Haemodynamic performance in dying critical patients in emergency medicine

In the Emergency Department (ED), patients present with diverse and undifferentiated medical conditions, of which patients are diagnosed and treated depending upon their presentation. The management and treatment of patients presenting to the ED rely on rapid identification of these conditions. Currently, the assessment of the patient’s hemodynamic status in the ED mainly depends on the measurements of patients’ physiological vital signs. Moreover, standard vital signs monitoring may lack sensitivity and specificity to detect impending cardiopulmonary deterioration and eventually shock during the early compensatory stage of haemorrhage.

Hemodynamic and oxygen delivery monitoring of patients presenting in the emergency departments permits frequent measurement of various variables. Although, there has been development and research of non-invasive technologies for hemodynamic monitoring in the ED, offering a new method to monitor additional hemodynamic indices (11). A lack of extensive studies reports objectively measured pre-treatment hemodynamic parameters of time-critical patients in the ED. Appropriate evaluation and assimilation of this enormous mass of physiological data into the clinical decision-making process are cumbersome at best. Previous work has only focused on assessing selected variables in fluid responsiveness. Minimal effort has been directed toward the formal, rigorous examination of the relative importance of combining all parameters in the ED setting. The additive prognostic and predictive significance of the combination of multiple hemodynamic variables can be collected by using non-invasive monitoring remains to be studied with a higher quality of the evidence, especially in the emergency department environments.

The aim of this project is, therefore, to evaluate the prognostic and predictive significance of a comprehensive selection of clinical and hemodynamic parameters derived from the Ultrasound Cardiac Output Monitor (the USCOM)in a large, unselected, prospective cohort of patients with different ages and a wide range of pathologies in the emergency department patients.