Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
Helicopter Emergency Medical Service Lifeliner 3, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands.
J Clin Monit Comput. 2022 Apr;36(2):363-370. doi: 10.1007/s10877-021-00657-5. Epub 2021 Jan 23.
Introducing advanced hemodynamic monitoring might be beneficial during Helicopter Emergency Medical Service (HEMS) care. However, it should not increase the on-scene-time, it should be easy to use and should be non-invasive. The goal of this study was to investigate the feasibility of non-invasive cardiac output measurements by electrical cardiometry (EC) and the quality of the EC signal during pre-hospital care provided by our HEMS.
A convenience sample of fifty patients who required HEMS assistance were included in this study. Problems with respect to connecting the patient, entering patient characteristics and measuring were inventoried. Quality of EC signal of the measurements was assessed during prehospital helicopter care. We recorded the number of measurements with a signal quality indicator (SQI) ≥ 80 and the number of patients having at least 1 measurement with a SQI ≥ 80. Furthermore, the SQI value distribution of the measurements within each patient was analysed.
In the experience of the attending HEMS caregivers application of the device was easy and did not result in increased duration of on-scene time. Patch adhesion was reported as a concern due to clammy skin in 22% of all cases. 684 measurements were recorded during HEMS care. In 47 (94%) patients at least 1 measurement with an SQI ≥ 80 was registered. Of all recorded measurements 5.8% had an SQI < 40, 11.4% had an SQI 40-59, 14.9% had a SQI between 60 and 79 and 67.8% had SQI ≥ 80.
Cardiac output measurements are feasible during prehospital HEMS care with good quality of the EC signal. Monitoring was easy to use and quick to install. In our view it is an promising candidate for the prehospital setting. Further research is needed to determine its clinical value during clinical decision making.
在直升机医疗急救服务（HEMS）中引入先进的血流动力学监测可能是有益的。然而，它不应增加现场时间，应易于使用，且应为非侵入性的。本研究的目的是调查使用电心图（EC）进行非侵入性心输出量测量的可行性，以及在我们的 HEMS 提供的院前护理期间 EC 信号的质量。
本研究纳入了 50 名需要 HEMS 协助的患者的方便样本。记录了与患者连接、输入患者特征和测量方面的问题。评估了在院前直升机护理期间 EC 测量的信号质量。我们记录了信号质量指标（SQI）≥80 的测量次数和至少有 1 次 SQI≥80 的患者数。此外，还分析了每位患者内的测量值的 SQI 值分布。
在参与 HEMS 护理的医护人员的经验中，该设备的应用简便，且不会导致现场时间延长。由于所有情况下 22%的患者皮肤潮湿，贴片粘连被认为是一个问题。在 HEMS 护理期间记录了 684 次测量。在 47（94%）名患者中，至少有 1 次 SQI≥80 的测量值被记录。在所有记录的测量值中，5.8%的 SQI<40，11.4%的 SQI 为 40-59，14.9%的 SQI 在 60-79 之间，67.8%的 SQI≥80。
在院前 HEMS 护理期间，使用电心图测量心输出量是可行的，EC 信号质量良好。监测易于使用且安装迅速。在我们看来，它是院前环境的有前途的候选者。需要进一步的研究来确定其在临床决策中的临床价值。
