TY - JOUR
T1 - Handheld Tissue Oximetry for the Prehospital Detection of Shock and Need for Lifesaving Interventions
T2 - Technology in Search of an Indication?
AU - Radowsky, Jason S.
AU - DuBose, Joseph J.
AU - Scalea, Thomas M.
AU - Miller, Catriona
AU - Floccare, Douglas J.
AU - Sikorski, Robert A.
AU - MacKenzie, Colin F.
AU - Hu, Peter
AU - Rock, Peter
AU - Galvagno, Samuel M.
N1 - Funding Information:
Supported by a grant from the Department of Defense, Air Force Research Laboratories (grant no. FA8650-15-2-6H01).
Publisher Copyright:
© 2019 Air Medical Journal Associates
PY - 2019/7/1
Y1 - 2019/7/1
N2 - 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 (StO2) value for all patients was 82% (interquartile range, 76%-87%; range, 42%-98%). StO2 was abnormal (< 75%) in 18 patients (20%). Eight were hypotensive (9%) and had laboratory-confirmed evidence of occult shock. StO2 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 StO2 < 75% and laboratory-confirmed shock. StO2 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 StO2 monitoring despite its inclusion in several published guidelines.
AB - 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 (StO2) value for all patients was 82% (interquartile range, 76%-87%; range, 42%-98%). StO2 was abnormal (< 75%) in 18 patients (20%). Eight were hypotensive (9%) and had laboratory-confirmed evidence of occult shock. StO2 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 StO2 < 75% and laboratory-confirmed shock. StO2 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 StO2 monitoring despite its inclusion in several published guidelines.
UR - http://www.scopus.com/inward/record.url?scp=85064631329&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064631329&partnerID=8YFLogxK
U2 - 10.1016/j.amj.2019.03.014
DO - 10.1016/j.amj.2019.03.014
M3 - Article
C2 - 31248537
AN - SCOPUS:85064631329
SN - 1067-991X
VL - 38
SP - 276
EP - 280
JO - Air Medical Journal
JF - Air Medical Journal
IS - 4
ER -