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Title: COMBED: Rapid non-invasive Cardiac Output Monitoring Baseline assessment in adult Emergency Department patients with haemodynamic instability.
Austin Authors: Eyeington, Christopher T;Canet, Emmanuel;Cutuli, Salvatore L ;Ancona, Paolo;Brown, Alistair J;Jenkins, Emily;Taylor, David McD ;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Intensive Care
Data Analytics Research and Evaluation (DARE) Centre
ANZIC Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia..
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia..
Division of Anaesthesia, Cambridge University Hospitals NHS Trust, Cambridge, UK..
Issue Date: Aug-2022
Date: 2022
Publication information: Emergency medicine Australasia : EMA 2022; 34(4): 528-538
Abstract: The application of rapid, non-operator-dependent, non-invasive cardiac output monitoring (COM) may provide early physiological information in ED patients with haemodynamic instability (HI). Our primary objective was to assess the feasibility of measuring pre-intervention (baseline) cardiac index (CI) and associated haemodynamic parameters. We performed a prospective observational study of adults shortly after presentation to the ED of a large university hospital with tachycardia or hypotension or both. We applied non-invasive COM for 5 min and recorded CI, mean arterial pressure (MAP), stroke volume index (SVI) and systemic vascular resistance index (SVRI). We assessed for differences between those presenting with hypotension or hypotension and tachycardia with tachycardia alone and between those with or without suspected infection. We obtained haemodynamic parameters in 46 of 49 patients. In patients with hypotension or hypotension and tachycardia (n = 15) rather than tachycardia alone (n = 31), we observed a lower MAP (60.8 vs 87.7, P < 0.0001), CI (2.8 vs 3.9, P = 0.0167) and heart rate (85.5 vs 115.4, P < 0.0001). There was no difference in SVI (33.7 vs 33.4, P = 0.93) or SVRI (1970 vs 2088, P = 0.67). Patients with suspected infection had similar haemodynamic values except for a lower SVRI (1706 vs 2237, P = 0.011). Rapid, non-operator-dependent, non-invasive COM was possible in >90% of ED patients presenting with HI. Compared with tachycardia alone, patients with hypotension had lower CI, MAP and heart rate, while those with suspected infection had a lower SVRI. This technology provides novel insights into the early state of the circulation in ED patients with HI.
DOI: 10.1111/1742-6723.13926
Journal: Emergency medicine Australasia : EMA
PubMed URL: 34981648
PubMed URL:
Type: Journal Article
Subjects: cardiac output
critical care
emergency medicine
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