Non-invasive cardiac output monitoring device “ICON” in trauma patients: a feasibility study
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Assessment of hemodynamics is crucial for the evaluation of major trauma patients. Cardiac output (CO) monitoring provides additional information and may improve volume resuscitation. The goal of this prospective pilot study was to evaluate the feasibility of a new non-invasive CO monitoring (NICOM) device in the emergency department (ED).
Single-center prospective observational pilot study including 20 trauma patients admitted to a level 1 trauma center. CO was continuously monitored for 60 min after ED admission using the new NICOM device ICON®. This device measures changes of the thoracic bioimpedance to calculate CO. Conventional vital signs were recorded simultaneously. Feasibility, safety, reliability, user-friendliness, and impact of the device on standard ED procedures were assessed.
Thirteen (65%) patients were male, median age was 57.5 (IQR 25), and median ISS was 10.5 (IQR 14.8). Median CO over time was 9.8 l/min (IQR 4.6). No adverse effects were recorded. The device proved to be user-friendly with no negative impact on routine ED care. In four patients, detachment of electrodes was observed, and in four patients, the CO recording was temporary discontinued. Short-term changes of the CO were observed 44 times after the placement of electrodes and during patient transfers.
Non-invasive CO monitoring proved to be feasible and safe for the initial hemodynamic evaluation of trauma patients. Problems with the NICOM device were detachment of electrodes and temporary signal loss. Due to the small sample size and relatively low injury burden of the patients included in this study, further prospective investigation is warranted.
KeywordsInitial care Emergency department Non-invasive hemodynamic monitoring Cardiac output Trauma
MK planned the study protocol, conducted the clinical data collection, assisted in the statistical analysis of data, drafted and composed the manuscript. TH participated in the planning of the study protocol, performed the statistical analysis of data, and revised the manuscript critically. AE revised the manuscript critically. BS conceived the study, participated in the planning of the study protocol, and revised the manuscript critically. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
Matthias Kuster, Tobias Haltmeier, Aristomenis Exadaktylos, and Beat Schnüriger declare that they have no conflict of interest or financial ties.
This study was approved by the cantonal ethics committee of Bern, Switzerland (KEK No. 353/2015). 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 was obtained from all individual participants included in the study.
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