Continuous noninvasive monitoring of cardiac performance and tissue perfusion in pediatric trauma patients B,BB Matthew Martin a, * , Carlos Brown a , David Bayard a , Demetrios Demetriades a , Ali Salim a , Ryan Gertz a , Kenneth Azarow b , Charles C.J. Wo a , William Shoemaker a a Division of Trauma and Surgical Critical Care, Los Angeles County Hospital + USC Medical Center, Los Angeles, CA 90033, USA b Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA 98431, USA Abstract Purpose: The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. Methods: Review of all patients entered into a prospective noninvasive monitoring protocol. Cardiac index (CI) was measured using a thoracic bioimpedance device and tissue perfusion was assessed by transcutaneous carbon dioxide (Ptcco 2 ) tension and oxygen tension indexed to the fraction of inspired oxygen (Ptco 2 /Fio 2 ). Survival probability (SP) was continuously calculated using a stochastic analysis program. Results: There were 45 patients with a total of 953 data sets. The mean age was 11 years (range, 1-16 years) with a mean Injury Severity Score of 24 (F16). There was no difference between survivors (n = 32) and nonsurvivors (n = 13) at study entry for heart rate, blood pressure, CI, or pulse oximetry (all P N .05). However, survivors demonstrated higher Ptcco 2 (45 vs 35), higher Ptco 2 /Fio 2 (236 vs 156), and higher predicted SP (89% vs 62%) compared with nonsurvivors at study entry and throughout the monitoring period (all P b .01). For the entire data set, the strongest independent predictors of survival were Ptco 2 / Fio 2 and SP. The area under the receiver operating characteristic curve for mortality prediction was 0.83 for SP and 0.71 for Ptco 2 /Fio 2 , compared with 0.6 for heart rate, 0.51 for blood pressure, and 0.53 for CI. Similar hemodynamic patterns were observed for all injury patterns with the exception of those with severe brain injury. Conclusions: Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival. D 2005 Elsevier Inc. All rights reserved. 0022-3468/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.08.017 Presented at the 38th Annual Meeting of the Pacific Association of Pediatric Surgeons, May 22-26, 2005, Vancouver, Canada. B This study was supported in part by grants RR-11526, GM-65619, and DOD BAA99-1 from the National Institutes of Health, Bethesda, Md. BB The award DAMD 17-01-2-0070 is by the US Army Medical Research Acquisition Activity, Fort Detrick, Md. The content of the information does not necessarily reflect the position or the policy of the Government, and no official endorsement should be inferred. T Corresponding author. Tel.: +1 323 226 8112; fax: +1 323 226 8116. E-mail address: docmartin2@yahoo.com (M. Martin). Index words: Trauma; Thoracic bioimpedance; Transcutaneous oxygen; Noninvasive monitoring; Survival prediction Journal of Pediatric Surgery (2005) 40, 1957 – 1963 www.elsevier.com/locate/jpedsurg