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Agreement between arterial and venous blood gases in trauma resuscitation in emergency department (AGREE)

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Abstract

Introduction

Arterial blood gas (ABG) sampling is routinely performed in major trauma patients to assess the severity of hemorrhagic shock. Compared to venous blood gas (VBG), ABG is an additional procedure with risks of hematoma and pain. We aim to determine if pH, base deficit (BD), and lactate from VBG and ABG in trauma patients are clinically equivalent. If proven, the need for ABG and its associated risks can be eliminated.

Methods

This prospective observational study was conducted in the Emergency Department of National University Hospital, Singapore, between February and October 2016. We correlated paired ABG and VBG results in adult trauma patients. VBG and ABG were obtained within 10 min and processed within 5 min using a point-of-care blood gas analyzer. Bland–Altman plot analysis was used to evaluate the agreement between peripheral VBG and ABG in terms of pH, base deficit and lactate.

Results

There were 102 patients included, with a median age of 34 (interquartile range 28–46) years and male predominance (90.2%). Majority of patients sustained blunt trauma (96.1%), and had injuries of Tier 1 and Tier 2 severity (60/102, 58.8%). Bland–Altman plot analyses demonstrated that only 72.6% of venous pH and 76.5% of venous BD lie within the pre-defined clinically acceptable limits of agreement, whereas 96.0% of venous lactate was within these limits.

Conclusion

Venous and arterial pH and BD are not within clinically acceptable limits of agreement, and ABG should be obtained for accurate acid–base status. However, venous lactate may be an acceptable substitute for arterial lactate.

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Acknowledgements

We thank our colleagues at the Emergency Medicine Department, National University Hospital, Singapore, for their contributions to image acquisition, data collection and patient recruitment.

Funding

Junior Pitch for Funds, National University Hospital (Grant No. JPFF-15-2-BYR).

Author information

Authors and Affiliations

  1. Emergency Department, National Healthcare Group, Woodlands Health Campus, 17 Woodlands Drive, Singapore, 738097, Singapore

    Yuru Boon

  2. Emergency Medicine Department, National University Hospital, National University Health System, 9 Lower Kent Ridge Road, Level 4, Singapore, 119085, Singapore

    Win Sen Kuan, Irwani Ibrahim & Mui Teng Chua

  3. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Win Sen Kuan, Irwani Ibrahim & Mui Teng Chua

  4. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 119077, Singapore

    Yiong Huak Chan

Authors
  1. Yuru Boon
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  2. Win Sen Kuan
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  5. Mui Teng Chua
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Corresponding author

Correspondence to Mui Teng Chua.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from patients who have mental capacity before study recruitment. For patients who were unable to provide consent, we obtained waiver of consent at time of enrolment with delayed written informed consent after the patient regained mental capacity. The study protocol was approved by the Domain Specific Review Board, National Healthcare Group, Singapore (DSRB 2015/00904).

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Boon, Y., Kuan, W.S., Chan, Y.H. et al. Agreement between arterial and venous blood gases in trauma resuscitation in emergency department (AGREE). Eur J Trauma Emerg Surg 47, 365–372 (2021). https://doi.org/10.1007/s00068-019-01190-6

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  • DOI: https://doi.org/10.1007/s00068-019-01190-6

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