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. 2023 Feb;49(1):217-225.
doi: 10.1007/s00068-022-02051-5. Epub 2022 Aug 3.

Association between hypotension and myocardial injury in patients with severe trauma

Alexandra Stroda  1 , Simon Thelen  2 , René M'Pembele  1 , Nick Khademlou  1 , Carina Jaekel  3 , Erik Schiffner  3 , Dan Bieler  3 , Michael Bernhard  4 , Ragnar Huhn  1   5 , Giovanna Lurati Buse  1 , Sebastian Roth  1
Affiliations

Association between hypotension and myocardial injury in patients with severe trauma

Alexandra Stroda et al. Eur J Trauma Emerg Surg. 2023 Feb.

Abstract

Purpose: During resuscitation of patients with severe trauma, guidelines recommend permissive hypotension prior to surgical bleeding control. However, hypotension may be associated with reduced organ perfusion and multiple organ dysfunction, e.g. myocardial injury. The association between hypotension and myocardial injury in trauma patients is underexplored. We hypothesized that hypotension is associated with myocardial injury in this population.

Materials and methods: This retrospective study included patients ≥ 18 years suffering from severe trauma [defined as Injury Severity Score (ISS) ≥ 16] that were treated in the emergency department resuscitation room between 2016 and 2019. Primary endpoint was the incidence of myocardial injury defined as high-sensitive troponin T > 14 ng/l. Main exposure was the duration of arterial hypotension during resuscitation period defined as mean arterial pressure < 65 mmHg.

Results: Out of 368 patients screened, 343 were analyzed (73% male, age: 55 ± 21, ISS: 28 ± 12). Myocardial injury was detected in 143 (42%) patients. Overall in-hospital mortality was 26%. Multivariate binary logistic regression with forced entry of nine predefined covariables revealed an odds ratio of 1.29 [95% confidence interval 1.16-1.44]; p = 0.012) for the association between the duration of hypotension and myocardial injury.

Conclusion: The duration of hypotension during resuscitation period is independently associated with the incidence of myocardial injury in patients with severe trauma.

Keywords: Blood pressure; Hemodynamics; Mean arterial pressure; Multiple trauma; Permissive hypotension; Troponin.

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Conflict of interest statement

All authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Association between troponin values (presented by quartiles) and the absolute duration of hypotension during resuscitation period in minutes (min). BP blood pressure, MAP mean arterial pressure
See this image and copyright information in PMC

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