Global end-diastolic volume as a predictor of the need for massive transfusion in multiple-trauma patients with hemorrhagic shock

Introduction

The PiCCO system enables hemodynamic evaluation and monitoring by two different approaches: the transpulmonary thermal dilution technique and pulse counter analysis. Optimal monitoring of cardiac preload is of paramount importance for the hemodynamic management of multiple-trauma patients with hemorrhagic shock. There have been only a few studies on the use of the PiCCO system (Pulsion, Germany) in multiple-trauma patients with hemorrhagic shock for hemodynamic monitoring. We hypothesized that performing a cardiac adequate preload evaluation with the PiCCO system would make it possible to predict latent hemorrhagic progress.

Methods

Data from 53 consecutive multiple-trauma patients (age 51 ± 17.8 years, injury severity score 30 ± 12.9) with hemorrhagic shock at the scene of the injury or in the emergency room between June 2007 and November 2008 were analyzed. All patients underwent a hemodynamic evaluation with the PiCCO system. We divided the patients into two groups according to whether they received a massive transfusion (MT) (>2,000 ml packed red blood cell transfusion after admission within 24 hours) and compared their PiCCO data: cardiac output (CO), systemic vascular resistance (SVR), indexed global end-diastolic volume (GEDVi), and indexed extravascular lung water on admission to the ICU. The chi-square test and paired t test were used to perform the statistical analysis.

Results

Twenty-seven patients required massive transfusion. Mortality was higher in the MT group (P = 0.05), and the CO, GEDVi and ITBVi values were significantly lower in the MT group (Table 1).

Table 1 abstract P212

Conclusion

The parameters measured with the PiCCO system enabled evaluation of the correct cardiac preload in the multiple-trauma patients with hemorrhagic shock. GEDVi was useful as a predictor of the need for MT.