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Non-invasive cardiac output monitoring device “ICON” in trauma patients: a feasibility study

European Journal of Trauma and Emergency Surgery volume 45, pages 1069–1076 (2019)Cite this article

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

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Author information

Affiliations

  1. Division of Acute Care Surgery, Department of Visceral and Transplant Surgery, Bern University Hospital, 3010, Bern, Switzerland

    Matthias Kuster, Tobias Haltmeier & Beat Schnüriger

  2. Department of Emergency Medicine, Bern University Hospital, University of Bern, Bern, Switzerland

    Aristomenis Exadaktylos

Authors
  1. Matthias Kuster
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  2. Tobias Haltmeier
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  3. Aristomenis Exadaktylos
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  4. Beat Schnüriger
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Contributions

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.

Corresponding author

Correspondence to Beat Schnüriger.

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Conflict of interest

Matthias Kuster, Tobias Haltmeier, Aristomenis Exadaktylos, and Beat Schnüriger declare that they have no conflict of interest or financial ties.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Kuster, M., Haltmeier, T., Exadaktylos, A. et al. Non-invasive cardiac output monitoring device “ICON” in trauma patients: a feasibility study. Eur J Trauma Emerg Surg 45, 1069–1076 (2019). https://doi.org/10.1007/s00068-018-0984-x

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  • DOI: https://doi.org/10.1007/s00068-018-0984-x

Keywords

  • Initial care
  • Emergency department
  • Non-invasive hemodynamic monitoring
  • Cardiac output
  • Trauma