Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Sherwin R, Mango L, Medado P, Levy P. Ann Emerg Med. 2009;54(Suppl 3):S59.
Objectives: The primary objective of this study was to describe the initial (< 2 hours from arrival) hemodynamic and perfusion state in a prospective cohort of congestive heart failure (CHF) patients presenting to an urban ED.
Methods (Design, Setting, Type of Participants): This was an observational study at a Level I tertiary care center with an annual volume of >96,000 patients. All patients presenting to the emergency department (ED) with a chief complaint of dyspnea in whom CHF was a diagnostic consideration by the treating physician were consented and enrolled. Perfusion status was assessed in each patient using capillary lactate measurement (systemic perfusion), near infrared spectroscopy (tissue level perfusion) and impedance cardiography (cardic output). Furthermore, each patient underwent a vascular occlusion test (VOT) during which tissue oxygenation (StO2) response was monitoring during and following a three-minute period of arterial occlusion. Only patients whose final ED or hospital discharge diagnosis was CHF were included in the final analysis for this study.
Results: Twenty-three patients were enrolled who had a final diagnosis of acute decompensated CHF. The mean age was 58.9 ± 13.6 years, 15/23(70%) were male and 100% were black. All the patients were admitted to the hospital and the in-hospital mortality was zero. The media BNP was 753 (IQR 463, 1410). Twelve patients (52%) had baseline capillary lactate levels > 2.0 mmoL suggesting systemic hypoperfusion. The mean capillary lactate, cardiac index and StO2 (tissue level oxygenation) was 2.6 ± 2.1 mmol/dL, 2.1 ± 1.1 L/min/m2 , 74.3 ± 9.3% respectively. The mean measured minimum StO2 following the VOT was 52.9 ± 14.2%. In univariate analysis only BNP (p = 0.043), the minimum StO2 value (p=0.028) and time to peak StO2 Recovery (p= 0.031) were significantly associated with a hospital length of stay > 48 hours.
Conclusions: In this pilot study, we found evidence of baseline hypoperfusion in patients with acute decompesated CHF which may be associated hospital outcome. Further defining these variables in this cohort may be useful in the initial assessment of these patients.