Knobloch K, Hubrich V, Rohmann P, Lüpkemann M, Phillips R, Gerich T, Krettek C
Unfallchirurgie, Medizinische Hochschule Hannover.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2005 Dec;40(12):750-5. doi: 10.1055/s-2005-861344.
Determination of cardiac output (CO) enables to assess the hemodynamic situation as well as to administer optimal catecholamine therapy especially in critically compromised patients with hemodynamic instability. Invasive determination of CO is possible via a Swan-Ganz-catheter with its associated risk of implantation in the hospital. Using the Doppler technique, we evaluated the feasibility of the USCOM-system for non-invasive CO determination in preclinical emergency medicine in air rescue service.
In 32 patients (17 months to 92-years-old) cardiac output was determined non-invasively (USCOM) at the scene and during the helicopter transport at Christoph 4, based at Hannover Medical School. Simultaneously, blood pressure, ECG and oxygen saturation were determined. Non-invasive CO was assessed by a suprasternal access aiming at the aorta ascendens. 19 patients were unconscious due to cardial and non-cardial reasons, and 13 were conscious (sepsis, status epilepticus, anaphylactic reaction). 7 patients were hemodynamically unstable. In three patients the monitor was used during interhospital transfer by helicopter.
Non-invasively determined CO via the USCOM system was 4.8 +/- 0.7 l/min with a cardiac index of 2.4 +/- 0.3 l/m (2). Highest CO values were determined in a patient with sepsis and during a grand-mal-status in epilepsy (CO 8.2 l/min). All examinations were done by the same emergency physician of the emergency helicopter Christoph 4 immediately after arrival at the scene. The examination took on average 25 seconds. During the helicopter transport, several consecutive CO measurements were performed to assess volume and catecholamine therapy with increase of stroke volume after volume load with colloidal fluids.
Using the USCOM system it is possible to determine the beat-to-beat cardiac output in air rescue service non-invasively. The emergency physician gains additional crucial hemodynamic information to diagnose and treat adequately by administration of volume load and catecholamines at the scene and during flight conditions. Further preclinical prospective trials are mandatory to elucidate the value of this novel device in emergency medicine.
心输出量（CO）的测定有助于评估血流动力学状况，并实施最佳的儿茶酚胺治疗，尤其是在血流动力学不稳定的重症患者中。通过 Swan - Ganz 导管进行有创心输出量测定可行，但存在在医院植入相关的风险。我们使用多普勒技术评估了 USCOM 系统在院前急救医学空中救援服务中进行无创心输出量测定的可行性。
对 32 例患者（年龄 17 个月至 92 岁）在现场以及基于汉诺威医学院的 Christoph 4 直升机转运过程中进行无创心输出量（USCOM）测定。同时测定血压、心电图和血氧饱和度。通过胸骨上入路针对升主动脉进行无创心输出量评估。19 例患者因心脏和非心脏原因昏迷，13 例清醒（脓毒症、癫痫持续状态、过敏反应）。7 例患者血流动力学不稳定。3 例患者在直升机院间转运期间使用了该监测仪。
通过 USCOM 系统无创测定的心输出量为 4.8±0.7 升/分钟，心脏指数为 2.4±0.3 升/（分钟·平方米）。脓毒症患者和癫痫大发作状态时测定的心输出量最高（心输出量 8.2 升/分钟）。所有检查均由急救直升机 Christoph 4 的同一名急诊医生在到达现场后立即进行。检查平均耗时 25 秒。在直升机转运过程中，进行了多次连续的心输出量测量，以评估容量和儿茶酚胺治疗，胶体液容量负荷后每搏输出量增加。
使用 USCOM 系统可以在空中救援服务中无创测定逐搏心输出量。急诊医生通过在现场和飞行过程中给予容量负荷和儿茶酚胺，获得额外关键的血流动力学信息，以进行充分的诊断和治疗。进一步的临床前前瞻性试验对于阐明这种新型设备在急诊医学中的价值是必要的。
