A comparison of central venous and arterial base deficit as a predictor of survival in acute trauma.
BACKGROUND
The arterial base deficit has been demonstrated to be a marker of shock and predictive of survival in injured patients. The venous blood, however, may better reflect tissue perfusion. Its usefulness in trauma is unknown. We compared central venous with arterial blood gas analysis to determine which was a better predictor of survival in injured patients.


METHODS
A prospective, nonrandomized series of acutely injured patients was investigated. Patients who had an arterial blood gas analysis for acid-base determination had a simultaneous central venous blood gas analysis and routine blood tests. Patient demographics, Injury Severity Score, and survival past 24 hours were recorded. Arterial and venous blood samples were analyzed for pH, PCO2, PO2, HCO3, hemoglobin-oxygen saturation, base deficit, and lactate.


RESULTS
One hundred patients were enrolled. There were 76 survivors and 24 nonsurvivors. Wilcoxon rank sum test and multivariate logistic regression were used for each recorded variable; only central venous base deficit was predictive of survival past 24 hours (P = .0081). Specifically, arterial base deficit was not predictive of survival past 24 hours.


CONCLUSIONS
In a prospective series of acutely injured patients, central venous base deficit, not arterial base deficit, was predictive of survival past 24 hours.
Schmelzer
Thomas M
TM
Department of Surgery, Section of Trauma, Carolinas Medical Center, Charlotte, NC 28203, USA.
Perron
Andrew D
AD
Thomason
Michael H
MH
Sing
Ronald F
RF
D000137:Acid-Base Imbalance / Q000097:blood*; D000208:Acute Disease; D000328:Adult; D001158:Arteries; D001774:Blood Chemical Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016019:Survival Analysis; D014680:Veins; D014947:Wounds and Injuries / Q000097:blood* / Q000401:mortality*