Comparison of Compensatory Reserve and Arterial Lactate as Markers of Shock and Resuscitation

Michael Johnson, Abdul Alarhayem, Victor Convertino, Robert Carter, Kevin Chung, Ronald M Stewart, John G Myers, Daniel L Dent, Lillian Liao, Ramon Cestero, Susannah Nicholson, Mark Muir, Martin Schwaca, David Wampler, Mark DeRosa, Brian J Eastridge

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: During traumatic hemorrhage, the ability to identify shock and intervene prior to decompensation is paramount to survival. Lactate is extremely sensitive to shock and its clearance has been demonstrated a useful gauge of shock and resuscitation status. Though lactate can be measured in the field, logistical constraints render it impractical in certain environments. The Compensatory Reserve represents a new clinical measurement reflecting the remaining capacity to compensate for hypoperfusion. We hypothesized the compensatory reserve index (CRI) would be an effective surrogate marker of shock and resuscitation compared to lactate. METHODS: The CRI device was placed on consecutive patients meeting trauma center activation criteria and remained on the patient until discharge, admission, or transport to operating suite. All subjects had a lactate level measured as part of their routine admission metabolic analysis. Time-corresponding CRI and lactate values were matched in regards to initial and subsequent lactate levels. Mean time from lactate sample collection to data availability in the electronic medical record was calculated. Predictive capacity of CRI and lactate in predicting hemorrhage was determined by receiver-operative characteristic curve analysis. Correlation analysis was performed to determine if any association existed between changing CRI and lactate values. RESULTS: Receiver-operator characteristic (ROC) curves were generated and area under the curve was 0.8052 and 0.8246 for CRI and lactate, respectively. There was no significant difference in each parameter’s ability to predict hemorrhage (p= 0.8015). The mean duration from lactate sample collection to clinical availability was 44 minutes while CRI values were available immediately. Analysis of the concomitant change in serial CRI and lactate levels revealed a Spearman’s correlation coefficient of -0.73 (p < 0.01). CONCLUSION: CRI performed with equivalent predictive capacity to lactate with respect to identifying initial perfusion status associated with hemorrhage and subsequent resuscitation. LEVEL OF EVIDENCE: II

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - May 22 2017

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Resuscitation
Shock
Lactic Acid
Hemorrhage
Patient Discharge
Electronic Health Records
Trauma Centers
Area Under Curve
Perfusion
Biomarkers
Equipment and Supplies

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Comparison of Compensatory Reserve and Arterial Lactate as Markers of Shock and Resuscitation. / Johnson, Michael; Alarhayem, Abdul; Convertino, Victor; Carter, Robert; Chung, Kevin; Stewart, Ronald M; Myers, John G; Dent, Daniel L; Liao, Lillian; Cestero, Ramon; Nicholson, Susannah; Muir, Mark; Schwaca, Martin; Wampler, David; DeRosa, Mark; Eastridge, Brian J.

In: Journal of Trauma and Acute Care Surgery, 22.05.2017.

Research output: Contribution to journalArticle

Johnson, M, Alarhayem, A, Convertino, V, Carter, R, Chung, K, Stewart, RM, Myers, JG, Dent, DL, Liao, L, Cestero, R, Nicholson, S, Muir, M, Schwaca, M, Wampler, D, DeRosa, M & Eastridge, BJ 2017, 'Comparison of Compensatory Reserve and Arterial Lactate as Markers of Shock and Resuscitation', Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000001595
Johnson, Michael ; Alarhayem, Abdul ; Convertino, Victor ; Carter, Robert ; Chung, Kevin ; Stewart, Ronald M ; Myers, John G ; Dent, Daniel L ; Liao, Lillian ; Cestero, Ramon ; Nicholson, Susannah ; Muir, Mark ; Schwaca, Martin ; Wampler, David ; DeRosa, Mark ; Eastridge, Brian J. / Comparison of Compensatory Reserve and Arterial Lactate as Markers of Shock and Resuscitation. In: Journal of Trauma and Acute Care Surgery. 2017.
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abstract = "BACKGROUND: During traumatic hemorrhage, the ability to identify shock and intervene prior to decompensation is paramount to survival. Lactate is extremely sensitive to shock and its clearance has been demonstrated a useful gauge of shock and resuscitation status. Though lactate can be measured in the field, logistical constraints render it impractical in certain environments. The Compensatory Reserve represents a new clinical measurement reflecting the remaining capacity to compensate for hypoperfusion. We hypothesized the compensatory reserve index (CRI) would be an effective surrogate marker of shock and resuscitation compared to lactate. METHODS: The CRI device was placed on consecutive patients meeting trauma center activation criteria and remained on the patient until discharge, admission, or transport to operating suite. All subjects had a lactate level measured as part of their routine admission metabolic analysis. Time-corresponding CRI and lactate values were matched in regards to initial and subsequent lactate levels. Mean time from lactate sample collection to data availability in the electronic medical record was calculated. Predictive capacity of CRI and lactate in predicting hemorrhage was determined by receiver-operative characteristic curve analysis. Correlation analysis was performed to determine if any association existed between changing CRI and lactate values. RESULTS: Receiver-operator characteristic (ROC) curves were generated and area under the curve was 0.8052 and 0.8246 for CRI and lactate, respectively. There was no significant difference in each parameter’s ability to predict hemorrhage (p= 0.8015). The mean duration from lactate sample collection to clinical availability was 44 minutes while CRI values were available immediately. Analysis of the concomitant change in serial CRI and lactate levels revealed a Spearman’s correlation coefficient of -0.73 (p < 0.01). CONCLUSION: CRI performed with equivalent predictive capacity to lactate with respect to identifying initial perfusion status associated with hemorrhage and subsequent resuscitation. LEVEL OF EVIDENCE: II",
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T1 - Comparison of Compensatory Reserve and Arterial Lactate as Markers of Shock and Resuscitation

AU - Johnson, Michael

AU - Alarhayem, Abdul

AU - Convertino, Victor

AU - Carter, Robert

AU - Chung, Kevin

AU - Stewart, Ronald M

AU - Myers, John G

AU - Dent, Daniel L

AU - Liao, Lillian

AU - Cestero, Ramon

AU - Nicholson, Susannah

AU - Muir, Mark

AU - Schwaca, Martin

AU - Wampler, David

AU - DeRosa, Mark

AU - Eastridge, Brian J

PY - 2017/5/22

Y1 - 2017/5/22

N2 - BACKGROUND: During traumatic hemorrhage, the ability to identify shock and intervene prior to decompensation is paramount to survival. Lactate is extremely sensitive to shock and its clearance has been demonstrated a useful gauge of shock and resuscitation status. Though lactate can be measured in the field, logistical constraints render it impractical in certain environments. The Compensatory Reserve represents a new clinical measurement reflecting the remaining capacity to compensate for hypoperfusion. We hypothesized the compensatory reserve index (CRI) would be an effective surrogate marker of shock and resuscitation compared to lactate. METHODS: The CRI device was placed on consecutive patients meeting trauma center activation criteria and remained on the patient until discharge, admission, or transport to operating suite. All subjects had a lactate level measured as part of their routine admission metabolic analysis. Time-corresponding CRI and lactate values were matched in regards to initial and subsequent lactate levels. Mean time from lactate sample collection to data availability in the electronic medical record was calculated. Predictive capacity of CRI and lactate in predicting hemorrhage was determined by receiver-operative characteristic curve analysis. Correlation analysis was performed to determine if any association existed between changing CRI and lactate values. RESULTS: Receiver-operator characteristic (ROC) curves were generated and area under the curve was 0.8052 and 0.8246 for CRI and lactate, respectively. There was no significant difference in each parameter’s ability to predict hemorrhage (p= 0.8015). The mean duration from lactate sample collection to clinical availability was 44 minutes while CRI values were available immediately. Analysis of the concomitant change in serial CRI and lactate levels revealed a Spearman’s correlation coefficient of -0.73 (p < 0.01). CONCLUSION: CRI performed with equivalent predictive capacity to lactate with respect to identifying initial perfusion status associated with hemorrhage and subsequent resuscitation. LEVEL OF EVIDENCE: II

AB - BACKGROUND: During traumatic hemorrhage, the ability to identify shock and intervene prior to decompensation is paramount to survival. Lactate is extremely sensitive to shock and its clearance has been demonstrated a useful gauge of shock and resuscitation status. Though lactate can be measured in the field, logistical constraints render it impractical in certain environments. The Compensatory Reserve represents a new clinical measurement reflecting the remaining capacity to compensate for hypoperfusion. We hypothesized the compensatory reserve index (CRI) would be an effective surrogate marker of shock and resuscitation compared to lactate. METHODS: The CRI device was placed on consecutive patients meeting trauma center activation criteria and remained on the patient until discharge, admission, or transport to operating suite. All subjects had a lactate level measured as part of their routine admission metabolic analysis. Time-corresponding CRI and lactate values were matched in regards to initial and subsequent lactate levels. Mean time from lactate sample collection to data availability in the electronic medical record was calculated. Predictive capacity of CRI and lactate in predicting hemorrhage was determined by receiver-operative characteristic curve analysis. Correlation analysis was performed to determine if any association existed between changing CRI and lactate values. RESULTS: Receiver-operator characteristic (ROC) curves were generated and area under the curve was 0.8052 and 0.8246 for CRI and lactate, respectively. There was no significant difference in each parameter’s ability to predict hemorrhage (p= 0.8015). The mean duration from lactate sample collection to clinical availability was 44 minutes while CRI values were available immediately. Analysis of the concomitant change in serial CRI and lactate levels revealed a Spearman’s correlation coefficient of -0.73 (p < 0.01). CONCLUSION: CRI performed with equivalent predictive capacity to lactate with respect to identifying initial perfusion status associated with hemorrhage and subsequent resuscitation. LEVEL OF EVIDENCE: II

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