Az orvos-, egészségtudományi- és gyógyszerészképzés tudományos műhelyeinek fejlesztése(EFOP-3.6.3-VEKOP-16-2017-00009)
Támogató: EFOP-VEKOP
(BO/00605/21/5)
Objectives
Heart rate (HR) is one of the physiological variables in the early assessment of trauma-related
haemorrhagic shock, according to Advanced Trauma Life Support (ATLS). However, its
efficiency as predictor of mortality is contradicted by several studies. Furthermore,
the linear association between HR and the severity of shock and blood loss presented
by ATLS is doubtful. This systematic review aims to update current knowledge on the
role of HR in the initial haemodynamic assessment of patients who had a trauma.
Design
This study is a systematic review and meta-regression that follows the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses recommendations.
Data
sources EMBASE, MEDLINE, CENTRAL and Web of Science databases were systematically
searched through on 1 September 2020.
Eligibility
criteria Papers providing early HR and mortality data on bleeding patients who had
a trauma were included. Patient cohorts were considered haemorrhagic if the inclusion
criteria of the studies contained transfusion and/or positive focused assessment with
sonography for trauma and/or postinjury haemodynamical instability and/or abdominal
gunshot injury. Studies on burns, traumatic spinal or brain injuries were excluded.
Papers published before January 2010 were not considered.
Data
extraction and synthesis Data extraction and risk of bias were assessed by two independent
investigators. The association between HR and mortality of patients who had a trauma
was assessed using meta-regression analysis. As subgroup analysis, meta-regression
was performed on patients who received blood products.
Results
From a total of 2017 papers, 19 studies met our eligibility criteria. Our primary
meta-regression did not find a significant relation (p=0.847) between HR and mortality
in patients who had a trauma with haemorrhage. Our subgroup analysis included 10 studies,
and it could not reveal a linear association between HR and mortality rate.
Conclusions
In accordance with the literature demonstrating the multiphasic response of HR to
bleeding, our study presents the lack of linear association between postinjury HR
and mortality. Modifying the pattern of HR derangements in the ATLS shock classification
may result in a more precise teaching tool for young clinicians.