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Accident-related deaths is the 7th leading cause of death in Taiwan, and most of them is due to trauma from falls and traffic accident. Among trauma patients, the common cause of death is from hemorrhagic shock. Thus, real-time and accurate blood pressure monitoring is important for trauma patients. Incorrect blood pressure monitoring can lead to adverse events like traumatic cardiac arrest and shock and can also delay the time for intervention (fluid resuscitation, blood transfusion and operation). The current practice of blood pressure monitoring in trauma patient is by non-invasive blood pressure monitoring, which may be incorrect and not timely. Patient's body type and peripheral perfusion can both influence the result of non-invasive blood pressure monitoring.
With continuous and correct blood pressure monitoring, the resuscitation team can give adequate and timely treatment. In some trauma centers, arterial line insertion in trauma patients is a daily practice, while the evidence is inadequate and the potential benefit in unknown.
The main purpose of this study is to investigate the application of arterial line insertion in trauma patients. The study design is a prospective before-after study to exam whether arterial line insertion in trauma patients can reduce adverse event rate like hypovolemic shock and improve patient's outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| trauma patients with arterial line insertion | Active Comparator | the after phase, actively recruited patients who are eligible for arterial line insertion |
|
| trauma patients without arterial line insertion | No Intervention | the before phase, retrospectively data collection from the past |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| arterial line | Device | insert arterial line for patients who meet major trauma criteria |
|
| Measure | Description | Time Frame |
|---|---|---|
| composite primary endpoint (including any hypotension, vasopressors usage, any cardiac arrest in ER, Shock index ) | including any hypotension, vasopressors usage, any cardiac arrest in ER, Shock index (HR/SBP)>1 | during ER stay, up to 6 hours |
| Measure | Description | Time Frame |
|---|---|---|
| prolong ICU admission | define as > 6 days of admission | up to 7 days |
| 30 days mortality rate | mortality within 30 days of trauma event |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Taiwan University Hospital Yunlin Branch | Douliu | Taiwan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18212658 | Background | Teixeira PG, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, Browder T, Noguchi TT, Demetriades D. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007 Dec;63(6):1338-46; discussion 1346-7. doi: 10.1097/TA.0b013e31815078ae. | |
| 2927596 | Background | Klauber MR, Marshall LF, Luerssen TG, Frankowski R, Tabaddor K, Eisenberg HM. Determinants of head injury mortality: importance of the low risk patient. Neurosurgery. 1989 Jan;24(1):31-6. doi: 10.1227/00006123-198901000-00005. |
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| ID | Term |
|---|---|
| D062666 | Vascular Access Devices |
| ID | Term |
|---|---|
| D057785 | Catheters |
| D004864 | Equipment and Supplies |
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We use se before-after study type and only the after phase receive intervention. Before phase will retrospectively collect data from patient without arterial line intervention.
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| mortality within 30 days of trauma event |
| volume of fluid administration | any type of fluid administration | during ER stay, up to 6 hours |
| Area under curve (AUC) difference under different time measuring frequency | We will use continuous blood pressure data and apply different intervals (1, 3, 5, and 10 minutes) to create a plot, then smooth it to calculate the area under the curve (AUC). | 1/3/5/10 minutes |
| units of red blood cell transfusion | units of red blood cell transfusion | during ER stay, up to 6 hours |
| arterial blood pressure trajectory | We will depict the arterial blood pressure trajectory for each patient. | during ER stay, up to 6 hours |
| 2213158 | Background | Eisenberg HM, Gary HE Jr, Aldrich EF, Saydjari C, Turner B, Foulkes MA, Jane JA, Marmarou A, Marshall LF, Young HF. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg. 1990 Nov;73(5):688-98. doi: 10.3171/jns.1990.73.5.0688. |
| 17426904 | Background | Tieu BH, Holcomb JB, Schreiber MA. Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg. 2007 May;31(5):1055-64. doi: 10.1007/s00268-006-0653-9. |
| 25807399 | Background | Schreiber MA, Meier EN, Tisherman SA, Kerby JD, Newgard CD, Brasel K, Egan D, Witham W, Williams C, Daya M, Beeson J, McCully BH, Wheeler S, Kannas D, May S, McKnight B, Hoyt DB; ROC Investigators. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: results of a prospective randomized pilot trial. J Trauma Acute Care Surg. 2015 Apr;78(4):687-95; discussion 695-7. doi: 10.1097/TA.0000000000000600. |
| 35887844 | Background | Wijnberge M, van der Ster B, Vlaar APJ, Hollmann MW, Geerts BF, Veelo DP. The Effect of Intermittent versus Continuous Non-Invasive Blood Pressure Monitoring on the Detection of Intraoperative Hypotension, a Sub-Study. J Clin Med. 2022 Jul 14;11(14):4083. doi: 10.3390/jcm11144083. |