Zipperle Johannes, Ziegler Bernhard, Schöchl Herbert, Voelckel Wolfgang, Schlimp Christoph J, Oberladstätter Daniel
Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria.
Perioperative Medicine and General Intensive Care Medicine, Department of Anaesthesiology, Paracelsus Medical University, 5020 Salzburg, Austria.
J Clin Med. 2022 Jun 23;11(13):3630. doi: 10.3390/jcm11133630.
Trauma and bleeding are associated with a high mortality, and most of these deaths occur early after injury. Viscoelastic haemostatic tests have gained increasing importance in goal-directed transfusion and bleeding management. A new generation of small-sized and thus portable ultrasound-based viscoelastic analysers have been introduced in clinical practice. We questioned whether a promising candidate can be used in emergency helicopters, with a focus on the susceptibility to vibration stress. We investigated whether the high vibration environment of an emergency helicopter would affect the operability of an ultrasound-based viscoelastic analyser and would yield reproducible results in flight and on the ground. We drew blood from 27 healthy volunteers and performed simultaneous analyses on two TEG 6s. Each measurement was performed in-flight on board an Airbus H135 emergency helicopter and was repeated on the ground, close to the flight area. Results from both measurements were compared, and the recorded tracings and numeric results were analysed for artifacts. Vibratometric measurements were performed throughout the flight in order to quantify changes in the magnitude and character of vibrations in different phases of helicopter operation. The high vibration environment was associated with the presence of artifacts in all recorded tracings. There were significant differences in citrated Kaolin + Heparinase measurements in-flight and on the ground. All other assays increased in variability but did not show significant differences between the two time points. We observed numerous artifacts in viscoelastic measurements that were performed in flight. Some parameters that were obtained from the same sample showed significant differences between in-flight and on-ground measurements. Performing resonance-based viscoelastic tests in helicopter medical service is prone to artifacts. However, a 10 min delay between initiation of measurement and take-off might produce more reliable results.
创伤和出血与高死亡率相关，且这些死亡大多发生在受伤后早期。粘弹性止血检测在目标导向输血和出血管理中变得越来越重要。新一代小型且便于携带的基于超声的粘弹性分析仪已应用于临床实践。我们质疑一种有前景的仪器是否可用于急救直升机，重点关注其对振动应力的敏感性。我们研究了急救直升机的高振动环境是否会影响基于超声的粘弹性分析仪的可操作性，以及在飞行中和地面上是否能产生可重复的结果。我们从27名健康志愿者身上采集血液，并在两台血栓弹力图仪（TEG 6s）上同时进行分析。每次测量在一架空中客车H135急救直升机上飞行时进行，并在靠近飞行区域的地面上重复进行。比较两次测量的结果，并分析记录的描记图和数值结果中的伪像。在整个飞行过程中进行振动测量，以量化直升机运行不同阶段振动幅度和特征的变化。高振动环境与所有记录的描记图中出现伪像有关。在飞行中和地面上进行的枸橼酸化高岭土+肝素酶测量存在显著差异。所有其他检测的变异性增加，但在两个时间点之间未显示出显著差异。我们在飞行中进行的粘弹性测量中观察到许多伪像。从同一样本获得的一些参数在飞行中和地面测量之间显示出显著差异。在直升机医疗服务中进行基于共振的粘弹性测试容易出现伪像。然而，在测量开始和起飞之间延迟10分钟可能会产生更可靠的结果。
