; Hu, Peter; Rock, Peter; Galvagno, Samuel M.

In: Air Medical Journal, 01.01.2019.

Research output: Contribution to journalArticle

Radowsky, Jason S. ; DuBose, Joseph J. ; Scalea, Thomas M. ; Miller, Catriona ; Floccare, Douglas J. ; Sikorski, Robert ; MacKenzie, Colin F. ; Hu, Peter ; Rock, Peter ; Galvagno, Samuel M. / Handheld Tissue Oximetry for the Prehospital Detection of Shock and Need for Lifesaving Interventions : Technology in Search of an Indication?. In: Air Medical Journal. 2019.
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abstract = "Improved prehospital methods for assessing the need for lifesaving interventions (LSIs) are needed to gain critical lead time in the care of the injured. We hypothesized that threshold values using prehospital handheld tissue oximetry would detect occult shock and predict LSI requirements. This was a prospective observational study of adult trauma patients emergently transported by helicopter. Patients were monitored with a handheld tissue oximeter (InSpectra Spot Check; Hutchinson Technology Inc, Hutchinson, MN), continuous vital signs, and 21 laboratory measurements obtained both in the field with a portable analyzer and at the time of admission. Shock was defined as base excess ≥ 4 or lactate > 3 mmol/L. Eighty-eight patients were enrolled with a median Injury Severity Score of 16 (interquartile range, 5-29). The median hemoglobin saturation in the capillaries, venules, and arterioles (StO 2 ) value for all patients was 82{\%} (interquartile range, 76{\%}-87{\%}; range, 42{\%}-98{\%}). StO 2 was abnormal (< 75{\%}) in 18 patients (20{\%}). Eight were hypotensive (9{\%}) and had laboratory-confirmed evidence of occult shock. StO 2 correlated poorly with shock threshold laboratory values (r = −0.17; 95{\%} confidence interval, −0.33 to 1.0; P =.94). The area under the receiver operating curve was 0.51 (95{\%} confidence interval, 0.39-0.63) for StO 2 < 75{\%} and laboratory-confirmed shock. StO 2 was not associated with LSI need on admission when adjusted for multiple covariates, nor was it independently associated with death. Handheld tissue oximetry was not sensitive or specific for identifying patients with prehospital occult shock. These results do not support prehospital StO 2 monitoring despite its inclusion in several published guidelines.",
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