title: Emergency department noninvasive (NICOM) cardiac outputs  are associated with trauma activation, patient injury  severity and host conditions and mortality.
abstract: BACKGROUND
  Anoninvasive cardiac output (CO) monitor (NICOM), using Bioreactance technology, has been validated in several nontrauma patient studies. We hypothesized that NICOM CO would have more significant associations with clinical conditions than would systolic blood pressure (sBP).
  
  
  METHODS
  This is a prospective observational study of consecutive trauma activation patients during the first 10 to 60 minutes after emergency department arrival.
  
  
  RESULTS
  Analysis includes 270 consecutive trauma activation patients with 1,568 observations. CO was decreased (p ≤ 0.002) with major blood loss, hypotension, red blood cell transfusion, Injury Severity Score (ISS) higher than 20, low PetCO₂, abnormal pupils, elderly, preexisting conditions, low body surface area level, females, hypothermia, and death. CO was increased (p < 0.0001) with base deficit, ethanol positivity, and illicit drug positivity. The sBP was decreased (p ≤ 0.0005) with major blood loss, red blood cell transfusion, low PetCO₂, low body surface area level, and illicit drug positivity. The sBP was increased (p e 0.01) with ISS higher than 20, elderly, and preexisting conditions. Total significant condition associations were CO 83% (15 of 18 patients) and sBP 47% (8 of 17 patients; p = 0.03). In hypotensive patients, CO was lower with major blood loss (3.3 ± 2.1 L/ min) than without (6.0 ± 2.2 L/min; p < 0.0001). Of survivors with ISS 15 or higher, NICOM patients experienced a shorter hospital length of stay (10.5 days) when compared with 2009 and 2010 patients (14.0 days; p = 0.03).
  
  
  CONCLUSIONS
  The multiple associations of CO with patient conditions imply that NICOM provides an objective and clinically valid, relevant, and discriminate measure of cardiac function in acutely injured trauma activation patients. NICOM use may be associated with a shorter length of stay in surviving patients with complex injuries.
authors.affiliation: Trauma/Critical Services, Level I Trauma Center, St. Elizabeth Health Center, Youngstown, Ohio, USA. dunham.michael@sbcglobal.net
authors.forename: C Michael
authors.initials: CM
authors.lastname: Dunham
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Chirichella
authors.forename: Brian S
authors.initials: BS
authors.lastname: Gruber
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Ferrari
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Martin
authors.forename: Brenda A
authors.initials: BA
authors.lastname: Luchs
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Hileman
authors.forename: Renee
authors.initials: R
authors.lastname: Merrell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002302:Cardiac Output / Q000502:physiology*; D016534:Cardiac Output, High / Q000175:diagnosis / Q000401:mortality; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy