title: Continuous hemodynamic monitoring in acute stroke: an exploratory analysis.
abstract: BACKGROUND
  Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements.
  
  
  METHODS
  This study was a secondary analysis of 7 stroke patients from a prospectively collected data set of patients that received 2 hours of hemodynamic monitoring in the ED. Stroke patients were included if hemorrhagic or ischemic stroke was confirmed by neuroimaging, and symptom onset was within 24 hours. They were excluded for the presence of a stroke mimic or transient ischemic attack. Monitoring was performed using the Nexfin device (Edwards Lifesciences, Irvine CA).
  
  
  RESULTS
  The mean age of the cohort was 71 ± 17 years, 43% were male, and the mean National Institute of Health Stroke Scale (NIHSS) was 6.9 ± 5.5. Two patients had hemorrhagic stroke. We obtained 42,456 hemodynamic data points, including beat-to-beat blood pressure measurements with variability of 18 mmHg and cardiac indices ranging from 1.8 to 3.6 l/min/m2. The correlation coefficient between continuous blood pressure measurements with the Nexfin device and standard ED readings was 0.83.
  
  
  CONCLUSIONS
  This exploratory investigation revealed that continuous, noninvasive monitoring in the ED is feasible in acute stroke. Further research is currently underway to determine how such monitoring may impact outcomes in stroke or replace the need for invasive monitoring.
authors.affiliation: Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Ayan
authors.initials: A
authors.lastname: Sen
authors.affiliation: Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Joseph
authors.initials: J
authors.lastname: Miller
authors.affiliation: Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Heidi
authors.initials: H
authors.lastname: Wilkie
authors.affiliation: Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Michele
authors.initials: M
authors.lastname: Moyer
authors.affiliation: Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lewandowski
authors.affiliation: Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan.
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
mesh_terms: D001741:Black or African American; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D020521:Stroke / Q000503:physiopathology*