Research Article
Volume 6 Issue 5 - 2022
Feasibility of Non-Invasive Advanced Haemodynamic and Cardiac Output Monitoring (ClearSightTM) in Guiding Goal Directed Therapy During Medical Emergency Team Response: A Pilot Study
MacGarty D1, Majumdar M2*, Cordy R3 and Riedel B4
1Anaesthetic Registrar, Department of Anaesthesia, Alfred Hospital, Melbourne, Australia
2ICU Consultant, ICU Department, Royal Melbourne Hospital, Melbourne, Australia
3Anaesthetic Registrar, Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Australia
4Director Department of Anaesthesia at Peter MacCallum Cancer Centre, Melbourne, Australia
*Corresponding Author: Majumdar M, ICU Consultant, ICU Department, Royal Melbourne Hospital, Melbourne, Australia.
Received: April 15, 2022; Published: April 28, 2022




Abstract

Purpose: This study evaluated the feasibility of goal directed therapy (GDT) in a general ward setting for haemodynamically unstable patients who triggered a medical emergency team (MET) call.

Methods: This prospective, observational, pilot study was conducted at a specialist teaching hospital, Peter MacCallum Cancer Centre, Melbourne following ethics approval. A continuous, non-invasive cardiac output monitor (Clear SightTM - Edwards Life Sciences, Irvine, CA, USA) was available to guide MET management via assessment of patient fluid responsiveness. Utility of the Clear SightTM system in the ward environment was assessed. The MET was free to implement or disregard GDT guidelines and each fluid management decision was recorded.

Results: Twenty patients were recruited and satisfactory Clear SightTM output data was obtained in 80% (16/20). Median Clear SightTM mobilization and set up time was 18.5 minutes. Twenty-eight fluid management decisions were made in thirteen patients. In seven of twenty-eight (25%) decisions the patient was identified as fluid-responsive and fluid was administered in each (7/7 decisions). In the remaining twenty-one (75%) decisions the patient was identified as non-fluid-responsive, yet the MET administered fluid in 95% (20/21 decisions) contrary to GDT guidelines. Of the sixteen patients with satisfactory Clear SightTM output data, 56% (9/16) required ICU admission for further haemodynamic management.

Conclusions: Our data supports the feasibility of Clear SightTM in delivering ward based GDT and in guiding MET management. Given that only 29% (8/28) of MET decisions were concordant with GDT guidelines, our data supports the need for a larger multicentre prospective study to further evaluate GDT in the ward setting.

Keywords: Advanced Haemodynamic Monitoring; Emergency Response Team; Failure to Rescue

References

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Citation: Majumdar M., et al. "Feasibility of Non-Invasive Advanced Haemodynamic and Cardiac Output Monitoring (ClearSightTM) in Guiding Goal Directed Therapy During Medical Emergency Team Response: A Pilot Study”. EC Emergency Medicine and Critical Care 6.5 (2022): 10-19.

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